bluuebunny/crossref_metadata_2025 huggingface dataset:
Nothingness
Authors: Løgstrup K. E.
Published: May 2023

Finally, Løgstrup accuses Kierkegaard’s understanding of Christianity and human existence of being fundamentally Platonistic because it devalues finitude and immediacy in favour of an idealized transcendence, which human beings can only achieve through dying away from finitude through suffering. He acknowledges that there are differences, such as Platonism’s focus on knowledge as opposed to Kierkegaard’s focus on action; but he also accuses Kierkegaard of overemphasizing this difference. He connects this critique with Kantian idealism and with Hegel. Furthermore, Løgstrup compares Kierkegaard’s idealism with Bertrand Russell’s empiricism through a discussion of the self. Like Kierkegaard, Russell rejects the notion of a substantial self, but where Kierkegaard’s reason for doing so is ethico-religious, Russell’s rejection is based in empiricism and science. Nevertheless, this shows how existentialism and empiricism share central views, and this provides an explanation for why positivism, empiricism, and existentialism are so prevalent in the middle of the twentieth century.
Neutral Impairment, Disadvantageous Disability
Authors: Begon Jessica
Published: May 2023

How should impairment be understood? Both the word and its widespread definition as suboptimal functioning suggests something that warrants removal. Yet this negative account is controversial, since determining which functionings are ‘worse’ is notoriously difficult. Further, this negative conception risks undermining both the coherence of disability pride (why be proud of a deficiency?), and the possibility of solidarity (dividing the ‘genuinely’ deficient from those merely perceived as such). This has led some to abandon the disability/impairment distinction altogether. I argue that, whilst the distinction should be retained, impairment should be understood as anomalous rather than deficient functioning. On this view, impairment is a broad church, including conditions that are relatively inert or even beneficial in our current context. When understood as difference rather than defect, it becomes clear why our goal should be eliminating the capability loss associated with impairment rather than eradicating anomalous functioning itself.
Introduction to The Cooperative Neuron
Authors: Phillips William A.
Published: May 2023

A new era is dawning in the sciences of mind and brain. This book provides an overview of a conceptual revolution that is occurring in our understanding of the cellular foundations of mental life and its disorders. It relates conscious perception, thought, and action to recently discovered capabilities of pyramidal cells, a special class of neocortical neuron that has long been known to be widely distributed through the cerebral neocortex. This introduction summarizes the main topics discussed and inferences drawn in each of the book’s ten chapters. It alerts the reader to some of the underlying assumptions on which those inferences are based. The evidence reviewed and arguments presented in this book are accompanied by a deep undercurrent of moral concern. Finally, chapters in the book show that, while this broadly conceived field of research is in its infancy it is already substantial and growing rapidly.
Life, Brain, and Mind
Authors: Phillips William A.
Published: May 2023

The organized complexity of life depends on cooperation between diverse people, organisms, cells, and molecules. To understand why and how that is so in mammalian neocortex, information-processing operations must be distinguished from the information processed. This chapter previews recent discoveries in cellular neurophysiology and shows that many pyramidal cells can amplify their information transmission when relevant to activity elsewhere in the brain. This context-sensitivity enables large numbers of neurons cooperate more effectively than they could do otherwise. Research that relates mental life in detail to this cellular physiology is described as ‘cellular psychology’ by analogy to ‘molecular biology’. Both arise from the discovery that what was thought to be ‘simple’ components can do more than previously supposed. The chapter touches on enduring philosophical issues and Shakespearean dramas of human mental life on which these discoveries cast new light.
Silvestre Revueltas
Authors: Kolb-Neuhaus Roberto
Published: May 2023

To this day, Silvestre Revueltas (1899–1940) has been systematically portrayed as a nationalist composer both in his native Mexico and abroad. His private and public writings belie this myth, however, as he sought to sound the voice of the downtrodden, not only those wandering the Mexican streets but also gypsy miners in Spain, black slaves in the US South, and those living in Cuba in colonial times. The various soundings of such social actors account for the diversity of aesthetics in his works, which Roberto Kolb-Neuhaus explores in this volume through a correlation of the musical texts with the composer’s writings as well as his wide-ranging political activism. With few exceptions, though, most of his works seek to transcend standards of political art expression, such as program music or scores variously linked to word or image. Revueltas’ early instrumental works appear to abstract a musical ontology from the time and space of his diverse and multiple social actors through a daringly free use of montage and collage. Avant-garde rebellion and satire are also present in his best-known late works. Revueltas’ art is unique and provocatively decolonial, one that pokes fun at the cosmopolitanistic fantasies of his Eurocentric peers at home as well as the exoticizing expectations he faced abroad. Unveiling the sense behind Revueltas’ irony and the form that political passion takes on in his music is the intention guiding Kolb-Neuhaus’s hermeneutic approach, which intertwines Revueltian art with his writings and political actions.
Experiencing Village Life
Authors: Molteno Marion
Published: May 2023

Two accounts of Russell’s time spent in South Asian villages, learning about daily life there: 1950, India: Umri, district Rohilkand, UP. Taken by Khurshidul Islam who had grown up in the village, Russell and his wife stayed with a young landlord called Said, who took him around the village to talk to men in various occupations. The women in Said’s household observed purdah so he could not meet them but his wife spent time with them. 1976, Pakistan: Kanyal, district Gujrat, Punjab. In the UK Russell met a woman from Kanyal who had migrated to the UK, and in Kanyal he stayed with her brother Akram. He joined in the daily routines of village life, observing roles of women and men; poetry as local entertainment; details of farming and other occupations; stories about migrant labour to cities or beyond; varieties of religious belief and observation.
Urdu Poetry Versus the Fundamentalists
Authors: Molteno Marion
Published: May 2023

In the wake of the terrorist attack of 2001 Edward Said wrote that it was important to stress that ‘there is more than one Islam’. Russell describes the anti-fundamentalist nature of Islam as embodied in classical Urdu (and Persian) poetry. He gives examples from Sadi, Hafiz, Ghalib, Hali, and other ghazal poets, particularly Mir, who stress that mere observance of the rituals of religion are in themselves without value, and attacking the traditionalists. The essential humanism of the ghazal derives from its Sufi origins, and stresses love for all humankind. Fundamentalist Muslims have always been uncomfortable with this tradition.
Hindi and Urdu, Languages and Scripts
Authors: Molteno Marion
Published: May 2023

The connections between Hindi and Urdu have long been controversial. Russell discusses their history as languages, the range of overlapping vocabulary; the impact of different scripts; the development of modern literary Hindi; attempts to ‘purify’ either language by avoiding words originating from other language sources. Premchand, Gandhi, and Nehru all wished to promote national unity by stressing that Hindi and Urdu are ‘one language with two scripts’—though this is not born out in an analysis of the language Premchand himself used. In India since Independence, Hindi has been prioritised and Urdu has not been taught in government schools. Children of Urdu speaking families often cannot read the Urdu script and community efforts to counteract this have had limited effect. Some Urdu literature is now being published in Devanagri script, and there is a growing need for Urdu literature to be made available in English translation.
Management of urologic prosthetic reservoirs at the time of inguinal or pelvic surgery
Authors: Tua-Caraccia Rafael D , Adams Eric S , Watters Christopher R , Lentz Aaron C
Published: May 2023

Introduction

The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic regions. Because of this, patients with urologic prosthetics sometimes present challenges during future nonprosthetic operations. Presently, there is no established guideline for device management with ensuing inguinal or pelvic surgery.

Aims

This article outlines concerns during pelvic and inguinal surgery for patients with an artificial urinary sphincter and/or inflatable penile prosthesis and proposes an algorithm for preoperative surgical planning and decision making.

Methods

We conducted a narrative review of the literature on operative management of these prosthetic devices. Publications were identified by searching electronic databases. Only peer-reviewed publications available in English were considered for this review.

Results

We review the important considerations as well as available options for operative management of these prosthetic devices during subsequent nonprosthetic surgery and highlight the advantages and disadvantages of each. Finally, we suggest a framework for helping surgeons determine which management strategy is most appropriate for their individual patients.

Conclusion

The best management strategy will differ depending on patient values, the planned surgery, and patient-specific factors. Surgeons should understand and counsel patients on all available options and encourage informed, shared decision making to determine the best individualized approach.
Neuromedin S regulates steroidogenesis and proliferation in goat Leydig cells through modulating mitochondrial function
Authors: Sun Xuan , Wang Yifei , Mai Qingyang , Fan Yixuan , Huang Qunhao , Du Yingli , Huang Hai , MA El‐Samahy , Wang Feng , Zhang Guomin
Published: May 2023

Neuromedin S (NMS) is a neuroregulatory substance and has many important roles in regulating physiological functions in animal cells, while their specific functions and mechanisms in Leydig cells (LCs) of the testis remain unclear. The current study aims to investigate the role and potential mechanisms of NMS and its receptors in regulating steroidogenesis and proliferation in goat LCs. We found that NMS and its receptors were mainly expressed in LCs of goat testes at different ages (1‐day‐old, 3‐month‐old, and 9‐month‐old), and the highest expressions detected at age three months. NMS addition significantly enhanced the testosterone secretion, STAR, CYP11A1, 3BHSD, and CYP17A1 expressions, cell proliferation, and PCNA expression in vitro cultured goat LCs. Mechanistically, NMS addition increased G1/S cell population, the expressions of CCND1, CDK4 and CDK6, the activities of SOD2 and CAT, and enhanced the mitochondrial fusion, the production of ATP, and mitochondrial membrane potential, while inhibited cellular ROS production, and maintained a low ubiquitination level of mitochondrial proteins. Notably, these effects of NMS addition on goat LCs were suppressed by co‐treatment with NMUR2 knockdown. Therefore, these data suggest that activating NMUR2 with NMS enhances testosterone production and cell proliferation in goat LCs through modulating mitochondrial morphology, function, and autophagy. These findings may provide a novel view of the regulatory mechanisms involved in male sexual maturation.
Expression of Apoptotic and Ubiquitin-Proteasome Genes Are Altered in Blastocoel Fluid From Preimplantation Euploid IVF Embryos That Result in Miscarriage [ID: 1365769]
Authors: Collins Carson , Chosed Renee , Green Lisa , Kordus Richard , Nguyen Dieu Thao , Vaillant Kayla
Published: May 2023

INTRODUCTION:

Infertility is one of the leading causes of recurrent miscarriage, affecting approximately 14% of reproductive-aged patients. Recurrent miscarriages are presumed to be the result of embryonic chromosomal abnormalities such as aneuploidy. Literature has indicated that apoptotic mechanisms may play a role in selective elimination of aneuploid cells during preimplantation embryo development. This study aims to identify the expression patterns of an apoptotic gene and a gene encoding a ubiquitin ligase within blastocoel fluid-conditioned media from preimplantation euploid in vitro fertilization (IVF) embryos that resulted in miscarriage to identify specific genes associated with poor implantation outcomes.

METHODS:

Candidate genes were identified through whole-transcriptome (RNA-seq) analysis of blastocoel fluid from euploid IVF embryos that resulted in successful or unsuccessful implantation. Blastocoel fluid from euploid IVF embryos resulting in miscarriage or successful implantation was selected for specific gene expression analysis using RT-qPCR and Taqman-specific primers. BCL2L12 and SHARPIN gene expression was assessed, compared to GAPDH control.

RESULTS:

Expression of BCL2L12, an antiapoptotic gene, and SHARPIN, a gene that encodes an ubiquitin ligase, was altered in blastocoel fluid samples associated with miscarriage. Initial studies indicate that SHARPIN has a higher expression in blastocoel fluid from samples associated with negative implantation outcomes.

CONCLUSION:

Identification of gene expression patterns during preimplantation development that are associated with miscarriage may allow for an additional embryo quality metric to improve the success of each IVF embryo transfer potentially reducing the number of miscarriages. Additionally, these metrics could be expanded to allow for the identification of potential high-risk pregnancies soon after implantation, without any harm to the fetus.
Evaluating Ob-Gyn Resident Beliefs Toward COVID-19 Vaccine and Its Safety and Efficacy in Pregnancy: A National Survey [ID: 1375473]
Authors: Weinstein Anna , Desai Chandani , Francis Antonia , Yacoel Tamar
Published: May 2023

INTRODUCTION:

Vaccination beliefs vary across the United States. The American College of Obstetricians and Gynecologists (ACOG) recently published formal recommendations for COVID-19 vaccination in pregnancy. Outlooks regarding maternal vaccination among obstetrician–gynecologists have important implications for maternal morbidity and mortality. Resident perception of COVID-19 vaccination has yet to be studied. Our national survey sought to evaluate ob-gyn resident views regarding COVID-19 vaccine safety and efficacy in pregnancy.

METHODS:

In April 2022, a national survey was sent to all Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency programs in the United States. Responses were obtained and descriptive analysis was performed. Institutional review board approval was obtained.

RESULTS:

The majority of ob-gyn residents believed that pregnant patients should be vaccinated against COVID-19 (96.1%, n=73). In the outpatient setting, most resident physicians reported that they strongly recommend the COVID-19 vaccine to pregnant patients (89.5%, n=68). The majority of respondents believed the COVID-19 vaccine is effective in reducing maternal morbidity and mortality (98.7%, n=75). Of that subgroup, a minority of respondents felt the safety profile of COVID-19 vaccine in pregnancy is unknown (10.7%, n=8). Geographic distribution of respondents, as defined by Centers for Disease Control and Prevention Census designations, were as follows: Midwest (34.3%, n=26); Northeast (40.8%, n=31); South (10.5%, n=8); West (14.4%, n=11).

CONCLUSION:

The majority of ob-gyn residents believed the COVID-19 vaccine to be effective in reducing maternal morbidity and mortality. Although a minority were uncertain regarding its safety profile, they continued to recommend vaccination per ACOG guidelines. While descriptive responses were homogenous, a paucity of respondents from the South and West regions made geographic distribution uneven.
Effect of Policies Aiming to Restrict Ultrasound Use [ID: 1375832]
Authors: Hemminger Anna , Louis Judette , Price Corley Rachelle
Published: May 2023

INTRODUCTION:

During the early months of the COVID-19 pandemic, policies were implemented that sought to reduce in-person prenatal visits and ultrasounds. We sought to evaluate the effect of those policies on the rate of diagnosed fetal growth restriction and infant low birth weight.

METHODS:

We performed a cohort study of patients delivered at an academic center. Participants who received prenatal care during the time period of restricted visits were matched in a 1:1 ratio to patients receiving care during an equivalent time period when there were no such restrictions (group I: July 1, 2019, to December 31, 2019; and group II: March 23, 2020, to September 23, 2020). Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following: stillbirth, neonatal death, preterm birth, neonatal intensive care unit admission, low birth weight. Data were analyzed using chi-square and Mann-Whitney U test where appropriate. P<.05 was significant.

RESULTS:

Our cohort included 580 patients. Overall, the group had a 13% preterm birth rate, 8.2% were diagnosed with fetal growth restriction, and 26% had the composite neonatal morbidity. All patients in the cohort had at least one ultrasound. Compared to group I, group II had more individuals who had only one ultrasound during the pregnancy (3.1 versus 0%, P=.004), but overall the group had more total ultrasounds performed (1.5 [1–3] versus 1 [1–2], P=.02) and had more patients who required fetal surveillance for maternal and fetal conditions (56 versus 44, P=.014). Group II was more likely to have a neonatal demise (1.4 versus 0.3%, P<.01), but there was no difference in the rate of prenatal diagnosis of fetal growth restriction or low birth weight.

CONCLUSION:

Policies to reduce prenatal ultrasounds were not effective in reducing ultrasounds performed, and there was no difference in the diagnosis of fetal growth restriction despite an increase in comorbidity.
Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042]
Authors: Groves Savannah , Hsu Albert
Published: May 2023

INTRODUCTION:

Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine.

METHODS:

This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683).

RESULTS:

In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331).

CONCLUSION:

In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.
Trust in Health Care Providers After 2 Years of COVID: Perceptions From a Missouri Birthing Population [ID: 1380219]
Authors: Williams Emily , Chrans K. Mariah , Lewis Elizabeth , Otto Ashlie , Ramaeker Devon , Smith Martha
Published: May 2023

INTRODUCTION:

Distrust in the medical system is rooted in American history and exacerbated after the rapid dissemination of COVID-19 vaccinations. Pregnant women were the lowest group to receive vaccinations. We sought to understand vaccine uptake and perceptions of provider credibility in the Missouri birthing population.

METHODS:

The Perinatal Quality Collaborative (PQC) of Missouri developed a questionnaire assessing perceived trustworthiness of medical providers. Further questions assessed willingness to receive a COVID-19 vaccination. A mailing list racially representative of the birthing population was purchased (Dynata) with grant support. Thirty-nine questions were distributed from March to August 2022 to birthing persons 18 or more years of age. Those without a Missouri zip code or who identified as male were excluded.

RESULTS:

One thousand seven hundred thirty-eight people met inclusion criteria with a response rate of 89%. Of those, 74.5% identified as White, 14% as Black, 3.5% as Hispanic, 3.6% as Native American, 2.5% as Asian, 0.3% as Hawaiian Native or Pacific Islander, and 1.6% as other/unknown. Eighty-five people who responded were currently pregnant. Trust in provider recommendations was high at 83% with 80.9% stating they look to their physicians for reliable medical advice. The majority of respondents were aware that pregnancy is a risk factor for COVID-related complications, but only 39.6% stated they would be willing to receive a vaccine while pregnant.

CONCLUSION:

Despite low willingness to accept a COVID vaccine while pregnant, the Missouri birthing population overall trusts and seeks medical advice from their providers. Time allocated for more targeted counseling from all health care workers could increase vaccine uptake in the pregnant population.
Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic: A Population-Based Study [ID: 1380265]
Authors: Gulersen Moti , Bornstein Eran , Chervenak Frank , Grunebaum Amos , Lenchner Erez
Published: May 2023

INTRODUCTION:

We previously reported that the prevalence of hypertensive disorders of pregnancy (HDP) increased during the COVID-19 pandemic. We aimed to ascertain potential sociodemographic factors contributing to this association.

METHODS:

This was a retrospective analysis of the U.S. Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). The prevalence of HDP, defined as a composite of gestational hypertension, preeclampsia, and eclampsia, was compared between the COVID-19 pandemic group (births from April 1, 2020, to December 31, 2020; n=2,728,674) and the pre-pandemic group (births from January 1, 2016, to February 29, 2020; n=15,967,803). A comparison of the prevalence of HDP among maternal sociodemographic factors and pregnancy characteristics between the two groups was also performed using χ2 test. Multivariable logistic regression was used to adjust for potential confounders. Statistical significance was set at P<.05.

RESULTS:

We detected an overall increase in odds of HDP during the COVID-19 pandemic period (8.7% versus 7.1%, adjusted odds ratio 1.25, 95% CI 1.24–1.26). The highest prevalence of HDP during the pandemic was seen in similar sociodemographic subgroups as in the pre-pandemic group, such as older maternal age, patients with some college credit, private insurance, and non-Hispanic Black race. A marked increase in HDP prevalence was noted during the pandemic in most maternal characteristic subgroups evaluated, with the greatest noted in Asian individuals and tobacco users. Interestingly, chronic hypertension, which was more prevalent during the pandemic period (1.2% versus 0.9%, P≤.001), was associated with a lower prevalence of HDP during that time.

CONCLUSION:

The prevalence of HDP increased in the United States during the COVID-19 pandemic among all sociodemographic factors evaluated. Although chronic hypertension was more prevalent during the pandemic period, it had a lower effect on the development of HDP during that time.
Breast/Chestfeeding and HIV: Shared Decision-Making and the Needs of Women [ID: 1372281]
Authors: Covin Ciarra , Conley Jenna , Ford Olivia , Levison Judy , Martel Krista , Picou Bridgette
Published: May 2023

INTRODUCTION:

Breast/chestfeeding is considered both the healthiest infant-feeding option for the general population and the standard of care for birthing parents living with human immunodeficiency virus (HIV) in resource-limited settings. Inadequate research on breastfeeding and HIV in high-resource settings has resulted in a lack of clinical guidance for providers to support informed decision-making among women living with HIV in these areas.

METHODS:

The Well Project, a nonprofit working to change the course of the HIV pandemic through a unique and comprehensive focus on women, conducted a survey in 2021 that included questions about breastfeeding experiences. Among 200 self-identified women living with HIV surveyed via Survey Monkey, 33 women reported experiences around breastfeeding.

RESULTS:

Forty-nine percent of women reported discussing breastfeeding with their provider—60% with ID providers and 57% with obstetrician–gynecologists. Half of respondents reported their provider initiated the discussion. Sixty-nine percent said their provider told them they could not breastfeed; 19% said they received incomplete/inaccurate breastfeeding information; and 13% reported their provider supported them in making the best decision for their families.

CONCLUSION:

These numbers, although small, supplement anecdotal evidence suggesting that most U.S. women living with HIV are not counseled according to the Perinatal HIV Guidelines, which recommend people living with HIV who are interested in breastfeeding receive patient-centered, evidence-based counseling on their options and those who choose to breastfeed be supported in order to minimize transmission risk. Education is greatly needed to ensure providers support their patients through this decision-making process.
Effect of the COVID-19 Pandemic on Substance Use in Pregnancy and Associated Neonatal Outcomes [ID: 1342912]
Authors: Moncada Kea Alexa , Beckerman Karen , Chacko Jerel , Fruhman Gary , Izard Stephanie
Published: May 2023

INTRODUCTION:

We sought to determine whether the COVID-19 pandemic resulted in an increase in positive urine drug screens (UDSs) in labor and delivery and whether the effect of drug use on neonatal outcomes differed before versus during the pandemic.

METHODS:

In this retrospective chart review, we identified patients from February 4, 2018, to May 11, 2022, with a completed UDS test and classified them into time periods: pre-COVID-19 and COVID-19. Pearson's χ2 test or Fisher's exact test was used to assess whether the proportion of positive tests and the presence of each drug type differed between the periods. A logistic regression was used to explore the effect of time period and test result on neonatal outcomes.

RESULTS:

We identified 7,648 UDS results; 3.6% were positive in the pre-COVID-19 period and 1.6% were positive in the COVID-19 period (P<.001). We found higher proportions of benzodiazepine and cannabinoid detection in the pre-COVID-19 period (P=.045 and P=.005, respectively). In the COVID-19 period, we found higher proportions of buprenorphine detection (P=.004). In the COVID-19 period, there was a stronger association between positive UDS results and neonatal intensive care unit (NICU) admission compared to the pre-COVID-19 period (odds ratio [OR] 16.78 [95% CI: 9.9, 28.6], 6.2 [95% CI: 3.8, 10.0], respectively). During the COVID-19 period, drug use was found to be a risk factor for small for gestational age (SGA) (OR 4.1 [95% CI: 2.3, 7.4]).

CONCLUSION:

We found a decrease in drug use during the COVID-19 pandemic. However, drug use during the pandemic was more strongly associated with NICU admission and was a risk factor for SGA.
Comparison of Weaning and Nonweaning of Medication-Assisted Treatments in Pregnant and Postpartum Women With Opioid Use Disorder: A Systematic Review [ID: 1376658]
Authors: Adelli Rakesh , Olsen Martin , Ramirez Andrea , Shah Darshan , Subbanna Maya , Walker McKenzie
Published: May 2023

INTRODUCTION:

The objective of this study was to perform a systematic review of studies reporting the maternal and infant outcomes associated with weaning (W) and nonweaning (NW) of medication-assisted treatments (MATs) in pregnant and postpartum women with opioid use disorder.

METHODS:

Studies done between the years 2000 and 2022 were extracted from PubMed using MeSH terms (neonatal abstinence syndrome, pregnancy, opioid disorder, and outcomes). Studies that reported maternal and infant outcomes associated with W and NW of MATs and done in English language were included. Thirty-eight studies out of 329 met the criteria. Data included study design, number of participants, and maternal and infant outcomes. SPSS was used to perform the analysis.

RESULTS:

Among the 38 studies included in this review, 8 were W studies, which included 1,214 participants, and 30 were NW, which included 5,727 participants. The average birth weight of infants was 3.07 kg (W group), 3.03 kg (NW group) (P=.01), and 3.3 kg (national average 2020); preterm deliveries were 13.6% (W group), 15.2% (NW group) (P=<.0001), and 10.1% (national rate 2020). Babies needing abstinence treatment was lower in W group (43.6% versus 51.6%, P=<.0001). Five in 286 deliveries in W group and 5 in 3,478 deliveries in NW group were recorded as pregnancy loss (P=<.0001).

CONCLUSION:

A statistically significant difference was observed between the preterm rates in MAT groups and the national average (P<.0001) and between pregnancy loss, average birth weight, and infants needing abstinence treatment of both groups. The W group had lower numbers of preterm babies, and babies needing abstinence treatment, and the average birth weight in W group was closer to the national average.
Cannabis Use in Pregnancy: Effects of a Hospital Policy on Toxicology Screening Practices [ID: 1377573]
Authors: DiBiase Florence , Brousseau Erin , Pileika Lindsey , Reddy Neha
Published: May 2023

INTRODUCTION:

Guidelines for toxicology screening in pregnancy are lacking. Studies suggest provider bias in implementation and potential serious consequences for patients. We examined the effect of a novel hospital policy.

METHODS:

A protocol was outlined for verbal screening, counseling, and toxicology screening by a hospital task force on cannabis use in pregnancy. Institutional review board approval was obtained for study. A retrospective chart review and analysis of practices on admission for delivery was performed 6 months pre- and post-policy implementation in resident low-risk and maternal–fetal medicine clinics.

RESULTS:

There were 2,373 deliveries during the study period and 129 mother–infant dyads underwent toxicology screening. The rate of maternal screening did not significantly differ pre- and post-policy implementation (2.6% versus 3.4%, P=.23). In those screened, the rate of maternal cannabinoid positivity increased significantly post-policy (13.8–42.9%, P=.005). Similarly, the rate of neonatal screening did not significantly differ pre- and post-policy implementation (3.4% versus 3.6%, P=.88), while the neonatal cannabinoid positivity rate increased significantly post-policy (7.7–31.8%, P=.005). There were no significant differences in demographics of those screened pre- versus post-policy.

CONCLUSION:

Implementing a hospital policy did not change the rate or demographics of screening but did correlate with an increased cannabinoid detection rate. The effects of the policy should be cautiously considered. The benefit of standardized verbal screening and discussion of risks is clear, but potential harm from toxicology screening remains.
Emergency Contraception Deserts in the New Orleans Metropolitan Area Post-Dobbs v Jackson Women's Health Organization [ID: 1369505]
Authors: Sisk Charles , Bergeron Lauren , Rault Lule , Ulrich Nicole , Williams Frank
Published: May 2023

INTRODUCTION:

Recent legal changes limit access to abortion in Louisiana. Ensuring access to over-the-counter (OTC) emergency contraception (EC) is essential in the current environment. Building on the idea of “food deserts,” we aimed to identify EC deserts, or places where urban residents would need to travel more than 1 mile to acquire OTC EC.

METHODS:

During the months of August and September 2022, secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes (counties) to ascertain the availability of OTC EC. Distance from such pharmacies was calculated for each of the 348 census tract centroids (CTCs) in the survey region. Chi-square analysis was used to compare the number of CTCs with a distance greater than 1 mile to OTC EC relative to the number of pharmacies stocking OTC EC in a given parish (county).

RESULTS:

Of 212 eligible pharmacies, 97 (46%) offered EC for sale OTC and had it in stock: 46% in Jefferson Parish, 46% in Orleans Parish, and 45% in Terrebonne Parish. Mean distance from CTC to a pharmacy stocking EC OTC was 1.45 miles, and median distance was 0.66 miles. Overall, 26% of CTCs met the above criteria for emergency contraception deserts; 21% of pharmacies in Jefferson and Orleans parishes met criteria compared to 69% of pharmacies in Terrebonne Parish (P<.001).

CONCLUSION:

Fewer than half of surveyed Louisiana retail pharmacies have immediately available OTC emergency contraception, with nearly 70% of census tracts located in Terrebonne Parish defined as EC deserts.
Immediate Postpartum Long-Acting Reversible Contraception Uptake and Outcomes [ID: 1371558]
Authors: Holland Kelsey , Mastronardi Alicia , Young Megan , Zite Nikki
Published: May 2023

INTRODUCTION:

Tennessee Medicaid began covering immediate postpartum (IPP) long-acting reversible contraception (LARC) in November 2017 with the goal of reducing the rate of short-interval births (SIBs) (defined as less than 24 months after a previous birth). In 2014, 22.7% of births in Tennessee were SIBs. We sought to determine IPP LARC uptake and SIB outcomes for women who received IPP LARC after this policy was implemented.

METHODS:

A retrospective chart review of women who delivered from March to December 2018 and received IPP LARC was conducted. LARC receipt and SIB outcomes were determined utilizing local, regional, and state records (IRB: 4768, 2021-0303).

RESULTS:

Among the 406 IPP LARC recipients, the average age was 25.9 (15–42), and the average number of living children was 1.28 (0–6). LARC type elected was 4.7% copper intrauterine system (Cu-IUS), 39.9% levonorgestrel-releasing intrauterine system (LNG-IUS), and 55.4% contraceptive implant. Subsequent SIB was identified in only 5.4% (22). Of these, 2 received Cu-IUS, 10 received LNG-IUS, and 10 received contraceptive arm implants. Timing and reason for removal were documented for 7 of these. Expulsion was identified in 1 copper and 1 hormonal IUD. Removals due to side effects were reported in 3 implant and 2 hormonal IUD users.

CONCLUSION:

The rate of SIB among the IPP LARC recipients was much lower than the general rate among Tennessee women, highlighting the benefit of IPP LARC provision. Additionally, the high preference for contraceptive implants may reflect provider counseling on the increased risk of IUD expulsion when placed IPP or other factors that may be elucidated by future studies.
Trends in Contraceptive Choices Among Patients Delayed in Receiving Bilateral Tubal Ligation Because of the COVID-19 Pandemic [ID: 1371694]
Authors: Conrad Sarah , Bohac Sarah , Carranco Sara , Casey Sarah
Published: May 2023

INTRODUCTION:

The COVID-19 pandemic led to a decline in access to elective surgeries and contraceptive care. Today, there remains a backlog of patients awaiting elective female sterilization. The use of alternative contraception during delays has yet to be explored. To address this gap, patients awaiting sterilization were surveyed to evaluate trends in contraception usage.

METHODS:

Patients at Ben Taub Hospital who desired tubal ligation between March 2020 and July 2022 were called and asked to complete a 23-question survey, which assessed obstetric history, current contraceptive usage, and demographics. Patients were called up to three times, and descriptive statistics were analyzed.

RESULTS:

Of 217 patients, 123 consented to the survey (56%). Respondents almost entirely identified as Black, Indigenous, and people of color (BIPOC), with 83% of surveys administered in Spanish. The average age was 36. While awaiting sterilization, 85% used an alternative form of contraception, with Depo-Provera (Depo) and oral contraceptive pills (OCPs) being the most common. 28.5% of Depo users endorsed missing injections. Thirty-eight percent of patients using OCPs reported missing doses. Thirty-two percent reported undesirable side effects of their contraceptive, such as pain or irregular bleeding. Overall, 58% were satisfied with their current contraceptive method with 89% still desiring tubal ligation. In total, there were six unplanned pregnancies.

CONCLUSION:

Despite extensive COVID-19-related delays in sterilization, most patients still desired the procedure. Patients most commonly chose Depo and OCPs for contraception to bridge the delay, as opposed to long-acting reversible contraceptives.
Trends in Contraception Use and Contraception Method Preference at Last Intercourse in Cisgender Women at High Risk for HIV Acquisition [ID: 1373337]
Authors: Satish Sanjana , Mantero Alejandro , Sonalkar Sarita
Published: May 2023

INTRODUCTION:

Cisgender women account for almost 20% of new human immunodeficiency virus (HIV) infections in the United States. This study aims to assess contraception use at last intercourse in cisgender women at high risk for HIV acquisition.

METHODS:

We abstracted demographics, socioeconomic status, HIV risk, and reproductive health information from the 2017 iteration of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. We used survey-weighted logistic regression adjusted for several demographic factors to compare trends of contraception use between those at low and high risk for HIV acquisition, which was defined as those who have engaged in transactional sex practices, used injection drugs, or been treated for a sexually transmitted infection in the past year.

RESULTS:

Women at high risk for HIV acquisition had no significant difference in contraception use at last intercourse compared to those at low risk (P=.262, odds ratio [OR] 1.11 [0.93–1.32]). Among those who did not use contraception at last intercourse, women at risk for HIV acquisition were more likely to state indifference toward getting pregnant (P=.029, OR 1.79 [1.06–3.01]) and lapse in method use (P=.001, OR 4.55 [1.80–11.5]) as reasons for not using contraception. Additionally, those at high risk for HIV were more likely to have had an intrauterine device (IUD) (unknown type) at last intercourse (P<.001, OR 1.70 [1.28–2.24]) and less likely to have used hormonal shots (P=.015, OR 0.47 [0.26–0.86]).

CONCLUSION:

Women at risk for HIV are more likely to have had an IUD at last intercourse, which could indicate a role for the integration of HIV preexposure prophylaxis and family planning. Contraception method preference in this population and attitudes toward pregnancy should be further investigated.
A Descriptive Analysis of Emergency Contraception Familiarity in Postpartum People [ID: 1377163]
Authors: Wegner Lindsay , Lu Connie , Patterson Lane , Serino Maeve , Turner Ashley
Published: May 2023

INTRODUCTION:

Ensuring access to emergency contraception (EC) is a fundamental component of comprehensive contraceptive counseling and reproductive health care. Despite this, little is known about familiarity with EC in postpartum people, a population motivated to prevent pregnancy in part because of the risk of short interpregnancy interval. This study aims to assess familiarity with EC in postpartum people.

METHODS:

After IRB approval, 76 participants choosing a lower-efficacy method of postpartum contraception were recruited from a large urban hospital on postpartum day 1. Most participants were between the ages of 25 and 34, married, employed, and have had multiple pregnancies. Familiarity with EC and reproductive health were assessed via surveys after attaining patient consent. Descriptive statistics were performed.

RESULTS:

Nearly all participants (91%) had heard of EC before. A minority of participants (18%) have brought up EC with a health care professional, while approximately half (46%) reported a health care professional bringing up EC with them. Most participants (75%) reported being at least somewhat likely to take EC if they wanted to prevent pregnancy. One-third of participants reported prior use of EC, while nearly half of participants (42%) reported having at least one unplanned pregnancy.

CONCLUSION:

A majority of participants were aware of and willing to use EC despite a minority of participants having discussed the option with a health care professional. For all patients but especially those who select a lower-efficacy postpartum contraceptive method, health care providers can supplement reproductive choice and reduce the risk of short interpregnancy interval through comprehensive counseling on when and how to use EC.
A Review of Female Sterilization in the United States in the Wake of Roe v Wade [ID: 1377581]
Authors: Shirazian Taraneh , Parker Mahdia , Zarcadoolas Christina
Published: May 2023

INTRODUCTION:

With the anticipation of the overturning of Roe v Wade, U.S. physicians reported an increase in demand for female sterilization procedures. This literature review aims to analyze existing survey tools and how they assess sterilization motivations and postprocedure regret.

METHODS:

Keywords “female sterilization tool,” “female sterilization assessment,” “female sterilization questionnaire,” and “female sterilization survey” were entered into the National Center for Biotechnology Information PubMed search. A title screen for female human studies and an abstract screen selection for survey-based, English, and full-text studies were applied. Seventy percent intercoding agreement was reached between four researchers.

RESULTS:

Sixty-five texts were fully reviewed. The minority (15.4%) were U.S. based and 18 (27.7%) of the publications utilized pretested questionnaires. One hundred seventy-four questions across six surveys were analyzed. Comprehension of complex vocabulary and medical terms cannot be assumed to be within the health literacy abilities of most nonmedical professionals. Cultural sensitivity was deficient in questions around contraception choices and family planning, which assumed that these practices are ubiquitous among sexually active women without acknowledging cultures that do not readily use contraception in family planning. Exclusive language regarding gender and sexuality assumed heterosexual preference and cisgender identity for both participants and their partners, which alienates participants who identify LGBTQ+, transgender, or nonbinary and obscures the nuance of sterilization practices among these identities.

CONCLUSION:

Data on sterilization regret and motivations could be hindered by literacy and biased questioning. A novel, pretested survey tool oriented toward inclusive and comprehensive language is needed to capture female sterilization trends.
Elagolix With Add-Back Rapidly Improves Nonbleeding Symptoms in Individuals With Fibroid-Associated Heavy Menstrual Bleeding [ID: 1368052]
Authors: Simon James , Jewell Susan , Li Moming , Ng Juki , Pinsky Brett
Published: May 2023

INTRODUCTION:

Elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) significantly improves heavy menstrual bleeding (HMB) in patients with uterine fibroids (UFs). Data on the effect of ELA+AB on nonbleeding symptoms in HMB-UF patients are limited.

METHODS:

Elaris UF-1 and UF-2 (NCT02654054 and NCT02691494) were duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month phase 3 studies. This post hoc analysis evaluated the Patients Global Impression of Change (PGIC) for menstrual bleeding (MB) and nonbleeding symptoms. Patients rated symptom change on a 7-point scale from “very much improved” (1) to “very much worse” (7).

RESULTS:

Among responders (6-month MBL <80 mL and ≥50% MBL reduction from baseline), mean (SD) PGIC-MB and PGIC-abdominal bloating were better for ELA+AB versus placebo as early as 1 month (2.1 [1.3], n=199 versus 2.8 [1.5], n=22; and 3.1 [1.2], n=201 versus 3.7 [1.0], n=21, respectively) through 6 months (1.3 [0.9], n=221 versus 2.9 [1.3], n=13; and 2.3 [1.3], n=221 versus 3.7 [0.9], n=13, respectively). Patients treated with ELA+AB had improvement in symptoms at 3 months compared to placebo and at 6 months reached scores in the domains abdominal/pelvic pain (1.8 [1.1] versus 3.2 [1.0]), abdominal/pelvic pressure (1.9 [1.2] versus 3.4 [0.9]), abdominal/pelvic cramping (1.8 [1.0] versus 2.9 [1.2]), and back pain (2.3 [1.3] versus 3.2 [1.0]). Similar results were observed for the total patient population.

CONCLUSION:

ELA+AB provides rapid bleeding and nonbleeding symptom improvement for patients with UF-associated HMB. Improvement for ELA+AB–treated patients was observed as early as 1 month, with nonbleeding PGIC scores consistently approaching “much and very much improved” in all domains by 6 months.
Elagolix Improves Low Hemoglobin in Women With Uterine Fibroid-Associated Heavy Menstrual Bleeding: Post Hoc Analysis of Elaris UF-1 and UF-2 [ID: 1368055]
Authors: Jewell Susan , Pinsky Brett , Schlaff William , Snabes Michael , Uribe Liz
Published: May 2023

INTRODUCTION:

Women with uterine fibroids (UFs) often experience heavy menstrual bleeding (HMB) and anemia. We report improvement in hemoglobin (Hgb) levels over time with elagolix (ELA) with estradiol 1 mg/norethindrone acetate 0.5 mg once-daily add-back (AB) therapy in women with UF-associated HMB.

METHODS:

This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo (PBO)-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated ELA 300 mg twice daily plus AB versus PBO in women with UF-associated HMB. Hgb concentration (in grams/deciliter) was assessed monthly; no adjustment for multiple comparisons were made. All patients received ELA+AB in the pivotal and extension periods. Patients with baseline Hgb>10.5 g/dL but ≤12 g/dL were classified as “HgbLow” and Hgb≤10.5 g/dL as “Hgb≤10.5.”

RESULTS:

Baseline demographics were balanced between treatment groups. Overall, by month 1 of treatment, patients receiving ELA+AB (n=395) showed significant improvement in mean change in Hgb compared with PBO (n=196, P=.001). At month 6, 58.8% (HgbLow) and 35.7% (Hgb≤10.5) of patients reached Hgb>12 g/dL with ELA+AB versus 27.7% and 7.2% with PBO, respectively. Improvements in Hgb levels were sustained through 12 months (HgbLow, 59.6%; Hgb≤10.5, 46.3%). During the extension period, 49.3% of patients in the Hgb≤10.5 group treated with ELA+AB reached Hgb>12 g/dL at 9 months of treatment, with responses sustained through 12 months (ELA+AB/ELA+AB, 46.3%). 71.9% of patients in the HgbLow group reached Hgb>12 g/dL by 9 months, with responses sustained through 12 months (ELA+AB/ELA+AB, 59.6%).

CONCLUSION:

ELA+AB results in rapid, sustained improvement in Hgb levels in women with UF-HMB, regardless of starting Hgb levels.