bluuebunny/crossref_metadata_2025 huggingface dataset:
Popular Literature
Authors: Molteno Marion
Published: May 2023

Russell divides literature broadly into three kinds, classical, folk and ‘popular’. The latter (like detective stories) are not taken seriously by literary critics. He discusses examples of popular literature in Urdu: the dastan, for example The Tale of Amir Hamza, originally recited in the Mughal courts in Persian, but put into Urdu by two nineteenth century dastan-go (reciters). Then there are stories like Akbar and Birbal, and Mulla Dopiaza, short anecdotes often with a humorous twist. Qassas ul Anbiya (Tales of the Prophets) is looked down upon by religious because it includes fanciful tales, but remains popular—he compares its appeal to that of A Thousand and One Nights. Thanavi’s Bihishti Zewar, a book of instruction for Muslim women, is still widely available. Kwaja Hasan Nizami’s writing to his followers gives, through down-to-earth stories, guidance on matters of daily life.
Remarkable Women—Two Memoirs
Authors: Molteno Marion
Published: May 2023

Anis Kidwai’s Azadi ki Chhaon Mein is a memoir about her experiences during the time of Partition. Russell was asked by a publisher to edit and translate it. He translated 100 pages but was not able to complete the project. (It was subsequently published in Anis Kidwai’s translation.) He admired her courage in moving beyond her home to help women victims of the violence. An extract from his translation describes the chaotic situation of trying to get wounded people to hospital. Shaukat Azmi’s Yad ki Rahguzar describes the traditional values in which she was raised in Hyderabad, and her long married life with Kaifi Azmi. Russell was asked to write a foreword to the English translation. He had known Kaifi as a fellow communist and a leading poet, but knew little about his personal life, and found Shaukat’s description of their life together vivid and moving.
On Translating Ghalib
Authors: Molteno Marion
Published: May 2023

Ghalib is considered a difficult poet, even for Urdu speakers, and there are particular difficulties in translating his ghazals. Russell describes his joint work with Kurshidul Islam to present Ghalib’s life largely through translations of his prose writing. His letters, written to friends particularly in his later years, are lively and accessible, but other prose (mainly in Persian) was carefully crafted within traditional styles, which for modern readers is more difficult to appreciate. Nevertheless Russell feels it important to translate it in the style Ghalib chose. The difficulties of translating ghazals lie in the genre itself—highly condensed language (a complete meaning in each couplet), and conventional imagery which conveys nuances to Urdu (or Persian) speakers that need explaining to others. But while compromise is inevitable he feels it important to respect the form of the ghazal by remaining concise, and as far as possible conveying a sense of the metrical patterns.
Aziz Ahmad and Urdu Sources on South Asian History
Authors: Molteno Marion
Published: May 2023

Aziz Ahmad was Russell’s colleague at the School of Oriental & African Studies, London, during which time Russell translated his novel Aisi Bulandi, Aisi Pasti, set in Hyderabad (loosely fictionalised as Farkhundanagar) where Aziz Ahmad had spent much of his life. His novels shocked readers of the time by their frankness about sexual attraction. For Russell their power lies in giving true-to-life portraits of the city’s noble families pre-Independence. His novel Ag similarly provides a picture of Kashmiri politics in the 1930s–1940s. Much other writing in Urdu that provides similar insights for social historians is still untranslated, so western historians who do not read Urdu have not benefited from their insights. Another limitation is that writers on South Asian Islam are often anxious not to give offence by stating unwelcome truths. Aziz Ahmad is a welcome exception to this.
FTOrepressesNLRP3‐mediated pyroptosis and alleviates myocardial ischemia–reperfusion injury via inhibitingCBL‐mediated ubiquitination and degradation of β‐catenin
Authors: Sun Fei , An Cheng , Liu Can , Hu Ying , Su Yue , Guo Zhixiang , Che Hong , Ge Shenglin
Published: May 2023

Cardiac ischemia/reperfusion (I/R) injury is a complicated pathological event, which has close association with pyroptosis. This study uncovered the regulatory mechanisms of fat mass and obesity‐associated protein (FTO) in NLRP3‐mediated pyroptosis during cardiac I/R injury. H9c2 cells were stimulated with oxygen–glucose deprivation/reoxygenation (OGD/R). Cell viability and pyroptosis were detected by CCK‐8 and flow cytometry. Western blotting or RT‐qPCR was performed to analyze target molecule expression. NLRP3 and Caspase‐1 expression was observed by immunofluorescence staining. IL‐18 and IL‐1β production was detected by ELISA. The total m6A and m6A level of CBL was determined by dot blot assay and methylated RNA immunoprecipitation‐qPCR, respectively. The interaction between IGF2BP3 and CBL mRNA was confirmed by RNA pull‐down and RIP assays. The protein interaction between CBL and β‐catenin and β‐catenin ubiquitination were evaluated by Co‐IP. Myocardial I/R model was established in rats. We determined infarct size by TTC staining and pathological changes by H&E staining. LDH, CK‐MB, LVFS, and LVEF were also assessed. FTO and β‐catenin were down‐regulated, while CBL was up‐regulated by OGD/R stimulation. FTO/β‐catenin overexpression or CBL silencing restrained OGD/R‐induced NLRP3 inflammasome‐mediated pyroptosis. CBL repressed β‐catenin expression via ubiquitination and degradation. FTO reduced the mRNA stability of CBL by inhibiting m6A modification. CBL‐mediated ubiquitination and degradation of β‐catenin were involved in FTO‐induced pyroptosis inhibition during myocardial I/R injury. FTO inhibits NLRP3‐mediated pyroptosis to attenuate myocardial I/R injury via repressing CBL‐induced ubiquitination degradation of β‐catenin.
SARS-CoV-2 Maternal Infection and Newborn Outcomes: A Comprehensive Systematic Review [ID: 1377802]
Authors: Ibrahim Tamara , Clore Lauren , Mathias-Prabhu Tara , Rubin Lewis , Scott Rachel , Yamamoto Rebecca
Published: May 2023

INTRODUCTION:

The COVID-19 pandemic has affected several maternal and perinatal outcomes. However, the effect of maternal SARS-CoV-2 infection on newborn birth weight has not been comprehensively evaluated. We performed a systematic review to determine the scope of literature considering the effect of maternal SARS-CoV-2 infection on birth weight normalized for gestational age.

METHODS:

We searched OVID Medline, EMBASE, Cochrane CENTRAL, Web of Science, and Google Scholar databases from January 1, 2019, to June 17, 2022, using keywords “gestational age,” “birthweight,” “newborn,” and “COVID-19.” Studies that were nonhuman, unspecified date/location, published in non-English language, systematic reviews, meta-analyses, case reports, case series, narrative reviews, and editorials were excluded. We extracted data from included publications on perinatal and maternal outcomes, demographics, and study type.

RESULTS:

Of 899 studies identified, 204 met criteria and 24 included birth weight and gestational age data on COVID-19-positive (n=10,193) and -negative (n=611,018) maternal/newborn dyads. 11 retrospective cohort, 10 prospective cohort, and 3 case–control studies from Europe (33%), North America (25%), Asia (21%), and the Middle East (13%) were evaluated. In those comparing COVID-19-positive versus -negative mothers, most studies did not find significant differences in gestational age and birth weight. Among those studies comparing mild versus severe disease, the majority found significant differences in gestational age and birth weight.

CONCLUSION:

This internationally aggregated systematic review reveals potential differences in birth weight by disease severity that prompt an ongoing investigation of the effects of maternal SARS-CoV-2 infection on gestational age-dependent birth weight.
Cost-Effectiveness Analysis of On-Demand, Any Cycle-Day Intrauterine Device Placement [ID: 1337731]
Authors: Reiser Hannah , Keller Michelle , Rible Radhika
Published: May 2023

INTRODUCTION:

Intrauterine devices (IUDs) are a highly effective form of long-acting reversible contraception. In addition to the TCu380A IUD, the 52-mg-levonorgestrel IUD was recently demonstrated as a noninferior emergency contraception (EC) method, which would increase the menstrual cycle days on which an on-demand IUD placement protocol would be safe. Especially, considering up to 46% of patients that are lost to follow up if two-visit IUD placement protocol is used. This analysis aims to determine the cost-effectiveness of IUD provision of on-demand, any cycle-day, even if unable to reasonably exclude pregnancy.

METHODS:

We developed a decision-analytic model using TreeAge Pro 2022 software (TreeAge Software, Williamstown, MA) beginning with a patient presenting to clinic for IUD placement, either TCu380A or 52-mg-levonorgestrel IUD. Two strategies are modeled: on-demand placement after shared decision-making, even if unable to reasonably exclude pregnancy, and placement at follow-up visit. Our primary outcome is costs over 1 year from start of model. Our secondary outcomes include unplanned pregnancies averted and pregnancy types.

RESULTS:

Preliminary model analysis of 1,000 women over 1 year indicates on-demand, any cycle-day IUD placement averts 298 unplanned pregnancies compared to two-visit. Ectopic pregnancies, however, would increase to 9.92 from 6.31 per 1,000 women. The preliminary incremental cost-effectiveness ratio for the model is $7,793 in favor of on-demand placement. Sensitivity analysis is forthcoming.

CONCLUSION:

A preliminary analysis favors the cost effectiveness of on-demand, any cycle-day IUD placement after shared-decision-making counseling. As we gather more data on the effectiveness of IUD as EC, the time frame for placement may extend, which will further support the practice of on-demand placement.
COVID-19 Infection as a Barrier to Postpartum Tubal Ligation [ID: 1355689]
Authors: DiCenzo Natalie , Glassman Danielle , Shah Nayna , Singla Ashima
Published: May 2023

INTRODUCTION:

About half of patients who do not obtain a requested postpartum tubal ligation experience pregnancy within the following year. There are many challenges to fulfilling postpartum tubal requests. Obstacles are exacerbated for those without private insurance, including Medicaid consent form requirements. Our institution considers postpartum tubal ligations “elective” and created policy prohibiting them for COVID-positive patients. We aimed to study how this creates additional barriers and delays to care for our patients.

METHODS:

This retrospective study identified patients with documented COVID infection at time of vaginal delivery who were unable to receive a requested postpartum tubal ligation at our institution between February 2020 and February 2022. Sociodemographic information, documented contraception ultimately obtained, and documented future unintended pregnancy were evaluated. Institutional review board approval was obtained.

RESULTS:

In a 2-year period, 24 patients were unable to receive requested postpartum tubal ligations at our institution because of COVID infection. 42% (n=10) of such patients were uninsured and 54% (n=13) had Medicaid. 92% (n=22) were Hispanic/Latinx. Average age was 33, and average number of prior pregnancies was 5. Only 21% (n=5) received an interval tubal ligation after delivery; no uninsured patients received an interval tubal ligation. Of the remaining patients (n=19), 37% (n=7) never received any contraception, 37% (n=7) received long-acting reversible contraceptives, and 26% (n=5) received another type of contraception. One patient had a future documented unintended pregnancy.

CONCLUSION:

Our institution's policy not to perform postpartum tubal ligations for COVID-positive patients prevented about 80% of patients requesting permanent sterilization after vaginal delivery from ever accessing this procedure.
Clinician Perspectives on the Barriers and Facilitators of Extended Use of the Contraceptive Implant [ID: 1373916]
Authors: Rigler Nicole , Averbach Sarah , Hildebrand Marisa , Kully Gennifer , Mody Sheila , Mody Sheila
Published: May 2023

INTRODUCTION:

The contraceptive implant is approved by the U.S. Food and Drug Administration (FDA) for 3 years. There is evidence that it is effective at preventing pregnancy for 5 years, known as extended use. We explored clinician perspectives and the barriers and facilitators to offering extended use.

METHODS:

We utilized the Consolidated Framework for Implementation Research (CFIR) to guide 20 IRB-approved, semistructured qualitative interviews among reproductive health clinicians. Participants were recruited from a nationwide cross-sectional survey on use of the contraceptive implant, with sampling to optimize the geographic and clinical diversity of participants. We coded interviews using ATLAS.ti, and then generated themes by CFIR domain and participant type.

RESULTS:

We interviewed 20 clinicians: 5 (25%) family medicine physicians, 6 (30%) advanced practice clinicians, 3 (15%) complex family planning (CFP) specialists, and 6 (30%) non-CFP obstetrician–gynecologists. Themes regarding barriers and facilitators to extended use emerged across CFIR domains. Within the outer setting, the dominant barrier was the current FDA approval for 3 years, while the strongest facilitator was educational materials for patients and providers. For the inner setting, the main barrier was clinician concern about liability with off-label use of a contraceptive device and the main facilitator was a champion of extended use. The primary barriers within intervention characteristics were patient concerns about changes in bleeding and future insurance coverage for contraception.

CONCLUSION:

Clinician education about extended use of the contraceptive implant up to 5 years as well as more data on the expected patient bleeding profile may increase offering of extended use of the contraceptive implant.
COVID-19 Pandemic Effect on Tubal Sterilization Accessibility [ID: 1376950]
Authors: Tran Khanh Hien , Hosein Safiyah , Mestad Renee
Published: May 2023

INTRODUCTION:

The COVID-19 pandemic preferentially allocated medical resources to emergent and urgent services with postponement of “elective” procedures such as surgical sterilization. This study aims to examine effect of postponing surgical sterilization on patients’ reproductive lives.

METHODS:

This retrospective review assesses patient consultations for tubal sterilization in a hospital-based clinic in 2019 (n=75) and 2020 (n=61). An IRB waiver was obtained. The primary outcome was the rate of unintended pregnancies within 1 year of consultation. The secondary outcomes included length of time between consultation and procedure, expiration of Medicaid sterilization consent, and alternate contraceptive uptake.

RESULTS:

There was no difference between unintended pregnancies between 2019 and 2020 (8% versus 11%, P=.49). There was no difference between procedure completion rate (65% versus 59%, P=.45). The rate of expiration of Medicaid sterilization consent was statistically different (7% versus 21%, P=.012). Initial consultation to procedure completion averaged 1.8 months in 2019 and 4.0 months in 2020. Of patients who did not undergo sterilization procedure, 96% received an alternate method of contraception in 2019 compared to 88% in 2020.

CONCLUSION:

No statistical difference was found between unintended pregnancy or rate of procedure completion despite the difference in delay, suggesting that tubal sterilization may be appropriately delayed during resource shortages. The difference in expiration of Medicaid sterilization consent may pose a significant burden to the patient who needs to return to clinic and reconsent prior to the procedure.
Increasing Contraception Options Immediately After Birth: Did Immediate Postpartum Long-Acting Reversible Contraception (IPP LARC) Utilization Increase During the COVID-19 Pandemic? [ID: 1377847]
Authors: Mastronardi Alicia , Maples Jill , Shelton Zachary , Young Megan , Zite Nikki
Published: May 2023

INTRODUCTION:

Preliminary research indicates prenatal and postpartum care decreased during the COVID-19 pandemic. Models also indicate increases in unintended pregnancies after 2020. The goal of this study was to assess whether immediate postpartum long-acting reversible contraception (IPP LARC) insertions and desire for IPP LARC increased during COVID-19 among patients insured under TennCare Medicaid (TennCare or CoverKids) with access to coverage for this type of contraception.

METHODS:

Deliveries in patients insured under TennCare Medicaid Programs (n=6,922) in one East Tennessee hospital were assessed before and during the COVID-19 pandemic (January 2019 to May 2020 and June 2020 to December 2021, respectively). Data from electronic health records were securely collected in Excel and analyzed using SPSS software. Comparisons were made using chi-square tests.

RESULTS:

During COVID, increased uptake of IPP LARC was statistically significant: 18.0% (CI 16.9–19.1%) before the COVID-19 pandemic and 22.0% (CI 20.6–23.3%) during (P<.001). In addition, desire for IPP LARC increased significantly among patients: 20.0% (CI 19.1–21.3%) before COVID-19 and 22.3% (CI 21.0–23.7%) during COVID-19 (P=.016). Significant increases in desire for IPP LARC during the pandemic occurred among adolescent patients (<20 years of age) (P=.003), those living HRSA-defined nonrural areas (P=.024), non-Hispanic women (P=.036), and White women (P=.027).

CONCLUSION:

IPP LARC is a highly effective, convenient contraception option for women, especially during times with possible increased limitations in accessing postpartum care. Perhaps because of shelter-at-home orders, limitations in “nonessential” health care being practiced, or personal preferences and desires during the pandemic, IPP LARC was more highly utilized and desired by those wishing to avoid unintended pregnancy after the pandemic began.
Online Clinical Decision Support Software Reduces Time to Diagnosis of Fertility Disorders to 8 Weeks on Average [ID: 1380156]
Authors: Chen Serena , Hecher Silvia , Van Dis Jane
Published: May 2023

INTRODUCTION:

Time to diagnosis of fertility disorders is reported to take up to 11 years and involves five to six physicians on average. Prolonged time to diagnosis is not just an immense burden on the health care system, but also means that in vitro fertilization (IVF) becomes necessary for couples who would have been able to conceive naturally had they been diagnosed sooner, often leaving these couples childless. This observational study evaluated how a clinical decision support software based on American Society for Reproductive Medicine, American College of Obstetricians and Gynecologists, and European Society of Human Reproduction and Embryology guidelines used by patients and obstetrician–gynecologists together can reduce the time to diagnosis of up to 65 conditions affecting female fertility.

METHODS:

One hundred eighty women aged 20–45 who had been trying to conceive for an average of 11 months were recruited to participate. Women completed a reproductive health assessment with a dynamic online questionnaire. The output of the assessment was a lab requisition with an individualized selection of female and male sex hormones, thyroid hormones, markers for glucose metabolism, vitamin deficiencies, complete blood count, as well as markers for immunology, genetics, and thrombophilia. The clinical decision support software combined the results from the online reproductive health assessment with the lab results to render recommendations for diagnosis, further diagnostics, and treatment.

RESULTS:

An average of four previously unknown health conditions affecting fertility were diagnosed with an average time of 8 weeks to diagnosis (range, 5–16). Diagnoses included polycystic ovarian syndrome, various forms of amenorrhea, premature ovarian insufficiency, vitamin and iron deficiency, hyperthyroidism and hypothyroidism, insulin sensitivity, and prolactinoma.

CONCLUSION:

An online clinical decision support tool can significantly reduce time to diagnosis of conditions affecting female fertility. It also reduces the number of patient–physician interactions and the time physicians spend on medical history and necessary patient education.
Socioeconomic and Racial Trends in Human Papillomavirus Vaccination: A 10-Year Retrospective Review [ID: 1366482]
Authors: Bell Christina , Beltran Thomas , Penick Emily
Published: May 2023

INTRODUCTION:

Human papillomavirus (HPV) vaccination in the United States is low, and lack of vaccination disproportionately affects minority patients and those of a lower socioeconomic status. We sought to assess the effect of race and ethnicity and socioeconomic factors on HPV vaccine adoption over the last decade.

METHODS:

An analysis was conducted on data from the National Health Nutrition Examination Survey from 2009 to 2018 of individuals aged 12–26 years. Sociodemographic and vaccination history was gathered via self-report. Logistic regression models assessed relationships between HPV vaccination and variables of interest.

RESULTS:

Data from 8,120 individuals were included in the analysis. Vaccine initiation among females rose from 30.5% (95% CI 25.7–35.8) in 2009–2010 to 55.1% (95% CI 50.0–60.0) in 2017–2018 and from 8.3% (95% CI 6.2–10.9) in 2011–2012 to 36.4% (95% CI 31.2–41.9) in 2017–2018 for males. Individuals with insurance coverage were 2.0 times more likely to report being vaccinated (95% CI 1.8–2.6). Independent of insurance coverage, having a routine place to seek health care was associated with a 1.9 times increase (95% CI 1.5–2.3) in HPV vaccination. Independent of insurance and access to care, Mexican American and non-Hispanic Black individuals were 1.7 times (95% CI 1.3–2.2) and 1.4 times (95% CI 1.1–1.9) less likely to complete the vaccine series compared to non-Hispanic White individuals.

CONCLUSION:

Human papillomavirus vaccination initiation has increased in the United States over the past 10 years; however, vaccination has plateaued among women with only half of females vaccinated and nearly a fifth initiating but not completing the series. Access to care appears to be a significant predictor of HPV vaccination.
Comparison of Postoperative Quality of Life Scores in Women Who Underwent Myomectomy Versus Hysterectomy for Uterine Fibroids [ID: 1379414]
Authors: Mitchell Jameson , Bradley Linda , Falcone Tommaso , Frisch Emily , Llarena Natalia , Omosigho Ukpebo
Published: May 2023

INTRODUCTION:

Uterine fibroids are highly prevalent and associated with significant effect on quality of life (QOL). The current study compares QOL scores in patients that underwent myomectomy or hysterectomy for management of fibroids.

METHODS:

After obtaining approval from the Cleveland Clinic IRB, we conducted a retrospective cohort study for patients that underwent hysterectomy or myomectomy for uterine fibroids. Eligible patients were sent validated surveys: 36-Item Short Form Health Survey (SF-36) and Uterine Fibroid Symptom and QOL questionnaire (UFS-QOL). Standard bivariate analyses were used to compare differences in QOL scores between groups, adjusting for age and race.

RESULTS:

Of the 142 survey respondents, 37 underwent myomectomy and 105 underwent hysterectomy. The median number of days between surgery and survey completion was 1,652 (1,142, 2,328) for myomectomy and 1,022 (740, 1,317) for hysterectomy. For SF-36, hysterectomy patients reported significantly less energy (P=.006) compared to myomectomy. Significant differences were not observed in postoperative physical functioning, role limitations, pain, health perceptions, vitality, social functioning, or mental health. Although there was no statistically significant difference in UFS-QOL scores, patients who underwent hysterectomy experienced significantly lower symptom severity (P=.009) and levels of concern (P<.001), and increased activity tolerance (P=.005) and sense of control (P=.029).

CONCLUSION:

While patients who underwent hysterectomy reported more fatigue, they experienced lower symptom severity, lower levels of concern, higher activity tolerance, and increased sense of control compared to myomectomy. These findings may help guide counseling for surgical fibroid treatment.
Preoperative Pain Control Discussion With EMR Documentation Prompt to Guide Opioid Prescriptions for Laparoscopic Sterilization Surgery [ID: 1377197]
Authors: Chase Gillian , Burrell Dayna , Eger Renee , Matteson Kristen
Published: May 2023

INTRODUCTION:

Our objective was to evaluate whether implementing a standardized patient–physician counseling and documentation process about pain and opioid use after laparoscopic bilateral salpingectomy (LSC BS) decreased opioid prescribing.

METHODS:

In this study, we evaluated a quality improvement project aimed at decreasing opioid overprescribing and promoting patient–physician conversations and documentation surrounding pain control after surgery. An electronic medical record (EMR) standardized smart phrase was implemented in the Resident GYN Specialty Clinic at the Obstetrics and Gynecology Care Center in order to standardize patient–physician counseling and documentation about postoperative pain, opioid use, storage, and disposal, providing written and verbal education at the time of preoperative and postoperative appointments for Lap BS. We collected EMR data from patients who had a LSC BS preintervention (January 2019 to December 9, 2020) and postimplementation (March 2021 to October 2022). To have 90% power to detect a 25% reduction in morphine milligram equivalents (MMEs) from preimplementation to postimplementation, we needed 78 patients per group.

RESULTS:

A total of 78 patients met inclusion criteria for both groups. Patients postintervention were prescribed significantly fewer opioids (58.3 versus 31.35 MME, P<.001, or 7.8 versus 4.2 oxycodone 5 mg tablets) compared to patients preintervention. Significant differences were also seen in secondary outcomes with increased documentation of discussion surrounding the addictive properties of opioids and expected pain postoperatively postintervention compared to preintervention.

CONCLUSION:

Implementation of physician education combined with EMR prompts decreased the amount of opioids prescribed and increased documentation of patient–physician communication about safe opioid use and pain control.
The Gonadotoxic Effects of Conditioning Chemotherapy Regimens Prior to Hematopoietic Stem Cell Transplantation [ID: 1376168]
Authors: Jiang Heng , Dong Rosemary , Kim So-Youn , Luan Yi , Thonen Macy , Wadhwa Aman
Published: May 2023

INTRODUCTION:

Primary ovarian insufficiency secondary to high-dose chemotherapy in females undergoing the conditioning regimen before hematopoietic stem cell transplantation is a challenging late complication. Limited studies have investigated the ovarian toxicity of various conditioning regimens. This study aimed to explore the gonadotoxic effects of cyclophosphamide (CY) and busulfan (BU) in CD-1 mice strain.

METHODS:

Sixteen 1-month-old female CD-1 mice (n=4/group) were subcutaneously injected with solvent, BU, CY, or BU+CY, respectively. The doses (144 mg/kg BU and 300 mg/kg CY) and injection plan were adjusted to human doses. The ovaries and female reproductive tracts were harvested 1 week after the last administration. Follicle counting was performed. The levels of serum antimüllerian hormone (AMH) and 17-beta-estradiol were measured. Animal use approval was obtained from the Institutional Animal Care and Use Committee at the University of Nebraska Medical Center.

RESULTS:

All mice survived the injections and grossly appeared normal. The average ovary weight was significantly lower in BU (P=.0007) and BU+CY (P<.0001) groups than in the control and CY groups. The primordial (P<.0001) and primary follicles (P=.01) in treatment groups were decreased compared to the control group. The serum AMH level in the BU group was also significantly lower than the control and CY group (P=.003).

CONCLUSION:

We show that conditioning chemotherapy with CY and BU can reduce the ovarian reserve in CD-1 mice strain and may have a synergic effect. Future studies to investigate the mechanism of chemotherapy-related ovarian follicle death are needed to improve fertility outcomes in patients receiving conditioning chemotherapy.
Oncofertility Referral Patterns for Female Adolescent and Young Adult Cancer Survivors [ID: 1380296]
Authors: Holley-Cuthrell Jenan , Choi Alexandria , Class Quetzal A. , Gorniak Adrianna , Hussein Nada , MacLaughlan David Shannon
Published: May 2023

INTRODUCTION:

Oncofertility counseling for adolescent and young adult (AYA) cancer survivors is standard of care, but referral rates to reproductive endocrinology and infertility (REI) are low. We examined factors associated with oncofertility referrals in a diverse urban cancer center.

METHODS:

This is a retrospective cohort study of female AYA survivors aged 15–39 years between 2015 and 2021.

RESULTS:

Female AYA survivors (n=303) had a mean age of 30.9 (±5.75), ranging 16–39 years. Only 21 (6.9%) patients had oncofertility counseling prior to starting cancer treatment. The population was 40.8% White (n=122) and 37.8% Black (n=113). Seventy-two (25.6%) were referred to REI, and 62.0% of those (n=44) underwent counseling. Black AYA survivors had three times higher odds of referral than White survivors (odds ratio [OR] 2.99, 95% CI 1.49–5.96), and parity was associated with lower odds of referral (OR 0.35, 95% CI 0.19–0.68). Eighteen of the Black survivors referred (52.9%) underwent counseling. Of the 22 White survivors referred, 81.8% (n=18) underwent counseling, more than expected compared with other races (X2=7.46, P=.05). Age (OR 0.82, 95% CI 0.71–0.94) and parity (OR 0.22, 95% CI 0.06–0.85) reduced odds of accepting referral. In a multivariable model including age, parity, race, insurance, cancer type, and treatment received, race was no longer predictive, but childbearing status remained associated with lower odds of oncofertility referral (OR 0.19, 95% CI 0.08–0.46).

CONCLUSION:

Most female AYA survivors did not receive timely oncofertility counseling. Black survivors were offered referral more than White individuals, which did not improve access to REI services. Future efforts will focus on integrating REI services into cancer center operations.
A Prospective Study to Assess for Histologic Changes on Vulvar Biopsies in Postmenopausal Women With Lichen Sclerosus Treated With Fractionated CO2 Laser Therapy [ID: 1339895]
Authors: Lee Jennifer , Cardis Michael , Dieter Alexis , Etcheverry Maria , Gonzales Melissa , Iglesia Cheryl
Published: May 2023

INTRODUCTION:

Lichen sclerosus (LS) is a chronic skin condition affecting men and women of all ages. Fractionated carbon dioxide (FxCO2) laser therapy has been proposed as a novel treatment modality. Our objective was to investigate histologic changes after FxCO2 laser therapy for vulvar LS and assess symptomatic improvement using the Skindex-16 questionnaire.

METHODS:

This prospective single-arm study was conducted from April 2021 to August 2022 at one academic medical center. Ten English-speaking postmenopausal women with biopsy-proven LS undergoing FxCO2 laser treatment were enrolled. Exclusion criteria included prior transvaginal mesh for prolapse, recent topical corticosteroid use, prior pelvic radiation, malignancy, active genital infection, or pregnancy. Institutional review board approval and written consent from participants were obtained. The vulvovaginal SmartXide2-V2-LR laser system FxCO2 laser (DEKA, Calenzano, Italy) was used to treat visually affected areas of vulvar and perianal LS with a single pass over three treatments spaced 4–6 weeks apart. Participants completed the Skindex-16 questionnaire and underwent vulvar biopsy at baseline and 4 weeks after the third FxCO2 laser therapy. Histologic slides were blinded and then scored by a dermatopathologist (MC) on a 5-point scale to assess sclerosus, inflammation, and epidermal atrophy.

RESULTS:

Participants had a mean age of 61 and were mostly White, privately insured with college/graduate-level education. Posttreatment vulvar biopsies showed significant improvement in sclerosus and epidermal atrophy (P<.05) with no statistically significant change in inflammation or Skindex-16 scores after FxCO2 laser treatment. A statistically significant correlation was found between sclerosus and Skindex-16 symptoms score (mean change of 21.4 units in Skindex-16 symptoms score for 1 unit change in histologic sclerosus score, P=.03).

CONCLUSION:

In postmenopausal women with vulvar LS undergoing FxCO2 laser therapy, symptomatic improvements are correlated with histologic changes in sclerosus on vulvar biopsy. FxCO2 laser therapy is a promising option for treatment of LS, and further studies are needed to assess safety and efficacy.
Quantitative Blood Loss in Cesarean Delivery Is More Accurate Than Visual Estimation [ID: 1376884]
Authors: Orzolek Charlotte , Durie Danielle , Flicker Amanda , Giacobbo Alexa , Quinones Joanne , Qureshey Emma
Published: May 2023

INTRODUCTION:

The objective of this study was to determine the difference in milliliters between calculated blood loss (CBL) and two measurement techniques: estimated blood loss (EBL) versus quantitative blood loss (QBL) for cesarean deliveries.

METHODS:

This was a retrospective cohort study at a tertiary hospital examining blood loss from singleton, term cesarean births. EBL and QBL groups contained 6 separate months of deliveries. Measurements were compared to a standard CBL: (0.75 × {[maternal height (inches)×50]+[maternal weight in pounds×25]}) by percent of blood volume lost ({predelivery HCT – postdelivery HCT}/predelivery HCT). Values of CBL − recorded blood loss=0 mL represented a more accurate measurement. Blood product transfusion was also compared.

RESULTS:

Median CBL did not differ between EBL (n=460) and QBL (n=507) groups: 836 mL (interquartile range [IQR] 566–1,135) versus 839 mL (IQR 608–1,175, P=.363). Reported blood loss was not different between EBL and QBL groups: 700 (IQR 600–800) mL and 677 (IQR 479–981, P=.501) mL, respectively. Differences between the CBL and recorded blood loss was larger in the EBL group (172 [IQR –101 to 474] mL) than the QBL group (−106 [IQR –379 to 118] mL), with P<.001. Transfusion rates did not differ between groups (P=.789).

CONCLUSION:

The positive value of 172 mL suggests that EBL is an underestimation of CBL, while the negative value of −106 mL suggests QBL is a slight overestimation, although a better approximator of CBL. These data offer insight into quantifiable value differences between EBL and QBL, which may be used in future investigation to adequately power studies that evaluate blood measurements techniques and influences on clinical decision-making.
Periviable Premature Rupture of Membranes—Maternal and Neonatal Risks: A Meta-Analysis [ID: 1363862]
Authors: Saucedo Alexander , Cahill Alison , Calvert Chase , Ghartey Kobina , Groves Alan , Harper Lorie M.
Published: May 2023

INTRODUCTION:

Periviable rupture of membranes counseling should describe maternal and neonatal outcomes associated with both immediate delivery or expectant management; unfortunately, most published data focuses on neonatal outcomes and maternal risk estimates vary widely. We performed a meta-analysis to describe outcomes associated with expectant management compared to immediate delivery of periviable PROM.

METHODS:

We performed a systematic review of the literature including published clinical trials and observational cohorts after the year 2000. Publications were selected if they included maternal and neonatal outcomes for both expectant management and immediate delivery. Gestational age range was limited from 14 to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences were calculated for each outcome using a random effects model. Publication bias was assessed using funnel plots and Harbord test.

RESULTS:

A total of 2,550 studies were initially screened, and 44 manuscripts were reviewed. Of these, 5 publications met inclusion for analysis: 4 retrospective and 1 prospective. Overall, 61.1% of women chose expectant management. Expectant management was associated with a 4% increased risk of maternal sepsis, 30% increased risk of chorioamnionitis, and 28% increased risk of any laparotomy. Neonatal survival with expectant management was 34% compared to 0% with immediate delivery.

CONCLUSION:

Women who choose to undergo expectant management experience an increased risk of sepsis, chorioamnionitis, and laparotomy with only one-third of neonates surviving to discharge. Knowledge of these risks is critical to counseling patients with this diagnosis.
Race and Ethnicity and Disparities in Neonatal Outcomes in Twin Pregnancies [ID: 1375610]
Authors: Pinson Kelsey , Ballas Jerasimos , Mims Joseph , Ramos Gladys
Published: May 2023

INTRODUCTION:

Twin pregnancies are associated with adverse neonatal outcomes. We aimed to investigate disparities in neonatal outcomes by maternal race and ethnicity.

METHODS:

This was an IRB-approved, retrospective cohort of twin deliveries at a single institution between 2001 and 2018. Pregnancies delivered less than 23 weeks’ gestational age (GA), fetal demise, or major anomaly were excluded. The primary exposure, race and ethnicity, was self-reported as follows: non-Hispanic White, Hispanic, non-Hispanic Black, Asian/Pacific Islander, and other/mixed race. The primary outcome was neonatal intensive care unit (NICU) admission of at least one twin. Secondary outcomes included 5-minute Apgar less than 7 for either twin, GA at delivery, small for GA (SGA) neonate (<10th percentile for GA), and NICU length of stay. Chi-square, ANOVA, and Student’s t test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences.

RESULTS:

Eight hundred four twin pregnancies were identified; 48% of patients identified as non-Hispanic White, 30% as Hispanic, 10% as Asian/Pacific Islander, 5.6% as non-Hispanic Black, and 6.6% as other/mixed race. Age, parity, chorionicity, and body mass index differed between groups. The overall rate of NICU admission was 77.5% and did not differ by race and ethnicity (P=.05). Pregnancies with at least one SGA neonate varied significantly by race and ethnicity (P=.02). Gestational age at delivery, Apgar of less than 7, and ICU length of stay did not differ.

CONCLUSION:

The risk of having an SGA neonate varies by race and ethnicity in twin gestations, with highest rates among non-Hispanic Black women. Additional racial and ethnic disparities in neonatal morbidity were not found. Disparities in rate of preterm birth were not seen in this cohort.
You Matter: Elevating the Community Voice to Improve Patient Knowledge of Severe Maternal Morbidity Warning Signs Through Innovative Video Education at Postpartum Discharge [ID: 1375906]
Authors: White Kelsey , Leon-Martinez Daisy , Lipkind Heather , Senter Lindsay , Son Moeun , Tortal Danna
Published: May 2023

INTRODUCTION:

The objective of this study was to determine whether a standardized video education campaign “You Matter” at postpartum discharge improves knowledge of warning signs for predominant causes of maternal morbidity (infection, hemorrhage, hypertensive disorders, and postpartum depression) compared to routine written instructions.

METHODS:

This was a randomized controlled trial of patients who delivered at a large, urban, tertiary care hospital. Eligible patients were enrolled and completed a baseline knowledge questionnaire. After delivery, they were randomized to written education or written plus video education, which was created with input from community stakeholders and included animated, ethnic and culturally diverse characters. After education, patients completed the same questionnaire. The primary outcome was improvement in patient knowledge, assessed by the number of correct responses. This study received IRB approval.

RESULTS:

From July to August 2022, 200 patients were enrolled (100 per group). Overall, patients were highly educated (college and/or graduate education, 82%) and most had commercial insurance (73.5%). There was no significant difference in baseline scores between the video and routine education (median 12 [11–14] versus 12 [11–13], P=.53). In the video arm, patients had significantly higher scores on posteducation questionnaires (median 14 [12–15] versus 13 [12–14], P<.01), and patients improved their scores more frequently than their written counterpart (62.4% versus 50.0%, P=.08). Patients more frequently reported that video education was “very helpful” (86.1% versus 73.2%) and were “very satisfied” with their education (86.1% versus 76.3%).

CONCLUSION:

Enhanced postpartum education through a novel video at discharge yielded statistically higher scores on posteducation questionnaires, as well as more frequently improved scores and satisfaction in their care.
Understanding the Role of Race in Doula Communities: Florida Doulas’ Perceptions of Maternal Health Disparities [ID: 1377606]
Authors: Joglekar Ria , Applequist Janelle , Louis-Jacques Adetola , Powis Richard , Wilson Ronee
Published: May 2023

INTRODUCTION:

This study, part of a larger qualitative project, spurred significant participant feedback related to BIPOC (Black, Indigenous, people of color) clients’ needs for support from racially similar doulas. As such, this study analyzed the data to investigate how doulas navigate client perceptions of race.

METHODS:

Seven in-depth interviews and six focus groups were conducted with doulas serving in Florida (n=31). Transcripts were coded post-inter-coder agreement using an inductive approach to thematic analysis. Participant consent and IRB approval were obtained.

RESULTS:

1) White doulas reported Black doulas advising them to refrain from taking on Black, Brown, non-English speaking clients and instead to refer when possible. Some participants explained tendency for implicit bias and discrimination when White doulas try to step into the perspective of clients of color, specifically Black women, despite good intent in trying to support a community facing health disparities. 2) A few doulas referred to White doulas reaching out to non-White clients as a savior/virtue signaling act, while others countered that White doulas can use their racial status for advocacy in medical settings.

CONCLUSION:

Doulas shared a desire to work with underserved families and discussed that issues surrounding race must first be acknowledged in order to create safer spaces for open communication surrounding maternal health, thereby mitigating disparities. It is important to note that our study relied on convenience sampling, utilizing predominantly White doulas, limiting our data on Black doula experiences and their perceptions on the role of race in the doula–client relationship. Future directions must include diversification of participants and speaking directly with Black doulas.
The Effect of Prenatal Care on Preterm Birth in a Low-Income Minority Population in DC [ID: 1378551]
Authors: Atkins Kristin , Belgrave Briana , Everett Aviana , Smith DeAshley , Tobo Betelihem , Zhang Rui
Published: May 2023

INTRODUCTION:

Structural and social barriers to health care affect prenatal care (PNC) utilization among underrepresented minorities in the District of Columbia (DC) and contribute to preterm birth (PTB) disparities. The PTB rate among Black people in DC was 13.1% (2018–2020), higher than the overall DC (9.8%, 2020) and United States (10.1%, 2020) rates. We evaluated the association between prenatal care utilization and preterm birth in a low-income minority population in DC.

METHODS:

As part of a collaborative effort with DC Health to reduce PTB, we designed a REDCap database to collect pregnancy and delivery data on all inpatient and outpatient patients at Howard University Hospital (HUH), between January 2020 and September 2022. Our primary exposure variable was PNC (yes or no). Our outcome was PTB (gestational age < or ≥37 weeks). Crude and adjusted logistic regression models analyzed the relationship between prenatal care and preterm birth.

RESULTS:

A total of 1,382 patient charts were evaluated, of which 11.6% had PTB and 95.1% had any PNC. Majority were Black (55.6%) or Hispanic (42.8%), and had Medicaid (92.2%). Any PNC was associated with a 54% reduced odds of PTB (adjusted odds ratio 0.46, 95% CI 0.22–0.97). Additionally, history of preeclampsia (3.75, 2.51–5.62) or spontaneous PTB (2.51, 1.50–4.18) were significantly associated with PTB.

CONCLUSION:

Prenatal care usage was associated with reduced odds of preterm birth in our population. Identifying and addressing barriers to prenatal care utilization may improve preterm birth rates among risk-entrenched patients at HUH.
The Association of Race and Ethnicity With Adverse Outcomes in Women Treated for Mild Chronic Hypertension During Pregnancy [ID: 1381420]
Authors: Moore Matthew , Sinkey Rachel
Published: May 2023

INTRODUCTION:

The effect of race and ethnicity on outcomes in the treatment of mild chronic hypertension (cHTN) in pregnancy is unknown.

METHODS:

This was a secondary analysis of a multicenter randomized trial of pregnant patients with mild cHTN comparing antihypertensive therapy to goal blood pressure less than 140/90 mm Hg (Active) versus usual care. Log-binomial regression assessed differences in outcomes between racial and ethnic groups among Active participants. Outcomes included a composite (preeclampsia with severe features, medically indicated preterm birth [PTB]<35 weeks, abruption, fetal/neonatal death), components of the composite, intensive care unit admission, HTN with end-organ dysfunction, low birth weight (LBW), PTB less than 37 weeks, neonatal intensive care unit admission, and small for gestational age (SGA).

RESULTS:

Baseline maternal characteristics of patients randomized to active treatment in the parent trial differed by race and ethnicity for age, married status, insurance, nulliparous, body mass index, tobacco use, aspirin, and prior preeclampsia. Models demonstrated increased risk of the primary composite (adjusted relative risk [aRR] 1.35 [1.05, 1.73]) among Black compared to White patients. Preeclampsia was not increased among Black (aRR 1.14 [0.87, 1.50]) or Hispanic patients (aRR 1.13 [0.82, 1.56]). Preterm birth was increased among Black (aRR 1.31 [1.02, 1.68]) and Hispanic patients (aRR 1.33 [1.00, 1.77]), and there was increased risk of LBW infants born to Black patients (aRR 1.54 [1.11, 2.14]), but not Hispanic (aRR 1.04 [0.69, 1.57]) compared to White. There was no difference in SGA between groups.

CONCLUSION:

Among women with mild cHTN treated to goal less than 140/90 mm Hg, baseline characteristics differed significantly, and Black and Hispanic women were at increased risk compared to White women for selected outcomes. Interventions to address disparities should further evaluate social determinants of health in addition to medical management.