bluuebunny/crossref_metadata_2025 huggingface dataset:
Racism, Colorism, and Language within Their Macro Contexts
Authors: Spears Arthur K.
Published: October 2020

This chapter contends that scholars of language and race have insufficiently attended to the constraints imposed by a pentad of forces that (re)produce racialized hierarchies. These macro-forces include the global capitalist system, the nation-state, political economic stratification, and other forms of socioeconomic inequality. It argues that racism in the United States emerges from the social inequality imposed by global capitalism and the hegemonic influence of institutionalized racism rationalized by ideologies of white supremacy. This emphasis on disclosing the basis for racialization and the deliberate construction and maintenance of racial hierarchies is a critical step in revealing and undermining the historical arc of racist thinking. The terror, violence, and brutality of these systems are not only the macro-contexts within which race and language are produced, but white supremacy comes to depend on the idea of race, and therefore, processes of racialization for its continued propagation.
The Medieval Expansion of Long-Distance Trade: Adam Smith on the Towns’ Escape from the Violent, Feudal Equilibrium
Authors: Weingast Barry R.
Published: October 2020

Most people in medieval Europe lived at subsistence level in a violent feudal world. Adam Smith explained both the long-term stability of the feudal system and how the towns escaped this violence trap through political exchange that fostered their ability to enter long-distance trade, create a significant division of labor, and encourage long-term economic growth and development. Violence is central to Smith’s approach to development, which Smith scholars have systematically underappreciated. In the face of episodic violence, individuals had little incentive to be industrious, to save, or to invest. Smith argued that medieval towns escaped the violence trap through three mutually reinforcing elements: law and liberty, commerce (including long-distance trade), and security from all forms of violence.
The Sociology of Mobile Apps
Authors: Lupton Deborah
Published: October 2020

Since their introduction in 2008, software applications for mobile devices (“apps”) have become extremely popular forms of digital media. Mobile apps are designed as small bits of software for devices such as smartphones, tablet computers, smartwatches, and other wearable devices. This chapter presents a sociological analysis of apps through the lens of three major theoretical perspectives: (1) the political economy approach, (2) Foucauldian perspectives, and (3) sociomaterialism. Each perspective adopts a different focus, but all elucidate important aspects of the sociocultural and political dimensions of apps. Relevant empirical research is incorporated into the discussion to illustrate how apps are designed, developed, and promoted by a range of actors and agencies and to provide examples of the ways in which people incorporate apps into the routines of their everyday lives. The chapter ends with identifying directions for further sociological research and theorizing related to apps.
Media and the Social Construction of Reality
Authors: Couldry Nick , Hepp Andreas
Published: October 2020

In this chapter, the authors argue that a phenomenological approach to sociology only can be preserved if a version of sociology is developed that takes seriously the existence of media and the entanglement of digital media technologies and interfaces in every aspect of daily life. That means, in turn, taking seriously the roles that data extraction and data processing play in both the operations of digital media and the production of what counts as knowledge of the social world. If so, then some adjustments to other key assumptions must be made, for example about the social world’s transparency. But those adjustments are worth making in order to preserve the project of phenomenological sociology, which still has much to contribute to a sense of the tensions at work in the social world and its forms of knowledge. To outline this, the authors first discuss the consequences of a mediated life for social theory, then reflect on how digital media and data changed processes of the mediated construction reality, and finally introduce “deep mediatization” as a “sensitizing concept” for such an analysis.
The Problem of Platform Law
Authors: Land Molly K.
Published: October 2020

The internet would seem to be an ideal platform for fostering norm diversity. The very structure of the internet resists centralized governance, while the opportunities it provides for the “long tail” of expression means even voices with extremely small audiences can find a home. In reality, however, the governance of online speech looks much more monolithic. This is largely a result of private “lawmaking” activity by internet intermediaries. Increasingly, social media companies like Facebook and Twitter are developing what David Kaye, UN Special Rapporteur for the Promotion and Protection of the Right to Freedom of Opinion and Expression, has called “platform law.” Through a combination of community standards, contract, technological design, and case-specific practice, social media companies are developing “Facebook law” and “Twitter law,” displacing the laws of national jurisdictions. Using the example of content moderation, this chapter makes several contributions to the literature. First, it expands upon the idea of “platform law” to consider the broad array of mechanisms that companies use to control user behavior and mediate conflicts. Second, using human rights law as a foundation, the chapter makes the case for meaningful technological design choices that enable user autonomy. Users should be able to make explicit choices about who and what they want to hear online. It also frames user choice in terms of the right to hear, not the right to speak, as a way of navigating the tension presented by hate speech and human rights without resorting to platform law that sanitizes speech for everyone.
The Eclipse of Global Legal Pluralism in Ethnology
Authors: Mallard Grégoire
Published: October 2020

Global legal pluralism in France was an approach strongly tied to the institutionalization of the field of ethnology, colonial law, and colonial administration in the interwar period. As France’s overseas possessions greatly expanded, and many colonial subjects were still administered according to a plurality of legal rules, with customary rules and French administrative or criminal law, ethnologists and colonial administrators were interested in raising the question of whether such combination of legal sources hampered or accelerated the “integration” of colonial subjects to the French Republic. Not surprisingly then, the strong attachment of a global legal pluralistic approach to the administration of colonial subjects in the field of anthropology has thus been profoundly questioned after the age of decolonization. By tracing the theoretical and normative ideas that inspired prominent ethnologists associated with the global legal pluralist approach in the colonial age, this chapter thus adds a building block to our comprehension of the evolution of the French colonial field and its impact on ethnology and global legal pluralism, before, during, and after the age of colonization.
Does Legal Theory Have a Pluralism Problem?
Authors: Mac Amhlaigh Cormac
Published: October 2020

Legal theory has been criticized by legal pluralists on the grounds that it has a “pluralism problem.” In a nutshell, legal theory’s pluralism problem stems from the fact that it explicitly or implicitly assumes the model of state law whenever it refers to law. This is problematic both because such a state-based conception of law fails to capture myriad nonstate forms of law existing in different contexts and because it runs the risk of supporting oppression in postcolonial contexts where indigenous laws are pushed out by colonial laws which conform to the (state-based) legal theoretical paradigm. This chapter focuses on the former, analytical, limb of legal theory’s pluralism problem by breaking the problem down into three specific claims; two which pluralists argue legal theory defends: a strong claim—that all law is necessarily state law; an intermediate claim—that state law is a paradigmatic or the “best” form of law; and one made by pluralists about legal theory: a weak claim that legal theory has unwarrantedly neglected nonstate forms of law. It analyzes each claim in turn reviewing the relevant claims in legal theory. It concludes that if legal theory does have a pluralism problem, and the analysis undertaken in this chapter suggests that it might in some respects, it is not a particularly profound one. As such, much of the resources of legal theory can be adopted to capture a wide variety of both extant and new emergent forms of nonstate law.
Global Legal Pluralism and Conflict of Laws
Authors: Michaels Ralf
Published: October 2020

Global legal pluralism makes three claims about law: (1) law includes both state law and nonstate law; (2) there is a plurality of laws; (3) laws overlap and interact in certain ways. Among these, the third one is the most difficult one and at the same time the one least theorized. Pluralists lack the instruments to deal with them. The main reason is that they, with rare exceptions, ignore conflict of laws as the discipline that deals with such overlaps and interactions. As a consequence, discussions have stalled: global legal pluralism is widely accepted as a helpful description of law in the world, but because a more precise conceptualization and theorization is lacking, that description has little impact for further analysis. This chapter introduces conflict of laws as a technique and as a discipline to scholars of global pluralists. And it makes the case for why conflict of laws is the adequate discipline, doctrinally and epistemologically, to deal with overlaps and interactions of laws in global legal pluralism. Conflict of laws is superior to other techniques of dealing with diversity due to its experience. Moreover, it is superior to other epistemologies due to a number of its characteristics, in particular its decentralized nature, its technical character, and its ethical position. Scholars working in global legal pluralism would do well to engage with it in a more comprehensive fashion.
Psychophysiology of Meditation
Authors: Dorjee Dusana
Published: October 2020

Psychophysiological research on meditation examines modulations in brain and body physiology resulting from, or associated with, meditation. This chapter considers the available evidence regarding the effects of meditation on psychophysiological markers, including frontal electroencephalography (EEG) alpha asymmetry, event-related brain potentials (ERPs), heart-rate variability (HRV) and its derivative indexes, and galvanic skin response (GSR). The emerging mosaic of findings suggests an inconclusive mixed pattern of evidence regarding changes in frontal EEG alpha asymmetry with meditation. The evidence base on ERP changes resulting from meditation is more consistent, particularly pointing to improvements in attention control. However, ERP evidence on modulations in emotion processing, language processing, and existential awareness (such as decentering) with meditation is very limited, not allowing for conclusive answers. Overall, the current evidence on psychophysiological changes with meditation underscores the potential of these methods in providing novel insights into the effects and mechanisms of meditation. More rigorous studies with long-term follow-up, comprehensive systemic assessments, and explorations of convergent/divergent patterns of findings across psychophysiological indexes are needed.
Monasteries, Society, Economy, and the State in the Byzantine Empire
Authors: Smyrlis Kostis
Published: October 2020

The chapter provides an overview of the social, political, and economic functions of Byzantine monasteries from the ninth to the fifteenth century. Relations between monasteries and the state, the Church, and lay society were complex. The monks received donations and protection in exchange for various spiritual and material services. The great landowning monasteries engaged in large-scale agrarian production and trade, and they played a substantial role in local and regional economies. Finally, the chapter addresses the fate and significance of monasteries in the long period of crisis that began in the middle of the fourteenth century and ended with the replacement of the Byzantine by the Ottoman Empire.
The sediment akinete bank links past and future blooms of Nostocales in a shallow lake
Authors: Yema Lilen , O'farrell Inés , de Tezanos Pinto Paula
Published: October 2020

In this paper we analyzed how well the akinete bank in the sediments from a shallow lake reflected past blooms of planktonic Nostocales (cyanobacteria), the akinete bank’s potential for reflecting future blooms and whether different nutrient scenarios affect germination and recruitment using a laboratory experiment. Most species found in the plankton were also found in the akinete bank and in the germination experiment. Based on their shape, the most abundant viable akinetes in the sediments potentially corresponded to some of the species forming intense blooms in previous years, and coincided with the most abundant species in a 3-week germination experiment. The effects of nutrients on germination and recruitment were only observed in the early phase of the life cycle (Day 7), where nitrogen-sufficient conditions enhanced germination, while phosphorus concentration had a positive effect on the number of heterocytes. Combined approaches of morphological analysis and experimental germination seem a good method for assessing the past diversity of Nostocales and allowing predictions of the diversity of potential future blooms in shallow lakes and as a tool for water quality management, especially in water bodies lacking information on previous cyanobacteria blooms.
Reduced Insulin-Like Growth Factor Family Member Expression Predicts Neurogenesis Marker Expression in the Subependymal Zone in Schizophrenia and Bipolar Disorder
Authors: Weissleder Christin , Webster Maree J , Barry Guy , Shannon Weickert Cynthia
Published: October 2020

The generation of inhibitory interneurons from neural stem cells in the subependymal zone is regulated by trophic factors. Reduced levels of trophic factors are associated with inhibitory interneuron dysfunction in the prefrontal cortex and hippocampus in psychiatric disorders, yet the extent to which altered trophic support may underpin deficits in inhibitory interneuron generation in the neurogenic niche remains unexplored in schizophrenia and bipolar disorder. We determined whether the expression of ligands, bioavailability-regulating binding proteins, and cognate receptors of 4 major trophic factor families (insulin-like growth factor [IGF], epidermal growth factor [EGF], fibroblast growth factor [FGF], and brain-derived neurotrophic factor [BDNF]) are changed in schizophrenia and bipolar disorder compared to controls. We used robust linear regression analyses to determine whether altered expression of trophic factor family members predicts neurogenesis marker expression across diagnostic groups. We found that IGF1 mRNA was decreased in schizophrenia and bipolar disorder compared with controls (P ≤ .006), whereas both IGF1 receptor (IGF1R) and IGF binding protein 2 (IGFBP2) mRNAs were reduced in schizophrenia compared with controls (P ≤ .02). EGF, FGF, and BDNF family member expression were all unchanged in both psychiatric disorders compared with controls. IGF1 expression positively predicted neuronal progenitor and immature neuron marker mRNAs (P ≤ .01). IGFBP2 expression positively predicted neural stem cell and neuronal progenitor marker mRNAs (P ≤ .001). These findings provide the first molecular evidence of decreased IGF1, IGF1R, and IGFBP2 mRNA expression in the subependymal zone in psychiatric disorders, which may potentially impact neurogenesis in schizophrenia and bipolar disorder.
Metabolomic Identification of Exosome-Derived Biomarkers for Schizophrenia: A Large Multicenter Study
Authors: Du Yang , Chen Lei , Li Xue-Song , Li Xiao-Lin , Xu Xiang-Dong , Tai Shao-Bin , Yang Geng-Lin , Tang Quan , Liu Hua , Liu Shu-Han , Zhang Shu-Yao , Cheng Yong
Published: October 2020

Exosomes have been suggested as promising targets for the diagnosis and treatment of neurological diseases, including schizophrenia (SCZ), but the potential role of exosome-derived metabolites in these diseases was rarely studied. Using ultra-performance liquid chromatography-tandem mass spectrometry, we performed the first metabolomic study of serum-derived exosomes from patients with SCZ. Our sample comprised 385 patients and 332 healthy controls recruited from 3 clinical centers and 4 independent cohorts. We identified 25 perturbed metabolites in patients that can be used to classify samples from patients and control participants with 95.7% accuracy (95% CI: 92.6%–98.9%) in the training samples (78 patients and 66 controls). These metabolites also showed good to excellent performance in differentiating between patients and controls in the 3 test sets of participants, with accuracies 91.0% (95% CI: 85.7%–96.3%; 107 patients and 62 controls), 82.7% (95% CI: 77.6%–87.9%; 104 patients and 142 controls), and 99.0% (95% CI: 97.7%–100%; 96 patients and 62 controls), respectively. Bioinformatic analysis suggested that these metabolites were enriched in pathways implicated in SCZ, such as glycerophospholipid metabolism. Taken together, our findings support a role for exosomal metabolite dysregulation in the pathophysiology of SCZ and indicate a strong potential for exosome-derived metabolites to inform the diagnosis of SCZ.
The Phylogeny and Evolution of the Flashiest of the Armored Harvestmen (Arachnida: Opiliones)
Authors: Benavides Ligia R , Pinto-da-Rocha Ricardo , Giribet Gonzalo
Published: October 2020

Gonyleptoidea, largely restricted to the Neotropics, constitutes the most diverse superfamily of Opiliones and includes the largest and flashiest representatives of this arachnid order. However, the relationships among its main lineages (families and subfamilies) and the timing of their origin are not sufficiently understood to explain how this tropical clade has been able to colonize the temperate zone. Here, we used transcriptomics and divergence time dating to investigate the phylogeny of Gonyleptoidea. Our results support the monophyly of Gonyleptoidea and all of its families with more than one species represented. Resolution within Gonyleptidae s.s. is achieved for many clades, but some subfamilies are not monophyletic (Gonyleptinae, Mitobatinae, and Pachylinae), requiring taxonomic revision. Our data show evidence for one colonization of today’s temperate zone early in the history of Gonyleptidae, during the Paleogene, at a time when the Neotropical area extended poleward into regions now considered temperate. This provides a possible mechanism for the colonization of the extratropics by a tropical group following the Paleocene–Eocene Thermal Maximum, explaining how latitudinal diversity gradients can be established. Taxonomic acts: Ampycidae Kury 2003 is newly ranked as family; Neosadocus Mello-Leitão is transferred to Progonyleptoidellinae (new subfamilial assignment). [Arachnids; biogeography; phylogenomics; transcriptomics.]
Thrive, not just survive: the experience of a fellow in the SBM Leadership Institute to enhance opportunities for success of mid-career nurse scientists
Authors: Kinser Patricia A
Published: October 2020

Mid-career nurse scientists are at risk of burnout and departure from research-focused roles due to a myriad of reasons, including a nationwide faculty shortage, vacant administrative roles, and the challenging extramural funding environment. Retention and success of mid-career scientists in any health-related discipline is essential to maintain educational and research endeavors that are important for public health and well-being. This commentary provides an account of recent efforts to address these issues, from the perspective of a former fellow in the Society of Behavioral Medicine Leadership Institute. Although these efforts are focused specifically on the needs of nurse scientists, the topic is relevant to researchers in any discipline. The intent of this commentary is for others to benefit from the lessons learned and to build upon our current efforts to help mid-career scientists thrive, not just survive.
Experiences of social scientists in health research settings: SBM Leadership Institute
Authors: Henrikson Nora B
Published: October 2020

The Society of Behavioral Medicine (SBM) Leadership Institute provides leadership training for mid-career behavioral medicine scientists. As an institute fellow, I explored the experiences of social scientists working in healthcare settings. Exploratory research to describe the experiences, barriers, and facilitators social scientists face working in a healthcare delivery and research system. Our research questions were exploratory, focused on understanding (a) the experiences of social scientists working in a healthcare delivery and research system, (b) barriers that social scientists face working in a healthcare delivery and research system, (c) perceived value of sociological and anthropologic methods to clinicians and other health researchers, and (4) to understand the landscape of organizational models that feature social scientists as part of a larger scientific enterprise. We developed a plan for needs assessment activities. We conducted a design workshop of social scientists (n = 11). Using human-centered design methods, we elicited experiences and asked participants to develop a prototype model where social scientists could find career fulfillment with minimal structural barriers. We found that social scientists feel a strong sense of pride in their social science training and passion for the work they do. They reported occupying multiple disciplines at once, including multiple promotion and reputational expectations. Participants commonly reported that they themselves, as well as collaborators, viewed social science work, particularly qualitative research, as supplemental to quantitative work. Participants described perceptions that social science research is less rigorous or requires less training compared with other disciplines. Participants identified several contextual factors that influenced the perceived value of social science research in healthcare, including the focus of external funding priorities on larger clinical questions, organizational structure, and tangible leadership support of social science. The SBM Leadership Institute created a space for preliminary research into an area that could improve the experiences and research impact of social and behavioral scientists.
Context-Dependent Modulation of Corticomuscular Coherence in a Series of Motor Initiation and Maintenance of Voluntary Contractions
Authors: Suzuki Rina , Ushiyama Junichi
Published: October 2020

For our precise motor control, we should consider “motor context,” which involves the flow from feedforward to feedback control. The present study focused on corticomuscular coherence (CMC) to physiologically evaluate how the sensorimotor integration is modulated in a series of movements depending on the motor context. We evaluated CMC between electroencephalograms over the sensorimotor cortex and rectified electromyograms from the tibialis anterior muscle during intermittent contractions with 2 contraction intensities in 4 experiments. Although sustained contractions with weak-to-moderate intensities led to no difference in CMC between intensities, intermittent ballistic-and-hold contractions with 2 intensities (10% and 15% or 25% of the maximal voluntary contraction, MVC) presented in a randomized order resulted in greater magnitude of CMC for the weaker intensity. Moreover, the relative amount of initial error was larger for trials with 10% of MVC, which indicated that initial motor output was inaccurate during weaker contractions. However, this significant difference in CMC vanished in the absence of trial randomization or the application of intermittent ramp-and-hold contractions with slower torque developments. Overall, CMC appears to be modulated context-dependently and is especially enhanced when active sensorimotor integration is required in feedback control periods because of the complexity and inaccuracy of preceding motor control.
Predicted Reference Equations for Spirometry Indices as a Proxy from Anthropometry Measurements of Nigerian Children with Sickle Cell Anaemia Aged 5–12 Years
Authors: Akodui Olufemi S , Faleti Abiodun O , Adekanmbi Folashade A , Ogunlesi Tinuade A
Published: October 2020

Background

Significant morbidity and mortality in patients with sickle cell disease are accounted for by lung complications. To facilitate good respiratory care for children with sickle cell anaemia the generation of local predicted values is highly important.

Objective

To determine the reference equations for spirometry indices estimation in children with sickle cell anaemia, which can be readily used as proxy when there is no easy accessibility to spirometer.

Methods

A cross-sectional study with linear regression models developed to estimate reference values for spirometric indices in Nigerian children with sickle cell anaemia aged 5–12 years.

Results

Age as independent variables for estimation of forced expiratory volume in 1 s (FEV1) was associated with lowest coefficient of determination (R2) and highest standard error. The coefficient of determination (R2) and standard error was highest and lowest, respectively, when arm span was used to determine peak expiratory flow rate (PEFR). Prediction models for PEFR and FEV1 gave the closest mean estimates that were 0.18 and 0.16 lower and higher than the actual mean PEFR and FEV1, respectively, but the differences was significant only in FEV1. On the contrary the prediction models for forced vital capacity (FVC) gave mean estimates that was 1.02 higher than the actual mean FVC, however, the finding was not significant.

Conclusion

Preferred proxy for spirometry indices in children with sickle cell anaemia may be arm span.
RS_CRZ1, a C2H2-Type Transcription Factor Is Required for Pathogenesis of Rhizoctonia solani AG1-IA in Tomato
Authors: Ghosh Srayan , Kant Ravi , Pradhan Amrita , Jha Gopaljee
Published: October 2020

Rhizoctonia solani is a necrotrophic fungal pathogen that causes disease in diverse plant species. In recent years, the genomic and transcriptomic studies have identified several candidate pathogenicity determinants of R. solani; however, most of them remain to be validated. In this study, we report a viral vector-based host-induced gene silencing (HIGS) as well as a dsRNA (double-stranded RNA)-based approach to effectively downregulate genes of R. solani AG1-IA (BRS1 strain) during pathogenesis in tomato. We tested a few of the in-planta upregulated R. solani genes and observed that silencing of one of them, i.e., RS_CRZ1 (a C2H2 type zinc finger transcription factor) significantly compromises the pathogenesis of R. solani in tomato. The RS_CRZ1-silenced plants not only exhibited significant reduction in disease symptoms, but the depth of pathogen colonization was also compromised. Furthermore, we identified the R. solani genes that were coregulated with RS_CRZ1 during the pathogenicity process. The HIGS-mediated silencing of a few of them [CL1756Contig1; subtilisin-like protease and CL1817Contig2; 2OG-Fe(II) oxygenase] compromised the pathogenesis of R. solani in tomato. The ectopic expression of RS_CRZ1 complemented the crz1 mutant of yeast and restored tolerance against various metal ion stress. Overall, our study reveals the importance of RS_CRZ1 in managing the hostile environment encountered during host colonization. Also, it emphasizes the relevance of the HIGS and dsRNA-based gene silencing approach toward functional characterization of pathogenicity determinants of R. solani.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Scale Insect Records from Ornamental Plants Help to Prioritize Plant Health Resource Development
Authors: Klingeman William E. , Chong Juang-Horng , Harmon Carrie , Ames Lisa , LeBude Anthony V. , Chandran Predeesh
Published: October 2020

Estimates about which scale insect species are most frequently encountered in U.S. landscapes and commercial production systems are largely anecdotal. This survey of records maintained across about 15 years within the National Plant Diagnostic Network (NPDN) National Data Repository (NDR) returned information from 10,671 records of 192 scale insect species and 23 suspected species that were associated with ornamental plants. This broad species diversity challenges our ability to effectively train diagnosticians, can confound species identification accuracy, and impedes outreach efforts and resource development. To help focus future efforts in the development of outreach resources and diagnostic training guides, lists were assembled that identified the 60 top-ranked soft, armored, mealybug, and other scale insect taxa most frequently diagnosed within NDR records. Diagnostic service records from Georgia, North Carolina, South Carolina, and Tennessee provided more extensive information regarding sites or client types from which submitted samples originated. Results are being used to develop web-based, image-rich guides to key scale insect taxa in the southeastern United States that will explain life cycles, behaviors, and biology for pest species. These web-based guides can be exploited to optimize pest management actions.
Naloxone Use by Emergency Medical Services During the COVID-19 Pandemic: A National Survey
Authors: Cone David C. , Bogucki Sandy , Burns Kevin , D’Onofrio Gail , Hawk Kathryn , Joseph Daniel , Fiellin David A.
Published: October 2020

Objectives:

The COVID-19 epidemic in the United States has hit in the midst of the opioid overdose crisis. Emergency medical services (EMS) clinicians may limit their use of intranasal naloxone due to concerns of novel coronavirus infection. We sought to determine changes in overdose events and naloxone administration practices by EMS clinicians.

Methods:

Between April 29, 2020 and May 15, 2020, we surveyed directors of EMS fellowship programs across the US about how overdose events and naloxone administration practices had changed in their catchment areas since March 2020.

Results:

Based on 60 respondents across all regions of the country, one fifth of surveyed communities have experienced an increase in opioid overdoses and events during which naloxone was administered, and 40% have experienced a decrease. The findings varied by region of the country. Eighteen percent of respondents have discouraged or prohibited the use of intranasal naloxone with 10% encouraging the use of intramuscular naloxone.

Conclusions:

These findings may provide insight into changes in opioid overdose mortality during this time and assist in future disaster planning.
Associations Between Comorbidities and Severe Maternal Morbidity
Authors: Brown Clare C. , Adams Caroline E. , George Karen E. , Moore Jennifer E.
Published: October 2020

OBJECTIVE:

To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity.

METHODS:

Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016–2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression.

RESULTS:

The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared with women with no comorbidities (rate 48.5/10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate 238.6; odds ratio [OR] 5.0, 95% CI 4.8–5.2), two comorbidities (rate 379.9; OR 8.1, 95% CI 7.8–8.5), or three or more comorbidities (rate 560; OR 12.1, 95% CI 11.5–12.7). In multivariable regressions, similar associations were noted for women with one (adjusted odds ratio [aOR] 4.4, 95% CI 4.2–4.6), two (aOR 6.6, 95% CI 6.3–6.9), or three or more comorbidities (aOR 9.1, 95% CI 8.7–9.6). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI 54–56%) of Black women having no comorbidities, compared with 67% (95% CI 67–68%) of White women, 68% (95% CI 67–69%) of Hispanic women, and 72% (95% CI 71–73%) of Asian women.

CONCLUSION:

We found a dose–response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions among women of childbearing age may have the potential to improve maternal outcomes across races and ethnicities.
Immediate Repair of a Complete Uterine Transection After Motor Vehicle Collision
Authors: Mankus Erin , Braun Andrew , Knudtson Jennifer , Medrano-Valle Gabriel , McCann Georgia
Published: October 2020

BACKGROUND:

Traumatic separation of the cervix from the uterine corpus is rare. We describe a case in which this injury was identified and surgically repaired at initial presentation to preserve fertility.

CASE:

An 18-year-old woman presented with a pelvic crush injury after a motor vehicle accident. Imaging revealed pelvic fractures and bladder rupture. Complete transection of the uterine corpus at the level of the internal os was identified at laparotomy. The gynecology service was consulted and circumferentially reattached the corpus to the cervix.

CONCLUSION:

Uterine integrity should be confirmed in female patients with pelvic crush injuries who undergo exploratory laparotomy given the unknown extent of intra-abdominal trauma. Immediate surgical correction of uterine transection at the time of injury with restoration of the genital outflow tract is feasible and may allow preservation of fertility.
The Case for Standardizing Cesarean Delivery Technique
Authors: Dahlke Joshua D. , Mendez-Figueroa Hector , Maggio Lindsay , Sperling Jeffrey D. , Chauhan Suneet P. , Rouse Dwight J.
Published: October 2020

In this Commentary, we explain the case for a standardized cesarean delivery surgical technique. There are three strong arguments for a standardized approach to cesarean delivery, the most common major abdominal surgery performed in the world. First, standardization within institutions improves safety, efficiency, and effectiveness in health care delivery. Second, surgical training among obstetrics and gynecology residents would become more consistent across hospitals and regions, and proficiency in performing cesarean delivery measurable. Finally, standardization would strengthen future trials of cesarean delivery technique by minimizing the potential for aspects of the surgery which are not being studied to bias results. Before 2013, more than 155 randomized controlled trials, meta-analyses or systematic reviews were published comparing various aspects of cesarean delivery surgical technique. Since 2013, an additional 216 similar studies have strengthened those recommendations and offered evidence to recommend additional cesarean delivery techniques. However, this amount of cesarean delivery technique data creates a forest for the trees problem, making it difficult for a clinician to synthesize this volume of data. In response to this difficulty, we propose a comprehensive, evidence-based and standardized approach to cesarean delivery technique.
Prioritizing Desiredness in Pregnancy of Unknown Location
Authors: Flynn Anne N. , Schreiber Courtney A. , Roe Andrea , Shorter Jade M. , Frarey Alhambra , Barnhart Kurt , Sonalkar Sarita
Published: October 2020

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.
Biomechanical Analysis of Retrograde Superior Ramus Screw Fixation Constructs
Authors: Lucas Justin F. , Chip Routt Milton L. , Eastman Jonathan G.
Published: October 2020

Objective:

To investigate the biomechanical performance of different size and length retrograde superior ramus screws.

Materials and Methods:

A vertical superior ramus fracture was created in osteoporotic composite hemipelvis bone models (Sawbones, Vashon Island, WA). After reduction, 4 fixation groups were created by inserting either a solid 4.5 mm (Depuy Synthes, Paoli, PA) or cannulated 7.0 mm screw (Zimmer, Warsaw, IN) of either 80 mm (short) or 140 mm (long) in length. An intact and an unstabilized osteotomy group were also created. Samples underwent cyclic loading for 5000 cycles with data acquisition at regular intervals. At the end of cyclic loading, load to failure was performed.

Results:

The displacement after 5000 cycles for 4.5 mm short screws was significantly greater than 4.5 mm long and 7.0 mm short screws. At 5000 cycles, the 4.5-mm short screws had a significantly lower stiffness and lower load to failure than all other screws and were not different from the osteotomy model.

Conclusions:

Short 4.5-mm screws demonstrated increased displacement, lower stiffness, and decreased load to failure compared with all other screws. The biomechanical performance of 4.5-mm short screws was no different than unstabilized controls. Longer bicortical screw fixation is suggested when possible. Additional biomechanical and clinical studies are needed to fully understand the significance of these findings.
The safety of oral versus transdermal estrogen
Authors: Black Denise
Published: October 2020

There exists a growing number of treatment options available to women who choose hormone therapy for management of systemic menopause symptoms. Choosing the product that is the “best fit” for each individual woman can be a challenging task. One of these decisions pertains to the optimal route of estrogen administration. This Practice Pearl will explore some of the differences between oral and transdermal estrogens.
Does age at the start of treatment for vaginal atrophy predict response to vaginal estrogen therapy? Post hoc analysis of data from a randomized clinical trial involving 205 women treated with 10 μg estradiol vaginal tablets
Authors: Derzko Christine M. , Röhrich Sebastian , Panay Nick
Published: October 2020

Objective:

Local estrogen therapy (ET) can improve vaginal atrophy symptoms and associated cellular changes in postmenopausal women. This study evaluated whether age at the start of treatment influences response.

Methods:

This post hoc analysis used data from a double-blind, randomized, placebo-controlled trial (NCT00108849), which treated 205 postmenopausal women aged ≥45 years with 10 μg vaginal ET for 52 weeks.

Women aged <60 or ≥60 years at treatment start were evaluated according to the following: vaginal maturation index (assessed by vaginal cytology samples), vaginal pH, and most bothersome symptom (both graded on four-point scales). Covariance analysis aimed to evaluate mean change differences between groups from baseline–week 52.

Results:

Vaginal ET improved vaginal maturation index (for all cell layers), vaginal pH, and symptom scores for both age groups. However, cytological profiles were significantly different in the <60 (n = 143) versus ≥60 years group (n = 55, estimated effect: –3.7, P 
= 0.0003 [parabasal cells]; 5.8, P 
= 0.0002 [intermediate cells]), indicating reduced cellular responsiveness to treatment among older women. Treatment effect on vaginal pH was less for older women, with a between-group difference of –0.19 (standard error = 0.05; P 
= 0.0003).

Conclusions:

Findings suggest that treatment may be initiated at any age since low-dose vaginal ET improved symptoms and signs of vaginal atrophy in both younger (<60 years) and older (≥60 y) women. The stronger response observed in younger women supports current clinical recommendations to start treatment early. Continued treatment may be important to avoid recurrence of vaginal atrophy.

Video Summary:

http://links.lww.com/MENO/A653.
Nocturnal hypertension: a common phenotype in a tertiary clinical setting associated with increased arterial stiffness and central blood pressure
Authors: Nolde Janis M. , Kiuchi Márcio Galindo , Lugo-Gavidia Leslie Marisol , Ho Jan K. , Chan Justine , Matthews Vance B. , Herat Lakshini Y. , Carnagarin Revathy , Azzam Omar , Schlaich Markus P.
Published: October 2020

Objective:

Although the detrimental effect of increased mean blood pressure (BP) is well established, the role of the dynamic and circadian features of BP is less well defined but may be similarly important. In this prospective analysis of hypertensive patients from a tertiary hospital hypertension clinic, we investigated whether the presence of night-time systolic hypertension is associated with more pronounced end-organ damage as assessed by measures of pulse wave analysis (PWA) and pulse wave velocity (PWV).

Methods:

A cohort of 222 consecutive hypertensive patients underwent ambulatory blood pressure measurements, PWA, PWV testing and collection of routine clinical data. Group differences and group-effects of daytime and night-time hypertension on target organ damage and cardiovascular risk parameters were analysed.

Results:

Nocturnal hypertension was evident in more than half of the study population. PWV, central systolic, mean arterial and pulse pressure were higher in patients with nocturnal hypertension. Stratification into four groups according to daytime and night-time hypertension status revealed group differences in all outcome parameters. Posthoc testing for individual group differences demonstrated significant differences between fully controlled individuals and the group with high daytime and night-time BP. In a regression analysis for independent effects of categorical night-time and daytime hypertension, nocturnal hypertension was a significant predictor for all PWA and PWV outcomes.

Conclusion:

Nocturnal hypertension was a highly prevalent phenotype in this population and associated with increased central BP and more pronounced target organ damage as indicated by elevated PWV. Regression analysis confirmed the role of night-time hypertension as an independent explanatory variable for elevated PWV.
Effect of ambulatory blood pressure monitoring guided antihypertensive treatment on renal progression in patients with chronic kidney disease: a randomized comparative study
Authors: Kim Yunmi , Kim Jayoun , Lee Sung Woo , Sung Suah , Yoo Tae-Hyun , Lee Kyu-Beck , Hwang Young-Hwan , Kim Taehee , Kang Sun Woo , Kim Yeong Hoon , Oh Kook-Hwan
Published: October 2020

Objectives:

Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear.

Methods:

Patients with hypertension and CKD stage 3–4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months.

Results:

A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was −5.5 [95% confidence interval (95% CI) −7.7 to  −3.4] ml/min per 1.73 m2 in the ABPM group and −5.0 (95% CI −6.9 to −3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120).

Conclusion:

The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes.
Superior hypertension control with betablockade in the European Sleep Apnea Database
Authors: Svedmyr Sven , Hedner Jan , Zou Ding , Parati Gianfranco , Ryan Silke , Hein Holger , Pepin Jean-Louis , Tkáčová Ružena , Marrone Oreste , Schiza Sophia , Basoglu Ozen K. , Grote Ludger
Published: October 2020

Aims:

Arterial hypertension is highly prevalent and difficult to control in patients with obstructive sleep apnea (OSA). High sympathoadrenergic activity is a hallmark physiological phenomenon in OSA. We hypothesized that an antihypertensive drug with inhibitory properties on this activity, such as beta blockers (BBs), may be particularly efficacious in OSA patients.

Methods:

Hypertensive OSA patients receiving blood pressure-lowing treatment in the European Sleep Apnea Database (ESADA) (n = 5818, 69% men, age 58 ± 11 years, body mass index 33 ± 7 kg/m2, apnea hypopnea index 34 ± 26 events/h) were analyzed. Reported medications [BB, diuretic, renin-angiotensin blocker (RAB), calcium channel blocker (CCB), and centrally acting antihypertensive (CAH)] were classified according to ATC code. Office blood pressure was compared in patients with monotherapy or combination therapy controlling for confounders.

Results:

Poorly controlled SBP according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 (95% CI 1.4–3.0), 3.0 (1.9–4.1) and 3.0 (1.7–4.7) mmHg higher SBP compared with those on BB (adjusted model, P = 0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, SBP was 5.5 (4.0–7.1), 5.1 (3.7–6.6), 4.3 (2.5–6.1) and 3.1 (1.6–4.6) mmHg higher in those on CCB/RAB, BB/RAB, BB/CCB or diuretic/RAB compared with those on BB/diuretic (adjusted model, P < 0.001, <0.001, 0.018 and 0.036, respectively).

Conclusion:

Poorly controlled blood pressure was common in OSA patients with antihypertensive medication. Treatment with BB alone or BB in combination with a diuretic was associated with the lowest systolic pressure in this large clinical cohort.