bluuebunny/crossref_metadata_2025 huggingface dataset:
Argentina and Brazil Face Polarity
Authors: de Santibañes Francisco
Published: May 2024

This chapter analyzes some of the challenges Argentina and Brazil face as a result of the strategic competition that is taking place between the United States and China. A one-hundred-year period defined by hegemonic stability, with Latin America under Washington’s influence, is now being followed by a conflict between these two great powers in South America. Indeed, Beijing needs to protect its growing interests in the region, interests that in some cases collide with those of Washington. The chapter also provides a description of the strategic communities in Brazil and Argentina, as well as a literature review of the works produced in these countries about geoeconomics, which help in understanding both the current geopolitical situation and its implications for geoeconomics. The main conclusion is that to avoid a return of major conflicts to the region, as a result of bipolarity, Argentina and Brazil, the most influential states in South America, will need to forge a closer collaboration.
Defining Geoeconomics, Economic Statecraft, and the Political Economy of National Security
Authors: Lee James
Published: May 2024

The concept of geoeconomics has gained wide currency in the policy community, but existing definitions overlap considerably with the established scholarly fields of economic statecraft and the political economy of national security. To show how geoeconomics can be distinguished from existing terms in a way that is grounded in international relations theory, which anchors the study of geoeconomics in the social sciences, this chapter defines geoeconomics as a concept based in the study of the system, economic statecraft as a concept based in the study of foreign policy, and political economy of national security as a concept based in the study of domestic institutions and resources. These distinctions draw on Waltz’s levels of analysis and his distinction between systemic and unit-level theories, as well as Putnam’s concept of two-level games. They create a conceptual division of labor for the broad range of issues at the intersection of international political economy and international security.
How Not to Let a Good Crisis Go to Waste
Authors: Ferchen Matt
Published: May 2024

Academics and policymakers have today become keenly interested in the relationship between economics and international politics. Despite this, and especially given interest in the security implications of the way states use economic instruments to pursue foreign policy objectives, researchers have too often failed to engage with the scholarship and policy lessons of previous eras like the 1970s when the academic field of International Political Economy (IPE) experienced a renaissance. This chapter argues that contemporary studies of economic statecraft and geoeconomics would benefit from three analytical insights and debates that emerged from real-world changes and crises in the 1960s and 1970s: (1) the need to acknowledge and bridge gaps in the study of international economics and politics, (2) the continued, if changing, relevance of economic interdependence on international security and power relations, and (3) the importance of state-firm relations for understanding the nexus of international economics and state power.
Bringing Domestic Politics Back into Economic Statecraft
Authors: Wong Audrye
Published: May 2024

While economic statecraft is often conceived of as a tool of geopolitical competition, its implementation and outcomes are very much intertwined with and complicated by domestic politics. This chapter examines how different patterns of domestic institutions, actors, and political economy incentives affect how sender countries use and implement economic statecraft, as well as how target countries respond to such coercion and inducement, which has corresponding implications for the success of economic statecraft. Additionally, this chapter highlights how different characteristics of new and emerging players have potentially reshaped our notions of economic statecraft and how it works. While much of the traditional literature on economic statecraft has drawn on Western and US-dominant experiences, the rise of China as a major player with a different economic and political system can shed further light on distinct approaches to economic statecraft. The chapter concludes with suggestions on future work to be done in this area, such as unpacking the microfoundations of economic statecraft within specific target countries.
Tahrir Square
Authors: El-Mahdi Rabab
Published: May 2024

As one of the landmark events of the ‘Arab Spring’, various myths have taken hold about the nature of the 2011 assembly in Tahrir Square. This chapter problematizes some of these flattened accounts, underscoring the use of violence in the making of this peaceful assembly. It questions the binary labels of ‘peaceful’ versus ‘violent’ in understanding resistance and shows a more complex relationship between the two. In addition, the chapter highlights how the assembly’s main strengths proved to be a double-edged sword, sometimes hampering the political process that ensued. In doing so, the chapter brings to the fore some of the limitations of public assemblies.
Economic and Social Rights
Authors: Langford Malcolm , Rosevear Evan
Published: May 2024

Economic and social rights (ESRs) have steadily found a place in constitutions and jurisprudence across the world. Yet, while South Asia was the site of many early social rights adjudication experiments, East and Southeast Asia are only outmatched by Arab states in their reluctance to recognize and judicialize ESRs. With its embedded mercantilist model of capitalism, East and Southeast Asia is the most conservative region in the world when it comes to core rights in the workplace. There is some variation among the states and apex courts of East and Southeast Asia regarding recognition or enforcement of ESRs, while some features are consistent across the entire region, such as hostility to international oversight of ESRs. This chapter first analyzes the macro patterns of constitutional recognition and judicial posture across East and Southeast region. It then examines variation within Asia and explanations for such heterogeneity and concludes with some thoughts on the impact of the constitutionalization and judicialization of ESR rights in Asia.
Magazines
Authors: Cronin Richard
Published: May 2024

From 1815, for a period of more than 20 years, magazines became a dominant, perhaps the dominant, literary form in Britain, although it was an achievement that even those who wrote for them regarded ambivalently. It was Blackwood’s Edinburgh Magazine, followed by the London Magazine, the New Monthly and Fraser’s, that established the character of the modern magazine. Its content was various, the transitions between different items abrupt and startling, and it was written in a prose that was easy, idiosyncratic, and intimate. These are qualities that were almost at once taken up and reproduced by novelists and poets: by Byron, for example, in Don Juan, and by Pierce Egan in Life in London. Magazine writers may have aspired, as William Hazlitt confesses, to have their magazine papers collected and published between hard covers, but it was a period when even the most celebrated literary figures began to write books that closely resembled magazines.
Asia
Authors: Roberts Daniel Sanjiv
Published: May 2024

This chapter examines imperial and ethnographic constructions of ‘Asia’ by the orientalists of British India. The foundation of the Asiatick Society of Bengal in 1784, accompanied by publications including literary translations of Indian texts and periodicals such as the Asiatick Researches, inaugurated a profound reimagining of Asia viewed from an Indocentric perspective during the Romantic period. Focusing on selected works of literary orientalism including William Jones’s Presidential discourses to the Asiatick Society, this chapter analyses the considerable cultural, ideological, and epistemological work involved in such a reframing of geographical understanding. The anxious and fractured nature of Romantic apprehensions of Asia, beset by spurious notions of sinology and troubled by China’s resistance to British imperial interests, is shown to impact on metropolitan prose writers, who distanced themselves from what they perceived as the Asiatic style, even as Asian ideas and motifs suffused and haunted their writings.
Regionalism
Authors: Jarrells Anthony
Published: May 2024

Starting with an account of the formal features of the regional novel as exhibited in the work of Maria Edgeworth and Walter Scott, this chapter goes on to consider two key aspects of regional writing in the period: first, how Scotland, with its own geographical divisions—between Highlands and Lowlands, for instance—and its peculiar status as both region and nation, became nearly synonymous with the category of region itself in these years; and, second, how other forms of writing that proliferated alongside the regional novel (the tour, the diary, the tale) articulated new kinds of regional identity and alternative ways of conceiving of the relation between a present moment caught in the midst of massive commercial change and a past that could be romanticized precisely to the extent that it could be imagined as cut off from such a present.
Children’s Literature
Authors: Ruwe Donelle
Published: May 2024

This chapter introduces the key authors, concepts, and genres of Romantic-era children’s literature. Romantic authors pioneered many of today’s common features of children’s books, such as motherese, conversational modes, large font, and active learning. The chapter presents these innovations and explains the scholarly lingo of children’s literature studies, such as cross-writing, cross-reading, and rational pedagogy. The chapter is organized around important prose genres for children. As the author introduces each genre—easy readers, mixed-genre anthologies, books of scenes, London cries, geographies, biographies, exemplary histories, and juvenilia—she highlights how books for children engage larger sociocultural phenomena such as anti-Semitism, commercial publishing, colonialism, gender, and poetics.
When Humanitarians Go to War
Authors: Dienelt Anne
Published: May 2024

International humanitarian law (IHL) regulates the conduct of hostilities. The oxymoron of describing warfare regulation as humanitarian has been criticized in the past. However, the label refers to the original motives when creating the laws of war in the 19th century. It also accounts for today’s purpose and objective of the four Geneva Conventions and the two Additional Protocols. This chapter delves into the history of IHL, and its European influences and origins. At the same time, it contextualizes today’s challenges in armed conflicts as well as IHL’s claim for universality despite initially being an exclusive European project for ‘civilized nations’. The pacifist and humanitarian motives of a range of actors in the creation process of the laws of war are considered, and specific documents drafted by Europeans are analysed in terms of their contribution to a more humanitarian warfare. Are they still impacting today’s conduct of hostilities?
The Council of Europe
Authors: Yudkivska Ganna
Published: May 2024

This chapter offers a concise overview of the Council of Europe, emphasizing its historical roots and its mission to foster unity and progress among member States. It introduces the three pillars of the Council—Democracy, Human Rights, and the Rule of Law—and highlights key institutions and structures, including the PACE, European Court of Human Rights, Venice Commission, Committee of Ministers, European Social Charter, CPT, and the Commissioner for Human Rights. The chapter explores the Council’s transformative journey from destructive conflicts to constructive dialogues and collective efforts, underscoring its role as a platform for sharing best practices and its global influence in promoting democracy and human rights. Additionally, it acknowledges the organization’s limitations and challenges, exemplified by the recent expulsion of the Russian Federation, emphasizing the need for collective action to strengthen the Council and safeguard the rule of law and democratic values.
Quantitative Approaches to Study Authoritarianism
Authors: Meng Anne
Published: May 2024

This chapter surveys quantitative empirical studies in the field of comparative authoritarianism, noting significant advances made over the last two decades. The chapter focuses on three major thematic developments and summarizes major global datasets used to study dictatorships. First, studies of leaders and regimes examine different ways in which elites share power as well as different regime types. Second, a large body of literature on authoritarian institutions focuses on the role of parties, legislatures, and elections in maintaining regime stability. Third, studies on conflict in autocracies center on the twin problems of power sharing and control. Methodological debates around the trade-offs of different measurement approaches are also highlighted, addressing the difference between regime typologies and authoritarian institutions, and the challenges of objective and subjective measurement. The chapter concludes with some recommendations for future research.
Contentious Politics under Authoritarianism
Authors: Perry Elizabeth J. , Wolf Anne
Published: May 2024

Classic theories of authoritarianism assume limited popular contention due to weak associational ties within society and harsh repression of incipient unrest. If ordinary people take to the streets, they are typically said to do so in the form of carefully scripted and controlled displays of state mobilization. Societal contention that takes place beyond these parameters is treated either as epiphenomenal to regime change or, if widespread and persistent, as a harbinger of regime-challenging revolution. This chapter, by contrast, draws attention to an important but understudied variety of contentious politics: state-mobilized movements, that is, movements that are actively promoted, overtly or covertly, by elements of the state itself. Specifically, it focuses on pro-regime contention in contemporary China and the Arab world. Though relatively unexplored and unexplained in the existing secondary literature, state-mobilized movements are arguably the most common form of contentious politics in contemporary authoritarian contexts, and critical to understanding authoritarian inception, regeneration, decay, and collapse.
Dictatorship in Europe
Authors: Berman Sheri
Published: May 2024

The end of World War I brought a wave of democratization to Europe, toppling longstanding dictatorships. Yet by the 1930s, many of these democracies were gone, some collapsing into a new and more dangerous form of dictatorship: fascism. Precisely because fascist dictatorships were so dangerous—causing millions of deaths and the deadliest war ever—trying to understand the dynamics of the interwar period, and in particular how and why fascist regimes arose, became the foundation of postwar studies of political development. This chapter will, accordingly, discuss what we know about why some democracies survived and others failed during the interwar years and why some of these failures generated traditional authoritarian regimes and others fascist, or totalitarian, ones. It will relatedly discuss the differences between authoritarian and totalitarian regimes, a theme that is once again topical as use of the term “fascism” has become almost commonplace in discussions of contemporary democratic backsliding.
Authoritarian State Repression of Women and Girls
Authors: Blaydes Lisa
Published: May 2024

Repression is among the most powerful strategies used by autocratic regimes to control their populations. Despite a growing literature on its causes and effects in autocracies, little of this research examines state repression using a gendered lens. Although most victims of authoritarian state repression are men, this chapter argues that women experience repression in ways that are distinct. It discusses two forms of state repression of women and girls: gendered custodial abuse and reproductive repression. In both cases, gender identity motivates the nature of abuse while having specific social and personal implications for women. This chapter provides examples of these two forms of gendered state repression from authoritarian China, Egypt, Peru, and Sudan, showing that gendered forms of state repression are particularly common and damaging in societies with conservative, patriarchal social norms where a woman’s social position depends on her reputation as a wife and value as a mother.
IIIMiddle English
Authors: Ash-Irisarri Kate , Atkinson Laurie , Brazil Sarah , Calder Natalie , Greene Darragh , Lindstedt Samira , Menmuir Rebecca , Ronan Mark , Strickland Seth , Wheaton Mary F
Published: May 2024

This chapter has 12 sections: 1. Early Middle English (c.1050–1350); 2. Manuscript and Technical Studies; 3. Religious Prose and Verse; 4. Secular Prose; 5. Secular Verse; 6. Piers Plowman; 7. Gower; 8. Older Scots; 9. Drama; 10. The Gawain-Poet; 11. Romance. 12. Hoccleve and Lydgate. Section 1 is by Samira Lindstedt; section 2 is by Mary F. Wheaton; section 3 is by Natalie Calder; section 4 is by Mark Ronan; sections 5, 10, and 11 are by Darragh Greene; section 6 is by Seth Strickland; section 7 is by Rebecca Menmuir; section 8 is by Kate Ash-Irisarri; section 9 is by Sarah Brazil; section 12 is by Laurie Atkinson.
Breeding of a Near-Isogenic Wheat Line Resistant to Wheat Blast at Both Seedling and Heading Stages Through Incorporation of Rmg8
Authors: Yoshioka Motohiro , Shibata Mai , Morita Kohei , Islam M. Thoihidul , Fujita Masaya , Hatta Koichi , Tougou Makoto , Tosa Yukio , Asuke Soichiro
Published: May 2024

Wheat blast caused by Pyricularia oryzae pathotype Triticum (MoT) has been transmitted from South America to Bangladesh and Zambia and is now spreading in these countries. To prepare against its further spread to Asian countries, we introduced Rmg8, a gene for resistance to wheat blast, into a Japanese elite cultivar, Chikugoizumi (ChI), through recurrent backcrosses and established ChI near-isogenic lines, #2-1-10 with the Rmg8/ Rmg8 genotype and #4-2-10 with the rmg8/ rmg8 genotype. A molecular analysis suggested that at least 96.6% of the #2-1-10 genome was derived from the recurrent parent ChI. The #2-1-10 line was resistant to MoT not only in primary leaves at the seedling stage but also in spikes and flag leaves at the heading stage. The strength of the resistance in spikes of this Rmg8 carrier was comparable to that of a carrier of the 2NS segment, which has been the only genetic resource released to farmers’ fields for wheat blast resistance. On the other hand, the 2NS resistance was not expressed on leaves at the seedling stage nor flag leaves at the heading stage. Considering that leaf blast has been increasingly reported and regarded as an important inoculum source for spike blast, Rmg8 expressed at both the seedling and heading stages, or more strictly in both leaves and spikes, is suggested to be useful to prevent the spread of MoT in Asia and Africa.
Intravenous Calcium to Decrease Blood Loss During Intrapartum Cesarean Delivery
Authors: Ansari J.R. , Yarmosh A. , Michel G. , Lyell D. , Hedlin H. , Cornfield D.N. , Carvalho B. , Bateman B.T.
Published: May 2024

(Obstet Gynecol 2024;143(1):104–112)

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide; uterine atony contributes 70% to 80% of cases to PPH. If PPH happens even after oxytocin administration, other therapies are few and ineffective, as well as unavailable in many areas of the world. One treatment that has potential for uterine atony treatment is calcium chloride (CaCl). Currently CaCl is used to treat magnesium toxicity and hypocalcemia, but increasing calcium concentration could improve the contractile ability of the uterus. This study was designed to test the hypothesis that calcium infusion would decrease quantitative blood loss at delivery in a population at risk of atonic PPH. The primary outcome was the effect of CaCl on quantitative blood loss measured at the time of intrapartum cesarean delivery.
Perinatal Outcomes and the Role of Obstetric Anesthesia Interventions
Authors: Lucas D.N. , Bamber J.H. , Quasim S.
Published: May 2024

(Lancet 2023;401:2038–2039)

This editorial discusses multiple recent studies that investigated perinatal outcomes and the impact of anesthetic interventions. A prior study published in the Lancet in 2022 reported poorer perinatal outcomes for neonates born to Black women compared to those born to White women. Another study examined nearly 450,000 deliveries and found an association between neonatal outcomes (Apgar <7 at 5 min, need for neonatal resuscitation, and neonatal admission to the intensive care unit) and maternal use of epidural analgesia. The authors of this editorial examined their own data regarding the incidence of obstetric anesthetic procedures among different ethnic groups and found that compared to White British women who had vaginal birth, incidence of epidural analgesia among Bangladeshi, Pakistani, Black African, and Black Caribbean women was much lower. They noted that similar disparities can be found in the United States and reiterated the socioeconomic and systemic disparities as one likely cause for poor neonatal outcomes, suggesting that offering equal access to neuraxial analgesia across all populations could lead to improved neonatal outcomes for Black women.
Folic Acid Supplementation to Prevent Neural Tube Defects Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Authors: Viswanathan M. , Urrutia R.P. , Hudson K.N. , Middleton J.C. , Kahwati L.C.
Published: May 2024

(JAMA. 2023;330(5):460–466)

Neural tube defects are among the most commonly recorded birth defects for babies in the United States, and they are typically caused by low folate concentrations during conception and early gestation. These malformations can cause disabilities and even death in fetuses and children. In 2017, the United States Preventative Services Task Force (USPSTF) determined that women who increase their intake of folic acid before becoming pregnant can significantly help reduce the likelihood of their babies developing neural tube defects. The USPSTF also asserted their 2009 recommendation that patients should take 0.4 to 0.8 mg (400 to 800 μg) of folic acid daily if they were planning or capable of pregnancy, and that there was no consistent strong evidence of harmful adverse effects. This evidence report was conducted to analyze studies post-2017 for the USPSTF’s current recommendation on folic acid supplementation.
Careful Considerations for Midcrisis Consent to and Refusal of Blood Products
Authors: Hester M.D. , Bunch L.
Published: May 2024

(Anesth Analg. 2024;138(1):85–88)

Obstetric hemorrhage is difficult in any circumstance but is especially so in cases when a patient has previously stated that they refuse blood products; this is the case for many patients who identify as Jehovah’s Witnesses (JW). A recent article examined the ethical and legal implications of revisiting previous decisions about blood transfusions midcrisis, arguing that in some cases informed consent or refusal can take place while respecting religious views, as refusal before a crisis may not accurately represent their feelings while experiencing one. This article discusses concerns with the previous argument of Holland and colleagues, mainly the 2 points on which the argument stands: first, that there is literature suggesting that individuals change their minds when faced with crisis; and second, that midcrisis discussions about decisions honor patient autonomy.
Common Street Drug Names for the Anesthesiologist and Pain Physician
Authors: Donald R.R. , Patel S. , Smith M. , Clayton S. , Potru S.
Published: May 2024

(Reg Anesth Pain Med. 2023;48(7):365–374)

Over the years, many drugs have acquired colloquial “street names” in addition to their official designations. Familiarizing medical professionals, including anesthesiologists, with these slang terms can be crucial for effective patient care. Some drugs are named based on their physical appearance or packaging, which may differ from their clinical labels. This allows drug users and dealers to discuss substances discreetly in everyday conversation. Therefore, having a comprehensive list of street names associated with various drugs is essential for health care providers to ensure patient safety and provide appropriate care.
Incorporating a Postpartum Hemorrhage Bundle on the Labor and Delivery Unit: A State-Wide Survey of Anesthesiologists in Massachusetts
Authors: Villela-Franyutti D. , Hackett K. , Lumbreras-Marquez M.I.
Published: May 2024

(Int J Obstet Anesth. 2023;55:103893/https://doi.org/10.1016/j.ijoa.2023.103893/)

Postpartum hemorrhage (PPH) is a significant contributor to preventable maternal morbidity and mortality, necessitating a comprehensive, interdisciplinary approach. Recognizing the urgency, the American College of Obstetricians and Gynecologists advocates adopting PPH bundles to ensure prompt identification and intervention. Obstetric anesthesiologists, possessing expertise in critical care and transfusion, are integral to the resuscitation efforts in PPH. Nevertheless, their involvement in implementing PPH bundles is inconsistent, prompting the need for a more dedicated focus on predelivery risk assessment, early recognition, and institutional protocol development.
Hospitalization for Nonlethal Self-Harm and Premature Mortality in the 3 Years Following Adolescent Pregnancy: Population-Based Nationwide Cohort Study
Authors: Goueslard K. , Jollant F. , Cottenet J. , Bechraoui-Quantin S. , Rozenberg P. , Simon E. , Quantin C.
Published: May 2024

(BJOG. 2023;130(9):1016–1027)

Research proves a rising risk of suicidal ideation and acts in the year before and the year after giving birth. Suicide is 1 of the 2 main causes of mortality for mothers in France. There is not a solid correlation between nonlethal self-harm and suicide following childbirth, so it is difficult to predict and prevent. Adolescents are at higher risk of nonlethal self-harm, and suicide is the second cause of premature deaths in their age category. Adolescent pregnancy is tied to additional mental disorders, psychosocial problems, anxiety, depression, and eating disorders, which are all risk factors for suicidal actions. This retrospective cohort study was designed to primarily provide insights about nonlethal self-harm risks and mortality in adolescent pregnancies. Secondarily, the study aimed to evaluate the causes of deaths when possible.
Identifying Risk of Stillbirth Using Machine Learning
Authors: Cersonsky T.E.K. , Ayala N.K. , Pinar H. , Dudley D.J. , Saade G.R. , Silver R.M. , Lewkowitz A.K.
Published: May 2024

(Am J Obstet Gynecol. 2023;229:327:e1–16)

A tool that could help identify women at risk for stillbirth would be a welcome addition to clinical practice. Machine learning models, which can look at relationships between variables in large data sets, was investigated in this article. This study’s aim was to refine a machine learning model to predict stillbirth using data available prior to the gestational age of viability (22 to 24 wk). The researchers performed a secondary analysis of data in the Stillbirth Collaborative Research Network (SCRN), a study database of 982 stillbirths and 3000 representative live births from 2006 to 2009. The study included patients who delivered a live or stillborn fetus at >18 weeks’ gestation from 59 hospitals in 5 states (Georgia, Massachusetts, Rhode Island, Texas, and Utah). The data set included 6000 measures collected from interviews with the mother, postmortem pathological exam, cause of death analysis, and medical record Abstractsion. Subsequently 101 risk factor variables were identified and used in the model. These included maternal and biological father demographics, family history, maternal health history, prenatal lab data, fetal genetics, second-trimester screen, prenatal care history, ultrasound, and social determinants of health.
Association of Pain, Analgesic, Psychological, and Socioeconomic Factors With Subacute Pain After Childbirth: A Prospective Cohort Study
Authors: Tan C. , Tan H. , Sultana R. , Meaney M. , Ling Kee M. , Sng B.
Published: May 2024

(J Clin Anesth. 2022;83:110978 | https://doi.org/10.1016/j.jclinane.2022.110978|)

Persistent postpartum pain poses significant societal and health care challenges. It is defined by the International Association for the Study of Pain as pain lasting beyond 3 months after tissue injury, affecting up to 30% of postpartum women. Research primarily focuses on risk factors for persistent pain, including severe acute postpartum pain, psychological factors, and social deprivation. However, there is a lack of investigation into subacute pain after childbirth (lasting 4 wk to 3 mo). A previous study identified some risk factors for subacute pain, but the relationship between acute postpartum pain and subacute pain remains unexplored. This study aims to investigate these associations and explore potential interventions by anesthesiologists.
Women and Partners’ Experience of Major Postpartum Hemorrhage: A Qualitative Study
Authors: Rosvig L. , Steffensen E. , Brogaard L. , Hvidman L. , Kierkegaard O. , Kjeldsen A.C. , Taastrøm K. , Uldbjerg N. , Lou S.
Published: May 2024

(BJOG. 2023;130(9):1087–1095)

Major postpartum hemorrhage (PPH) is classified as losing more than or equal to 1 L of blood within 2 hours of vaginal birth. In Denmark, this occurs in 7.2% of vaginal deliveries, compared with an incidence of about 4% in the developed countries. Managing major PPH requires a quick and appropriate response from multiple clinical professionals and providing proper medicine. Women and their partners often have negative experiences of PPH, which may relate to deficiencies in communication.
Maternal Morbidity and Mortality Among Patients With Cancer at Time of Delivery
Authors: Sundermann A.C. , Cate J.M. , Campbell A.K. , Dotters-Katz S.K. , Myers E.R. , Federspiel J.J.
Published: May 2024

(Am J Obstet Gynecol. 2023;229:324.e1–324.e7)

Women with a cancer diagnosis during pregnancy face higher maternal morbidity and mortality. Current prenatal care guidelines focus on care coordination between obstetricians and oncologists. But knowing more about the risks these women face during delivery could help clinicians provide better care and improve outcomes.
Trial of Selective Early Treatment of Patent Ductus Arteriosus With Ibuprofen
Authors: Gupta S. , Subhedar N.V. , Bell J.L. , Field D. , Bowler U. , Juszczak E ,   Baby-OSCAR Collaborative Group
Published: May 2024

(N Engl J Med. 2024;390(4):314–325)

In the past 20 years, survival rates among exceedingly premature neonates have risen. There is also a documented slight decrease in neonatal illness in the same time period, although bronchopulmonary dysplasia rates have climbed. Among exceedingly premature neonates, a patent ductus arteriosus (PDA) with a diameter of at least 1.5 mm persisting beyond 72 hours after birth correlates with heightened mortality, morbidity, and a greater chance of bronchopulmonary dysplasia compared with infants without a PDA. The occurrence of PDA declines as gestational age decreases. The risk of bronchopulmonary dysplasia or death in exceedingly premature neonates also rises with PDA persisting beyond 1 to 2 weeks after birth.
Patent Ductus Arteriosus—To Close or Not to Close?
Authors: Maron J.L.
Published: May 2024

(N Engl J Med. 2024;390(4):370–371)

Patent ductus arteriosus (PDA) is the most frequently encountered cardiac condition in neonates. The ductus arteriosus plays the crucial role of allowing blood to bypass the lungs in the fetal stage. At birth, with the initiation of lung function, changes in pressure and oxygen lead to the closure of the ductus arteriosus, redirecting blood flow through the newly operational pulmonary circulation. When a baby is born too early, birth is not enough to cause the duct to close, resulting in PDA.
Syphilis Complicating Pregnancy and Congenital Syphilis
Authors: Stafford I.A. , Workowski K.A. , Bachmann L.H.
Published: May 2024

(N Engl J Med. 2024;390(3):242–253)

Congenital syphilis primarily occurs when the bacterium Treponema pallidum passes from an infected mother to her fetus through the placenta, and it continues to have significant global repercussions. Despite a decline in primary and secondary syphilis cases in the United States after 1990, reaching a low point in 2001, rates have since risen among both men and women of reproductive age, as well as among infants. In 2021, the rate of congenital syphilis in the United States reached its highest level in nearly 3 decades. This increase in cases is particularly evident in populations with limited access to health care.
A National Cohort Study to Investigate the Association Between Ethnicity and the Provision of Care in Obstetric Anesthesia in England Between 2011 and 2021
Authors: Bamber J.H. , Goldacre R. , Lucas D.N. , Quasim S. , Knight M.
Published: May 2024

(Anaesthesia. 2023;78:820–829)

Evidence exists that there are ethnic disparities in obstetric and neonatal care in the UK, showing that maternal death, stillbirth, preterm labor, and fetal growth restriction are more common in Black and South Asian women compared with White women. In addition, ethnic minorities more often report a negative maternity care experience than White women. In a similar vein, ethnic differences in anesthesia care in the UK have not been studied; in the United States, research has shown that black women are less likely to receive neuraxial anesthesia (NA) and are more likely to receive general anesthesia (GA), but this may potentially reflect socioeconomic status in a way that is not generalizable to the UK health care system. This study used national maternity data to examine ethnic disparities in delivery of anesthesia, with specific focus on GA for individuals undergoing cesarean delivery (CD) and NA for individuals undergoing vaginal delivery (VD).
The Association Between Epidural Analgesia During Labor and Mother-Infant Bonding
Authors: Binyamin Y. , Wainstock T. , Sheiner E. , Battat T.L. , Reuveni I. , Pariente G. ,   et al
Published: May 2024

(J Clin Anesth. 2022;80:110795 | https://doi.org/10.1016/j.jclinane.2022.110795 |)

Labor involves significant pain for the mother, influenced by various factors. The ability to control this pain positively impacts the mother’s psychological and physiological well-being. Epidural analgesia is commonly chosen for pain relief during vaginal delivery. Mother-infant bonding, crucial for a child’s later attachment and self-perception, develops from pregnancy into early childhood. A strong bond correlates with positive parenting, cognitive development, and improved neurobehavioral outcomes. Impaired bonding, affecting 7% to 11.3% of mothers, can lead to long-term issues for both mother and child, including depression, anxiety, and socioemotional challenges. Several risk factors for impaired bonding include primiparity, negative feelings toward pregnancy, low birth weight, higher education, and postpartum depression. Pain during labor, a significant element, may impact the bonding process. Studies on epidural analgesia’s association with postpartum depression yield conflicting results, and no research examines its connection to mother-infant bonding. The primary study’s aim is to explore the link between epidural analgesia and mother-infant bonding, with a secondary focus on its association with postpartum depression immediately after childbirth.
Maternal and Neonatal Outcomes With the Addition of Intrathecal Midazolam as an Adjuvant to Spinal Anesthesia in Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Hung T. , Huang Y. , Lin Y.
Published: May 2024

(J Clin Anesth. 2022;80:110786 | https://doi.org/10.1016/j.jclinane.2022.110786.)

In 2015, global cesarean deliveries (CD) reached 29.7 million. While evidence indicates comparable outcomes between general and regional anesthesia, the latter is preferred for elective CD due to benefits like reduced fetal exposure to anesthetics. Intrathecal bupivacaine is effective but can cause adverse effects like hypotension. Low-dose bupivacaine minimizes risks but may require additional analgesics, potentially leading to general anesthesia. Various adjuvants, such as opioids and alpha-2-agonists, enhance spinal anesthesia quality, each with unique effects. Intrathecal midazolam, studied since the 1980s, has shown promise in reducing nausea and vomiting. However, its safety for neonates and effectiveness in cesarean delivery remained uncertain. This systematic review and meta-analysis aimed to fill this gap by comprehensively assessing the efficacy and safety of adding intrathecal midazolam to spinal anesthesia for CD in healthy pregnant patients, considering maternal and neonatal outcomes.
Quality of Recovery Following Childbirth: A Prospective, Multicenter Cohort Study
Authors: O'Carroll J.E. , Zucco L. , Warwick E. , Arbane G. , Moonesinghe S.R. , El-Boghdadly K. , Guo N. , Carvalho B. , Sultan P. ,   ObsQoR Collaborators
Published: May 2024

(Anaesthesia. 2023;78(9):1071–1080)

The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for delivering high-quality clinical care, as it has the potential to positively influence maternal physical and psychological well-being. Despite the escalating focus on postpartum-related research, prior studies on recovery have been predominantly confined to single-center endeavors with limited sample sizes, deploying disparate outcome measures or unvalidated metrics, primarily evaluating inpatient recovery with insufficient scrutiny of outpatient recovery.
CHEMICAL ADHERENCE IN RESISTANT HYPERTENSION: PILOT STUDY IN AN ESH EXCELLENCE CENTER
Authors: Sautenet Bénédicte , Halimi Jean Michel , Longuet Hélène , Gueguen Juliette , Gatault Philippe , Rabot Nolwenn , François Maud , Buchler Matthias , Auclair Hugo , Debacq Florian , Darrouzain François , Bejan-angoulvant Theodora
Published: May 2024

Objective:

Arterial hypertension (HTN) is responsible for the largest proportion of preventable mortality in the world.

The primary cause of resistant hypertension (rHTN) is poor medication adherence. Blood or urine drug assays enable us to assess chemical adherence more accurately than self-reported questionnaires.

We assayed anti-hypertensive drugs in patients with rHTN at our Center of Excellence in Hypertension, in collaboration with the Pharmacology and Toxicology Laboratory.

Design and method:

Patients with rHTN (office SBP/DBP >140/90 mmHg or out of office daytime >135/85 mmHg despite being prescribed 3 drugs at optimal dosage, including a diuretic, a renin angiotensin system inhibitor (RASI) and a calcium channel blocker (CCB), were informed of the study and agreed to have blood drugs concentrations measured. We describe the results for chemical adherence in the first 54 patients included between January 1, 2021 and September 1, 2023 in our center.

Results:

Of the 54 patients included, 38 (70%) were men, with a mean age of 65 +/- 11 years. The mean number of antihypertensive treatments prescribed was 5 +/- 1 (min 3, max 8). The proportions of treatments were RASI 87%, CCB (mainly dihydropyridines) 81%, diuretics 81%, beta-blockers 76%, alpha-blockers 57%, mineralocorticoid receptor antagonists (MRA) 37%, and central antihypertensives 26%.

The best compliance was observed with alpha-blockers 81%, followed by CCB 50%, RASI 45%, diuretics 37% and beta-blockers 34%. The least compliant were central antihypertensives 0% and MRA 5%. All prescribed drugs were completely absent in the blood in 26% of patients, and 63% of patients had incomplete adherence (1 or more but not all drugs present in the blood), of whom 1/3 were non-compliant to 3 or more medications. Only for 9% of patients chemical adherence was excellent.

Conclusions:

Chemical adherence when measured at clinical visit was poor in this cohort of patients followed in a center of excellence. Limitations of this study are lack of follow-up for the same patient to assess variation in adherence over time, and small sample size. These results suggest the need to develop therapeutic education to improve patient involvement in the management of HTN and compliance.
PREDICTING NEW CASES OF HYPERTENSION IN PRIMARY CARE WITH A MACHINE LEARNING TOOL
Authors: Norrman Anders , Hasselström Jan , Ljunggren Gunnar , Wachtler Caroline , Eriksson Julia , Kahan Thomas , Wändell Per , Gudjonsdottir Hrafnhildur , Lindblom Sebastian , Ruge Toralph , Rosenblad Andreas , Brynedal Boel , Carlsson Axel C
Published: May 2024

Objective:

Many individuals with hypertension remain undiagnosed and therefore untreated. Consequently, there is a pressing need to pinpoint patients at risk of developing hypertension to avoid cardiometabolic morbidity and mortality. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in primary health care.

Design and method:

This sex- and age-matched case-control (1:5) study included patients aged 30–65 years living in Stockholm County, Sweden with a newly recorded diagnosis of hypertension during 2010–19 (cases) and individuals without a recorded hypertension diagnosis during 2010–19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary health care during the three years preceding the diagnosis of hypertension.

Results:

The model showed an area under the curve (95% confidence interval) of 0.748 (0.742–0.753) for females and 0.745 (0.740-0.751) for males for predicting newly diagnosed hypertension (Figures 1 and 2). The sensitivity was 63% and 68%, and the specificity 76% and 73%, for females and males, respectively (Table 1). The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence > 1%, as detailed in Tables 2a and 2b. The diagnoses contributing most to the model, all with an odds ratio of marginal effects > 1 for both sexes were dyslipidemia and obesity, along with people encountering health services in other circumstances, painful conditions, and anxiety.

Conclusions:

This machine learning model, developed with artificial intelligence based on earlier diagnoses within primary health care may contribute to identification of patients at risk of developing hypertension.
FEASIBILITY OF WATCH-TYPE CUFF-LESS BLOOD PRESSURE MEASUREMENT DEVICE IN DAILY BLOOD PRESSURE MONITORING
Authors: Lee Youngro , Seo Jongmo , Lee Haeyoung
Published: May 2024

Objective:

Cuff-less blood pressure (BP) measurement devices integrated into smartwatches have gained prominence for daily monitoring, yet limited studies provide the analysis of real-world BP data collected by such devices. In this study, we evaluated the feasibility of photoplethysmographic BP measuring smartwatch by analyzing data collected in real-world.

Design and method:

The campaign, “Smartwatch Blood Pressure Monitoring Challenge with Korean Hypertension Society”, was held in June 1-14, 2023 and 896 participants reported 35592 BP values measured by smartwatch (Samsung Galaxy Watch 6, approved in Korean Ministry of Food and Drug Safety). Participants were instructed to measure BP daily, in the morning (5AM-8AM) and evening (6PM-9PM) for two weeks, with initial calibration and re-calibration after the first week. We evaluated 1) BP difference between before and after re-calibration, and 2) difference in morning and evening BP. We also evaluated the determining factors of the BP differences.

Results:

Morning and evening BP values showed significant difference, higher in the evening by 1.42±5.25 mmHg (p<0.05). However, the diurnal variation was much smaller than reported in other studies using conventional BP monitoring devices. ANOVA identified significant variables for evening-morning differences, including basal metabolic rate, skeletal muscle mass, total body water, average systolic BP (SBP), diastolic BP (DBP), and heart rate in the morning (p < 0.01 in both ITT and PP). Participants who have evening-morning difference higher than the third quartile, where evening SBP was significantly higher than morning SBP, exhibited smaller variable sizes. Turkey’s Honest Significant Difference showed that this relationship is statistically significant between Q1-Q4 and Q2-Q4 in all variables.

The calibration stability was assessed by the difference in average BP before and after calibration, resulting in an SBP difference of 4.64±4.73 mmHg and DBP of 3.66±3.62 mmHg, smaller than a 2021 campaign (6.8±5.6mmHg). When the difference of average was measured between same period of time (morning versus morning and evening versus evening), SBP of 5.39±5.22 mmHg and DBP of 4.3±3.99 mmHg.

Conclusions:

In conclusion, watch-based devices may not detect clinical-level BP variability, but refining calibration protocols offers improvement potential.
THREE-YEAR NIGHTTIME BLOOD PRESSURE REDUCTIONS AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND CHRONIC KIDNEY DISEASE
Authors: Schlaich Markus , Mahfoud Felix , Narkiewicz Krzysztof , Ruilope Luis , Williams Bryan , Schmieder Roland E , Mancia Giuseppe , Sharif Faisal , Ribichini Flavio , Fahy Martin , Böhm Michael
Published: May 2024

Objective:

Nocturnal hypertension (HTN), highly prevalent in chronic kidney disease (CKD), is strongly associated with cardiovascular risk, and is difficult to control with pharmacotherapy. An additional therapy such as radiofrequency renal denervation (RF RDN) may effectively lower nighttime BP in hypertensive patients with CKD, long-term.

Design and method:

Patients with uncontrolled HTN enrolled into the Global SYMPLICITY Registry (GSR) DEFINE were evaluated. All patients underwent RF RDN and were grouped by their estimated glomerular filtration rate (eGFR): <60mL/min/1.73m2 (CKD) or eGFR more than or equal to 60mL/min/1.73m2 (non-CKD). Nighttime systolic BP (NSBP) changes at 3yrs after RF RDN were compared between groups.

Results:

As of March 2023, a total of 3331 patients with uncontrolled BP were enrolled of which 805 (24.2%) had CKD. CKD group were 64±12yrs old, 47.3% female, 54.9% had diabetes, and 56.9% had cardiac disease. Of those, 12.3% had eGFR <30mL/min/1.73m2 (Figure 1A). The baseline NSBP was higher in the CKD vs non-CKD groups (149.0±22.9mmHg vs 144.9 ± 21.0mmHg; p=0.0002), whilst prescribed 5.2±1.7 vs 4.8 ± 1.7 antihypertensive drugs, respectively (p<0.0001).

3yrs after RF RDN, significant NSBP change was observed in the CKD group (-7.8mmHg), similar to the non-CKD group (-8.4mmHg; adjusted p=0.64; Figure 1B). The eGFR changed similarly in both groups (CKD -4.7±17.4mL/min/1.73m2 vs non-CKD -7.0±17.0mL/min/1.73m2; p=0.34). There was also no significant difference between groups for changes in daytime SBP, sodium, potassium, or creatinine.

Conclusions:

In this large registry cohort of patients with CKD and uncontrolled BP, nocturnal HTN was prevalent, and RF RDN significantly reduced NSBP after 3 years. RDN, in addition to pharmacotherapy, may help to reduce the risk of long-term cardiovascular events in these high risk patients.