bluuebunny/crossref_metadata_2025 huggingface dataset:
Host galaxies and electromagnetic counterparts to binary neutron star mergers across the cosmic time: detectability of GW170817-like events
Authors: Perna Rosalba , Artale M Celeste , Wang Yi-Han , Mapelli Michela , Lazzati Davide , Sgalletta Cecilia , Santoliquido Filippo
Published: March 2022

The association of GRB170817A with a binary neutron star (BNS) merger has revealed that BNSs produce at least a fraction of short gamma-ray bursts (SGRBs). As gravitational wave (GW) detectors push their horizons, it is important to assess coupled electromagnetic (EM)/GW probabilities and maximize observational prospects. Here, we perform BNS population synthesis calculations with the code mobse, seeding the binaries in galaxies at three representative redshifts, $z$ = 0.01, 0.1, and 1 of the Illustris TNG50 simulation. The binaries are evolved and their locations numerically tracked in the host galactic potentials until merger. Adopting the microphysics parameters of GRB170817A, we numerically compute the broad-band light curves of jets from BNS mergers, with the afterglow brightness dependent on the local medium density at the merger site. We perform Monte Carlo simulations of the resulting EM population assuming either a random viewing angle with respect to the jet, or a jet aligned with the orbital angular momentum of the binary, which biases the viewing angle probability for GW-triggered events. We find a gamma-ray detection probability of $\sim\!2{{\rm per\ cent}},10{{\rm per\ cent}},\mathrm{and}\ 40{{\rm per\ cent}}$ for BNSs at $z$ = 1, 0.1, and 0.01, respectively, for the random case, rising to $\sim\!75{{\rm per\ cent}}$ for the $z$ = 0.01, GW-triggered aligned case. Afterglow detection probabilities of GW-triggered BNS mergers vary in the range of $\sim \! 0.3 \!-\! 0.5{{\rm per\ cent}}$, with higher values for aligned jets, and are comparable across the high- and low-energy bands, unlike gamma-ray-triggered events (cosmological SGRBs) which are significantly brighter at higher energies. We further quantify observational biases with respect to host galaxy masses.
Oxidative stress-CBP axis modulates MOB1 acetylation and activates the Hippo signaling pathway
Authors: Jin Jiaqi , Zhang Lei , Li Xueying , Xu Weizhi , Yang Siyuan , Song Jiagui , Zhang Wenhao , Zhan Jun , Luo Jianyuan , Zhang Hongquan
Published: March 2022

Reactive oxygen species (ROS) are constantly produced in cells, an excess of which causes oxidative stress. ROS has been linked to regulation of the Hippo pathway; however, the underlying detailed mechanisms remain unclear. Here, we report that MOB1, a substrate of MST1/2 and co-activator of LATS1/2 in the canonical Hippo pathway, interacts with and is acetylated at lysine 11 by acetyltransferase CBP and deacetylated by HDAC6. MOB1-K11 acetylation stabilizes itself by reducing its binding capacity with E3 ligase Praja2 and subsequent ubiquitination. MOB1-K11 acetylation increases its phosphorylation and activates LATS1. Importantly, upstream oxidative stress signals promote MOB1 acetylation by suppressing CBP degradation, independent of MST1/2 kinase activity and HDAC6 deacetylation effect, thereby linking oxidative stress to activation of the Hippo pathway. Functionally, the acetylation-deficient mutant MOB1-K11R promotes lung cancer cell proliferation, migration and invasion in vitro and accelerates tumor growth in vivo, compared to the wild-type MOB1. Clinically, acetylated MOB1 corresponds to better prediction of overall survival in patients with non-small cell lung cancer. Therefore, as demonstrated, an oxidative stress-CBP regulatory axis controls MOB1-K11 acetylation and activates LATS1, thereby activating the Hippo pathway and suppressing YAP/TAZ nuclear translocation and tumor progression.
Outcome and Failure Analysis of 132 Episodes of Hematogenous Periprosthetic Joint Infections—A Cohort Study
Authors: Renz Nora , Trampuz Andrej , Perka Carsten , Rakow Anastasia
Published: March 2022

Background

The outcomes of hematogenous periprosthetic joint infection (PJI) and reasons for failure are largely unknown.

Methods

The outcomes of consecutive patients with hematogenous PJI treated at our institution between 2010 and 2019 were evaluated. Failure was classified as persistence or relapse of infection or new infection. Failure-free survival was assessed using Kaplan-Meier analysis. Proportions between groups were compared with the Fisher exact test.

Results

One hundred thirty-two hematogenous PJI episodes involving knee (n = 76), hip (n = 54), shoulder (n = 1), or elbow (n = 1) prostheses experienced by 110 patients were included. The median follow-up (range) was 20.7 (0.2–89.9) months. Hematogenous PJIs were caused by Staphylococcus aureus (n = 49), Streptococcus spp. (n = 36), Enterococcus faecalis (n = 17), Enterobacterales (n = 16), coagulase-negative staphylococci (n = 9), and other (n = 6). Debridement and implant retention were performed in 50 (38%), prosthesis exchange or removal in 79 (60%), and no surgery in 3 episodes (2%). Treatment failed in 42 episodes (32%), including 6 infection-related deaths. Among 36 nonfatal failures, 21 were caused by a new pathogen and 8 by the same pathogen, in 7 episodes no pathogen was isolated. Of all nonfatal failures, 19 (53%) PJIs were of hematogenous origin. Identification of the primary focus, causative pathogen, and CRIME80 Score did not influence treatment outcome, but the failure rate was higher following prosthesis retention compared with multistage exchange.

Conclusions

Persistence-/relapse-free survival after treatment of hematogenous PJI was high (84%). New hematogenous PJI due to the same or a new pathogen occurred frequently, reducing treatment success to 62% after 4 years of follow-up, suggesting an individual predisposition to hematogenous PJI. The outcome was similar for different pathogens but worse in episodes treated with prosthesis retention compared with multistage exchange.
A field evaluation of a matching mechanism: University applicant behavior in Australia
Authors: Guillen Pablo , Kesten Onur , Kiefer Alexander , Melatos Mark
Published: March 2022

The majority of undergraduate university applications in the state of New South Wales—Australia's largest state—are processed by a clearinghouse, the Universities Admissions Centre (UAC). Applicants submit an ordered list of degrees to the UAC, which applies a matching algorithm to allocate university places to eligible applicants. Applicants receive advice on how to construct their degree preference list from multiple sources including individual universities. This advice is often confusing and misleading. To evaluate the performance of the current system, we run a large sample (832 observations) online experiment with experienced participants in a choice environment that mimics the UAC application process, and in which truth telling is optimal. We vary the advice received across treatments: no advice, the UAC advice only, an instance of misleading university advice only, and both the UAC and the misleading university advice together. Overall, 75.5% of participants fail to behave in their best interest. High rates of applicant manipulation persist even when applicants are provided with the UAC's accurate advice. Students who attend nonselective government high schools are more prone to use strictly dominated strategies than those who attend academically selective government high schools and private high schools.
The Processing of Semantic Complexity and Cospeech Gestures in Schizophrenia: A Naturalistic, Multimodal fMRI Study
Authors: Cuevas Paulina , He Yifei , Steines Miriam , Straube Benjamin
Published: March 2022

Schizophrenia is marked by aberrant processing of complex speech and gesture, which may contribute functionally to its impaired social communication. To date, extant neuroscientific studies of schizophrenia have largely investigated dysfunctional speech and gesture in isolation, and no prior research has examined how the two communicative channels may interact in more natural contexts. Here, we tested if patients with schizophrenia show aberrant neural processing of semantically complex story segments, and if speech-associated gestures (co-speech gestures) might modulate this effect. In a functional MRI study, we presented to 34 participants (16 patients and 18 matched-controls) an ecologically-valid retelling of a continuous story, performed via speech and spontaneous gestures. We split the entire story into ten-word segments, and measured the semantic complexity for each segment with idea density, a linguistic measure that is commonly used clinically to evaluate aberrant language dysfunction at the semantic level. Per segment, the presence of numbers of gestures varied (n = 0, 1, +2). Our results suggest that, in comparison to controls, patients showed reduced activation for more complex segments in the bilateral middle frontal and inferior parietal regions. Importantly, this neural aberrance was normalized in segments presented with gestures. Thus, for the first time with a naturalistic multimodal stimulation paradigm, we show that gestures reduced group differences when processing a natural story, probably by facilitating the processing of semantically complex segments of the story in schizophrenia.
Is renewable energy more favorable to diversity than conventional energy sources on R&D performance?
Authors: Kim Dohyoung , Hwang Junseok
Published: March 2022

Diversity is often key to solving challenging problems. It sparks creativity through embracing various perspectives. Energy transition and climate change are challenges that require significant creativity and innovative ideas. This study is designed to analyze if diversity in the workforce has a meaningful relation to research and development (R&D) performance of public renewable energy in South Korea, and possibly, to compare the diversity of the workforce and its relation to performance between power generation industries. Using 538 public R&D projects, this study analyzed intellectual and economic performance along with workforce diversity based on gender, age, educational background, and educational level. Among several findings in this study, this study found a positive relationship between gender diversity and intellectual performance but a negative relationship between age diversity and intellectual performance. In addition, a clear distinction was found between renewable energy and nuclear and thermal power in terms of the research workforce itself and its relation to performance.
Stroke-Induced Neurological Dysfunction in Aged Mice Is Attenuated by Preconditioning with Young Sca-1+ Stem Cells
Authors: Wlodarek Lukasz , Alibhai Faisal J , Wu Jun , Li Shu-Hong , Li Ren-Ke
Published: March 2022

Aims

To date, stroke remains one of the leading causes of death and disability worldwide. Nearly three-quarters of all strokes occur in the elderly (>65 years old), and a vast majority of these individuals develop debilitating cognitive impairments that can later progress into dementia. Currently, there are no therapies capable of reversing the cognitive complications which arise following a stroke. Instead, current treatment options focus on preventing secondary injuries, as opposed to improving functional recovery.

Methods

We reconstituted aged (20-month old) mice with Sca-1+ bone marrow (BM) hematopoietic stem cells isolated from aged or young (2-month old) EGFP+ donor mice. Three months later the chimeric aged mice underwent cerebral ischemia/reperfusion by bilateral common carotid artery occlusion (BCCAO), after which cognitive function was evaluated. Immunohistochemical analysis was performed to evaluate host and recipient cells in the brain following BCCAO.

Results

Young Sca-1+ cells migrate to the aged brain and give rise to beneficial microglial-like cells that ameliorate stroke-induced loss of cognitive function on tasks targeting the hippocampus and cerebellum. We also found that young Sca-1+ cell-derived microglial-like cells possess neuroprotective properties as they do not undergo microgliosis upon migrating to the ischemic hippocampus, whereas the cells originating from old Sca-1+ cells proliferate extensively and skew toward a pro-inflammatory phenotype following injury.

Conclusions

This study provides a proof-of-principle demonstrating that young BM Sca-1+ cells play a pivotal role in reversing stroke-induced cognitive impairments and protect the aged brain against secondary injury by attenuating the host cell response to injury.
The Effect of Work on Antisocial Behavior among Formerly Incarcerated Young Adults: A Panel Analysis
Authors: Lee Lewis H , Kim Minseop
Published: March 2022

Although there is ample research on the association between employment and adults’ crime, few studies have focused on formerly incarcerated juveniles transitioning to emerging adults, especially studies using panel data. Using data from the Pathways to Desistance Study (N = 1,289) with a group of high-risk emerging adults (ages 18 to 24), this panel analysis addresses the effect of employment on antisocial behavior guided by Laub and Sampson’s social bond theory. The results show average weeks worked for the sample is below 26 weeks per year at each time point, indicating low levels of labor market participation. A fixed effects model using a structural equation modeling approach confirms that those with more work are significantly likely to decrease antisocial behavior. Consistent with previous studies, individuals with more substance use and gang involvement are positively associated with antisocial behavior. The article concludes with a discussion of the role of employment and emerging adults.
Universal Accessible Biomarkers of Drug-Induced Tissue Injury and Systemic Inflammation in Rat: Performance Assessment of TIMP-1, A2M, AGP, NGAL, and Albumin
Authors: Vlasakova Katerina , Bourque Jennifer , Bailey Wendy J , Patel Shetal , Besteman Elizabeth G , Gonzalez Raymond J , Sistare Frank D , Glaab Warren E
Published: March 2022

The ability to monitor for general drug-induced tissue injury (DITI) or systemic inflammation in any tissue using blood-based accessible biomarkers would provide a valuable tool in early exploratory animal studies to understand potential drug liabilities. Here we describe the evaluation of 4 biomarkers of tissue remodeling and inflammation (α2-macroglobulin [A2M], α1-acid glycoprotein [AGP], neutrophil gelatinase-associated lipocalin [NGAL], and tissue inhibitor of metalloproteinases [TIMP-1]) as well as the traditional serum parameter albumin as potential blood-based biomarkers of DITI and systemic inflammatory response (SIR). Biomarker performance was assessed in 51 short-term rat in vivo studies with various end-organ toxicities or SIR and receiver operating characteristic curves were generated to compare relative performances. All 4 biomarkers performed well in their ability to detect DITI and SIR with an area under the curve (AUC) of 0.82–0.78, however TIMP-1 achieved the best sensitivity (at 95% specificity) of 61%; AGP, NGAL, and A2M sensitivity was 51%–52%. AUC for albumin was 0.72 with sensitivity of 39%. A2M was the best performer in studies with only SIR (AUC 0.91). In the subset of studies with drug-induced vascular injury, TIMP-1 performed best with an AUC of 0.96. Poor performance of all tested biomarkers was observed in samples with CNS toxicity. In summary, TIMP-1, A2M, AGP, and NGAL demonstrated performance as sensitive accessible biomarkers of DITI and SIR, supporting their potential application as universal accessible tissue toxicity biomarkers to quickly identify dose levels associated with drug-induced injury in early exploratory rat safety and other studies.
Virtual Compared With In-Clinic Transvaginal Ultrasonography for Ovarian Reserve Assessment
Authors: Chung Esther H. , Petishnok Laura C. , Conyers Jesse M. , Schimer David A. , Vitek Wendy S. , Harris Amy L. , Brown Michelle A. , Jolin Julie A. , Karmon Anatte , Styer Aaron K.
Published: March 2022

OBJECTIVE:

To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment.

METHODS:

We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority.

RESULTS:

Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19–35 years), BMI (19.5–33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met “clinical quality.” The difference of −2.4% (97.5% CI lower bound −5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI −0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3–79.0, P<.01), indicating greater satisfaction with the virtual experience.

CONCLUSION:

Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care.

FUNDING SOURCE:

This study was sponsored by Turtle Health.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04687189.
Evaluation of Surgical Morbidity After Hysterectomy During an Obesity Epidemic
Authors: Davidson Brittany A. , Weber Jeremy M. , Monuzsko Karen A. , Truong Tracy , Havrilesky Laura J. , Moss Haley A.
Published: March 2022

OBJECTIVE:

To assess 30-day outcomes for hysterectomy by body mass index (BMI) classification and estimate trends in 30-day outcomes by BMI over time.

METHODS:

This is a retrospective cohort study of patients older than age 18 years undergoing hysterectomy with data in the National Surgical Quality Improvement Program database from 2005 to 2018. Exclusions were made for ambiguous indication or route of surgery and missing values in covariates or outcomes of interest. Patient characteristics and outcomes were compared across BMI classifications. Outcomes included operative time, length of stay, and major and minor complications. Multivariable linear regression models were used for continuous outcomes, and modified Poisson regression models were used for binary outcomes. Patients with benign and malignant indications for hysterectomy were analyzed separately. Models were adjusted for age, race, hysterectomy route, hypertension, diabetes, smoking, selected preoperative laboratory values, and cancer type, if applicable.

RESULTS:

Obesity rate increased from 41.2% in 2005–2007 to 51.8% in 2018. Among 319,462 patients, minimally invasive surgery was the most common approach (58.8% vs 24.5% laparotomy vs 16.7% vaginal). Higher BMI classifications were associated with longer operative times (benign indication: average 25.0 minutes longer, 95% CI 22.1–27.9; malignant indication: average 25.1 minutes longer, 95% CI 20.8–29.4) and higher risk of complications compared with normal-weight BMIs, though operative time declined over time for patients with malignant surgical indications. Relative to normal-weight patients, rates of major complications did not increase until a BMI of 40 for hysterectomy for benign indications and 50 for hysterectomy for malignant indications.

CONCLUSION:

Operative times and complications both increase with obesity when performing hysterectomy. Knowledge of evolving risk level at various weight subclassifications can improve shared decision making preoperatively.
Introduction to Machine Learning in Obstetrics and Gynecology
Authors: Shazly Sherif A. , Trabuco Emanuel C. , Ngufor Che G. , Famuyide Abimbola O.
Published: March 2022

In the digital age of the 21st century, we have witnessed an explosion in data matched by remarkable progress in the field of computer science and engineering, with the development of powerful and portable artificial intelligence–powered technologies. At the same time, global connectivity powered by mobile technology has led to an increasing number of connected users and connected devices. In just the past 5 years, the convergence of these technologies in obstetrics and gynecology has resulted in the development of innovative artificial intelligence–powered digital health devices that allow easy and accurate patient risk stratification for an array of conditions spanning early pregnancy, labor and delivery, and care of the newborn. Yet, breakthroughs in artificial intelligence and other new and emerging technologies currently have a slow adoption rate in medicine, despite the availability of large data sets that include individual electronic health records spanning years of care, genomics, and the microbiome. As a result, patient interactions with health care remain burdened by antiquated processes that are inefficient and inconvenient. A few health care institutions have recognized these gaps and, with an influx of venture capital investments, are now making in-roads in medical practice with digital products driven by artificial intelligence algorithms. In this article, we trace the history, applications, and ethical challenges of the artificial intelligence that will be at the forefront of digitally transforming obstetrics and gynecology and medical practice in general.
Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse
Authors: Gerjevic Kristen A. , Newton Helen , Leggett Christopher , Skinner Jonathan , Erekson Elisabeth , Strohbehn Kris
Published: March 2022

OBJECTIVE:

To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries.

METHODS:

We conducted a retrospective, cross-sectional study and used 100% Medicare fee-for-service claims to identify a cohort of women aged 65–99 years who had an apical support procedure, defined by Current Procedural Terminology codes, in 2016–2018. We included all vaginal and abdominal approaches (native tissue and mesh colpopexies) and obliterative procedures. We excluded vaginectomies with a diagnosis of gynecologic cancer that did not have a diagnosis for prolapse. We created rates of apical POP procedures by hospital referral region and computed coefficients of variation to measure the degree of geographic variation.

RESULTS:

An average of 26,005 apical POP procedures were performed annually from 2016 to 2018. The majority of patients were aged 65–74 years (64.3%), and 28.5% had concomitant hysterectomy. From 2016 to 2018, there was a mean of 1.79 apical POP procedures per 1,000 female beneficiaries performed across hospital referral regions (95% CI 1.74–1.84). Rate estimates ranged between 0.87 (95% CI 0.63–1.11) apical POP procedures per 1,000 female beneficiaries (Alexandria, Louisiana) and 3.33 (95% CI 2.91–3.74) per 1,000 beneficiaries (Akron, Ohio), a nearly fourfold difference in rates. Variation between hospital referral regions for abdominal apical prolapse procedures was the greatest (coefficient of variation 0.52). Vaginal and obliterative approaches demonstrated less variation between hospital referral regions (respectively, coefficient of variation 0.36 and 0.40).

CONCLUSION:

There is wide geographic variation among hospital referral regions for the treatment of POP. Women may be treated differently based on where they live and seek care, which raises questions about possible overuse in some regions and concerns about underuse and lack of access in other regions.
Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention
Authors: Groves Allison K. , Vadaketh Jessica , Raziano Valerie T. , Nkwihoreze Hervette , Short William R. , Momplaisir Florence
Published: March 2022

OBJECTIVE:

To understand perspectives on and preferences for preexposure prophylaxis (PrEP) for pregnant individuals who are at risk for human immunodeficiency virus (HIV) infection.

METHODS:

In this qualitative study, we purposively sampled and conducted in-depth interviews with pregnant participants at risk of HIV infection (indicated by a recent sexually transmitted infection [STI]) from a U.S. urban obstetrics clinic. Interview questions focused on perceived HIV risk, knowledge and perceptions of PrEP, and preferences for different PrEP formulations. We coded data using deductive and inductive codes, created matrices to explore patterns in findings, and wrote memos to interpret emergent themes.

RESULTS:

Twenty patients were enrolled. Median age of the participants was 24 years (interquartile range 19–26 years), 95.0% were African American, 65.0% were high school graduates, and 70.0% had unplanned pregnancies. Participants had low knowledge of PrEP and most saw themselves at low to no risk of HIV acquisition, despite their recent STI. Further, participants' low HIV risk perception and medication safety concerns reduced PrEP acceptability. Moreover, very few had discussed PrEP with their obstetrician–gynecologists (ob-gyns) during antenatal care, which further affected perceived acceptability. However, participants who did discuss PrEP with their ob-gyns had favorable perceptions of it. These participants indicated that they would choose a formulation based on individual preferences, which were largely shaped by perceived ease of use, acceptability, and prior experience with other medication regimens.

CONCLUSION:

Obstetrician–gynecologists may play an important role in increasing pregnant individuals’ knowledge of and access to PrEP during pregnancy among those who are at risk of HIV acquisition. To maximize uptake and adherence during this time, PrEP formulations should be tailored to individual preferences. Prevention of HIV during this critical life transition is important not only for the long-term health and well-being of pregnant individuals and their infants, but to the plan to end the HIV epidemic in the United States by 2030.
Educational Multimedia Tool Compared With Routine Care for the Uptake of Postpartum Long-Acting Reversible Contraception in Individuals With High-Risk Pregnancies
Authors: Qureshey Emma J. , Chauhan Suneet P. , Wagner Stephen M. , Batiste Oliver , Chen Han-Yang , Ashimi Sunbola , Ross Patti Jayne , Blackwell Sean C. , Sibai Baha M.
Published: March 2022

OBJECTIVE:

To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies.

METHODS:

In this single-center randomized trial, we assigned individuals aged 13–50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3–5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated.

RESULTS:

From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome—available for more than 90% of participants—was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09–2.21; NNT nine, with 95% CI 5–42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03–1.32).

CONCLUSION:

Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04291040.

FUNDING SOURCE:

Funded in part by Investigator-Initiated studies of Organon.
The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury: a retrospective comparative cohort study
Authors: Stevens Trent T. , Hartline Jacob T. , Brolin Tyler J. , Bernholt David L. , Dibaba Daniel T. , Azar Frederick M. , Throckmorton Thomas W.
Published: March 2022

Background:

The purpose of this study was to evaluate the role of initial assessment of acute subacromial injury by an orthopaedic surgeon to identify surgical lesions that would benefit from early imaging.

Methods:

Patients with subacromial injury were identified. Patients who had MRI ordered at the initial visit for suspicion of a surgical lesion comprised the study group. The remaining patients were treated conservatively.

Results:

A total of 367 patients were identified; 298 (81%) underwent conservative treatment, 84 of whom had later MRI, and 69 (19%) had an MRI ordered initially. In the early MRI group, 31 (44.9%) underwent surgery an average of 85 days from presentation compared to 38 (12.8%) in the conservative group who underwent surgery 140 days from presentation (P=0.019). MRI scan review revealed that 41/69 (59.4%) patients in the early MRI group had full-thickness rotator cuff tear compared with 33/84 (39.3%) in the conservative group with MRI (P=0.020). Partial-thickness tears were noted in 8/69 (11.6%) in the early MRI group. In the conservative group that subsequently had MRI, 17/84 (20.2%) had a partial-thickness tear.

Conclusions:

Nearly 60% of patients undergoing initial MRI based on orthopaedic surgeon judgment had a full-thickness rotator cuff tear, significantly more than patients treated conservatively upon initial evaluation. Patients who first undergo conservative treatment for suspected acute subacromial injury experience a significant delay both in MRI and surgical intervention. Surgeon judgment is an important factor in the decision to obtain MRI in acute subacromial injury to prevent delays in care.

Level of Evidence:

Level III.
The utilization of tranexamic acid in orthopaedic procedures and gap in research for its benefits conferred in hip arthroscopy: a literature review
Authors: Tuluca Andrei , Crespi Zachary , Krebs Nathan
Published: March 2022

Tranexamic acid (TXA) is a commonly used drug that has many uses within multiple medical fields. Within orthopedics, TXA has been used heavily because of the benefits it confers for reducing perioperative bleeding and preventing reductions in hemoglobin/hematocrit. However, despite these advantages, no set indications for the use of TXA have been defined. The authors performed a literature review assessing current literature for TXA use in knee arthroscopy, shoulder arthroscopy, and hip arthroscopy. Articles were searched in Google Scholar using a combination of keywords including, “tranexamic acid,” “arthroscopy,” “arthroplasty,” “hip,” “knee,” and “shoulder.” The authors reviewed 17 articles that were current and relevant to the use of TXA in arthroscopic procedures based on a focus-grouped discussion. The use of TXA for arthroscopic procedures is growing in both clinical orthopaedic practice and the literature. Although numerous benefits have been noted in knee arthroscopy and shoulder arthroscopy, a paucity of literature on TXA effects in hip arthroscopy still exists, and the topic warrants exploration.
The roaring 2020s: a new decade of systemic therapy for renal cell carcinoma
Authors: Srivastava Arnav , Doppalapudi Sai K. , Patel Hiren V. , Srinivasan Ramaprasad , Singer Eric A.
Published: March 2022

Purpose of review

The genomic and immunologic profiling of renal cell carcinoma (RCC) has provided the impetus for advancements in systemic treatments using combination therapy – either with immune check point inhibitor (ICI) + ICI or with ICI + targeted therapy. This approach has been examined in several landmark trials, treating both clear cell (ccRCC) and nonclear cell (nccRCC) histologies. In this review, we highlight systemic therapy advancements made in this new decade, the 2020s.

Recent findings

Targeting the programmed death receptor 1/PD-L1 pathway has created more tolerable and effective immunotherapy regimens, expanding the applications of ICIs. These new applications, paired with trial data, include ICI monotherapy in nccRCC and adjuvant pembrolizumab in resected, high-risk RCC. In addition, ICI + ICI and ICI + TKI combination therapy have demonstrated oncologic efficacy in advanced ccRCC and sarcomatoid RCC. Similar progress has been noted regarding new targeted therapies. Along the hypoxia inducible factor pathway, belzutifan has received FDA approval in von Hippel-Lindau-associated RCC. In addition, in papillary RCC, agents such as cabozantinib target the MET proto-oncogene pathway and have demonstrated impressive oncologic outcomes.

The 2020s utilize the molecular profiling of advanced RCC as a scaffold for recent trials in immunotherapy and targeted therapies. Going forward, emphasizing patient-reported outcomes and careful clinical trial construction remain critical to improve systemic therapy in RCC.
ASSOCIATION OF PLASMA ω-3 FATTY ACIDS WITH EARLY AGE-RELATED MACULAR DEGENERATION IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS
Authors: Karger Amy B. , Guan Weihua , Nomura Sarah O. , Weir Natalie L. , Klein Barbara E.K. , Burke Gregory L. , Johnson W. Craig , Tsai Michael Y.
Published: March 2022

Purpose:

To examine the association between omega-3 polyunsaturated fatty acids, docosahexaenoic acid, and eicosapentaenoic acid and age-related macular degeneration (AMD) in the Multi-Ethnic Study of Atherosclerosis cohort.

Methods:

Multi-Ethnic Study of Atherosclerosis is a multicenter, prospective cohort study designed to identify risk factors for cardiovascular disease in four ethnic groups. Six thousand eight hundred and fourteen participants of White, African American, Hispanic/Latino, and Chinese descent, aged 45–84 years, were recruited, with those found to have cardiovascular disease excluded. Our study population included all Multi-Ethnic Study of Atherosclerosis participants with baseline polyunsaturated fatty acid measurements and retinal photography at Examination 5 (n = 3,772). Fundus photographs were assessed for AMD using a standard grading protocol. Relative risk regression (log link) determined associations between polyunsaturated fatty acid levels and AMD.

Results:

There was a significant association between increasing docosahexaenoic acid levels and increasing docosahexaenoic acid + eicosapentaenoic acid levels with reduced risk for early AMD (n = 214 participants with early AMD, of which n = 99 (46.3%) are non-White). Eicosapentaenoic acid levels alone were not significantly associated with AMD.

Conclusion:

Our analysis suggests increasing levels of docosahexaenoic acid are associated with reduced risk for early AMD in a multiethnic cohort. This represents the first racially diverse study demonstrating an association between omega-3 polyunsaturated fatty acids and AMD risk.
Development of the Port Delivery System with ranibizumab for neovascular age-related macular degeneration
Authors: Adamis Anthony P. , de Juan Eugene
Published: March 2022

Purpose of review

This review provides background on the remaining unmet needs with antivascular endothelial growth factor (VEGF) therapies for the treatment of neovascular age-related macular degeneration (nAMD). We also discuss the developmental story of the Port Delivery System with ranibizumab (PDS; SUSVIMO, Genentech, Inc., South San Francisco, CA, USA).

Recent findings

Real-world studies have shown that undertreatment is a major reason for continued vision loss in the anti-VEGF era. As a result, there is a need for long-acting anti-VEGF treatment options for patients with nAMD, diabetic macular edema, and other retinal diseases. The PDS is a solid state, refillable, intraocular long-acting drug delivery system that continuously delivers a customized formulation of ranibizumab into the vitreous for 6 months. In a phase 3 trial, the PDS showed equivalent visual acuity improvements with monthly ranibizumab injections in patients with nAMD and adverse events associated with the PDS were well understood and manageable.

The PDS is the first US Food and Drug Administration-approved treatment for nAMD that provides continuous delivery of an anti-VEGF molecule. The PDS offers a unique drug delivery system that has the potential to serve as a platform to be used with other molecules in the future.
The moderating effect of personality traits on acute tinnitus sensation in idiopathic sudden sensorineural hearing loss
Authors: Huang Chii-Yuan , Cheng Yen-Fu , Yang Albert C , Lin Chia-Ju , Ieong Pak-In , Hsueh Chien-Yu
Published: March 2022

Background:

People may experience tinnitus after sudden hearing impairment. The details of the relationship between tinnitus improvement and hearing recovery are still unclear. Personality traits may play a role in the modulation of tinnitus sensation. We investigated the moderating effect of personality traits on pretreatment and posttreatment tinnitus sensation in patients with idiopathic sudden sensorineural hearing loss (ISSHL).

Methods:

This prospective longitudinal study enrolled 33 patients diagnosed with unilateral ISSHL and acute tinnitus in 2018-2019 at one institute. Clinical data were collected before and after treatment, including results of pure-tone audiometry (PTA), the Clinical Tinnitus Questionnaire (CTQ), the Tinnitus Handicap Inventory (THI), tinnitus loudness and annoyance (Visual Analog Scale; VAS), the Hospital Anxiety and Depression Scale (HADS), and the Big Five Inventory (BFI)-44.

Results:

Eighteen men and 15 women with an average age of 48.3 ± 15.8 years were enrolled. The pretreatment hearing threshold and THI score were 58.0 ± 27.4 dB HL and 42.9 ± 26.2 (range: 0-88), respectively; the posttreatment values were 39.8 ± 22.4 dB HL and 20.7 ± 22.5 (range: 0-64), respectively. There were significant differences between pretreatment and posttreatment hearing thresholds as well as THI, VAS, and HADS scores (p < 0.001) but not BFI-44 results. Neuroticism and openness had significant positive and negative correlations, respectively, with acute tinnitus stress before treatment (r = 0.561, p = 0.001; r = −0.359, p = 0.040). After 3 months of follow-up, all patients were analyzed separately by dividing them into recovery (n = 16) and nonrecovery groups (n = 14) according to their hearing improvement status by Siegel’s criteria. Neuroticism showed a significant moderating effect on acute tinnitus sensation in the ISSHL recovery group (p < 0.001) but not in the nonrecovery group (p = 0.106).

Conclusion:

Neuroticism and openness may affect acute tinnitus stress in ISSHL patients. Practitioners should consider personality traits when managing ISSHL patients with bothersome tinnitus.
Forensic Mental Health Nurses’ Experiences of Clinical Supervision
Authors: Newman Claire , Eason Michelle , Kinghorn Grant
Published: March 2022

Background

Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges.

Aim

The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program.

Methods

Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program.

Findings

Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise.

Conclusion

Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development.

Implications for Clinical Forensic Nursing Practice

To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.
Using Telehealth Technology to Serve Patients Reporting Sexual Assault
Authors: Shaw Jessica , Feeney Hannah , Meunier-Sham Joan , Petricone Randi , Preiss Rachel M.
Published: March 2022

Many communities across the country are developing, implementing, or already operating programs that provide patients with access to sexual assault nurse examiner (SANE) expertise and care through telehealth technology (e.g., teleSANE or teleSAFE). The speed at which teleSANE programs are proliferating is outpacing the available research and evaluation to inform key decisions on program development and implementation. During the height of the COVID-19 pandemic, the Massachusetts Department of Public Health SANE Program and its National TeleNursing Center decided to rapidly and temporarily convert a set of hospitals from providing in-person SANE care to remote teleSANE care. Several specific changes were made to this program's established teleSANE model for the rapid, temporary conversion. This article reports on findings from an evaluation of the temporary TeleSANE model that provide insight into key decisions that must be made in the development and implementation of teleSANE program features. Communities considering developing or already operating a teleSANE program should be intentional in making program goals, purposes, and values explicit as well as develop their program accordingly.
Improving Access to Postassault Healthcare for College Students: Creating a Campus-Based Sexual Assault Nurse Examiner Program
Authors: Campbell Rebecca , Markowitz Jenifer , Fedewa Tana , Shareef Sameerah , Fenton Danielle , Southard Kimmins
Published: March 2022

National prevalence data indicate that college students are at a high risk for sexual assault, but most institutions of higher education do not provide postassault medical forensic examinations as part of student-facing healthcare services. College sexual assault patients might have access to sexual assault nurse examiners (SANEs) in local hospitals, if they are available where they are attending school, but unfortunately, many student victims do not have options for postassault health services. Creating campus-based SANE programs could address this gap in services and increase access to healthcare. In this article, we describe how we created a free-standing, campus-based SANE program at Michigan State University. We worked with a multidisciplinary community advisory board to identify core guiding principles to inform stakeholder engagement, program location decisions, program policies, training protocols, staffing plans, and collaborative partnerships with other disciplines (e.g., advocacy, law enforcement, prosecution, forensic sciences). We discuss how we navigated opening the program in the midst of the global COVID-19 pandemic and share lessons learned for creating campus-based SANE programs.
Network meta-analysis: efficacy of treatment for acute, chronic, and prevention of pouchitis in ulcerative colitis
Authors: Poo Stephanie , Sriranganathan Danujan , Segal Jonathan P
Published: March 2022

Introduction

Pouchitis is a clinically significant complication of ileal pouch-anal anastomosis. There is a paucity of head-to-head comparisons between treatments and no data were available about how each treatment rank against each other. A network meta-analysis of the different treatments used for acute, chronic and prevention of pouchitis was conducted.

Methods

Biomedical databases and the Cochrane Central registry were searched between 1978 and 2021 for randomised controlled trials examining treatment for acute, chronic and prevention of pouchitis. A network meta-analysis was performed using the frequentist model with pooled relative risks and P scores used to rank treatments.

Results

18 studies were included from a screen of 4291 abstracts. When compared to placebo, rifaximin was found to be the best antibiotic for acute pouchitis whereas ciprofloxacin ranked highest against metronidazole. For chronic pouchitis, metronidazole followed by probiotics was statistically significant and effective treatments in inducing remission although metronidazole had the highest adverse events. Adalimumab and bismuth were also found to be superior to placebo; however, they did not reach statistical significance. Probiotics proved superior to placebo in the prevention of pouchitis development.

Conclusions

This is the first network meta-analysis which compares the efficacy and tolerability of treatments in the management and prevention of acute and chronic pouchitis. It confirms that antimicrobial therapy remains the mainstay of treatment and adds weight to current guideline recommendations. Our results demonstrate that rifaximin and probiotics may deserve a more prominent role. While biologics are starting to show promise, large-scale head-to-head comparisons are warranted to validate the efficacy of these treatments.
New therapeutics for primary hyperoxaluria type 1
Authors: Dejban Pegah , Lieske John C.
Published: March 2022

Purpose of review

Primary hyperoxaluria type 1 (PH1) is a rare genetic disorder that causes hepatic overproduction of oxalate and, often, nephrocalcinosis, nephrolithiasis, chronic kidney disease, and kidney failure. The purpose of the review is to provide an update on current emerging therapies for the treatment of PH1.

Recent findings

Use of ribonucleic acid interference (RNAi) therapeutics that target the liver to block production of key enzymes along pathways that generate oxalate is a promising approach. Available evidence supports the efficacy of both Lumasiran (targeting glycolate oxidase) and Nedosiran (targeting hepatic lactate dehydrogenase (LDHa)) to reduce urinary oxalate excretion in PH1. The efficacy of alternative approaches including stiripentol (an anticonvulsant drug that also targets LDHa), lanthanum (a potential gastrointestinal oxalate binder), and Oxalobacter formigenes (a bacterium that can degrade oxalate within the gastrointestinal tract and may also increase its secretion from blood) are all also under study. Genetic editing tools including clustered regularly interspaced short palindromic repeats/Cas9 are also in preclinical study as a potential PH1 therapeutic.

Novel treatments can reduce the plasma oxalate concentration and urinary oxalate excretion in PH1 patients. Thus, it is possible these approaches will reduce the need for combined kidney and liver transplantation to significantly decrease the morbidity and mortality of affected patients.