bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Comparison of Local Cesarean Rates Influence Where Women Deliver? A Randomized Controlled Trial [21K]
Authors: Gourevitch Rebecca , Mehrotra Ateev , Galvin Grace , Plough Avery , Shah Neel T.
Published: April 2018

INTRODUCTION:

Few women search publicly available data on hospital cesarean rates when selecting a hospital for childbirth. We assess whether providing women with this data in Ovia Health, a popular mobile application suite, influences their selection of obstetric hospital.

METHODS:

We recruited and randomized 18,293 Ovia Health users who were trying to conceive or were in the first trimester of their pregnancy. Women in both groups were given general information about the importance of cesarean delivery rates. Women in the intervention group also saw a one-time, interactive display of data about cesarean rates of hospitals in their area. Participants were then asked to self report their hospital and answer several questions on cesarean delivery rates. The primary outcome was delivering at a hospital with a primary cesarean delivery rate 23.9% or below.

RESULTS:

We found no difference in the proportion of women who selected a hospital with a low cesarean delivery rate between the intervention and control groups (6.8% versus 7.0%, P=.54). Women in the intervention group were more likely to report that hospitals in their community have different cesarean delivery rates (66.9% versus 55.9%, P<.001), and that they looked at hospital cesarean delivery rates before selecting their provider (44.5% versus 33.9%, P<.001).

CONCLUSION:

Facilitating comparison of hospital cesarean rates improved women's understanding of the rates of hospitals in their community, but did not motivate women to select hospitals with lower cesarean delivery rates. Future efforts should facilitate more sustained exposure and availability of their data.
Whole Genome Sequencing Coverage & Quality at Prenatal Carrier Screening Loci: An Analysis of 15,496 gnomAD Genomes [23K]
Authors: Scott Erick R. , Birch Ashley , Mclellan Andrew , Housman Laura , Gross Susan Joy , Edelmann Lisa
Published: April 2018

INTRODUCTION:

Current expanded prenatal carrier screening (EPCS) tests leverage several technologies to analyze genomic regions associated with Mendelian disorders. As whole genome sequencing (WGS) becomes more widely utilized some have speculated WGS could replace current EPCS methods. However, a large-scale technical analysis of WGS coverage and genotype dropout at EPCS loci is, to our knowledge, unpublished.

METHODS:

In order to assess the potential to use Illumina WGS methods for EPCS, we downloaded autosomal data for 15,496 genomes (gnomAD browser). We analyzed read coverage at ∼3,400 EPCS loci and frequency of missing/low-quality genotype calls at ∼1,300 EPCS loci.

RESULTS:

We found that WGS provided an average and median coverage of 32 and 31, respectively, across the ∼3,400 EPCS loci. Coverage predicted to yield <99% accuracy (≤10 reads) was found in an average of 17/15,496 genomes (median 11, range 0–728) across the ∼3,400 loci. Considering each of the ∼1,300 loci with gnomAD genotype calls, we found a missing genotype call in an average of 52/15,496 genomes (range 2–11,529). Simulations using a negative binomial distribution predict WGS coverage ≥65X is needed to achieve 99.99% adequate coverage (≥20X) across all genotypes.

CONCLUSION:

This investigation demonstrates that the methods used to generate gnomAD WGS data would provide missing genotype calls that fail to meet clinical standards for a maximum of ∼74% of analyzed genomes; 6 loci had missing genotype calls in more than 500 genomes. Targeted EPCS panels or Sanger confirmation would be required to supplement these WGS results.
Providing Breastmilk to Infants in the NICU: Factors Associated With Lack of Breastfeeding [27K]
Authors: Brown Brooke , Thompson Amy , DeFranco Emily
Published: April 2018

INTRODUCTION:

This study aims to identify factors influencing breastfeeding non-initiation among NICU infants, compared to non-NICU infants, and inform tailored educational/support interventions.

METHODS:

We performed a population-based, retrospective cohort study of singleton live births using Ohio birth certificates between 2006 and 2015. Univariate analyses assessed the association between NICU breastfeeding non-initiation and predictors relating to the mother, neonate, and delivery events. A multivariate logistic regression model evaluated highly significant predictors, adjusting for socioeconomic, demographic, and neonatal covariates.

RESULTS:

Of 76,855 live births, 5.83% reported NICU admission, 39.4% of which reported non-initiation of breastfeeding, compared with 31.5% of newborn nursery infants (P<.001). Among NICU infants, congenital anomalies and abnormal newborn conditions were the most significant risk factor for non-initiation of breastfeeding, while gastroschisis, low birth weight and very low birth weight were protective for breastfeeding initiation. The most significant maternal risk factors for non-initiation included: smoking during pregnancy (RR 1.91 [95% CI 1.82–2.02]), multiparity (RR 1.72 [95% CI 1.64–1.79]), unmarried (RR 1.68 [95% CI 1.60–1.77]), Medicaid recipient (RR 1.51 [95% CI 1.44–1.58]), no high school diploma (RR 1.48 [95% CI 1.40–1.57]), ≤5 prenatal visits (RR 1.41 [95% CI 1.34–1.49]), age <20 years (RR 1.30 [95% CI 1.21–1.40]), and BMI ≥40.0 (RR 1.26 [95% CI 1.16–1.37]).

CONCLUSION:

Socioeconomically disadvantaged mothers and mothers who smoke are the least likely to initiate breastfeeding for their NICU infants. Maternal-targeted, NICU breastfeeding intervention efforts present an opportunity to reduce infant deaths and improve outcomes.
Nitrous Oxide Versus Epidural for Pain Management During Labor and Delivery [32K]
Authors: Hirschmann-Levy Kate , Pan Stephanie , Cole David
Published: April 2018

INTRODUCTION:

Expansion of analgesic options is a strong interest of obstetric providers and patients. Epidural leaves women bed-bound; hence, many women desire a less-extreme option, like nitrous oxide (N2O). This study's purpose was to directly compare and determine whether patients preferred N2O to epidural during labor and delivery.

METHODS:

This IRB-approved prospective study included women who gave birth at Mount Sinai West's Labor and Delivery Unit between January 2017 and March 2017. All women who started their labor course using either N2O or epidural, and did not deliver by cesarean section, were asked to complete an anonymous questionnaire after delivery and before discharge. The questionnaire explored subjective experience with analgesia, using yes-no or 1–10 scale answers.

RESULTS:

47 women were included; 29 received epidural as their initial analgesia, while 18 started with N2O. There were no demographic differences between these two groups. Women in the epidural group experienced significantly less pain (3 [2–5] versus 8 [7–9], P<.001); were more likely to complete their delivery using their first analgesic method (29/29 [100%] versus 5/18 [27.8%], P<.001); were more satisfied with their labor and delivery experience (9 [8–10] versus 6 [4–9], P=.002) and stated they were more likely to use their pain relief method again (27/29 [93%] versus 11/18 [61%], P=.018).

CONCLUSION:

This is the first direct comparison of epidural and nitrous oxide. There was a clear preference for epidural. However, responses from women desiring a “natural” birth should be identified and compared. Further research is also needed to study nitrous oxide as a bridge for pain control before receiving an epidural.
Incidence and Predictors of Mortality in Gastroschisis: A Population-Based Study of 4,803 Cases in the United States [35K]
Authors: Brebner Alison , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie
Published: April 2018

INTRODUCTION:

Gastroschisis is a rare congenital anomaly consisting of a full-thickness abdominal wall defect, with survival normally exceeding 90%. Few large-scale studies have examined the predictors of mortality for these infants. Our objective was to use a large database to determine predictors of mortality in gastroschisis, its incidence and mortality rate over time.

METHODS:

Using the “Period linked Birth-Infant Death” database (CDC) from 2009 to 2013, we collected all infants coded as having gastroschisis. Using multivariable linear regression for various maternal and infant characteristics, we calculated predictors of mortality. We also determined the incidence, death rate and age of death for our cohort.

RESULTS:

There were 4,803 cases of gastroschisis, with 287 deaths. The incidence of gastroschisis increased from 2.04 to 2.49/10,000 births. The rate of death stayed constant around 5.9%. 38.1% of these infants died on day 0 of life. Statistically significant predictors of mortality were paying out of pocket for healthcare, maternal obesity, pre-pregnancy diabetes, birth weight <2,500 g, gestational age <34 weeks and the presence of an additional congenital anomaly (46.2% mortality, OR 13.91).

CONCLUSION:

The incidence of gastroschisis in the United States increased, yet mortality rate remained stable. Mothers with DM1 or 2 should be counselled on the significantly higher risk of mortality, and be encouraged to diligently control their glycemias. The infants born preterm <34 weeks, or with birth weights <2,500 g were at the highest risk. The presence of an additional congenital anomaly is an important prognostic factor, with a high associated mortality. This information can be used in prenatal counselling.
Depression Screening: A “Systems Thinking” Approach to Address Health Disparities in Ob/Gyn Practice [5L]
Authors: Mirhosseini Pegah , Wohlmuth Cinna , Hayes-Bautista Teodocia
Published: April 2018

INTRODUCTION:

Ob/Gyn patient populations can face many risk factors for depression: lack of social support; history of substance use; poverty; and low educational attainment. If left unaddressed, depression can impact quality of life. This study helps to provide a baseline of knowledge about the implementation of a screening tool, the PHQ-9.

METHODS:

The quality improvement methodology of Plan-Do-Study-Act (PDSA) was used to redesign the clinical microsystem to have an onsite licensed clinical social worker (LCSW), and include a depression screening tool, PHQ-9, to help clinicians and patients assess for symptoms of depression.

RESULTS:

In a 7-month period, 1,673 women were offered a PHQ-9 screen: 68% scored minimal depression; 31% scored mild to severe depression; and 1% declined to participate. Of the 516 women whose score identified mild to severe depression, only 24% (124) of these completed a follow up PHQ-9 screen. Of these 124 women, only 29% had an improvement in their follow up scores, while 46% had no change in their follow up scores. By comparison, of the 1,136 women whose score identified minimal depression, only 15% (166) completed a follow up PHQ-9. Of these 166 women, 79% had no change in their scores, and 14% scored an increased in depression.

CONCLUSION:

These results indicate that while the on-site availability of a LCSW and the use of a PHQ-9 screening tool can help clinicians to assess for depression and monitor improvement, a more robust system is needed to address disparities in mental health care.
Antepartum Vaccination Rates After Initiation of Electronic Medical Record Reminders [8L]
Authors: Keepers Katie , Reddy Madhuri , Satterwhite Catherine , Fitzgerald Sharon
Published: April 2018

INTRODUCTION:

Tetanus, Diphtheria and acellular Pertussis (Tdap) vaccination is recommended by the CDC between 27 and 36 weeks gestation in order to maximize maternal antibody response and passive antibody transfer to the infant. This study was developed as a quality improvement project for increasing vaccination rates in our university-based clinic.

METHODS:

We developed a best practice advisory alert in the electronic medical record that was implemented September 8, 2016. This alert prompts providers to order the Tdap vaccine or document previous vaccination. It is triggered during clinic visits between 27 and 36 weeks gestation. A chart review was completed for all deliveries at our hospital during a 3 month period prior to implementation and 3 month period post-implementation. A χ2 test was completed to assess differences in Tdap uptake pre- and post-implementation. A Breslow-Day test was completed to identify any differences in uptake by age, parity, and time after initiation.

RESULTS:

A total of 531 pre-implementation and 574 post-implementation charts were reviewed and included in the analysis. The rates of appropriately timed Tdap vaccinations was significantly higher post-implementation than pre-implementation (60.28% versus 39.72% P<.0001). This change was most noticeable in the first month after implementation (P=.0123).

CONCLUSION:

Use of a pop-up reminder in the electronic medical record increased Tdap vaccination rates among women during their third trimester. Although with maximum vaccination rates less than 70% at the peak, more can be done to educate providers and patients about the importance of antepartum vaccination.
Breaking Bad News to Patients With Breast Cancer—The Benefits of Hope and Optimism [9L]
Authors: Vakada Saritha , Bachmann Gloria A. , Lu Chi-Wei
Published: April 2018

INTRODUCTION:

Receiving a diagnosis of breast cancer can be devastating. In the interest of avoiding false hope, health care professionals may break the news without imparting a sense of optimism. Studies reflect that optimistic patients may have a greater sense of well-being and employ useful coping skills. Incorporating strategies for optimism could be an important psychological intervention.

METHODS:

A literature review using standard search engines was utilized which involved a total of 7 scholarly articles, journals and websites devoted to breast cancer, hope and optimism.

RESULTS:

Studies reflected in multiple articles suggested that optimistic breast cancer patients may be less susceptible to depression and have a greater sense of well-being. Optimists often employ coping traits such as self-transcendence (finding meaning), mindfulness (mitigating negative thinking and worry) resilience (imparting strength in adversity), positive reframing, humor, and spirituality. These traits may help breast cancer patients improve their ability to adjust emotionally and psychologically. Studies show optimism may also help reduce stress and avoid or lessen depressive symptoms, may foster better mental and emotional adjustment, and promote feelings of physical attractiveness. Installing interventions that promote optimism with auxiliary coping skills would be a practical way to empower patients with coping tools requiring no additional pharmacological resources.

CONCLUSION:

Optimism can be acquired through behavioral modifications. Hospitals and clinics should consider developing optimism intervention strategies and begin teaching them to patients at the point of diagnosis. This could help empower women to immediately begin employing positive coping skills.
Cannabis Use and Fetal Growth in Pregnant Women With Diabetes [18L]
Authors: Hamilton Owen J. C. , Fowose Mobolaji , Colditz Graham , Tuuli Methodius G. , Carter Ebony B.
Published: April 2018

INTRODUCTION:

Cannabis use during pregnancy is associated with lower birth weight, but little is known about the impact of prenatal cannabis use in women with co-morbidities. Our objective was to examine the association between cannabis use and birthweight in women with pre-existing and gestational diabetes.

METHODS:

We performed a retrospective cohort study at the Center for Diabetes and Pregnancy at Barnes Jewish Hospital from 2012 to 2016. Women who self-reported cannabis use or had positive maternal or infant drug screens for cannabinoids were compared with those who did not. The primary outcome was large for gestational age (LGA) defined as birthweight >90 percentile. Secondary outcomes were mean birthweight and small for gestational age (SGA, birthweight <10 percentile). Outcomes were compared between women who used cannabis and those who did not. Logistic regression was used to control for potential confounders.

RESULTS:

Of 298 women who received care during the study period, 12.8% (38) used prenatal cannabis. Women who used cannabis were more likely to have a history of depression and use tobacco. Birthweight was significantly lower in women who used cannabis (2,732 versus 3,170 g; P<.003). Women who used cannabis prenatally were 78% less likely to have babies who were LGA (5.3% versus 19.2%, aOR 0.22, 95% CI 0.05–0.98) after controlling for tobacco use. There was no significant difference in SGA.

CONCLUSION:

Women with diabetes who use cannabis during pregnancy have lower rates of LGA. Larger prospective studies are needed to determine the impact of prenatal cannabis use on maternal, neonatal, and childhood behavioral outcomes in women with diabetes.
Preoperative Vaginal Preparation for Prevention of Post-Cesarean Endometritis [22L]
Authors: Edinoff Amber , Drake Chelsea , Pile Rachel , Sutton Maureen , Bhattarai Bikash , Coonrod Dean
Published: April 2018

INTRODUCTION:

Endometritis complicates 6%–27% cesarean deliveries (CD). A recent meta-analysis showed a reduction in endometritis with vaginal cleansing prior to CD (4.5% versus 8.8%). Our study examines the proportions of endometritis from two time periods–prior to and after the implementation of vaginal preparation prior to CD at one hospital. We aim to see the effect shown in research in clinical practice.

METHODS:

A retrospective chart review of 356 women undergoing cesarean delivery prior to and after the policy change. After implementation of the vaginal preparation protocol, a policy of administration of 400 μg of buccal misoprostol for postpartum hemorrhage prophylaxis was instituted so this was recorded. Odds ratios (OR) and 95% confidence interval (CI) of endometritis diagnosed by ICD code or 2+ symptoms were calculated.

RESULTS:

The rate of endometritis was 3.8% in the pre-policy period and 15.2% post-policy, OR 4.5 (95% CI 1.7–11.8). Notably the frequency of fever was 4.5% pre-policy compared with 22.2% post-policy. When the rates of endometritis with those given misoprostol were excluded the rates were 3.8% pre-policy and 6.7% post-policy, OR 1.8 (95% CI 0.5–6.6).

CONCLUSION:

When comparing rates of endometritis after instituting a vaginal preparation protocol we found a paradoxical increase in the rate of endometritis. However, this could be driven by the increased rate of fevers associated with misoprostol prophylaxis. When this was accounted for, there was a non-significant increase. Confounding factors may lead to important differences from randomized studies and are important to assess when evaluating practice change.
Characterization of Placental Pathology in Treated Chronic Hypertensive Women [23L]
Authors: Ambia Anne M. , DuBois Molly , Morgan Jamie L. , Roberts Scott W. , Wells C. Edward , Nelson David B.
Published: April 2018

INTRODUCTION:

Women with chronic hypertension (CHTN) during pregnancy are at increased risk for fetal-growth restriction. The fetal-placental (F/P) weight ratio has been used as a marker for abnormal growth of both the fetus and placenta. The aim of this study was to examine placental pathology among women with treated CHTN.

METHODS:

This was a retrospective cohort study of women with treated CHTN delivered from October 2008 to January 2016 with histopathological placental examination. The F/P ratio was analyzed and compared with published ratios for normal pregnancies. Placental pathology was grouped into categories including infection, vasculopathy, no abnormality, hypoplasia, and hyperplasia. Findings were examined according to gestational ages (23 to <34, 34 to <37, and 37 weeks). Each placenta may have had numerous findings in different categories.

RESULTS:

Histopathological examination was performed in 182 women. When the F/P weight ratios were plotted against previously published normal values, women with treated CHTN had significantly lower ratios beginning at 32 weeks (P<.05). This finding persisted in both small for gestational age and appropriate for gestational age infants. Pathological findings were described in 178 women. The prevalence of inflammatory lesions, vasculopathy, and hypoplasia were prominent across gestational ages at delivery. Those with deliveries <34 w were found to have increased rates of vasculopathy with 70% having evidence of vascular lesions (P=.008).

CONCLUSION:

Women with treated CHTN have evidence for abnormal fetal and placental growth when compared with growth curves for normal pregnant women. Moreover, the presence of placental vasculopathy was more prominent in preterm deliveries prior to 34 weeks.
Breast Cancer in Pregnancy: A Retrospective Cohort Study [24L]
Authors: Al-Sehli Hanan , D'Souza Rohan , Maxwell Cynthia
Published: April 2018

INTRODUCTION:

Our objective is to report pregnancy outcomes and placental histopathologic findings in women with breast cancer.

METHODS:

We conducted a retrospective study including pregnant women with a prior history of breast cancer and those with gestational breast cancer (GBC) managed at Mount Sinai Hospital, Toronto, Canada between 2004 and 2015.

RESULTS:

We identified 69 patients—47 with a prior history of breast cancer and 22 with GBC. In 21/22 cases of GBC, treatment was initiated antepartum (surgeries in 16, mean gestational age [GA] 22.5 weeks and chemotherapy in 13 [mean GA 26 weeks]). Radiotherapy was deferred until the postpartum period. There was a significant difference between groups in terms of labor induction (32.6 versus 50%, P=.045) to facilitate treatment, resulting in higher preterm birth rates (8.7% versus 63.6%, P<.0001), but no difference in GA (37.8±4.4 versus 36.3±2.0 weeks, P=.95), birthweight (3,095.2±871.2 versus 2,727±663.4, P=.43) or spontaneous vaginal deliveries (41.3% versus 59.1%). Placental histopathology was abnormal in 42.9% versus 44.4% cases.

CONCLUSION:

With multidisciplinary management, women with breast cancer can anticipate good pregnancy outcomes. Surgery, chemotherapy and late preterm labour induction are not associated with adverse outcomes or higher cesarean delivery rates.
Maternal and Neonatal Outcomes in Pregnancies With Invasive Cancer [33L]
Authors: Alpay Savasan Zeynep , Zeb Amna
Published: April 2018

INTRODUCTION:

To assess the maternal and neonatal outcomes in patients who had active cancer during pregnancy.

METHODS:

We reviewed the perinatal records of patients who had active cancer during or within the same year of pregnancy and delivered at Beaumont Health System between 2008 and 2017. We identified obstetrical maternal and neonatal adverse outcomes.

RESULTS:

There were total of 25 patients who had active cancer during pregnancy. These cancers include breast (n=12), lymphoma (n=5), uterine (n=2), malignant melanoma (n=1), acute myeloid leukemia (n=1), pancreas (n=1), colon (n=1), thyroid (n=1) and tongue (n=1). Among these patients 36% (9/25) had no maternal or neonatal complications, 28% (7/25) had both maternal and neonatal complications (spontaneous preterm delivery, gestational diabetes, thrombocytopenia, chorioamnionitis, low Apgar and meconium aspiration), 20% (5/25) had only maternal (epidural abscess, venous thrombosis, pulmonary embolism, hypertensive disorder of pregnancy, placental abruption and accreta), and 12% (3/25) had only neonatal (prematurity, small for gestational age, cleft palate and torticollis) complications. Patient with leukemia had termination of pregnancy. There were no neonatal or childhood cancers diagnosed among this group. The cancer type had no effect on identified perinatal complications.

CONCLUSION:

Patients with active cancer during pregnancy have an increased risk for perinatal complications. Due to the low prevalence of active cancer during pregnancy, a multicenter data analysis should be considered to confirm our data.
Pregnancy Outcomes in Anti Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Systematic Review [37L]
Authors: Elnazir Patrick , Andrejevic Katarina , Pagnoux Christian , D'Souza Rohan
Published: April 2018

INTRODUCTION:

Information on pregnancy outcomes in Anti Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis is limited to small case series. We systematically reviewed the literature to determine pregnancy outcomes in women with ANCA-associated vasculitis, to help with counselling and management of these women.

METHODS:

We searched Medline, Embase, Web of Science and PubMed from inception until July 2017, using keywords and subject headings related to pregnancy and ANCA-associated vasculitis. Abstract screening, data extraction and risk of bias assessment using the National Institute of Health tool for case reports and case series were performed in duplicate. Vasculitis- and pregnancy-related outcomes were obtained, and pooled incidence (95% confidence intervals) calculated.

RESULTS:

After screening 628 titles and 183 full texts, we included nine studies reporting 124 pregnancies in 89 women. Most studies (77.8%) had low risk of bias. There were 119 (91%) live births with a mean gestational age of 38.24 (37.35, 39.14) weeks and birth weight of 3.16 (2.95, 3.38) kg. Vasculitis flares were mostly in the ear, nose and throat 12.7% (4.9, 20.6%) and lungs 8.9% (2.9, 14.8%). Most patients were on glucocorticoids (43.5%) and/or Azathioprine (24.2%), increased doses of which successfully treated flares. Adverse outcomes included prematurity 10.3% (3.5, 17.1%), preeclampsia 5.5% (1.4, 9.5%), fetal growth restriction 4.9% (0.9, 8.9%) and congenital anomalies 3.7% (0.3, 7%).

CONCLUSION:

Women with ANCA-associated vasculitis can be assured that despite large numbers of flares during pregnancy, severe flares are rare and easily managed by high-dose glucocorticoids and immunosuppressants. Pregnancy outcomes are comparable to low-risk populations, apart from an increased risk of preterm birth.
Targeted inhibition of the BRAF pathway in a patient with stage IV melanoma
Authors: Buckley Breea , Pierce Bradley
Published: April 2018

This article describes the use of vemurafenib, a BRAF inhibitor, to achieve disease regression in a woman with extensive metastatic melanoma and the BRAF V600 gene mutation. Given the improved survival rates seen in these patients, clinicians need to be aware of long-term patient management and adverse reactions to the drug.
Adopt Zero Tolerance for Hospital Staff Bullying Nursing Students
Authors: Burkley John
Published: April 2018

Negative clinical experiences can have a formative influence on aspiring nurses.
AHRQ Resources for Preventing Falls in Hospitals
Authors: Ortelli Tracy A.
Published: April 2018

A toolkit and a training curriculum can facilitate change.
Evaluation of Antepartum and Postpartum Remote Monitoring of Gestational Weight Gain in Low-Risk Pregnancy [1A]
Authors: DeNicola Nathaniel , Ganju Nihar , Marko Kathryn
Published: April 2018

INTRODUCTION:

Gestational weight gain is an important marker of perinatal health. This study evaluates remote monitoring to track appropriate weight gain in low-risk pregnancies.

METHODS:

1058 low-risk pregnant women in 27 offices were enrolled in BabyscriptsTM (BRx), an integrated technology platform with a mobile application and connected blood pressure cuff and weight scale. Antepartum weight recordings were tabulated from 12–36 weeks gestation. Postpartum weight recordings were tabulated from 42–48 weeks gestation. Data was analyzed for mean weight gain during pregnancy and average interval between recordings.

RESULTS:

Antepartum weight monitoring of 1058 women showed a mean gestational weight gain: 22.42 lbs for underweight women (n=218), 20.27 lbs for normal weight women (n=468), 16.36 lbs for overweight women (n=203), and 11.22 lbs for obese women (n=169). A total of 45450 weight readings were recorded, with an average interval between recordings of 3.5 days. Postpartum monitoring of 395 women showed a mean weight loss of 7.79 lbs. On average 50% of gestational weight gain was lost by 6 weeks postpartum. During the postpartum period a total of 6071 weight readings were recorded, with an average interval between recordings of 3.5 days.

CONCLUSION:

Remote monitoring of gestational weight gain in low-risk pregnancy resulted in frequent recordings during the antepartum and postpartum period. In the future there is an opportunity for early intervention aided by connected platforms where deviations in recommend weight gain are identified. Adherence to weight monitoring highlights the ability to integrate this tool with high-risk care.
Anteverting Bernese periacetabular osteotomy in the treatment of neurogenic hip dysplasia in cerebral palsy
Authors: Georgiadis Andrew G. , Dutt Vivek , Truong Walter H. , Novotny Susan A. , Novacheck Tom F.
Published: April 2018

All patients with hypertonic cerebral palsy undergoing Bernese periacetabular osteotomy (PAO) between 2005 and 2014 were reviewed. Clinical and radiographic parameters, including the cerebral palsy hip classification and anterior and posterior wall indices were collected to assess acetabular reorientation. Twenty (83%) of 24 procedures involved the correction of posterolateral acetabular insufficiency and were ‘anteverting PAOs’. All 20 experienced improvements in radiographic indices. Eleven (58%) of 19 PAOs in ambulatory patients were performed in the setting of other multilevel orthopedic surgery. The anteverting PAO is successful in correcting the posterolateral acetabular insufficiency present in spastic hip dysplasia, and can be performed in conjunction with a single-event multilevel surgery.
Multivariate machine learning distinguishes cross-network dynamic functional connectivity patterns in state and trait neuropathic pain
Authors: Cheng Joshua C. , Rogachov Anton , Hemington Kasey S. , Kucyi Aaron , Bosma Rachael L. , Lindquist Martin A. , Inman Robert D. , Davis Karen D.
Published: April 2018

Communication within the brain is dynamic. Chronic pain can also be dynamic, with varying intensities experienced over time. Little is known of how brain dynamics are disrupted in chronic pain, or relates to patients' pain assessed at various timescales (eg, short-term state vs long-term trait). Patients experience pain “traits” indicative of their general condition, but also pain “states” that vary day to day. Here, we used network-based multivariate machine learning to determine how patterns in dynamic and static brain communication are related to different characteristics and timescales of chronic pain. Our models were based on resting-state dynamic functional connectivity (dFC) and static functional connectivity in patients with chronic neuropathic pain (NP) or non-NP. The most prominent networks in the models were the default mode, salience, and executive control networks. We also found that cross-network measures of dFC rather than static functional connectivity were better associated with patients' pain, but only in those with NP features. These associations were also more highly and widely associated with measures of trait rather than state pain. Furthermore, greater dynamic connectivity with executive control networks was associated with milder NP, but greater dynamic connectivity with limbic networks was associated with greater NP. Compared with healthy individuals, the dFC features most highly related to trait NP were also more abnormal in patients with greater pain. Our findings indicate that dFC reflects patients' overall pain condition (ie, trait pain), not just their current state, and is impacted by complexities in pain features beyond intensity.
Unexplained reciprocal regulation of diabetes and lipoproteins
Authors: Higuchi Sei , Izquierdo M. Concepción , Haeusler Rebecca A.
Published: April 2018

Purpose of review

Type 2 diabetes is associated with a characteristic dyslipidemia that may exacerbate cardiovascular risk. The causes of, and the effects of new antihyperglycemia medications on, this dyslipidemia, are under investigation. In an unexpected reciprocal manner, lowering LDL-cholesterol with statins slightly increases the risk of diabetes. Here we review the latest findings.

Recent findings

The inverse relationship between LDL-cholesterol and diabetes has now been confirmed by multiple lines of evidence. This includes clinical trials, genetic instruments using aggregate single nucleotide polymorphisms, as well as at least eight individual genes – HMGCR, NPC1L1, HNF4A, GCKR, APOE, PCKS9, TM6SF2, and PNPLA3 – support this inverse association. Genetic and pharmacologic evidence suggest that HDL-cholesterol may also be inversely associated with diabetes risk. Regarding the effects of diabetes on lipoproteins, new evidence suggests that insulin resistance but not diabetes per se may explain impaired secretion and clearance of VLDL-triglycerides. Weight loss, bariatric surgery, and incretin-based therapies all lower triglycerides, whereas SGLT2 inhibitors may slightly increase HDL-cholesterol and LDL-cholesterol.

Diabetes and lipoproteins are highly interregulated. Further research is expected to uncover new mechanisms governing the metabolism of glucose, fat, and cholesterol. This topic has important implications for treating type 2 diabetes and cardiovascular disease.
Muscle Strength of Lower Limbs as a Predictor of Postural Stability and Fear of Falling in Physically Active and Inactive Older Men and Women
Authors: Sadowska Dorota , Osiński Wiesław , Gumny Margareta
Published: April 2018

Objectives:

The aim of this study was to analyze the strength of lower limb muscles, adjusted for potential modulating effects of physical activity, as a predictor of postural stability and the fear of falling (FoF) in older women and men.

Materials and Methods.

The study included 113 physically active and inactive persons older than 60 years (73.35 ± 7.05 years). The strength of 4 groups of lower limb muscles was determined, along with postural stability, that is, Timed Up and Go (TUG) test, Functional Reach (FR) test, and subjective FoF.

Results and Conclusions.

Shorter time to complete TUG test coexisted with the greater strength of all examined muscles (from r = −0.28 to r = −0.48), except the gastrocnemius. The results of FR test in physically active individuals correlated significantly with gastrocnemius muscle strength (r = 0.34). Subjective FoF showed statistically significant correlations with the strength of all examined muscles (from R = −0.38 to R = −0.44), as well as with the results of TUG (R = 0.45) and FR tests (R = −0.43). Physically inactive older men show a considerable decrease in quadriceps muscle and hamstring strength. The strength of these muscles is similar to that observed in physically inactive women. The strength of quadriceps muscle, hamstrings, and hip abductors is a good predictor of the results of TUG test, whereas the strength of the gastrocnemius predicts the outcome of FR test. Lesser strength of lower limb muscles and worse results of TUG and FR tests are associated with greater subjective FoF.
The Impact of Weight Status on Health-Related Quality of Life and Body Image in Adults With Cystic Fibrosis
Authors: Gomes Allison , Rothpletz-Puglia Pamela , Matarese Laura , Ziegler Jane
Published: April 2018

The increased life expectancy seen in patients with cystic fibrosis (CF) shifts the focus of nutrition interventions from supporting survival to improving quality of life. The aim of this narrative review is to explore the importance of weight status and health-related quality of life in adults with CF. This review also identifies research supporting the differences in body image based on sex, which impacts an individual's weight status and health-related quality of life. Based on the literature, the CF care team should incorporate body image screening into clinical practice to optimize weight status and increase health-related quality of life in the adult with CF.
Association of intrauterine alcohol exposure and offspring depression: A negative control analysis of maternal and partner consumption
Authors: Easey Kayleigh E , Timpson Nicholas J , Munafò Marcus R
Published: April 2018

Background

Previous research has suggested that intrauterine alcohol exposure is associated with a variety of adverse outcomes in offspring. However, few studies have investigated its association with offspring internalising disorders in late adolescence.

Methods

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations of maternal drinking in pregnancy with offspring depression at age 18. We also examined partner drinking as a negative control for intrauterine exposure for comparison.

Results

Offspring of mothers that consumed any alcohol at 18 weeks gestation were at increased risk of having a diagnosis of depression (OR 1.15, 95% CI 1.00 to 1.32), but there was no clear evidence of association between partners alcohol consumption during pregnancy and increased risk of offspring depression (OR 0.90, 95% CI 0.78 to 1.04).

Conclusions

Maternal drinking in pregnancy was associated with increased risk of offspring depression at age 18. Residual confounding may explain this association, but the negative control comparison of paternal drinking provides some evidence that it may be causal, and this warrants further investigation.
Inferring the ancestry of parents and grandparents from genetic data
Authors: Pei Jingwen , Zhang Yiming , Nielsen Rasmus , Wu Yufeng
Published: April 2018

Inference of admixture proportions is a classical statistical problem in population genetics. Standard methods implicitly assume that both parents of an individual have the same admixture fraction. However, this is rarely the case in real data. In this paper we show that the distribution of admixture tract lengths in a genome contains information about the admixture proportions of the ancestors of an individual. We develop a Hidden Markov Model (HMM) framework for estimating the admixture proportions of the immediate ancestors of an individual, i.e. a type of decomposition of an individual’s admixture proportions into further subsets of ancestral proportions in the ancestors. Based on a genealogical model for admixture tracts, we develop an efficient algorithm for computing the sampling probability of the genome from a single individual, as a function of the admixture proportions of the ancestors of this individual. This allows us to perform probabilistic inference of admixture proportions of ancestors only using the genome of an extant individual. We perform extensive simulations to quantify the error in the estimation of ancestral admixture proportions under various conditions. To illustrate the utility of the method, we apply it to real genetic data.

Author summary

Ancestry inference is an important problem in genetics and is used commercially by a number of companies affecting millions of consumers of genetic ancestry tests. In this paper, we show that it is possible, not only to estimate the ancestry fractions of an individual, but also, with some uncertainty, to estimate the ancestry fractions of an individual’s ancestors. For example, if an individual traces his/her ancestry 50% to Asia and 50% to Europe, it is possible to distinguish between the individual having two parents that each are 50:50 composites of Asian and European ancestry, or one parent from Asia and one from Europe. It is likewise also possible to make inferences about grandparents. We present a computationally efficient method for making such inferences called PedMix. PedMix is based on a probabilistic model for the descendant and the recent ancestors. PedMix infers admixture proportions of recent ancestors (parents, grandparents or even great grandparents) using whole-genome genetic variation data from a focal individual. Results on both simulated and real data show that PedMix performs reasonably well in most scenarios.
Evolution of Environmentally-Enforced, Repeat Protein Topology in the Outer Membrane
Authors: Franklin Meghan Whitney , Nepomnyachiy Sergey , Feehan Ryan , Ben-Tal Nir , Kolodny Rachel , Slusky Joanna S.G.
Published: April 2018

Outer membrane beta barrels (OMBBs) are the proteins on the surface of Gram negative bacteria. These proteins have diverse functions but only a single topology, the beta barrel. It has been suggested that this common fold is a repeat protein with the repeating unit of a beta hairpin. By grouping structurally solved OMBBs by sequence, a detailed evolutionary story unfolds. A strand-number based pathway manifests with progression from a primordial 8-stranded barrel to 16-stranded and then to 18-stranded barrels. The transitions from 16- to 18-stranded barrels show mechanisms of strand number variation without domain duplication, such as a loop to hairpin transition. This indicates that repeat protein topology can be perpetuated without genetic duplication likely because the topology is being enforced by the membrane environment. Moreover, we find the evolutionary trace is particularly prominent in the C-terminal half of OMBBs which may be relevant to understanding OMBB folding pathways.
Crystal structure of (4bS,8aR)-1-isopropyl-4b,8,8-trimethyl-7-oxo-4b,7,8,8a,9,10-hexahydrophenanthren-2-yl acetate
Authors: Laamari Yassine , Ait Itto Moulay Youssef , Riahi Abdelkhalek , Chevreux Sylviane , Auhmani Aziz , Ketatni El Mostafa
Published: April 2018

The title compound, C22H28O3, was prepared by a direct acetylation reaction of naturally occurring totarolenone. The molecule contains three fused rings, which exhibit different conformations. The central ring has a half-chair conformation, while the non-aromatic oxo-substituted ring has a screw-boat conformation. In the crystal, molecules are linked by C—H...O hydrogen bonds and C—H...π interactions, forming sheets parallel to the bc plane. The carbonyl O atoms and the C atom at the 6-position of the cyclohexene ring are each disordered over two sets of sites with major occupancy components of 0.63 (7) and 0.793 (14), respectively.
Crystal structures of a manganese(I) and a rhenium(I) complex of a bipyridine ligand with a non-coordinating benzoic acid moiety
Authors: Lense Sheri , Guzei Ilia A. , Andersen Jessica , Thao Kong Choua
Published: April 2018

The structures of two facially coordinated Group VII metal complexes are reported, namely: fac-bromido[2-(2,2′-bipyridin-6-yl)benzoic acid-κ2
N,N′]tricarbonylmanganese(I) tetrahydrofuran monosolvate, [MnBr(C17H12N2O2)(CO)3]·C4H8O, I, and fac-[2-(2,2′-bipyridin-6-yl)benzoic acid-κ2
N,N′]tricarbonylchloridorhenium(I) tetrahydrofuran monosolvate, [ReCl(C17H12N2O2)(CO)3]·C4H8O, II. In both complexes, the metal ion is coordinated by three carbonyl ligands, a halide ion, and a 2-(2,2′-bipyridin-6-yl)benzoic acid ligand, in a distorted octahedral geometry. In manganese complex I, the tetrahydrofuran (THF) solvent molecule could not be refined due to disorder. The benzoic acid fragment is also disordered over two positions, such that the carboxylic acid group is either positioned near to the bromide ligand or to the axial carbonyl ligand. In the crystal of I, the complex molecules are linked by a pair of C—H...Br hydrogen bonds, forming inversion dimers that stack up the a-axis direction. In the rhenium complex II, there is hydrogen bonding between the benzoic acid moiety and a disordered co-crystallized THF molecule. In the crystal, the molecules are linked by C—H...Cl hydrogen bonds, forming layers parallel to (100) separated by layers of THF solvent molecules.
1-[(Oxiran-2-yl)methyl]-3-phenyl-1,2-dihydroquinoxalin-2-one
Authors: Abad Nadeem , El Bakri Youness , Sebhaoui Jihad , Ramli Youssef , Essassi El Mokhtar , Mague Joel T.
Published: April 2018

The asymmetric unit of the title compound, C17H14N2O2, consists of two independent molecules differing mainly in the orientations of the phenyl and oxirane substituents. In the first molecule, the dihedral angle between the dihydroquinoxaline ring system and phenyl ring is 28.4 (2)° and the N—C—C—O torsion angle is 87.8 (5)°; corresponding data for the second molecule are 23.1 (2) and −85.6 (5)°, respectively. In the crystal, offset π-stacking interactions between the dihydroquinoxaline moieties form oblique stacks, which are connected into layers parallel to the bc plane by C—H...O hydrogen bonds and C—H...π(ring) interactions. Additional C—H...π(ring) interactions tie the layers together. The model was refined as a two-component twin.
Dynamics of stakeholder relations with multi-person aggregation
Authors: Blanco-Mesa Fabio , Gil-Lafuente Anna Maria , Merigo Jose M.
Published: April 2018

Purpose

The purpose of this paper is to develop a novel method to analyse dynamic interactions of stakeholders to explain how a set of agents can act by considering the power/influence positions.

Design/methodology/approach

A novel mathematical application uses the importance of characteristics algorithm in combination with composition max-min to compare, group and order information according to the importance of its characteristics. The mathematical application is focused on a strategic analysis, evaluating stakeholder dynamics through power relationships.

Findings

The results show a comparison of the relationships among each of the stakeholders to obtain the relative intensity and importance of relationships between them, given by the fuzzy matrix FRInM and the fuzzy matrix FRIM, respectively. This application provides a useful tool for a dynamic analysis of stakeholders in a complex environment, where the best approach to performing a strategic analysis process is sought.

Research limitations/implications

The main implication of the proposed approach is taking into account the importance of information to establish the boundaries and relationships of each characteristic according to its intensity. However, limitations are due to the nature of this research, based on theoretical assumptions regarding stakeholders and the use of a hypothetical example to show the operation of algorithms.

Originality/value

The primary advantage of this proposition is that it takes into account the importance of information to establish the relationships among the characteristics according to their intensity. In addition, it performs multiple comparisons among each characteristic of the information. The interests and opinions of decision makers can be parameterised. A mathematical application shows how each interest group could be classified and related according to subjective information.
A Paleogeographic and Depositional Model for the Neogene Fluvial Succession, Pishin Belt, Northwest Pakistan: Effect of Post Collisional Tectonics on Sedimentation in a Peripheral Foreland Setting
Authors: KASI Aimal K. , KASSI Akhtar M. , UMAR Muhammad , FRIIS Henrik , MOHIBULLAH Mohibullah , MANAN Razzaq A.
Published: April 2018

Detailed facies analysis of the Neogene successions of the Pishin Belt (Katawaz Basin) has enabled documentation of successive depositional systems and paleogeographic settings of the basin formed by the collision of the northwestern continental margin of the Indian Plate and the Afghan Block. During the Early Miocene, subaerial sedimentation started after the final closure of the Katawaz Remnant Ocean. Based on detailed field data, twelve facies were recognized in Neogene successions exposed in the Pishin Belt. These facies were further organized into four facies associations i.e. channels, crevasse splay, natural levee and floodplain facies associations. Facies associations and variations provided ample evidence to recognize a number of fluvial architectural components in the succession e.g., low‐sinuosity sandy braided river, mixed‐load meandering, high‐sinuosity meandering channels, single‐story sandstone and/or conglomerate channels, lateral accretion surfaces (point bars) and alluvial fans. Neogene sedimentation in the Pishin Belt was mainly controlled by active tectonism and thrusting in response to the oblique collision of the Indian Plate with the Afghan Block of the Eurasian Plate along the Chaman‐Nushki Fault. Post Miocene deformation of these formations successively caused them to contribute as an additional source terrain for the younger formations.