bluuebunny/crossref_metadata_2025 huggingface dataset:
Tentative breakpoints and areas of technical uncertainty for early reading automated disc diffusion for Enterobacterales
Authors: Mancini Stefano , Röthlin Kim , Bodendoerfer Elias , Herren Sebastian , Kolesnik-Goldmann Natalia , Courvalin Patrice , Zbinden Reinhard , Böttger Erik C
Published: February 2020

Background

Disc diffusion is a reliable, accurate and cost-efficient procedure for antimicrobial susceptibility testing (AST) but requires long (18–24 h) incubation times. Reading of disc diffusion after short incubation times (6–8 h) by automated systems is feasible but should be categorized with time-adapted breakpoints to reduce errors.

Objectives

This study systematically compared early readings (6 and 8 h) of disc diffusion using an automated system with that of the standard 18 h EUCAST method. Time-adapted tentative breakpoints were proposed to discriminate susceptible from resistant isolates and areas of technical uncertainty were defined to minimize the risk of errors.

Methods

A total of 1106 Enterobacterales isolates with a wide variety of resistance mechanisms and resistance profiles were included. All isolates were analysed for susceptibility to amoxicillin/clavulanic acid, ceftriaxone, cefepime, meropenem, ciprofloxacin and gentamicin using the automated WASPLabTM system. Part of the collection (515 isolates) was also analysed for susceptibility to an additional 10 antibiotics.

Results

Separation between WT and non-WT populations was poorer at early incubation times than following standard incubation. Editing of rapid automated AST results after 6 and 8 h incubation with time-adapted breakpoints resulted in 84.0% and 88.5% interpretable results with assignment to the resistant or susceptible category. Major error and very major error rates for the 6 h readings were only 0.4% and 0.3%, virtually identical to those of 18 h AST reading.

Conclusions

Time-adapted clinical breakpoints in disc diffusion testing for Enterobacterales allow for accurate automated AST interpretation after shortened incubation times for a large number of antibiotics, with the additional possibility of subsequent confirmation after 18 h incubation.
Molecular genetic analysis of an XDR Pseudomonas aeruginosa ST664 clone carrying multiple conjugal plasmids
Authors: Li Zhenpeng , Cai Zhao , Cai Zeqiong , Zhang Yanhong , Fu Tongtong , Jin Yongxin , Cheng Zhihui , Jin Shouguang , Wu Weihui , Yang Liang , Bai Fang
Published: February 2020

Objectives

A group of ST664 XDR Pseudomonas aeruginosa strains have been isolated from a burn clinic. Here we decipher their resistomes and likely mechanisms of resistance acquisition.

Methods

The complete nucleotide sequences of representative isolates were determined, by PacBio and Illumina MiSeq sequencing, and analysed for antimicrobial resistance (AMR) genes as well as sequence variations. S1-PFGE was used to determine the sizes and numbers of plasmids harboured by the isolates. Purified plasmid DNA was further sequenced by PacBio technology, closed manually and annotated by RAST. The mobility of plasmids was determined by conjugation assays.

Results

The XDR P. aeruginosa ST664 clone carries 11 AMR genes, including a blaKPC-2 gene that confers resistance to carbapenems. Most of the ST664 isolates carry three coexisting plasmids. blaKPC-2 and a cluster of three AMR genes (aadB-cmlA1-sul1) are encoded on a 475 kb megaplasmid pNK546a, which codes for an IncP-3-like replication and partitioning mechanism, but has lost the conjugative transfer system. Interestingly, however, pNK546a is mobilizable and can be transferred to P. aeruginosa PAO1 with the help of a co-residing IncP-7 conjugative plasmid. The blaKPC-2 gene is carried by an IS6100-ISKpn27-blaKPC-2-ΔISKpn6-Tn1403 mobile element, which might be brought into the ST664 clone by another co-resident IncP-1α plasmid, which is inclined to be lost. Moreover, pNK546a harbours multiple heavy metal (mercury, tellurite and silver) resistance modules.

Conclusions

To the best of our knowledge, pNK546a is the first fully sequenced blaKPC-2-carrying megaplasmid from P. aeruginosa. These results give new insights into bacterial adaptation and evolution during nosocomial infections.
Victims' Goal Understanding, Uncertainty Reduction, and Perceptions in Cyberbullying: Theoretical Evidence From Three Experiments
Authors: Palomares Nicholas A , Wingate V Skye
Published: February 2020

Cyberbullying is repetitive and aggressive behavior transmitted through mediated channels aimed at directing malice toward a victim with a to-harm goal. Three experiments manipulated a cyberbully's identity uncertainty—each employing different stimuli and scenarios—and assessed individuals' responses to being victimized. Experiment 1 demonstrated victims' information-seeking about a bully's identity and motives, emotional valence, and social attractiveness to the bully depend on victims' uncertainties about the bully's motives and identity. Experiment 2 examined victims' particular inferences about a bully's goals, revealing victims find bullies more socially attractive when they think a bully is trying to personally attack them or gain status, but only if the bully is anonymous. Experiment 3 aimed to replicate findings with a modified method and an extended rationale explaining why inferring attack and upward-mobility goals enhances the attractiveness of an unknown bully, showing that victims' ability to cope with the bullying episode is a critical mediator.
A case report of osteochondritis dissecans of the first metatarsophalangeal joint treated with autologous cancellous bone and chondral flap reconstruction
Authors: Delniotis Ioannis , Leidinger Benedikt
Published: February 2020

Although osteochondritis dissecans (OD) is well-described in the bibliography, cases of OD in the 1st metatarsophalangeal joint (MTP) are rare clinical situations. We present a 25-year-old male who presented to our department for big toe pain on the left side. Clinical and radiological examination showed the typical findings of OD lesion on the 1st metatarsal head (MH), establishing the diagnosis of OD. Intraoperatively the articular cartilage of the partially detached part of the MH was intact and under it, an empty cavity with a big defect was obvious. Autogenous cancellous bone transplantation from the metatarsal metaphysis, reattachment of the cartilage surface as a chondral flap and edge sealing with fibrin glue was our treatment of choice. OD of the 1st MH should be included in the differential diagnosis of big toe pain, as early diagnosis and treatment are crucial to prevent future osteoarthritis of the 1st MTP.
Intra-abdominal cystic lymphangioma of the mesocolon sigmoids: a rare entity in adult patient woman
Authors: Guachilema Ribadeneira Alex , Monard Ángel Raúl Tapia , Endara Maria Cristina , Garcia Cristian German , Sandoval Milton Omar , Cárdenas David Alejandro , Basantes Andrea Daniela
Published: February 2020

The lymphangioma is a benign neoplasm, mostly connate, it occurs more often in children. It is more frequently located in the head–neck region, as well as in the armpit, and less frequently in the abdomen. The diagnosis, as well as their appearance is variant, they can be asymptomatic depending on the size. The signs on the physical exam are usually nonspecific and can look like an acute abdomen. Imaging tests used are the ultrasound and tomography, which determine the therapeutic behavior. The differential diagnosis should be made with other intra-abdominal injuries, such as cavernous hemangioma, mesotheliomas, pancreatic and ovarian tumors and even peritoneal hydatid cyst. The definitive treatment is surgical in most cases, with complete excision of the mass. The definitive diagnosis is obtained with the histopathological study of the surgical piece.
Doppler shifts and spectral line profile changes in the starlight scattered from an exoplanet
Authors: Strachan John B P , Anglada-Escudé Guillem
Published: February 2020

Scattered starlight from an exoplanet, commonly called reflected light, can be used to characterize the planet including the determination of its albedo and inclination of orbit. The relatively low flux ratio between directly observed starlight and starlight scattered off hot Jupiters make these systems the prime candidates for detection of reflected light using high-resolution spectroscopy. The first detections have been claimed for 51 Peg b. In a first calculation, we derive the Doppler shift of reflected light measured by a remote observer for a planet modelled as a point-like particle in orbit around a star. We find that the Doppler shift of reflected light from planets have a different Doppler shift to that of light emitted directly from the planet with magnitude equivalent to the radial motion of the planet with respect to the star. This only occurs for non-circular orbits. Secondly, restricting our investigation to planets that are tidally locked and orbit in circular orbits we account for the finite size of the star and planet by integrating the contribution to a simulated spectral line across both their surfaces. Since exact analytical expressions cannot be easily derived as a function of all free parameters of the problem, we have developed a software tool called REflected STARlighT (restart) that produces the resulting line profiles. By applying it to study cases found in the literature, we explicitly show that hot Jupiters such as WASP-19b and 51 Peg b should show substantial broadening and asymmetric distortions compared to the nominal stellar line.
Impact of convective boundary mixing on the TP-AGB
Authors: Wagstaff G , Miller Bertolami M M , Weiss A
Published: February 2020

The treatment of convective boundaries remains an important source of uncertainty within stellar evolution, with drastic implications for the thermally pulsing stars on the asymptotic giant branch (AGB). Various sources are taken as motivation for the incorporation of convective boundary mixing (CBM) during this phase, from s-process nucleosynthesis to hydrodynamical models. In spite of the considerable evidence in favour of the existence of CBM on the pre-AGB evolution, this mixing is not universally included in models of TP-AGB stars. The aim of this investigation is to ascertain the extent of CBM, which is compatible with observations when considering full evolutionary models. Additionally, we investigate a theoretical argument that has been made that momentum-driven overshooting at the base of the pulse-driven convection zone should be negligible. We show that, while the argument holds, it would similarly limit mixing from the base of the convective envelope. On the other hand, estimations based on the picture of turbulent entrainment suggest that mixing is possible at both convective boundaries. We demonstrate that additional mixing at convective boundaries during core-burning phases prior to the thermally pulsing AGB has an impact on the later evolution, changing the mass range at which the third dredge-up and hot-bottom burning occur, and thus also the final surface composition. In addition, an effort has been made to constrain the efficiency of CBM at the different convective boundaries, using observational constraints. Our study suggests a strong tension between different constraints that makes it impossible to reproduce all observables simultaneously within the framework of an exponentially decaying overshooting. This result calls for a reassessment of both the models of CBM and the observational constraints.
Galactic Center threads as nuclear magnetohydrodynamic waves
Authors: Sofue Yoshiaki
Published: February 2020

Propagation of fast-mode magnetohydrodynamic (MHD) compression waves is traced in the Galactic Center with a poloidal magnetic cylinder. MHD waves ejected from the nucleus are reflected and guided along the magnetic field, exhibiting vertically stretched fronts. The radio threads and non-thermal filaments are explained as due to tangential views of the waves driven by sporadic activity in Sgr A$^*$, or by multiple supernovae. In the latter case, the threads could be extremely deformed relics of old supernova remnants exploded in the nucleus.
L’importance de l’apport alimentaire en sodium chez les enfants
Authors: Gowrishankar Manjula , Blair Becky , Rieder Michael J
Published: February 2020

L’organisme a besoin de très petites quantités de sodium alimentaire pour soutenir le volume sanguin et la tension artérielle. Selon les données de surveillance nutritionnelle disponibles, la plupart des enfants canadiens consomment une quantité de sodium supérieure à leurs besoins nutritionnels. Environ 80 % du sodium que consomment les Canadiens proviennent d’aliments transformés et emballés. Chez les enfants, un fort apport en sodium peut être indicateur d’un régime alimentaire de piètre qualité. Les résultats d’analyses systématiques et de méta-analyses démontrent que la diminution du sodium alimentaire chez les enfants entraîne une réduction modeste, mais cliniquement non significative, de la tension artérielle. Les stratégies en population pour limiter la consommation de sodium, telles que la reformulation des produits alimentaires, la modification des processus d’approvisionnement alimentaire et les politiques fédérales de saine alimentation, sont d’importantes initiatives en santé publique qui peuvent réduire considérablement la consommation de sodium et contribuer à prévenir des maladies chroniques à l’âge adulte.
The Rise of Trump, The Fall of Prejudice? Tracking White Americans’ Racial Attitudes Via A Panel Survey, 2008–2018
Authors: Hopkins Daniel J , Washington Samantha
Published: February 2020

In his campaign and first few years in office, Donald Trump consistently defied contemporary norms by using explicit, negative rhetoric targeting ethnic/racial minorities. Did this rhetoric lead White Americans to express more or less prejudiced views of African Americans or Hispanics, whether through changing norms around racial prejudice or other mechanisms? We assess that question using a thirteen-wave panel conducted with a population-based sample of Americans between 2008 and 2018. We find that via most measures, White Americans’ expressed anti-Black and anti-Hispanic prejudice declined after Trump’s political emergence, and we can rule out even small increases in the expression of prejudice. These results suggest the limits of racially charged rhetoric’s capacity to heighten prejudice among White Americans overall. They also indicate that rather than being a fixed predisposition, prejudice can shift by reacting against changing presidential rhetoric.
HOMOLOGICAL STABILITY FOR UNLINKED CIRCLES IN A 3-MANIFOLD
Authors: Kupers Alexander
Published: February 2020

We prove a homological stability theorem for unlinked circles in $3$-manifolds and give an application to certain groups of diffeomorphisms of 3-manifolds.
A Hyperfinite Factor Which is not an Injective C*-Algebra
Authors: Wright J D Maitland , Saitô Kazuyuki
Published: February 2020

We exhibit a wild monotone complete C*-algebra which is a hyperfinite factor but is not an injective C*-algebra.
Characterizing infection in anti-neutrophil cytoplasmic antibody–associated vasculitis: results from a longitudinal, matched-cohort data linkage study
Authors: Sarica Shifa H , Dhaun Neeraj , Sznajd Jan , Harvie John , McLaren John , McGeoch Lucy , Kumar Vinod , Amft Nicole , Erwig Lars , Marks Angharad , Black Corri , Basu Neil
Published: February 2020

Objectives

Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV.

Methods

We conducted a multicentre matched cohort study of AAV. Complementary data on infections were retrieved via data linkage with the population-based Scottish microbiological laboratory, hospitalization and primary care prescribing registries.

Results

A total of 379 AAV patients and 1859 controls were followed up for a median of 3.5 years (interquartile range 1.9–5.7). During follow-up, the proportions of AAV patients with at least one laboratory-confirmed infection, severe infection and primary care antibiotic prescription were 55.4%, 35.6% and 74.6%, respectively. The risk of infection was higher in AAV than in matched controls {laboratory-confirmed infections: incidence rate ratio [IRR] 7.3 [95% confidence interval (CI) 5.6, 9.6]; severe infections: IRR 4.4 [95% CI 3.3, 5.7]; antibiotic prescriptions: IRR 2.2 [95% CI 1.9, 2.6]}. Temporal trend analysis showed that AAV patients remained at a higher risk of infections throughout the follow-up period, especially year 1. Although the Escherichia genus was the most commonly identified pathogen (16.6% of AAV, 5.5% of controls; P < 0.0001), AAV patients had the highest risk for Herpes [IRR 12.5 (95% CI 3.7, 42.6)] and Candida [IRR 11.4 (95% CI 2.4, 55.4)].

Conclusion

AAV patients have up to seven times higher risk of infection than the general population and the overall risk remains significant after 8 years of follow-up. The testing of enhanced short- to medium-term prophylactic antibiotic regimes should be considered.
Theory of minds: managing mental state inferences in working memory is associated with the dorsomedial subsystem of the default network and social integration
Authors: Meyer Meghan L , Collier Eleanor
Published: February 2020

We often interact with multiple people at a time and consider their various points of view to facilitate smooth social interaction. Yet, how our brains track multiple mental states at once, and whether skill in this domain links to social integration, remains underspecified. To fill this gap, we developed a novel social working memory paradigm in which participants manage two- or four-people’s mental states in working memory, as well as control trials in which they alphabetize two- or four-people’s names in working memory. In Study 1, we found that the dorsomedial subsystem of the default network shows relative increases in activity with more mental states managed in working memory. In contrast, this subsystem shows relative decreases in activity with more non-mental state information (the number of names alphabetized) managed in working memory. In Study 2, only individual differences in managing mental states in working memory, specifically on trials that posed the greatest mental state load to working memory, correlated with social integration. Collectively, these findings add further support to the hypothesis that social working memory relies on partially distinct brain systems and may be a key ingredient to success in a social world.
Volatile Organic Compounds of EndophyticBurkholderia pyrrociniaStrain JK-SH007 Promote Disease Resistance in Poplar
Authors: Liu Ake , Zhang Pengfei , Bai Bianxia , Bai Fenglin , Jin Tingting , Ren Jiahong
Published: February 2020

Volatile organic compounds (VOCs) play important roles in the regulation of plant growth and pathogen resistance. However, little is known about the influence of VOCs released from endophytic strains (Burkholderia pyrrocinia strain JK-SH007) on controlling pathogens or inducing systemic resistance in poplar. In this study, we found that VOCs produced by strain JK-SH007 inhibit three poplar canker pathogens (Cytospora chrysosperma, Phomopsis macrospora, and Fusicoccum aesculi) and promote defense enzyme activity and malondialdehyde (MDA) and total phenol (TP) accumulation. Thirteen kinds of VOC components were identified using the solid-phase microextraction combined with gas chromatography-mass spectrometry method. Dimethyl disulfide (DMDS) accounted for the largest proportion of these VOCs. Treatments of poplar seedlings with different volumes of VOC standards (DMDS, benzothiazole, dimethylthiomethane, and phenylacetone) showed that DMDS had the greatest effects on various defense enzyme activities and MDA and TP accumulation. We also found that the inhibitory effect of the VOCs on the three pathogens was gradually enhanced with increasing standard volume. Moreover, the treatment of samples with DMDS significantly reduced the severity and development of the disease caused by three poplar canker pathogens. Comparative transcriptomics analysis of poplar seedlings treated with DMDS showed that there were 1,586 differentially expressed genes in the leaves and stems, and quantitative PCR showed that the gene expression trends were highly consistent with the transcriptome sequencing results. The most significant transcriptomic changes induced by VOCs were related to hormone signal transduction, transcriptional regulation of plant–pathogen interactions, and energy metabolism. Moreover, 137 transcription factors, including members of the ethylene response factor, NAC, WRKY, G2-like, and basic helix-loop-helix protein families, were identified to be involved in the VOC-induced process. This study elucidates the resistance induced by Burkholderia pyrrocinia strain JK-SH007 to poplar canker at the molecular level and can make possible a new method for the comprehensive prevention and control of poplar disease.
The Use of Theoretical Frameworks Guiding Interprofessional Simulation: An Integrative Review
Authors: Bell Rhonda , Fredland Nina
Published: February 2020

AIM

The aim of the review was to describe and summarize the use of theoretical premises noted in published studies on the implementation of interprofessional simulation (IPE-Sim).

BACKGROUND

IPE-Sim is an educational methodology being used throughout nursing, allied health, and health science programs of study. Understanding frameworks currently used in IPE-Sim is essential in advancing the knowledge of this type of educational methodology.

METHOD

An integrative literature review on the use of theories and models guiding IPE-Sim was performed.

RESULTS

Ten studies meeting the inclusion criteria were categorized into theoretical frameworks (n = 4) or competency frameworks (n = 6) guiding the development and implementation of IPE-Sim and were included in the review. The literature review revealed a lack of consistent theoretical and competency-based frameworks guiding the development, implementation, assessment, and research of IPE-Sim.

CONCLUSION

The integrative literature review describes specific theoretical and competency frameworks currently used in the literature on IPE-Sim.
Red cell use in trauma
Authors: Shander Aryeh , Zacharowski Kai , Spahn Donat R.
Published: February 2020

Purpose of review

Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting.

Recent findings

Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7–8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated.

Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).
Variables Associated With Administration of Nurse-initiated Analgesia in Pediatric Triage
Authors: Shavit Itai , Hecht-Sagie Lior , Allon Raviv , Leiba Ronit , Barbi Egidio , Poonai Naveen , Shavit Danielle , Feldman Oren
Published: February 2020

Objectives:

Triage nurse-initiated analgesia (TNIA) has been shown to be associated with decreased time to the provision of analgesia and improved patient satisfaction. We examined variables that influence the provision of analgesia in a pediatric emergency department that uses TNIA.

Methods:

A 4-year retrospective cohort study of all children with triage pain scores ≥1 was conducted. Data on demographics and patients’ and nurses’ characteristics were collected. Logistic regression analyses were used to examine the effect of multiple variables on the provision of any analgesia and opioid analgesia.

Results:

Overall, 28,746 children had triage pain scores ≥1; 14,443 (50.2%) patients received analgesia of any type and 1888 (6.6%) received opioid analgesia. Mean time to any analgesia was 8.0±3.7 minutes. Of the 9415 patients with severe pain, 1857 (19.7%) received opioid analgesia. Age, sex, hourly number of patients waiting to be triaged, and nurse experience were not associated with the provision of any analgesia or opioid analgesia. Severe pain had the highest odds ratios (ORs) for the provision of any analgesia and opioid analgesia (7.7; 95% confidence interval [CI]: 7.1-8.2 and 22.8; 95% CI: 18.1-28.8, respectively). Traumatic injury and time-to-triage <8 minutes were associated with the provision of opioid analgesia (OR: 4.7; 95% CI: 4.2-5.2 and OR: 1.6; 95% CI: 1.5-1.8, respectively).

Discussion:

TNIA yielded a short time to analgesia, but rates of any analgesia and opioid analgesia were low. Several variables associated with the provision of any analgesia and opioid analgesia were identified. Our findings provide evidence to guide future educational programs in this area.
Gay Fatherhood in the NICU
Authors: Logan Rickey
Published: February 2020

Background:

With advances in reproductive health, gay males are increasingly given the opportunity to reproduce. It is not a common occurrence for infants of gay male fathers to enter the neonatal intensive care unit (NICU); however, this may change and should be acknowledged.

Purpose:

To give insight into the barriers, perspectives, and stresses of gay male caregivers (families) in their time spent in the NICU and to offer recommendations as to how better to serve them and their families.

Methods/Search Strategy:

Searched using PubMed, CINAHL, SCOPUS, and Google Scholar. Key words used were “gay families,” “fatherhood,” “neonatal intensive care unit,” “lesbians,” and “surrogacy.”

Findings/Results:

There remains a very limited amount of data for healthcare providers as these relate to gay male fathers in the NICU, aside from narratives. Most of the research and literature that highlight potential barriers stem from heterosexual fatherhood in the NICU and lesbian parenting in the healthcare system.

Implications for Practice:

To have an understanding and knowledge to improve support for gay fathers in the NICU.

Implications for Research:

Research on gay fathers in the NICU and further research on lower economic gay fatherhood and gay men of color and fatherhood are required. Because of the small sample size, multicentered studies may warranted to aid in clinical significance.
Association of Time of Delivery With Composite Adverse Outcomes in Low-Risk Pregnancies
Authors: Wagner Stephen M. , Chen Han-Yang , Gupta Megha , Chauhan Suneet P.
Published: February 2020

OBJECTIVE:

To compare the composite neonatal and maternal adverse outcomes among low-risk pregnant women who labor and subsequently deliver at different time shifts.

METHODS:

This was a population-based retrospective cohort study using the U.S. vital statistics data set on Period Linked Birth-Infant Death Data from 2012 to 2016. The study population was restricted to live births from low-risk women with nonanomalous singletons who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. Time of delivery was categorized as the first shift (7:00–15:00), the second shift (15:00–23:00), and the third shift (23:00–7:00). The primary outcome was composite neonatal adverse outcome, and the secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI).

RESULTS:

Of 19.9 million live births during the study period, 58.8% (more than 11.6 million) met the inclusion criteria. The overall composite neonatal adverse outcome was 6.6 per 1,000 live births. The multivariable adjusted analysis demonstrated that, compared with neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the second shift (relative risk [RR] 1.15, aRR 1.07, 95% CI 1.05–1.09), and the third shift (RR 1.28, aRR 1.24, 95% CI 1.22–1.27). The overall composite maternal adverse outcome was 2.45 per 1,000 live births. After adjustment, there was no significant difference in the risk of composite maternal adverse outcome based on the time of delivery.

CONCLUSION:

Among low-risk singleton pregnancies, compared with delivery at 7:00–15:00, the composite neonatal adverse outcome is marginally but significantly higher if the delivery occurs at the second (15:00–23:00) and the third (23:00–7:00) shifts. The composite maternal adverse outcome is similar among the three different time shifts.
Association of Overweight and Obesity Development Between Pregnancies With Stillbirth and Infant Mortality in a Cohort of Multiparous Women
Authors: Yu Ya-Hui , Bodnar Lisa M. , Himes Katherine P. , Brooks Maria M. , Naimi Ashley I.
Published: February 2020

OBJECTIVE:

To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality.

METHODS:

We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003–2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29–365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose–response curves, respectively, adjusting for race–ethnicity, smoking, and other confounders (eg, age, education).

RESULTS:

A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6–2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3–5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4–4.4) excess neonatal deaths per 1,000 live births. There was a dose–response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals.

CONCLUSION:

Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.
Placental Growth Factor and the Risk of Adverse Neonatal and Maternal Outcomes
Authors: Parchem Jacqueline G. , Brock Clifton O. , Chen Han-Yang , Kalluri Raghu , Barton John R. , Sibai Baha M. ,   for the Preeclampsia Triage by Rapid Assay Trial (PETRA) Investigators
Published: February 2020

OBJECTIVE:

To evaluate whether abnormal plasma placental growth factor (PlGF) level is associated with adverse neonatal and maternal outcomes.

METHODS:

This was a secondary analysis of the Preeclampsia Triage by Rapid Assay Trial (PETRA), a prospective, multicenter, observational study that enrolled women with suspected preeclampsia. Our analysis included women age 18–45 years with a singleton pregnancy between 20 and 41 weeks of gestation. Plasma collected at enrollment was used for PlGF measurement. Abnormal PlGF was defined as low (100 pg/mL or less) or very low (less than 12 pg/mL). The primary outcomes were composite adverse neonatal and maternal outcomes. We used multivariable Poisson regression models to examine the association between PlGF and outcomes.

RESULTS:

Of 1,112 women who met the inclusion criteria, plasma PlGF was low in 742 (67%) and very low in 353 (32%). In the cohort, the overall rates of the composite adverse neonatal and maternal outcomes were 6.4% and 4.8%, respectively. Compared with normal PlGF (more than 100 pg/mL), low PlGF was significantly associated with an increased risk of the composite neonatal outcome (9.2% vs 0.8%; adjusted relative risk [aRR] 17.2, 95% CI 5.2–56.3), and the composite maternal outcome (6.2% vs 1.9%; aRR 3.6, 95% CI 1.7–8.0). Very low PlGF was also significantly associated with both neonatal and maternal outcomes. The sensitivity and specificity of low PlGF were 95.8% and 35.3%, respectively, for the composite neonatal outcome, and 86.8% and 34.3% for the composite maternal outcome. Although the positive predictive values were low (9.2% and 6.2%, respectively), the negative predictive value of low PlGF for neonatal and maternal outcomes was 99.2% and 98.1%, respectively.

CONCLUSION:

Among women being evaluated for preeclampsia, those with abnormal PlGF are significantly more likely to experience adverse neonatal and maternal outcomes. These outcomes occur infrequently when the PlGF is normal. These findings suggest that PlGF may be useful for risk stratification of women with suspected preeclampsia.

FUNDING SOURCE:

No funding was received for this study. The original PETRA study was supported by funding from Alere.
Maternal Sense of Control During Childbirth and Infant Feeding Method
Authors: Dude Annie , Fette Lida M. , Reddy Uma M. , Tita Alan T.N. , Silver Robert M. , El-Sayed Yasser Y. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Iams Jay D. , Chien Edward K. , Casey Brian M. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network
Published: February 2020

OBJECTIVE:

To estimate whether maternal sense of control in labor is associated with breastfeeding at 4–8 weeks postpartum.

METHODS:

This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6–96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4–8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders.

RESULTS:

Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4–8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145–182). The median Labor Agentry Scale score was 169 (interquartile range 151–183) for women exclusively breastfeeding, 166 (interquartile range 142–182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142–181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant.

CONCLUSION:

After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4–8 weeks postpartum among nulliparous women.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.
Multidrug Therapy for Refractory Immune Thrombocytopenia in Pregnancy
Authors: Chon Andrew H. , Chan Randall , Lee Richard H. , Kwong Kenny , Wertheimer Fiona B. , Weitz Ilene C.
Published: February 2020

BACKGROUND:

Severe immune thrombocytopenia complicating pregnancy may require treatment beyond first-line medications (intravenous immunoglobulins or corticosteroids), but there is a paucity of literature on the use of such second-line agents in pregnancy.

CASE:

The patient is a 29-year-old woman with early-onset severe immune thrombocytopenia at 13 weeks of gestation. Maternal platelet counts reached a nadir of less than 5×109/L. The thrombocytopenia persisted despite first-line medications. Romiplostim, rituximab, and azathioprine were added to the therapeutic regimen. Platelet counts eventually stabilized at greater than 150×109/L before delivery. After delivery at term, the neonate had transient B-cell suppression, which was presumed to be secondary to rituximab, but was otherwise doing well and meeting all milestones at 7 months of age.

CONCLUSION:

The addition of second-line agents was associated with sustained elevation in maternal platelet counts and may have obviated the need for splenectomy.
Occult Tubal Carcinoma After Risk-Reducing Salpingo-oophorectomy
Authors: Piedimonte Sabrina , Frank Cairina , Laprise Claudie , Quaiattini Andrea , Gotlieb Walter H.
Published: February 2020

OBJECTIVE:

To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy.

DATA SOURCE:

A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors.

METHODS OF STUDY SELECTION:

Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria.

TABULATION, INTEGRATION, AND RESULTS:

Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I2=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4–67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5–53%) and 24 cases of post–risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4–1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy.

CONCLUSION:

Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.
A Collaborative Model of a Community Birth Center and a Tertiary Care Medical Center
Authors: Lotshaw Richard R. , Phillippi Julia C. , Buxton Margaret , McNeill-Simaan Edwina , Newton J Michael
Published: February 2020

OBJECTIVE:

To describe the development, implementation, and evaluation of a collaborative model between a freestanding birth center and a tertiary care medical center.

METHODS:

An interdisciplinary team developed a freestanding accredited birth center in collaboration with a tertiary care medical center in the southeast United States. We performed a retrospective cohort study of all women obtaining care at the birth center and assessed the rate (and 95% CIs) of cesarean delivery, patient transfers, and adverse maternal and neonatal events.

RESULTS:

Between January 2017 and December 2018, 1,394 women initiated prenatal care at the birth center. The study cohort consisted of 1,061 women who continued their prenatal care and planned to deliver at the birth center, of whom 358 (34%) were subsequently transferred before admission and 703 (66%) presented to the birth center in labor. Of those, 573 (82%) were subsequently delivered vaginally in the birth center, and 130 (18%) were transferred for hospital birth. Of those admitted to the birth center in labor, 41 ultimately underwent cesarean delivery for an overall cesarean delivery rate of 6% (95% CI 4–8%). Maternal transfers for postpartum hemorrhage occurred in eight patients (1%; 95% CI 1–2%). There were 39 neonatal intensive care admissions (6%; 95% CI 4–8%), eight cases (1%; 95% CI 0.5–2%) of 5-minute Apgar scores less than 7, and two previable neonatal deaths (0.3%; 95% CI 0–1%).

CONCLUSION:

We describe a collaborative model between a freestanding birth center and a tertiary care medical center, which provided women with access to a traditional birth center experience while maintaining access to the specialized care provided by a tertiary care medical center. We believe that the model may facilitate options for maternity care in regional perinatal systems.
The 5-Year Outcome of the Ponseti Method in Children With Idiopathic Clubfoot and Arthrogryposis
Authors: Church Chris , McGowan Abigail , Henley John , Donohoe Maureen , Niiler Tim , Shrader Michael W. , Nichols Louise R.
Published: February 2020

Background:

The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis.

Methods:

The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded.

Results:

A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility.

Conclusions:

Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention.

Level of Evidence:

Level III, Therapeutic Studies—Investigating the Results of Treatment.
Characteristics of and Factors Influencing College Nursing Students' Willingness to Utilize mHealth for Health Promotion
Authors: Sittig Scott , Hauff Caitlyn , Graves Rebecca J. , Williams Susan G. , McDermott Ryon C. , Fruh Sharon , Hall Heather , Campbell Matt , Swanzy Debra , Wright Theresa , Hudson Geoffrey M.
Published: February 2020

More than half of practicing nurses have suboptimal physical or mental health. Impaired health is associated with a 76% higher likelihood that nurses will make medical errors. Improving the health habits of nursing students is essential to shaping and sustaining health prior to joining the workforce. Technology such as mobile health applications holds great promise in facilitating behavioral change and encouraging healthy habits in nursing students. Identifying the predictors of willingness to use mobile health is essential to creating mobile health applications that will engage nursing students and promote sustainable usage. Evaluation of psychological, attitudinal, and health-related correlates of mobile health can highlight predictors of willingness to use mobile health, which can influence nursing students' utilization and long-term engagement with mobile health applications. Analysis of these correlates shows that psychological attributes, such as hope, play a role in the willingness to use and may facilitate engagement in the utilization of a mobile health application. Development of a mobile health application that increases hope and helps establish healthy habits may enable nursing students to remain healthy throughout their lives, creating a new generation of happier, healthier nurses and, ultimately, improving safety for patients under their care.