bluuebunny/crossref_metadata_2025 huggingface dataset:
Monasticism in Early Modern France
Authors: Hurel Daniel-Odon
Published: October 2020

Early modern France, that is, France of the fifteenth, sixteenth, and seventeenth centuries, experienced two waves of reform directly related to the birth of the modern state, the reform of the Church, and the experience of long and bloody religious wars. The ideals of the first were steeped in the late medieval devotio moderna, characterized by the rise in importance of the individual and the individual’s inner life, as well as by the necessity of integrating that individualism into a community’s spirituality and its spiritual life. The second wave of reforms drew its energies from the first and took from them its energies and models: amalgamation and centralization, oversight of revenues and accounts, a rededication to the Benedictine Rule, and the rediscovery of medieval monastic structures.
Monasticism in the Early Modern Atlantic World
Authors: Deslandres Dominique
Published: October 2020

The chapter investigates the historical experience of early modern Atlantic monasticism by exploring the migrations of Catholic religious orders in the Atlantic world (Europe, Africa, and the Americas) between the sixteenth and early eighteenth centuries. The discussion is divided into three sections. The first explores the distinctiveness of monasticism in the early modern Atlantic basin. The second surveys the implantation of monastic institutions in the Atlantic world, underlining common traits and differences among monasticisms in both the Old and the New Worlds. The final section compares the Iberian and French female forms of the vowed life in the Atlantic world in the context of recent historiographical developments.
Monasticism in Early Modern Italy and Spain
Authors: Lehfeldt Elizabeth A.
Published: October 2020

Two developments have shaped recent scholarship on monasticism in Italy and Spain: the rise of social history and the concomitant rise of women’s history. Social history examined the place and meaning of monastic foundations within their larger communities and presented monastic institutions as part of a larger social matrix that included local families, patrons, and civic leaders. These developments have led to a new interpretation of monasteries and convents not as isolated and withdrawn, but as well integrated into the life of surrounding cities and towns. Advances in women’s history have contributed to an explosion in the study of convents. Convents were communities composed entirely of women, and they often controlled considerable resources. They therefore offer prime research opportunities for scholars seeking a fuller understanding of the role of women in early modern Europe. Scholarship on early modern male monasticism, on the other hand, appears to be less active.
Non-lethal effects of the predator Meganyctiphanes norvegica and influence of seasonal photoperiod and food availability on the diel feeding behaviour of the copepod Centropages typicus
Authors: Olivares Manuel , Tiselius Peter , Calbet Albert , Saiz Enric
Published: October 2020

Predators can induce changes in the diel activity patterns of marine copepods. Besides vertical migration, diel feeding rhythms have been suggested as an antipredator phenotypic response. We conducted experiments to assess the non-lethal direct effects of the predator Meganyctiphanes norvegica (northern krill) on the diel feeding patterns of the calanoid copepod Centropages typicus. We also analysed the influence of seasonal photoperiod and prey availability on the intensity of copepod feeding rhythms. We did not detect any large effect of krill presence on the diel feeding behaviour of copepods, either in day-night differences or total daily ingestions. Seasonal photoperiod and prey availability, however, significantly affected the magnitude of copepod feeding cycles, with larger diel differences in shorter days and at lower prey concentrations. Therefore, the role of non-lethal direct effects of predators on the diel feeding activity of marine copepods remain debatable and might not be as relevant as in freshwater zooplankton.
Judge-Made Lore: Public Management and Public Authority
Authors: Prebble Mark
Published: October 2020

Law is a fundamental aspect of public management, but many public management scholars and jurists view each other with mutual incomprehension. The misunderstanding stems in part from incompatible concepts about the nature of government and the nature of people. By combining a legal perspective on the nature of government with a managerial perspective on the nature of people, this article produces law-based management principles that are relevant in any common law country. Officials’ actions could be improved by observing three simple rules of thumb: every action needs legal authority; every decision needs relevant facts; and every person may make a case. These principles are not law, but they are derived from court judgments: they are judge-made lore. A central aspect of judge-made lore is the importance and implications of the use of public authority.
The Use and Misuse of Coordinated Punishments*
Authors: Barron Daniel , Guo Yingni
Published: October 2020

Communication facilitates cooperation by ensuring that deviators are collectively punished. We explore how players might misuse communication to threaten one another, and we identify ways that organizations can deter misuse and restore cooperation. In our model, a principal plays trust games with a sequence of short-run agents who communicate with each other. An agent can shirk and then extort pay by threatening to report that the principal deviated. We show that these threats can completely undermine cooperation. Investigations of agents’ efforts, or dyadic relationships between the principal and each agent, can deter extortion and restore some cooperation. Investigations of the principal’s action, on the other hand, typically do not help. Our analysis suggests that collective punishments are vulnerable to misuse unless they are designed with an eye toward discouraging it.
Interdisciplinary knowledge combinations and emerging technological topics: Implications for reducing uncertainties in research evaluation
Authors: Kwon Seokbeom , Youtie Jan , Porter Alan L
Published: October 2020

This article puts forth a new indicator of emerging technological topics as a tool for addressing challenges inherent in the evaluation of interdisciplinary research. We present this indicator and test its relationship with interdisciplinary and atypical research combinations. We perform this test by using metadata of scientific publications in three domains with different interdisciplinarity challenges: Nano-Enabled Drug Delivery, Synthetic Biology, and Autonomous Vehicles. Our analysis supports the connection between technological emergence and interdisciplinarity and atypicality in knowledge combinations. We further find that the contributions of interdisciplinary and atypical knowledge combinations to addressing emerging technological topics increase or stay constant over time. Implications for policymakers and contributions to the literature on interdisciplinarity and evaluation are provided.
Low dose IL-2 in patients with steroid-dependent dysimmune manifestations associated with myelodysplastic syndromes: a three-case report
Authors: Corfmat Marion , Willekens Christophe , Vinit Julien , Bussone Guillaume , Fenaux Pierre , Fain Olivier , Klatzmann David , Mekinian Arsene , Comont Thibault ,   MINHEMON (French network of dysimmune disorders associated to hematological malignancies)
Published: October 2020

Objectives

Systemic inflammatory and autoimmune diseases can be associated with myelodysplastic syndromes. Current treatments (steroids, immunosuppressive agents, biologics) are unsatisfactory because of their low response rate, dependence or adverse events. We aimed at evaluating the effects of low doses of IL-2 (ld-IL2) as a regulatory T-cell inducer in this context.

Methods

We treated three patients with ld-IL2 with myelodysplastic syndromes and an associated dysimmune disorder (polymyalgia rheumatic, relapsing polychondritis associated with Sweet’s syndrome and vasculitis with cutaneous and joint involvement, respectively). All three patients were dependent on steroids and refractory to biologics or azacitidine. They received doses of 1–1.5 million units of proleukin/day during 5 days and then every fortnight.

Results

The treatment led to a clinical improvement and steroid sparing in 2/3 patients with no serious adverse events, and no progression of the disease.

Conclusion

Our results support the investigation of ld-IL2 in MDS associated with immune disorders in controlled clinical studies.
Effect of method of drying piglets at birth on rectal temperature over the first 24 h after birth1
Authors: Vande Pol Katherine D , Tolosa Andres F , Shull Caleb M , Brown Catherine B , Alencar Stephan A S , Ellis Michael
Published: October 2020

Piglets are born wet, and evaporation of that moisture decreases body temperature, increasing the risk of mortality. The objective of this study was to compare the effect of two commercially applicable methods for drying piglets at birth on piglet rectal temperature over 24 h after birth. The study was carried out in standard commercial farrowing facilities with 52 litters, using a completely randomized design with three Drying Treatments: Control (not dried); Desiccant (dried at birth using a cellulose-based desiccant); Paper Towel (dried at birth using paper towels). Litters were randomly allotted to treatments at the birth of the first piglet. At birth, piglets were individually identified, and the treatment was applied. Rectal temperature was measured at 0, 10, 20, 30, 45, 60, 120, and 1,440 min (24 h) after birth. Data were analyzed using a repeated measures model with PROC MIXED of SAS, with litter as the experimental unit and piglet a subsample of the litter. The model included the fixed effects of treatment and time (as a repeated measure), and the interaction. There was no effect (P > 0.05) of treatment on temperature at birth, or 10 or 1,440 min after birth. Piglet temperatures between 20 and 120 min after birth were similar (P > 0.05) for the Desiccant and Paper Towel treatments, but were greater (P ≤ 0.05) than the Control. The effect of birth weight on the response to Drying Treatment was evaluated by dividing the data into Light (<1.0 kg), Medium (1.0 to 1.5 kg), or Heavy (>1.5 kg) piglet Birth Weight Categories. Piglet rectal temperature data at each measurement time were analyzed using a model that included the fixed effects of Birth Weight Category, Drying Treatment, and the interaction. Temperatures of Light piglets were lower (P ≤ 0.05) than those of Heavy piglets between 20 and 120 min after birth, with Medium piglets being intermediate and generally different to the other two weight categories at these times. The difference in temperature between Light as compared with Medium or Heavy piglets was greater for the Control than the other two Drying Treatments at 60 min after birth. These results suggest that drying piglets at birth is an effective method to reduce rectal temperature decline in the early postnatal period, especially for low birth weight piglets.
The effects of fiber source on extrusion processing parameters and kibble characteristics of dry cat foods
Authors: Donadelli Renan Antunes , Dogan Hulya , Aldrich Charles Gregory
Published: October 2020

Cellulose and beet pulp have been commonly used in the pet food industry to increase the dietary fiber content of cat foods. However, pet food companies seek alternatives to these so-called byproducts. Miscanthus grass is grown for its fiber content and may serve as an alternative to traditional fibrous ingredients. The objectives of this study were to determine the effects of fiber sources on extrusion processing and kibble structure of cat foods. Three replicate batches of a complete and balanced foods for adult cats at maintenance each containing 10% of Miscanthus grass, cellulose, or beet pulp was mixed and kibbles were produced on a single-screw extruder. Feed rate, preconditioner water and steam, extruder screw speed, extruder water and steam addition, and knife speed were adjusted to achieve a wet bulk density of 330 g/L. After extrusion, kibbles were dried at 115.5 ºC to less than 10% moisture. Dried kibbles were coated with chicken fat and flavor enhancer. No effects due to fiber source were reported for extrusion parameters or kibble measurements (P > 0.05) with the exception of compression energy, wherein kibbles produced with cellulose required more energy to compress than those containing beet pulp (6,917 N mm vs. 3,591 N mm, respectively). In conclusion, tested fiber sources had no impact on extrusion parameters and most kibble characteristics. Kibbles containing cellulose required more energy to compress than kibbles containing beet pulp. Miscanthus grass could be used as an alternative to traditional fiber sources used to produce cat foods.
SBM Mid-Career Leadership Institute: replacing “fake it till you make it” with authentic leadership
Authors: Winter Sandra J
Published: October 2020

Increasingly the organizational environments in which we work can be characterized as Volatile, Uncertain, Complex, and Ambiguous (VUCA). Equipping leaders to thrive in VUCA environments requires more than merely imparting a list of competencies that can be observed, described, and measured. Indeed, competency-based leadership training runs the risk of being insufficient, incongruous, idealized, fragmented, and unconsciously coercive. Rather than helping leaders develop the more elusive and subtle leadership qualities and attributes necessary to thrive in VUCA environments, competency-based training can leave them feeling inadequate, as if they do not ever quite measure up, and can fuel “imposter syndrome”. The Society of Behavioral Medicine (SBM) Mid-Career Leadership Institute provided training that was far more than competency based. It was broad enough to be relevant to fellows working in a variety of contexts and provided a framework directly applicable across settings. The training was multipronged and included: a 2 day in-person workshop designed to maximize active participation; intensive mentoring by both peers and senior members of SBM; three individual one-on-one executive coaching sessions with a professional career coach; and a leadership project in which we applied the knowledge gained during our training in our diverse organizational settings. The SBM Mid-Career Leadership Institute training increased my self-awareness about important leadership concepts, the executive coaching sessions helped me become more productive, and the relationships I built have helped me develop my professional network and deepen my connection with fellow scientists and practitioners. “Fake it till you make it” and feelings of insecurity and self-doubt have been replaced by authentic leadership.
Perspectives on the benefits of leadership training for career growth among three mid-career behavioral scientists
Authors: Pekmezi Dori , Cadmus-Bertram Lisa , Lewis Beth
Published: October 2020

Participation in the Society of Behavioral Medicine (SBM) Mid-Career Leadership Institute was invaluable in navigating challenges and opportunities experienced by behavioral scientists at key mid-career transitions. Professionals are expected to take on more responsibilities at mid-career, often with minimal guidance and/or relevant training in the requisite leadership skills. The SBM Leadership Institute provided concrete practical strategies for managing time, work email, planning/goal setting, and conflict resolution. The purpose of this commentary is to review the impact of the SBM Leadership Institute on new leadership roles obtained by three SBM Leadership Fellows. Practices adopted as a result of the Leadership Institute will be discussed (e.g., right sizing the workload, “inbox zero,” starting with priority work, and single tasking). The use of these strategies resulted in increased productivity and reduced work stress. Furthermore, one-on-one executive career coaching and participation in our learning community cultivated the direct, effective communication skills needed to take on new leadership roles/projects (e.g., transitioning to department chair, running for SBM board, launching ACSM Exercise is Medicine On Campus program). The leadership projects helped to push Fellows out of their comfort zones and provided excellent opportunities for networking and increased involvement in organizations and professional societies. In sum, the SBM Leadership Institute helped instill the confidence and focus needed to surmount midcareer obstacles and accelerate into the next career phase.
Lessons learned from the initial 4 years of the SBM Mid-Career Leadership Institute
Authors: Fitzgibbon Marian L , Rutten Lila J , Yaroch Amy , Peterson Caryn
Published: October 2020

In 2015, the Society of Behavioral Medicine (SBM) created the Mid-Career Leadership Institute. The initial model that motivated the creation of the institute came from my participation in the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) program, specifically designed to enhance the leadership skills of senior female faculty in the health sciences. My participation in ELAM was transformative. It led me to run for president of SBM in 2014, to consider how behavioral scientists could similarly benefit from mid-career leadership training, and ultimately to work with the SBM Executive Director, the SBM Leadership Institute Steering Committee, and leadership training professionals to launch the Leadership Institute in 2016. The overarching goal of the SBM Leadership Institute is to train mid-career behavioral scientists engaged in academic and health care settings to develop essential skills needed to navigate the unique challenges of mid-career. Central to this goal is a focus on integrating diversity, equity, and inclusion into their emerging leadership roles through participation in training exercises, lectures, and dynamic group discussions. To optimize the Leadership Institute experience, opportunities were developed, including mentoring from SBM seasoned members, peer mentoring through the creation of “learning communities,” career coaching, and additional networking opportunities. The purpose of this brief commentary is to summarize lessons learned by highlighting program evaluation, describing key changes over the initial 4 years, and sharing future plans for leadership training.
Medical Students’ Views on Implementing the Core EPAs: Recommendations From Student Leaders at the Core EPAs Pilot Institutions
Authors: Geraghty Joseph R. , Ocampo Raechelle G. , Liang Sherry , Ona Ayala Kimberly E. , Hiltz Kathleen , McKissack Haley , Hyderi Abbas , Ryan Michael S.
Published: October 2020

In 2014, the Association of American Medical Colleges recruited 10 institutions across the United States to pilot the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). The goal was to establish a competency-based framework to prepare graduating medical students for the transition to residency. Within the Core EPAs pilot, medical students play an influential role in the development and implementation of EPA-related curricula. Student engagement was a priority for the Core EPAs institutions given students’ roles as the end users of the curriculum, thus they may offer valuable insight into its design and implementation.

Here, the authors provide the perspective of medical students who serve as leaders in the Core EPAs pilot at their respective institutions. They describe student leadership models across the pilot institutions as well as 6 key challenges to implementation of the Core EPAs: (1) How and when should the Core EPAs be introduced? (2) Who is responsible for driving the assessment process? (3) What feedback mechanisms are required? (4) What systems are required for advising, mentoring, or coaching students? (5) Should EPA performance contribute to students’ grades? and (6) Should entrustment decisions be tied to graduation requirements?

Using a polarity management framework to address each challenge, the authors describe inherent tensions, approaches used by the Core EPAs pilot institutions, and student-centered recommendations for resolving each tension. By sharing the experiences and perspectives of students engaged in the Core EPAs pilot, the authors hope to inform implementation of EPA-oriented assessment practices and feedback across institutions in the United States.
Establishing Validity for a Vaginal Hysterectomy Simulation Model for Surgical Skills Assessment
Authors: Chen Chi Chung Grace , Lockrow Ernest G. , DeStephano Christopher C. , Nihira Mikio A. , Matthews Catherine , Kammire Leslie , Landrum Lisa M. , Anderson Bruce D. , Miyazaki Douglas
Published: October 2020

OBJECTIVE:

To use the Messick validity framework for a simulation-based assessment of vaginal hysterectomy skills.

METHODS:

Video recordings of physicians at different levels of training and experience performing vaginal hysterectomy on a high-fidelity vaginal surgery model were objectively assessed using a modified 10-item Vaginal Surgical Skills Index, a one-item global scale of overall performance, and a pass–fail criterion. Participants included obstetrics and gynecology trainees and faculty from five institutions. Video recordings were independently assessed by expert surgeons blinded to the identities of the study participants.

RESULTS:

Fifty surgeons (11 faculty, 39 trainees) were assessed. Experience level correlated strongly with both the modified Vaginal Surgical Skills Index and global scale score, with more experienced participants receiving higher scores (Pearson r=0.81, P<.001; Pearson r=0.74, P<.001). Likewise, surgical experience was also moderately correlated with the modified Vaginal Surgical Skills Index and global scale score (Pearson r=0.55, P<.001; Pearson r=0.58, P<.001). The internal consistency of the modified Vaginal Surgical Skills Index was excellent (Cronbach's alpha=0.97). Interrater reliability of the modified Vaginal Surgical Skills Index and global scale score, as measured by the intraclass correlation coefficient, was moderate to good (0.49–0.95; 0.50–0.87). Using the receiver operating characteristic curve and the pass–fail criterion, a modified Vaginal Surgical Skills Index cutoff score of 27 was found to most accurately (area under the curve 0.951, 95% CI 0.917–0.983) differentiate competent from noncompetent surgeons.

CONCLUSION:

We demonstrated validity evidence for using a high-fidelity vaginal surgery model with the modified Vaginal Surgical Skills Index or global scale score to assess vaginal hysterectomy skills.
Risk Factors for Surgical Failure and Worsening Pelvic Floor Symptoms Within 5 Years After Vaginal Prolapse Repair
Authors: Jakus-Waldman Sharon , Brubaker Linda , Jelovsek John Eric , Schaffer Joseph I. , Ellington David R. , Mazloomdoost Donna , Whitworth Ryan , Gantz Marie G. ,   for the NICHD Pelvic Floor Disorders Network (PFDN)
Published: October 2020

OBJECTIVE:

To assess independent risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse surgery.

METHODS:

This secondary analysis includes OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) (n=374) and E-OPTIMAL (Extended) (n=285) trial participants. Surgical failure was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery or bothersome vaginal bulge. Worsening pelvic floor symptoms were defined as increases from baseline as large as the minimally important difference for subscale scores of the Pelvic Floor Distress Inventory: 11 for the Urinary Distress Inventory and Colorectal-Anal Distress Inventory and 34.3 for the Pelvic Organ Prolapse Distress Inventory. Outcomes were measured at 6 months then 1, 2, 3, 4, and 5 years. Chi-square and t test results from bivariate models and clinical relevance were used to inform final models.

RESULTS:

Baseline risk factors for surgical failure were Hispanic ethnicity (adjusted odds ratio [aOR] 1.92, 95% CI 1.17–3.15), perineal body (aOR 1.34, 95% CI 1.09–1.63), and pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 1.16, 95% CI 1.05–1.28). Risk factors for worsening of pelvic floor symptoms were pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 0.75, 95% CI 0.60–0.94) for worsening Pelvic Organ Prolapse Distress Inventory score, vaginal deliveries (aOR 1.26, 95% CI 1.10–1.44) and pretreatment Urinary Distress Inventory score (aOR 0.86, 95% CI 0.80–0.93) for worsening Urinary Distress Inventory score, and age (aOR 1.03, 95% CI 1.01–1.05) and pretreatment Colorectal-Anal Distress Inventory score (aOR 0.95, 95% CI 0.92–0.98) for worsening Colorectal-Anal Distress Inventory score.

CONCLUSIONS:

Hispanic ethnicity, larger preoperative perineal body, and higher pretreatment Pelvic Organ Prolapse Distress Inventory scores were risk factors for surgical failure up to 5 years after vaginal prolapse repair. Participants with higher baseline Pelvic Floor Distress Inventory scores were less likely to worsen. Risk factors for worsening Urinary Distress Inventory and Colorectal-Anal Distress Inventory scores included more vaginal deliveries and increased age, respectively.

CLINICAL TRIAL REGISTRATION:

NCT00597935, NCT01166373.
Detection and Prevention of Postpartum Posttraumatic Stress Disorder
Authors: Canfield Dana , Silver Robert M.
Published: October 2020

The rising maternal mortality rate has drawn increased focus to postpartum depression. However, other mental health conditions, such as birth-related postpartum traumatic stress disorder, have not garnered the same level of attention. The majority of research about postpartum posttraumatic stress disorder (PTSD) is published in journals focused on psychiatry, psychology, and nursing, where this phenomenon is well recognized. In contrast, there is a lack of awareness among most obstetricians. Consequently, few recommendations are available to guide clinical practice. This commentary will present a clinical vignette, provide background that is key to the detection of PTSD, explore available data on postpartum PTSD, and provide recommendations for recognition and prevention of this disorder.
Primary Dysmenorrhea
Authors: Ferries-Rowe Elizabeth , Corey Elizabeth , Archer Johanna S.
Published: October 2020

Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.
Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program
Authors: Avni-Singer Lital , Oliveira Carlos R. , Torres Ashlynn , Shapiro Eugene D. , Niccolai Linda M. , Sheth Sangini S.
Published: October 2020

OBJECTIVE:

To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic.

METHODS:

In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests.

RESULTS:

From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76–3.58). On average, there were 30.7 fewer (95% CI 5.8–55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86–10.38).

CONCLUSION:

The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.
Association of a Pediatric Gynecology eLearning Module With Resident Knowledge and Clinical Skills
Authors: Huguelet Patricia S. , Abraham Margaret , Alaniz Veronica I. , Dolinko Andrey V. , Dumont Tania , Karjane Nicole , Pearce Janina V. , Ruder Kara , Wheeler Carol , Guiahi Maryam
Published: October 2020

OBJECTIVE:

To assess whether a pediatric and adolescent gynecology electronic learning (eLearning) module improves knowledge and clinical performance among obstetrics and gynecology residents.

METHODS:

We conducted a multi-institutional, single-blinded, randomized controlled trial across four university programs; three had pediatric and adolescent gynecology rotations, and two had pediatric and adolescent gynecology fellowship-trained faculty. Applying permutated block randomization, residents were randomized to no intervention or completion of a validated eLearning module on prepubertal bleeding. All residents subsequently completed a pediatric and adolescent gynecology–related knowledge assessment that queried understanding of prepubertal bleeding and an objective structured clinical examination that assessed history collection, performance of a prepubertal genital examination, vaginal culture, and vaginoscopy for a pediatric patient. Objective structured clinical examinations were videotaped and reviewed by two faculty, blinded to randomization group; interrater reliability score was 97%. We calculated descriptive frequencies and compared randomization groups using χ2 analyses and Fisher exact tests for categorical variables, and median tests for continuous variables; a value of P<.05 was considered significant.

RESULTS:

From July 2018 to June 2019, we invited 115 residents to participate; 97 (83%) completed both objective structured clinical examination and follow-up knowledge assessments. Most were female (91%) and the majority reported limited pediatric and adolescent gynecology didactic or clinical experience, with 36% reporting prior didactics on prepubertal vaginal bleeding and 33% reporting prior exposure to the prepubertal genital examination. Forty-five participants (46%) were randomized to the module and groups were similar across training levels. Residents assigned to the module scored significantly higher on the knowledge assessment (4/5 vs 2/5, P<.001) and objective structured clinical examination (13/16 vs 7/16, P<.001) and were more likely to avoid a speculum in the examination of a pediatric patient (95.6% vs 57.7%, P<.001).

CONCLUSION:

Our pediatric and adolescent gynecology eLearning module resulted in improved short-term resident knowledge and simulated clinical skills among obstetrics and gynecology residents. Applying this learning technique in other programs may help address deficiencies in pediatric and adolescent gynecology education and training.
Contributions, Aspirations, and Challenges of Academic Specialist Divisions in Obstetrics and Gynecology
Authors: LaCoursiere D. Yvette , Scott James R. , Chelmow David , Young Amy E. , Sawaya George F. , Delancey John , Learman Lee A.
Published: October 2020

Shortly after its inception, the Society for Academic Specialists in General Obstetrics and Gynecology recognized that no data described the composition and faculty activities of “academic generalist divisions.” Consequently, in 2018, the Society for Academic Specialists in General Obstetrics and Gynecology appointed a presidential task force and conducted the current surveys of chairs and division directors and key informant interviews to understand the composition and faculty activities in divisions of academic specialists in departments of obstetrics and gynecology and propose criteria for excellence in each mission area to guide development of divisions. In 2014, with Society for Academic Specialists in General Obstetrics and Gynecology's guidance, these divisions were referred to as academic specialists divisions and the faculty within as academic specialists to emphasize that they provide specialized women's health care in academic settings. The divisions comprised approximately 30% of departments' full-time faculty (median 12). In 27% of the departments, these divisions contributed more than half of departmental revenue, and 49% contributed 26–50%. Nearly 90% of divisions provided a sizeable proportion of the department's total teaching efforts. Compensation relied more on clinical productivity than on seniority, quality, academic contributions, or academic rank. Subsequently, five performance domains were identified to help divisions define divisional excellence: clinical, education, research, service & advocacy, and academic environment. Furthermore, excellent divisions were characterized as those with outstanding clinicians and educators who emphasize scholarly productivity. Although academic specialists contribute significantly to their departments' financial, clinical, and educational productivity, many have limited opportunities for scholarly activity. Achieving divisional excellence likely will depend on the ability to recruit and retain faculty with career expectations that align with the division's prioritized performance domains.
Wireless Laparoscopy in the 2020s
Authors: Chatzipapas Ioannis , Kathopoulis Nikolaos , Siemou Panagiota , Protopapas Athanasios
Published: October 2020

BACKGROUND:

Wireless signal transduction is the future in the field of laparoscopic surgery. Cable-free endoscopic equipment would be the ideal surgical instrument for every laparoscopic surgeon.

INSTRUMENT:

Our department has developed a new cable-free laparoscopic setup that couples a rigid 0°, 10-mm laparoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable LED cold light source. The signal was wirelessly transmitted from the camera to a tablet computer using the corresponding mobile application.

EXPERIENCE:

Our team has used this setup in 14 laparoscopic operations with excellent results. Two cases performed exclusively with the new setup are presented in the videos. The image quality obtained was comparable with the conventional laparoscopic setup, and the operations performed were unaffected.

CONCLUSION:

This report presents the use of a wireless camera throughout the course of a laparoscopic surgery, and the results are promising. The new systems’ favorable characteristics, such as wireless signal transmission, cost, flexibility, and size, support this as a feasible new technique for performing laparoscopic surgery.
Foley Bulb Added to an Oral Misoprostol Induction Protocol
Authors: Adhikari Emily H. , Nelson David B. , McIntire Donald D. , Leveno Kenneth J.
Published: October 2020

OBJECTIVE:

To evaluate whether the induction of labor in term gravid women with cervical dilation 2 cm or less and intact membranes by using oral misoprostol preceded by transcervical Foley bulb placement results in a significantly increased vaginal delivery rate compared with the use of oral misoprostol alone.

METHODS:

We randomized the induction method by week of admission to labor and delivery, with each week group described as a cluster in a block randomized design. Women with gestational age of 37 weeks or greater, cervical dilation 2 cm or less, intact membranes, and indication for labor induction were included. Study arms were either 100 micrograms of oral misoprostol after transcervical Foley bulb placement or 100 micrograms of oral misoprostol alone. The primary outcome was vaginal delivery with the first induction attempt. Secondary outcomes included time to delivery, clinical chorioamnionitis (maternal temperature of 38°C or greater during labor with or without fundal tenderness, without other identified cause), cesarean delivery indication, and adverse outcomes. We estimated that a sample size of 1,077 per arm was needed to detect a 5% increase in vaginal delivery rate with a type I error of 5% and power of 80%, accounting for interim analysis and cluster size of 30 inductions per week. This was a pragmatic trial, and analysis was by intention-to-treat.

RESULTS:

From January 1, 2018, to May 13, 2019, 1,117 women (34 clusters) were assigned to oral misoprostol plus Foley and 1,110 women (34 clusters) to oral misoprostol alone. Demographic characteristics were similar. Vaginal delivery at the first induction occurred in 78% of the misoprostol plus Foley arm and in 77% of the misoprostol arm (relative risk [RR] 1.00; 95% CI 0.96–1.05; adjusted relative risk [aRR], 1.00; 95% CI 0.95–1.05). Clinical chorioamnionitis occurred in 18% of the misoprostol plus Foley arm and in 14% of the misoprostol arm (RR 1.30; 95% CI 1.07–1.58; aRR 1.30; 95% CI 1.08–1.56). There were no differences in neonatal outcomes.

CONCLUSION:

Induction of labor in gravid women at term with intact membranes by using oral misoprostol plus Foley bulb did not result in a higher vaginal delivery rate, but it did result in more clinical chorioamnionitis compared with the use of oral misoprostol alone.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03407625.
Changes in Sexual Activity and Function After Pelvic Organ Prolapse Surgery
Authors: Antosh Danielle D. , Kim-Fine Shunaha , Meriwether Kate V. , Kanter Gregg , Dieter Alexis A. , Mamik Mamta M. , Good Meadow , Singh Ruchira , Alas Alexandriah , Foda Mohamed A. , Balk Ethan M. , Rahn David D. , Rogers Rebecca G.
Published: October 2020

OBJECTIVE:

We aimed to systematically review the literature to describe sexual activity and function before and after prolapse surgery.

DATA SOURCES:

We searched MEDLINE, EMBASE, and ClinicalTrials.gov databases from inception to April 2018.

METHODS OF STUDY SELECTION:

Prospective, comparative studies of reconstructive pelvic organ prolapse (POP) surgeries that reported sexual function outcomes were included. Studies were extracted for population characteristics, sexual function outcomes, and methodologic quality. Data collected included baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Change in validated scores were used to categorize overall sexual function as improved, unchanged, or worsened after surgery.

TABULATION, INTEGRATION, AND RESULTS:

The search revealed 3,124 abstracts and identified 74 articles representing 67 original studies. The overall quality of evidence was moderate to high. Studies reporting postoperative results found higher rates of sexual activity than studies reporting preoperative sexual activity in all POP surgeries except sacrospinous suspension, transvaginal mesh, and sacrocolpopexy. The prevalence of dyspareunia decreased after all prolapse surgery types. The risk of de novo dyspareunia ranged from 0% to 9% for all POP surgeries except posterior repair, which lacked sufficient data. Overall sexual function based on PISQ-12 (Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12) scores improved for mixed native tissue repairs, anterior repairs, uterosacral suspensions, sacrospinous suspensions, and sacrocolpopexy; scores were similar for posterior repairs, transvaginal mesh, and biologic grafts. Sexual function did not worsen after any POP surgeries.

CONCLUSION:

Sexual function improves or remains unchanged after all types of reconstructive POP surgeries and does not worsen for any surgery type. Prevalence of total dyspareunia was lower after all POP surgery types, and de novo dyspareunia was low ranging 0–9%. This information can help surgeons counsel patients preoperatively.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42019124308.
A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care
Authors: Fauconnier Arnaud , Provot Johan , Le Creff Isabelle , Boulkedid Rym , Vendittelli Françoise , Doret-Dion Muriel , Sroussi Jérémy , Giraudet Géraldine , Jacobs Romain , Bourret Antoine , Bauville Estelle , Carvalho Solenn , Tourette Claire , Koskas Martin , Akladios Chérif , Nisolle Michelle , Lejeune Christophe , Huchon Cyrille , Alberti Corinne , Dumont Alexandre , Bouvier-Colle Marie-Hélène
Published: October 2020

OBJECTIVE:

To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments.

METHODS:

We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients.

RESULTS:

Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7).

CONCLUSIONS:

Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
Maternal age at last birth and leukocyte telomere length in a nationally representative population of perimenopausal and postmenopausal women
Authors: Latour Chase D. , O’Connell Kelli , Romano Megan E. , Kantor Elizabeth D. , Du Mengmeng
Published: October 2020

Objective:

The primary aim of this study was to evaluate if maternal age at birth of last child is associated with leukocyte telomere length in a nationally representative population of perimenopausal and postmenopausal women.

Methods:

We conducted a cross-sectional analysis of 1,232 women from the National Health and Nutrition Examination Survey to examine maternal age at last birth and telomere length, surveyed between 1999 and 2002. We included perimenopausal and postmenopausal women age 40 years and older. Maternal age at last live birth was self-reported, and leukocyte telomere length was measured using quantitative polymerase chain reaction. We calculated least-squares geometric mean telomere length across categories of maternal age adjusted for age, race/ethnicity, number of live births, survey cycle, and history of hysterectomy or oophorectomy. P trend < 0.05 was considered statistically significant. For hypothesis-generation, we explored modification by reproductive and sociodemographic factors.

Results:

Maternal age at last birth was positively associated with telomere length: the multivariable-adjusted least-squares geometric mean leukocyte telomere length across categories of age at last birth (<25, 25-29, 30-34, 35-39, ≥40 y) was 0.90, 0.93, 0.93, 0.95, and 0.96, respectively (P trend = 0.04). There was suggestive evidence this association may be restricted to those women with one or two live births or women who reported ever using oral contraceptives (P interaction <0.10 for both).

Conclusions:

Later maternal age was associated with longer telomere length in a nationally representative population of women. These data provide new insight into the biological relationship between reproductive history and long-term health.

Video Summary:

http://links.lww.com/MENO/A662.
Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults
Authors: Matsumoto Kenji , Jin Zhezhen , Homma Shunichi , Elkind Mitchell S.V. , Schwartz Joseph E. , Rundek Tatjana , Mannina Carlo , Ito Kazato , Sacco Ralph L. , Di Tullio Marco R.
Published: October 2020

Objectives:

Recently, more sophisticated blood pressure (BP) measurements, such as central and ambulatory BP (ABP), have proven to be stronger predictors of future cardiovascular disease than conventional office BP. Their predictive value for atrial fibrillation development is not established. We investigated the prognostic impact for incident atrial fibrillation of office, central and ambulatory BP measurements in a predominantly older population-based cohort.

Methods:

Of 1004 participants in the Cardiovascular Abnormalities and Brain Lesions (CABL) study, 769 in sinus rhythm with no history of atrial fibrillation or stroke (mean age 70.5 years) underwent ABP and arterial wave reflection analysis for central BP determination. Fine and Gray's proportional subdistribution hazards models were used to assess the association of BP parameters with incident atrial fibrillation.

Results:

During 9.5 years, atrial fibrillation occurred in 83 participants. No office BP variable showed a significant association with incident atrial fibrillation. Central SBP and central pulse pressure were marginally associated with incident atrial fibrillation in multivariate analysis. Among ABP variables, 24-h SBP [adjusted hazard ratio per 10 mmHg, 1.24; 95% confidence interval (CI) 1.07--1.44; P = 0.004], daytime SBP (adjusted hazard ratio per 10 mmHg, 1.21; 95% CI 1.04--1.40; P = 0.011) and night-time SBP (adjusted hazard ratio per 10 mmHg, 1.22; 95% CI 1.07--1.39; P = 0.002) were significantly associated with incident atrial fibillation.

Conclusion:

In a predominantly older, stroke-free community-based cohort, ABP was a better independent predictor of incident atrial fibrillation than central BP, whereas office BP was inadequate for this purpose.