bluuebunny/crossref_metadata_2025 huggingface dataset:
The inositol polyphosphate kinase Ipk1 transcriptionally regulates mitochondrial functions in Candida albicans
Authors: Zhu Hangqi , Zhu Nali , Peng Liping , Zhang Bing , Yu Qilin , Li Mingchun
Published: August 2020

Inositol polyphosphates (IPs) is an important family of signaling molecules that regulate multiple cellular processes, such as chromatin remodeling, transcription and mRNA export. Inositol polyphosphate kinases, as the critical enzymes for production and transformation of IPs, directly determine the intracellular levels of IPs and therefore are involved in many cellular processes. However, its roles in Candida albicans, the leading fungal pathogen in human beings, remain to be investigated. In this study, we identified the inositol polyphosphate kinase Ipk1 in C. albicans and found that it localizes in the nucleus. Moreover, in the ipk1Δ/Δ mutant, the activity of mitochondrial respiratory chain complexes and the mitochondrial function was severely impaired, which were associated with down-regulation of mitochondrial function-related genes revealed by transcription profiling analysis. The ipk1Δ/Δ mutant also displayed hypersensitivity to a series of environmental stresses, such as antifungal drugs, oxidants, cell wall perturbing agents and macrophage attacks, followed by attenuation of virulence in a mouse systematic infection model. These findings firstly reported the importance of inositol polyphosphate kinase Ipk1 in C. albicans, especially its role in mitochondrial function maintenance and pathogenicity.
Comparison of linear regression, k-nearest neighbour and random forest methods in airborne laser-scanning-based prediction of growing stock
Authors: Cosenza Diogo N , Korhonen Lauri , Maltamo Matti , Packalen Petteri , Strunk Jacob L , Næsset Erik , Gobakken Terje , Soares Paula , Tomé Margarida
Published: August 2020

In this study, for five sites around the world, we look at the effects of different model types and variable selection approaches on forest yield modelling performances in an area-based approach (ABA). We compared ordinary least squares regression (OLS), k-nearest neighbours (kNN) and random forest (RF). Our objective was to test if there are systematic differences in accuracy between OLS, kNN and RF in ABA predictions of growing stock volume. The analyses are based on a 5-fold cross-validation at five study sites: an eucalyptus plantation, a temperate forest and three different boreal forests. Two completely independent validation datasets were also available for two of the boreal sites. For the kNN, we evaluated multiple measures of distance including Euclidean, Mahalanobis, most similar neighbour (MSN) and an RF-based distance metric. The variable selection approaches we examined included a heuristic approach (for OLS, kNN and RF), exhaustive search among all combinations (OLS only) and all variables together (RF only). Performances varied by model type and variable selection approaches among sites. OLS and RF had similar accuracies and were more efficient than any of the kNN variants. Variable selection did not affect RF performance. Heuristic and exhaustive variable selection performed similarly for OLS. kNN fared the poorest amongst model types, and kNN with RF distance was prone to overfitting when compared with a validation dataset. Additional caution is therefore required when building kNN models for volume prediction though ABA, being preferable instead to opt for models based on OLS with some variable selection, or RF with all variables together.
It Is Time to Resolve the Direct Care Workforce Crisis in Long-Term Care
Authors: Scales Kezia
Published: August 2020

Nearly 4.6 million direct care workers—including personal care aides, home health aides, and nursing assistants—provide daily support to older adults and people with disabilities across a range of settings in the United States, predominantly in long-term care (LTC). Even as the population grows older and drives up demand for LTC, the sector continues its decades-long struggle to fill direct care positions and stabilize this essential workforce. Recent events and emerging trends have converged, however, to produce new opportunities to address this longstanding workforce crisis, including the unprecedented attention generated by the coronavirus disease 2019 (COVID-19) pandemic and the systemic shifts to managed care and value-based payment in LTC. This Forum article outlines the pressing direct care workforce challenges in LTC before describing these potential levers of change, emphasizing the importance of not just expanding the workforce but also maximizing direct care workers’ contributions to the delivery of high-quality services for a growing and evolving population of LTC consumers.
Applied Functional Biology: Linking Ecological Morphology to Conservation and Management
Authors: McElroy Eric J , Sustaita Diego , McBrayer Lance D
Published: August 2020

Synopsis

Many researchers work at the interface of organisms and environment. Too often, the insights that organismal, or functional, biologists can bring to the understanding of natural history, ecology, and conservation of species are overlooked. Likewise, natural resource managers are frequently focused on the management of populations and communities, while ignoring key functional traits that might explain variation in abundance and shifts in species composition at these ecological levels. Our intention for this symposium is two-fold: (1) to bring to light current and future research in functional and ecological morphology applicable to concerns and goals of wildlife management and conservation and (2) to show how such studies can result in measurable benchmarks useful to regulatory agencies. Symposium topics reveal past, present, and future collaborations between functional morphologists/biomechanists and conservation/wildlife biologists. During the SICB 2020 Annual Meeting, symposium participants demonstrated how data gathered to address fundamental questions regarding the causes and consequences of organismal form and function can also help address issues of conservation and wildlife management. Here we review how these, and other, studies of functional morphology, biomechanics, ecological development morphology and performance can inform wildlife conservation and management, principally by identifying candidate functional traits that have clear fitness consequences and population level implications.
Is disrupted sleep a risk factor for Alzheimer’s disease? Evidence from a two-sample Mendelian randomization analysis
Authors: Anderson Emma L , Richmond Rebecca C , Jones Samuel E , Hemani Gibran , Wade Kaitlin H , Dashti Hassan S , Lane Jacqueline M , Wang Heming , Saxena Richa , Brumpton Ben , Korologou-Linden Roxanna , Nielsen Jonas B , Åsvold Bjørn Olav , Abecasis Gonçalo , Coulthard Elizabeth , Kyle Simon D , Beaumont Robin N , Tyrrell Jessica , Frayling Timothy M , Munafò Marcus R , Wood Andrew R , Ben-Shlomo Yoav , Howe Laura D , Lawlor Deborah A , Weedon Michael N , Davey Smith George
Published: August 2020

Background

It is established that Alzheimer’s disease (AD) patients experience sleep disruption. However, it remains unknown whether disruption in the quantity, quality or timing of sleep is a risk factor for the onset of AD.

Methods

We used the largest published genome-wide association studies of self-reported and accelerometer-measured sleep traits (chronotype, duration, fragmentation, insomnia, daytime napping and daytime sleepiness), and AD. Mendelian randomization (MR) was used to estimate the causal effect of self-reported and accelerometer-measured sleep parameters on AD risk.

Results

Overall, there was little evidence to support a causal effect of sleep traits on AD risk. There was some suggestive evidence that self-reported daytime napping was associated with lower AD risk [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.50–0.99). Some other sleep traits (accelerometer-measured ‘eveningness’ and sleep duration, and self-reported daytime sleepiness) had ORs of a similar magnitude to daytime napping, but were less precisely estimated.

Conclusions

Overall, we found very limited evidence to support a causal effect of sleep traits on AD risk. Our findings provide tentative evidence that daytime napping may reduce AD risk. Given that this is the first MR study of multiple self-report and objective sleep traits on AD risk, findings should be replicated using independent samples when such data become available.
Effects of inoculation of corn silage with Lactobacillus hilgardii and Lactobacillus buchneri on silage quality, aerobic stability, nutrient digestibility, and growth performance of growing beef cattle
Authors: Nair Jayakrishnan , Huaxin Niu , Andrada Estefanía , Yang Hee-Eun , Chevaux Eric , Drouin Pascal , McAllister Tim A , Wang Yuxi
Published: August 2020

This study evaluated the effects of inoculation of whole crop corn silage with a mixture of heterofermentative lactic acid bacteria (LAB) composed of Lactobacillus hilgardii and Lactobacillus buchneri on ensiling, aerobic stability, ruminal fermentation, total tract nutrient digestibility, and growth performance of beef cattle. Uninoculated control corn silage (CON) and silage inoculated with 3.0 × 105 cfu g−1 of LAB containing 1.5 × 105 cfu g−1 of L. hilgardii CNCM I-4785 and 1.5 × 105 cfu g−1 of L. buchneri NCIMB 40788 (INOC) were ensiled in silo bags. The pH did not differ (P > 0.05) between the two silages during ensiling but was greater (P < 0.001) for CON than INOC after 14 d of aerobic exposure (AE). Neutral detergent insoluble crude protein (NDICP) content (% of DM and % of CP basis) of terminal INOC silage was greater (P ≤ 0.05) than that of CON. In terminal silage, concentrations of total VFA and acetate were greater (P < 0.001), while water-soluble carbohydrates were lower (P < 0.001) for INOC than CON. Yeast and mold counts were lower for INOC than CON (P ≤ 0.001) in both terminal and aerobically exposed silages. The stability of INOC was greater (P < 0.001) than that of CON after 14 d of AE. Ruminal fermentation parameters and DMI did not differ (P > 0.05) between heifers fed the two silages, while there was a tendency (P ≤ 0.07) for lower CP and starch digestibility for heifers fed INOC than CON. Total nitrogen (N) intake and N retention were lower (P ≤ 0.04) for heifers fed INOC than CON. Dry matter intake as a percentage of BW was lower (P < 0.04) and there was a tendency for improved feed efficieny (G:F; P = 0.07) in steers fed INOC vs. CON silage. The NEm and NEg contents were greater for INOC than CON diets. Results indicate that inoculation with a mixture of L. hilgardii and L. buchneri improved the aerobic stability of corn silage. Improvements in G:F of growing steers fed INOC silage even though the total tract digestibility of CP and starch tended to be lower for heifers fed INOC are likely because the difference in BW and growth requirements of these animals impacted the growth performance and nutrient utilization and a greater proportion of NDICP in INOC than CON.
Explaining the Limits of the WTO in Shaping the Rule of Law in China
Authors: Du Ming , Kong Qingjiang
Published: August 2020

When China acceded to the World Trade Organization in 2001, pundits were enthusiastic about the prospect that China’s World Trade Organization membership would boost international trade, encourage China’s restructuring toward a market economy, discipline the domestic legal system, and strengthen the rule of law in China. More recently, however, serious concerns have been raised regarding China’s record on the rule of law. The first National Security Strategy report issued by the Trump Administration in December 2017 claimed that China’s increased participation in the liberal international economic system had not effectuated China’s deeper engagement with, or respect for, the rule of law.

The purpose of this article is to take a critical look at the two contrasting narratives on the impact of the World Trade Organization on China’s rule of law construction over the past two decades. It concludes that, although the World Trade Organization has played a positive role in advancing the rule of law in China, such a role has long been exaggerated. Accordingly, we provide an account of why the World Trade Organization has failed to play a catalyst role in instituting the rule of law in China widely expected in the western world.
Methods for Surveying Stable Fly Populations
Authors: Taylor David B , Harrison Kyle , Zhu Junwei J
Published: August 2020

Stable flies are among the most important pests of livestock throughout much of the world. Their painful bites induce costly behavioral and physiological stress responses and reduce productivity. Stable flies are anthropogenic and their population dynamics vary depending on agricultural and animal husbandry practices. Standardized sampling methods are needed to better identify the factors controlling stable fly populations, test novel control technologies, and determine optimal management strategies. The current study reviewed methods used for a long-term study of stable fly population dynamics in the central Great Plains. An additional study compared the relative size of flies sampled from the general population with that of flies sampled emerging from substrates associated with livestock production. Flies developing in livestock associated substrates are significantly larger than those in the general population indicating that other types of developmental sites are contributing significant numbers of flies to the general population. Because efforts to identify those sites have yet to be successful, we speculate that they may be sites with low densities of developing stable flies, but covering large areas such as croplands and grasslands. The stable fly surveillance methods discussed can be used and further improved for monitoring stable fly populations for research and management programs.
Hedging Demand in Long-Term Asset Allocation with an Application to Carry Trade Strategies
Authors: Laborda Ricardo , Olmo Jose
Published: August 2020

We derive a closed-form expression for the mean and marginal hedging demand on risky assets in long-term asset allocation problems for individuals with constant relative risk aversion preferences. Our parametric portfolio policy rule accommodates an arbitrarily large number of state variables for predicting the state of nature and number of assets in the portfolio. The closed-form expression for the hedging demand is exact under polynomial specifications of the portfolio policy rule and a suitable approximation for unknown smooth parametric portfolio policy rules using Taylor expansions. The hedging demand on risky assets depends positively on the predictability of the risky asset and the persistence of the predictors, and negatively on the degree of investor’s relative risk aversion. We illustrate these insights empirically for a basket of currencies by showing the outperformance of rebalancing carry trade strategies over different investment horizons against a short-term (myopic) portfolio.
Safety of total body irradiation using intensity-modulated radiation therapy by helical tomotherapy in allogeneic hematopoietic stem cell transplantation: a prospective pilot study
Authors: Konishi Tatsuya , Ogawa Hiroaki , Najima Yuho , Hashimoto Shinpei , Wada Atsushi , Adachi Hiroto , Konuma Ryosuke , Kishida Yuya , Nagata Akihito , Yamada Yuta , Kaito Satoshi , Mukae Junichi , Marumo Atsushi , Noguchi Yuma , Toya Takashi , Igarashi Aiko , Kobayashi Takeshi , Ohashi Kazuteru , Doki Noriko , Karasawa Katsuyuki
Published: August 2020

Total body irradiation using intensity-modulated radiation therapy total body irradiation (IMRT-TBI) by helical tomotherapy in allogeneic hematopoietic stem cell transplantation (allo-HSCT) allows for precise evaluation and adjustment of radiation dosage. We conducted a single-center pilot study to evaluate the safety of IMRT-TBI for allo-HSCT recipients. Patients with hematological malignancies in remission who were scheduled for allo-HSCT with TBI-based myeloablative conditioning were eligible. The primary endpoint was the incidence of adverse events (AEs). Secondary endpoints were engraftment rate, overall survival, relapse rate, non-relapse mortality, and the incidence of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). Between July 2018 and November 2018, ten patients were recruited with a median observation duration of 571 days after allo-HSCT (range, 496–614). D80% for planning target volume (PTV) in all patients was 12.01 Gy. Average D80% values for lungs, kidneys and lenses (right/left) were 7.50, 9.03 and 4.41/4.03 Gy, respectively. Any early AEs (within 100 days of allo-HSCT) were reported in all patients. Eight patients experienced oral mucositis and gastrointestinal symptoms. One patient experienced Bearman criteria grade 3 regimen-related toxicity (kidney and liver). All cases achieved neutrophil engraftment. There was no grade III–IV aGVHD or late AE. One patient died of sinusoidal obstruction syndrome 67 days after allo-HSCT. The remaining nine patients were alive and disease-free at final follow-up. Thus, IMRT-TBI was well tolerated in terms of early AEs in adult patients who underwent allo-HSCT; this warrants further study with longer observation times to monitor late AEs and efficacy.
Brown Root Rot Disease of Phyllanthus myrtifolius: The Causal Agent and Two Potential Biological Control Agents
Authors: Leung Ka-Tung , Chen Chi-Yu , You Bang-Jau , Lee Miin-Huey , Huang Jenn-Wen
Published: August 2020

Brown root rot (BRR), caused by Phellinus noxius (Corner) G. Cunningham, occurs on over 200 species of plants, especially woody trees and shrubs. Ceylon myrtle (Phyllanthus myrtifolius [Wight] Müll.Arg.), a common hedge plant, was recently observed to be infected with BRR. Disease diagnosis was performed by completing Koch’s postulates, and Ceylon myrtle was confirmed to be a new host of P. noxius. Typical symptoms of BRR were observed, including reduction in leaf size, dieback of branches, and suspended growth of young leaves. A disease severity index was used to quantify BRR in this study. Compared with Malabar chestnut, Ceylon myrtle was relatively resistant to BRR. Surprisingly, phylogenetic analysis of the ITS and 28S sequences revealed that isolates identified as P. noxius from Taiwan and many other countries were clustered in the same clade but separate from the clade comprising isolates from China, which were designated Pyrrhoderma noxium based on P. noxius. Therefore, to temporarily distinguish these pathogens, the former clade was designated GPN (global P. noxius), whereas the latter clade was designated CPN (China Py. noxium). In biocontrol assays, Streptomyces padanus and Bacillus sp. were selected for BRR control of Ceylon myrtle. Disease severity was reduced from 0.51 to 0.37 by S. padanus and to 0.14 by Bacillus sp. in greenhouse trials. In addition, the two biocontrol agents, especially S. padanus, exhibited good growth-promoting effects on cuttings of Ceylon myrtle. With these double advantages, S. padanus and Bacillus sp. have great potential to control BRR in practical applications.
Resistance to Boscalid inBotrytis cinereaFrom Greenhouse-Grown Tomato
Authors: Liu Shengming , Fu Liuyuan , Tan Huanhuan , Jiang Jia , Che Zhiping , Tian Yuee , Chen Genqiang
Published: August 2020

Gray mold, caused by the fungus Botrytis cinerea Pers ex Fr., is one of the most destructive spoilage diseases, severely affecting tomato production in Henan Province, China. Spraying fungicides from the flowering to the harvest stage is a necessary measure to reduce losses associated with B. cinerea infection. However, B. cinerea has developed resistance to fungicides in many countries. Boscalid is a succinate dehydrogenase inhibitor (SDHI) fungicide and was registered for the control of gray mold. In this study, a total of 269 B. cinerea isolates were collected from tomato in commercial greenhouses in different locations of Henan Province in 2014 and 2015. The sensitivity and resistance of B. cinerea field isolates were determined based on mycelial growth. The effective concentration 50 ranged from 0.11 to 15.92 µg/ml and 0.16 to 8.54 µg/ml, in 2014 and 2015, respectively. The frequency of low resistance to boscalid was 12.6 and 7.6%, and moderate resistance was 2.7 and 1.3% in 2014 and 2015, respectively. No highly resistant isolates were found in Henan Province, China. Mycelial growth, mycelial dry weight, spore production, and pathogenicity were not significantly different between resistant and sensitive phenotypes of the B. cinerea isolates. The results of cross-resistance testing showed no correlation between boscalid and carbendazim, procymidone, pyrimethanil, fluazinam, or fluopyram. In this study, the succinate dehydrogenase genes B (sdhB), C (sdhC), and D (sdhD) were analyzed and compared in sensitive and low-resistance and moderately resistant B. cinerea isolates to boscalid. Results showed that point mutations occurred simultaneously at sdhC amino acid positions 85 (G85A), 93 (I93V), 158 (M158V), and 168 (V168I) in 4 out of 10 sensitive isolates and 23 of 26 low-resistance and 5 of 5 moderately resistant B. cinerea isolates to boscalid. No point mutations were found in the sdhB and sdhD genes of all isolates. Furthermore, no point mutations were found in sdhB, sdhC, and sdhD genes in 3 of 26 low-resistance B. cinerea isolates to boscalid. Therefore, we speculate that the simultaneous point mutations in the sdhC gene may not be related to the resistance of B. cinerea to boscalid. These results suggested that there might be a substitution mechanism for the resistance of B. cinerea to the SDHI fungicide boscalid.
Maternal and Infant Outcomes After Different Methods of Umbilical Cord Management
Authors: Rabe H. , Andersson O.
Published: August 2020

(JAMA. 2019;322:1864–1865)

Immediate umbilical cord clamping after delivery had been the standard of care until more recent data suggested that volume expansion could lead to better outcomes in preterm infants. Accordingly, in 2014 the World Health Organization (WHO) recommended delaying cord clamping and cutting for at least 60 seconds for preterm infants and 1 to 3 minutes for term infants. This recommendation was based on evidence that the delay would allow placental transfusion to take place, thus improving neonatal outcomes such as higher iron values and improved neurodevelopmental outcomes. Since then, additional studies have been conducted that add to the knowledge around umbilical cord interventions, including 2 studies that were published in the same issue of the Journal of the American Medical Association upon which this editorial is written.
Labor Pain, Analgesia, and Postpartum Depression: Are We Asking the Right Questions?
Authors: Lim G. , Levine M.D. , Mascha E.J. , Wasan A.D.
Published: August 2020

(Anesth Analg. 2020;130:610–614)

The major life events of pregnancy and postpartum recovery are known to be capable of triggering depression, anxiety, and adjustment disorders. As acute pain has also been linked to depression (as a risk factor for persistent postsurgical pain), questions have been raised regarding labor pain, epidural analgesia (EDA), and their link to depression. The authors of the above study interpreted findings of a longitudinal cohort study (which comprised 1503 pregnant women in Sweden) by utilizing conceptual path analysis. The analysis held Edinburgh Postnatal Depression Scale of ≥12 at 6 weeks postpartum as the primary outcome, with the use of EDA as the primary predictor of interest. A directed acyclic graph was used to assess the relationship between EDA and postpartum depression (PPD), as this type of diagram displays all variables of interest and their hypothesized relationships (with a stipulation of unidirectional relationships indicating causation in the direction of the arrow).
Lumbar Neuraxial Procedures in Thrombocytopenic Patients Across Populations: A Systematic Review and Meta-analysis
Authors: Bauer M.E. , Toledano R.D. , Houle T. , Beilin Y. , MacEachern M. , McCabe M. , Rector D. , Cooper J.P. , Gernsheimer T. , Landau R. , Leffert L.
Published: August 2020

(J Clin Anesth. 2020;61:109666)

Presently, there is no agreement among experts in regards to the safe minimum threshold platelet count for lumbar neuraxial anesthetic procedures, as there are limited data available on neuraxial anesthetic procedures performed on thrombocytopenic patients. During cesarean deliveries, there are important maternal and fetal factors and side effects to consider when choosing to administer general anesthesia rather than neuraxial anesthesia. Because more data on spinal epidural hematoma are needed, Bauer and colleagues conducted this systematic review to assemble reported lumbar neuraxial procedures (lumbar puncture; spinal, epidural, or combined spinal-epidural analgesia/anesthesia; epidural catheter removal) from various thrombocytopenic populations to bring some clarity to the risk of spinal epidural hematoma.
Long-term Cognition and Behavior in Children Born at Early-Term Gestation: A Systematic Review
Authors: Nielsen T.M. , Pedersen M.V. , Milidou I. , Glavind J. , Henriksen T.B.
Published: August 2020

(Acta Obstet Gynecol Scand. 2019;98:1227–1234)

Infants that are born between 37 and 38 weeks gestation carry higher risk of neonatal morbidity in comparison to infants born at or after 39 weeks gestation, and the American College of Obstetricians and Gynecologists has designated infants born at 37+0 weeks through 38+6 weeks as “early-term.” This is a change from the previously held belief that all “term” infants (infants born after 37+0 wk gestation) are similar in development. Recent studies have suggested that late-preterm children (born from 34+0 and 36+6 wk) are more likely to have academic challenges and behavioral problems, although the evidence provided is not definitive. Nielsen and collegues conducted this systematic review to thoroughly examine the literature on the differences between early-term children compared with full-term children in long-term cognitive, educational, and behavioral outcomes.
Human Uterine Transplantation: A Review of Outcomes From the First 45 Cases
Authors: Jones B.P. , Saso S. , Bracewell-Milnes T. , Thum M.Y. , Nicopoullos J. , Diaz-Garcia C. , Friend P. , Ghaem-Maghami S. , Testa G. , Johannesson L. , Quiroga I. , Yazbek J. , Smith J.R.
Published: August 2020

(BJOG. 2019;126:1310–1319)

Women with absolute uterine factor infertility (AUFI) cannot conceive or sustain pregnancy due to a dysfunctional uterus or absence of a uterus. Because adoption and surrogacy both have many limitations, researchers have developed uterine transplantation (UTx) as a potential solution for women with AUFI to conceive and deliver a genetically related child. After the first live birth following UTx occurred in 2014, obstetric researchers have published studies and collected detailed information on 45 different transplant cases, including 9 live births. This review compiles the data and outcomes from these 45 cases to note trends and make recommendations for best care practices.
Preeclampsia Causing Severe Maternal Morbidity—A National Retrospective Review of Preventability and Opportunities for Improved Care
Authors: MacDonald E.J. , Lepine S. , Pledger M. , Geller S.E. , Lawton B. , Stone P.
Published: August 2020

(Aust N Z J Obstet Gynaecol. 2019;59:825–830)

Preeclampsia complicates 3% to 8% of all pregnancies and is a major cause of mortality and morbidity for both mother and baby. Pregnancy-related severe maternal morbidity (SMM) is often preventable. As a result, there have been worldwide efforts to identify preventable factors of SMM with the goal of improving patient outcomes. A national preventability review of SMM in New Zealand between 2013 and 2015 found 23.3% of SMM cases admitted to intensive care units (ICUs) or high-dependency units (HDUs) involved preeclampsia. This study aimed to analyze the cohort of women from that study who had severe preeclampsia to identify factors associated with preventability and develop strategies to improve care.
Maternal Drug-related Death and Suicide are Leading Causes of Postpartum Death in California
Authors: Goldman-Mellor S. , Margerison C.E.
Published: August 2020

(Am J Obstet Gynecol. 2019;221:489.e1–489.e9)

Efforts to reduce maternal mortality has become a priority worldwide and in the United States. In 2018, the Preventing Maternal Deaths Act was enacted to support state efforts to track and review maternal deaths. Also, targeted action plans and safety bundles for clinical care that focus on common causes of maternal mortality have been developed. Yet, there is limited evidence on the impact that drug-related deaths and suicide have on postpartum women. The aim of this study was to determine the incidence of drug-related deaths and suicide among women in California up to a year after giving birth and to examine their utilization of health care services between delivery and postpartum death.
Recovery of Physical Activity After Cesarean Delivery and Its Relationship With Pain
Authors: Sharpe E.E. , Booth J.L. , Houle T.T. , Pan P.H. , Harris L.C. , Aschenbrenner C.A. , Eisenach J.C.
Published: August 2020

(Pain. 2019;160:2350–2357)

While all patients experience pain when recovering from a major surgery, not much is known about the day-to-day recovery from pain and inactivity that surgical patients experience. Previous research has attempted to quantify postoperative activity and pain levels, but these studies do not employ a practical approach to data collection that is both consistent and adequately detailed. The goals of this study were 4-fold: (1) characterize a feasible approach to recording exercise and pain for postoperative patients, (2) determine the connection between daily pain and levels of activity or inactivity, (3) determine the form of recovery of activity, and (4) explore factors that influence physical activity and determine if they could predict recovery time.
Introduction of a Novel System for Quantitating Blood Loss After Vaginal Delivery: A Retrospective Interrupted Time Series Analysis With Concurrent Control Group
Authors: Lumbreras-Marquez M. , Reale S.C. , Carusi D.A. , Robinson J.N. , Scharf N. , Fields K.G. , Farber M.K.
Published: August 2020

(Anesth Analg. 2020;130:857–868)

The most preventable cause of maternal mortality worldwide is postpartum hemorrhage (PPH). Timely detection of abnormal bleeding is critical for the treatment of PPH, and the National Partnership for Maternal Safety (NPMS) recommends quantitative measurement of cumulative blood loss, as visual estimation leads to both a 30% to 50% underestimation of blood loss and a subsequent increase in the magnitude of the hemorrhage. Gravimetry is recommended by the NPMS for measuring blood loss, but as it is a multistep process involving calculation and cumulative recording, it proves difficult to perform amidst an acute bleeding circumstance. The authors hypothesized that in vaginal deliveries (VDs), the transition from visual estimation of blood loss (vBL) to gravimetric and volumetric estimation of blood loss (tBL) would yield increased odds of immediate PPH detection. This hypothesis was based on the primary aim of finding the change in odds of immediate PPH detection in VDs before and following the implementation of the tBL device [using cesarean deliveries (CDs) as a concurrent control group]. The primary outcome of the study was detection of immediate PPH (≥500 mL vBL or tBL immediately following VD, or ≥1000 mL vBL immediately following CD). Total blood loss, blood loss ≥1000 mL, secondary uterotonic use, and a composite outcome related to PPH management (such as transfusion) before and after tBL implementation were all secondary outcomes.
Managing Obstetric Hemorrhage: Is It Time for a More Personalized Approach?
Authors: Shah A. , Collis R.E.
Published: August 2020

(Anaesthesia. 2019;74:961–964)

Worldwide, an increasing number of women are experiencing complications from major obstetric hemorrhage without an apparent comparable rise in the risk factors associated with obstetric hemorrhage. This editorial addressed a study that reported on the use of a rotational thromboelastometry (ROTEM)-guided algorithm for the management of obstetric hemorrhage. The research found a substantial improvement in patient outcomes, along with a decrease in transfusion volume, when compared with the institution’s previous practice of administering a standardized “shock pack.” This work illustrated that significant improvements in the treatment of obstetric hemorrhage can be achieved.
Assessment of Coagulation by Thromboelastography During Ongoing Postpartum Hemorrhage: A Retrospective Cohort Analysis
Authors: Rigouzzo A. , Louvet N. , Favier R. , Ore M.V. , Piana F. , Girault L. , Farrugia M. , Sabourdin N. , Constant I.
Published: August 2020

(Anesth Analg. 2020;130:416–425)

Early detection is crucial in the management of postpartum hemorrhage (PPH), a leading global cause of maternal mortality. A fibrinogen concentration ≤2 g/L at the onset of PPH is a strong predictive factor, but measurement of fibrinogen level takes too long to obtain for decision-making. Thromboelastography (TEG) is a point of care coagulation monitor that may be able to guide management and improve outcomes in PPH patients. This study aimed to evaluate TEG parameters for accuracy in the diagnosis of coagulopathy during PPH and accuracy in the prediction of severe hemorrhage >2500 mL.
Determinants of Women’s Dissatisfaction With Anesthesia Care in Labor and Delivery
Authors: Yurashevich M. , Carvalho B. , Butwick A.J. , Ando K. , Flood P.D.
Published: August 2020

(Anaesthesia. 2019;74:1112–1120)

Patient satisfaction has become a priority for health care organizations as it is considered a quality indicator. In the United States and other countries, payment for medical services can now be withheld by government payors for low patient satisfaction. Previous studies of patient satisfaction have been conducted in settings where anesthesiologists practice, such as ambulatory surgery centers and chronic pain clinics. However, studies assessing maternal satisfaction have not focused on obstetric anesthesia, which is quite distinct from other anesthesia practice settings based on a mostly healthy patient population undergoing a major life event. The purpose of this study was to determine factors associated with maternal dissatisfaction with anesthesia care so that interventions to improve patient care and experience can then be identified and implemented.
Maternal Cardiac Parameters Can Help in Differentiating the Clinical Profile of Preeclampsia and in Predicting Progression From Mild to Severe Forms
Authors: Di Pasquo E. , Ghi T. , Dall’Asta A. , Angeli L. , Fieni S. , Pedrazzi G. , Frusca T.
Published: August 2020

(Am J Obstet Gynecol. 2019;221:633.e1–633.e9)

Given the impact of preeclampsia on maternal and perinatal outcomes, many studies have evaluated the pathophysiology of the disease. Studies support the hypothesis that there are 2 types: early-onset preeclampsia associated with fetal growth restriction, and late-onset preeclampsia triggered by metabolic or inflammatory maternal factors. The aim of this study was to assess the maternal hemodynamic parameters for early-onset and late-onset preeclampsia, and to determine if these cardiac findings can help to identify the disease’s severity and progression.
Six-Year Follow-up of a Trial of Antenatal Vitamin D for Asthma Reduction
Authors: Litonjua A.A. , Carey V.J. , Laranjo N. , Stubbs B.J. , Mirzakhani H. , O’Connor G.T. , Sandel M. , Beigelman A. , Bacharier L.B. , Zeiger R.S. , Schatz M. , Hollis B.W. , Weiss S.T.
Published: August 2020

(N Engl J Med. 2020;382:525–533)

Maternal vitamin D deficiency may be a factor in the development of asthma in infants according to some observational studies. The study authors previously conducted the Vitamin D Antenatal Asthma Reduction Trial (VDAART) and reported prenatal vitamin D supplementation was associated with reduced rates of asthma and recurrent wheeze in 3-year-old children. This study reports on the follow-up of the children in the VDAART study group through their sixth birthday to determine the effects of prenatal vitamin D supplementation on the incidence of asthma and recurrent wheeze.
Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception
Authors: Romano D.N. , Hyman J. , Katz D. , Knibbs N. , Einav S. , Resnick O. , Beilin Y.
Published: August 2020

(Anesth Analg. 2020;130:436–444)

As births using assisted reproductive technology increase, the maternal and neonatal safety of these pregnancies continues to be of concern. There are established associations between assisted reproductive technology pregnancies and a number of adverse outcomes, including gestational diabetes, hypertensive disorders of pregnancy, obstetric hemorrhage, abnormal placentation, and cesarean delivery. There is a lack of studies examining the risk of intensive care unit (ICU) admission in women using assisted reproductive technology. This study compared parturients who conceived via in vitro fertilization (IVF) and those who did not in terms of etiology and course of ICU admission, particularly focusing on postpartum hemorrhage.
A Combination of Inhaled Nitrous Oxide and Low-Dose Ketamine Infusion for Labor Analgesia
Authors: Potter J. , Perez-Velasco D. , Maxymiv N.G. , Graham J. , Faircloth A. , Thakrar S.
Published: August 2020

(J Clin Anesth. 2019;57:64–65)

While ketamine is useful in a labor analgesia setting, it is typically used infrequently due to its association with lower Apgar scores, uterine hypertonus, and maternal psychological reactions. Inhaled nitrous oxide (iNO) is another analgesia option, although it provides maternal anxiolytic effects but limited labor analgesia. Not much research has been done on using the combination of a low-dose ketamine infusion (<0.5 mg/kg/h intravenous) and iNO for labor analgesia. These authors outlined 2 cases that apply this analgesic regimen.
Effect of Ear Acupuncture on Pregnancy-related Pain in the Lower Back and Posterior Pelvic Girdle: A Multicenter Randomized Clinical Trial
Authors: Vas J. , Cintado M.C. , Aranda-Regules J.M. , Aguilar I. , Ruiz F.R.
Published: August 2020

(Acta Obstet Gynecol Scand. 2019;98:1307–1317)

Almost half of all pregnant women experience low back pain and/or pelvic girdle pain (LBPGP), which can significantly affect their quality of life (QoL) and interfere with the ability to perform daily activities at work and at home. Interestingly, parturients in Spain have reported higher rates of lumbar pain (71.3%) and pelvic girdle pain (64.7%) than women in other countries. While many women experience pain resolution after delivery, previous studies have found that some women have persistent LBPGP up to 3 years after delivery. In addition, experiencing this pain in one pregnancy elevates the risk of developing pain in future pregnancies. There is a limited number of effective and safe pain management treatments for LBPGP in pregnant women, but research has indicated that acupuncture treatment during pregnancy reduces LBPGP and improves work function and QoL. However, the acupuncture techniques described in these studies require specialized training, thus making their availability limited. The current investigators attempted to evaluate the effectiveness of ear acupuncture, which can be performed in a primary care setting by midwives, for reducing LBPGP in pregnant patients.
Obstetric Neuraxial Anesthesia at Low Platelet Counts in the Context of Immune Thrombocytopenia: A Systematic Review and Meta-analysis
Authors: Bailey L.J. , Nadine Shehata N. , De France B. , Carvalho J.C.A. , Malinowski A.K.
Published: August 2020

(Can J Anesth. 2019;66:1396–1414)

Immune thrombocytopenia purpura (ITP) is a rare autoimmune condition marked by a low platelet count, typically <100×109/L. It may initially present during the preconception or antenatal periods. Most women are asymptomatic, but some may experience epistaxis, petechiae, easy bruising, or mucosal bleeding. Consensus on a safe threshold for platelet counts for placement of neuraxial anesthesia in pregnancy is unclear. The American Society of Anesthesiologists recommends an individualized approach to determine the risk of excessive bleeding without suggesting a minimum platelet threshold. The aim of this study was to examine obstetric neuraxial anesthesia (OBNA) outcomes in patients with platelet counts <100×109/L in the context of primary ITP.
Transversus Abdominis Plane Block and Intrathecal Morphine Use in Cesarean Section: A Retrospective Review
Authors: Cole J. , Hughey S. , Longwell J.
Published: August 2020

(Reg Anesth Pain Med. 2019;44:1035–1037)

In women undergoing cesarean delivery, the anesthesia technique is most commonly spinal or epidural anesthesia. Postoperative pain is most frequently managed by administering morphine into the intrathecal or epidural space. However, transversus abdominis plane (TAP) block can also be utilized. While both modalities, used separately, have been shown to be effective in managing pain after surgery, the literature on the combined use of intrathecal morphine and TAP block needs further investigation. The aim of this study was to evaluate whether the TAP block in combination with intrathecal morphine delays the need to initiate opioid administration following cesarean delivery under spinal anesthesia, versus intrathecal morphine alone.
The Impact of Occupational Activities During Pregnancy on Pregnancy Outcomes: A Systematic Review and Metaanalysis
Authors: Cai Chenxi , Vandermeer Ben , Khurana Rshmi , Nerenberg Kara , Featherstone Robin , Sebastianski Meghan , Davenport Margie H.
Published: August 2020

(Abstracted from Am J Obstet Gynecol 2020;222(3):224–238)

Many women engage in work that is physically demanding. Work that includes carrying heavy loads or working in tiring or painful positions has been associated with adverse outcomes in pregnancy, such as preterm delivery and miscarriage.
Optimizing Medical Student Clerkship Schedules Using a Novel Application of the Hungarian Algorithm
Authors: MacLean Matthew T. , Lysikowski Jerzy R. , Rege Robert V. , Sendelbach Dorothy M. , Mihalic Angela P.
Published: August 2020

Problem

Medical students often have preferences regarding the order of their clinical rotations, but assigning rotations fairly and efficiently can be challenging. To achieve a solution that optimizes assignments (i.e., maximizes student satisfaction), the authors present a novel application of the Hungarian algorithm, designed at the University of Texas Southwestern Medical Center (UTSW), to assign student schedules.

Approach

Possible schedules were divided into distinct pathway options with k total number of seats. Each of n students submitted a ranked list of their top 5 pathway choices. An n × k matrix was formed, where the location (i, j) represented the cost associated with student i being placed in seat j. Progressively higher costs were assigned to students receiving less desired pathways. The Hungarian algorithm was then used to find the assignments that minimize total cost. The authors compared the performance of the Hungarian algorithm against 2 alternative algorithms (i.e., the rank and lottery algorithms). To evaluate the 3 algorithms, 4 simulations were conducted with different popularity weights for different pathways and were run across 1,000 trials. The algorithms were also compared using 3 years of UTSW student preference data for the classes of 2019, 2020, and 2021.

Outcomes

In all 4 computer simulations, the Hungarian algorithm resulted in more students receiving 1 of their top 3 choices and fewer students receiving none of their preferences. Similarly, for UTSW student preference data, the Hungarian algorithm resulted in more students receiving 1 of their top 3 preferences and fewer students receiving none of their ranked preferences.

Next Steps

This approach may be broadly applied to scheduling challenges in undergraduate and graduate medical education. Furthermore, by manipulating cost values, additional constraints can be enforced (e.g., requiring certain seats to be filled, attempting to avoid schedules that begin with a student’s desired specialty).
Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Authors: Zhao Xu , Xiao Huaping , Cai Junying , Meng Lingzhong
Published: August 2020

Purpose of review

Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment?

Recent findings

There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although muscular tissue oxygen saturation-guided care did not reduce the overall occurrence of postoperative nausea and vomiting for all patients, it did reduce the occurrence of these symptoms in patients who had a body mass index ≥25. It was also observed that muscular tissue oxygen saturation increases when blood pressure falls following the administration of nicardipine. These studies highlight the persistence of interest in understanding the value of tissue oximetry in patient care.

Pulse oximetry and tissue oximetry are treated differently although neither monitor has robust evidence attesting to its outcome benefits. This difference may root in the difference in the physiology they monitor, the cost, the ease of use/interpretation/intervention and the relevance to patient safety and care quality. Pulse oxygen saturation represents a vital sign, whereas tissue oxygen saturation is likely a quality sign; however, further research endeavors are required to fully understand how to best use tissue oximetry.
Changing Outdated Methadone Regulations That Harm Pregnant Patients
Authors: McCarthy John J. , Jones Hendree E. , Terplan Mishka , Rudolf Vania P. , von Klimo Melinda Campopiano
Published: August 2020

Methadone regulations have changed minimally since 1974, despite advances in the understanding of the nature of opioid use disorder (OUD) and the role of medications in its treatment. At that time, most patients with OUD were considered to have anti-social personality disorders and the regulations aimed to exert maximal control over medication access. Six- or seven-day clinic attendance is required for months, regardless of distance, or childcare and other social responsibilities. Take home medications are not allowed unless rigid and formulaic conditions are met. Although addiction medicine has rejected the “criminal” paradigm in favor of OUD as a treatable medical disorder, methadone regulations have not kept pace with the science.

Pregnancy is characterized by an ultra-rapid metabolic state, but regulations prevent the use of daily divided doses of methadone to maintain stability. This results in repeated episodes of maternal/fetal opioid withdrawal, as well as other fetal physiologic abnormalities. Interference with dose regimen adjustments prevents optimal outcomes.

Further, methadone clinics are mostly urban, leaving patients in rural areas without access. This led to excessive morbidity and mortality when the opioid crisis hit. The response of merely expanding capacity in overcrowded urban clinics created a contagion menace when Covid-19 arrived. Pregnant women (and parents with children) were forced to negotiate dosing in dangerous conditions.

A revised methadone system must provide treatment that is local, flexible, and limited in size to manage viral contagion risks. This regulatory change can most easily be started by changing regulations that adversely affect pregnant women.