bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Novel Degradable Synthetic Biomaterial Patch for Augmentation of Tendon Healing in a Large Animal Model
Authors: Gersoff Wayne , Bozynski Chantelle , Cook Cristi , Pfeiffer Ferris , Kuroki Keiichi , Cook James
Published: April 2018

Tendon injury is common in sports. The standard of care (SOC) for tendon repair is surgical treatment. However, restored tendons often lack complete strength and functionality, and surgical repair is often unsuccessful. This controlled laboratory study investigates the healing of an Artelon patch (AP)-augmented tendon versus tendon repair alone in a preclinical canine patellar tendon defect model. Full-thickness proximal and distal flap defects were created in the patella tendons of eight purpose-bred research mongrel dogs. Dogs were randomly allocated into either the AP-augmented repair group or the SOC group (N = 8; four knees per group). Outcomes measures included limb function and pain; range of motion (ROM) and ultrasound assessment at 2, 4, and 8 weeks; and measurements of elongation, biomechanical testing, and histology at 8 weeks. Data were compared for statistically significant differences to preoperative measures and between groups (p < 0.05). The AP group had higher limb function scores compared with the SOC group at 2, 4, and 8 weeks, with statistically significant differences observed at 2 weeks (AP: 7.1 ± 1.4, SOC: 5.5 ± 0.4, p < 0.05) and 8 weeks (AP: 9.5 ± 0.7, SOC: 7.0 ± 0.9, p < 0.05). The ROM was significantly higher for the AP group at 4 weeks (AP: 105 degrees ± 4, SOC: 89 degrees ± 5, p < 0.05). Pain scores were statistically significantly lower in the AP group at 4 (AP: 0.6 ± 0.5, SOC: 2.2 ± 0.5) and 8 weeks (p < 0.05 for both comparisons). All animals in the AP group displayed full bridging tissue at week 4, while most animals of the SOC group displayed full bridging by week 8. Minimal tendon elongation was observed in both groups. Significantly more force was required to elongate tendons in the AP group compared with the SOC group (p < 0.05). Animals with AP-augmented tendon repair show an earlier regain of function, earlier regain of range of movement, less postoperative pain, and improved tendon strength when compared with animals treated with tendon repair alone.
Computer Navigation Assisted Total Hip Arthroplasty: Use and Outcomes Compared with Conventional Technique
Authors: Behery Omar , Kester Benjamin , Kouk Shalen , Vigdorchik Jonathan , Schwarzkopf Ran
Published: April 2018

Computer-assisted surgery (CAS) for total hip arthroplasty (THA) was developed to improve the accuracy of component positioning. There is insufficient evidence on CAS THA in terms of early postoperative outcomes and complications. The aim of this study is to determine the time-related trends in computer navigation use and to compare outcomes to conventional technique. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database containing primary THAs from 2008 to 2015 was retrospectively analyzed. Demographics, operative time, postoperative transfusions, hospital length of stay (LOS), wound complications, early reoperation, and readmissions were compared between CAS THA and traditional THA using univariate and multivariable regression analyses. The percent use of navigation in THA within the NSQIP database shows an increasing trend. There were more smokers and patients with higher American Society of Anesthesiologists ratings (p < 0.011) in the traditional THA group. According to multivariable regression, CAS THA was associated with lower postoperative transfusion rate and shorter LOS, but longer operative time (p < 0.001 for all) than traditional THA. Similarly, superficial infections were also lower in that group after controlling confounders (p = 0.028). There were no differences in overall infections, wound dehiscence, return to the operating room, or readmissions. CAS THA appears to be increasingly used over time within this database and is associated with lower transfusion rates, superficial infections, and shorter LOS. However, it may not afford any major advantages in operative time, overall infection rate, early return to the operating room, or early readmissions. These findings should be interpreted in light of potential long-term benefits that may be associated with CAS THA.
Comparison of Mortality and 30-Day Complication Rates for Patients Undergoing Fixation versus Revision Arthroplasty after Periprosthetic Fractures of the Hip and Knee
Authors: Kouk Shalen , Kester Benjamin , Behery Omar , Vigdorchik Jonathan , Schwarzkopf Ran
Published: April 2018

Periprosthetic fractures of the hip and knee are often associated with significant morbidity and mortality and may require operative fixation or revision arthroplasty to restore ambulation and functional status. There is scarce literature comparing patient profiles and operative complications between periprosthetic fractures of the hip/knee and the predisposing risk factors. The main study goal is to compare the postoperative complication rates and mortality between operative osteosynthesis fixation and revision arthroplasty while also evaluating the patient characteristics, intraoperative factors, and 30-day postoperative complications of periprosthetic total hip arthroplasty (THA) and total knee arthroplasty (TKA) fractures, as well as patient-related risk factors for serious adverse events. Patients who underwent surgery for periprosthetic fractures around a THA/TKA prosthesis were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2008 and 2015. Preoperative patient demographics and comorbidities, as well as operative factors and 30-day postoperative complications were compared between periprosthetic factures of the hip and those of the knee. A multivariable logistic regression analysis was used to identify patient risk factors for adverse events. Of 1,171 identified patients, patients with THA and TKA periprosthetic fractures had similar characteristics and were more likely female, with age over 70 years and a body mass index of > 25. Both groups had similar 30-day complication rates, with 9.8% of hip patients and 11.2% of knee patients having a postoperative complication. Mortality rate for THA periprosthetic fracture status postrevision or fixation was 3.6% and 3.3% for those with TKA periprosthetic fractures. There was no significant difference in 30-day mortality or postoperative complication rates in periprosthetic fractures treated with operative osteosynthesis fixation versus revision arthroplasty for THA and TKA. Patients with periprosthetic hip and knee arthroplasty fractures can be effectively managed with either operative osteosynthesis fixation or revision arthroplasty when properly indicated, with no significant difference in mortality, complication, or reoperation rates.
A Fast Track to Hypoalgesia – The Anaerobic Exercise Effect on Pain Sensitivity
Authors: Samuelly-Leichtag Gil , Kodesh Einat , Meckel Yoav , Weissman-Fogel Irit
Published: April 2018

Maximal anaerobic exercise, is a short high intensity effort, involves activation of the hypothalamus-pituitary-adrenal axis, and may suggest hypoalgesic effects. In addition, this exercise-induced muscle pain may contribute to hypoalgesia via the pain inhibits pain phenomenon, which is related to the diffuse noxious inhibitory control (DNIC) mechanism. We aimed to investigate whether: 1) a single bout of 30 s maximal anaerobic exercise has an analgesic effect on experimental pain sensitivity; 2) DNIC is the underlying mechanism of anaerobic exercise-induced hypoalgesia (EIH). Fifty healthy subjects participated. The experimental group performed the ‘Wingate Anaerobic Test’ (WAT) and controls set on the bikes without exercising. Psychophysical tests, performed before and after the intervention, in local and remote areas, included: heat (HPT) and pressure pain thresholds (PPT); suprathreshold heat and cold pain stimulation; the conditioned pain modulation (CPM) paradigm testing the DNIC mechanism. Following WAT, PPT and HPT increased (p<0.001) , pain ratings in response to heat and cold stimuli (p<0.001) and CPM (p=0.029) decreased compared with controls. No correlation was found between muscle pain, blood lactate level and EIH. To conclude WAT induces local and remote analgesic effects. The involvement of central pain modulatory processes with DNIC probably not the underline mechanism of EIH.
An intelligent hybrid short-term load forecasting model optimized by switching delayed PSO of micro-grids
Authors: Deng Buqing , Peng Daogang , Zhang Hao , Qian Yuliang
Published: April 2018

Short-term load forecasting is an important part in the energy management of micro-grids, and the forecasting error directly affects the economic efficiency of operation. Considering the strong randomness and high volatility of loads on the user side of micro-grids, a short-term load forecasting method based on Empirical Mode Decomposition (EMD), Extreme Learning Machine with different Kernels, and Switching Delayed Particle Swarm Optimization (SDPSO) is proposed. First, the history load dataset is decomposed into several independent Intrinsic Mode Functions (IMFs) by EMD, and the sample entropy values of the IMFs are calculated. According to the approximation degree of sample entropy values, the IMFs are divided into three categories. Then, ELM with different kernels is adopted to forecast the three categories. Finally, the prediction results are summed to obtain the final prediction result. SDPSO is used to optimize the relevant parameters in the forecasting model. Three micro-grids with different capacities are used to verify the model, and the experimental results demonstrate that the proposed forecasting model can provide better accuracy than the other two methods. The proposed model can provide practical reference for the efficient operation of micro-grids.
Stochastic scheduling of integrated electricity-heat-hydrogen systems considering power-to-hydrogen and wind power
Authors: Ye Jun , Yuan Rongxiang
Published: April 2018

Wind power is often curtailed due to the strong coupling relationship between power and heat supply of combined heat and power units. Power-to-hydrogen (P2H) is a promising technology to integrate the wind power, by which the surplus wind power can be converted into hydrogen and stored in the hydrogen storage. Then, hydrogen can be not only converted into electricity but also sold to the hydrogen market. The comprehensive utilization of hydrogen can increase the flexibility of the energy system. In this paper, the P2H system considering the sales of hydrogen is modeled and integrated into the stochastic dispatch model of the integrated electricity-heat-hydrogen system. The model considers the constraints of the hydrogen storage, sales of hydrogen, electric power systems, and district heating systems. To verify the feasibility and effectiveness of the proposed method, two case studies are simulated and the results show that P2H systems can improve the wind power integration and reduce the operating cost of the system. The installation location of P2H systems has an impact on the system operation. Moreover, the price of hydrogen will influence the operation of P2H systems.
Broadband photocarrier dynamics and nonlinear absorption of PLD-grown WTe2 semimetal films
Authors: Gao Wenbin , Huang Lei , Xu Jinlong , Chen Yequan , Zhu Chunhui , Nie Zhonghui , Li Yao , Wang Xuefeng , Xie Zhenda , Zhu Shining , Xu Jun , Wan Xiangang , Zhang Chao , Xu Yongbing , Shi Yi , Wang Fengqiu
Published: April 2018

WTe2 is a unique material in the family of transition metal dichalcogenides and it has been proposed as a candidate for type-II Weyl semimetals. However, thus far, studies on the optical properties of this emerging material have been significantly hindered by the lack of large-area, high-quality WTe2 materials. Here, we grow a centimeter-scale, highly crystalline WTe2 ultrathin film (∼35 nm) by a pulsed laser deposition technique. Broadband pump-probe spectroscopy (1.2–2.5 μm) reveals a peculiar ultrafast optical response where an initial photo-bleaching signal (lasting ∼3 ps) is followed by a long-lived photoinduced absorption signature. Nonlinear absorption characterization using femtosecond pulses confirms the saturable absorption response of the WTe2 ultrathin films, and we further demonstrated a mode-locked Thulium fiber laser using a WTe2 absorber. Our work provides important insights into linear and nonlinear optical responses of WTe2 thin films.
Mass-correlated rotational Raman spectra with high resolution, broad bandwidth, and absolute frequency accuracy
Authors: Schröter Christian , Lee Jong Chan , Schultz Thomas
Published: April 2018

Significance

Mass-correlated rotational alignment spectroscopy (mass-CRASY) is a laser spectroscopic method for the simultaneous characterization of molecular composition and rotational structure in a heterogeneous (impure) sample. The present work extends CRASY by referencing the spectroscopic data via a stable laser oscillator frequency to an external clock. Data for carbon disulfide provide mass-selected rotational spectra for multiple isotopologues with significantly improved spectroscopic accuracy compared to preceding measurements.
Complementation of ashamed – diachrony and determinants of variation
Authors: Höglund Mikko
Published: April 2018

The present chapter will contribute to the area of English complementation studies by investigating the adjective ashamed. The study focuses on the diachronic development of the use of ashamed during the past two centuries in different environments, and the variation between two rivalling non-finite complements, to infinitive and of -ing. The data was collected from COHA and COCA. The results show that since the 1870s ashamed has been used less and less, and that it occurs nowadays regularly without a complement whereas in the 19th century the to infinitive complement was common. The of -ing complement is not used much, but some contexts such as negation or copula in the complement clause were observed to attract this complement type.
Application of pulsed electric current in immiscible liquid and droplet processing
Authors: Sultana Shalahin
Published: April 2018

Electromagnetic, chemical and thermo-mechanical processing can be applied to the fabrication of polymeric materials which react to external fields such as stress, temperature, moisture, pH, electric or magnetic fields to optimise properties. In this article, the application of the pulsed electromagnetic field in an immiscible liquid phase is reviewed. The droplet behaviour of polymer emulsion's liquid phases is enriched with significant complex phenomena. In emulsion, droplet break-up, size evolution, coalescence, coarsening, flocculation and interfacial interaction among droplets are assessed as a function of processing.

This review was submitted as part of the 2018 Materials Literature Review Prize of the Institute of Materials, Minerals and Mining run by the Editorial Board of MST. Sponsorship of the prize by TWI Ltd is gratefully acknowledged.
Dysregulation of sphingolipid metabolism contributes to bortezomib-induced neuropathic pain
Authors: Stockstill Katherine , Doyle Timothy M. , Yan Xisheng , Chen Zhoumou , Janes Kali , Little Joshua W. , Braden Kathryn , Lauro Filomena , Giancotti Luigino Antonio , Harada Caron Mitsue , Yadav Ruchi , Xiao Wen Hua , Lionberger Jack M. , Neumann William L. , Bennett Gary J. , Weng Han-Rong , Spiegel Sarah , Salvemini Daniela
Published: April 2018

The development of chemotherapy-induced painful peripheral neuropathy is a major dose-limiting side effect of many chemotherapeutics, including bortezomib, but the mechanisms remain poorly understood. We now report that bortezomib causes the dysregulation of de novo sphingolipid metabolism in the spinal cord dorsal horn to increase the levels of sphingosine-1-phosphate (S1P) receptor 1 (S1PR1) ligands, S1P and dihydro-S1P. Accordingly, genetic and pharmacological disruption of S1PR1 with multiple S1PR1 antagonists, including FTY720, blocked and reversed neuropathic pain. Mice with astrocyte-specific alterations of S1pr1 did not develop neuropathic pain and lost their ability to respond to S1PR1 inhibition, strongly implicating astrocytes as a primary cellular substrate for S1PR1 activity. At the molecular level, S1PR1 engaged astrocyte-driven neuroinflammation and altered glutamatergic homeostasis, processes blocked by S1PR1 antagonism. Our findings establish S1PR1 as a target for therapeutic intervention and provide insight into cellular and molecular pathways. As FTY720 also shows promising anticancer potential and is FDA approved, rapid clinical translation of our findings is anticipated.
Emergence of coherent vortices from Leslie’s perturbation method in a rotating turbulent ﬂuid
Authors: Dutta Kishore
Published: April 2018

Publisher's Note: This article was withdrawn in July 2018 due to a dispute over the authorship of the work.

The Coriolis force that plays a fundamental role in determining the anisotropic structure of rotating turbulent fluid, has evaded most analytical attempts in understanding the emergence of coherent columnar structures. Here we treated the Coriolis term appearing in the rotating turbulence dynamics as a perturbation acting on the isotropic Kolmogorov state and show that it generates anisotropic (angle-dependent) contribution to the spectral energy density. We find that, with increasing length scales, the turbulent energy density resides more and more predominantly in the wavevectors perpendicular to the rotation axis. This signifies the generation of coherent columnar vortices at sufficiently large scales which is consistent with experimental observations and numerical predictions in rotating turbulence.
The null-geodesic flow near horizons
Authors: Gannot Oran
Published: April 2018

This note describes the behavior of null-geodesics near nondegenerate Killing horizons in language amenable to the application of a general framework, due to Vasy and Hintz, for the analysis of both linear and nonlinear wave equations. Throughout, the viewpoint of Melrose’s b-geometry on a suitable compactification of spacetime at future infinity is adopted.
3. Balance of powers
Authors: Bodenhamer David J.
Published: April 2018

Two questions guided the framers when dividing power among the branches of government: What were the limits and purposes of national power? What were the roles and responsibilities of the various branches in exercising the government’s authority? ‘Balance of powers’ explains that no single event resolved these questions. Each branch has made large claims of power; each has experienced stinging rebuffs to those claims. The struggle involving the balance of power is described, including the Supreme Court and the President seizing opportunities to define their own constitutional powers as equal to Congress. Today’s hyper-partisanship has weakened Congress, although both division and inaction serves as an informal set of checks and balances.
7. How do we control crime?
Authors: Newburn Tim
Published: April 2018

‘How do we control crime?’ discusses the formal and less formal means thought to control crime. The formal means refer to the use of the criminal justice system: the police, courts, and prison system. Arising from what we know to be the limitations of organized criminal justice in relation to crime control, the less formal means to control crime are considered as the processes of socialization, whereby social norms and values are learned, reinforced by what is often referred to as informal social control. Recent trends in the use of punishment, from incarceration in prisons to the use of non-custodial, community-based penalties are also discussed.
Closing the Capacity-Ability Gap: Using Technology to Support Aging With Disability
Authors: Mitzner Tracy L , Sanford Jon A , Rogers Wendy A
Published: April 2018

There is a critical need to develop supports for older adults who have a wide range of abilities, including those aging with long-term impairments. Without appropriate support, many individuals will be functioning below optimal levels and will face participation barriers. Technology holds great promise to provide individualized support for a wide range of abilities and for a variety of domains. To ensure technology interventions are designed well and meet research-documented user requirements, we need more specific, actionable models to provide guidance for those developing and designing interventions. In this paper, we present the TechSAge Aging and Disability Model to bridge models from the aging and disability literatures and to disambiguate the population of individuals aging into disability from those aging with disability (i.e., pre-existing impairments). We also present the TechSAge Technology Intervention Model to support aging with pre-existing impairments, which provides direction and touch points for technology interventions. These models reflect the complex and dynamic interaction between age-related changes and an individual’s prior capabilities and limitations. We describe the need for these models with respect to filling a gap in the disability and aging literature by highlighting the importance of differentiating between age-related changes and long-term impairments when designing interventions. We also show the need for quantitative and qualitative data to refine the models given complexities of the current state of the literature and survey data. The TechSAge Technology Intervention Model can be used to drive and inform technology redesign and development.
Schur complement preconditioners for multiple saddle point problems of block tridiagonal form with application to optimization problems
Authors: Sogn Jarle , Zulehner Walter
Published: April 2018

The importance of Schur-complement-based preconditioners is well established for classical saddle point problems in $\mathbb{R}^N \times \mathbb{R}^M$. In this paper we extend these results to multiple saddle point problems in Hilbert spaces $X_1\times X_2 \times \cdots \times X_n$. For such problems with a block tridiagonal Hessian and a well-defined sequence of associated Schur complements, sharp bounds for the condition number of the problem are derived, which do not depend on the involved operators. These bounds can be expressed in terms of the roots of the difference of two Chebyshev polynomials of the second kind. If applied to specific classes of optimal control problems the abstract analysis leads to new existence results as well as to the construction of efficient preconditioners for the associated discretized optimality systems.
Barbados in the Atlantic World
Authors: Roberts Justin
Published: April 2018

Barbados, settled by Europeans in 1627, was among the first permanent English colonies in the Americas, and it was where the English variant of race-based plantation slavery first took root; not surprisingly, it plays a central role in the scholarship of the Atlantic world. Although Barbados was uninhabited when the English arrived, they were certainly not the first people on the island. Arawak-speaking peoples first migrated to Barbados from South America long before 1492. The Kalinago were the last people to live on Barbados before the English arrived. The Portuguese and Spanish visited the island after 1492 but never established colonies there. The Spanish claimed that the island was uninhabited in the mid-sixteenth century. Yet, by the mid-seventeenth century, Barbados was the most densely populated and lucrative colony in the English Americas. Barbadian planters began growing sugar in the 1640s. They were innovators and they developed a proto-industrial and integrated sugar plantation system that was more productive than the sugar industry had been in Brazil. At first, planters relied on a mixture of Africans and white servants, but the Barbadian plantation model became increasingly dependent on a brutal and ruthlessly efficient system of racial slavery. The island was quickly deforested, the environment was destroyed, and the soils were degraded by sugar. Barbadians became the vanguard of expansion through the English plantation in the Americas, and they helped extend their new model of race-based plantation slavery and the legislative measures designed to entrench it to Surinam, Jamaica, Antigua, the Carolinas, and the Chesapeake. Although the island was threatened by hurricanes, the Barbadian elite benefited from fewer threats to production than the planters in other British Caribbean islands; no other European power invaded Barbados before emancipation, and there was only one major slave insurrection. After the transition to sugar, Barbados continued to have a majority black population throughout its history, but the ratio of blacks to whites was smaller than in other major British Caribbean colonies. Barbados had the only naturally reproducing slave population among all the Caribbean sugar colonies before emancipation. A Barbadian creole culture developed among the peoples of African and European descent. The white population, however, was divided into a planter elite and a marginalized poor white population. A small number of free blacks also carved out lives on the island. After emancipation in 1833, the Barbadian sugar economy recovered but the ex-slaves continued to struggle against economic and racial oppression.
Membership determination of open clusters based on a spectral clustering method
Authors: Gao Xin-Hua
Published: April 2018

We present a spectral clustering (SC) method aimed at segregating reliable members of open clusters in multi-dimensional space. The SC method is a non-parametric clustering technique that performs cluster division using eigenvectors of the similarity matrix; no prior knowledge of the clusters is required. This method is more flexible in dealing with multi-dimensional data compared to other methods of membership determination. We use this method to segregate the cluster members of five open clusters (Hyades, Coma Ber, Pleiades, Praesepe, and NGC 188) in five-dimensional space; fairly clean cluster members are obtained. We find that the SC method can capture a small number of cluster members (weak signal) from a large number of field stars (heavy noise). Based on these cluster members, we compute the mean proper motions and distances for the Hyades, Coma Ber, Pleiades, and Praesepe clusters, and our results are in general quite consistent with the results derived by other authors. The test results indicate that the SC method is highly suitable for segregating cluster members of open clusters based on high-precision multi-dimensional astrometric data such as Gaia data.
Fanconi Anemia Type C: Results of Population Carrier Testing [2A]
Authors: Bardos Jonah D. , Terhaar Catherine , Echeverri Natalia , Longman Ryan
Published: April 2018

INTRODUCTION:

Fanconi Anemia Type C (FAC) is an autosomal recessive disorder characterized by skeletal malformations, bone marrow failure, increased risk of malignancy, and severe aplastic anemia. Currently, carrier testing for FAC is recommended for the Ashkenazi Jewish (AJ) population. A joint ACOG/ACMG statement highlighted the increasingly multi-ethnic society as consideration for pan-ethnic carrier testing, and recent ACOG committee opinion states that pan-ethnic testing is a reasonable strategy. Our current study assesses how many non-AJ individuals screened positive for FAC when pan-ethnic carrier testing was implemented.

METHODS:

Retrospective database analysis of individuals that received expanded carrier testing utilizing a genotyping panel for three pathologic variants of FAC (c.322delG, IVS4 c.456(+4)A>T, p.R548X) was performed. Expected number of positive carriers in AJ and non-AJ groups were calculated and compared to observed rates. Chi-square analysis was performed to assess for statistical significance (p < 0.01).

RESULTS:

A total of 71,235 individuals were tested for FAC. A higher than expected number of non-AJ individuals tested positive for FAC (56 observed vs 8.89 expected, p<0.001). The number of AJ individuals that screened positive was consistent with expected values (10 observed vs 11.11 expected, p<0.73).

CONCLUSION:

Non-AJ carriers of FAC were more common than expected in this cohort. Pan-ethnic expanded carrier testing will increase the detection of carriers for FAC compared with current ethnicity based screening recommendations. Importantly, carriers of FAC who would be missed by ethnicity based testing convention, will be identified allowing for more complete genetic counseling and family planning options for those who choose testing.
Removal of Bakri Intrauterine Balloon by Rapid or Stepwise Deflation: Which Technique is Better? [5A]
Authors: Wong Melissa , Greene Naomi , Gregory Kimberly D.
Published: April 2018

INTRODUCTION:

Intrauterine balloon tamponade (IBT) is an effective method for reducing the morbidity associated with postpartum hemorrhage but the best method for removal is unknown. The objective of this study is to determine whether stepwise deflation of the IBT is associated with a reduced likelihood of secondary hemorrhage and blood loss after removal.

METHODS:

This is a retrospective cohort study of patients who received an IBT from 2012-2016. Patients were included if the IBT remained in place at least 2 hours and were excluded in cases of failed IBT placement. Patients were assigned to 1 of 2 groups: the (1) RAPID group underwent deflation all at once and the (2) STEPWISE group underwent deflation in 2 or more serial visits.

RESULTS:

124 subjects met our inclusion criteria: 24 underwent Rapid deflation and 100 underwent Stepwise deflation. There were no significant differences in baseline characteristics between the two groups. Less blood loss after deflation was noted in the patients who underwent Rapid deflation compared to the Stepwise Group (2.1 vs 31 mL, p = 0.005). There were no instances of significant post-deflation hemorrhage in either group. There were no differences in other secondary outcomes including need for additional interventions.

CONCLUSION:

Rapid deflation was associated with less blood loss, though this may reflect a reduced likelihood of accurate measurement in this group given that the catheter is no longer in situ. Rapid deflation rather than stepwise deflation should be considered (and may be preferred) for IBT removal.
Changing the Definition of Postpartum Hemorrhage [10A]
Authors: Coviello Elizabeth , Chornock Rebecca , Cheney Megan , Iqbal Sara , Fries Melissa
Published: April 2018

INTRODUCTION:

To determine the amount of blood that predicts postpartum hemorrhage, as defined by standard definition compared to Maryland's Hospital Association's definition.

METHODS:

This is a retrospective chart review that identified all women in the electronic medical record with PPH (standard definition >500 ml for vaginal delivery [VD] and >1000 ml for cesarean delivery [CD] and Maryland definition [MD] >=1000 ml for VD and >=1500 ml for CD) as estimated by eBL (n=49) and qBL (n=209)) between September 2014 and September 2015, as estimated by EBL (n=166), and October 2015 and October 2016, as estimated by qBL (n=733). The primary outcome was the area under the receiver-operating-characteristic (ROC) curve (AUC) for blood transfusion in women with PPH. The ROC was generated by calculating the amount of blood loss by each technique and PPH definition, that best predicted blood product transfusion.

RESULTS:

The rate of PPH using the standard definition with eBL and qBL was 5% and 21.23%, respectively (p<0.01). The rate of PPH using MD with eBL and qBL was 1.5% and 6%, respectively (p<0.01). PPH defined by standard definition, postpartum transfusion was predicted by eBL of 1377 ml with 89.2% sensitivity and AUC 0.921 and qBL of 1400 ml with 82.5% sensitivity and AUC 0.866. PPH defined by MD's, postpartum transfusion was predicted by eBL of 1525 ml with 80.6% sensitivity and AUC 0.825 and qbl 1688 ml with 65% sensitivity and AUC 0.759.

CONCLUSION:

PPH by standard definitions predicted blood transfusions at lower blood loss with greater AUC than MD's definition.
Evaluating Hospital Hemorrhage Protocol Components and Maternal Morbidity [15A]
Authors: Srinivas Sindhu
Published: April 2018

INTRODUCTION:

The Council for Patient Safety in Women's Health suggested implementation of a hemorrhage bundle to reduce obstetrical hemorrhage and improve related morbidity. We previously reported that approximately 20% of the variation in hospital postpartum hemorrhage (PPH) frequency was related to provider/hospital factors. We aim to assess whether the number of recommended components included in a hospital’s obstetrical hemorrhage protocol reduces maternal morbidity.

METHODS:

A total of 14,283 women who delivered at 4 hospitals with hemorrhage protocols between March 2008 and February 2011 were analyzed. Two hospitals updated their protocol during the study period resulting in evaluation of 6 protocols, with analyses being performed based on the protocol in place at the time of delivery. Each protocol was evaluated by two independent reviewers to assess for the presence of 14 components, as recommended by the Council for Patient Safety in Women's Health. Disagreements were adjudicated by a third reviewer, masked to prior determinations. The primary outcome was a composite hemorrhage outcome including transfusion, blood loss>1000 cc, or hysterectomy. Hierarchical models were adjusted for multiple confounders.

RESULTS:

The number of elements present ranged from 1 to 7 per protocol. Nearly all protocols (83%) included a hemorrhage risk assessment and checklist for hemorrhage management. None of the protocols reported existence of a hemorrhage cart or specified the structure of reporting or debriefing. There was no association between the number of protocol elements present and the composite hemorrhage outcome (aOR 1.09; 95%CI 0.80-1.48).

CONCLUSION:

Among the hemorrhage protocols evaluated, only 1 had at least half of the suggested elements. Further evaluation is needed to determine the association of adverse outcomes with these protocols, and which elements are truly key factors in reducing maternal morbidity.
The Relationship Between Treatments and Recurrence in Borderline Ovarian Tumors [30A]
Authors: Lou Tong , Yuan Fang , Bai Huimin , Zhang Zhenyu
Published: April 2018

INTRODUCTION:

To evaluate the relationship between treatments and recurrence in borderline ovarian tumors.

METHODS:

In a retrospective study, 281 patients, from 2 institutions, with borderline ovarian tumors were investigated. The demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging, lymph node removal, appendicectomy and chemotherapy on recurrence rates were calculated by using Kaplan-Meier method and multivariate Cox proportional hazards model analysis.

RESULTS:

This study investigated 281 patients who were finally diagnosed with borderline epithelial ovarian tumors. The median follow-up for survivors was 43.0 months (range, 5-237). Median time to recurrence was 41.0 months (range, 2-190). Twenty patients (7.1%) experienced relapse and 4 patients (1.4%) died of disease within the observations period. In multivariate analysis, removing ipsilateral ovary (HR: 0.074 [95% CI, 0.023-0.234], p=0.000), FIGO stage II-III (HR: 3.719 [95% CI, 1.418-9.749], p=0.008) and ovary surface involvement (HR: 9.720 [95% CI, 1.006-93.893], p=0.049) were independent prognostic factors on recurrence. The ovary surface involvement (HR: 64.996 [95%CI, 4.054-1041.941], p=0.003) was independent prognostic factor on OS.

CONCLUSION:

Our study reveals the impact of removing ipsilateral ovary, FIGO stage II-III and ovary surface involvement on the recurrence, and ovary surface involvement was co-related with overall survival. Patients presenting these risk factors should undergo closer follow-up.
Association Between Perinatal Outcomes and Mode of Conception in Twin Pregnancies [8B]
Authors: Janssen Ashley , Dahlke Joshua , Hultgren Elizabeth , Satpathy Hemant , Bonebrake Robert , Patel Emily
Published: April 2018

INTRODUCTION:

Artificial reproductive technology (ART) is associated with increased risks of adverse perinatal outcomes in singleton gestations; however, the association in twin gestations is less clear. Minimal data exists on the impact of oral and injectable fertility medications on maternal and perinatal outcomes in twins. Our objective was to examine the impact of conception method on perinatal outcomes.

METHODS:

We performed a retrospective cohort of all twin pregnancies delivered in a single-tertiary care-center with ultrasound evaluation between 1/1/2013 and 4/1/2016. Women with unknown conception method, missing maternal or neonatal data, and monochorionic-monoamniotic twins were excluded. The primary outcome was maternal and neonatal morbidity in twin pregnancies conceived among three groups.

RESULTS:

Of 424 twin pregnancies during the study period, 417 met inclusion criteria. 199 conceived spontaneously (G1), 86 conceived through oral/injectable medications (G2), and 132 conceived through in-vitro fertilization (IVF) (G3). Compared to G1, G2 and G3 were more likely nulliparous, privately insured, diagnosed with preeclampsia (G2: P=.03; G3: P<.01), experienced greater rates of postpartum hemorrhage (G2: P=.02; G3: P<.01) and less likely to conceive monochorionic-diamniotic twins. No difference was noted in composite maternal or neonatal morbidity between groups.

CONCLUSION:

Twin gestations conceived via IVF or oral/injectable medications are similarly associated with an increased risk of preeclampsia and postpartum hemorrhage compared to spontaneous conception. Women who conceive by infertility treatment, regardless of the type, should be counseled regarding this increased maternal risk.
Premature Ovarian Insufficiency with a Balanced Reciprocal Translocation of Chromosomes 1 and 13 [13B]
Authors: Wiltshire Ashley , Wang Emily , Saint-Louis Hedwige , Phillips Kiwita
Published: April 2018

INTRODUCTION:

Premature ovarian insufficiency (POI) is defined as hypergonadotropic hypogonadism before the age of 40 years. Though most commonly deemed as idiopathic, specific etiologies include genetic abnormalities, autoimmune conditions, infections, and toxin exposure. Genetic etiologies of POI are usually due to abnormalities involving the X chromosome and are rarely associated with autosomal mutations.

METHODS:

The clinical case was analyzed and followed with a literature review.

RESULTS:

The patient is a 36-year-old G0 female who presented with four months of secondary amenorrhea, a recent abrupt development of kidney failure, and hyperparathyroidism. Laboratory results revealed a negative urine pregnancy test, euprolactinemia, euthyroidism and negative serum 21-hydroxylase antibody. Serum FSH was markedly elevated. Serum Estradiol, Inhibin-B, and Anti-Mullerian Hormone were below normal limits. Pelvic ultrasonography revealed an endometrial lining of 1.1 cm, with inability to identify bilateral ovaries.

A balanced reciprocal translocation between the long arms of chromosomes 1 and 13 was identified: 46,XX,t(1;13)(q25;q14.1).

CONCLUSION:

Balanced translocations are associated with a relatively high risk for adverse reproductive history. However, they are not commonly associated with POI. Interestingly, chromosome 13q14.1 is a region encompassing the FOXO1 gene, which plays a significant role in granulosa cell function and follicular maturation. This specific gene break point is most likely the etiology of her POI and possibly her other new-onset co-morbidities. There are no other reported POI cases associated with a balanced translocation between chromosomes 1 and 13 in the literature. Further research is needed on this specific gene break point to understand the timing and mechanism of its effects.
Pregnancy and Fertility Concerns: A Survey of United States Obstetrics and Gynecology Residents [16B]
Authors: Schwartz Kaia , Martin Caitlin , Hipp Heather S. , Kawwass Jennifer
Published: April 2018

INTRODUCTION:

Reproductive life planning is an important aspect of OBGYN resident education. Despite learning about declining fertility and the potential problems associated with delaying pregnancy, OBGYN residents overestimate the age at which fertility declines and the success rates of fertility treatment. We aim to characterize attitudes towards infertility, pregnancy timing, and oocyte cryopreservation among current OBGYN residents.

METHODS:

We present a cross sectional study of female trainees from 27 academic OBGYN resident training programs. A voluntary, anonymous online survey was used to assess resident reproductive experiences and characterize attitudes towards personal family planning and infertility.

RESULTS:

Of 756 trainees who were sent the survey, 487 opened the email, and 309 participated (63.4% response rate per opened email, 40.9% overall). Average respondent age was 29.7 years. The majority of residents expressed the desire to have children, but reported not yet having started childbearing (75.8%, n=210). Almost half described delaying conception for career/education reasons (45.4%, n=196). The majority desired to start childbearing at age <35 (90%, n=210). Of those not complete with childbearing, 78.5% reported worrying about infertility (n=205) and 40.8% reported considering embryo or oocyte cryopreservation (n=111).

CONCLUSION:

Although female OBGYN residents learn to help patients with reproductive health planning, many delay their own pregnancies until after residency past the peak fertile window with the intention of having a first child before age 35. Many also report considering fertility preservation. To help alleviate anxiety and improve reproductive autonomy, residents may benefit from fertility preservation counseling and creation of an environment that allows trainees to begin family building.
A Qualitative Study of Pregnancy and Birth Experience for Women with Opioid Use Disorder and a History of Sexual Trauma [22B]
Authors: Sobel Lauren , O'Rourke-Suchoff Danielle , Remis Kimberly , Sia Michelle , Saia Kelley , Bell Shannon L.
Published: April 2018

INTRODUCTION:

Opioid use in pregnancy has increased dramatically, paralleling the epidemic observed in the general population. Many of these women have a history of sexual trauma. Our objective was to identify factors that adversely affect the labor and delivery experience for women with opioid use disorder and concomitant sexual trauma history.

METHODS:

This is a subgroup analysis of 13 women with a history of sexual trauma who participated in an opioid replacement therapy program during pregnancy. Participants underwent semi-structured qualitative interviews for a study about women with a history of sexual trauma. Interviews focused on the antenatal, intrapartum, and immediate post-partum experiences.

RESULTS:

Participants felt stigmatized by unfamiliar providers for their opioid use disorder and voiced desire for a childbirth experience unaffected by addiction, except when medically necessary. Most participants were concerned their opioid tolerance would lead to inadequate intrapartum pain management. Many felt they received less breastfeeding encouragement than women without opioid use disorder. Separation from infants for routine care or management of neonatal abstinence syndrome without adequate explanation concerned participants. In this situation, many feared they had lost custody, felt there was little institutional concern for maternal-infant bonding and reported guilt about the impact of addiction on the infant.

CONCLUSION:

Women with opioid use disorder and concomitant sexual trauma history report distrust of the medical system. Emphasizing established therapeutic relationships, ensuring clear communication regarding intrapartum pain control, promoting infant care in the post-partum room, and reinforcing legal determination of custody may improve labor and delivery experiences for this group of women.
Routine Postpartum Rosette/Kleihauer-Betke Testing Is Unnecessary in Rh Negative Women [28B]
Authors: Peleg David , Tendler Shlomo , Warsof Steven L.
Published: April 2018

INTRODUCTION:

A standard dose of 300 micrograms of anti-D, enough to equalize a 30 ml fetal-maternal hemorrhage, is given after vaginal and operative deliveries unless Rosette/Kleihauer-Betke testing indicates an increased fetal-maternal hemorrhage. Our objective was to determine the incidence during the previous year in which routine Rosette/Kleihauer-Betke testing indicated a fetal-maternal hemorrhage greater than 30 ml of fetal blood.

METHODS:

We reviewed the 2016 blood bank results for women delivering at a major Academic Perinatal Center. In routine fashion, cord blood from Rh negative women was collected at delivery. If the newborn was Rh positive, a Rosette test was performed, and if positive, this was followed by a Kleihauer-Betke to determine the quantity of anti-D required.

RESULTS:

There were 180 Rh negative women with Rh positive newborns. 106 women had spontaneous vaginal delivery, 65 cesarean delivery, 7 VBAC, and 2 instrumental vaginal delivery. Rosette tests performed on all 180. Of these, 166 (92.2%) were negative, 7 (3.9%) were positive, and 7 (3.9%) were invalid. Kleihauer-Betke test was performed on the 14 positive and invalid samples, all of which were negative. We were unable to demonstrate any case in which more than the standard 300 mcg dose of anti-D was required.

CONCLUSION:

In this study, the Rosette/Kleihauer-Betke model was found to be unnecessary, as there were no cases in which the fetal-maternal hemorrhage exceeded 30 ml. We anticipate extending this review for several years and if confirmed, could alter the way blood banks manage this common clinical situation, saving thousands of dollars in unneeded testing. We suggest that Rosette/Kleihauer-Betke testing be reserved for those clinical situations in which an increased fetal-maternal hemorrhage is suspected.
Implementation of Delayed Umbilical Cord Clamping Guideline for a Labor & Delivery Unit [36B]
Authors: Williams Nayo , Townsel Courtney , Assad Maushumi , Johnson Kendall , Campbell Winston , Sink David
Published: April 2018

INTRODUCTION:

Delayed cord clamping (DCC) allows for placental transfusion and has proven benefits. Our institution’s delivery unit and Neonatal Intensive Care Unit (NICU) had no guideline for DCC despite good evidence for the practice since 2012. Working as a multi-disciplinary team, our aim was to develop, implement and monitor with quality improvement (QI) review a DCC guideline initiated in January 2017.

METHODS:

The guideline was drafted during inter-divisional perinatal-neonatal conferences using the Plan-Do-Study-Act model. The guideline included umbilical cord milking (UCM) as an option for placental transfusion. A department-wide email was sent to obstetrical and neonatal providers, as well as information sessions for the labor unit and NICU nursing staff explaining the new guideline, and exclusion criteria (unconfirmed dichorionic gestation, abruption and immediate resuscitation/stabilization of neonate and/or mother). Obstetrical residents documented whether DCC/UCM was performed. Our target was 80% of all neonates to undergo DCC/UCM. Descriptive statistics and chi-square test were utilized; P < .05 was significant.

RESULTS:

January through August 2017, 500 neonates delivered and 84.3%, of eligible neonates (408/484) underwent DCC/UCM (when DCC/UCM was not documented, we assumed it wasn’t performed). The rate increased over time, ranging from 63.5% to 98.3%. There was no statistical difference in DCC/UCM rates by preterm vs term (P=.70) or delivery route (P=.62).

CONCLUSION:

We reached our goal 80% of neonates undergoing DCC/UCM one month after initiation of the guideline. The QI review identified that documentation, communication, length of stay and hyperbilirubinemia rates are important areas for improvement and should be reevaluated with the next Plan-Do-Study-Act cycle.