bluuebunny/crossref_metadata_2025 huggingface dataset:
Independence Inheritance and Diophantine Approximation for Systems of Linear Forms
Authors: Allen Demi , Ramírez Felipe A
Published: June 2022

The classical Khintchine–Groshev theorem is a generalization of Khintchine’s theorem on simultaneous Diophantine approximation, from approximation of points in ${\mathbb {R}}^m$ to approximation of systems of linear forms in ${\mathbb {R}}^{nm}$. In this paper, we present an inhomogeneous version of the Khintchine–Groshev theorem that does not carry a monotonicity assumption when $nm>2$. Our results bring the inhomogeneous theory almost in line with the homogeneous theory, where it is known by a result of Beresnevich and Velani [11] that monotonicity is not required when $nm>1$. That result resolved a conjecture of Beresneich et al. [5], and our work resolves almost every case of the natural inhomogeneous generalization of that conjecture. Regarding the two cases where $nm=2$, we are able to remove monotonicity by assuming extra divergence of a measure sum, akin to a linear forms version of the Duffin–Schaeffer conjecture. When $nm=1$, it is known by work of Duffin and Schaeffer [16] that the monotonicity assumption cannot be dropped. The key new result is an independence inheritance phenomenon; the underlying idea is that the sets involved in the $((n+k)\times m)$-dimensional Khintchine–Groshev theorem ($k\geq 0$) are always $k$-levels more probabilistically independent than the sets involved the $(n\times m)$-dimensional theorem. Hence, it is shown that Khintchine’s theorem itself underpins the Khintchine–Groshev theory.
Beauville–Voisin Filtrations on Zero-Cycles of Moduli Space of Stable Sheaves on K3 Surfaces
Authors: Li Zhiyuan , Zhang Ruxuan
Published: June 2022

The Beauville–Voisin conjecture predicts the existence of a filtration on a projective hyper-Kähler manifold opposite to the conjectural Bloch–Beilinson filtration, called the Beauville–Voisin filtration. In [13], Voisin has introduced a filtration on zero-cycles of an arbitrary projective hyper-Kähler manifold. On the moduli space of stable objects on a projective K3 surface, there are other candidates constructed by Shen–Yin–Zhao and Barros–Flapan–Marian–Silversmith in [1, 10] and more recently by Vial in [11] from a different point of view. According to the work in [11], all of them are proved to be equivalent except Voisin’s filtration. In this paper, we show that Voisin’s filtration is the same as the other filtrations. As an application, we prove a conjecture in [1].
Designing and Evaluating Iconic Gestures for Child-Robot Second Language Learning
Authors: de Wit Jan , Willemsen Bram , de Haas Mirjam , van den Berghe Rianne , Leseman Paul , Oudgenoeg-Paz Ora , Verhagen Josje , Vogt Paul , Krahmer Emiel
Published: June 2022

In this paper, we examine the process of designing robot-performed iconic hand gestures in the context of a long-term study into second language tutoring with children of approximately 5 years old. We explore four factors that may relate to their efficacy in supporting second language tutoring: the age of participating children; differences between gestures for various semantic categories, e.g. measurement words, such as small, versus counting words, such as five; the quality (comprehensibility) of the robot’s gestures; and spontaneous reenactment or imitation of the gestures. Age was found to relate to children’s learning outcomes, with older children benefiting more from the robot’s iconic gestures than younger children, particularly for measurement words. We found no conclusive evidence that the quality of the gestures or spontaneous reenactment of said gestures related to learning outcomes. We further propose several improvements to the process of designing and implementing a robot’s iconic gesture repertoire.
Artistic Motives in Korean Art Traditions: Self-Cultivation, Self-Enjoyment, and Self-Forgetting
Authors: Choi Dobin
Published: June 2022

In this essay, I discuss Korean artists’ multi-layered, internal motives for engaging in artistic practices: their artistic devotion derives from their desires for moral self-cultivation, self-enjoyment, and self-forgetting. I speculate that these tendencies were intensified in Korean cultural traditions by distinctive sociopolitical circumstances of the Joseon period under the dominance of Neo-Confucianism, such as a fixed social hierarchy and Sino-centrist perspectives. This interpretation provides a useful lens for better understanding contemporary Korean artistic practices in both the fine and popular arts.
International risk of SARS-CoV-2 Omicron variant importations originating in South Africa
Authors: Bai Yuan , Du Zhanwei , Xu Mingda , Wang Lin , Wu Peng , Lau Eric H Y , Cowling Benjamin J , Meyers Lauren Ancel
Published: June 2022

Omicron, a fast-spreading SARS-CoV-2 variant of concern reported to the World Health Organization on 24 November 2021, has raised international alarm. We estimated there is at least 50% chance that Omicron had been introduced by travellers from South Africa into 11 of the 14 countries studied by 28 November 2021.
Linking the brightest stellar streams with the accretion history of Milky Way like galaxies
Authors: Vera-Casanova Alex , Gómez Facundo A , Monachesi Antonela , Gargiulo Ignacio , Pallero Diego , Grand Robert J J , Marinacci Federico , Pakmor Rüdiger , Simpson Christine M , Frenk Carlos S , Morales Gustavo
Published: June 2022

According to the current galaxy-formation paradigm, mergers and interactions play an important role in shaping present-day galaxies. The remnants of this merger activity can be used to constrain galaxy-formation models. In this work, we use a sample of 30 hydrodynamical simulations of Milky Way mass haloes, from the AURIGA project, to generate surface brightness maps and search for the brightest stream in each halo as a function of varying limiting magnitude. We find that none of the models shows signatures of stellar streams at $\mu _{r}^{\lim} \le 25$ mag arcsec−2. The stream detection increases significantly between 28 and 29 mag arcsec−2. Nevertheless, even at 31 mag arcsec−2, 13 per cent of our models show no detectable streams. We study the properties of the brightest streams progenitors (BSPs). We find that BSPs are accreted within a broad range of infall times, from 1.6 to 10 Gyr ago, with only 25 per cent accreted within the last 5 Gyrs; thus, most BSPs correspond to relatively early accretion events. We also find that 37 per cent of the BSPs survive to the present day. The median infall times for surviving and disrupted BSPs are 5.6 and 6.7 Gyr, respectively. We find a clear relation between infall time and infall mass of the BSPs, such that more massive progenitors tend to be accreted at later times. However, we find that the BSPs are not, in most cases, the dominant contributor to the accreted stellar halo of each galaxy.
All-fibre wavefront sensor
Authors: Wright T A , Yerolatsitis S , Harrington K , Harris R J , Birks T A
Published: June 2022

We report on a tapered three-core optical fibre that can be used as a tip–tilt wavefront sensor. In this device, a coupled region of a few millimetres at the sensing tip of the fibre converts fragile phase information from an incoming wavefront into robust intensity information within each of the cores. The intensity information can be easily converted to linear wavefront error over small ranges, making it ideal for closed loop systems. The sensor uses minimal information to infer tip–tilt and is compatible with remote detector arrays. We explore its application within adaptive optics and present a validation case to show its applicability to astronomy.
Protective effect of sacubitril/valsartan (Entresto) on kidney function and filtration barrier injury in a porcine model of partial nephrectomy
Authors: Brignone Juan , Jensen Mia , Jensen Boye L , Assersen Kasper Bostlund , Goetze Jens P , Jødal Lars , Andersen Trine Borup , Magnusdottir Sigriður Olga , Kloster Brian , Jønler Morten , Lund Lars
Published: June 2022

Kidney surgery often includes organ ischaemia with a risk of acute kidney injury. The present study tested if treatment with the combined angiotensin II–angiotensin II receptor type 1 and neprilysin blocker Entresto (LCZ696, sacubitril/valsartan) protects filtration barrier and kidney function after ischaemia and partial nephrectomy (PN) in pigs. Single kidney glomerular filtration rate (GFR) by technetium-99m diethylene-triamine-pentaacetate clearance was validated (n = 6). Next, four groups of pigs were followed for 15 days (n = 24) after PN (one-third right kidney, 60 min ischaemia) + Entresto (49/51 mg/day; n = 8), PN + vehicle (n = 8), sham + Entresto (49/51 mg/day; n = 4) and sham + vehicle (n = 4). GFR, diuresis and urinary albumin were measured at baseline and from each kidney after 15 days. The sum of single-kidney GFR (right 25 ± 6 mL/min, left 31 ± 7 mL/min) accounted for the total GFR (56 ± 14 mL/min). Entresto had no effect on baseline blood pressure, p-creatinine, mid-regional pro-atrial natriuretic peptide (MR-proANP), heart rate and diuresis. After 15 days, Entresto increased GFR in the uninjured kidney (+23 ± 6 mL/min, P < .05) and reduced albuminuria from both kidneys. In the sham group, plasma MR-proANP was not altered by Entresto; it increased to similar levels 2 h after surgery with and without Entresto. Fractional sodium excretion increased with Entresto. Kidney histology and kidney injury molecule-1 in cortex tissue were not different. In conclusion, Entresto protects the filtration barrier and increases the functional adaptive response of the uninjured kidney.
Ovarian Function Suppression: A Deeper Consideration of the Role in Early Breast Cancer and its Potential Impact on Patient Outcomes: A Consensus Statement from an International Expert Panel
Authors: Arboleda Bolivar , Bartsch Rupert , de Azambuja Evandro , Hamilton Erika , Harbeck Nadia , Klemp Jennifer , Knauer Michael , Kuemmel Sherko , Mahtani Reshma , Schwartzberg Lee , Villarreal-Garza Cynthia , Wolff Antonio
Published: June 2022

It has been suggested that the benefit of adjuvant chemotherapy (CT) in premenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) early breast cancer may be related, at least in part, to CT-induced ovarian function suppression (OFS) in this subgroup of patients. Although this hypothesis has not been directly tested in large randomized clinical trials, the observations from prospective studies have been remarkably consistent in showing a late benefit of CT among the subgroup of patients who benefit (ie, women who were close to menopause). The hypothesis has important clinical implications, as it may be possible to spare the associated adverse effects of adjuvant CT in a select group of women with early breast cancer, in favor of optimizing OFS and endocrine therapy (ET), without compromising clinical outcomes. Such an approach has the added benefit of preserving the key quality of life outcomes in premenopausal women, particularly by preventing the irreversible loss of ovarian function that may result from CT use. For this reason, we convened an international panel of clinical experts in breast cancer treatment to discuss the key aspects of the available data in this area, as well as the potential clinical implications for patients. This article summarizes the results of these discussions and presents the consensus opinion of the panel regarding optimizing the use of OFS for premenopausal women with HR+, HER2− early breast cancer.
CLASS-II KNOXgenes coordinate spatial and temporal ripening in tomato
Authors: Keren-Keiserman Alexandra , Shtern Amit , Levy Matan , Chalupowicz Daniel , Furumizu Chihiro , Alvarez John Paul , Amsalem Ziva , Arazi Tzahi , Alkalai-Tuvia Sharon , Efroni Idan , Ori Naomi , Bowman John L , Fallik Elazar , Goldshmidt Alexander
Published: June 2022

Fruits can be divided into dry and fleshy types. Dry fruits mature through senescence and fleshy fruits through ripening. Previous studies have indicated that partially common molecular networks could govern fruit maturation in these different fruit types. However, the nature of such networks remains obscure. CLASS-II KNOX genes were shown to regulate the senescence of the Arabidopsis (Arabidopsis thaliana) dry fruits, the siliques, but their roles in fleshy-fruit development are unknown. Here, we investigated the roles of the tomato (Solanum lycopersicum) CLASS-II KNOX (TKN-II) genes in fleshy fruit ripening using knockout alleles of individual genes and an artificial microRNA line (35S:amiR-TKN-II) simultaneously targeting all genes. 35S:amiR-TKN-II plants, as well as a subset of tkn-II single and double mutants, have smaller fruits. Strikingly, the 35S:amiR-TKN-II and tknII3 tknII7/+ fruits showed early ripening of the locular domain while their pericarp ripening was stalled. Further examination of the ripening marker-gene RIPENING INHIBITOR (RIN) expression and 35S:amiR-TKN-II rin-1 mutant fruits suggested that TKN-II genes arrest RIN activity at the locular domain and promote it in the pericarp. These findings imply that CLASS-II KNOX genes redundantly coordinate maturation in both dry and fleshy fruits. In tomato, these genes also control spatial patterns of fruit ripening, utilizing differential regulation of RIN activity at different fruit domains.
Circulating and renal fibrocytes are associated with interstitial fibrosis in lupus nephritis
Authors: Kim Jihye , Go Heounjeong , Lim Joon Seo , Oh Ji Seon , Ahn Soo Min , Kim Yong-Gil , Lee Chang-Keun , Yoo Bin , Hong Seokchan
Published: June 2022

Objectives

Fibrocytes, the extracellular matrix-producing cells derived from bone marrow progenitors, contribute to organ fibrosis. We investigated the presence and characteristics of fibrocytes in the peripheral blood and kidney of patients with lupus nephritis (LN), and the association of the abundance of fibrocytes with renal tubular epithelial cells (RTECs) in LN fibrogenesis.

Methods

Fibrocytes were identified with type I collagen (colI), α-smooth muscle actin (α-SMA), CD34 and CD45 using flow cytometry and confocal imaging. The associations between the levels of fibrocytes and pathological features of patients with LN were analysed. The contribution of RTECs to fibrocyte generation was determined using LN sera-treated HK-2 cells.

Results

Spindle-shaped fibrocytes (colI+α-SMA+CD34+CD45+ cells) were present in the peripheral blood and their abundance was especially high in LN patients with interstitial fibrosis compared with healthy control. Renal fibrocytes (colI+α-SMA+CD45+ cells) were found in the tubulointerstitium in patients with LN, and their numbers were significantly associated with the degrees of chronicity indices including interstitial fibrosis and renal dysfunction. Stimulation of peripheral blood mononuclear cells with supernatants from LN serum-treated HK-2 cells led to a significant generation of fibrocytes, which was abrogated by the addition of IL-6 neutralizing antibody.

Conclusion

Fibrocytes were significantly increased in the blood and kidney tissue of patients with LN, especially those with interstitial fibrosis. Fibrocytes could be differentiated from blood cells, with an active contribution from RTECs. Our results show a possible link between fibrocytes and tubulointerstitial fibrosis, which may serve as a novel therapeutic target for LN fibrogenesis.
Behçet syndrome in children and adults: discovering similarities and differences by a comparative study
Authors: Mastrolia Maria Vincenza , Bettiol Alessandra , Marrani Edoardo , Maccora Ilaria , Taddei Emilia , Pagnini Ilaria , Canfora Maria , Emmi Giacomo , Silvestri Elena , Prisco Domenico , Simonini Gabriele
Published: June 2022

Objective

Behçet’s syndrome (BS) is a rare disorder with a relapsing-remitting course. Clinical variance across geographical regions and different age groups has been observed. This study matched the demographic, clinical and treatment features of adult- and juvenile-onset BS in the Italian population.

Methods

Two clinical databases of BS patients were compared. The paediatric BS database was collected at the Meyer Children’s Hospital, Florence, while the adult BS database was collected at the Careggi University Hospital, Florence.

Results

A familiar predisposition for BS was significantly more frequent in the paediatric cohort (3/33 vs 1/165, P = 0.015). No difference emerged in terms of prevalence of HLA-B51 positivity. The proportion of patients meeting the revised ICBD and/or the ISG criteria at BS diagnosis was comparable in the two cohorts. No significant difference emerged between the two cohorts in terms of muco-cutaneous, ocular and neurological involvement, and gastrointestinal symptoms. Articular manifestations resulted as more common in the paediatric cohort, whereas venous vascular events were more frequent in the adult cohort. Regarding treatment strategy, paediatric patients more frequently received no treatment or corticosteroid monotherapy. Conversely, the use of DMARDs, both traditional and biologic, was significantly higher in the adult cohort.

Conclusion

Remarkable differences between juvenile-onset and adult-onset BS, both in terms of gender, familiar predisposition and clinical manifestations have been observed and a different therapeutic approach in the real clinical practice of the two settings emerged. Prospective, comparison studies with a longer follow-up are encouraged to provide further data about the disease course for juvenile- and adult-onset BS.
Potential Biomarker Identification by RNA-Seq Analysis in Antibiotic-Related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Pilot Study
Authors: Teo Ying Xin , Haw Wei Yann , Vallejo Andreas , McGuire Carolann , Woo Jeongmin , Friedmann Peter Simon , Polak Marta Ewa , Ardern-Jones Michael Roger
Published: June 2022

One of the most severe forms of cutaneous adverse drug reactions is “drug reaction with eosinophilia and systemic symptoms” (DRESS), hence subsequent avoidance of the causal drug is imperative. However, attribution of drug culpability in DRESS is challenging and standard skin allergy tests are not recommended due to patient safety reasons. Whilst incidence of DRESS is relatively low, between 1:1000 and 1:10 000 drug exposures, antibiotics are a commoner cause of DRESS and absence of confirmatory diagnostic test can result in unnecessary avoidance of efficacious treatment. We therefore sought to identify potential biomarkers for development of a diagnostic test in antibiotic-associated DRESS. Peripheral blood mononuclear cells from a “discovery” cohort (n = 5) challenged to causative antibiotic or control were analyzed for transcriptomic profile. A panel of genes was then tested in a validation cohort (n = 6) and compared with tolerant controls and other inflammatory conditions which can clinically mimic DRESS. A scoring system to identify presence of drug hypersensitivity was developed based on gene expression alterations of this panel. The DRESS transcriptomic panel identified antibiotic-DRESS cases in a validation cohort but was not altered in other inflammatory conditions. Machine learning or differential expression selection of a biomarker panel consisting of 6 genes (STAC, GPR183, CD40, CISH, CD4, and CCL8) showed high sensitivity and specificity (100% and 85.7%–100%, respectively) for identification of the culprit drug in these cohorts of antibiotic-associated DRESS. Further work is required to determine whether the same panel can be repeated for larger cohorts, different medications, and other T-cell-mediated drug hypersensitivity reactions.
The XadA Trimeric Autotransporter Adhesins in Xylella fastidiosa Differentially Contribute to Cell Aggregation, Biofilm Formation, Insect Transmission and Virulence to Plants
Authors: Feitosa-Junior Oseias R. , Souza Ana Paula S. , Zaini Paulo A. , Baccari Clelia , Ionescu Michael , Pierry Paulo M. , Uceda-Campos Guillermo , Labroussaa Fabien , Almeida Rodrigo P. P. , Lindow Steven E. , da Silva Aline M.
Published: June 2022

Surface adhesion strategies are widely employed by bacterial pathogens during establishment and systemic spread in their host. A variety of cell-surface appendages such as pili, fimbriae, and afimbrial adhesins are involved in these processes. The phytopathogen Xylella fastidiosa employs several of these structures for efficient colonization of its insect and plant hosts. Among the adhesins encoded in the X. fastidiosa genome, three afimbrial adhesins, XadA1, Hsf/XadA2, and XadA3, are predicted to be trimeric autotransporters with a C-terminal YadA-anchor membrane domain. We analyzed the individual contributions of XadA1, XadA2, and XadA3 to various cellular behaviors both in vitro and in vivo. Using isogenic X. fastidiosa mutants, we found that cell-cell aggregation and biofilm formation were severely impaired in the absence of XadA3. No significant reduction of cell-surface attachment was found with any mutant under flow conditions. Acquisition by insect vectors and transmission to grapevines were reduced in the XadA3 deletion mutant. While the XadA3 mutant was hypervirulent in grapevines, XadA1 or XadA2 deletion mutants conferred lower disease severity than the wild-type strain. This insight of the importance of these adhesive proteins and their individual contributions to different aspects of X. fastidiosa biology should guide new approaches to reduce pathogen transmission and disease development.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Infection by Endophytic Epichloë sibirica Was Associated with Activation of Defense Hormone Signal Transduction Pathways and Enhanced Pathogen Resistance in the Grass Achnatherum sibiricum
Authors: Shi Xinjian , Qin Tianzi , Qu Yaobing , Zhang Junzhen , Hao Guang , Zhao Nianxi , Gao Yubao , Ren Anzhi
Published: June 2022

Epichloë endophytes can improve the resistance of host grasses to pathogenic fungi, but the underlying mechanisms remain largely unknown. Here, we used phytohormone quantifications, gene expression analysis, and pathogenicity experiments to investigate the effect of Epichloë sibirica on the resistance of Achnatherum sibiricum to Curvularia lunata pathogens. Comparison of gene expression patterns between endophyte-infected and endophyte-free leaves revealed that endophyte infection was associated with significant induction of 1,758 and 765 differentially expressed genes in the host before and after pathogen inoculation, respectively. Functional analysis of the differentially expressed genes suggested that endophyte infection could activate the constitutive resistance of the host by increasing photosynthesis, enhancing the ability to scavenge reactive oxygen species, and actively regulating the expression of genes with function related to disease resistance. We found that endophyte infection was associated with induction of the expression of genes involved in the biosynthesis pathways of jasmonic acid, ethylene, and pipecolic acid and amplified the defense response of the jasmonic acid/ethylene co-regulated EIN/ERF1 transduction pathway and Pip-mediated TGA transduction pathway. Phytohormone quantifications showed that endophyte infection was associated with significant accumulation of jasmonic acid, ethylene, and pipecolic acid after pathogen inoculation. Exogenous phytohormone treatments confirmed that the disease index of plants was negatively related to both jasmonic acid and ethylene concentrations. Our results demonstrate that endophyte infection can not only improve the constitutive resistance of the host to phytopathogens before pathogen inoculation but also be associated with enhanced systemic resistance of the host to necrotrophs after C. lunata inoculation.
Circadian clock function does not require the histone methyltransferase MLL3
Authors: Baxter Matthew , Poolman Toryn , Cunningham Peter , Hunter Louise , Voronkov Maria , Kitchen Gareth B. , Goosey Laurence , Begley Nicola , Kay Danielle , Hespe Abby , Maidstone Robert , Loudon Andrew S. I. , Ray David W.
Published: June 2022

The circadian clock controls the physiological function of tissues through the regulation of thousands of genes in a cell‐type‐specific manner. The core cellular circadian clock is a transcription–translation negative feedback loop, which can recruit epigenetic regulators to facilitate temporal control of gene expression. Histone methyltransferase, mixed lineage leukemia gene 3 (MLL3) was reported to be required for the maintenance of circadian oscillations in cultured cells. Here, we test the role of MLL3 in circadian organization in whole animals. Using mice expressing catalytically inactive MLL3, we show that MLL3 methyltransferase activity is in fact not required for circadian oscillations in vitro in a range of tissues, nor for the maintenance of circadian behavioral rhythms in vivo. In contrast to a previous report, loss of MLL3‐dependent methylation did not affect the global levels of H3K4 methylation in liver, indicating substantial compensation from other methyltransferases. Furthermore, we found little evidence of genomic repositioning of H3K4me3 marks. We did, however, observe repositioning of H3K4me1 from intronic regions to intergenic regions and gene promoters; however, there were no changes in H3K4me1 mark abundance around core circadian clock genes. Output functions of the circadian clock, such as control of inflammation, were largely intact in MLL3‐methyltransferase‐deficient mice, although some gene‐specific changes were observed, with sexually dimorphic loss of circadian regulation of specific cytokines. Taken together, these observations indicate that MLL3‐directed histone methylation is not essential for core circadian clock function; however, it may influence the inflammatory response.
YouTube as a Source of Information on COVID-19 Vaccination and Fertility: A Content Analysis [A330]
Authors: Radoc Jeannie G. , Gonzalez Gabriela , Alkhalaf Zeina , Liu Chi-Mei
Published: June 2022

INTRODUCTION:

Social media claims of COVID-19 vaccination causing infertility has contributed to vaccine hesitancy among reproductive-aged women. YouTube is the most extensively used video sharing platform, delivering information to 2.3 billion users. We conducted a cross-sectional study to assess the accuracy, content, and viewership of YouTube videos on COVID-19 vaccines and fertility.

METHODS:

YouTube videos identified using the search term ‘COVID vaccine fertility’ were classified independently by three professionals. Five-point ordinal scales were used to grade reliability and quality. Information regarding source of upload, video content in six pre-defined domains, reasons for vaccine hesitancy in eight pre-defined domains, and various video-viewer interaction metrics were collected.

RESULTS:

Of the 112 videos with cumulative duration of 17.2 hours and viewership of approximately 3.5 million, 16 (14.41%) were from government/professional societies, 41 (36.94%) were from hospitals, 36 (32.43 %) were from News/Commercial organizations, and 18 (16.22%) were from individual users. Videos from government/professional societies were rated more likely to be useful and had the highest quality scores. However, individual accounts had the highest viewership at a median of 286.5 views per day compared to 28.8 views per day for government videos (P<.05). Among videos from government/professional societies, 62.50% reported on pregnancy related complications. In contrast, among individual videos, 66.67% reported on COVID-19 vaccine clinical trials. Among all videos, the most reported reason for vaccine hesitancy were claims of antibodies disrupting placentation.

CONCLUSION:

Social media websites such as YouTube may provide an accessible platform for disseminating information to reproductive-aged women contemplating COVID-19 vaccination.
Team Performance in High-Fidelity Simulations of Postpartum Hemorrhage Management [A336]
Authors: Buttle Rae A. , Detlefs Sarah , Goffman Dena , Foley Michael R. , Crump Cade , Deering Shad
Published: June 2022

INTRODUCTION:

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and presents care teams with unique, time-sensitive challenges. Simulation provides a way to evaluate team performance with no risk to patients. Identification of common errors is important to target training and optimize outcomes.

METHODS:

High-fidelity simulation exercises were conducted at a national obstetric critical care conference between 2014 and 2019. A simulated case of a PPH preceded by placental abruption was performed by multidisciplinary teams using high-fidelity simulators. Team performance was evaluated using a standardized checklist of key actions, and each item was scored as “not done”, “poorly done”, or “well done”. Descriptive statistics were then compiled for analysis. The study was reviewed and determined to be exempt by the hospital institutional review board.

RESULTS:

Complete performance data was available for 155 teams. Appropriate diagnosis of etiology of the hemorrhage (uterine atony) and timely recognition of the need for operative management was well done by most teams (91% and 92.3%, respectively). However, a significant number of teams demonstrated poor performance regarding inspection for lacerations (34.2%) and checking for retained products of conception (38.1%). Additionally, poor performance was identified for timely initiation of blood transfusion (11.6%) and activation of a massive transfusion protocol (20.6%).

CONCLUSION:

Thorough assessment of time-sensitive care interventions revealed specific deficits in team performance of PPH. High-fidelity simulation provides opportunities for exposure to obstetric emergency and may help to both target and determine the effectiveness of trainings designed to address these identified performance gaps.
Accessibility of Obstetrician–Gynecologists and Gynecologic Oncologists to the Medicare Population: A State-By-State Analysis [A296]
Authors: Talbott Jennifer , Khurana Aditya , Wasson Megan
Published: June 2022

INTRODUCTION:

Access to care is a predictor of health outcomes for the aged female population. The purpose of this study was to evaluate the accessibility of obstetrician–gynecologists (ob-gyns) and gynecologic oncologists to the U.S. Medicare population, over time and by state.

METHODS:

The supply of ob-gyns and gynecologic oncologists was extracted from the Physician and Other Supplier Public Use File (POSPUF) database of Medicare Part B claims submitted to the U.S. Centers for Medicare and Medicaid Services. This supply was compared to the number of providers normalized by the number of Original Medicare beneficiaries; values reported are providers per 100,000 beneficiaries by state from 2012 to 2019, obtained from the Kaiser Family Foundation.

RESULTS:

In 2019, the average number of ob-gyns per 100,000 beneficiaries across all states was 67.2 (standard deviation [SD] ±19.3), and ranged from 157.01 (District of Columbia) to 45.39 (Wyoming). The average number of gynecologic oncologists was 2.48 (SD±1.18), and ranged from 6.60 (District of Columbia) to 0.83 (Mississippi). From 2012 to 2019, the average absolute difference in number of ob-gyns across all states was −7.71±8.59 and ranged from+15.74 (Connecticut) to −37.32 (Alaska). For gynecologic oncologists, this difference was+0.10±1.04 and ranged from+5.22 (District of Columbia) to −1.84 (South Dakota).

CONCLUSION:

There is wide geographic variation in the accessibility and growth rate of ob-gyns and GYNONCs for the Medicare population. This provides insight into areas of the country where the supply of ob-gyns and gynecologic oncologists may not meet current and future demand.
Leveraging Quality Improvement to Promote Health Equity: Prenatal Aspirin Recommendations by Race [A303]
Authors: Gross Maya , Hughes Ainsley E. , Sampene Katherine
Published: June 2022

INTRODUCTION:

Black patients are disproportionately affected by preeclampsia and associated morbidity and mortality. Aspirin (ASA) reduces these risks and the United States Preventative Services Task Force (USPSTF) recommends ASA for pregnant patients at moderate to high risk for preeclampsia. We aimed to assess whether a quality-improvement intervention to standardize ASA screening and prescription resulted in similar rates of indicated ASA recommendations for patients who self-identified as Black versus non-Black.

METHODS:

Using a quality-improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. We analyzed 201 new OB (NOB) visits pre-intervention and 199 NOB visits 3 months post-intervention. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factor or 2 or more moderate-risk factors. ASA orders were signed by physicians. Results were stratified by self-identified Black versus non-Black race.

RESULTS:

Pre-intervention, 88% of Black patients met criteria, and 29% of those patients correctly received a recommendation for ASA. Among non-Black patients, 41% met criteria for ASA, and 27% of those patients a recommendation. Post-intervention, 93% and 41% of Black and non-Black patients met criteria, respectively, with 80% and 79% of those patients, respectively, receiving the recommendation.

CONCLUSION:

A strikingly high percentage of Black patients warrant a recommendation for ASA to reduce preeclampsia risk, as per USPSTF guidelines. Our standardized approach to prenatal screening and prescribing of ASA resulted in similar rates of correct prescriptions for ASA in Black and non-Black patients, suggesting a mechanism for delivering equitable preventative obstetric care.
A Systematic Review of Patient-Reported Outcomes to Inform Women's Health Quality Improvement [A304]
Authors: Ling Vivian , Kang Minji M. , Nguyen Buu-Hac , McGowan Makazhia , Peahl Alex F. , Moniz Michelle
Published: June 2022

INTRODUCTION:

Patient-reported outcomes (PROs) are defined as data reported from patients without interpretation or alteration from others. Use of PROs in health care can identify opportunities for quality improvement (QI) that may be overlooked by clinician-based metrics. This rapid review evaluated best practices for selecting, implementing, and utilizing PROs to inform QI initiatives.

METHODS:

We performed a systematic review of studies addressing PROs in PubMed and Google Scholar. Inclusion criteria specified use of PROs in a health care setting for QI. We excluded articles where PROs were utilized only as an outcome. Further evaluation was based on the PICOS (Population, Intervention, Comparator, Outcomes, Setting) framework. Two members of the study team independently reviewed articles for inclusion and data abstraction.

RESULTS:

A total of 156 articles were independently reviewed: 111 were removed following title and abstract screening, and 21 after full-text assessment, resulting in 24 articles for qualitative synthesis. The most common populations were clinical trial participants (46%), patients with cancer (16.7%), and postpartum patients (8.3%). Articles revealed key considerations for integrating PROs in QI work, including: 1) selection (e.g., use of specific criteria, expert or literature review), 2) implementation (e.g., data management, survey use), and 3) utilization (e.g., for decision-making, future PRO selection).

CONCLUSION:

This review highlights several important steps in effective integration of PROs in QI initiatives, including selection, implementation, and application. Future work is needed to define best practices for incorporating these principles in quality initiatives to improve patient-centeredness and equity among diverse populations.
Human Papillomavirus Vaccination for Postpartum Patients: A Quality Improvement Initiative [A324]
Authors: Thayer Sydney , Vest Robin , Wecker Eric , Calvert Leah , Luty Jacob
Published: June 2022

INTRODUCTION:

Human papillomavirus (HPV) vaccination decreases rates of cervical cancer and pre-cancer, yet many remain undervaccinated. This quality improvement initiative aims to increase HPV vaccination postpartum.

METHODS:

Institutional review board exemption was obtained. Patients aged 26 years or younger who delivered viable fetus(es) at a tertiary care center were screened for HPV vaccination eligibility. Patients were included if HPV vaccine data was available in the electronic medical record. Eligible patients were counseled and offered the HPV vaccine in the immediate postpartum period, defined as within 6 weeks postpartum. Additionally, physicians from the obstetrics and gynecology and Family Medicine departments were given a 1-question survey three times during the study period to assess clinician-reported patient screening for HPV vaccine eligibility. A program evaluation was conducted after 4 and 8 months.

RESULTS:

Three hundred twenty one women aged 26 years and younger delivered during the study period, with 260 meeting inclusion criteria. A total of 185 (71.2%) previously completed the HPV vaccine series. Of the 75 undervaccinated patients, 38 (50.7%) received at least one HPV vaccine postpartum, a significant increase from 2.3% in the 1 year prior to program initiation (P<.001). Seventeen percent of physicians surveyed reported screening at least half of their prenatal patients for HPV vaccine eligibility prior to the program's initiation, which significantly increased to 34% at 4 months and 47% at 8 months during the initiative (P<.001).

CONCLUSION:

Postpartum is a crucial and often overlooked period to optimize maternal health care. Counseling and offering HPV vaccination in the postpartum period is efficacious in increasing vaccine uptake among women aged 26 years and younger.
Associations Between Emotional Resilience and Mental Health Problems in Underserved Pregnant Women [A325]
Authors: Guo Yuqing , Jimah Tamara , Borg Holly , Pimentel Pamela , Kehoe Priscilla
Published: June 2022

INTRODUCTION:

Prenatal distress (ie, depression and anxiety) is associated with adverse maternal and infant outcomes. Importantly, emotional resilience has been found to protect women from mental health conditions. The goals of this research were to identify the prevalence of depression and anxiety and to examine relationships between emotional resilience and depression/anxiety in low socioeconomic (LSE) prenatal women during the COVID-19 pandemic.

METHODS:

The study adopted a cross-sectional design. We recruited 15 underserved Hispanic women who were aged 18-40 years and had a singleton pregnancy through WIC in California. The validated surveys were used to collect participants' demographics, mental health, and emotional resilience, including Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Freiburg Mindfulness Inventory, and Coping Self-Efficacy. The Cronbach's alpha of these surveys ranged from 0.77 to 0.93. Descriptive statistics and partial correlations were conducted using SPSS.

RESULTS:

Maternal mean age was 26.8 (SD=3.73). Approximately one half of pregnant women (46.7%) had a Bachelor's degree or higher, 20% did not live with the baby's father, and 33.3% indicated having an at-risk pregnancy (e.g., anemia). Appropriately 13.3% of Hispanic pregnant women experienced prenatal depression and/or anxiety. After controlling for maternal education, higher mindfulness was significantly associated with a lower level of anxiety (r= −0.67, P=.009), and greater coping self-efficacy was significantly associated with a lower level of depression (r= −0.54, P=.049).

CONCLUSION:

It would be critical to improve pregnant women's mental health by increasing their ability to practice mindfulness and confidence to cope with distress.
Characteristics of Patients Most Likely to Use Postpartum Text-Based Breastfeeding Support Platform [A267]
Authors: Bender Whitney , Durnwald Celeste
Published: June 2022

INTRODUCTION:

The aim was to describe the patient population most likely to utilize a postpartum text-based breastfeeding support platform.

METHODS:

This is a secondary analysis of an IRB-approved randomized controlled trial (RCT) at an urban tertiary care center from January 2020 to January 2021 comparing (1) a control group receiving weekly text messages inquiring about infant feeding method versus (2) an intervention group receiving educational texts and personalized text-based breastfeeding support as needed in addition to a weekly feeding question. Only patients randomized to the intervention arm were analyzed. The primary outcome was utilization of text-based support as defined by asking ≥1 feeding-related question in the first 6 weeks postpartum.

RESULTS:

Of the 216 subjects in the RCT, 106 were randomized to the intervention arm. Within this cohort, mean age was 31.4 years, 50% self-identified as Black, 51.9% were nulliparous, and 54.7% had commercial insurance. Overall, nulliparous patients were more likely than multiparous patients to utilize the text-based support platform (65.5% vs. 34.6%, P=.004). Patients with commercial insurance were also more likely to engage with the text-based support platform (65.5% vs. 34.6%, P=.02). Platform usage did not differ based on other clinical characteristics analyzed.

CONCLUSION:

Nulliparous and commercially insured patients were more likely to utilize a postpartum text-based breastfeeding support platform than their multiparous or publicly insured counterparts. Understanding the patient populations most likely to engage with a text-based health platform is critical to advancing health care delivery in the future.
Addressing Racial Disparities in Cesarean Delivery Rates Using A Digital Program: Preliminary Findings [A271]
Authors: Pickover Alison , Moss Christa , Shah Neel
Published: June 2022

INTRODUCTION:

Current U.S. data indicate racial disparities in cesarean delivery rates, with Black mothers most likely to deliver via cesarean. We examined the association between use of a digital health program with virtual education appointments and cesarean delivery rates, overall and by race and ethnicity.

METHODS:

Participants were 524 women with singleton pregnancies who enrolled in a digital health program in 2020 and completed self-report questionnaires on race/ethnicity, medical history, and pregnancy outcomes. We used logistic regression to test associations between program engagement (operationalized as total virtual appointments) and cesarean delivery, controlling for age, trimester at program enrollment, and history of cesarean delivery.

RESULTS:

Overall, 29% delivered via cesarean section in their current pregnancy; 12% reported cesarean delivery in a past pregnancy. History of cesarean delivery was higher among Black mothers (29%). In the full sample, appointments and type of delivery were unrelated. When inspecting this association separately for different racial and ethnic groups of sufficient sample size (Asian, Black, Hispanic, Multiracial, White), a significant, inverse relationship between appointments and likelihood of cesarean delivery was observed specifically among Black mothers (P=.043). Providers most popularly sought by Black mothers included doulas (27%) and obstetricians (21%), and Black mothers had higher rates of birth-planning appointments (14%) than other groups.

CONCLUSION:

These preliminary data suggest that access to virtual appointments may help reduce racial disparities in cesarean delivery rates. Research is needed to clarify the mechanisms by which digital health engagement addresses these disparities.
Autoimmune Diseases and Rates of Thromboembolism in Pregnancy [A278]
Authors: Brewerton Charles , Thomas Jacob , Harrison Rachel , Holmgren Calla
Published: June 2022

INTRODUCTION:

Antiphospholipid syndrome (APLS) is associated with an increased risk of thromboembolism during pregnancy. Other autoimmune diseases are less well-studied. Given the pro-inflammatory state associated with these conditions, we sought to identify the risk of thromboembolic disease in pregnant patients with autoimmune conditions.

METHODS:

This is a retrospective cohort study utilizing the National Inpatient Sample (Healthcare Cost and Utilization Project) for the year 2018. Subjects were excluded if they had a history of thrombosis, inherited thrombophilia, or APLS. Patients with at least one autoimmune condition (rheumatoid arthritis, Type 1 diabetes, systemic lupus erythematosus, myositis, ulcerative colitis, Crohn's, Sjogren's, scleroderma, and Hashimoto's thyroiditis) were compared to unaffected pregnancies. The primary outcome was a composite of thrombotic events. Secondary outcomes included individual components of the composite including deep vein thrombosis, PE, arterial embolism, and cerebrovascular thrombosis. The groups were compared via Student's t-tests, Chi-square, and logistic regression analyses.

RESULTS:

The control cohort comprised 750,743 pregnancies. The study cohort had 8,605 patients with≥1 autoimmune condition. The patients with autoimmune conditions were more likely to be older, White, obese, chronic hypertensive, tobacco users, privately insured, and in the upper quartile of household income (all P<.001). After controlling for confounders that differed between groups with P<.05, presence of an autoimmune disease was independently associated with higher rates of thrombosis and embolic events, with rates of 0.6% compared to 0.2% in controls (aOR 2.40, 95%CI 1.75–3.28).

CONCLUSION:

Autoimmune disease is associated with an increased risk of thromboembolic disease in pregnancy.
Trauma-Informed Pelvic Examination Practices Among Clinicians [A286]
Authors: Terrell Stephanie , Mehari Kathleen , Oshman Lauren , Otto Alana K. , Ruff Allison , Owens Lauren
Published: June 2022

INTRODUCTION:

Most people have experienced assault, an adverse childhood event, or other trauma. Trauma adversely impacts reproductive health outcomes and patients' experiences of health care. Survivors' preferences for trauma-informed pelvic care are established in the literature, but there are scant data on clinicians' adherence to these practices. This study assessed clinicians' knowledge, attitudes, and practices regarding trauma-informed care (TIC) and pelvic examinations.

METHODS:

The study team distributed an anonymous Qualtrics survey to 1,017 clinicians across 12 departments at a large academic medical center in June 2021. Clinicians who had performed at least one pelvic examination in the last year were eligible. Descriptive statistics are reported.

RESULTS:

Of 1,017 clinicians contacted, 362 responded, for a response rate of 35.6%. Overall, 81 (22.4%) reported no familiarity with TIC, and 106 (29.3%) had no training in TIC. Although 203 (56.1%) thought it was extremely important to use a trauma-informed approach to the pelvic examination when patients had a known history of trauma, only 88 (24.3%) thought it was extremely important to use a trauma-informed approach when no trauma history was known. Ninety-seven clinicians (26.8%) endorsed using trauma-informed practices during pelvic examinations “often” or “always.”

CONCLUSION:

Clinicians reported a lack of training in TIC. They did not see the need for universal application of TIC, and they reported inconsistent usage of trauma-informed practices during pelvic examinations. These data demonstrate a pressing need to improve training for clinicians and appropriate care for patients.