bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear electrohydrodynamic instability through two jets of an Oldroydian viscoelastic fluids with a porous medium under the influence of electric field
Authors: Moatimid Galal M. , Mostapha Doaa R.
Published: May 2019

In the light of the viscous potential theory, a nonlinear instability of the surface waves propagating through two jets of viscoelastic fluids is scrutinized. The flow is jetting through porous media under the action of a uniform axial electric field. The Oldroyd B model is employed to characterize the rheological behavior of the viscoelastic fluid. A weakly nonlinear theory of wave propagation is deemed. A general dispersion relation and neutral curves are addressed and plotted for the different parameters. The Routh-Hurwitz criterion is utilized to determine the stability criteria. Several special cases are reported. It found that, in absence of porous media, the stability happens for large relaxation time and small retardation time. In addition, small retardation time leads to increase the elasticity of the fluid. Therefore, the stability is determined due to the elasticity of the fluid. However, in the presence of porous medium, the elasticity of the fluid decreases with the increase of relaxation time. Thus, the elasticity has a destabilizing effects. Furthermore, fluid viscosity has showed dual role of the stability diagram. Also, the case of Maxwell fluid is illustrated graphically. It is observed that Maxwell model is less stabilizing than Oldroyd model. The method of multiple time scale with the Taylor’s expansion is employed to conduct the well-known Ginzburg-Landau equation, which governs the nonlinear stability of the system. New several regions of stability and instability are identified due to the nonlinear effects.
Modification of strain and optical polarization property in AlGaN multiple quantum wells by introducing ultrathin AlN layer
Authors: Luo Zongyan , Lu Shiqiang , Li Jinchai , Wang Chuanjia , Chen Hangyang , Liu Dayi , Lin Wei , Yang Xu , Kang Junyong
Published: May 2019

The effects of ultrathin AlN insertion layers on the strain status, as well as optical properties of AlGaN multiple quantum wells (MQWs), were studied. A large stress variation of about -1.46 GPa can be achieved by introducing two ultrathin AlN layers at each interface between the quantum well and the barrier, thereby resulting in the fact that the degree of polarization is increased from 17.8% to 22.3% in traditional MQWs. In addition, the quantum well emission are found to become symmetric and narrower due to the suppression of compositional fluctuation. These results provide a simple technique to modify the strain field of MQWs so as to improve transverse-electric polarized emission for deep ultraviolet light emitting diodes.
Tellurium radionuclides produced by major accidental events in nuclear power plants
Authors: Gil-Díaz Teba
Published: May 2019

Environmental contextHistorical accidents in nuclear power plants have released radionuclides of several elements, including tellurium, to the environment. Although tellurium radionuclides are significant radioactive emission products, and show medium-term persistence in the environment, the mechanisms behind their widespread dispersion are unknown. Future research into the biogeochemical behaviour of stable tellurium is proposed as an appropriate approach to develop tellurium dispersion scenarios fundamental for post-accident management.
AbstractTellurium (Te) is a technology critical element (TCE) and a non-negligible fission product in nuclear facilities. This work compiles the environmental releases of Te radionuclides registered after two nuclear power plant (NPP) major accidental events in human history (Chernobyl and Fukushima Daiichi). Despite the registered non-negligible activities and environmental persistence, Te radionuclides are scarcely monitored, which limits the current understanding of their biogeochemical behaviour, dispersion and fate in all environmental compartments. This lack of knowledge implies an underestimation of the role of Te radionuclides during and after accidents and its consideration in dispersion scenarios, which are fundamental for post-accidental risk assessment and management.
Anthony William Linnane 1930–2017
Authors: Nagley Phillip
Published: May 2019

Anthony (Tony) Linnane isolated mitochondria from bakers’ yeast during his doctoral studies at the University of Sydney in the 1950s. He subsequently pioneered research into the biogenesis of mitochondria, covering enzymology, membrane biochemistry, and molecular biology and genetics, over more than two decades until the mid-1980s. These discoveries were made mostly at Monash University and earned him election as FAA (1972) and FRS (1980). Linnane thereafter broadened his research towards medical topics, especially the role of mitochondria in human ageing, together with studies on interferon and cancer-specific mucinous antigens. After retirement from Monash in 1996, Linnane worked towards ameliorating disease through bioenergetic strategies, based at the Centre for Molecular Biology and Medicine in Melbourne. He played significant roles in the Australian Biochemical Society and the International Union of Biochemistry.
Adipocytokines may delay pubertal maturation of human Sertoli cells
Authors: Wagner I. V. , Yango P. , Svechnikov K. , Tran N. D. , Söder O.
Published: May 2019

Reproduction is an important target of obesity complications, including adverse effects on spermatogenesis and steroidogenesis. Adipocytokines are key mediators in various complications of obesity. Our aim was to study the potential of adipocytokines to affect Sertoli cell function, which is crucial for spermatogenesis, and possibly link these findings to the observed attenuation of spermatogenesis in obese males. Testicular biopsies were obtained from healthy donors. Highly purified adult human Sertoli cells (HSCs) were isolated by fluorescence-activated cell sorting. Cells were cultured and exposed to different concentrations of adipocytokines (10–1000ngmL−1) for 2–7 days. Expression of selected Sertoli cell genes was quantified by quantitative polymerase chain reaction. Long-term treatment (7 days) of HSCs with higher concentrations of chemerin, irisin, nicotinamide phosphoribosyltransferase (Nampt), resistin and progranulin significantly suppressed FSH receptor expression (by 79%, 83%, 64%, 71% and 26% respectively; P<0.005 for all) and significantly upregulated cytochrome P450 family 26 subfamily A member 1 (CYP26A1) expression (by 48%, 90%, 126%, 126% and 153% respectively P<0.005 for all), comparable to what is found in the prepubertal state. Further, these adipocytokines significantly attenuated the expression of bone morphogenetic protein-4, glial cell line-derived neurotrophic factor, leukaemia inhibitory factor and fibroblast growth factor-2 by HSCs. We propose that adipocytokines, at high concentrations, which are often observed in obese males when tested invitro, may negatively affect Sertoli cell maturation and retain these cells in a more prepubertal stage. This could negatively affect testis function and add to fertility problems in obese adults.
Patient and companion shared decision making and satisfaction with decisions about starting cholinesterase medication at dementia diagnosis
Authors: McCabe Rose , Pavlickova Hana , Xanthopoulou Penny , Bass Nick J , Livingston Gill , Dooley Jemima
Published: May 2019

Background

there is little research on how people with dementia are involved in treatment decisions at diagnosis.

Objective

to measure shared decision making when starting cholinesterase inhibitors, investigate associations with contextual factors and explore satisfaction and experience of the diagnostic meeting.

Setting

nine UK memory clinics in two geographical locations.

Subjects

74 people receiving dementia diagnoses (with 69 companions) and 21 doctors.

Methods

we video-recorded 74 memory clinic consultations and rated doctor-shared decision making behaviours using the Observing Patient Involvement in Decision Making scale (OPTION-5 scale). Patients and companions rated their satisfaction and experience. Mixed-effects regressions investigated involvement and (i) number people present, meeting length, capacity, cognitive functioning, diagnosis; and (ii) patient/companion satisfaction and consultation experience.

Results

mean consultation time was 26.7 min. Mean OPTION-5 score was 22.5/100 (Standard Deviation = 17.3). Doctors involved patients in decisions more often when patients had mixed dementia (β = 10.13, 95% confidence interval 1.25–19.0, P = 0.025) and in shorter meetings (β = −0.51, 95% CI −0.87 to −0.15, P = 0.006). Patient and companion satisfaction were high and not associated with whether doctors invited patient involvement. Half of patients and one-third companions were uncertain about the meeting outcome, experienced communication barriers and negative emotions.

Conclusions

consultations scored low on shared decision making, but were comparable to other settings and were not lower with more cognitively impaired patients. Negative patient and companion experiences reflect the importance of supporting healthcare providers to address patient and companion emotions and need for information.
Does grandparental care select for a longer lifespan in non-human mammals?
Authors: Péron Guillaume , Bonenfant Christophe , Lemaitre Jean-François , Ronget Victor , Tidiere Morgane , Gaillard Jean-Michel
Published: May 2019

Several non-human mammalian species provide grandparental care but remain fertile until death, unlike our species. This might call into question the ‘grandmother hypothesis’ that the ability to provide grandparental care, associated with an increase in the cost of breeding with age, promote the early cessation of reproduction. Here, we analyse individual longevity records from non-human mammals to determine whether the few species with grandparental care also stand out among mammals in terms of age-specific survival patterns. Indeed, females of species with grandparental care lived on average 43% longer than males (range: 24–61%), compared with 12% in other polygynous species (95% quantile: −8 to 30%), because of low baseline mortality rates and delayed onset of actuarial senescence. We discuss this finding with respect to the ‘stopping early’ vs. ‘living longer’ debate. We review the role of the environmental context and of the decrease in offspring performance with maternal age (Lansing effect). We formalize the idea of a continuum of parental–grandparental allocation instead of a discrete switch to grandparental care only. Lastly, we suggest that the evolution of menopause has been driven by different forces in different species.
Anaplastic Large Cell T Cell Lymphoma in a Patient With Severe Therapy-refractory Crohn’s Disease on Long-standing Immunosuppressive Medication During Ustekinumab Treatment: A Case Report and Review of the Literature
Authors: Smeets Fabiënne G M , Liedorp Paulien R , van der Poel Marjolein , Miclea Razvan L , Masclee Ad A M , Pierik Marieke
Published: May 2019

Use of ustekinumab in Crohn’s disease was approved in 2016, and consequently data regarding its real-world safety are still limited. We here present a 29-year-old woman with severe therapy-refractory Crohn’s disease, who developed an anaplastic large cell T cell lymphoma during treatment with ustekinumab.
Successful right heart remodelling and subsequent pregnancy in a patient with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty: a case report
Authors: Ikeda Nobutaka , Hatano Masaru , Nagamatsu Takeshi , Nakamura Masato
Published: May 2019

Background

To date, the management of pregnancy in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and the associated risk of maternal mortality have not been established. Although balloon pulmonary angioplasty (BPA) in patients with CTEPH is still an emerging procedure, this approach represents a promising alternative to pulmonary endarterectomy (PEA), especially in patients with inoperable CTEPH.

Case summary

We present a case of a 34-year-old woman with CTEPH who desired to have a child. Right heart catheterization showed a mean pulmonary artery pressure of 54 mmHg. Since the lesions were observed in the distal part of subsegmental pulmonary arteries, there was no indication for PEA. After improvement in her haemodynamic status by BPA, she became pregnant. At 40 weeks of gestation, a normal baby was delivered vaginally. Both mother and baby have made satisfactory progress.

Discussion

In cases in which the haemodynamic status is improved by effective BPA, pregnancy and childbirth may be possible, even in patients with CTEPH.
Relationship between degree of heparin anticoagulation and clinical outcome in patients receiving potent P2Y12-inhibitors with no planned glycoprotein IIb/IIIa inhibitor during percutaneous coronary intervention in acute myocardial infarction: a VALIDATE-SWEDEHEART substudy
Authors: Sharma Tania , Rylance Rebecca , Karlsson Sofia , Koul Sasha , Venetsanos Dimitrios , Omerovic Elmir , Fröbert Ole , Persson Jonas , James Stefan , Erlinge David
Published: May 2019

Aims

Heparin is the preferred choice of anticoagulant in percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). An established dosage of heparin has not yet been determined, but treatment may be optimized through monitoring of activated clotting time (ACT). The aim of this study was to determine the relationship between heparin dose or ACT with a composite outcome of death, MI, or bleeding using data from the registry-based, randomized, controlled, and open-label VALIDATE-SWEDEHEART trial, although patients were not randomized to heparin dose in this substudy.

Methods and results

Patients with MI undergoing PCI and receiving treatment with a potent P2Y12-inhibitor and anticoagulation with heparin, without the planned use of glycoprotein IIb/IIIa inhibitor (GPI), were enrolled in this substudy. The primary endpoint was a composite endpoint of death, MI, and bleeding at 30 days. The individual components and stent thrombosis were analysed separately. We divided patients into groups according to the initial dose of unfractionated heparin during PCI (<70 U/kg, 70–100 U/kg, and >100 U/kg) or ACT (ACT <250 s, 250–350 s, and >350 s) as well as investigating them as continuous variables in Cox proportional hazards models using univariable and multivariable analyses. No major differences were noted between heparin stratified in groups (P = 0.22) or heparin as a continuous variable in relation to the primary composite endpoint hazard ratio (HR) 1.0 confidence interval (CI) (0.99–1.01) for heparin dose/kg. No differences were found between ACT stratified in groups (P = 0.453) or ACT in seconds HR 1.0 CI (0.99–1.00) regarding the primary endpoint. The individual components of death, MI, major bleeding, and stent thrombosis were not significantly different across heparin doses or ACT levels either.

Conclusion

We found no association between heparin dose or ACT levels and death, MI bleeding complications, or stent thrombosis. Therefore, there is no strong support for a specific heparin dose or mandatory ACT monitoring in patients treated with potent P2Y12-inhibitors with no planned GPI.
Carbon Emission Flow and Transfer through International Trade of Forest Products
Authors: Shrestha Prativa , Sun Changyou
Published: May 2019

The environmental impact of commodity trade has become a considerable concern in recent decades. In this study, carbon emissions embodied in forest products trade are examined through a multiregional input–output model. Compared with other industries, the forest products industry is clean with a small total emission and mean emission intensity. The paper sector is more substantial in total emission and dirtier in emission intensity than the wood sector. Most countries with extensive forest products trade have experienced declining consumption-based carbon emissions over 1995–2009, and all countries have become cleaner based on the emission intensity value. Carbon emissions embodied in international trade of forest products are about 25 percent of total emissions from production activities. Developing countries generally have much higher emission intensities than developed countries. Uncertainties in the carbon emission data have a larger impact than those in the intermediate and final consumption data. These findings are helpful for policymakers to understand the economic–environmental relations of forest products trade and to improve policy and agreement designs.
Revisiting the Evolution and Taxonomy of Clostridia, a Phylogenomic Update
Authors: Cruz-Morales Pablo , Orellana Camila A , Moutafis George , Moonen Glenn , Rincon Gonzalo , Nielsen Lars K , Marcellin Esteban
Published: May 2019

Clostridium is a large genus of obligate anaerobes belonging to the Firmicutes phylum of bacteria, most of which have a Gram-positive cell wall structure. The genus includes significant human and animal pathogens, causative of potentially deadly diseases such as tetanus and botulism. Despite their relevance and many studies suggesting that they are not a monophyletic group, the taxonomy of the group has largely been neglected. Currently, species belonging to the genus are placed in the unnatural order defined as Clostridiales, which includes the class Clostridia. Here, we used genomic data from 779 strains to study the taxonomy and evolution of the group. This analysis allowed us to 1) confirm that the group is composed of more than one genus, 2) detect major differences between pathogens classified as a single species within the group of authentic Clostridium spp. (sensu stricto), 3) identify inconsistencies between taxonomy and toxin evolution that reflect on the pervasive misclassification of strains, and 4) identify differential traits within central metabolism of members of what has been defined earlier and confirmed by us as cluster I. Our analysis shows that the current taxonomic classification of Clostridium species hinders the prediction of functions and traits, suggests a new classification for this fascinating class of bacteria, and highlights the importance of phylogenomics for taxonomic studies.
Techno-poetics in micro-stories of the digital age: The case of Alex Epstein
Authors: Levin Orna
Published: May 2019

In this study, I frame the concept of techno-poetics by analyzing Alex Epstein’s micro-stories and by examining the development of the micro-fiction genre throughout the world. Epstein is a contemporary Israeli author whose universal micro-stories have been translated into several languages (English, Spanish, French, and Russian). Epstein uses a dual language: given his career as a computer programmer in a high-tech company, the language of his thoughts is conveyed through the logic of technology, whereas, as an artist, he is loyal to the language of poetics. Is Epstein a “programmer” of micro-stories? Within the framework of this study, I analyze the dynamic relationship between the polar opposites of technology and poetics, as it is revealed in Epstein’s micro-stories, taking into account the genre’s characteristics as well as the unique features with which Epstein—as a contemporary author—imbues his works. More specifically, I analyze six categories that describe the relationship between digital technology and the world of art, a relationship that informs Epstein's micro-stories. Epstein's work was not created in a void; nevertheless, his micro-stories differ not only from the works of previous authors of the genre, but also from those of his contemporaries, whose work, likewise, deals with the tension between technology and poetics. A major difference is the methods of publication that Epstein uses, which form part of the techno-poetical process. In this sense, the themes, the conception of art, and the method of publication are all indications of a unique artistic phenomenon.
VoroMQA web server for assessing three-dimensional structures of proteins and protein complexes
Authors: Olechnovič Kliment , Venclovas Česlovas
Published: May 2019

The VoroMQA (Voronoi tessellation-based Model Quality Assessment) web server is dedicated to the estimation of protein structure quality, a common step in selecting realistic and most accurate computational models and in validating experimental structures. As an input, the VoroMQA web server accepts one or more protein structures in PDB format. Input structures may be either monomeric proteins or multimeric protein complexes. For every input structure, the server provides both global and local (per-residue) scores. Visualization of the local scores along the protein chain is enhanced by providing secondary structure assignment and information on solvent accessibility. A unique feature of the VoroMQA server is the ability to directly assess protein-protein interaction interfaces. If this type of assessment is requested, the web server provides interface quality scores, interface energy estimates, and local scores for residues involved in inter-chain interfaces. VoroMQA, the underlying method of the web server, was extensively tested in recent community-wide CASP and CAPRI experiments. During these experiments VoroMQA showed outstanding performance both in model selection and in estimation of accuracy of local structural regions. The VoroMQA web server is available at http://bioinformatics.ibt.lt/wtsam/voromqa.
Kazan Tatar Teacher School: The Global Entanglement of A Local Imperial Institution in The Late Russian Empire
Authors: Tuna Mustafa
Published: May 2019

This article examines the ‘global life’ of a teacher school that Russian imperial officials opened in 1876 to Russify the tsarist empire’s Turkic-speaking Muslim subjects in the Volga-Ural region. Interventions and transformations at the local, imperial and transregional scales over the next several decades altered the context in which this imperial institution the Kazan Tatar Teacher School operated. The school’s effectiveness in achieving its pedagogical goals turned into a political problem for the tsarist center as a result. A Berlin-born German Turkologist in Russian government service designed the school’s curriculum to offer European-inspired secular knowledge. He called it ‘Russian knowledge’ and introduced it to his superiors as a gateway to Russification. He also incorporated Islamic studies and some Muslim daily practices into the school programme to avoid a backlash from the local Muslim population. Over time, a small but vocal cohort of progressivist Muslims took advantage of this programme to acquire conversance in the language and culture of the empire’s evolving cosmopolitan public. As Eurocentric transregional movements from socialism to nationalism permeated that culture, however, the Kazan Tatar Teacher School served as an incubator for politicization among Russia’s Muslims to the ire of the tsarist regime’s centrist advocates and agents.
Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis
Authors: Onyeakusi Nnaemeka E , Mukhtar Fahad , Gbadamosi Semiu O , Oshunbade Adebamike , Adejumo Adeyinka C , Olufajo Olubode , Owoh Jude
Published: May 2019

Background

About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients.

Objective

The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population.

Methods

Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest.

Results

Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68–8.67, P < 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11–1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316).

Conclusions

CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.
What Does He Think? A Pilot Study Examining Male Knowledge and Attitudes of Long Acting Reversible Contraception [2G]
Authors: George Jessica , Hussain Nuzhath , Hussein Nada
Published: May 2019

INTRODUCTION:

Contraceptive counseling, especially regarding long acting reversible contraception (LARC), is generally directed at women. However, male partners and peers may influence contraceptive decision making. As there are no published studies examining male perceptions of LARC in the United States, this study investigates male knowledge and attitudes of LARC.

METHODS:

An anonymous electronic cross sectional survey was administered from May to September 2018 to males age 18 to 24 years old. Participants were recruited via university email listservs and in-person at a campus student organization fair. Qualitative and quantitative data were analyzed using SPSS.

RESULTS:

Participants (n=97) are predominantly heterosexual (83.5%) men. Of those who are sexually active (63.9%), 98.4% report female partners and trying to avoid pregnancy. The most commonly used methods of contraception are oral contraceptive pills (48.4%) and condoms (80.6%). The majority (76.3%) of participants have not heard of LARC. Prior LARC use is associated with knowledge of LARC (X2(1,97)=4.26, P<.05); however, this association is not seen with use of other contraceptive methods. Despite large confidence intervals (CI), the magnitude of association suggests prior sex is predictive of knowledge of LARC (OR 1.19 95% CI 0.45-3.11). Participants familiar with LARC are generally neutral to very supportive of LARC (87.0%). Additionally, 80.4% of participants are neutral to very interested in learning more about LARC.

CONCLUSION:

Males age 18 to 24 have limited knowledge of LARC, with an interest in learning more about LARC. This information can be used to shape interventions to bridge knowledge gaps, ultimately helping women make supported contraceptive choices.
Cervical Preparation and Dilation Prior to Second Trimester Abortion [8G]
Authors: Economou Nicole I. , Ihenacho Ugonna , Cortessis Victoria , Natavio Melissa Faith Q.
Published: May 2019

INTRODUCTION:

Dilation and evacuation (D&E) is the most common method of second trimester abortion in the United States. Cervical preparation prior to the procedure is essential for its safety as inadequate dilation can result in complications including cervical laceration and uterine perforation. This research study explores the relationship between cervical preparation and achieving adequate cervical dilation at the time of D&E.

METHODS:

IRB-approved, retrospective cohort study of patients between 16w0d to 24w0d who underwent overnight cervical preparation with laminaria prior to D&E.

RESULTS:

265 patients met criteria for analysis. Increasing summed cross-sectional area of laminaria was associated with an increase in cervical dilation (as determined by digital exam) at the time of D&E. Cervical dilation of 2.5 cm was adequate to complete all procedures between 16w0d to 19w6d without needing mechanical dilation. Cervical dilation of 3 cm was adequate to complete the majority of procedures (98.2%) between 20w0d to 24w0d without needing mechanical dilation; at 3.5 cm dilation, all procedures were completed without mechanical dilation. Major complication rate was 4% overall and was not increased in those needing additional mechanical dilation, regardless of gestational age. All procedures were completed as scheduled; none were cancelled or delayed due to inadequate dilation.

CONCLUSION:

The goal of cervical preparation should be to achieve a dilation of at least 2.5-3 cm in order to complete the majority of D&E procedures without need for mechanical dilation. Data analysis is ongoing to determine the optimal number and size of laminaria needed to achieve these levels of cervical dilation.
An Evaluation of the Maternal and Neonatal Characteristics Associated With Preterm Birth in Haiti [24G]
Authors: Buckley Ayisha , Persad Malini D. , Milone Gina F. , Pardo Christina , Davilmar Inolson , Garretto Diana J.
Published: May 2019

INTRODUCTION:

Haiti is an impoverished country with poor health infrastructure and pregnancy outcomes. In Haiti, a 2010 study estimated the preterm birth (PTB) rate to be 14.1%, similar to the United States. Few studies have assessed PTB in Haiti. We aim to characterize maternal and perinatal characteristics associated with PTB in Haiti.

METHODS:

IRB-approved, retrospective cohort study from January 2017 to May 2017 looking at all deliveries at St. Damien Hospital. 423 paper charts were reviewed. Patients were placed into 2 groups based on gestational age at time of delivery (<37 weeks defined as PTB). Parametric and non-parametric statistics were used to analyze the data, P-value <.05 was significant.

RESULTS:

The incidence of PTB was 24.3% (103/320). The average gestational age in the PTB group was 31.9 weeks, vs. 39.3 in the non-PTB group (P<.001). Patients with PTB were more likely to have chronic hypertension (6.8% vs. 2.2%, P<.02) or preeclampsia with severe features (33.0% vs. 8.8%, P<.001), and receive antenatal steroids (31.1% vs. 0.6%, P<.001) and magnesium sulfate (32.0% vs. 8.1%, P<.001). 13.5% of patients with PTB had oligohydramnios (P<.005) and 4.9% had fetal growth restriction (P<.02). PTB neonates were more likely to be small for gestational age (18.4% vs. 9.7%, P<.001), have lower 5-minute Apgar scores (P<.001), and respiratory distress syndrome (7.8% vs. 1.3%, P<.001).

CONCLUSION:

The incidence of PTB in Haiti was higher than previously estimated, although studies are lacking. This innovative study further characterizes PTB, its risk factors, outcomes and potential areas of intervention in the Haitian population.
Antenatal Ultrasound Compared to MRI Evaluation of Fetal Myelomeningocele: A Prenatal and Postnatal Evaluation [28G]
Authors: Munoz Jessian Louis , Bishop Elaine , Reider Mitchell , Singh Katherine
Published: May 2019

INTRODUCTION:

Spina bifida affects 0.5-1 in 1000 pregnancies in the United States. Imaging has played a major role in pregnancies complicated by spinal defects. Our goal was to directly compare ultrasounds and MRI obtained antenatally in the diagnosis and localization of fetal myelomeningocele and compare these to the postnatal outcomes of these infants.

METHODS:

A retrospective analysis of patients referred to the Fetal Care Center at the Cleveland Clinic from 2005-2017. Ultrasounds and MRIs were obtained within the Cleveland Clinic electronic medical record. Infants were followed up at an interdisciplinary myelomeningocele pediatrics clinic.

RESULTS:

MRI and US varied in correlation with physical exam at time of birth and surgery. While no differences were detected in demographics, pregnancy outcomes or pediatric outcomes, it was noted the majority of patients developed neurogenic bladders irrespective of lesion level.

CONCLUSION:

MRI is not superior to US in the diagnosis of MMC. Pregnancies complicated by MMC do not vary in morbidity and pediatric outcomes remain similar regardless of level of lesion. This data provides additional information for the counseling of patients when faced with this antenatal diagnosis.
Are There Characteristics Associated With Hypertension Beyond the Fourth Trimester? [32G]
Authors: Weeks Corinne M. , Marcov Lauren J. , Lynch Kerry , Wiese Sarah L. , Leung Katherine , Leftwich Heidi Kay
Published: May 2019

INTRODUCTION:

Literature reports women with hypertensive disorders of pregnancy are at threefold increased risk of having hypertension and twofold increased risk of developing cardiovascular disease later in life. We sought to identify characteristics associated with hypertension in the 12 weeks to 24 months postpartum period.

METHODS:

We performed an IRB approved, retrospective cohort study on postpartum hypertension from deliveries from 07/09 to 07/16. Inclusion criteria were delivery at our institution, presence of a hypertensive disorder of pregnancy, and a documented blood pressure between 12 weeks to 24 months postpartum. Exclusion criteria were discharge home on antihypertensive medication. Postpartum hypertension was defined as a systolic blood pressure ≥-140 or diastolic blood pressure ≥90. Chi-square test was used for categorical and Student T-test was used for continuous variables.

RESULTS:

697 women met inclusion and exclusion criteria. Of these women, 245 were identified as having hypertension 12 weeks to 24 months postpartum. Women with hypertension were more likely to be older (p=0.046), have a higher pre-pregnancy BMI (p<0.001), and be multiparous (p=0.002). There was a statistically significant difference in hypertension when comparing the hypertensive disorders of pregnancy (p<0.001). There were no differences amongst other study variables.

CONCLUSION:

Of the women who delivered at our institution with a hypertensive disorder of pregnancy, 35% had hypertension in the 12 weeks to 24 months postpartum period. Characteristics more likely associated with postpartum hypertension include older age, higher pre-pregnancy BMI, and multiparity. These characteristics may be important to consider when counseling patients on the importance of continued follow up beyond the fourth trimester.
Association Between Hemoglobin A1C and Hypertensive Disorders in Type 2 Diabetics [34G]
Authors: Holthaus Emily , Singh Katherine
Published: May 2019

INTRODUCTION:

Pre-gestational type 2 diabetes is increasing in prevalence and is known to be associated with poor pregnancy outcomes. There is conflicting data about the association between hemoglobin A1c (HbA1c) and pregnancy outcomes, with very limited data specifically examining type 2 diabetics. This is a retrospective cohort study examining patients with pre-gestational type 2 diabetes who delivered within the Cleveland Clinic system between 2012 and 2018.

METHODS:

Type 2 diabetics were identified using ICD code extraction from pregnancy episodes. IRB approval was obtained. We examined the association between gestational HbA1c and a pooled hypertension outcome which included gestational hypertension, preeclampsia with and without severe features, eclampsia, and pregnancy induced hypertension. Odds ratios with 95% confidence intervals were calculated for first, second, and third trimester HbA1c values.

RESULTS:

We identified 611 pregnancy episodes with pre-gestational type 2 diabetes diagnoses. No differences in age, race, BMI, or parity were found between the two groups. Increased first trimester HbA1c was more likely to result in the pooled hypertension outcome (Odds ratio 1.25, 95% CI 1.03-1.52), while second trimester HbA1c (OR 1.25, 95% CI 0.97-1.61) and third trimester HbA1c (OR 1.23, 95% CI 0.96-1.57) were not found to have statistically significant associations with the pooled outcome.

CONCLUSION:

Our analysis show a positive association between first trimester HbA1c and our pooled hypertension outcome. Utilizing HbA1c may be of benefit in our rapidly growing patient population of type 2 diabetics, particularly in those presenting late to care or those diagnosed in early screening.
Evaluating the Impact of a Student-Run Clinic on Expanding Access to Gynecologic Care for Uninsured Patients [36G]
Authors: Kumar Natasha Raj , DuVernois Gabriele , Almeida-Monroe Valerie , Siegert Nicole , DeGroot Annie
Published: May 2019

INTRODUCTION:

Significant disparities in access to gynecologic services persist for uninsured women, who are far less likely to obtain preventive screenings against breast or cervical cancer than insured women. Safety net institutions reduce health disparities, but gaps in service provision for gynecologic services remain. Student-run clinics, or clinics coordinated and staffed by medical students that are supervised by licensed physicians, provide preventive services at rates similar to other safety net institutions.

METHODS:

A retrospective chart review examined the prevalence of gynecologic issues addressed by a student-run women's clinic at a free clinic in Providence, Rhode Island and quantified the service provision provided to this population of uninsured, predominantly Latina women.

RESULTS:

Between May 2015 and 2017, the women's clinic saw 138 patients over 171 encounters during 48 clinics. Most visits included Pap smears or mammograms (85.2%). Other prevalent issues were abnormal uterine bleeding (23.9%), contraception (13.0%), abnormal vaginal discharge (12.3%), and infertility (11.6%). The clinic provided 83 Pap smears, 35 STI tests, 19 vaginitis screens and referrals for mammograms (n=42), colposcopy (n=7), and sub-specialists (n=14). Culturally sensitive interventions were designed to address linguistic and social barriers to care for patients seeking subspecialty care.

CONCLUSION:

Student-run clinics can effectively deliver gynecologic services to safety net populations. With their unique access to faculty preceptors and funding, medical students can play a significant role in expanding the specialty services available to uninsured patients. Safety net institutions should consider empowering medical students to create student-run specialized clinics under appropriate supervision to address the needs of their patient populations.
Impact of Sex Assessment Methodology on Natal Sex-Specific Condition Data: Pap Smears and Transmen [38G]
Authors: Crissman Halley P. , Berger Mitchell B. , Stroumsa Daphna
Published: May 2019

INTRODUCTION:

Most surveys use a single question to assess sex. The recommended two-step process asks two questions, sex assigned at birth and current gender identity, which better identifies gender minority populations. We use Pap smear data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the impact of single question sex assessment on natal sex-specific condition data.

METHODS:

We analyzed data among people eligible for Pap smears in the 2014-2016 BRFSS (n= 294,171). In 2014-2015 “sex” was determined by interviewers' perception with “clarification if necessary;” in 2016 respondents were asked, “Are you male or female?” “Females” were asked about Paps. Transgender status was determined by asking “Do you consider yourself to be transgender?” We analyzed the “sex” and transgender status of respondents that were and were not asked about Paps using design-adjusted chi-square tests.

RESULTS:

Half of transmen (48.7%), compared to two-thirds (69.8%) of ciswomen, were asked whether they ever had a Pap (p-value <0.001). Sex was coded “male” for 31.8% (24.9-43.0%) of transmen. Pap data was not collected for any individuals coded as “male”. Among transmen labeled “female” there was no difference in those asked about Paps (71.4%) compared to ciswomen (69.8%, p-value=0.709). Of those who were asked, 17.5% of transmen had never had a pap compared to 6.8% of ciswomen (p-value <0.001).

CONCLUSION:

Transmen are less likely to be asked about, or to have had, a Pap than ciswomen. With a single sex question, surveys fail to capture natal sex-specific conditions accurately in gender minority populations.
Implementation of a Standardized Integrated Screening Tool to Identify Behavioral Risks in Pregnancy [39G]
Authors: Dean Sara , Fox Karin , Denning Stacie , Jackson Aimee , Gandhi Manisha
Published: May 2019

INTRODUCTION:

Pregnancy provides a unique opportunity to identify women exposed to risky behavior. Standardization has proven to decrease variability and improve quality of care across a breadth of disciplines. We aimed to increase screening and detection of behavioral health risks by introducing the standardized Integrated Screening Tool (IST). The IST uses 11 yes or no questions to screen for patient, peer and family substance use, domestic violence, and emotional health, and takes less than 3 minutes to complete.

METHODS:

We retrospectively reviewed 100 charts to evaluate baseline rates of screening. No standard tool was used at baseline. In January 2018, we launched universal screening using the IST at intake, 28-week, and 36-week visits within the Maternal-Fetal Medicine ambulatory clinic. Clinical staff instructed all patients to complete the IST while awaiting the provider. We reviewed 186 active patients' charts from January to July 2018.

RESULTS:

During the study period, 295 screening visits occurred. Chart review of these visits revealed 90% of opportunities to screen were completed compared to only 65% at baseline. Positive screens were significantly higher at intake and 28-week visits than when compared to baseline (33% vs 16% [P=.006], and 26% vs 11% [P=.017], respectively).

CONCLUSION:

Our data demonstrate a standardized, written tool increases screening in our patient population and significantly increases the detection of positive screens in pregnant patients. Identification of behavioral health risks in pregnancy can lead to potential interventions to mitigate the effect of these behaviors.
Is Screening for Uterine Cancers an Opportunity to Reduce Cancer's Burden Among Populations With Disparities? [40G]
Authors: Del Priore Giuseppe , Khozaim Kareem Hamed , Chen Yi-Ju , Timoteo-Liaina Ianeta , Matthews Roland P.W. , Buenconsejo Lee
Published: May 2019

INTRODUCTION:

We sought to compare cancers currently screened for and uterine cancers (UC) due to its relative ascendancy in incidence, using a vanguard of contemporary cancer risk with high non-communicable disease rates (American Samoa [AS]), as a demonstration project in a population with disparities.

METHODS:

Public access de-identified databases covering the entire national population of AS over several time periods.

RESULTS:

The annualized incidence of UC increased from 21/100,000 women/year (2004) to 50 (2011) to 60 (2015) and eclipsed breast, colon, and skin since 2011. Gynecologic cancers were the leading cause of cancer death among women after lung since approximately 2014. UC was the leading cause of gynecologic deaths (1.6x greater than ovarian or cervical) and was 33% more likely to be diagnosed than breast cancer, 3.8x greater than colon, 4.6x cervical, 7.7x ovarian, and 23x lung. Compared to mainland incidence, uterine was 2.3x and cervical 1.5x greater on AS. In a recent 24-month period, there were 33 UCs among 291 biopsies for abnormal bleeding (PPV 33/291 11.3%). The median age was 55 with 25% <50 years old; BMI-38.2 with 95% > 30; and 33.3% grade 3.

CONCLUSION:

This may be the first report of UC being the leading cause of cancer death in any population. UC has similar characteristics to currently screened cancers with an incidence in this high-risk population just under breast and prostate, but ahead of lung and colon. An enriched population, eg, BMI combined with age, especially with disparities, could benefit most from changes in screening strategy and management.
Difficulty of Intrauterine Contraceptive Insertion in Relation to Menstrual Cycle Day of Insertion [3H]
Authors: Baer Samantha , Roncari Danielle Marie
Published: May 2019

INTRODUCTION:

The November 2017 American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 186 states that an intrauterine contraceptive (IUC) can be inserted “at any time during the menstrual cycle as long as pregnancy may be reasonably excluded”. However, many providers insert IUCs during menstruation to ensure that a woman is not pregnant and because of a belief that this timing leads to easier insertions. A delay in insertion may be an obstacle to access. This study aims to evaluate if menstruation decreases the rate of difficult insertions.

METHODS:

We conducted a retrospective chart review of 250 women with IUC insertions in our Gynecology outpatient clinic within 5 days of the start of last menstrual period (LMP) compared to women with insertion outside of menses. Difficult insertions were defined as an initial failed attempt at placement, need for additional dilation, need for pharmacologic cervical preparation, need for second provider, or need for ultrasound guidance.

RESULTS:

IUCs were inserted within 5 days of LMP in 18.8% of patients (n = 47). The overall difficult insertion rate was 10.0% (n = 25) with 4 failed placements (1.6%). For insertions within 5 days of LMP, 17.0% were difficult compared to 8.4% for insertions not within 5 days of LMP.

CONCLUSION:

Our results indicate that IUC insertion within 5 days of LMP is not associated with a higher rate of difficult placements. Changing practice patterns to encourage interval IUC insertion would decrease the barrier of timing for women seeking a long-acting form of contraception.
Discontinuation of Levonorgestrel Intrauterine System (LNGIUS) Versus Low Dose LNGIUS (LD-LNGIUS) [4H]
Authors: Cope Adela G. , Weaver Amy , Casey Petra
Published: May 2019

INTRODUCTION:

Rates of long acting reversible contraception (LARC) use, including LNGIUS and LD-LNGIUS the United States are increasing. The aim of this study was to compare rates of and reasons for discontinuation of these two LARC.

METHODS:

Following IRB approval, premenopausal women 13-55 years old undergoing LD-LNGIUS (13.5 mg) insertion for contraception at Mayo Clinic Rochester from 1/1/2013 to 12/31/2015 were identified (n=82). A random sample of 328 women meeting the same criteria with LNGIUS insertion was identified. The cumulative incidence of discontinuation for symptom-related complaints was compared between groups after taking into account discontinuation for other reasons as a competing risk.

RESULTS:

Compared to those with LNGIUS, women with LD-LNGIUS were younger (mean age, 25.9 vs. 30.3 years), more likely to be nulliparous (86.6% vs. 28.0%), less likely to have previously used LARC (13.4% vs. 35.1%), and had lower BMI (mean, 25.2 vs. 27.0 kg/m2). In women with subsequent follow-up, 57.3% (43/75) of the women with LD-LNGIUS expressed a symptom concern compared to 60.9% (171/281) of the women with LNGIUS. The cumulative incidence of discontinuation for symptom-related complaints by 2 years was higher in the LD-LNGIUS group, with rates of 20.0% vs. 13.8% based on patients with follow-up and 23.4% vs.12.8% based on a subset of 58+58 women matched on age, race, gravidity, and insertion year.

CONCLUSION:

Women with LD-LNGIUS are less likely to express symptom concerns than women with LNGIUS, but more likely to discontinue for symptom-related complaints. These findings may inform counseling of women with hormonal intrauterine contraception placement.