bluuebunny/crossref_metadata_2025 huggingface dataset:
Migraine care practices in primary care: results from a national US survey
Authors: Callen Elisabeth , Clay Tarin , Alai Jillian , Crawford Paul , Visconti Adam , Nederveld Andrea , Cruz Inez , Perez Bailey , Roper Karen L , Oser Tamara K , Saint Laurent May-Lorie , Jabbarpour Yalda
Published: May 2023

Background

Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations.

Methods

The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week.

Results

Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries.

Conclusions

Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented.
Fast and provable tensor robust principal component analysis via scaled gradient descent
Authors: Dong Harry , Tong Tian , Ma Cong , Chi Yuejie
Published: May 2023

An increasing number of data science and machine learning problems rely on computation with tensors, which better capture the multi-way relationships and interactions of data than matrices. When tapping into this critical advantage, a key challenge is to develop computationally efficient and provably correct algorithms for extracting useful information from tensor data that are simultaneously robust to corruptions and ill-conditioning. This paper tackles tensor robust principal component analysis (RPCA), which aims to recover a low-rank tensor from its observations contaminated by sparse corruptions, under the Tucker decomposition. To minimize the computation and memory footprints, we propose to directly recover the low-dimensional tensor factors—starting from a tailored spectral initialization—via scaled gradient descent (ScaledGD), coupled with an iteration-varying thresholding operation to adaptively remove the impact of corruptions. Theoretically, we establish that the proposed algorithm converges linearly to the true low-rank tensor at a constant rate that is independent with its condition number, as long as the level of corruptions is not too large. Empirically, we demonstrate that the proposed algorithm achieves better and more scalable performance than state-of-the-art tensor RPCA algorithms through synthetic experiments and real-world applications.
SARS-CoV-2 Infection and Response to COVID-19 Vaccination in Patients With Primary Immunodeficiencies
Authors: Paris Robert
Published: May 2023

Primary immunodeficiencies (PIDs) are heterogeneous, rare disorders that increase susceptibility to infection and/or immune dysregulation. Individuals with certain PIDs are at high risk of severe or fatal outcomes from SARS-CoV-2 infections (the causative agent of COVID-19), either due to the underlying PID and/or due to the presence of comorbidities such as severe lung and liver disease. Vaccination remains the primary strategy to protect individuals with PID from COVID-19. However, populations with PID exhibit variable vaccine seroresponse rates, antibody titers, and neutralization activity depending on the type of PID and/or COVID-19 vaccine, and consequently, are at an elevated risk of severe disease. In this article, we review the COVID-19 burden in patients with PIDs and focus in-depth on findings from patients with predominantly antibody deficiencies or combined immunodeficiencies. We conclude by providing COVID-19 vaccination recommendations for this population.
Government Choices of Debt Instruments
Authors: Mosley Layna , Rosendorff B Peter
Published: May 2023

Governments borrow from a range of creditors—commercial banks, sovereign bondholders, official bilateral creditors, and multilateral financial institutions. Sovereigns’ creditor portfolios vary significantly across space and time. While creditor portfolios partly reflect supply-side considerations (macroeconomic profiles and associated default risk), they also reflect governments’ preferences over fiscal transparency. Governments that prefer to disclose less information about economic outcomes will choose borrowing instruments that are less public, such as private loans from banks (versus bondholders) and official sector borrowing from bilateral (versus multilateral) creditors. Empirical analyses of government debt composition across developing nations confirm these predictions. We also find support for our claims at the subnational level, using data from Mexican municipalities. We treat various types of credit (bilateral lending, multilateral finance, and sovereign bonds) as related, rather than distinct.
The Thigh of Its Mother: The Fetus and the Subordinated Subject in the Babylonian Talmud
Authors: Ronis Sara
Published: May 2023

Modern discussions of abortion in Jewish thought often invoke the Talmudic phrase “ubar yerekh imo,” the fetus is the thigh of its mother. This article examines the ten instances in which the phrase first appears in the Babylonian Talmud. I demonstrate that the rabbis of Late Antique Sasanian Babylonia deploy the phrase in two specific contexts: discussions of the sanctification, criminalization, or sale of non-human animal fetuses, and discussions of the sale and manumission of the fetuses of enslaved people. Drawing on insights from animal studies and studies of slavery, I argue that this phrase illuminates how the rabbis think with the fetus to value some lives over others in a world reliant on the exploitation of enslaved humans and animals, and compare this approach with that of the Roman jurist Ulpian. Ultimately, I shed light on ancient rabbinic anthropologies of the human body and the body politic.
Enzymatic degradation of ochratoxin A in the gastrointestinal tract of piglets
Authors: Prasad Shreenath , Streit Barbara , Gruber Christina , Gonaus Christoph
Published: May 2023

Animal feeds are often contaminated with ochratoxin A (OTA), a potent natural mycotoxin hazardous to animal and human health that accumulates in blood and tissues. To the best of our knowledge, this study is the first to investigate the in vivo application of an enzyme (OTA amidohydrolase; OAH) that degrades OTA into the nontoxic molecules phenylalanine and ochratoxin α (OTα) in the gastrointestinal tract (GIT) of pigs. Piglets were fed six experimental diets over 14 days, varying in OTA contamination level (50 or 500 μg/kg; OTA50 and OTA500) and presence of OAH; a negative control diet (no OTA added) and a diet containing OTα at 318 µg/kg (OTα318). The absorption of OTA and OTα into the systemic circulation (plasma and dried blood spots, DBS), their accumulation in kidney, liver, and muscle tissues, and excretion through feces and urine were assessed. The efficiency of OTA degradation in the digesta content of the GIT was also estimated. At the end of the trial, accumulation of OTA in blood was significantly higher in OTA groups (OTA50 and OTA500) in comparison to enzyme groups (OAH50 and OAH500, respectively). The supplementation of OAH explicitly reduced the absorption of OTA (P < 0.005) into plasma by 54% and 59% (from 40.53 ± 3.53 to 18.66 ± 2.28 ng/mL in piglets fed the 50 μg OTA/kg diets and from 413.50 ± 71.88 to 168.35 ± 41.02 ng/mL in piglets fed the 500 μg OTA/kg diets, respectively) and in DBS by 50% and 53% (from 22.79 ± 2.63 to 10.67 ± 1.93 ng/mL in piglets fed the 50 μg OTA/kg diets and from 232.85 ± 35.16 to 105.71 ± 24.18 ng/mL in piglets fed the 500 μg OTA/kg diets, respectively). The OTA concentrations in plasma were positively associated with the OTA levels detected in all tissues analyzed; adding OAH reduced OTA levels in the kidney, liver, and muscle (P < 0.005) by 52%, 67%, and 59%, respectively. The analysis of GIT digesta content showed that OAH supplementation led to OTA degradation in the proximal GIT where natural hydrolysis is inefficient. Overall, the data of present in vivo study demonstrated that supplementation of swine feeds with OAH successfully reduced OTA levels in blood (plasma and DBS) as well as in kidney, liver, and muscle tissues. Therefore, an approach to use enzymes as feed additives might be most promising to mitigate the harmful effects of OTA on the productivity and welfare of pigs and at the same time improving the safety of pig-derived food products.
Melittobia acasta (Hymenoptera: Eulophidae) female longevity and life stage-dependent parasitism using commercially managed Megachile rotundata (Hymenoptera: Megachilidae) as hosts
Authors: Anderson Alan R , Ramirez Ricardo A , Earl Creech J , Pitts-Singer Theresa L
Published: May 2023

Melittobia acasta Walker is one among other hymenopterous parasitoids of Megachile rotundata F. Commercial M. rotundata populations are employed to pollinate North American alfalfa for seed production. This wasp can be prolific when using M. rotundata as a host and can reduce or destroy bee stocks. Hundreds of M. acasta female offspring can develop in a single M. rotundata cell and disperse to infest other cells, producing thousands of more parasitoids. In this study, we determined (i) upon what bee life stages M. acasta females choose to lay eggs and if those eggs ultimately become adults and (ii) M. acasta female longevity when exposed to various resources within M. rotundata cells. We found that M. acasta females lay eggs on M. rotundata prepupae and pupae and that those eggs can hatch and survive to adulthood. Eggs are not laid on early instar bee larvae; eggs laid on adults do not survive. Average female life span is 5 days without feeding, 8–9 days if a pollen–nectar provision is available while the bee develops through larval stages, and 34 days if the wasp can feed on prepupal hemolymph. Wasp females can emerge from bee cells several days after trays of cells are taken to fields. Therefore, adult females could survive long enough for new bee offspring to become prepupae. Our findings support a better understanding of host life stage preference and the longevity of M. acasta females that can inform the timing of the implementation of possible control measures.
Exorista sorbillans (Diptera: Tachinidae) parasitism shortens host larvae growth duration by regulating ecdysone and juvenile hormone titers in Bombyx mori (Lepidoptera: Bombycidae)
Authors: Wang Shan-shan , Wang Lei-lei , Pu Yue-xia , Liu Ji-yin , Wang Mei-xian , Zhu Juan , Shen Zhong-yuan , Shen Xing-jia , Tang Shun-ming
Published: May 2023

The tachinid fly, Exorista sorbillans, is a notorious ovolarviparous endoparasitoid of the silkworm, Bombyx mori, causing severe damage to silkworm cocoon industry. Silkworm larvae show typically precocious wandering behavior after being parasitized by E. sorbillans; however, the underlying molecular mechanism remains unexplored. Herein, we investigated the changes in the levels of 20-hydroxyecdysone (20E) and juvenile hormone (JH) titer, and they both increased in the hemolymph of parasitized silkworms. Furthermore, we verified the expression patterns of related genes, which showed an upregulation of 20E signaling and biosynthesis genes but a significant downregulation of ecdysone oxidase (EO), a 20E inactivation enzyme, in parasitized silkworms. In addition, related genes of the JH signaling were activated in parasitized silkworms, while related genes of the JH degradation pathway were suppressed, resulting in an increase in JH titer. Notably, the precocious wandering behavior of parasitized silkworms was partly recoverable by silencing the transcriptions of BmCYP302A1 or BmCYP307A1 genes. Our findings suggest that the developmental duration of silkworm post parasitism could be shortened by regulation of 20E and JH titers, which may help silkworm to resist the E. sorbillans infestation. These findings provide a basis for deeper insight into the interplay between silkworms and E. sorbillans and may serve as a reference for the development of a novel approach to control silkworm myiasis.
(037) Hypersexuality with the Use of Selective Serotonin Receptor Inhibitors
Authors: Dominguez-bali A , Baqer A , Sharma R , Hassan Z , Marquez L , Dominguez-bali C
Published: May 2023

Introduction

We present two cases of hypersexuality in perimenopausal women evaluated, diagnosed, and being managed at this time for what seems to be a sexual dysfunction recently described as a consequence of the use of a combination of 2 kinds of medications: Bupropion, a Norepinephrine Dopamine Reuptake Inhibitor (NDRI), and Sertraline/Fluoxetine, a Selective Serotonin Receptor Inhibitor (SSRI), used as an anti-depressant and anxiolytics for psychiatric conditions. Both cases arrived at our centers referred by their primary care physicians or a psychiatrist for sexual therapy and sexological evaluation.

Objective

To show a new sexual dysfunction related to the use of SSRI medications.

Methods

The analysis of 2 cases of a new described sexual dysfunction related with the use of SSRI medications: Bupropion at 150 mg PO bid, and Fluoxetine at 125 mg PO qd.

Results

The first case, one week after the initiation of Fluoxetine, having been taking Bupropion for months, started to develop uncontrolled need for sex, having sex with multiple men, in addition to her husband. Her husband accepted to have sexual relationships in trios, a situation that lasted for several months. However, after 4-6 weeks, she started to look for additional partners other than her husband. He left. She arrived with extreme anxiety during her first visit. Neither her, nor the psychiatrist understood why this was happening. At that moment, she was having sex with several men on a daily basis. She wanted to preserve her marriage but her sexual compulsion was an impediment. The second patient decided to be unfaithful to her husband of 10 years. In this case, she decided to have hidden sexual relations with several men at the same time with just one. She was also undergoing psychiatric treatment with both medications, Fluoxetine and Bupropion. There was a temporal correlation between the initiation of Fluoxetine and the appearance of the sexual dysfunction. We suspended both medications and around 10 days after this therapeutic step, there was a frank decline in the compulsive sexual behavior. However, due to depression and anxiety symptoms, the psychiatrist decided to restart only Bupropion without the Fluoxetine that was the medication with which the appearance of symptoms have been related. Now, she is okay.

Conclusions

We describe the possible pharmacological mechanisms involved in the pathophysiology of this disorder and the way in which we have managed the two cases up to now. This condition needs to be differentiated from the hyperactive sexual arousal disorder, previously described in the sexological literature and we need to determine if this is a variant of that kind of syndrome. We have never encountered this kind of reaction before and have only found one publication describing a similar case.

Disclosure

No
(131) Sexual Activity After Pelvic Surgery
Authors: Dominguez-Bali A , Baqer A , Sharma R , Hassan Z , Dominguez-Bali C , Marquez L
Published: May 2023

Introduction

Around 50%-70% of all women, at any moment of their lives, will undergo pelvic surgery such as abdominal and vaginal hysterectomies, laparoscopic or robotic-assisted hysterectomies, and exploratory laparotomies for multiple reasons. These reasons include; endometriosis, chronic pelvic pain, pelvic adhesions secondary to pelvic inflammatory disease, infected or perforated IUDs, previous surgeries, abscesses or cysts, peritonitis, and genital prolapses such as cystoceles, rectoceles, uterine prolapse or vaginal prolapse in patients with previous hysterectomies, urinary and fecal incontinence, and total procidentia. The general public knowledge, distorted sexual education curriculum, and the influence of this inappropriate sexual education (produced by religions and cultures) affect the medical practice and investigations at scientific levels. These influences have expanded the beliefs that sexual activity is deteriorated for all of these kinds of procedures. Few American publications and many Asian publications report the frank deterioration of the sexual response in women who have had pelvic surgeries.

Objective

To show how a very high percentage of women, that have had pelvic surgeries, have an improvement in their sexual activity after these kinds of procedures.

Methods

This investigation analyzed the postoperative sexual function of hundreds of patients at our two centers in which all the procedures previously named were practiced.

Results

We found an improvement in sexual activity, not only in the women but also in the couples in more than 95% of the cases. The pre and post-procedure evaluations were done.

Conclusions

Contradictory to what several studies have shown regarding how pelvic surgeries produced deterioration in sexual activity, we have demonstrated the opposite. We found that in more than 95% of the cases, sexual activity was improved. These procedures included repairing total procidentia, cystocele, rectocele, urinary incontinence or rectal incontinence, fibroid uterus, or chronic pelvic pain.

Disclosure

No
The Fitness Effects of Codon Composition of the Horizontally Transferred Antibiotic Resistance Genes Intensify at Sub-lethal Antibiotic Levels
Authors: Shaferman Michael , Gencel Melis , Alon Noga , Alasad Khawla , Rotblat Barak , Serohijos Adrian W R , Alfonta Lital , Bershtein Shimon
Published: May 2023

The rampant variability in codon bias existing between bacterial genomes is expected to interfere with horizontal gene transfer (HGT), a phenomenon that drives bacterial adaptation. However, delineating the constraints imposed by codon bias on functional integration of the transferred genes is complicated by multiple genomic and functional barriers controlling HGT, and by the dependence of the evolutionary outcomes of HGT on the host's environment. Here, we designed an experimental system in which codon composition of the transferred genes is the only variable triggering fitness change of the host. We replaced Escherichia coli's chromosomal folA gene encoding dihydrofolate reductase, an essential enzyme that constitutes a target for trimethoprim, with combinatorial libraries of synonymous codons of folA genes from trimethoprim-sensitive Listeria grayi and trimethoprim-resistant Neisseria sicca. The resulting populations underwent selection at a range of trimethoprim concentrations, and the ensuing changes in variant frequencies were used to infer the fitness effects of the individual combinations of codons. We found that when HGT causes overstabilization of the 5′-end mRNA, the fitness contribution of mRNA folding stability dominates over that of codon optimality. The 5′-end overstabilization can also lead to mRNA accumulation outside of the polysome, thus preventing the decay of the foreign transcripts despite the codon composition-driven reduction in translation efficiency. Importantly, the fitness effects of mRNA stability or codon optimality become apparent only at sub-lethal levels of trimethoprim individually tailored for each library, emphasizing the central role of the host's environment in shaping the codon bias compatibility of horizontally transferred genes.
Encapsulation of conjugated linoleic acid and ruminant trans fatty acids to study the prevention of metabolic syndrome—a review
Authors: Mohammadi Farzad , Dikpati Amrita , Bertrand Nicolas , Rudkowska Iwona
Published: May 2023

Studies have reported the potential benefits of consuming conjugated linoleic acid (CLA) and ruminant trans fatty acids (R-TFAs) in reducing the risk factors of metabolic syndrome (MetS). In addition, encapsulation of CLA and R-TFAs may improve their oral delivery and further decrease the risk factors of MetS. The objectives of this review were (1) to discuss the advantages of encapsulation; (2) to compare the materials and techniques used for encapsulating CLA and R-TFAs; and (3) to review the effects of encapsulated vs non-encapsulated CLA and R-TFAs on MetS risk factors. Examination of papers citing micro- and nano-encapsulation methods used in food sciences, as well as the effects of encapsulated vs non-encapsulated CLA and R-TFAs, was conducted using the PubMed database. A total of 84 papers were examined; of these, 18 studies were selected that contained information on the effects of encapsulated CLA and R-TFAs. The 18 studies that described encapsulation of CLA or R-TFAs indicated that micro- or nano-encapsulation processes stabilized CLA and prevented oxidation. CLA was mainly encapsulated using carbohydrates or proteins. So far, oil-in-water emulsification followed by spray-drying were the frequently used techniques for encapsulation of CLA. Further, 4 studies investigated the effects of encapsulated CLA on MetS risk factors compared with non-encapsulated CLA. A limited number of studies investigated the encapsulation of R-TFAs. The effects of encapsulated CLA or R-TFAs on the risk factors for MetS remain understudied; thus, additional studies comparing the effects of encapsulated and non-encapsulated CLA or R-TFAs are needed.
An update on sugar allocation and accumulation in fruits
Authors: Ren Yi , Liao Shengjin , Xu Yong
Published: May 2023

Fruit sweetness is determined by the amount and composition of sugars in the edible flesh. The accumulation of sugar is a highly orchestrated process that requires coordination of numerous metabolic enzymes and sugar transporters. This coordination enables partitioning and long-distance translocation of photoassimilates from source tissues to sink organs. In fruit crops, sugars ultimately accumulate in the sink fruit. Whereas tremendous progress has been achieved in understanding the function of individual genes associated with sugar metabolism and sugar transport in non-fruit crops, there is less known about the sugar transporters and metabolic enzymes responsible for sugar accumulation in fruit crop species. This review identifies knowledge gaps and can serve as a foundation for future studies, with comprehensive updates focusing on (1) the physiological roles of the metabolic enzymes and sugar transporters responsible for sugar allocation and partitioning and that contribute to sugar accumulation in fruit crops; and (2) the molecular mechanisms underlying the transcriptional and posttranslational regulation of sugar transport and metabolism. We also provide insights into the challenges and future directions of studies on sugar transporters and metabolic enzymes and name several promising genes that should be targeted with gene editing in the pursuit of optimized sugar allocation and partitioning to enhance sugar accumulation in fruits.
Transcription factor CsMADS3 coordinately regulates chlorophyll and carotenoid pools in Citrus hesperidium
Authors: Zhu Kaijie , Chen Hongyan , Mei Xuehan , Lu Suwen , Xie Heping , Liu Junwei , Chai Lijun , Xu Qiang , Wurtzel Eleanore T , Ye Junli , Deng Xiuxin
Published: May 2023

Citrus, 1 of the largest fruit crops with global economic and nutritional importance, contains fruit known as hesperidium with unique morphological types. Citrus fruit ripening is accompanied by chlorophyll degradation and carotenoid biosynthesis, which are indispensably linked to color formation and the external appearance of citrus fruits. However, the transcriptional coordination of these metabolites during citrus fruit ripening remains unknown. Here, we identified the MADS-box transcription factor CsMADS3 in Citrus hesperidium that coordinates chlorophyll and carotenoid pools during fruit ripening. CsMADS3 is a nucleus-localized transcriptional activator, and its expression is induced during fruit development and coloration. Overexpression of CsMADS3 in citrus calli, tomato (Solanum lycopersicum), and citrus fruits enhanced carotenoid biosynthesis and upregulated carotenogenic genes while accelerating chlorophyll degradation and upregulating chlorophyll degradation genes. Conversely, the interference of CsMADS3 expression in citrus calli and fruits inhibited carotenoid biosynthesis and chlorophyll degradation and downregulated the transcription of related genes. Further assays confirmed that CsMADS3 directly binds and activates the promoters of phytoene synthase 1 (CsPSY1) and chromoplast-specific lycopene β-cyclase (CsLCYb2), 2 key genes in the carotenoid biosynthetic pathway, and STAY-GREEN (CsSGR), a critical chlorophyll degradation gene, which explained the expression alterations of CsPSY1, CsLCYb2, and CsSGR in the above transgenic lines. These findings reveal the transcriptional coordination of chlorophyll and carotenoid pools in the unique hesperidium of Citrus and may contribute to citrus crop improvement.
Children’s Indirect Exposure to the U.S. Justice System: Evidence From Longitudinal Links between Survey and Administrative Data
Authors: Finlay Keith , Mueller-Smith Michael , Street Brittany
Published: May 2023

Children’s indirect exposure to the justice system through biological parents or coresident adults is both a marker of their own vulnerability and a measure of the justice system’s expansive reach in society. Estimating the size of this population for the United States has historically been hampered by inadequate data resources, including the inability to observe nonincarceration events, follow children throughout their childhood, and measure adult nonbiological parent cohabitants. To overcome these challenges, we leverage billions of restricted administrative and survey records linked with Criminal Justice Administrative Records System data and find substantially larger exposure rates than previously reported: prison, 9% of children born between 1999–2005; felony conviction, 18%; and any criminal charge, 39%. Charge exposure rates exceed 60% for Black, American Indian, and low-income children. While broader definitions reach a more expansive population, strong and consistently negative correlations with childhood well-being suggest that these remain valuable predictors of vulnerability. Finally, we document substantial geographic variation in exposure, which we leverage in a movers design to estimate the effect of living in a high-exposure county during childhood. We find that children moving into high-exposure counties are more likely to experience postmove exposure events and exhibit significantly worse outcomes by age 26 on multiple dimensions (earnings, criminal activity, teen parenthood, mortality); effects are strongest for those who moved at earlier ages.
Determination of internal gamma dose assessment due to natural radioactivity for river sand using a gamma-ray spectrometer
Authors: Kumar Chinnasamy Kuppan Senthil , Chandrasekaran Ananthanarayanan , Gurumoorthy Chandrasekharan , Sathish Vilvanathan
Published: May 2023

River sand is an environmental component that is always used as a building material in India and hence the present study, activity concentrations of 226Ra, 232Th and 40K have been measured in sand samples collected from Ponnai river, Tamil Nadu using a high-resolution gamma-ray spectrometer consisting of high-purity germanium detector. Calculated mean specific activity is 31, 84 and 416 Bq kg−1 for 226Ra, 232Th and 40K, respectively. These results reveal that 226Ra was found to be less than the world average value of 33 Bq kg−1 whereas 232Th and 40K were higher than the global mean value of 30 and 400 Bq kg−1, respectively. In order to assess the internal dose to population a standard index radium equivalent activity (Raeq) is calculated for these samples. Based on the obtained results, it is seen that these sand samples do not pose significant health hazards to the inhabitants of the houses constructed.
Mind the Gap: Schooling, Informality, and Fiscal Externalities in Nepal
Authors: Bleakley Hoyt , Gupta Bhanu
Published: May 2023

While increasing years of schooling has been a long-standing development priority, the associated fiscal costs and benefits have been less studied, because of a lack of appropriate data. Recently, an UNESCO-funded project measured subsidies, by levels of schooling, from all levels of government, in eight developing countries including Nepal. The household-level Nepal Living Standards Measurement Survey provides information to estimate the degree of formality, tax payments, and benefit receipts as a function of schooling years. Using a simple Mincer-like model, this study estimates the fiscal externality of an additional year of school. It finds that within primary school, fiscal benefits and costs, on the margin, are quite balanced, with subsidies close to the present value of future taxes minus benefits. At higher levels of schooling, however, marginal fiscal benefits exceed costs by 5 percent of per capita consumption. This contrasts with previous literature on social returns and assumptions underlying multilateral development goals.
Pregnancy-associated and Pregnancy-related Deaths in the United States Military, 2003–2014
Authors: Romano C.J. , Hall C. , Bukowinski A.T. , Gumbs G.R. , Conlin A.M.S.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:508.e1–508.e9)

The Centers for Disease Control defines pregnancy-associated deaths as those that occur while pregnant or within 1 year of the end of pregnancy from any cause. Pregnancy-related deaths are those that occur within the same time frame from any cause related to or aggravated by pregnancy itself. While the rates of death due to hemorrhage and hypertensive events have declined in the military population, pregnancy-associated overdose and suicide deaths are on the rise. Active-duty service members have distinct circumstances from the civilian population that are normally considered protective against maternal morbidity: free and full health care coverage, stable employment, and lower rates of chronic disease. Despite these factors, a sharp rise in severe maternal morbidity in the US military is evident over 2003-2015, and it is acknowledged that suicide, overdose, and homicide are rising contributors to this trend. Frequent relocation or deployment are mental health stressors that may be an exacerbating factor in these deaths.
Using Mean Anesthesia Workload to Plan Anesthesia Workforce Allocations: The “Flaw of Averages”
Authors: Ginosar Y. , Wimpfheimer A. , Weissman C.
Published: May 2023

(Anesth Analg. 2022;135:1138–1141)

Workforce planning within acute care hospital services is especially important, though especially complicated due to inherently unpredictable, unstable, and frequently emergent needs. This editorial comments on the Im et al article “Obstetric Anesthesia Procedure-Based Workload and Facility Utilization of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Designated Institutions,” which studies procedure-based obstetric anesthesia workload and staff utilization using self-reported data collected from the Society of Obstetric Anesthesia and Perinatology Centers of Excellence.
Expert Consensus Regarding Core Outcomes for Enhanced Recovery After Cesarean Delivery Studies: A Delphi Study
Authors: Sultan P. , George R. , Weiniger C.F. , El-Bodhdadly K. , Pandal P. , Carvalho B. ,   CRADLE Study Investigators
Published: May 2023

(Anesthesiology. 2022;137:201–211)

Obstetric units are increasingly using enhanced recovery after cesarean delivery (ERAC) protocols. A number of studies have shown ERAC protocols reduce opioid consumption, length of hospital stay, and time to mobilization. There have been a wide range of outcomes by which to evaluate ERAC protocols, making it challenging to interpret data and findings from these studies. This study used a Delphi methodology to develop a core outcome set by which to evaluate ERAC protocols.
A Systematic Scoping Review of Peridelivery Pain Management for Pregnant People With Opioid Use Disorder: From the Society for Obstetric Anesthesia and Perinatology and Society for Maternal Fetal Medicine
Authors: Lim G. , Soens M. , Wanaselja A. , Chyan A. , Carvalho B. , Landau R. , George R.B. , Klem M.L. , Osmundson S.S. , Krans E.E. , Terplan M. , Bateman B.T.
Published: May 2023

(Anesth Analg. 2022;135:912–925)

Opioid use disorder (OUD) has been on the rise over the past decade and is the leading cause of mortality among pregnant women in the United States. Information and evidence-based recommendations on how to best treat pain in parturients with OUD is lacking. The aim of this scoping review was to highlight existing literature on peripartum pain management for women with OUD, both untreated and treated with medications for opioid use disorder (MOUD), and provide a summary of the information.
Pregnancy in Women with Liver Cirrhosis is Associated With Increased Risk for Complications: A Systematic Review and Meta-analysis of the Literature
Authors: van der Slink L.L. , Scholten I. , van Etten-Jamaludin F.S. , Takkenberg R.B. , Painter R.C.
Published: May 2023

(BJOG. 2022;129:1644–1652)

Pregnancy in women with liver cirrhosis is rare (1 in 4500 pregnancies) and when it does occur, cirrhosis most commonly originates from autoimmune and viral hepatitis, and alcoholic and nonalcoholic fatty liver disease. The concurrence of pregnancy with liver cirrhosis is increasing and this combination warrants careful attention to family planning and obstetric management. Previous small studies have shown cirrhotic pregnancies have high risk of maternal and perinatal morbidity and mortality. This systematic review and meta-analysis combined a larger patient population over time to detail the obstetric, fetal, and maternal complications experienced by women with liver cirrhosis.
Protecting Pregnant People and Babies From the Health Effects of Climate Change
Authors: Rasmussen S.A. , Jamieson D.J.
Published: May 2023

(N Engl J Med. 2022;387:957–959)

Among other populations, pregnant people and newborns are especially vulnerable to the effects of climate change, notably from wildfires. The smoke from wildfires releases toxic gases, particulate matter, and volatile compounds. These exposures are associated with increased risk for gestational diabetes, hypertension, preterm birth, low birthweight and subsequent lifelong health effects. In addition, social support networks can be disrupted by community displacement from wildfires, leading to poorer health for pregnant and postpartum people and newborns, particularly in marginalized populations.
Association of Umbilical Cord Blood Gas Values With Mortality and Severe Neurologic Injury in Preterm Neonates <29 Weeks’ Gestation: A National Cohort Study
Authors: Shah P.S. , Barrett J. , Claveau M. , Cieslak Z. , Makary H. , Monterrosa L. , Sherlock R. , Yang J. , McDonald S.D.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:85.e1–10)

The acid-base status of a neonate at the time of birth is determined through analysis of umbilical cord blood gas values. Deranged umbilical cord arterial (UA) and umbilical cord venous (UV) blood gas values can be linked to poor neonatal outcomes. Previous studies have found an association between a UA or UV pH value of <7.0 and neonatal mortality. However, the relationship between umbilical cord blood gas values and adverse outcomes, specifically in preterm neonates born before 29 weeks gestation, is not clear. This study aimed to explore the association between umbilical cord blood gas values with neonatal mortality and severe neurological injury (SNI) in infants born before 29 weeks gestation.
Chorioamnionitis and Risk of Long-term Neurodevelopmental Disorders in Offspring: A Population-based Cohort Study
Authors: Tsamantioti E. , Lisonkova S. , Muraca G. , Örtqvist A.K. , Razaz N.
Published: May 2023

(Am J Obstet Gynecol. 2022;227:287.e1–17)

Chorioamnionitis is a common type of maternal infection associated with cerebral palsy and other long-term neonatal outcomes. However, there is a lack of studies on the risks of other long-term neurodevelopmental outcomes following neonates exposure to chorioamnionitis. This study aimed to examine the association between chorioamnionitis and neurological disorders in offspring, including epilepsy, attention deficit hyperactivity disorder, cerebral palsy, autism, and intellectual disability, and how preterm delivery affects these risks.
Risk of Postpartum Hemorrhage is Associated With Ethnicity: A Cohort Study of 981,801 Births in England
Authors: Jardine J. , Gurol-Urganci I. , Harris T. , Hawdon J. , Pasupathy D. , van der Meulen J. , Walker K. ,   on Behalf of the NMPA Project Team
Published: May 2023

(BJOG. 2022;129:1269–1277)

Postpartum hemorrhage (PPH) is associated with increased risk of maternal morbidity, mortality, and postpartum depression. In the United States, United Kingdom, and beyond, maternal outcomes vary by ethnicity. In the United Kingdom, Black parturients have a higher risk of intensive care unit admission. This study aimed to investigate the association between the risk of PPH and ethnicity, and how socioeconomic background interacts with this association.
Placenta Accreta Spectrum—Variations in Clinical Practice and Maternal Morbidity Between the UK and France: A Population-based Comparative Study
Authors: McCall S.J. , Deneux-Tharaux C. , Sentilhes L. , Ramakrishnan R. , Collins S.L. , Seco A. , Kurinczuk J.J. , Knight M. , Kayem G.
Published: May 2023

(BJOG. 2022;129:1676–1685)

Placenta accreta spectrum (PAS) carries significant maternal risk following birth when the placenta does not spontaneously detach from the uterus. Risks include massive obstetric hemorrhage (PPH), further maternal morbidity, and possible death. Three subtypes characterize the spectrum (placenta accreta, placenta increta, and placenta percreta) and all are managed by either cesarean hysterectomy or a conservative approach that preserves the uterus in situ in full or part. Practice guidelines in France encourage a uterine-conserving approach when possible, while the standard of care in the UK recommends cesarean hysterectomy as the default. This country level variation in practice allows for comparison of maternal outcomes for a large number of women with PAS receiving different interventions. The aim of this study was to compare management and outcomes in patients with PAS in the United Kingdom and France.
Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study
Authors: Seiler F.A. , Scavone B.M. , Shahul S. , Arnolds D.E.
Published: May 2023

(Anesth Analg. 2022;135:1153–1158)

Neuraxial labor analgesia commonly results in maternal fevers, though the cause is unknown. Possible causes include infection, inflammation, and altered thermoregulation. An alternative pain management to epidural labor is continuous spinal analgesia, which has lower neuraxial and systemic bupivacaine levels and may decrease the rate of maternal fever. No studies to date have compared maternal fever rates between epidural labor and continuous spinal analgesia. The aim of this study is to compare 2 techniques and better understand the mechanism that drives maternal fevers in association with epidural labor analgesia.
Quantitative Blood Loss After Vaginal Delivery: A Retrospective Analysis of 104,079 Measurements at 41 Institutions
Authors: Ansari J. , Farber M.K. , Thurer R.L. , Guo N. , Rubenstein A. , Carvalho B.
Published: May 2023

(Int J Obstet Anesth. 2022;51:103256)

Postpartum hemorrhage (PPH) is increasingly problematic throughout the United States. To improve care and timely PPH treatment, an accurate estimation of blood loss during delivery is critical. Visual estimation was the standard for years, but quantitative blood loss (QBL) is a more accurate measurement. However, normal values of QBL have not yet been estimated for the United States. This study primarily aimed to establish a normal range and distribution for QBL after a vaginal delivery (VD). The authors also looked at how often PPH occurred and how much the gravimetric method involving the weighing of sponges and laparotomy (lap) sponges contributed to total QBL compared with the V-drape, which presents a volumetric measurement.
Mandatory Reporting of Emissions to Achieve Net-Zero Health Care
Authors: Singh H. , Eckelman M. , Berwick D.M. , Sherman J.D.
Published: May 2023

(N Engl J Med. 2022;387:2469–2476)

Threats to human health from climate instability include food and water shortages, heat, modified disease-vector ranges and active seasons, wildfires, and severe weather-related events, all of which have the potential to disrupt health care delivery as well. With awareness of the contribution of greenhouse gasses and toxic emissions by the health care sector—~8.5% of emissions in the United States and 5% globally—many health care systems are prioritizing initiatives to achieve “net zero.” This refers to individual institution-led structures that support offsetting the release of greenhouse gas emissions by providing the means to neutralize their effect on the atmosphere. While many government organizations and consulting bodies to health care call for pledges to reduce greenhouse gas emissions, voluntary initiatives will fall short of net-zero health care goals. A consensus is growing for the need to develop a standardized metric for reporting, promoting accountability, quantifying progress, and recognizing best practices. It is recommended that all health care delivery organizations (HCOs)—all inpatient, outpatient, residential, and support services—be required to report and measure greenhouse gas emissions, in step with the climate goals of other leading organizations to achieve net-zero emissions over the coming decades.
Development of Clinical Risk-prediction Models for Uterine Atony Following Vaginal and Cesarean Delivery
Authors: Ende H.B. , French B. , Shi Y. , Dertai M.D. , Osmundson S.S. , Bauchat J.R.
Published: May 2023

(Int J Obstet Anesth. 2022;51:103550)

As 2.5% of births in the United States are impacted by uterine atony, identifying high-risk women can promote timely treatment and subsequently minimize adverse outcomes. However, there is no current risk assessment model that solely focuses on the risk for uterine atony rather than the overall risk for postpartum hemorrhage (PPH). This retrospective study created and tested 2 risk prediction models for antepartum and intrapartum uterine atony.
Impact of Obesity on Uterine Contractile Activity During Labor: A Blinded Analysis of a Randomized Controlled Trial Cohort
Authors: Hautakangas T. , Uotila J. , Kontiainen J. , Huhtala H. , Palomäki O.
Published: May 2023

(BJOG. 2022;129:1790–1797)

With conflicting results of previous studies on the need for increased oxytocin during labor for obese parturients, there is no clear consensus on the causes of halted labor progression in this population. Studies of intrauterine pressure (IUP) in obese women during labor are also contradictory, and some show that even with satisfactory IUP [≥200 Montevideo units (MVU)] there is still risk of slowed labor progression and unplanned cesarean delivery (CD). This study aimed to determine whether, when compared to leaner parturients, the contractions of the obese parturient are less powerful, and if greater amounts of oxytocin are needed for successful vaginal delivery (VD).
A Comparison of Praevia and Nonpraevia Outcomes in Placenta Accreta Spectrum Cases: A Single Center Analysis
Authors: Heading R. , Slade L. , Kennedy-Andrews S. , Atkinson E. , Grivell R.
Published: May 2023

(Aust N Z J Obstet Gynaecol. 2022;62:487–493)

Placenta accreta spectrum (PAS) disorders relate to abnormal placental attachment and are difficult to treat and detect. The variety of both risk factors, including in vitro fertilization and uterine surgeries, and invasion of the placenta can present challenges. Praevia-related PAS is easier to identify, and identifying PAS predelivery greatly improves maternal and neonatal outcomes. This study aimed to identify and compare PAS without previa risk factors and outcomes to PAS with previa risk factors and outcomes.
Nicardipine for Treating Severe Antepartum Hypertension During Pregnancy: 9 Years of Experience in More Than 800 Women
Authors: Bijvank S.W. , Hengst M. , Cornette J.C. , Huigen S. , van Winkelen A. , Edens M.A. , Duvekot J.J.
Published: May 2023

(Acta Obstet Gynecol Scand. 2022;101:1017–1025)

Hypertensive disorders of pregnancy are the second leading direct cause of maternal death. Pregnant patients with severe hypertension should be treated with magnesium sulfate and antihypertensive medication, but it is not clear which antihypertensive is the best drug to use. Nicardipine is a (di)hydralazine calcium antagonist that has shown promising results in previous studies. This multicenter retrospective case series aimed to evaluate nicardipine in terms of efficacy and safety in pregnant women with severe antepartum hypertension.
Association of Gestational Diabetes Mellitus With Overall and Type Specific Cardiovascular and Cerebrovascular Diseases: Systematic Review and Meta-analysis
Authors: Xie W. , Wang Y. , Xiao S. , Qiu L. , Yu Y. , Zhang Z.
Published: May 2023

(BMJ. 2022;378:e070244)

Gestational diabetes (GDM) typically resolves after birth, but can cause lingering risk for adverse maternal effects, such as the development of type 2 diabetes and an increased risk in cardiovascular and cerebrovascular disease. There is a lack of information on the risk of type-specific cardiovascular disease, cerebrovascular disease, and thromboembolism following GDM, but these risks are present even in women who do not later develop type 2 diabetes. This systematic review and meta-analysis aimed to quantify the risk of overall and type-specific cardiovascular and cerebrovascular diseases in women who developed GDM using the currently available observational studies.
Modifiable Risk Factors and Long-term Risk of Type 2 Diabetes Among Individuals With a History of Gestational Diabetes Mellitus: Prospective Cohort Study
Authors: Yang J. , Qian F. , Cavarro J.E. , Ley S.H. , Tobais D.K. , Yeung E. , Hinkle S.N. , Bao W. , Li M. , Liu A. , Mills J.L. , Sun Q. , Willett W.C. , Hu F.B. , Zhang C.
Published: May 2023

(BMJ. 2022;378:e070312)

About 8% of US pregnancies are complicated by gestational diabetes mellitus (GDM). Type 2 diabetes is caused by a combination of genetic and lifestyle factors, and undiagnosed diabetes can cause potentially irreversible cardiovascular, renal, or neurological damage. Those affected by GDM are at a heightened risk for type 2 diabetes. This study aimed to evaluate the associations between modifiable risk factors [body mass index (BMI), high-quality diet, regular physical activity, moderate alcohol consumption, and not smoking] and risk of progression to type 2 diabetes in patients who have experienced GDM. A secondary aim was to evaluate whether these associations varied by BMI or genetic susceptibility to type 2 diabetes.