bluuebunny/crossref_metadata_2025 huggingface dataset:
Dialogic construction of a culture of lawfulness in basic education institutions in Mexico (Construcción dialógica de una cultura de la legalidad en instituciones de educación básica en México)
Authors: Reyes-Angona Sergio , Fernández-Cárdenas Juan-Manuel , Heredia Yolanda , Castro Adriana
Published: May 2020

Culture of Lawfulness at my School (CLS) is a programme to build a culture of respect for and appreciation of lawfulness implemented in primary and secondary schools, with a total of 3,234 students at 76 schools in Monterrey and five community centres in Tijuana, two regions in northern Mexico which have particularly been affected by the violence associated with drug trafficking. The programme promotes the moral development of students using a pedagogical model based on dialogue by discussing moral dilemmas in the classroom. A total of 298 ethnographic notes from class sessions and 62 questionnaires administered to the directors of the participating schools are analysed. The inductive processing of these data in accordance with grounded theory reveals that this dialogic pedagogy fosters the participative construction of a culture of lawfulness. In light of this case, several guidelines for similar interventions are proposed.
Digital storytelling in the ecology of learning (Relatos digitales personales en la ecología del aprendizaje)
Authors: Rodríguez-Illera José-Luis , Barberà-Gregori Elena , Martínez-Fernàndez Anna
Published: May 2020

Digital storytelling in the ecology of learning is a project which strives to understand digital storytelling in which youths capture an important aspect or event of their lives, give it meaning and share this meaning on social media. To do so, the goal is to better understand these new practices of posting content (posts, selfies, etc.) via a survey of more than 850 students aged 12 to 22, as well as with 20 or more in-depth interviews during the period 2018–19. The project is also developing a set of materials for the training and self-training of users and educators who want to work with advanced storytelling making use of digital formats. This will be hosted on its own open-access online platform by providing a downloadable kit with step-by-step instructions, references and examples, along with an independent course that can be taken autonomously, including examples, theoretical contents and self-assessment exercises. Effects are expected in the entire field of education, both formal and non-formal.
Winding numbers and full extendibility in holomorphic motions
Authors: Jiang Yunping
Published: May 2020

We construct an example of a holomorphic motion of a five-point subset of the Riemann sphere over an annulus such that it satisfies the zero winding number condition but is not fully extendable.
Through Scandinavia, Darkly: A Criminological Critique of Nordic Noir
Authors: Hayward Keith J , Hall Steve
Published: May 2020

Nordic noir is a popular crime genre associated with a region (Scandinavia), a narrative style (unpretentious/socially critical) and a particular aesthetic look (dark/foreboding). Renowned for its psychologically complex characterization and gloomy Mise-en-scène, and spanning best-selling crime fiction, film, and globally successful television drama, Nordic noir has mushroomed from regional niche market to international phenomenon in little more than a decade. A review of both popular and academic accounts of the genre suggest that much of Nordic noir’s appeal comes from its supposed ‘gritty’ or ‘realist’ account of Scandinavian society. This paper, however, adopts a different perspective. Drawing on cultural criminology, ultra-realism and Lacanian psychoanalytic theory, we argue that, rather than accurately reflecting the complex social and political problems currently confronting late modern Scandinavian welfare societies, Nordic noir has lost its grip on realism and any meaningful association with actual/established Scandinavian values. Instead, Nordic noir is now functioning as a displacement narrative, a form of cultural expression that allows artists, producers and their audiences to push the region’s social problems outside the realm even of the Imaginary.
Overarching Principles and Dimensions of the Functional Organization in the Inferior Parietal Cortex
Authors: Humphreys Gina F , Jackson Rebecca L , Lambon Ralph Matthew A
Published: May 2020

The parietal cortex (PC) is implicated in a confusing myriad of different cognitive processes/tasks. Consequently, understanding the nature and organization of the core underlying neurocomputations is challenging. According to the Parietal Unified Connectivity-biased Computation model, two properties underpin PC function and organization. Firstly, PC is a multidomain, context-dependent buffer of time- and space-varying input, the function of which, over time, becomes sensitive to the statistical temporal/spatial structure of events. Secondly, over and above this core buffering computation, differences in long-range connectivity will generate graded variations in task engagement across subregions. The current study tested these hypotheses using a group independent component analysis technique with two independent functional magnetic resonance imaging datasets (task and resting state data). Three functional organizational principles were revealed: Factor 1, inferior PC was sensitive to the statistical structure of sequences for all stimulus types (pictures, sentences, numbers); Factor 2, a dorsal–ventral variation in generally task-positive versus task-negative (variable) engagement; and Factor 3, an anterior–posterior dimension in inferior PC reflecting different engagement in verbal versus visual tasks, respectively. Together, the data suggest that the core neurocomputation implemented by PC is common across domains, with graded task engagement across regions reflecting variations in the connectivity of task-specific networks that interact with PC.
New-onset atrial fibrillation: incidence, characteristics, and related events following a national COVID-19 lockdown of 5.6 million people
Authors: Holt Anders , Gislason Gunnar H , Schou Morten , Zareini Bochra , Biering-Sørensen Tor , Phelps Matthew , Kragholm Kristian , Andersson Charlotte , Fosbøl Emil L , Hansen Morten Lock , Gerds Thomas A , Køber Lars , Torp-Pedersen Christian , Lamberts Morten
Published: May 2020

Aim

To determine the incidence, patient characteristics, and related events associated with new-onset atrial fibrillation (AF) during a national COVID-19 lockdown.

Methods and results

Using nationwide Danish registries, we included all patients, aged 18–90 years, receiving a new-onset AF diagnosis during the first 3 months of 2019 and 2020. The main comparison was between patients diagnosed during lockdown (12 March 12–1 April 2020) and patients diagnosed in the corresponding period 1 year previously. We found a lower incidence of new-onset AF during the 3 weeks of lockdown compared with the corresponding weeks in 2019 [incidence rate ratios with 95% confidence intervals (CIs) for the 3 weeks: 0.66 (0.56–0.78), 0.53 (0.45–0.64), and 0.41 (0.34–0.50)]. There was a 47% drop in total numbers (562 vs. 1053). Patients diagnosed during lockdown were younger and with a lower CHA2DS2-VASc score, while history of cancer, heart failure, and vascular disease were more prevalent. During lockdown, 30 (5.3%) patients with new-onset AF suffered an ischaemic stroke and 15 (2.7%) died, compared with 45 (4.3%) and 14 (1.3%) patients during the corresponding 2019 period, respectively. The adjusted odds ratio of a related event (ischaemic stroke or all-cause death) during lock-down compared with the corresponding weeks was 1.41 (95% CI 0.93–2.12).

Conclusions

Following a national lockdown in Denmark, a 47% drop in registered new-onset AF cases was observed. In the event of prolonged or subsequent lockdowns, the risk of undiagnosed AF patients developing complications could potentially translate into poorer outcomes in patients with AF during the COVID-19 pandemic.
Late gadolinium enhancement role in arrhythmic risk stratification of patients with LMNA cardiomyopathy: results from a long-term follow-up multicentre study
Authors: Peretto Giovanni , Barison Andrea , Forleo Cinzia , Di Resta Chiara , Esposito Antonio , Aquaro Giovanni Donato , Scardapane Arnaldo , Palmisano Anna , Emdin Michele , Resta Nicoletta , Santoni Anna , Guaricci Andrea Igoren , Santobuono Vincenzo Ezio , Pepe Martino , Favale Stefano , Ferrari Maurizio , Benedetti Sara , Della Bella Paolo , Sala Simone
Published: May 2020

Aims

We aimed at addressing the role of late gadolinium enhancement (LGE) in arrhythmic risk stratification of LMNA-associated cardiomyopathy (CMP).

Methods and results

We present data from a multicentre national cohort of patients with LMNA mutations. Of 164 screened cases, we finally enrolled patients with baseline cardiac magnetic resonance (CMR) including LGE sequences [n = 41, age 35 ± 17 years, 51% males, mean left ventricular ejection fraction (LVEF) by echocardiogram 56%]. The primary endpoint of the study was follow-up (FU) occurrence of malignant ventricular arrhythmias [MVA, including sustained ventricular tachycardia (VT), ventricular fibrillation, and appropriate implantable cardioverter-defibrillator (ICD) therapy]. At baseline CMR, 25 subjects (61%) had LGE, with non-ischaemic pattern in all of the cases. Overall, 23 patients (56%) underwent ICD implant. By 10 ± 3 years FU, eight patients (20%) experienced MVA, consisting of appropriate ICD shocks in all of the cases. In particular, the occurrence of MVA in LGE+ vs. LGE− groups was 8/25 vs. 0/16 (P = 0.014). Of note, no significant differences between LGE+ and LGE− patients were found in currently recognized risk factors for sudden cardiac death (male gender, non-missense mutations, baseline LVEF <45% and non-sustained VT), all P-value >0.05.

Conclusions

In LMNA-CMP patients, LGE at baseline CMR is significantly associated with MVA. In particular, as suggested by this preliminary experience, the absence of LGE allowed to rule-out MVA at 10 years mean FU.
The Restructuring of the British Empire and the Colonization of Australia, 1832–8
Authors: Lester Alan , Vanderbyl Nikita
Published: May 2020

Analysing a comprehensive shift in the governance of the British Empire in the mid 1830s, this article introduces the context for the following three articles in the Feature, ‘Legacies of Slave Ownership’. This shift included the abolition of slavery in the Caribbean, upon which these articles concentrate, but also the restructuring of the East India Company. A reformed British parliament introduced transitions in the western and eastern halves of the Empire in a concentrated burst of legislation between 1833 and 1838. While vested interests were protected, not least by facilitating a surge in the colonization of Australia, the transition produced the template of a liberal Empire.
Ingredients to become a scientist: curiosity, enthusiasm, perseverance, opportunity, and a good pinch of luck
Authors: Meyer-Rochow Victor Benno
Published: May 2020

Writing a 200-word abstract about the life of a 76-year-old scientist, in which luck played a significant role, is not an easy task. Even knowing this scientist well (for I am talking about myself) does not make it any easier. When you notice something is not right, do not fear changing your major (I changed twice before settling on Fisheries and Marine Science). For my PhD in neurobiology, I changed again. Grab opportunities when they arise. Join field trips and expeditions, attend conferences, and spread your interests widely. Spend time in different countries, learn new techniques and languages, and always stay curious. Remain humble. I carried out speleological research in Jamaica and France, participated in a 4-month South Atlantic Fisheries Research Trip and a 3-month Bioluminescence Expedition to the Moluccas, and pioneered comparative physiological and functional anatomical research in Antarctica and the Arctic. Be adventurous. My ethnobiological field work took me to Papua Niugini, NE-India, and Central Australia. Having lived in Australia, Finland, France, Germany, Jamaica, Japan, and New Zealand (I am a New Zealander currently living in Korea) and having spent sabbaticals in Brazil, India, New Caledonia, and North Korea, I consider myself a global scientist. You can become one too.
Does parental farm upbringing influence the risk of asthma in offspring? A three-generation study
Authors: Timm Signe , Svanes Cecilie , Frydenberg Morten , Sigsgaard Torben , Holm Mathias , Janson Christer , Bråbäck Lennart , Campbell Brittany , Kjaer Madsen Marie , Jõgi Nils Oskar , Jõgi Rain , Schiöler Linus , Bertelsen Randi Jacobsen , Johannessen Ane , Sanchez-Ramos Jose Luis , Martinez-Moretalla Jesus , Dratva Julia , Dharmage Shyamali , Schlünssen Vivi
Published: May 2020

Background

A farm upbringing has been associated with lower risk of asthma and methylation of asthma-related genes. As such, a farm upbringing has the potential to transfer asthma risk across generations, but this has never been investigated. We aimed to study the generational effects from a parental farm upbringing on offspring asthma.

Methods

Our study involved three generations: 5759 participants from the European Community Respiratory Health Survey (ECRHS) study (born 1945–1971, denoted G1), their 9991 parents (G0) and their 8260 offspring (G2) participating in RHINESSA (Respiratory Health In Northern Europe, Spain and Australia). Questionnaire data were collected on G0 and G1 from G1 in 2010 and on G2 from themselves in 2013. The parental/grandparental place of upbringing was categorized: (i) both parents from farm; (ii) mother from farm, father from village/city; (iii) father from farm, mother from village/city; (iv) both parents from village or one parent from village and one from city; (v) both parents from city (reference group). Grandparental upbringing was equivalently categorized. Offspring asthma was self-reported and data were analysed using Cox-regression models with G2 age as the time scale.

Results

A parental farm upbringing was not associated with offspring asthma when compared with city upbringing [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.74–1.69]. Findings remained similar when stratified by offspring upbringing and asthma phenotypes. Quantitative bias analyses showed similar estimates for alternative data sources. A grandparental farm upbringing was not associated with offspring asthma in either the maternal (HR 1.05, 95% CI 0.67–1.65) or paternal line (HR 1.02, 95% CI 0.62–1.68).

Conclusions

This multigenerational analysis suggests no evidence of an association between parental/grandparental farm upbringing and offspring asthma.
Remdesivir (GS-5734) Is Efficacious in Cynomolgus Macaques Infected With Marburg Virus
Authors: Porter Danielle P , Weidner Jessica M , Gomba Laura , Bannister Roy , Blair Christiana , Jordan Robert , Wells Jay , Wetzel Kelly , Garza Nicole , Van Tongeren Sean , Donnelly Ginger , Steffens Jesse , Moreau Alicia , Bearss Jeremy , Lee Eric , Bavari Sina , Cihlar Tomas , Warren Travis K
Published: May 2020

Marburg virus (MARV) is a filovirus with documented human case-fatality rates of up to 90%. Here, we evaluated the therapeutic efficacy of remdesivir (GS-5734) in nonhuman primates experimentally infected with MARV. Beginning 4 or 5 days post inoculation, cynomolgus macaques were treated once daily for 12 days with vehicle, 5 mg/kg remdesivir, or a 10-mg/kg loading dose followed by 5 mg/kg remdesivir. All vehicle-control animals died, whereas 83% of animals receiving a 10-mg/kg loading dose of remdesivir survived, as did 50% of animals receiving a 5-mg/kg remdesivir regimen. Remdesivir-treated animals exhibited improved clinical scores, lower plasma viral RNA, and improved markers of kidney function, liver function, and coagulopathy versus vehicle-control animals. The small molecule remdesivir showed therapeutic efficacy in this Marburg virus disease model with treatment initiation 5 days post inoculation, supporting further assessment of remdesivir for the treatment of Marburg virus disease in humans.
Sustained transmission of the ceftriaxone-resistant Neisseria gonorrhoeae FC428 clone in China
Authors: Chen Shao-Chun , Yuan Liu-Feng , Zhu Xiao-Yu , van der Veen Stijn , Yin Yue-Ping
Published: May 2020

Background

Ceftriaxone resistance in Neisseria gonorrhoeae has become an imminent threat to effective control of gonorrhoea globally. In recent years, the ceftriaxone-resistant FC428 clone has shown international dissemination. After our first report of the FC428 clone in China in 2016, we now describe another six cases of FC428-related ceftriaxone-resistant N. gonorrhoeae isolates from 2017 and 2018.

Objectives

To identify the phenotypic and molecular characteristics of newly reported ceftriaxone-resistant isolates in China and to investigate the relationship between these isolates and FC428 clones reported globally.

Methods

Antimicrobial susceptibility to ceftriaxone, cefixime, azithromycin, spectinomycin, penicillin, ciprofloxacin and tetracycline was determined by the agar dilution method. N. gonorrhoeae multi-antigen sequence typing (NG-MAST), MLST and N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) were performed for genotyping and SNPs extracted from whole-genome sequences were used for phylogenetic analysis.

Results

All isolates were resistant to ceftriaxone, cefixime, penicillin, tetracycline and ciprofloxacin, but were susceptible to azithromycin and spectinomycin. NG-MAST, MLST and NG-STAR genotyping showed that all isolates shared identical or similar STs (<10 bp difference) to FC428 (NG-MAST ST3435, MLST ST1903, NG-STAR ST233) and contained the same mosaic penA allele 60.001. Phylogenetic analysis showed the Chinese isolates spreading in the whole phylogenetic tree and fully mixed with other international isolates. Half of the Chinese isolates were more closely related (<100 SNPs) to Japanese isolates than other international isolates.

Conclusions

The newly reported cases in China were related to the internationally spreading FC428 clone. These isolates might have played a central role in international transmission of the FC428 clone. High ceftriaxone doses (1–2 g) still provide effective therapy.
The Right to an Effective Defence During ECCC Investigations
Authors: Sluiter Göran , Tiernan Marc
Published: May 2020

The present article seeks to explore and discuss to what extent the position of the defence in the course of investigations before the Extraordinary Chambers in the Courts of Cambodia (ECCC) is in conformity with fair trial norms and sufficiently robust to ensure high-quality fact-finding. After recalling the general features and structure of the ECCC proceedings at the pre-trial stage, the authors critically assess how the inquisitorial imprint given to the ECCC investigation phase has ultimately affected the rights of the suspects and accused to an effective defence.
High sensitivity X-ray analysis for a low accelerating voltage scanning electron microscope using a transition edge sensor
Authors: Tanaka Keiichi , Takano Akira , Nagata Atsushi , Nakayama Satoshi , Takahashi Kaname , Ajima Masahiko , Obara Kenji , Chinone Kazuo
Published: May 2020

A scanning electron microscope transition edge sensor has been developed to analyze the minor or trace constituents contained in a bulk sample and small particles on the sample under a low accelerating voltage (typically <3 keV). The low accelerating voltage enables to improve the spatial analysis resolution because the primary electron diffusion length is limited around the sample surface. The characteristic points of our transition edge sensor are 1) high-energy resolution at 7.2 eV@Al-Kα, 2) continuous operation by using a cryogen-free dilution refrigerator and 3) improvement of transmission efficiency at B-Kα by using thin X-ray film windows between the sample and detector (about 30 times better than our previous system). Our system could achieve a stabilization of the peak shift at Nd-Mα (978 eV) within 1 eV during an operation time of 27 000 s. The detection limits with B-Kα for detection times 600 and 27 000 s were 0.27 and 0.038 wt%, respectively. We investigated the peak separation ability by measuring the peak intensity ratio between the major constitute (silicon) and the minor constitute (tungsten) because the Si-Kα line differs from the W-Mα line by only 35 eV and a small W-Mα peak superimposed on the tail of the large Si-Kα peak. The peak intensity ratio (I(W-Mα)/I(Si-Kα)) was adjusted by the W particle area ratio compared with the Si substrate area. The transition edge sensor could clearly separate the Si-Kα and W-Mα lines even under a peak intensity ratio of 0.01.
Spontaneous massive duodenal perforation after ovarian cancer treatment with bevacizumab
Authors: Karanikas Michael , Kofina Konstantinia , Potolidis Dimitrios , Foutzitzi Soultana , Deftereos Savas , Effraemidou Eleni , Lyratzopoulos Nikolaos
Published: May 2020

Bevacizumab has been used as an effective drug for ovarian cancer. However, serious adverse effects, such as gastrointestinal perforation, can occur. Spontaneous gastrointestinal perforation is an uncommon, yet life-threatening complication related to bevacizumab administration. We present the case of a 65-year-old Caucasian female who presented with acute abdomen 10 days after the first administration of bevacizumab for ovarian cancer treatment, and she was diagnosed intraoperatively with a massive duodenal perforation. Bowel perforation after bevacizumab administration is a serious and potentially lethal complication. Careful follow-up of the patients is necessary in order to detect any signs of this condition in time.
Merger rate density of binary black holes formed in open clusters
Authors: Kumamoto Jun , Fujii Michiko S , Tanikawa Ataru
Published: May 2020

Several binary black holes (BBHs) have been observed using gravitational wave detectors. For the formation mechanism of BBHs, two main mechanisms, isolated binary evolution and dynamical formation in dense star clusters, have been suggested. Future observations are expected to provide more information about BBH distributions, and it will help us to distinguish the two formation mechanisms. For the star cluster channel, globular clusters have mainly been investigated. However, recent simulations have suggested that BBH formation in open clusters is not negligible. We estimate a local merger rate density of BBHs originated from open clusters using the results of our N-body simulations of open clusters with four different metallicities. We find that the merger rate per cluster is the highest for our 0.1 solar metallicity model. Assuming a cosmic star formation history and a metallicity evolution with dispersion, we estimate the local merger rate density of BBHs originated from open clusters to be ∼70 yr−1 Gpc−3. This value is comparable to the merger rate density expected from the first and second observation runs of LIGO and Virgo. In addition, we find that BBH mergers obtained from our simulations can reproduce the distribution of primary mass and mass ratio of merging BBHs estimated from the LIGO and Virgo observations.
Influence of modification of gravity on the complexity factor of static spherical structures
Authors: Yousaf Z , Khlopov Maxim Yu , Bhatti M Z , Naseer T
Published: May 2020

The aim of this paper is to generalize the definition of complexity for the static self-gravitating structure in f (R, T, Q) gravitational theory, where R is the Ricci scalar, T is the trace part of energy–momentum tensor, and Q ≡ RαβT αβ. In this context, we have considered locally anisotropic spherical matter distribution and calculated field equations and conservation laws. After the orthogonal splitting of the Riemann curvature tensor, we found the corresponding complexity factor with the help of structure scalars. It is seen that the system may have zero complexity factor if the effects of energy density inhomogeneity and pressure anisotropy cancel the effects of each other. All of our results reduce to general relativity on assuming f (R, T, Q) = R condition.
Improving the prediction accuracy of protein abundance in Escherichia coli using mRNA accessibility
Authors: Terai Goro , Asai Kiyoshi
Published: May 2020

RNA secondary structure around translation initiation sites strongly affects the abundance of expressed proteins in Escherichia coli. However, detailed secondary structural features governing protein abundance remain elusive. Recent advances in high-throughput DNA synthesis and experimental systems enable us to obtain large amounts of data. Here, we evaluated six types of structural features using two large-scale datasets. We found that accessibility, which is the probability that a given region around the start codon has no base-paired nucleotides, showed the highest correlation with protein abundance in both datasets. Accessibility showed a significantly higher correlation (Spearman’s ρ = 0.709) than the widely used minimum free energy (0.554) in one of the datasets. Interestingly, accessibility showed the highest correlation only when it was calculated by a log-linear model, indicating that the RNA structural model and how to utilize it are important. Furthermore, by combining the accessibility and activity of the Shine-Dalgarno sequence, we devised a method for predicting protein abundance more accurately than existing methods. We inferred that the log-linear model has a broader probabilistic distribution than the widely used Turner energy model, which contributed to more accurate quantification of ribosome accessibility to translation initiation sites.
Delivery Hospital Characteristics and Postpartum Maternal Mortality: A National Case-Control Study in France
Authors: Saucedo M. , Bouvier-Colle M.H. , Blondel B. , Bonnet M.P. , Deneux-Tharaux C.
Published: May 2020

(Anesth Analg. 2020;130:52–62)

While obstetric care providers are always focused on ensuring the best outcomes for their patients, not much empirical evidence is available to illustrate how a hospital’s organizational structure can affect maternal and neonatal outcomes. Research has shown that premature infants who are transferred to specialty centers experience better health outcomes, but there is variability in how facilities classify maternal risk factors that would indicate a need for preterm delivery. This inconsistency in procedure presents a number of maternal health risks, and so Saucedo and colleagues conducted their study to determine how a hospital’s organizational characteristics affect the risk of postpartum maternal death.
National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria Are Associated With Maternal Morbidity
Authors: Arnolds D.E. , Smith A. , Banayan J.M. , Holt R. , Scavone B.M.
Published: May 2020

(Anesth Analg. 2019;129:1621–1626)

Maternal mortality and severe obstetric morbidity in the United States are increasing by substantial rates. From 1987 to 2010, mortality increased to near 75%, and severe morbidity increased by a similar rate. Many maternal deaths are due to a delayed response to clinical warning signs. It is estimated close to half of maternal deaths attributed to provider factors are preventable. Therefore, vital sign (VS) triggers were proposed as components of early warning systems in the obstetric population. The maternal early warning criteria (MEWC) were created by The National Partnership for Maternal Safety (NPMS) to identify pregnant women at risk for morbidity and mortality. It is a single parameter system in which triggering any criterion prompts bedside evaluation. The goal of this study was to evaluate the relationship between the MEWC and subsequent maternal morbidity and mortality
Spinal Tranexamic Acid—A New Killer in Town
Authors: Palanisamy A. , Kinsella S.M.
Published: May 2020

(Anaesthesia. 2019;74:831–833)

Tranexamic acid has become an important component in the management of postpartum hemorrhage since the WOMAN trial was published in 2017. A recent article by Patel and colleagues identified 21 case reports of accidental spinal administration of tranexamic acid, with several occurring in women receiving spinal anesthesia for cesarean delivery. These drug errors resulted in a mortality rate >50% and permanent neurological injuries in many survivors.
Prevalence and Main Outcomes of Placenta Accreta Spectrum: A Systematic Review and Meta-analysis
Authors: Jauniaux E. , Bunce C. , Grønbeck L. , Langhoff-Roos J.
Published: May 2020

(Am J Obstet Gynecol. 2019;221:208–218)

Placenta accreta spectrum occurs when the villous tissue of the placenta adheres or invades the uterine wall, at times even connecting surrounding pelvic organs and vasculature. During delivery, these adherent villi result in either parts or the entire placenta failing to detach spontaneously from the uterine wall. Access to specialist centers, blood banks, and neonatal and maternal intensive care is inconsistent in some high-income countries and often restricted or nonexistent in most low- and middle-income countries. This study was a systematic review and meta-analysis evaluating the prevalence of placenta accreta spectrum in studies of the general population. Specifically the authors evaluated the heterogeneity across studies in clinical diagnostic criteria reporting to assess the impact on incidence of maternal outcomes.
Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case-Control Study
Authors: Bauer M.E. , Housey M. , Bauer S.T. , Behrmann S. , Chau A. , Clancy C. , Clark E.A.S. , Einav S. , Langen E. , Leffert L. , Lin S. , Madapu M. , Maile M.D. , McQuaid-Hanson E. , Priessnitz K. , Sela H.Y. , Shah A. , Sobolewski P. , Toledo P. , Tsen L.C. , Bateman B.T.
Published: May 2020

(Anesth Analg. 2019;129:1613–1620)

Sepsis is the third leading cause of maternal morbidity and mortality, making up ∼12.7% of pregnancy-related deaths. Early identification and prompt treatment of patients can improve maternal outcomes. However, it is difficult to diagnose sepsis in pregnancy because physiological changes of pregnancy can mimic the signs of sepsis. The quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) criteria, systemic inflammatory response syndrome (SIRS) criteria, and the maternal early warning (MEW) criteria all provide different screening methods that may be useful, but their validity for the identification of early sepsis in pregnancy are unknown. Therefore, the primary objective of this multicenter case-control study was to evaluate the performance characteristics of the SIRS, qSOFA, and MEW criteria for identifying cases of early maternal sepsis during perinatal hospitalization. In addition, the authors sought to identify which of the 3 screening criteria is best used in maternal sepsis.
Maternal Short-term Complications After Planned Cesarean Delivery Without Medical Indication: A Registry-based Study
Authors: Otkjær A.M. , Jørgensen H.L. , Clausen T.D. , Krebs L.
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:905–912)

In Denmark, the cesarean delivery rate increased from 12.8% in 1996 to 20.8% in 2006. Since then the rate has stabilized to ∼20%. Many hospitals in Denmark have been striving to reduce cesarean delivery rates, based on the belief that there are higher rates of maternal complications with cesarean delivery compared with vaginal delivery. However, whether the rate of complications for healthy women requesting a planned cesarean delivery (PCD) without medical indication is actually increased has been called into question. This large, retrospective, population-based cohort study used the Danish Medical Birth Registry to compare short-term maternal outcomes between PCD and planned vaginal delivery (PVD) in term, low-risk women.
Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data
Authors: Glance L.G. , Hasley S. , Glantz J.C. , Stevens T.P. , Faden E. , Kreso M.A. , Pyne S.G. , Wissler R.N. , Fichter J. , Gloff M.S. , Dick A.W.
Published: May 2020

(Anesthesiology. 2019;131:238–253)

In recent years, complications after childbirth have become more prevalent, and the quality of obstetric care throughout the United States is uneven. By reporting risk-adjusted maternal and neonatal outcomes, hospitals may be provided with feedback, and quality of care can be evaluated. This study used administrative and birth data to develop a risk-adjusted composite outcome of severe maternal morbidity and severe newborn morbidity.
Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes
Authors: Corsi D. , Walsh L. , Weiss D. , Hsu H. , El-Chaar D. , Hawken S. , Fell D. , Walker M.
Published: May 2020

(JAMA. 2019;322:145–152)

The rate of cannabis use among pregnant women in Canada was 2% in 2017. With recent legalization, it is anticipated that cannabis use among pregnant women will continue to rise. Cannabinoids can cross the placenta and enter the fetal blood supply. Previous studies have demonstrated a relationship between pregnant mothers who use cannabinoids and increased incidence of low birth weight, small for gestational age (SGA), stillbirth, and admission to neonatal intensive care. The aim of this study was to evaluate associations between reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes.
Racial and Ethnic Inequities in Postpartum Pain Evaluation and Management
Authors: Johnson J.D. , Asiodu I.V. , McKenzie C.P. , Tucker C. , Tully K.P. , Bryant K. , Verbiest S. , Stuebe A.M.
Published: May 2020

(Obstet Gynecol. 2019;134:1155–1162)

Racial disparities in perinatal outcomes have been extensively researched, but discrepancies in health care and health outcomes among black women and neonates still remain. One nonobstetric example of racial disparity in medical care is the inconsistency of narcotic pain medication administered to white patients and black patients who present with migraines or back pain in emergency departments. The current investigators conducted their study to assess whether obstetric care given at a tertiary academic medical center in North Carolina was inequitable between minority patients and white patients based on the frequency of pain assessment and how patients’ postcesarean pain was treated.
Hyperoxygenation in Pregnancy Exerts a More Profound Effect on Cardiovascular Hemodynamics Than is Observed in the Nonpregnant State
Authors: McHugh A. , El-Khuffash A. , Bussmann N. , Doherty A. , Franklin O. , Breathnach F.
Published: May 2020

(Am J Obst Gynecol. 2019;220:397.e1–397.e8)

Supplemental oxygen, or hyperoxygenation, in the pregnant population is used in a number of clinical scenarios. Studies have shown that maternal hyperoxygenation (MHO2) improves fetal oxygen levels and fetal heart rate (FHR) patterns. Yet, we lack data to demonstrate improvement in maternal and neonatal outcomes with this therapy. Despite wide use of hyperoxygenation in obstetric practice, there is also no clear guidance on indication, dose range, duration, and benefit. This study aimed to compare the effect of hyperoxygenation on cardiac index, systemic vascular resistance (SVR), stroke volume, blood pressure, and heart rate in third trimester pregnant women to the hemodynamic effects of hyperoxygenation in nonpregnant women.
The Importance of Nontechnical Performance for Teams Managing Postpartum Hemorrhage: Video Review of 99 Obstetric Teams
Authors: Brogaard L. , Kierkegaard O. , Hvidman L. , Jensen K. , Musaeus P. , Uldbjerg N. , Manser T.
Published: May 2020

(BJOG. 2019;126:1015–1023)

Major postpartum hemorrhage contributes to almost a quarter of worldwide maternal deaths. Effective management and team collaboration could reduce mortality. Competencies supporting successful performance of teams during time-critical and stressful moments are referred to as nontechnical skills. During postpartum hemorrhage, lacking skills of communication, teamwork, leadership, and decision-making can contribute to adverse events. This study aimed to analyze videos of obstetric teams managing actual patients with major postpartum hemorrhage.
Severe Maternal Morbidity During Delivery Hospitalization in a Large International Administrative Database, 2008-2013: A Retrospective Cohort
Authors: Lipkind H.S. , Zuckerwise L.C. , Turner E.B. , Collins J.J. , Campbell K.H. , Reddy U.M. , Illuzi J.L. , Merriam A.A.
Published: May 2020

(BJOG. 2019;126:1223–1230)

Despite programs to improve maternal health, maternal mortality in the United States has increased over the past few decades. Other developed countries such as England and Australia, by contrast, have decreasing rates. As the incidence of maternal morbidity increases, evaluating cases of severe maternal morbidity (SMM) functions as a proxy for risk factors of mortality. This study aimed to utilize Centers for Disease Control and Prevention (CDC) SMM diagnostic codes to examine SMM rates in the United States, England, and Australia in the Dr Fosters Global Comparators Project (GC).
Isoniazid Preventive Therapy in HIV-Infected Pregnant and Postpartum Women
Authors: Gupta A. , Montepiedra G. , Aaron L. , Theron G. , McCarthy K. , Bradford S. , Chipato T. , Vhembo T. , Stranix-Chibanda L. , Onyango-Makumbi C. , Masheto G.R. , Violari A. , Mmbaga B.T. , Aurpibul L. , Bhosale R. , Mave V. , Rouzier V. , Hesseling A. , Shin K. , Zimmer B. , Costello D. , Sterling T.R. , Chakhtoura N. , Jean-Philippe P. , Weinberg A.
Published: May 2020

(N Engl J Med. 2019;381:1333–1346)

Among persons with human immunodeficiency virus (HIV) infection who reside in low-income and middle-income countries, tuberculosis (TB) is the leading cause of health complications and death. Among women, TB predominantly affects those of reproductive age. When developing during pregnancy or the early postpartum period, TB is associated with adverse maternal, pregnancy, and infant outcomes. While consensus exists for the net benefit of treating TB during pregnancy, safety and efficacy data are lacking regarding isoniazid (INH) preventive therapy in pregnant women who are receiving antiretroviral therapy (ART).
Serious Adverse Events Attributed to Remifentanil Patient-controlled Analgesia During Labour in The Netherlands
Authors: Logtenberg S.L.M. , Vink M.L. , Godfried M.B. , Beenakkers I.C.M. , Schellevis F.G. , Mol B.W. , Verhoeven C.J.
Published: May 2020

(Int J Obstet Anesth. 2019;39:22–28)

Although epidural analgesia remains the preferred method of labor analgesia, remifentanil patient-controlled analgesia (PCA) is a popular alternative due to its quick onset and rapid metabolic properties. Remifentanil PCA has been used in Europe for several years, but its safety has been questioned by some due to concerns about potential serious side effects, such as respiratory depression for both mother and neonate. Since the current rate of serious adverse events (SAEs) connected to remifentanil PCA use during labor is unknown, the current investigators conducted this study to measure the frequency of SAEs, as well as examine the clinical circumstances associated with SAEs and the management of those events.
Remifentanil Patient-controlled Intravenous Analgesia During Labour: A Retrospective Observational Study of 10 Years’ Experience
Authors: Murray H. , Hodgkinson P. , Hughes D.
Published: May 2020

(Int J Obstet Anesth. 2019;39:29–34)

Remifentanil patient-controlled analgesia (PCA) has been an analgesic option for labor on several obstetric units for 15 to 20 years. It is not as efficacious as epidural analgesia for providing pain relief during labor, but it is considered to have a satisfactory analgesic effect. However, there have been reports of respiratory arrest in obstetric patients receiving remifentanil PCA. The current investigators routinely offer remifentanil for labor analgesia at their institution. They conducted this retrospective study to determine delivery outcomes in women receiving remifentanil PCA compared with women receiving intramuscular (IM) diamorphine or epidural analgesia.
Dural Puncture Epidural Analgesia for Labor: A Randomized Comparison Between 25 and 27 G Pencil Point Spinal Needles
Authors: Contreras F. , Morales J. , Bravo D. , Layera S. , Jara A. , Riaño C. , Pizarro R. , De La Fuente N. , Aliste J. , Finlayson R. , Tran D.
Published: May 2020

(Reg Anesth Pain Med. 2019;44:750–753)

Dural puncture epidural analgesia (DPEA) is the technique of passing a small gauge spinal needle through a Tuohy needle located in the epidural space to create a hole in the dura. Following the creation of this hole, the spinal needle is withdrawn without injection of intrathecal medication, and a catheter is placed within the epidural space. DPEA performed with 25 and 26 G pencil point spinal needles have demonstrated shorter onset time and improved sacral blockade compared with the traditional epidural technique; however, a large prospective trial demonstrated an increased incidence of postdural puncture headache (PDPH) after using a 25 G compared with a 27 G needle. Thus, the goal of this study was to compare DPEA using 25 and 27 G pencil point spinal needles. The primary outcome was onset time, which was defined as the temporal interval required after catheter placement to obtain a pain score ≤1 using a 0 to 10 Numeric Rating Scale.
A Randomized Controlled Trial of Phenylephrine and Noradrenaline Boluses for Treatment of Postspinal Hypotension During Elective Caesarean Section
Authors: Mohta M. , Garg A. , Chilkoti G.T. , Malhotra R.K.
Published: May 2020

(Anaesthesia. 2019;74:850–855)

Phenylephrine is the preferred vasopressor for treating spinal-induced hypotension during cesarean delivery due to its rapid onset, short duration of action, and lack of adverse effects on fetal acid-base status. However, norepinephrine is often used in critical care settings, especially in patients with septic shock, and may be less likely than phenylephrine to cause bradycardia. Although several studies have been conducted in recent years on the use of norepinephrine for the treatment and prevention of spinal-induced hypotension during cesarean delivery, there are limited data comparing phenylephrine and norepinephrine in terms of safety, efficacy, neonatal outcomes, and side effects. This study aimed to compare the rate of maternal bradycardia between the 2 drugs when administered as intravenous boluses to treat hypotension during elective cesarean delivery with spinal anesthesia.
Dexmedetomidine for Every Cesarean Delivery … Maybe Not?
Authors: Bautista L. , George R.
Published: May 2020

(Can J Anesth/J Can Anesth. 2019;66:751–754)

Perioperative shivering is a commonly observed clinical problem for women undergoing cesarean delivery (CD). The median incidence of shivering in patients having a CD with epidural or spinal anesthesia is estimated to be 52%. Previous studies have analyzed pharmacologic agents such as meperidine, butorphanol, clonidine, fentanyl, tramadol, and dexmedetomidine and their ability to reduce shivering following neuraxial anesthesia. However, side effects including nausea, hypotension, vomiting, and excessive sedation limit the utility of these agents.
Successful Recovery From a Delayed Amniotic Fluid Embolism
Authors: Guo F. , Yan Z. , Zhu Y. , Yu Y.
Published: May 2020

(J Clin Anesth. 2019;56:4–5)

Amniotic fluid embolism (AFE) is a catastrophic syndrome that typically occurs during labor and delivery. Most cases occur during labor (70%), but it can also occur after a vaginal delivery (11%) or a cesarean delivery (19%).
Cervical spine subdural hematoma
Authors: Shearer James Levi , Sciandra Rebecca , Gendron Brett
Published: May 2020

Spinal subdural hematomas (SSDH) are a rare radiographic finding that can lead to significant long-term disability. Many clinicians are unfamiliar with this condition and the available treatment options. This article describes one approach to managing a patient with an SSDH.
Vitamin D, melanoma risk, and tumor thickness in PLCO cancer screening trial patients
Authors: Hyde Mark A. , Grossman Douglas , Wu Yelena P. , Buys Saundra , Gren Lisa H. , Hashibe Mia
Published: May 2020

Objective:

The incidence of melanoma is increasing. Other than limiting UV exposure, few factors prevent or reduce the risk of melanoma. The aim of this study is to evaluate the relationship between vitamin D intake and melanoma risk in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial.

Methods:

A secondary data analysis was performed on PLCO data. More than 1,300 participants developed melanoma.

Results:

Melanoma risk may be increased among men within the highest quartile of vitamin D intake (HR 1.27, 95% CI 0.99, 1.61). Women in the highest quartile of vitamin D intake had a decreased risk of invasive melanoma (HR 0.63, 95% CI 0.41, 0.96). Higher education and being white corresponded with deeper tumors (P < .001).

Conclusion:

High reported vitamin D intake resulted in an increased risk of melanoma among men. Vitamin D intake yielded a protective effect against invasive melanoma in women.
Sex differences in disease activity and efficacy of treatment in spondyloarthritis: is body composition the cause?
Authors: Ibáñez Vodnizza Sebastián , van der Horst-Bruinsma Irene
Published: May 2020

Purpose of review

The body composition and fat distribution is different between men and women, with different levels of circulating adipokines. These differences become more evident when suffering from an inflammatory disease, such as spondyloarthritris. In this review, we will explore the influence of obesity, body composition and adipokines on the differences in disease activity, progression and response to treatment, between men and women with spondyloarthritis.

Recent findings

Obesity, mainly determined by the body fat content, which is higher in women, is related to worse disease activity scores. Men with higher disease activity lose more muscle mass than women. Leptin, which is usually found at higher levels in overweight women, seems to be associated with greater spinal radiographic progression when it rises during the course of the disease. Being a woman and obesity, mainly because of the body fat content, are related to a worse response to TNF-α blockers.

Overlooking biological sex variation in body composition, circulating adipokines and hormonal levels, and the subsequent differences in clinical presentation, may ultimately hamper clinical treatment.