bluuebunny/crossref_metadata_2025 huggingface dataset:
Methods for cluster cosmology and application to the SDSS in preparation for DES Year 1 release
Authors: Costanzi M , Rozo E , Simet M , Zhang Y , Evrard A E , Mantz A , Rykoff E S , Jeltema T , Gruen D , Allen S , McClintock T , Romer A K , von der Linden A , Farahi A , DeRose J , Varga T N , Weller J , Giles P , Hollowood D L , Bhargava S , Bermeo-Hernandez A , Chen X , Abbott T M C , Abdalla F B , Avila S , Bechtol K , Brooks D , Buckley-Geer E , Burke D L , Rosell A Carnero , Kind M Carrasco , Carretero J , Crocce M , Cunha C E , da Costa L N , Davis C , De Vicente J , Diehl H T , Dietrich J P , Doel P , Eifler T F , Estrada J , Flaugher B , Fosalba P , Frieman J , García-Bellido J , Gaztanaga E , Gerdes D W , Giannantonio T , Gruendl R A , Gschwend J , Gutierrez G , Hartley W G , Honscheid K , Hoyle B , James D J , Krause E , Kuehn K , Kuropatkin N , Lima M , Lin H , Maia M A G , March M , Marshall J L , Martini P , Menanteau F , Miller C J , Miquel R , Mohr J J , Ogando R L C , Plazas A A , Roodman A , Sanchez E , Scarpine V , Schindler R , Schubnell M , Serrano S , Sevilla-Noarbe I , Sheldon E , Smith M , Soares-Santos M , Sobreira F , Suchyta E , Swanson M E C , Tarle G , Thomas D , Wechsler R H
Published: July 2019

We implement the first blind analysis of cluster abundance data to derive cosmological constraints from the abundance and weak lensing signal of redMaPPer clusters in the Sloan Digital Sky Survey (SDSS). We simultaneously fit for cosmological parameters and the richness–mass relation of the clusters. For a flat Λ cold dark matter cosmological model with massive neutrinos, we find $S_8 \equiv \sigma _{8}(\Omega _\mathrm{ m}/0.3)^{0.5}=0.79^{+0.05}_{-0.04}$. This value is both consistent and competitive with that derived from cluster catalogues selected in different wavelengths. Our result is also consistent with the combined probes analyses by the Dark Energy Survey (DES), the Kilo-Degree Survey (KiDS), and with the cosmic microwave background (CMB) anisotropies as measured by Planck. We demonstrate that the cosmological posteriors are robust against variation of the richness–mass relation model and to systematics associated with the calibration of the selection function. In combination with baryon acoustic oscillation data and big bang nucleosynthesis data (Cooke et al.), we constrain the Hubble rate to be h = 0.66 ± 0.02, independent of the CMB. Future work aimed at improving our understanding of the scatter of the richness–mass relation has the potential to significantly improve the precision of our cosmological posteriors. The methods described in this work were developed for use in the forthcoming analysis of cluster abundances in the DES. Our SDSS analysis constitutes the first part of a staged-unblinding analysis of the full DES data set.
The HST large programme on NGC 6752 – III. Detection of the peak of the white dwarf luminosity function
Authors: Bedin L R , Salaris M , Anderson J , Libralato M , Apai D , Nardiello D , Rich R M , Bellini A , Dieball A , Bergeron P , Burgasser A J , Milone A P , Marino A F
Published: July 2019

We report on the white dwarf (WD) cooling sequence of the old globular cluster NGC 6752, which is chemically complex and hosts a blue horizontal branch. This is one of the last globular cluster WD cooling sequences accessible to imaging by the Hubble Space Telescope. Our photometry and completeness tests show that we have reached the peak of the luminosity function of the WD cooling sequence, at a magnitude mF606W  = 29.4 ± 0.1, which is consistent with a formal age of ∼14 Gyr. This age is also consistent with the age from fits to the main-sequence turn-off (13–14 Gyr), reinforcing our conclusion that we observe the expected accumulation of WDs along the cooling sequence.
Tidal disruption events from massive black hole binaries: predictions for ongoing and future surveys
Authors: Thorp Stephen , Chadwick Eli , Sesana Alberto
Published: July 2019

We compute the expected cosmic rates of tidal disruption events (TDEs) induced by individual massive black holes (MBHs) and by MBH binaries (MBHBs) – with a specific focus on the latter class – to explore the potential of TDEs to probe the cosmic population of sub-pc MBHBs. Rates are computed by combining MBH and MBHB population models derived from large cosmological simulations with estimates of the induced TDE rates for each class of objects. We construct empirical TDE spectra that fit a large number of observations in the optical, UV, and X-ray and consider their observability by current and future survey instruments. Consistent with results in the literature, and depending on the detailed assumption of the model, we find that LSST and Gaia in optical and eROSITA in X-ray will observe a total of 3000–6000, 80–180, and 600–900 TDEs per year, respectively. Depending on the survey, 1 to several per cent of these are prompted by MBHBs. In particular, both LSST and eROSITA are expected to see 150–450 MBHB-induced TDEs in their respective mission lifetimes, including 5–100 repeated flares. The latter provide an observational sample of binary candidates with relatively low contamination and have the potential of unveiling the sub-pc population of MBHBs in the mass range $10^5\lt M\lt 10^7\, \mathrm{M}_\odot$, thus informing future low-frequency gravitational wave observatories.
New active asteroid (6478) Gault
Authors: Hui (許文韜) Man-To , Kim (김윤영) Yoonyoung , Gao (高興) Xing
Published: July 2019

Main-belt asteroid (6478) Gault was observed to show cometary features in early 2019. To investigate the cause, we conducted BVR observations at Xingming Observatory, China, from 2019 January to April. The two tails were formed around 2018 October 26–November 8, and 2018 December 29–2019 January 8, respectively, and consisted of dust grains of ≳20 $\mu$m to 3 mm in radius ejected at a speed of 0.15 ± 0.05 m s−1 and following a broken power-law size distribution bending at grain radius ∼70 $\mu$m (bulk density 1 g cm−3 assumed). The total mass of dust within a 104 km-radius aperture around Gault declined from ∼9 × 106 kg since 2019 January at a rate of 2.28 ± 0.07 kg s−1, but temporarily surged around 2019 March 25, because Earth then crossed the orbital plane of Gault, near which the ejected dust was mainly distributed. No statistically significant colour or short-term light-curve variation was seen. Nonetheless we argue that Gault is currently subjected to rotational instability. Using the available astrometry, we did not detect any non-gravitational acceleration in the orbital motion of Gault.
Pre-marked chromatin and transcription factor co-binding shape the pioneering activity of Foxa2
Authors: Cernilogar Filippo M , Hasenöder Stefan , Wang Zeyang , Scheibner Katharina , Burtscher Ingo , Sterr Michael , Smialowski Pawel , Groh Sophia , Evenroed Ida M , Gilfillan Gregor D , Lickert Heiko , Schotta Gunnar
Published: July 2019

Pioneer transcription factors (PTF) can recognize their binding sites on nucleosomal DNA and trigger chromatin opening for recruitment of other non-pioneer transcription factors. However, critical properties of PTFs are still poorly understood, such as how these transcription factors selectively recognize cell type-specific binding sites and under which conditions they can initiate chromatin remodelling. Here we show that early endoderm binding sites of the paradigm PTF Foxa2 are epigenetically primed by low levels of active chromatin modifications in embryonic stem cells (ESC). Priming of these binding sites is supported by preferential recruitment of Foxa2 to endoderm binding sites compared to lineage-inappropriate binding sites, when ectopically expressed in ESCs. We further show that binding of Foxa2 is required for chromatin opening during endoderm differentiation. However, increased chromatin accessibility was only detected on binding sites which are synergistically bound with other endoderm transcription factors. Thus, our data suggest that binding site selection of PTFs is directed by the chromatin environment and that chromatin opening requires collaboration of PTFs with additional transcription factors.
An independently validated nomogram for isocitrate dehydrogenase-wild-type glioblastoma patient survival
Authors: Gittleman Haley , Cioffi Gino , Chunduru Pranathi , Molinaro Annette M , Berger Mitchel S , Sloan Andrew E , Barnholtz-Sloan Jill S
Published: July 2019

Background

In 2016, the World Health Organization reclassified the definition of glioblastoma (GBM), dividing these tumors into isocitrate dehydrogenase (IDH)-wild-type and IDH-mutant GBM, where the vast majority of GBMs are IDH-wild-type. Nomograms are useful tools for individualized estimation of survival. This study aimed to develop and independently validate a nomogram for IDH-wild-type patients with newly diagnosed GBM.

Methods

Data were obtained from newly diagnosed GBM patients from the Ohio Brain Tumor Study (OBTS) and the University of California San Francisco (UCSF) for diagnosis years 2007–2017 with the following variables: age at diagnosis, sex, extent of resection, concurrent radiation/temozolomide (TMZ) status, Karnofsky Performance Status (KPS), O6-methylguanine-DNA methyltransferase (MGMT) methylation status, and IDH mutation status. Survival was assessed using Cox proportional hazards regression, random survival forests, and recursive partitioning analysis, with adjustment for known prognostic factors. The models were developed using the OBTS data and independently validated using the UCSF data. Models were internally validated using 10-fold cross-validation and externally validated by plotting calibration curves.

Results

A final nomogram was validated for IDH-wild-type newly diagnosed GBM. Factors that increased the probability of survival included younger age at diagnosis, female sex, having gross total resection, having concurrent radiation/TMZ, having a high KPS, and having MGMT methylation.

Conclusions

A nomogram that calculates individualized survival probabilities for IDH-wild-type patients with newly diagnosed GBM could be useful to physicians for counseling patients regarding treatment decisions and optimizing therapeutic approaches. Free software for implementing this nomogram is provided: https://gcioffi.shinyapps.io/Nomogram_For_IDH_Wildtype_GBM_H_Gittleman/.
Selective Deafness of Political Parties: Strategic Responsiveness to Media, Protest and Real-World Signals on Immigration in Belgian Parliament
Authors: Wouters Ruud , Sevenans Julie , Vliegenthart Rens
Published: July 2019

How do political parties react to different signals from society indicating the saliency of a particular social problem? Are all parties equally responsive to all signals or do certain signals prove more effective in engaging some parties than others? We address these questions from an agenda-setting perspective. In particular, we investigate how media attention, protest activity and real-world signals shape parties’ attention for immigration in the federal parliament of Belgium. A time series model suggests that media attention, protest activity and real-world indicators all increase parliamentary attention as measured by weekly oral questions. More detailed models show the impact of these signals to differ across parties. Media attention and protest activity engage left wing parties, whereas asylum applications drive political action of the party delivering the responsible secretary. Far-right parties, finally, react both to media attention and real-world indicators. We conclude that political parties are ‘selectively deaf’; they act (or do not act) strategically upon incoming signals, depending on whether the signal fits their political goals or not. This article contributes to agenda-setting research by including multiple societal signals in its research design and by focusing on party characteristics and party competition to disentangle the conditionality of various agenda-setting effects.
PREVENT Policing in Practice—The Need for Evidenced-Based Research
Authors: Dresser Paul
Published: July 2019

This article examines the PREVENT agenda, part of the UK government’s counter-terrorism strategy, CONTEST. Informed by semi-structured interviews conducted with a Special Branch PREVENT team, as well as individuals drawn from various security disciplines, this article highlights several practical barriers to realizing collaborative counter-radicalization. This is important given the third objective of PREVENT: to work with a wide range of institutions where there are risks of radicalization. This article departs from analyses that have examined PREVENT in the context of suspect profiling; rather, the focus is on illuminating the implementation, (re)configuration and performance of PREVENT policing. The article concludes by advocating the necessity for evidence-based research—this proffers pragmatic implications for the governance of counter-terrorism.
Reflections on the Persistent Issue of Relevance in Public Administration
Authors: AbouAssi Khaldoun , Amirkhanyan Anna , Billingsley Gloria , Lyon Randolph
Published: July 2019

Relevance was a central issue at the Minnowbrook I Conference in 1968, reflecting a long-standing concern prior to that seminal gathering. It has also repeatedly been raised, debated, and investigated at follow-up meetings, including the Minnowbrook II and III Conferences, and in relevant publications. In this piece, we want to keep the conversation going and reflect the discussions and comments by scholars from various subfields of our discipline and at various stages in their careers.
Revelation and Phenomenal Relations
Authors: Broi Antonin
Published: July 2019

Revelation, or the view that the essence of phenomenal properties is presented to us, is as intuitively attractive as it is controversial. It is notably at the core of defences of anti-physicalism. I propose in this paper a new argument against Revelation. It is usually accepted that low-level sensory phenomenal properties, like phenomenal red, loudness or brightness, stand in (phenomenal) relation of similarity and quantity. Furthermore, these similarity and quantitative relations are taken to be internal, that is, to be fixed by what their relata are. I argue that, under some plausible additional premises, no account of what grounds these relations in the essence of their relata is consistent with Revelation, at least if we take common phenomenological descriptions for granted. As a result, the plausibility of Revelation is undermined. One might however resist this conclusion by weakening the epistemic relation postulated between subjects and their phenomenal properties.
Frictional Intermediation in Over-the-Counter Markets
Authors: Hugonnier Julien , Lester Benjamin , Weill Pierre-Olivier
Published: July 2019

We extend Duffie et al.’s (2005) search-theoretic model of over-the-counter (OTC) asset markets, allowing for a decentralized inter-dealer market with arbitrary heterogeneity in dealers’ valuations (or, equivalently, inventory costs). We develop a solution technique that makes the model fully tractable and allows us to derive, in closed form, theoretical formulas for key statistics analysed in empirical studies of the intermediation process in OTC markets. A calibration to the market for municipal bonds allows us to quantify important unobservable characteristics of this market, including the severity of search and bargaining frictions and the nature of heterogeneity across dealers. We use our calibrated model to study the effect of these market characteristics on total welfare and the distribution of gains from trade across customers and dealers.
Dynamic changes in cerebral and peripheral markers of glutamatergic signaling across the human sleep–wake cycle
Authors: Weigend Susanne , Holst Sebastian C , Treyer Valérie , O’Gorman Tuura Ruth L , Meier Josefine , Ametamey Simon M , Buck Alfred , Landolt Hans-Peter
Published: July 2019

Sleep and brain glutamatergic signaling are homeostatically regulated. Recovery sleep following prolonged wakefulness restores efficient functioning of the brain, possibly by keeping glutamatergic signaling in a homeostatic range. Evidence in humans and mice suggested that metabotropic glutamate receptors of subtype-5 (mGluR5) contribute to the brain’s coping mechanisms with sleep deprivation. Here, proton magnetic resonance spectroscopy in 31 healthy men was used to quantify the levels of glutamate (Glu), glutamate-to-glutamine ratio (GLX), and γ-amino-butyric-acid (GABA) in basal ganglia (BG) and dorsolateral prefrontal cortex on 3 consecutive days, after ~8 (baseline), ~32 (sleep deprivation), and ~8 hours (recovery sleep) of wakefulness. Simultaneously, mGluR5 availability was quantified with the novel radioligand for positron emission tomography, [18F]PSS232, and the blood levels of the mGluR5-regulated proteins, fragile X mental retardation protein (FMRP) and brain-derived neurotrophic factor (BDNF) were determined. The data revealed that GLX (p = 0.03) in BG (for Glu: p < 0.06) and the serum concentration of FMRP (p < 0.04) were increased after sleep loss. Other brain metabolites (GABA, N-acetyl-aspartate, choline, glutathione) and serum BDNF levels were not altered by sleep deprivation (pall > 0.6). By contrast, the night without sleep enhanced whole-brain, BG, and parietal cortex mGluR5 availability, which was normalized by recovery sleep (pall < 0.05). The findings provide convergent multimodal evidence that glutamatergic signaling is affected by sleep deprivation and recovery sleep. They support a role for mGluR5 and FMRP in sleep–wake regulation and warrant further studies to investigate their causality and relevance for regulating human sleep in health and disease.

Clinical Trial Registration: www.clinicaltrials.gov (study identifier: NCT03813082)
Constitutional Statutes—Roots and Recognition
Authors: Mcgarry John , Spence Samantha
Published: July 2019

Sir John Laws, the originator of the principle of constitutional statutes, suggests that the protection accorded to them has its roots in the protection from implied repeal given to the European Communities Act 1972 and to constitutional fundamentals. We argue that this suggestion is more convincing with regard to the latter than it is with the former. Further, we contend that founding constitutional statutes on the protection afforded to constitutional fundamentals rather than the 1972 Act may provide a stronger basis for the principle of such statutes if the United Kingdom leaves the European Union. We then provide evidence that the idea of constitutional statutes has been accepted across the three arms of state and argue that, as a consequence, the rule of recognition may be taken to have changed to encompass the amendment to the implied repeal rule that such statutes represent.
Heterogeneity of the Cystic Fibrosis Phenotype in a Large Kindred Family in Qatar with Cystic Fibrosis Mutation (I1234V)
Authors: Wahab A. Abdul , Al Thani G. , Dawod S. T. , Kambouris M. , Al Hamed M.
Published: July 2019

Twenty-nine subjects (17 families) with cystic fibrosis belonging to the same Bedouin tribe were screened for cystic fibrosis transmembrane regulator gene mutations (CFTR). Homozygous I1234V mutation in exon 19 was identified in all families with a relatively high rate of consanguinity (96.6 per cent). The homozygous I1234V mutation tended to present with a variable degree of pulmonary disease, pancreatic insufficiency and electrolyte imbalance. Homozygous I1234V was found to be a common mutation in the studied Bedouin tribe in Qatar.
Sero-molecular evaluation of Toxoplasma gondii infection among HIV-positive patients
Authors: Ahmadpour Ehsan , Pishkarie-Asl Reza , Spotin Adel , Samadi Kafil Hossein , Didarlu Hasan , Azadi Yaghob , Barac Aleksandra
Published: July 2019

Background

Toxoplasmosis is one of the most common comorbidities in HIV-positive patients with CD4+ T lymphocytes below 200 cells/μl. Early diagnosis and treatment of toxoplasmosis reduces the mortality rate in HIV-positive people. The aim of this study was to estimate the seroprevalence of Toxoplasma gondii infection in HIV-positive patients in northwest Iran using serological and molecular methods.

Methods

This prospective cross-sectional study included 124 HIV-positive outpatients and was conducted from January to May 2016. Anti-T. gondii IgM and IgG antibodies were detected from sera samples by chemiluminescence, while buffy coat samples were analyzed by RT-PCR for DNA detection. Patients’ socioepidemiological data were collected.

Results

Using chemiluminescence, 47/124 samples (37.9%) were positive for anti-Toxoplasma IgG antibodies, 2/124 samples (1.62%) were positive for IgM antibodies while 2/124 samples (1.62%) contained both IgM and IgG. There were no IgM-positive or IgG-negative patients. RT-PCR revealed four (3.22%) positive samples. On the basis of the results, a statistically significant relationship was found between anti-Toxoplasma IgG antibody seropositivity and residence (p=0.012).

Conclusions

The study showed a relatively low seroprevalence of anti-T. gondii IgG and IgM antibodies in HIV-positive patients in northwest Iran, while the prevalence was much higher in other regions of Iran. However, regular screening for T. gondii antibodies and early initiation of therapy are very important to decrease the mortality rate in HIV-positive patients.
Transmission Characteristics of Wheat Yellow Striate Virus by its Leafhopper VectorPsammotettix alienus
Authors: Du Zhenzhen , Fu Yumei , Liu Yan , Wang Xifeng
Published: July 2019

Wheat yellow striate virus (WYSV), which is found in wheat fields of Northwest China and transmitted by leafhopper vector Psammotettix alienus, is a tentative new species in the genus Nucleorhabdovirus. Although the insect vector and host range of WYSV have been characterized, many aspects of the acquisition and transmission processes by its insect vector have not been elucidated. Here, the transmission parameters of WYSV by P. alienus were determined using wheat cv. Yangmai 12 as the indicator plant under a controlled temperature (23 ± 1°C) and photoperiod (16 h of light). The results showed that the minimum periods for acquisition were 5 min and 10 min for inoculation access. The latent period for successful transmission was most commonly 16 to 20 days (minimum, 10 days; maximum, 22 days). The quantitative reverse-transcriptase PCR results indicated that the WYSV titer increased with time after acquisition, suggesting that WYSV can replicate in P. alienus. Notably, female P. alienus transovarially transmitted the virus to next generations at relatively high efficiency. Electron microscopy of the WYSV-infected leafhopper revealed bacilliform particles aggregated in the cytoplasm of the salivary gland and midgut tissues. Our present studies suggested that acquisition and transmission of WYSV by P. alienus is consistent with a propagative, circulative, and persistent mode of transmission. Details regarding transmission competencies and distribution of WYSV in P. alienus will provide a basis for designing preventive measures.
The Influences Burnout and Lack of Empowerment Have on Creativity in Nursing Faculty
Authors: Drafahl Bridget
Published: July 2019

AIM

The aim was to establish a correlation between burnout and lack of empowerment in associate degree nursing faculty and their creativity in the classroom.

METHOD

A descriptive, quantitative research study was completed. An email with a survey link was sent to members of the National Organization for Associate Degree Nursing asking for anonymous, voluntary participation and inviting members to forward to additional faculty; 217 participants completed the survey in its entirety. Pearson correlation and multiple linear regression tests were completed on the data.

RESULTS

Statistically significant (personal burnout, p = .004; work burnout, p = .003; student burnout, p = .000) relationships were found between burnout and creativity. No relationship was established between lack of empowerment and creativity.

CONCLUSION

Nursing faculty who perceived feelings of burnout were less motivated or engaged in their workplace, including interactions with students, which was directly correlated to a decrease in perceived feelings of creativity.
Changing Practice Through Meaningful Assignments: Ideas for Supporting RN-BSN Students
Authors: DeBrew Jacqueline Kayler
Published: July 2019

Although nurses entering RN-BSN programs often perceive that earning the BSN will be of little benefit, upon completion, they do believe they have made professional gains, demonstrating that they have experienced a change in perspective. Mezirow’s theory of perspective transformation can guide educators to develop learning activities that allow RN-BSN students to find meaning in the BSN degree while enrolled in a program, rather than after the program has been completed. Examples of learning activities and student reflections are provided.
Exam Wrappers: It Is Time to Adopt a Nursing Student Metacognitive Tool for Exam Review
Authors: Williams Cheryl A.
Published: July 2019

Examining test performance, a common practice in nursing education, can be a vital learning tool, as well as a means of assessment. Exam or cognitive wrappers, performed by students after an exam but before the exam review, can explicitly teach students to discern between what they do and what they do not know. The process teaches metacognition, the highest level of critical thinking. Nursing students need to be proficient in metacognition for professional growth well beyond the classroom. However, little information about these cognitive exercises, known as exam wrappers, exists in nursing education today.
Role of the Neonatal Nurse Practitioner in the Community Hospital
Authors: Snapp Barbara , Reyna Barbara
Published: July 2019

Background:

The role of the neonatal nurse practitioner (NNP) is well established in the neonatal intensive care unit. The level IV NNP is traditionally supported by large multidisciplinary teams while the level I to III NNP may be the sole in-house provider with limited resources.

Purpose:

The purpose of this research project is to identify the NNP role, responsibilities, and barriers to practice in the level I, II, and III newborn care settings.

Methods:

This study used a descriptive, exploratory design to examine NNP roles and responsibilities in level I, II, and III care centers via an online survey.

Results:

Of the respondents (171), the majority (71.3%) work 24-hour shifts, 51.5% being the single NNP during the day with 67.8% being alone at night. Nearly 27% have limited or are without ancillary support while 29.8% cannot meet some standards of care due to inadequate resources. Almost 22% lack written protocols and procedural opportunities are limited or a concern for 15.8% of the NNPs.

Implications for Practice:

A better understanding of the responsibilities of the level I to III NNP will assist with developing staffing guidelines, influence practice models, and guide recruitment and retention of the NNP.

Implications for Research:

A systematic literature review yielded articles on the value of nurse practitioners and their ability to deliver safe, effective and cost-conscience care but not on what the role entails on a daily basis. Further studies are needed to specifically compare the role of the level IV NNP to the level I, II, and III NNP to further delineate NNP functionality according to level of care.
Maternal Distress in the Neonatal Intensive Care Unit
Authors: Staver Morgan A. , Moore Tiffany A. , Hanna Kathleen M.
Published: July 2019

Background:

The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use.

Purpose:

To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings.

Methods/Search Strategy:

A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide.

Findings/Results:

Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal–infant bond, adverse infant development, and decreased maternal quality of life.

Implications for Practice:

A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population.

Implications for Research:

Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.
Predictive Model of Factors Associated With Maternal Intensive Care Unit Admission
Authors: Rossi Robert M. , Hall Eric , Dufendach Kevin , DeFranco Emily A.
Published: July 2019

OBJECTIVE:

Severe maternal morbidity has increased in the United States over the past two decades by approximately 200%, to 144 cases per 10,000 delivery hospitalizations. There are limited data available to assist in identifying at-risk women before parturition. We sought to evaluate risk factors associated with maternal admission to an intensive care unit (ICU).

METHODS:

We conducted a population-based cohort study of all live births delivered between 20 and 44 weeks of gestation in the United States during 2012–2016. Our primary objective was to identify prenatal factors associated with increased risk of maternal ICU admission to build a multivariable predictive model to estimate the association of these factors with ICU admission risk. We performed k-fold cross-validation for internal validation and then externally validated the model on a separate live birth cohort (2006–2011, n=856,255).

RESULTS:

There were 18,745,615 live births in the United States between 2012 and 2016. Among the mothers of these live newborns, 27,602 (0.15%) were admitted to the ICU in the peripartum period. Fourteen variables were selected for inclusion in the predictive model for maternal ICU admission. The predicted minimal and maximal risk for ICU admission ranged 0–25%. The receiver operating characteristic curve for these 14 variables achieved an area under the curve (AUC) of 0.81 (95% CI 0.79–0.81). External validation with a separate live birth cohort demonstrated a consistent measure of discrimination with an AUC of 0.83 (95% CI 0.82–0.84). Using a relatively high cut point of 5.0% or more predicted risk for ICU admission, achieved a positive predictive value (PPV) of only 4.0%.

CONCLUSION:

This model provides insight as to the cumulative effect of multiple risk factors on maternal ICU admission risk. The predictive model achieves an AUC of 0.81, discriminating women with significantly increased risk (30-fold) for ICU admission. Nonetheless, because of the low frequency of maternal ICU admission, the PPV of the model was low and therefore whether models such as ours may be beneficial in future efforts to reduce the prevalence and burden of maternal morbidity is uncertain.
Tissue Adhesive Compared With Sterile Strips After Cesarean Delivery
Authors: Braginsky Lena , Javellana Melissa , Cleveland Emily , Elue Rita , Wang Chi , Boyle Deborah , Plunkett Beth A.
Published: July 2019

OBJECTIVE:

To assess whether tissue adhesive after closure of Pfannenstiel incision for cesarean delivery lowers the risk of wound complications when compared with sterile strips.

METHODS:

In this multicenter randomized controlled trial, women undergoing cesarean delivery using Pfannenstiel skin incision were randomized to receive tissue adhesive (2-octyl cyanoacrylate) compared with sterile strips after closure of the skin incision. The primary outcome was a composite of wound complications (drainage, cellulitis, abscess, seroma, hematoma, or isolated wound separation) within 8 weeks of delivery. Secondary outcomes included operative time, readmission, office or emergency department visits, or antibiotic use for wound complications, and patient satisfaction with the cesarean scar. With 80% power and a 95% CI, a sample size of 432 per group (n=864) was required to detect a 50% reduction in the primary outcome. A planned interim analysis was performed after 500 patients delivered. A conditional power analysis revealed that the probability of showing a benefit with tissue adhesive was extremely low (6.2%), and the study was halted owing to futility.

RESULTS:

Between November 2016 and April 2018, 504 patients were randomized, and follow-up was achieved in 479 (95%). Wound complications occurred in 18 out of 238 patients (7.6%) in the tissue adhesive group and 19 out of 241 patients (7.9%) in the sterile strips group (relative risk 0.96; 95% CI 0.51–1.78). There were no significant differences with regard to types of wound complications, operative time, readmission, office or emergency department visits, antibiotics prescribed for wound complications, or patient scar assessment scores of pain, stiffness, and irregularity between the two groups. However, tissue adhesive performed slightly better in regard to itchiness of scar and overall scar satisfaction.

CONCLUSION:

Compared with sterile strips, tissue adhesive after closure of Pfannenstiel incision for cesarean delivery is unlikely to lower the risk of wound complications.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02838017.
Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California
Authors: Wall-Wieler Elizabeth , Carmichael Suzan L. , Gibbs Ronald S. , Lyell Deirdre J. , Girsen Anna I. , El-Sayed Yasser Y. , Butwick Alexander J.
Published: July 2019

OBJECTIVE:

To assess the prevalence and risk of severe maternal morbidity among delivery hospitalization for stillbirth compared with live birth deliveries.

METHODS:

Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cross-sectional study of 6,459,842 deliveries between 1999 and 2011. We identified severe maternal morbidity using an algorithm comprising diagnoses and procedures developed by the Centers for Disease Control and Prevention and used log-binomial regression models to examine the relative risk (RR) of severe maternal morbidity for stillbirth compared with live birth deliveries, adjusting for maternal demographic, medical, and obstetric characteristics. We also examined severe maternal morbidity prevalence by cause of fetal death among stillbirth deliveries.

RESULTS:

The prevalence of severe maternal morbidity for stillbirth and live birth was 578 and 99 cases per 10,000 deliveries, respectively. After adjusting for maternal demographic, medical, and obstetric characteristics, the risk of severe maternal morbidity among stillbirth deliveries was more than fourfold higher (adjusted RR 4.77; 95% CI 4.53–5.02) compared with live birth deliveries. The severe maternal morbidity prevalence was highest among stillbirths caused by hypertensive disorders and placental conditions (24 and 19 cases/100 deliveries, respectively), and lowest among stillbirths caused by fetal malformations or genetic abnormalities (1 case per 100 deliveries).

CONCLUSION:

Women who have stillbirths are at substantially higher risk for severe maternal morbidity than women who have live births, regardless of cause of fetal death. The prevalence of severe maternal morbidity varies by cause of fetal death.
Elective Induction of Labor in the 39th Week of Gestation Compared With Expectant Management of Low-Risk Multiparous Women
Authors: Sinkey Rachel G. , Blanchard Christina T. , Szychowski Jeff M. , Ausbeck Elizabeth , Subramaniam Akila , Neely Cherry L. , Casey Brian M. , Tita Alan T.
Published: July 2019

OBJECTIVE:

To compare perinatal and maternal outcomes in low-risk multiparous women who underwent elective induction of labor in the 39th week of gestation with those who were expectantly managed.

METHODS:

We performed a single center retrospective cohort study of low-risk multiparous women delivering nonanomalous singletons between 39 and 42 completed weeks of gestation from 2014 to 2018. The primary outcome was a perinatal composite of death, neonatal respiratory support, a 5-minute Apgar score of 3 or less, and shoulder dystocia. Groups were compared using χ2, Fisher exact, two sample t-test, and Wilcoxon rank sum tests, as appropriate. Multivariable logistic regression models were used to adjust for potential confounders.

RESULTS:

Of the 3,703 low-risk multiparous women meeting inclusion criteria, 453 (12%) delivered between 39 0/7 and 39 4/7 after an elective induction of labor. Women who underwent elective induction of labor were more likely to be privately insured, non-Hispanic, and weigh more at their first prenatal visit (all P<.01) compared with expectant management. An elective induction of labor was associated with decreased frequency of the perinatal composite morbidity (4.0% vs 7.1%; adjusted odds ratio [aOR] 0.57, 95% CI 0.34–0.96) compared with expectant management. Fewer cesarean deliveries occurred among women in the elective induction of labor group (5.1% vs 6.6%; aOR 0.60, 95% CI 0.37–0.97). Other maternal outcomes (hypertensive disorders, chorioamnionitis, and operative vaginal deliveries) as well as neonatal intensive care unit admissions were not different between groups.

CONCLUSION:

Elective induction of labor in low-risk multiparous women in the 39th week of gestation was associated with decreased perinatal morbidity and a lower frequency of cesarean delivery compared with expectant management.
Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers
Authors: Hill Amber L. , Jones Kelley A. , McCauley Heather L. , Tancredi Daniel J. , Silverman Jay G. , Miller Elizabeth
Published: July 2019

OBJECTIVE:

To investigate demographic differences and evaluate how reproductive coercion and relationship abuse influences young females' care-seeking and sexual health behaviors.

METHODS:

We conducted a secondary analysis of cross-sectional baseline survey data from sexually active female students (aged 14–19 years) who sought care from school health centers. Outcomes included recent (previous 3 months) reproductive coercion, physical or sexual adolescent relationship abuse, and nonpartner sexual violence victimization. Cluster-adjusted χ2 tests compared demographics and generalized linear mixed models estimated associations among reproductive coercion, adolescent relationship abuse (physical and sexual abuse in romantic relationships), and care-seeking and sexual health behaviors.

RESULTS:

Of 550 sexually active high school females, 12% reported recent reproductive coercion and 17% reported physical or sexual adolescent relationship abuse, with no significant demographic differences. Prevalence of recent nonpartner sexual violence was 17%. There were no observed significant differences in care-seeking behaviors among those with recent reproductive coercion compared with those without. Physical or sexual adolescent relationship abuse was associated with increased odds of seeking testing or treatment for sexually transmitted infections (adjusted odds ratio [aOR] 2.08, 95% CI 1.05–4.13). Females exposed to both adolescent relationship abuse and reproductive coercion had higher odds of having a partner who was 5 or more years older (aOR 4.66, 95% CI 1.51–14.4), having two or more recent sexual partners (aOR 3.86, 95% CI 1.57–9.48), and using hormonal contraception only (aOR 3.77, 95% CI 1.09–13.1 vs hormonal methods with condoms).

CONCLUSION:

Almost one in eight females experienced recent reproductive coercion. We did not observe significant demographic differences in reproductive coercion. Partner age and number of sexual partners may elevate risk for abusive relationships. Relationship abuse is prevalent among high school students seeking care, with no clear pattern for case identification. By failing to identify factors associated with harmful partner behaviors, our results support universal assessment for reproductive coercion and relationship abuse among high school–aged adolescents, involving education, resources, and harm-reduction counseling to all patients.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01678378.
Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients
Authors: Thimm Matthew A. , Rositch Anne F. , VandenBussche Christopher , McDonald Lynn , Garonzik Wang Jacqueline M. , Levinson Kimberly
Published: July 2019

OBJECTIVE:

To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development.

METHODS:

This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia.

RESULTS:

Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29–53). Forty-seven (11.9%; 95% CI 8.8–15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6–12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33–6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96–18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years.

CONCLUSIONS:

One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.
What Is New in Chronic Pelvic Pain Research?
Authors: El-Nashar Sherif A.
Published: July 2019

This month we focus on current research in chronic pelvic pain. Dr. El-Nashar discusses four recent publications, which are concluded with a “bottom-line” that is the take-home message. A complete reference for each can be found on Box 1 on this page along with direct links to abstracts.
Evaluation of opioid disposal opportunities in the United States
Authors: Iobst Christopher A. , Singh Satbir , Balch Samora Julie
Published: July 2019

Background:

We sought to determine whether caregivers, pharmacies, and law enforcement authorities would accept the return of unused opioids, and whether pharmacies provide patient education regarding the return of unused opioids.

Methods:

The pharmacies of every children’s hospital in the United States, along with a large sample of chain pharmacies, nonchain pharmacies, and police stations in every state were contacted to determine if their facility would accept unused opioids.

Results:

One thousand four hundred and seventy-seven phone calls were successfully placed to 858 pharmacies (436 chain, 422 nonchain), 431 police stations, and 188 children’s hospitals in all 50 states. Overall, only 415 of the 1477 (28%) of the contacted locations offered to take the medication. Police stations offered to take the opioids at a significantly higher rate (60%, P<0.001) than pharmacies (15%) or children’s hospitals (11%). There was also a significant difference in pharmacy types, with independent pharmacies having a higher take-back rate (24%, P<0.001) than retail chain pharmacies (7%). Finally, 78% of children’s hospital pharmacies reported that they recommend proper disposal of any unused opioids at the time the medication is dispensed compared to only 29% of chain and nonchain pharmacies (P<0.0001).

Conclusions:

This study demonstrated that only 28% of children’s hospital pharmacies, police stations, and commercial pharmacies across the country would accept the return of unused opioids. Only 29% of commercial pharmacies reported educating patients about options to return unused opioids. Patients would benefit from more consistent and better-publicized efforts to secure the return of unused medications.
The Community Orthopaedic Surgeon Taking Trauma Call: Radial Neck Fracture Pearls and Pitfalls
Authors: Gibly Romie F. , Garg Sumeet , Mehlman Charles T.
Published: July 2019

Pediatric radial neck fractures will inevitably be encountered by the general orthopaedist, and they carry great potential for poor outcomes. Acceptable displacement varies by age, and unlike adults, most of these injuries can be managed by closed means. If they are taken to the operating room, the mainstays of treatment are percutaneous techniques. Increasing patient age, inadequate reduction, unnecessary open reductions, and prolonged immobilization are all associated with worse outcomes, most commonly manifesting as significant elbow stiffness. Knowledge of the age-specific acceptable displacement criteria, a stepwise approach to closed and percutaneous techniques, and safe strategies for open reduction when needed as a last resort will greatly improve treatment success.
Atorvastatin Attenuates Cold-Induced Hypertension by Preventing Gut Barrier Injury
Authors: Zhang Song , Zhang Yun , Ahsan Mian Zeeshan , Yuan Yue , Liu Guangzhong , Han Xuejie , Zhang Jiawei , Zhao Xinbo , Bai Bing , Li Yue
Published: July 2019

Chronic exposure to cold causes arterial hypertension [cold-induce hypertension (CIH)]. Emerging data have indicated that gut barrier dysfunction is involved in the pathogenesis of hypertension. In this study, we explored the effect of gut barrier dysfunction on vascular inflammation induced by cold exposure and the therapeutic effect of atorvastatin in a CIH rat model. The CIH was established by cold exposure for 2 weeks. Two groups of Sprague Dawley rats were exposed to moderate cold (4 ± 1°C), whereas the control group was maintained at room temperature (23 ± 1°C) (10 rats/group). The 2 groups received atorvastatin or vehicle at the beginning of cold exposure, respectively, for 2 weeks. Cold exposure increased mean arterial pressure compared with room temperature group, indicating that animals developed arterial hypertension. Cold exposure induced vascular dysfunction due to decreasing phosphorylated endothelial nitric oxide synthase protein expression in aorta, and these were blunted by atorvastatin. Cold exposure increased the levels of gut-derived inflammatory cytokines, tumor necrosis factor-α, and interleukin-6 production in aorta and resulted in vascular inflammation, whereas atorvastatin prevented these effects. Cold exposure also increased gut permeability, inhibited tight junction protein expression in proximal colon, and resulted in gut barrier dysfunction. Interestingly, atorvastatin eliminated increasing gut permeability, decreasing tight junction protein expression, and gut pathology and reversed gut barrier dysfunction. Atorvastatin attenuated CIH and improved gut barrier function; the beneficial effects might be via inhibiting gut-derived inflammatory cytokines and reversing cold-induced vascular inflammation, suggesting that gut barrier dysfunction may be involved in the pathogenesis of CIH.