bluuebunny/crossref_metadata_2025 huggingface dataset:
8. The Free Movement of Goods
Authors: Foster Nigel
Published: August 2019

This chapter discusses EU law on the free movement of goods. It covers legislative provisions; progress towards the treaty goals; integration methods; the establishment of the internal market; the prohibition of discriminatory taxation; summary on tariff barriers; quantitative restrictions and measures having equivalent effect; the ban of Article 34 TFEU and derogations of Article 36 TFEU; equally applicable measures (indistinctly applicable measures); and notable cases including Dassonville, Cassis de Dijon, Keck, and Mithouard.
Reaching rural communities through ‘Healthy Entrepreneurs’: a cross-sectional exploration of community health entrepreneurship’s role in sexual and reproductive health
Authors: Borst Robert A J , Hoekstra Trynke , Muhangi Denis , Jonker Isis , Kok Maarten Olivier
Published: August 2019

The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30–3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81–21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14–3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18–2.85). The association between exposure to community health entrepreneurship and communities’ comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97–1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.
Health Care Cost for Children Newly Diagnosed With Inflammatory Bowel Disease
Authors: Fondell Andrew W , Mosha Maua H , Frank Cliff R , Brangi Jeffrey M , Hyams Jeffrey S
Published: August 2019

Background

The increasing incidence of pediatric inflammatory bowel disease (IBD), along with more extensive and severe disease in children, raises concern for related health care expenditures.

Aim

The aim of this study was to quantify and characterize costs of pediatric IBD in the year following diagnosis.

Methods

We identified all patients diagnosed with IBD at Connecticut Children’s Medical Center in 2016 with a minimum of 1 year follow-up. Clinical and demographic factors were recorded at diagnosis. We examined paid service and professional costs related to outpatient medications and infusions, outpatient procedures and radiology imaging, inpatient services, and outpatient visits. Actual dollar reimbursements were from private and public payers. Data is reported as mean ± SD and median (IQR).

Results

First-year cost data were collected on 67 patients (43 Crohn’s disease [CD], 24 ulcerative colitis [UC], mean age 13 years [SD 3.22]) revealing a mean cost of $45,753 (SD $37,938), with $43,095 (SD $30,828) for CD and $50,516 (SD $48,557) for UC. Severe CD (n = 11) had a mean cost of $71,176 (SD $43,817) and severe UC (n = 5) $134,178 (SD $40,920). Patients receiving infusion therapy had a mean cost of $59,376 (SD $38,724) compared with $27,903 (SD $28,795) for those not receiving infusions. Overall cost distribution showed 37% from infusion costs, 25% hospital costs, 18% outpatient procedures, 10% outpatient oral medications, 7% outpatient imaging, and 3% outpatient visits.

Conclusions

Infusion therapy is a key driver of first-year costs for children newly diagnosed with IBD. Understanding cost distribution in relation to disease presentation can be helpful to anticipate future related costs.
The Changing Epidemiology of Inflammatory Bowel Disease: What Goes Up May Come Down
Authors: Khalili Hamed
Published: August 2019

Recent epidemiologic studies have shown that although the incidence of inflammatory bowel disease (IBD) is rapidly increasing in newly industrialized countries, at the turn of the 21st century the incidence had stabilized in the Western world. In this issue of Inflammatory Bowel Diseases, Torabi and colleagues present their findings on the temporal trends and geographic variations in IBD incidence in Manitoba from 1990 to 2012 using the Manitoba Health population registry and the University of Manitoba IBD epidemiology database. Their results demonstrate an overall decrease in the incidence of IBD during the study period. They also found significant regional variations in disease incidence within Manitoba, with rates of new diagnosis of IBD remaining high in several regions. Lastly, the study found that a higher proportion of the indigenous population had a lower rate of IBD. These findings provide new insights on the changing epidemiology of IBD in the Western world. The overall declining incidence of IBD and identification of persistently low and high-risk populations in Manitoba, which traditionally has had some of the highest incidence rates of IBD, is intriguing and can provide new avenues of research for epidemiologists in the field.
Synchrony in networks of Franklin bells
Authors: Şayli Mustafa , Lai Yi Ming , Thul Rüdiger , Coombes Stephen
Published: August 2019

The Franklin bell is an electro-mechanical oscillator that can generate a repeating chime in the presence of an electric field. Benjamin Franklin famously used it as a lightning detector. The chime arises from the impact of a metal ball on a metal bell. Thus, a network of Franklin bells can be regarded as a network of impact oscillators. Although the number of techniques for analysing impacting systems has grown in recent years, this has typically focused on low-dimensional systems and relatively little attention has been paid to networks. Here we redress this balance with a focus on synchronous oscillatory network states. We first study a single Franklin bell, showing how to construct periodic orbits and how to determine their linear stability and bifurcation. To cope with the non-smooth nature of the impacts we use saltation operators to develop the correct Floquet theory. We further introduce a new smoothing technique that circumvents the need for saltation and that recovers the saltation operators in some appropriate limit. We then consider the dynamics of a network of Franklin bells, showing how the master stability function approach can be adapted to treat the linear stability of the synchronous state for arbitrary network topologies. We use this to determine conditions for network induced instabilities. Direct numerical simulations are shown to be in excellent agreement with theoretical results.
Follicular Helper T Cells Are Major Human Immunodeficiency Virus-2 Reservoirs and Support Productive Infection
Authors: Godinho-Santos Ana , Foxall Russell B , Antão Ana V , Tavares Bárbara , Ferreira Tiago , Serra-Caetano Ana , Matoso Paula , Sousa Ana E
Published: August 2019

Follicular helper T cells (Tfh), CD4 lymphocytes critical for efficient antibody responses, have been shown to be key human immunodeficiency virus (HIV)-1 reservoirs. Human immunodeficiency virus-2 infection represents a unique naturally occurring model for investigating Tfh role in HIV/acquired immune deficiency syndrome, given its slow rate of CD4 decline, low to undetectable viremia, and high neutralizing antibody titers throughout the disease course. In this study, we investigated, for the first time, Tfh susceptibility to HIV-2 infection by combining in vitro infection of tonsillar Tfh with the ex vivo study of circulating Tfh from HIV-2-infected patients. We reveal that Tfh support productive HIV-2 infection and are preferential viral targets in HIV-2-infected individuals.
Breast Cancer Screening: Beyond Mortality
Authors: Yaffe Martin J , Jong Roberta A , Pritchard Kathleen I
Published: August 2019

Traditionally, the effectiveness of breast cancer screening has been measured in terms of reducing the number of deaths attributable to breast cancer. Other metrics such as the number of life-years or quality-adjusted life-years gained through screening may be more relevant and certainly may better reflect the important burden of the disease on younger women, their families, and society. The effects of earlier detection of breast cancer in reducing morbidities associated with treatment have often also been neglected. In addition, the harms and limitations associated with cancer screening have been poorly quantified and are seldom put into perspective vis-à-vis the benefits. Here, these alternative measures will be discussed and quantified.
Iron and Ferritin Deposition in the Ovarian Tissues of the Yellow Fever Mosquito (Diptera: Culicidae)
Authors: Geiser Dawn L , Thai Theresa N , Love Maria B , Winzerling Joy J
Published: August 2019

Dengue, yellow fever, and Zika are viruses transmitted by yellow fever mosquito, Aedes aegypti [Linnaeus (Diptera: Culicidae)], to thousands of people each year. Mosquitoes transmit these viruses while consuming a blood meal that is required for oogenesis. Iron, an essential nutrient from the blood meal, is required for egg development. Mosquitoes receive a high iron load in the meal; although iron can be toxic, these animals have developed mechanisms for dealing with this load. Our previous research has shown iron from the blood meal is absorbed in the gut and transported by ferritin, the main iron transport and storage protein, to the ovaries. We now report the distribution of iron and ferritin in ovarian tissues before blood feeding and 24 and 72 h post-blood meal. Ovarian iron is observed in specific locations. Timing post-blood feeding influences the location and distribution of the ferritin heavy-chain homolog, light-chain homolog 1, and light-chain homolog 2 in ovaries. Understanding iron deposition in ovarian tissues is important to the potential use of interference in iron metabolism as a vector control strategy for reducing mosquito fecundity, decreasing mosquito populations, and thereby reducing transmission rates of vector-borne diseases.
Body mass index at diagnosis is associated with survival outcome in peripheral T-cell lymphoma: a study of Chinese population
Authors: Ma Shanshan , Zhao Yanchun , Lu Danlei , Ye Xiujin , Xie Wanzhuo
Published: August 2019

Objective

Obesity increases the risk for many diseases, including some malignancies. We found that in diffuse large B-cell lymphoma, the most common form of non-Hodgkin’s lymphoma, patients with higher body mass index had significantly longer overall survival. Patients with peripheral T-cell lymphoma usually have worse outcomes than those with diffuse large B-cell lymphoma. Nonetheless, the association between body mass index at diagnosis and survival in patients with peripheral T-cell lymphoma remains unclear.

Methods

This retrospective study included 411 peripheral T-cell lymphoma patients from January 2010 to July 2017. Patients were stratified by body mass index into low body mass index (<24.0 kg/m2) and high body mass index (≥24.0 kg/m2) groups. We mainly used Cox modelling and the Kaplan–Meier method to evaluate survival and other variables.

Results

Multivariate analysis demonstrated that body mass index, international prognostic index and triglyceride level were independent prognostic factors of overall survival. Interestingly, patients with high body mass index had significantly longer overall survival (P < 0.01), with 69% of patients alive at 3 years versus 43% in the low body mass index group. Cox analysis showed reduced mortality in the high body mass index group compared with the low body mass index group (hazard ratio = 0.511, 95% CI, 0.309–0.846, P = 0.009). In addition, patients with high body mass index and low international prognostic index had the longest overall survival (P < 0.001).

Conclusions

High body mass index at the time of diagnosis was associated with improved overall survival in Chinese peripheral T-cell lymphoma patients.
The afterglow and kilonova of the short GRB 160821B
Authors: Troja E , Castro-Tirado A J , González J Becerra , Hu Y , Ryan G S , Cenko S B , Ricci R , Novara G , Sánchez-Rámirez R , Acosta-Pulido J A , Ackley K D , Caballero García M D , Eikenberry S S , Guziy S , Jeong S , Lien A Y , Márquez I , Pandey S B , Park I H , Sakamoto T , Tello J C , Sokolov I V , Sokolov V V , Tiengo A , Valeev A F , Zhang B B , Veilleux S
Published: August 2019

GRB 160821B is a short duration gamma-ray burst (GRB) detected and localized by the Neil Gehrels Swift Observatory in the outskirts of a spiral galaxy at z=0.1613, at a projected physical offset of ≈16 kpc from the galaxy’s center. We present X-ray, optical/nIR and radio observations of its counterpart and model them with two distinct components of emission: a standard afterglow, arising from the interaction of the relativistic jet with the surrounding medium, and a kilonova, powered by the radioactive decay of the sub-relativistic ejecta. Broadband modeling of the afterglow data reveals a weak reverse shock propagating backward into the jet, and a likely jet-break at ≈3.5 d. This is consistent with a structured jet seen slightly off-axis (θview ∼ θcore) while expanding into a low-density medium (n ≈ 10−3 cm−3). Analysis of the kilonova properties suggests a rapid evolution toward red colors, similar to AT2017gfo, and a low nIR luminosity, possibly due to the presence of a long-lived neutron star. The global properties of the environment, the inferred low mass (Mej ≲ 0.006 M⊙) and velocities (vej ≳ 0.05c) of lanthanide-rich ejecta are consistent with a binary neutron star merger progenitor.
Anomaly Detection in the Open Supernova Catalog
Authors: Pruzhinskaya M V , Malanchev K L , Kornilov M V , Ishida E E O , Mondon F , Volnova A A , Korolev V S
Published: August 2019

In the upcoming decade large astronomical surveys will discover millions of transients raising unprecedented data challenges in the process. Only the use of the machine learning algorithms can process such large data volumes. Most of the discovered transients will belong to the known classes of astronomical objects. However, it is expected that some transients will be rare or completely new events of unknown physical nature. The task of finding them can be framed as an anomaly detection problem. In this work, we perform for the first time an automated anomaly detection analysis in the photometric data of the Open Supernova Catalog (OSC), which serves as a proof of concept for the applicability of these methods to future large scale surveys. The analysis consists of the following steps: 1) data selection from the OSC and approximation of the pre-processed data with Gaussian processes, 2) dimensionality reduction, 3) searching for outliers with the use of the isolation forest algorithm, 4) expert analysis of the identified outliers. The pipeline returned 81 candidate anomalies, 27 (33%) of which were confirmed to be from astrophysically peculiar objects. Found anomalies correspond to a selected sample of 1.4% of the initial automatically identified data sample of ∼2000 objects. Among the identified outliers we recognised superluminous supernovae, non-classical Type Ia supernovae, unusual Type II supernovae, one active galactic nucleus and one binary microlensing event. We also found that 16 anomalies classified as supernovae in the literature are likely to be quasars or stars. Our proposed pipeline represents an effective strategy to guarantee we shall not overlook exciting new science hidden in the data we fought so hard to acquire. All code and products of this investigation are made publicly available‡.
Morphological evolution and galactic sizes in the L-Galaxies SA model
Authors: Irodotou Dimitrios , Thomas Peter A , Henriques Bruno M , Sargent Mark T , Hislop Jessica M
Published: August 2019

In this work we update the L-Galaxies semi-analytic model (SAM) to better follow the physical processes responsible for the growth of bulges via disc instabilities (leading to pseudo-bulges) and mergers (leading to classical bulges). We address the former by considering the contribution of both stellar and gaseous discs in the stability of the galaxy, and we update the latter by including dissipation of energy in gas-rich mergers. Furthermore, we introduce angular momentum losses during cooling and find that an accurate match to the observed correlation between stellar disc scale length and mass at z ∼ 0.0 requires that the gas loses 20% of its initial specific angular momentum to the corresponding dark matter halo during the formation of the cold gas disc. We reproduce the observed trends between the stellar mass and specific angular momentum for both disc- and bulge-dominated galaxies, with the former rotating faster than the latter of the same mass. We conclude that a two-component instability recipe provides a morphologically diverse galaxy sample which matches the observed fractional breakdown of galaxies into different morphological types. This recipe also enables us to obtain an excellent fit to the morphology-mass relation and stellar mass function of different galactic types. Finally, we find that energy dissipation during mergers reduces the merger remnant sizes and allows us to match the observed mass-size relation for bulge-dominated systems.
Investigation of Stark line broadening within spectral series of potassium and copper isoelectronic sequences
Authors: Dojčinović Ivan P , Trklja Nora , Tapalaga Irinel , Purić Jagoš
Published: August 2019

We have investigated Stark line broadening within the spectral series of potassium-like and copper-like emitters, both separately and together. The analysis was performed for fixed values of electronic density Ne = 1022 m−3 and temperature $T = 100\, 000$ K. Algorithms made for fast data processing also serve for temperature and density normalization of data. Relations obtained using the regularity-based analysis enable predictions of Stark widths for transitions that have not yet been calculated or measured. Results of present investigation can be used for quality control of available Stark width data.
CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012–2016
Authors: Ostrom Quinn T , Cioffi Gino , Gittleman Haley , Patil Nirav , Waite Kristin , Kruchko Carol , Barnholtz-Sloan Jill S
Published: August 2019

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.41 (Malignant AAAIR = 7.08, non-Malignant AAAIR = 16.33). This rate was higher in females compared to males (25.84 versus 20.82), Whites compared to Blacks (23.50 versus 23.34), and non-Hispanics compared to Hispanics (23.84 versus 21.28). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.6% of all tumors), and the most common non-malignant tumor was meningioma (37.6% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0–19 years), the incidence rate of all primary brain and other CNS tumors was 6.06. An estimated 86,010 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2019 (25,510 malignant and 60,490 non-malignant). There were 79,718 deaths attributed to malignant brain and other CNS tumors between 2012 and 2016. This represents an average annual mortality rate of 4.42. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.8%, and the five-year relative survival rate following diagnosis of a non-malignant brain and other CNS tumors was 91.5%.
Thermal-siphon phenomenon and thermal/electric conduction in complex networks
Authors: Xiong Kezhao , Liu Zonghua , Zeng Chunhua , Li Baowen
Published: August 2019

In past decades, a lot of studies have been carried out on complex networks and heat conduction in regular lattices. However, very little attention has been paid to the heat conduction in complex networks. In this work, we study (both thermal and electric) energy transport in physical networks rewired from 2D regular lattices. It is found that the network can be transferred from a good conductor to a poor conductor, depending on the rewired network structure and coupling scheme. Two interesting phenomena were discovered: (i) the thermal-siphon effect—namely the heat flux can go from a low-temperature node to a higher-temperature node and (ii) there exits an optimal network structure that displays small thermal conductance and large electrical conductance. These discoveries reveal that network-structured materials have great potential in applications in thermal-energy management and thermal-electric-energy conversion.
The role of networks in antitrust investigations
Authors: Elliott Matthew , Galeotti Andrea
Published: August 2019

Antitrust investigations typically focus on the competitive pressures coming from within the defined markets of interest. However, competitive pressures can also come from other markets. Even when individually these markets place only weak constraints on one another, collectively they may matter. A networks approach to modelling competition permits a systemic view of competition that can sometimes paint a more accurate picture. We demonstrate this through some simple examples, and show more generally how tools from the networks literature can be applied to capture competition across a system of interrelated markets. As a leading example, we consider antitrust investigations into supermarkets where local geographic markets have been used as the basis of investigation.
Comparative Transcriptomics Analysis of Brassica napus L. during Seed Maturation Reveals Dynamic Changes in Gene Expression between Embryos and Seed Coats and Distinct Expression Profiles of Acyl-CoA-Binding Proteins for Lipid Accumulation
Authors: Liao Pan , Woodfield Helen K , Harwood John L , Chye Mee-Len , Scofield Simon
Published: August 2019

Production of vegetable oils is a vital agricultural resource and oilseed rape (Brassica napus) is the third most important oil crop globally. Although the regulation of lipid biosynthesis in oilseeds is still not fully defined, the acyl-CoA-binding proteins (ACBPs) have been reported to be involved in such metabolism, including oil accumulation, in several plant species. In this study, progressive changes in gene expression in embryos and seed coats at different stages of seed development were comprehensively investigated by transcriptomic analyses in B. napus, revealing dynamic changes in the expression of genes involved in lipid biosynthesis. We show that genes encoding BnACBP proteins show distinct changes in expression at different developmental stages of seed development and show markedly different expression between embryos and seed coats. Both isoforms of the ankyrin-repeat BnACBP2 increased during the oil accumulation period of embryo development. By contrast, the expression of the three most abundant isoforms of the small molecular mass BnACBP6 in embryos showed progressive reduction, despite having the highest overall expression level. In seed coats, BnACBP3, BnACBP4 and BnACBP5 expression remained constant during development, whereas the two major isoforms of BnACBP6 increased, contrasting with the data from embryos. We conclude that genes related to fatty acid and triacylglycerol biosynthesis showing dynamic expression changes may regulate the lipid distribution in embryos and seed coats of B. napus and that BnACBP2 and BnACBP6 are potentially important for oil accumulation.
Urban Uprisings: The Troubled Relationship Between Citizens and Police in France, the UK, and the USA
Authors: Slooter Luuk
Published: August 2019

Violent outbursts in Paris (2005), London (2011), and Ferguson (2014) illustrate the problematic and disturbing relationship between citizens and police in the ‘West’. While these episodes are often portrayed as ‘apolitical’ and ‘criminal’ in media and political debates, they are in the academic literature predominantly seen as (unarticulated) forms of political protests against structural inequalities. Building on this political perspective, I will first argue that the interplay between structural, police, and ‘private’ violence is at the core of these urban uprisings. Subsequently, I will identify four common factors that contributed to the onset and legitimization of collective violence in Paris, London, and Ferguson: an emotive and symbolically significant incident, often with a young inhabitant of a marginalized neighbourhood as protagonist; police involvement; unclarity and pre-violence rumours; and pre-existing us-them divides. In the conclusion, I will emphasize the importance and need of a systemic approach towards police reform.
Clustering of primordial black holes with non-Gaussian initial fluctuations
Authors: Suyama Teruaki , Yokoyama Shuichiro
Published: August 2019

We formulate the two-point correlation function of primordial black holes (PBHs) at their formation time, based on the functional integration approach which has often been used in the context of halo clustering. We find that PBH clustering on super-Hubble scales could never be induced in the case where the initial primordial fluctuations are Gaussian, while it can be enhanced by the so-called local-type trispectrum (four-point correlation function) of the primordial curvature perturbations.
Immunization to rituximab is more frequent in systemic autoimmune diseases than in rheumatoid arthritis: ofatumumab as alternative therapy
Authors: Combier Alice , Nocturne Gaétane , Henry Julien , Belkhir Rakiba , Pavy Stephan , Le Tiec Clotilde , Descamps Elise , Seror Raphaele , Mariette Xavier
Published: August 2019

Objectives

The frequency and consequences of anti-drug antibodies to rituximab (RTX-ADA) are not well known in RA and even less in other systemic auto-immune diseases (sAID). We aimed to evaluate the frequency, consequences and predictive factors of RTX-ADA in RA and sAID.

Methods

All patients presenting with RA or other sAID treated with RTX from 2012 to 2017 in our tertiary reference centre for sAID were retrospectively studied. Patients who were tested for RTX-ADA were identified.

Results

One hundred and ninety-nine patients were treated with RTX (RA: 124, other sAID: 75). Among 62/199 (31.1%) tested for RTX-ADA, 14 were positive: 3/35 RA (8.6%) and 11/27 (40.7%) other sAID, (P = 0.0047). Among the whole RTX-treated populations, the frequency of RTX-ADA was 2.4% and 14.7% (P = 0.0026) in RA and sAID, respectively. Most of the immunized patients had infusion reactions to second or subsequent RTX cycles (11/14) and loss of efficacy (2/14). Predictive factors of immunization were sAID vs RA (78.6% vs 21.4%, P = 0.026, adjusted odds ratio (OR) = 5.35[1.43—54.75]) and African ethnicity (57.1% vs 4.2%, P < 0.001, adjusted OR = 9.25 [5.08—302.12]). Associated immunosuppressive therapy did not protect against immunization. Three patients with pSS immunized against RTX were treated with ofatumumab with complete remission of their disease.

Conclusion

Immunization against RTX is more frequent in other sAID than in RA. Testing for RTX-ADA must be performed in patients with infusion reactions or loss of efficacy especially if they are of African origin. Immunized patients might be treated efficiently and safely with ofatumumab. This alternative should be further evaluated for sAID.
Effect of Immediate Versus Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial
Authors: Cahill A.G. , Srinivas S.K. , Tita A.T.N. , Caughey A.B. , Richter H.E. , Gregory W.T. , Liu J. , Woolfolk C. , Weinstein D.L. , Mathur A.M. , Macones G.A. , Tuuli M.G.
Published: August 2019

(JAMA. 2018;320(14):1444–1454)

Although >3 million women give birth in the United States every year, there is a lack of evidence regarding optimal labor management. In an effort to optimize cesarean delivery rates, there has been extensive research examining the management of labor. There are conflicting data on whether the mother should push immediately or delay pushing, as prolonged labor is associated with adverse outcomes for both mother and infant. The objective of this study was to evaluate whether immediate or delayed pushing would impact rates of spontaneous vaginal delivery as well as be more effective to reduce maternal and neonatal morbidities.
Guidelines for Intraoperative Care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)
Authors: Caughey A.B. , Wood S.L. , Macones G.A. , Wrench I.J. , Huang J. , Norman M. , Pettersson K. , Fawcett W.J. , Shalabi M.M. , Metcalfe A. , Gramlich L. , Nelson G. , Wilson R.D.
Published: August 2019

(Am J Obstet Gynecol. 2018;219:533–544)

This is the second document in a series of 3 focused on the Enhanced Recovery After Surgery (ERAS) care program, specifically in regards to cesarean delivery (CD) and its intraoperative care. ERAS has both clinical benefits (decreased length of stay, complications, and readmissions) and decreased cost of care. This special report focused on the period beginning 30 to 60 minutes before the start of the procedure (decision to operate) and ending at hospital discharge. The ERAS CD program provides audit and feedback cycles for both scheduled and unscheduled CD, and creates recommendations based on clinical evidence that allow physicians to learn, modify, and improve their care processes, leading to improved patient health outcomes.
Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis
Authors: Uppal V. , Retter S. , Casey M. , McKeen D.M.
Published: August 2019

(Anesth Analg. 2019 Jan 8. doi: 10.1213/ANE.0000000000003975)

Numerous studies have evaluated the risks and benefits of intrathecal fentanyl when added to bupivacaine during cesarean delivery. While potential advantages of intrathecal fentanyl over intrathecal morphine include faster onset and less cephalad spread, some have feared an increased risk of respiratory depression, a “ceiling effect” at doses >0.25 μg/kg, and increased postoperative intravenous opioid requirement. In order to clarify the benefits, harms, and optimal dosing of this opioid for cesarean delivery, these authors systematically reviewed evidence regarding the efficacy and safety of fentanyl when used as an additive to intrathecal bupivacaine with and without morphine.
Maternal Age and Risk for Adverse Outcomes
Authors: Sheen J.J. , Wright J.D. , Goffman D. , Kern-Goldberger A.R. , Booker W. , Siddiq Z. , D'Alton M.E. , Friedman A.M.
Published: August 2019

(Am J Obstet Gynecol. 2018;219:390.e1–15)

Over the past decade, the rate of births to women aged 30 years and older has risen. This trend will likely continue with the widespread availability of newer reproductive technologies. As women age, they are more likely to have comorbid conditions and women of advanced maternal age have increased complications in pregnancy. The objective of this study was to characterize the risk for severe maternal morbidity and other pregnancy complications by maternal age during delivery hospitalizations.
A Conceptual Framework for the Impact of Obesity on Risk of Cesarean Delivery
Authors: Rogers A. , Harper L. , Mari G.
Published: August 2019

(Am J Obstet Gynecol. 2018:219:356–363)

In the United States in 2014, cesarean deliveries (CD) accounted for 32.3% of the nearly 4 million births. A third of reproductive-age women are obese. When compared with normal-weight women, obese women who delivered via CD had an increased risk of venous thromboembolism, infection, blood transfusion, and maternal mortality. The mechanisms through which obesity increases risk for CD are poorly understood. This study presented a conceptual framework that hypothesized how obesity may impact factors that would lead to a CD.
Association of Maternal First-trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring
Authors: Huybrechts K.F. , Hernández-Díaz S. , Straub L. , Gray K.J. , Zhu Y. , Patorno E. , Desai R.J. , Mogun H. , Bateman B.T.
Published: August 2019

(JAMA. 2018;320(23):2429–2437)

Ondansetron, a 5-HT3 receptor antagonist, has become the most frequently prescribed drug for nausea and vomiting during pregnancy. However, this medication is not formally approved for this use, and available evidence regarding ondansetron and fetal safety is limited or conflicting. The American College of Obstetricians and Gynecologists has concluded that further studies are warranted. Therefore, the authors of the present study investigated potential associations between ondansetron exposure during the first trimester of pregnancy and the risk of cardiac malformations and/or oral clefts in neonates.
The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-induced Contractility of Human Myometrium In Vitro
Authors: Talati C. , Carvalho J.C.A. , Luca A. , Balki M.
Published: August 2019

(Anesth Analg. 2019;128(4):671–678. Doi:10.1213/ANE.0000000000002834)

Uterine atony is the leading cause of postpartum hemorrhage, which is responsible for nearly a quarter of maternal deaths worldwide. One risk factor for uterine atony is exposure to large quantities of oxytocin during labor induction and augmentation. Compared with nonlaboring women delivering via cesarean, laboring women who receive oxytocin augmentation require 9 times more oxytocin in order to achieve adequate uterine tone during cesarean delivery (CD). Previous studies have compared a pulsatile oxytocin administration technique with continuous infusion in terms of time from initiation of infusion to delivery, but none have compared these techniques in terms of postpartum hemorrhage rate. This study aimed to compare intermittent oxytocin pretreatment with continuous oxytocin for effect on subsequent oxytocin-induced myometrial contractility.
Screening Extremely Obese Pregnant Women for Obstructive Sleep Apnea
Authors: Dominguez J.E. , Grotegut C.A. , Cooter M. , Krystal A.D. , Habib A.S.
Published: August 2019

(Am J Obstet Gynecol. 2018;219:613.e1.1–10)

Obstructive sleep apnea (OSA), in addition to its multiple comorbidities, is associated with a significantly increased risk of preeclampsia and gestational diabetes mellitus in obese, pregnant women. However, current OSA diagnostic tools are costly and time-consuming to implement on a wide scale, and although portable at-home, unattended sleep apnea testing is emerging, such tools may be impractical in this particular patient population. This study evaluated the validity of existing OSA screening tools in a cohort of extremely obese pregnant women [body mass index (BMI) ≥40 kg/m2] and determined what screening factors were most strongly associated with OSA in this cohort.
Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review
Authors: Cohen S. , Levin D. , Mellender S. , Zhao R. , Patel P. , Grubb W. , Kiss G.
Published: August 2019

(Reg Anesth Pain Med. 2018;43(8):880–884)

Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population. Approximately 80% of patients suffer from this type of headache after an accidental dural puncture. A PDPH can limit postpartum mother-baby interactions, extend hospital stays, and raise health care costs. The gold standard treatment for postpartum PDPH is an epidural blood patch (EBP). This retrospective study aimed to compare the effectiveness of treatment with EBP to treatment with a sphenopalatine ganglion block (SPGB).
Is Ultrasound Measured Fetal Biometry Predictive of Intrapartum Cesarean Section for Failure to Progress?
Authors: Yang J.M. , Hyett J.A. , Mcgeechan K. , Phipps H. , de Vries B.S.
Published: August 2019

(Aust N Z J Obstet Gynaecol. 2018;58:620–628)

The rate of cesarean section births in Australia in 2013 was more than double the World Health Organization’s recommended rate. A previous population-based study by the authors of the current article established a strong independent relationship between birthweight/neonatal head circumference (HC) and cesarean section for failure to progress in labor (CS-FTP). This study aimed to determine whether ultrasound biometry measurements were associated with intrapartum cesarean section for FTG.
Diagnostic Point-of-Care Ultrasound: Applications in Obstetric Anaesthetic Management
Authors: Zieleskiewicz L. , Bouvet L. , Einav S. , Duclos G. , Leone M.
Published: August 2019

(Anaesthesia. 2018;73:1265–1279)

Even in low-risk centers, pregnancies can become complicated seriously and quickly, without time to obtain diagnostic help from specialists. While ultrasound has been routinely used in fetal monitoring, it can also be a useful tool in maternal bedside diagnosis and screening. This report reviewed the use of ultrasound in assessing patients’ gastric contents and airways, managing breathless patients, diagnosing shock, and predicting fluid responsiveness.
Echocardiographic Determination of Resting Hemodynamics and Optimal Positioning in Term Pregnant Women
Authors: Dennis A.T. , Buckley A. , Mahendrayogam T. , Castro J.M. , Leeton L.
Published: August 2019

(Anaesthesia. 2018;73:1345–1352)

In pregnant women undergoing anesthesia, positioning is important for minimizing the risk of airway trauma or failed tracheal intubation as well as preventing aortocaval compression and reduced cardiac output. These 2 goals are achieved through 2 different positions: the head elevated ramped position for tracheal intubation and left lateral pelvic tilt for prevention of aortocaval compression. There have been no studies examining the hemodynamic effects of combining these 2 positions in parturients. This study aimed to determine whether there was any significant difference in maternal cardiac output between the ramped position combined with left lateral pelvic tilt compared with the ramped position alone determined by calculations based on transthoracic echocardiographic measurements.
Influence of Pregnancy on Cardiac Function and Hemodynamics in Women With Ebstein’s Anomaly
Authors: Kanoh M. , Inai K. , Shinohara T. , Shimada E. , Shimizu M. , Tomimatsu H. , Ogawa M. , Nakanishi T.
Published: August 2019

(Acta Obstet Gynecol Scand. 2018;97:1025–1031)

Ebstein’s anomaly is a rare congenital abnormality that is characterized by tricuspid regurgitation (TR) in association with apical displacement of the septal leaflet of the valve along with a small right ventricle. The severity of symptoms varies among patients with Ebstein’s anomaly and depends on factors such as right ventricular function, the severity of TR, and the presence of associated cardiac malformations. Atrial septal defect (ASD) and patent foramen ovale (PFO) have been reported in at least 50% of patients with Ebstein’s anomaly and Wolff-Parkinson-White syndrome is also relatively common in these patients. While women with Ebstein’s anomaly who reach child-bearing age are usually asymptomatic, some of these patients do experience severe maternal complications, primarily due to increased right heart dysfunction that develops during pregnancy. The goal of this current retrospective study was to analyze the course of pregnancy and mode of delivery in women with Ebstein’s anomaly, with particular focus on the hemodynamic changes associated with right ventricular function.
Labor Pain in Women With and Without Severe Fear of Childbirth: A Population-based, Longitudinal Study
Authors: Junge C. , von Soest T. , Weidner K. , Seidler A. , Eberhard-Gran M. , Garthus-Niegel S.
Published: August 2019

(Birth. 2018;45:469–477)

It has been suggested that antenatal fear regarding labor pain can alter patient pain thresholds. In particular, a severe fear of childbirth can cause the release of catecholamines that enervate uterine contractility and alter nociceptive receptors, resulting in augmented pain perception and prolonged labor. However, current literature lacks prospective population-based studies that investigate the link between fear of childbirth and degree of experienced labor pain. The aim of the present study thereby was to investigate the association between severe fear of childbirth and pain perceptions during labor, as well as to identify potential maternal and neonatal risk factors.
“Is It Safe?”: The Many Unanswered Questions about Medications and Breast-feeding
Authors: Byrne J.J. , Spong C.Y.
Published: August 2019

(N Engl J Med. 2019;380(14):1296–1297. Doi:10.1056/NEJMp1817420)

While an estimated 83% of mothers in the United States breastfeed, and more than half of mothers worldwide take medication in the postpartum period, there has been a lack of clinical studies examining the effects of drugs on breastfeeding mothers and children. In 2006, LactMed, an online database from the National Library of Medicine, published information on the levels of 1408 drugs in breast milk and infant blood and the effects of these drugs on lactation. However, the recommendations for more than half of those drugs were not based on lactation-specific data as of November 2018 and very few (2%) were based on strong data.
The Mediating Effects of Gestational Diabetes on Fetal Growth and Adiposity in Women Who are Overweight and Obese: Secondary Analysis of the LIMIT Randomized Trial
Authors: Poprzeczny A.J. , Louise J. , Deussen A.R. , Dodd J.M.
Published: August 2019

(BJOG. 2018;125:1558–1566.)

Overweight and obesity represent a significant impact on the world’s public health, and are associated with increased risks of adverse maternal and infant outcomes during pregnancy and delivery. As maternal body mass index (BMI) increases, gestational diabetes mellitus (GDM) also increases in prevalence. GDM is associated with adverse perinatal outcomes similar to those seen in obese pregnant women, including the need for induction of labor and cesarean section, and having an infant born large for gestational age or birthweight over 4 kg. The aim of this secondary analysis from the LIMIT randomized trial was to describe the mediating effect of GDM in obese pregnant women on fetal growth and adiposity.
The Impact of Analgesic Intervention During the Second Stage of Labour: A Retrospective Cohort Study
Authors: Munro A. , George R.B. , Allen V.M.
Published: August 2019

(Can J Anesth. 2018;65(11):1240–1247)

The second stage of labor is made up of passive descent of the fetus as well as the active phase of maternal pushing. Because the duration of active pushing significantly impacts maternal and neonatal outcomes, a rest period has been advocated at full dilatation to allow the fetus to passively rotate and descend. A “top-up” or bolus of local anesthetic is occasionally provided to ameliorate breakthrough pain, thus reducing pain and ineffective pushing. In this study it was hypothesized that an epidural top-up to resolve inadequate analgesia in the second stage of labor may promote vaginal delivery.
Body Temperature, Cutaneous Heat Loss, and Skin Blood Flow During Epidural Anaesthesia for Emergency Cesarean Section
Authors: Mullington C.J. , Low D.A. , Strutton P.H. , Malhotra S.
Published: August 2019

(Anaesthesia. 2018;73:1500–15006)

During the peripartum period, hypothermia and hyperthermia are both associated with adverse outcomes. Neuraxial anesthesia hinders a patient’s ability to regulate body temperature by interrupting the sympathetic supply to the cutaneous vasculature. It is unclear how body temperature is affected by epidural administration of a concentrated local anesthetic for emergency cesarean section. This study aimed to determine how dosing of a labor epidural to provide anesthesia for cesarean section would affect mean body temperature and cutaneous vasomotor tone, hypothesizing that active cutaneous vasodilation would be blocked and therefore mean body temperature would increase.
Increasing number of fibroblast, capillary and collagen amount in Achilles tendons of rats with diabetic mellitus after application of stromal vascular fraction derived from adipose tissue
Authors: Sananta Panji , Sintong Langga , Andarini Sri , Putera Marvin Anthony , Dradjat Respati Suryanto
Published: August 2019

Background:

Achilles tendinopathy is common in diabetes mellitus and makes the tendon susceptible to rupture. Achilles tendon rupture healing is impaired in diabetics. Stromal vascular fraction can be an alternative treatment for Achilles tendon rupture in diabetic tendinopathy.

Methods:

Eighteen rats were used in this experimental study and divided into three groups: group 1, normoglycemia; group 2, diabetes mellitus; and group 3, diabetes mellitus injected with stromal vascular fraction. After 2 wk, we evaluated the fibroblasts, capillaries, and collagen.

Results:

The number of fibroblasts and capillaries and the amount of collagen were increased significantly in group 3 compared to group 1 and group 2 (P<0.05).

Conclusions:

Stromal vascular fraction increased the number of fibroblasts, angiogenesis, and the amount of collagen. Thus, stromal vascular fraction improved healing of Achilles tendon ruptures in rats with diabetic tendinopathy.
Diagnosing Fracture-Related Infection: Current Concepts and Recommendations
Authors: Govaert Geertje A. M. , Kuehl Richard , Atkins Bridget L. , Trampuz Andrej , Morgenstern Mario , Obremskey William T. , Verhofstad Michael H. J. , McNally Martin A. , Metsemakers Willem-Jan ,   on behalf of the Fracture-Related Infection (FRI) Consensus Group
Published: August 2019

Fracture-related infection (FRI) is a severe complication after bone injury and can pose a serious diagnostic challenge. Overall, there is a limited amount of scientific evidence regarding diagnostic criteria for FRI. For this reason, the AO Foundation and the European Bone and Joint Infection Society proposed a consensus definition for FRI to standardize the diagnostic criteria and improve the quality of patient care and applicability of future studies regarding this condition. The aim of this article was to summarize the available evidence and provide recommendations for the diagnosis of FRI. For this purpose, the FRI consensus definition will be discussed together with a proposal for an update based on the available evidence relating to the diagnostic value of clinical parameters, serum inflammatory markers, imaging modalities, tissue and sonication fluid sampling, molecular biology techniques, and histopathological examination. Second, recommendations on microbiology specimen sampling and laboratory operating procedures relevant to FRI will be provided.

Level of Evidence:

Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.