bluuebunny/crossref_metadata_2025 huggingface dataset:
Provision of NICE-recommended varicose vein treatment in the NHS
Authors: Hitchman Louise H , Mohamed Abduraheem , Smith George E , Pymer Sean , Chetter Ian C , Forsyth James , Carradice Daniel
Published: November 2022

Background

Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins. In the National Health Service (NHS) in England, commissioning of care for people with varicose veins is performed by Clinical Commissioning Groups (CCGs) and clinical guidelines have been developed by the National Institute for Health and Care Excellence (NICE CG168). The Evidence-Based Intervention (EBI) programme was introduced in the NHS with the aim of improving care quality and supporting implementation of NICE CG168. The aim of this study was to assess access to varicose vein treatments in the NHS and the impact of EBI.

Methods

CCG policies for the delivery of varicose vein treatments in the NHS in England were obtained from 2017 (before EBI introduction) and 2019 (after EBI introduction) and categorized by two independent reviewers into levels of compliance with NICE CG168. Hospital Episode Statistics data were compared with the NICE commissioning model predictions. A quality-adjusted life-year was valued at £20 000 (Euro 23 000 15 November 2022).

Results

Despite the introduction of the EBI programme, CCG compliance with NICE CG168 fell from 34.0 per cent (64 of 191) to 29.0 per cent (55 of 191). Some 33.0 per cent of CCG policies (63 of 191) became less compliant and only 7.3 per cent (14 of 191) changed to become fully compliant. Overall, 66.5 per cent of CCGs (127 of 191) provided less than the recommended intervention rate before EBI and this increased to 73.3 per cent (140 of191) after EBI. The overall proportion of patients estimated to require treatment annually who received treatment fell from 44.0 to 37.0 per cent. The associated estimated loss in net health benefit was between £164 and 174 million (Euro 188 million and 199 million 15 November 2022) over 3 years. A compliant policy was associated with a higher intervention rate; however, commissioning policy was associated with only 16.8 per cent of the variation in intervention rate (R2 = 0.168, P < 0.001).

Conclusion

Many local varicose vein commissioning policies in the NHS are not compliant with NICE CG168. More than half of patients who should be offered varicose vein treatment are not receiving it, and there is widespread geographical variation. The EBI programme has not been associated with any improvement in commissioning or access to varicose vein treatment.
The RAGE/DIAPH1 axis: mediator of obesity and proposed biomarker of human cardiometabolic disease
Authors: Arivazhagan Lakshmi , Popp Collin J , Ruiz Henry H , Wilson Robin A , Manigrasso Michaele B , Shekhtman Alexander , Ramasamy Ravichandran , Sevick Mary Ann , Schmidt Ann Marie
Published: November 2022

Overweight and obesity are leading causes of cardiometabolic dysfunction. Despite extensive investigation, the mechanisms mediating the increase in these conditions are yet to be fully understood. Beyond the endogenous formation of advanced glycation endproducts (AGEs) in overweight and obesity, exogenous sources of AGEs accrue through the heating, production, and consumption of highly processed foods. Evidence from cellular and mouse model systems indicates that the interaction of AGEs with their central cell surface receptor for AGE (RAGE) in adipocytes suppresses energy expenditure and that AGE/RAGE contributes to increased adipose inflammation and processes linked to insulin resistance. In human subjects, the circulating soluble forms of RAGE, which are mutable, may serve as biomarkers of obesity and weight loss. Antagonists of RAGE signalling, through blockade of the interaction of the RAGE cytoplasmic domain with the formin, Diaphanous-1 (DIAPH1), target aberrant RAGE activities in metabolic tissues. This review focuses on the potential roles for AGEs and other RAGE ligands and RAGE/DIAPH1 in the pathogenesis of overweight and obesity and their metabolic consequences.
Uncomfortable yet necessary: The impact of PPE on communication in emergency medicine
Authors: Aengst Jennifer , Walker-Stevenson Grace , Harrod Tabria , Ivankovic Jonathan , Neilson Jacob , Guise Jeanne-Marie
Published: November 2022

Background

The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team and also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of personal protective equipment (PPE).

Objective

We sought to analyze the impacts of the COVID-19 pandemic on emergency medical service (EMS) workers and pre-hospital care delivery.

Methods

We conducted focus groups and one-on-one interviews with fire-based EMS first responders between September 2021 and 2022. Interviews included questions about job-related stress, EMS skills, work experiences and changes during COVID-19. Interviews were recorded, independently dual coded and analyzed for themes.

Results

Two hundred twenty-three first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of PPE was reported to have significantly impaired efficiency and perceptions of quality of care—among EMS team members and also between EMS workers and patients. EMS personnels also experienced on-scene hostility on arrival (from both families and other agencies). Extensive use of PPE muffles voices, obscures facial expressions and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone’s shoulder, wearing name tags on suits and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients.

Conclusion

Human connection is an important element of health-care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full-body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider–patient interactions in pre-hospital EMS. Additionally, ‘communication-friendly’ adaptations of PPE equipment may be an important area for future research and development in manufacturing and the health-care industry.
Antibody-Based Methods Reveal the Protein Expression Properties of Glucosinolate Sulfatase 1 and 2 in Plutella xylostella
Authors: Xiong Yu , Jiang Chaoyang , Amir Muhammad Bilal , Dong Yuhong , Xie Lianjie , Liao Yuan , He Weiyi , Lu Zhanjun , Chen Wei
Published: November 2022

The glucosinolates (GLs) and myrosinase defensive systems in cruciferous plants were circumvented by Plutella xylostella using glucosinolate sulfatases (PxGSSs) during pest-plant interaction. Despite identifying three duplicated GSS-encoding genes in P. xylostella, limited information regarding their spatiotemporal and induced expression is available. Here, we investigated the tissue- and stage-specific expression and induction in response to GLs of PxGSS1 and PxGSS2 (PxGSS1/2) at the protein level, which shares a high degree of similarity in protein sequences. Western blotting (WB) analysis showed that PxGSS1/2 exhibited a higher protein level in mature larvae, their guts, and gut content. A significantly high protein and transcript levels of PxGSS1/2 were also detected in the salivary glands using WB and qRT-PCR. The immunofluorescence (IF) and immunohistochemistry (IHC) results confirmed that PxGSS1/2 is widely expressed in the larval body. The IHC was more appropriate than IF when autofluorescence interference was present in collected samples. Furthermore, the content of PxGSS1/2 did not change significantly under treatments of GL mixture from Arabidopsis thaliana ecotype Col-0, or commercial ally (sinigrin), 4-(methylsulfinyl)butyl, 3-(methylsulfinyl)propyl, and indol-3-ylmethyl GLs indicating that the major GLs from leaves of A. thaliana Col-0 failed to induce the expression of proteins for both PxGSS1 and PxGSS2. Our study systemically characterized the expression properties of PxGSS1/2 at the protein level, which improves our understanding of PxGSS1/2-center adaptation in P. xylostella during long-term insect-plant interaction.
The Visible Cash Effect with Prepaid Incentives: Evidence for Data Quality, Response Rates, Generalizability, and Cost
Authors: DeBell Matthew
Published: November 2022

A prior study found that mailing prepaid incentives with $5 cash visible from outside the envelope increased the response rate to a mail survey by 4 percentage points compared to cash that was not externally visible. This “visible cash effect” suggests opportunities to improve survey response at little or no cost, but many unknowns remain. Among them: Does the visible cash effect generalize to different survey modes, respondent burdens, and cash amounts? Does it differ between fresh samples and reinterview samples? Does it affect data quality or survey costs? This article examines these questions using two linked studies where incentive visibility was randomized in a large probability sample for the American National Election Studies. The first study used $10 incentives with invitations to a long web questionnaire (median 71 minutes, n = 17,849). Visible cash increased response rates in a fresh sample for both screener and extended interview response (by 6.7 and 4.8 percentage points, respectively). Visible cash did not increase the response rate in a reinterview sample where the baseline reinterview response rate was very high (72 percent). The second study used $5 incentives with invitations to a mail-back paper questionnaire (n = 8,000). Visible cash increased the response rate in a sample of prior nonrespondents by 4.0 percentage points (from 31.5 to 35.5), but it did not increase the response rate in a reinterview sample where the baseline reinterview rate was very high (84 percent). In the two studies, several aspects of data quality were investigated, including speeding, non-differentiation, item nonresponse, nonserious responses, noncredible responses, sample composition, and predictive validity; no adverse effects of visible cash were detected, and sample composition improved marginally. Effects on survey costs were either negligible or resulted in net savings. Accumulated evidence now shows that visible cash can increase incentives’ effectiveness in several circumstances.
Judging the Law of the Sea
Authors: Klein Natalie , Parlett Kate
Published: November 2022

Judging the Law of the Sea focuses on how the law of the sea is being developed through cases by judges interpreting and applying the UN Convention on the Law of the Sea (UNCLOS). The cases have not only progressively refined the parameters for the exercise of compulsory jurisdiction under UNCLOS, but also steadily contributed to the interpretation and application of substantive rights and obligations in the law of the sea. The book details considerations relating to jurisdiction over and admissibility of disputes under UNCLOS. It further assesses the substantive law of the sea that has been addressed during UNCLOS dispute settlement. These issues extend to questions about maritime space, maritime boundary delimitation, rights of navigation, fisheries, and the protection of the marine environment. The book provides an intensive study of the decisions to date and assesses how those decisions have influenced and will continue to influence the law of the sea in the future. Judging the Law of the Sea also contemplates what role any judge could or should play in reaching decisions to resolve critical international disputes.
Maritime Boundary Delimitation
Authors: Klein Natalie , Parlett Kate
Published: November 2022

The adjudication of maritime boundary delimitations has occurred through dispute settlement procedures available in the UN Convention on the Law of the Sea (UNCLOS) as well as by other agreements to refer disputes to the International Court of Justice or arbitration. Judicial discussion on the method of boundary delimitation as well as the relevant considerations in drawing a boundary is examined in this chapter. The chapter considers the delimitation of the territorial sea, as well as the delimitation of overlapping entitlements to the exclusive economic zone and continental shelf. More recent cases have also prompted judicial decisions on the delimitation of the outer continental shelf. The final part of the chapter examines cases that have assessed requirements relating to the establishment of provisional arrangements pending the delimitation of maritime boundaries.
Marine Environment
Authors: Klein Natalie , Parlett Kate
Published: November 2022

This chapter examines cases arising under the UN Convention on the Law of the Sea (UNCLOS) that relate to the marine environment. It assesses judicial decisions on the core obligation to protect and preserve the marine environment and its application to all maritime zones and the types of activities that are implicated in that obligation, such as island-building, habitat destruction, and transporting and processing during deep seabed mining. The chapter also addresses cases concerned with obligations to protect the marine environment from pollution, the conservation of marine living resources and the protection of the deep seabed (Area). The chapter further reflects on judicial discourse pertaining to the duty to cooperate, environmental impact assessments and the precautionary approach. Safeguards against the enforcement of environmental requirements have received some judicial consideration and are examined in the chapter. Finally, the relevance of due diligence standards in disputes concerning the protection and preservation of the marine environment is canvassed.
Judging the Law of the Sea
Authors: Klein Natalie , Parlett Kate
Published: November 2022

The concluding chapter of Judging the Law of the Sea seeks to summarise the main findings on jurisdiction for the compulsory resolution of disputes under the UN Convention on the Law of the Sea (UNCLOS). It also summarises the central conclusions that have emerged from judicial consideration of maritime space, maritime boundary delimitation, navigation, fisheries, and the protection of the marine environments. This chapter also revisits the role of the judge in light of the analysis set out in Judging the Law of the Sea. The significant roles played by international judges are acknowledged, while still noting that international judges are one of many actors that make decisions contributing to the public order of the oceans. It concludes that UNCLOS dispute settlement continues to play an important role in elaborating on international obligations in UNCLOS and setting future expectations on ocean governance.
iMAPping the Perturb-Atlas
Authors: Sun Yiwen , Lin Wenyang , Kaundal Ravinder , Chi Tian
Published: November 2022

A key objective of the research in the postgenomic era is to decipher the functions of the mammalian genome, which has remained largely enigmatic despite intensive efforts in the functional genomics field over the past two decades. To attack this problem, we have combined the CRISPR-Cas and Cre-Lox technologies to develop iMAP (inducible Mosaic Animal for Perturbation), a transformative tool for rapidly unraveling mammalian genome function in situ. Furthermore, we have used iMAP to rapidly construct a “Perturb-Atlas” profiling the functions of 90 protein-coding genes across 39 tissues in mice, which has offered rich insights into gene functions difficult to readily obtain using conventional mouse gene-targeting models. In this research highlight, we offer a brief primer on the iMAP technology, outlining its mechanism, strengths and limitations, and pointing out future directions of research in the area.
The Serious Side of Supplements: An Ischemic Stroke in a Healthy 38-year-old Female
Authors: Pence Sierra T , Mehta Ketan , Crum-Bailey Jennifer
Published: November 2022

The incidence of ischemic stroke in the young is on the rise. With young stroke victims, providers must consider both typical risk factors and other rare causes. We present a case of a healthy, 38-year-old female military dependent who presented with an ischemic right posterior central gyrus stroke in the setting of a patent foramen ovale and supplement diindolylmethane use. This case serves as a reminder of the hazards associated with supplement use and the importance of a thorough investigation of etiology in medical cases of ischemic stroke in the young.
Correction performance uniformity on ground-layer adaptive optics
Authors: Yang Ying , Zhang Lanqiang , Rao Changhui
Published: November 2022

Ground-layer adaptive optics (GLAO) is generally used to improve the seeing for large-aperture ground-based optical telescopes across a wide field of view with uniform imaging quality. In this paper, a new criterion, which is defined as the weighted sum of the mean and mean-square-error values of the full width at half-maximum of the field-dependent point spread function of the image over the whole field of view, is proposed to evaluate GLAO performance uniformity. An analytic model of the GLAO-corrected point spread function based on spatial filtering methods is used to investigate the uniformity and image quality over the whole field of view for different guide-star layouts, telescope apertures, numbers of actuators for the deformable mirror, and turbulence profiles. Simulations are performed on the GLAO configurations for the 1-m New Vacuum Solar Telescope at Fuxian Solar Observatory. The results show that, compared with that of the classical evaluation, the correction uniformity improves by 63 per cent, with the resolution sacrificing only 5 per cent for a measured turbulence profile at Fuxian Solar Observatory. Furthermore, this criterion is applied to various requirements, and some critical system parameters are suggested for the wide field-of-view GLAO.
Expanding antiviral therapy indications for HBeAg-negative chronic hepatitis B patients with normal ALT and positive HBV DNA
Authors: Zhou Jing , Wang Fada , Li Lanqing , Chen Enqiang
Published: November 2022

With the improved efficacy and accessibility of antiviral agents as well as the concerns about disease progression, there is a hot discussion on whether HBeAg-negative chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) and positive HBV DNA should be treated. According to the international guidelines on the stages of the natural history of HBV infection, HBeAg-negative CHB patients with normal ALT and positive HBV DNA can be divided into two groups: one is the well-known “inactive carrier phase”, which is defined as serum HBV DNA < 2000 IU/ml and no significant liver inflammation; and the other is the “indeterminate phase”, which is defined as serum HBV DNA ≥ 2000 IU/mL regardless of the pathological changes in liver tissue, or HBV DNA < 2000 IU/mL but accompanied by significant pathological changes in the liver. In this minireview, we will expound the disease characteristics, disease progression, and clinical management status of these two groups. Based on the analysis, we propose that HBeAg-negative patients with normal ALT but detectable serum HBV DNA should be treated, regardless of their age, family history of hepatocellular carcinoma (HCC) or the severity of liver necroinflammation. Expanding the indications of antiviral therapy will help improve the survival and quality of life of patients by preventing disease progression, and consequently reduce the risk of HCC development.
The mutual history of Schlegel’s Japanese gecko (Reptilia: Squamata: Gekkonidae) and humans inscribed in genes and ancient literature
Authors: Chiba Minoru , Hirano Takahiro , Yamazaki Daishi , Ye Bin , Ito Shun , Kagawa Osamu , Endo Komei , Nishida Shu , Hara Seiji , Aratake Kenichiro , Chiba Satoshi
Published: November 2022

Knowing how the present distribution of organisms was formed is an essential issue in evolutionary ecology. Recently, the distribution of organisms on Earth has been significantly changed by human-mediated dispersal due to globalization. Therefore, significant attention has been paid to such processes. However, although humankind has taken considerable time to achieve modernization, the impact of ancient human activity on ecosystems has not yet been thoroughly studied. We hypothesized that ancient urban development and transitions had a non-negligible effect on species distribution. Inferring the impact of past human activity on ecosystems from ancient literature and verifying that impact by genetic analysis and human history is an effective means of tackling this problem. As geckos, a popular neighbor of human dwellings, are good material for this model, we performed this combination approach using Schlegel’s Japanese gecko, Gekko japonicus. We show that G. japonicus migrated from China to the western Japanese archipelago before Christ. The gecko species dispersed itself from western to eastern the archipelago on a time scale of thousands of years. There are many synchronizations between the dispersal history of G. japonicus and the historical development of human society. It is suggested by such synchronizations that humans have influenced the distribution of G. japonicus many times throughout its dispersal history.
Do Nonfinancial Firms Use Financial Assets to Take Risk?
Authors: Chen Zhiyao , Duchin Ran
Published: November 2022

Using hand-collected data on financial asset portfolios and exploiting the 2014 oil price crisis as an exogenous cash flow shock, we investigate financial risk-taking at distressed firms. We find that distressed firms, with high debt rollover risk proxied for by short-term liabilities, substantially increase their investments in risky financial assets, including corporate debt, equity, and mortgage-backed securities. The effects are stronger for unhedged firms with low collateral assets. Overall, we provide new evidence that distressed firms take risk using financial assets camouflaged as cash reserves, which, compared to real assets, are less visible and carry lower transaction costs and accelerated payoffs. (JEL G32, G34)
Identification, Diversity, and Distribution of Meloidogyne spp. in Vegetable Fields of South Georgia, U.S.A.
Authors: Marquez Josiah , Hajihassani Abolfazl
Published: November 2022

Root-knot nematode (RKN; Meloidogyne spp.) is the most prevalent plant-parasitic nematode in vegetable fields of Georgia, with an incidence of 67.3%. Because aggressive RKN species are reported in the southeastern United States, molecular-based identification of RKN species was conducted on soil samples taken from a nematode surveillance study in 2018 from 292 RKN-infested vegetable fields in southern Georgia. The RKN-infested soil was potted with tomato cultivar Rutgers, and individual nematode females were isolated from galled roots and subjected to species-specific PCR and mitochondrial haplotype-based RKN species identification. The incidence (%), mean, and maximum relative abundance (second-stage juveniles per 100 cm3 of soil) of the five RKN species identified consisted of M. incognita (91.9, 486, 14,144), M. arenaria (36.0, 707, 14,144), M. floridensis (2.2, 909, 5,264), M. javanica (5.5, 352, 1,488), and M. haplanaria (0.7, 8, 14). A large proportion of fields (29%) had mixed populations of M. incognita and M. arenaria, which may reflect the region's long history of cotton and peanut cultivation. For unknown reasons, mixed populations of M. incognita and M. arenaria were associated with higher population densities. M. incognita is the most important RKN species in vegetable fields, followed by M. arenaria; therefore, pure or mixed populations of these species should be addressed in nematode management programs. Although at a lower incidence, the newly detected species, M. floridensis and M. haplanaria, have the potential to become a major threat since they reproduce on vegetables with Mi-resistant genes.
Navigating Loss of Abortion Services: A large Academic Medical Center Prepares for the Overturn of Row v. Wade
Authors: Harris L.
Published: November 2022

(N Engl J Med. 2022;386:2061–2064. doi: 10.1056/NEJMp2206246)

Because of its highly politicized nature, the authors fear medical centers will not be prepared to face the health care challenges put in place by the sudden illegalization of abortion across many states, especially Michigan. A 1931 Michigan law criminalizing abortion except to save the life of a pregnant person is forcing health care workers to begin understanding the consequences of this law. However, only some patients at the University of Michigan seeking abortion definitively require a life-saving abortion. This article discusses marginalized individuals, health care legal proceedings, and that health care workers themselves that will be affected by this change.
Uterine Exteriorization Versus In Situ Repair in Cesarean Delivery: A Systematic Review and Meta-Analysis
Authors: Tan H.S. , Taylor C.R. , Sharawi N. , Sultana R. , Barton K.D. , Habib A.S.
Published: November 2022

(Can J Anesth/J Can Anesth. 2022;69:216–2123)

Optimizing surgical technique is an important part of improving outcomes in cesarean delivery. It is unclear whether uterine exteriorization is associated with hemostasis benefits, and if there is a benefit, it is unclear if that outweighs the risks of nausea and vomiting. This review aimed to compare uterine exteriorization for cesarean delivery with in situ repair. The primary outcome of the study was intraoperative nausea and vomiting (IONV) and decrease in hemoglobin concentration.
Preventing Postpartum Hemorrhage After Cesarean Delivery: A Network Meta-Analysis of Available Pharmacologic Agents
Authors: Jaffer D. , Singh P.M. , Aslam A. , Cahill A.G. , Palanisamy A. , Monks D.T.
Published: November 2022

(Am J Obstet Gynecol. 2022;226:347–365)

Postpartum hemorrhage (PPH) is a leading cause of maternity mortality. Cesarean deliveries (CDs) put women at an increased risk of PPH. The World Health Organization (WHO) suggests oxytocin be administered to women to mitigate the risk of PPH without regards to type of delivery or whether CD was prepartum or intrapartum. This study aimed to use network meta-analysis (NMA) to determine whether prophylactic agent efficacy is influenced by surgical context for parturients undergoing CD.
Scientific Evidence Supporting Coronavirus Disease 2019 (COVID-19) Vaccine Efficacy and Safety in People Planning to Conceive or Who Are Pregnant or Lactating
Authors: Girardi G. , Bremer A.
Published: November 2022

(Obstet Gynecol. 2022;139:3–8. doi: 10.1097/AOG.0000000000004636)

The COVID-19 vaccine was approached with hesitancy, despite the vaccine’s importance in achieving herd immunity. This is particularly true among females ages 18 to 39, possibly due to inaccurate social media claims regarding vaccines and infertility or spontaneous abortion. This publication summarizes past research regarding the COVID-19 vaccine and menstruation, fertility, pregnancy, and lactation.
Incidence, Morbidity, and Associated Factors for Sepsis in Women Hospitalized for Delivery: A Nationwide Retrospective Observational Population-based Study in Canada
Authors: Balki  , Baghirzada L , Walker A , Lapinsky S , Balki M.
Published: November 2022

(Can J Anaesth. 2022;69:298–310. doi: 10.1007/s12630-021-02158-0)

Sepsis is a leading cause of death and leads to 25% to 40% maternal deaths worldwide. Sepsis-caused maternal morbidity is a concern as well. Despite the prevalence of sepsis deaths in countries around the world, Canada lacks an epidemiological analysis regarding maternal sepsis. The aim of the study was to examine causes of sepsis for women hospitalized during pregnancy in Canada. Incidence, the progression of sepsis, trends, and associated obstetric and medical conditions were evaluated.
The Continued Evolution of Peripartum Anesthesiologists
Authors: Lee W. , George R.B.
Published: November 2022

(Can J Anaesth. 2022;69:283–288. doi: 10.1007/s12630-021-02159-z)

The role of an obstetric anesthesiologist has evolved from providing effective and safe analgesia and anesthesia during cesarean deliveries. Obstetric anesthesiologists now help ensure effective and safe neuraxial catheters; offer low concentrations of local anesthetics for epidural analgesia to minimize instrumental vaginal deliveries and maximize parturient movement; use vasopressors to reduce the risk of parturient hypotension; and develop emergency protocols to best treat adverse outcomes such as pre-eclampsia and hemorrhage.
Neonatal Outcomes of Births in Freestanding Birth Centers and Hospitals in the United States, 2016-2019
Authors: Grunebaum A. , McCullough L. , Bornstein E. , Lenchner E. , Katz A. , Spiryda L. , Klein R. , Chervenak F.
Published: November 2022

(Am J Obstet Gynecol. 2022;226:116.e1–116.e7)

Free-standing birth centers, a group of locations offering delivery care matching a home setting, do not have access to cesarean deliveries, epidural anesthesia, labor inductions, and more. Transfer between these locations and a hospital takes time and happens frequently, ~23.4% to 45.5% of the time. Despite many studies describing unfavorable results, the number of birth centers and deliveries therein have increased, especially during the COVID-19 pandemic. This study compared neonatal safety in freestanding birth centers and in-hospital delivery centers.
Baseline Parameters for Nonactivated Rotational Thromboelastometry Tests With and Without Heparinase in Healthy Pregnant Women at Term Gestation
Authors: Getrajdman C. , Shin D.W. , Sison M. , Katz D.
Published: November 2022

(J Clin Anesth. 2021;75:110484. doi: 10.1016/j.jclinane.2021.110484)

Rotational thromboelastometry (ROTEM) provides point-of-care technology for detecting hyperfibrinolysis, a condition that can precede coagulopathy and lead to excessive bleeding with childbirth. Early awareness of the contribution of hyperfibrinolysis to postpartum hemorrhage in patients allows for targeted anti-fibrinolytic treatment that can reduce the risk of severe bleeding. This study investigates the efficacy of ROTEM for predicting the development of excessive blood loss by timely detection of hyperfibrinolysis at the earliest stages of severe hemorrhage. In addition, anticoagulation therapy is increasing in the obstetric population in response to thromboembolism as a primary cause of maternal mortality.
Introduction to Machine Learning in Obstetrics and Gynecology
Authors: Shazly S.A. , Trabuco E.C. , Ngufor C.G. , Famuyide A.O.
Published: November 2022

(Obstet Gynecol. 2022;139:669–679. doi: 10.1097/AOG.0000000000004706)

Artificial intelligence has been shown to outperform human intelligence at times. A technology’s ability to accurately and quickly perform medical tasks makes machine learning an important innovation within obstetrics and gynecology. This article reviews and identifies how artificial intelligence enhances the medical practice, specifically the field of obstetrics and gynecology.
A Randomized Trial to Investigate Needle Redirections/Reinsertions Using a Handheld Ultrasound Device Versus Traditional Palpation for Spinal Anesthesia in Obese Women Undergoing Cesarean Delivery
Authors: Weiniger C.F. , Carvalho B. , Ronel . , Greenberger C. , Aptekman B. , Almog O. , Kagan G. , Shalev S.
Published: November 2022

(Int J Obstet Anes. 2022;49:103229)

Compared with palpation (PAL), using ultrasound to identify the insertion point in neuraxial procedures is associated with higher success rates. Handheld ultrasound (H-US) devices use an algorithm to analyze images, rather than clinician interpretation with console or laptop ultrasound. These devices may be especially useful in obese obstetric patients. This study aimed to compare H-US and PAL in terms of number of reinsertions and redirections in obese patients undergoing spinal anesthesia for cesarean delivery.
Improving Resident Knowledge of Ergonomics Guidelines
Authors: Jeffries E. , Hardesty S. , Scott N.
Published: November 2022

(Obstet Gynecol. 2022;139:1194–1195. doi: 10.1097/AOG.0000000000004814)

Surgeons often face musculoskeletal disorders resulting from the work environment. These injuries likely affect surgeons’ well-being and their ability to provide care. By educating obstetricians and gynecologists, injury prevention could prolong and enhance their careers and their patients’ experience. In honor of ACOG Wellness Week, this article outlines their efforts and the effectiveness of educating obstetrician and gynecology residents regarding individual preventative actions.
Care Levels for Fetal Therapy Centers
Authors: Baschat A.A. , Blackwell S.B. , Chatterjee D. , Cummings J.J. , Emery S.P. , Hirose S. , Hollier L.M. , Johnson A. , Kilpatrick S.J. , Luks F.I. , Menard M.K. , McCullough L.B. , Moldenhauer J.S. , Moon-Grady A.J. , Mychaliska G.B. , Narvey M. , Norton M.E. , Rollins M.D. , Skarsgard E.D. , Tsao K. , Warner B.B. , Wilpers A. , Ryan G.
Published: November 2022

(Obstet Gynecol. 2022;139:1027–1042. doi: 10.1097/AOG.0000000000004793)

Fetal therapy carries both benefits and extensive risks for the fetus and pregnant patient. As such, outlines created by several different groups and organizations are used throughout the country, but these general guidelines do not anticipate the needs of individual circumstances. This article recommends certain parameters for resources at fetal therapy centers in order to provide both pregnant patients and their fetus with an adequate level of care.
Early Cryoprecipitate Transfusion Versus Standard Care in Severe Postpartum Haemorrhage: A Pilot Cluster-randomized Trial
Authors: Green L. , Daru J. , Gonzalez Carreras F.J. , Lanz D. , Pardo M.C. , Perez T. , Philip S. , Tanqueray T. , Khan K.S. ,   Collaborators
Published: November 2022

(Anaesthesia. 2022;77:175–184)

Fibrinogen levels play a key role in maintaining homeostasis during postpartum hemorrhage (PPH). Fibrinogen levels <2 g/L is significantly associated with adverse outcomes. Fibrinogen substitution effectively improves outcomes in severe PPH. However, the only studies evaluating early fibrinogen use describe the fibrinogen concentrate utilization, although cryoprecipitate is the more commonly used product. This study assessed the feasibility of early cryoprecipitate administration during PPH and other aspects needed to conduct future large trials to evaluate early cryoprecipitate use in PPH.
Carbetocin Versus Oxytocin Following Vaginal and Cesarean Delivery: A Before-After Study
Authors: Tareef A. , Downey K. , Ma B. , Whittle W. , Carvalho J.
Published: November 2022

(Can J Anaesth. 2022;69:97–105)

Postpartum hemorrhage increases mortality, morbidity, potential blood transfusion, and length of hospital stay. Usually oxytocin, an effective agent with a short half-life and various possible side effects, is most used to treat postpartum hemorrhage. Carbetocin, though an unpopular method of treatment, has a longer half-life. Because of the shortage of oxytocin in Canada between the months of October and November in 2019, all stakeholders began to use carbetocin. This study researched the difference between carbetocin and oxytocin, especially regarding additional uterotonic medication administration, incidence of postpartum hemorrhage, and blood transfusion rates in a pragmatic before-after study.
Preeclampsia
Authors: Magee L.A. , Nicolaides K.H. , von Dadelszen P.
Published: November 2022

(N Engl J Med. 2022;386:1817–1832. doi: 10.1056/NEJMra2109523)

Preeclampsia affects 2% to 4% of global pregnancies, targeting low- and middle-income countries specifically, and it results in serious complications for 5% to 20% of women. Preeclampsia often causes or contributes to endothelial damage, increased peripheral vascular resistance, hypertension, pulmonary edema, hemorrhagic stroke, ischemic encephalopathy, kidney, liver, hematologic, and perinatal injury. Demographic characteristics, medical history, current pregnancy characteristics, physiological abnormalities, abnormal laboratory test results, and ultrasonography abnormalities are risk factors for preeclampsia. These risk factors play a critical role in early identification and treatment during pregnancy.
Management and Implications of Severe COVID-19 in Pregnancy in the United Kingdom: Data From the UK OBSTETRIC Surveillance System National Cohort
Authors: Vousden N. , Ramakrishnan R. , Bunch K. , Morris E. , Simpson N. , Gale C. , O’Brien P. , Quigley M. , Brocklehurst P. , Kurinczuk J.J. , Knight M.
Published: November 2022

(Acta Obstet Gynecol Scand. 2022;101:461–470. doi: 10.1111/aogs.14329)

With the inauspicious rise to dominance of the Sars-CoV-2 Delta variant (B.1.617.2) in the United Kingdom in May 2021, the proportion of pregnant women experiencing severe disease proliferated significantly [35.8% during the Alpha variant duration vs. 45% in the Delta-dominant duration, adjusted odds ratio (aOR): 1.53]. A high proportion of pregnant women with COVID-19 deliver prematurely, are admitted to intensive care, and have neonates that also require intensive care. Most data thus far have come from single-center cohorts with small sample sizes, and present conflicting conclusions. There is an urgent need to investigate the risks and outcomes of severe COVID-19 illness in pregnant women to update guidelines for clinical management and prevention practices.
The Effect of High-dose Versus Low-dose Epidural Fentanyl on Gastric Emptying in Nonfasted Parturients: A Double-blinded Randomized Controlled Trial
Authors: Fiszer E. , Aptekman B. , Baar Y. , Weiniger C.F.
Published: November 2022

(Eur J Anaesthesiol. 2022;39:50–57. doi: 10.1097/EJA.0000000000001514)

Aspiration of gastric contents is a risk for laboring women who may undergo general anesthesia. Although organizations regard the risk/benefit of eating during labor with varying approaches, it is still important to clarify factors that may contribute to pulmonary aspiration during childbirth. High-dose epidural fentanyl (≥100 µg) has been previously associated with delayed gastric emptying by paracetamol absorption test, but not low-dose fentanyl (<100 µg). As paracetamol does not directly measure the volume of gastric contents, the previously validated gastric ultrasonography technique is used in this study to measure the cross-sectional area (CSA) of the antrum to observe the effects of epidural fentanyl on gastric emptying in nonfasted laboring women.
Factors Driving the Difference in Quality of Recovery Scores Between Scheduled and Unscheduled Cesarean Delivery Patients
Authors: Bhiladvala C. , French-O’Carroll R. , Dadkhah Y. , Bright S. , Chau A. , Seligman K.M.
Published: November 2022

(Br J Anaesth. 2022;128:e219–e221. doi: 10.1016/j.bja.2021.11.026)

Patients undergoing unscheduled cesarean deliveries (CDs) are shown to have worse Obstetric Quality of Recovery Scores (ObsQoR-11) than those undergoing scheduled CDs. This quality improvement study investigated the causes behind this difference in scores.
Defining the Decision-to-Delivery Interval at Cesarean Section: Narrative Literature Review and Proposal for Standardization
Authors: May R.L. , Clayton M.A. , Richardson A.L. , Kinsella S.M. , Khalil A. , Lucas D.N.
Published: November 2022

(Anaesthesia. 2022;77:96–104. doi: 10.1111/anae.15570)

The 30-minute decision-delivery interval for emergency cesarean delivery (CD) is a deeply embedded and widely studied standard for the evaluation of outcomes in high-resource settings. Despite the self-evident nature of the term, there is no consensus for what specifically defines the instance of “decision,” “delivery,” “incision,” or other timepoints related to carrying out the surgery. This review investigates how these terms have been used in publications in the preceding 40 years, and how inconsistent approaches may undermine the utility of this framework.
Varying Dosages of Subcutaneous Unfractionated Heparin and Activated Partial Thromboplastin Time in Hospitalized Antepartum Patients: A Retrospective Cohort Analysis
Authors: Elmofty D.H. , Tucker A. , Wuenstel A.M. , Cheng P.K. , Fox E. , Knoebel R. , Liao C. , Scavone B.
Published: November 2022

(Anesth Analg. 2022;134:1028–1034. doi: 10.1213/ANE.0000000000005866)

Approximately 10% of all maternal deaths in the United States are from venous thromboembolism (VTE). Clinical guidelines have been put into place, including what to administer antepartum patients with history of VTE who require an empiric pharmacologic prophylaxis. The recommended dosage for subcutaneous unfractionated heparin (UFH) corresponds to gestational age: 5000 to 7500 units every 12 hours for first trimester, 7500 to 10,000 units every 12 hours for second trimester, and 10,000 units every 12 hours for third trimester antepartum patients. The increased dosage is due to changing distribution volume, bioavailability, clearance, and metabolism during pregnancy. These clinical guideline adjustments may impact anesthetic use during labor and cesarean delivery, as UFH potentially inhibits coagulation, increases activated partial thromboplastin time (aPTT), and subsequently increases the risk of neuraxial hematoma associated with neuraxial anesthesia. The primary aim of this study was to determine the effect UFH has on coagulation by assessing what proportion of hospitalized antepartum women with aPTT over 40 seconds following subcutaneous UFH. The secondary aim was to identify the association between aPTT over 40 seconds and other risk factors.
In-Hospital Opioid Consumption After the Previous Cesarean Delivery Weakly Predicts Opioid Consumption After Index Delivery: A Retrospective Cohort Study
Authors: Komatsu R. , Nash M. , Mandalia S. , Dinges E. , Kamal U. , Singh D. , El-Omrani H. , Anwar A. , Delgado C. , Ziga T.M. , Carvalho B.
Published: November 2022

(Anesth Analg. 2022;134:1280–1287. doi: 10.1213/ANE.0000000000005918)

Opioid administration is a common form of analgesia for breakthrough pain following cesarean deliveries (CDs) when nonopioid medication is not sufficient. Pain severity can differ from patient to patient, so an individualized approach to care can be taken. Predicting in-hospital opioid consumption following a repeat CD has not been previously studied. The primary aim is to identify if prior opioid consumption 48 hours postoperatively following CD correlates with patient opioid consumption following index CD. The primary aim of the investigations was that an associated prediction would exist. Secondary aims included whether pain scores correlated and if obstetric and demographic variable improved prediction accuracy.
Performing the 3-level Anterior Cervical Discectomy and Fusion (ACDF)
Authors: Park Paul J. , Lehman Ronald A.
Published: November 2022

The anterior cervical discectomy and fusion is a common and effective treatment for degenerative cervical myelopathy, either with or without concomitant radiculopathy. In many cases, patients with degenerative cervical spondylosis can present with disease at multiple levels. With each additional level included in the procedure, rates of complication rate can increase—both due to the nature of the anterior cervical approach (dysphagia) as well as fusion across all levels. Here, we review several technical considerations with the goal of increasing efficiency and improving outcomes with the 3-level anterior cervical discectomy and fusion.
Electrodiagnostic Studies in Degenerative Cervical Myelopathy
Authors: Davenport Ryan , Jandzinski Michal , Ahmed Muhammad , Stino Amro , Aleem Ilyas
Published: November 2022

The diagnosis of degenerative cervical myelopathy can generally be made with a thorough history, physical examination, and spinal imaging. Electrodiagnostic studies, consisting of nerve conduction studies and electromyography, are a useful adjunct when the clinical picture is inconsistent or there is concern for overlapping pathology. Electrodiagnostic studies may be particularly helpful in identifying cases of myeloradiculopathy, when there is combined nerve root and spinal cord injury, both with regards to prognosis and guiding surgical treatment. Electrodiagnostic studies are a useful adjunct for the spine surgeon and should be used when there are features atypical for degenerative cervical myelopathy or when there is suspicion for a concomitant disease process.
The Combination of the Mini-Punch Technique and Photodynamic Therapy for the Treatment of Mandibular Keloids and Hypertrophic Scars
Authors: Luo Xian Yan , Wu Xin Gang , Xu Ai E. , Song Xiu Zu , Peng Jian Zhong
Published: November 2022

BACKGROUND

Mandibular keloids and hypertrophic scars can exert significant effects on the appearance of a patient. However, current treatments are not effective in all cases. Consequently, it is vital to identify a safe and effective treatment method.

OBJECTIVE

To investigate the therapeutic effect of the mini-punch technique combined with photodynamic therapy (PDT) on mandibular keloids and hypertrophic scars.

PATIENTS AND METHODS

Twenty patients with mandibular keloids and hypertrophic scars were enrolled, including 5 cases of keloids and 15 cases of hypertrophic scars, with a total of 40 lesions. The mini-punch technique was performed first, and then, PDT was conducted, once a week on 3 occasions in total.

RESULTS

After 12 months of follow-up, 30 lesions had improved by more than 50%, thus achieving a good therapeutic effect. The Vancouver Scar Scale score of patients ranged between 8 and 12 points with a mean of 9.60 ± 1.09 points before surgery and between 2 and 9 points with a mean of 4.15 ± 2.05 points at 12 months after surgery. The mean Vancouver Scar Scale score after treatment was significantly lower than that before treatment (t = 11.80, p < .001).

CONCLUSION

A combination of the mini-punch technique and PDT is an effective treatment for mandibular keloids and hypertrophic scars.
Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts
Authors: Richey Patricia M. , Hashemi David A. , Avram Mathew M.
Published: November 2022

BACKGROUND

Within the aesthetic realm, the influence of social media is quite prominent, with a growing percentage of patients using this technology to seek out health care recommendations and education.

OBJECTIVE

To ascertain the most accurate representation of what our patients may encounter on social media, we sought to characterize the top posts on the most popular visually-based social media platform (Instagram).

MATERIALS AND METHODS

We queried Instagram with variations of hashtags related to filler to determine which hashtags had the greatest number of posts associated with them. We then reviewed the top 100 posts associated with the top 9 hashtags, making note of whether the poster was a physician or nonphysician and whether an off-label procedure was performed or discussed.

RESULTS

Most (85.6%) of the 900 reviewed posts were written by nonphysicians, and most (84.6%) of the posts focused on off-label procedures were posted by nonphysicians. Among the physician posters, the most common specialties were Plastic Surgery and Family Medicine, followed by Dermatology.

CONCLUSION

At a time when patients are increasingly turning to social media for health care recommendations and education, most “top” content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.