bluuebunny/crossref_metadata_2025 huggingface dataset:
The score: how do ratings correlate with politics and policy?
Authors: Barta Zsófia , Johnston Alison
Published: May 2023

This chapter presents a quantitative analysis of the relationship between rating scores and politics and policy, mapping out the pattern of rating penalties and rewards on particular political and policy choices. This pattern is more consistent with the logic of insurance than with neoliberal orthodoxy. Ratings are significantly lower in the presence of generous entitlement systems, heavy personal income and consumption taxes, checks and balances and left and center governments. Spending on social services, public employment, and corporate taxation have either neutral or positive effects on ratings. The examination of the reaction of bond yields to the same variables demonstrates significant differences in how investors and rating agencies treat politics and policy, but rewards and penalties on certain political and policy choices enter into bond yields via ratings.
Renaissance Rome
Authors: Story Joanna
Published: May 2023

This chapter traces the evidence for the placement of Pope Hadrian’s epitaph within St Peter’s, its survival throughout the Middle Ages, its removal from the old basilica, and its preservation in the sixteenth and early seventeenth centuries. It uses all of the antiquarian sources, both textual and visual, which observed and commented on the inscription in situ in the south transept, alongside those that traced the destruction of the old church and its monuments. It argues that the decision to preserve the epitaph for Hadrian I was taken during the pontificate of Pope Hadrian VI, who was closely allied to the Holy Roman Emperor Charles V, precisely because it recalled the earlier partnership between Hadrian I and Charlemagne. It also shows how the mood towards the old basilica and its monuments changed after the Council of Trent, and how antiquarians in Rome started to record the ancient monuments and to install some of them, including Hadrian’s epitaph, in the new structure, because they served a contemporary political and religious purpose.
The ‘Life’ and Death of Pope Hadrian I
Authors: Story Joanna
Published: May 2023

The chapter reviews the evidence and the historiography for the life and career of Pope Hadrian I over the course of his exceptionally long pontificate (772–95). Especially important are the letters contained in the Codex Carolinus, collated at the Carolingian court in 791, and in the biography of his career contained in the Liber Pontificalis, compiled in Rome, during and soon after his period of rule. It argues that the epithet ‘magnus’ (the Great) was first applied to Charlemagne in a papal source, and that Frankish sources recorded the king’s reactions to the news of Hadrian’s death. It discusses the embassy that was sent to Rome in early 796, and the gifts that had been prepared in advance, including Dagulf’s Psalter, and compares the diction of the poem that opened that manuscript with the verses composed for Hadrian by Theodulf of Orléans. The annalistic evidence from Francia and England is analysed, including the entry in the Northumbrian annals, probably from York that are embedded in the Historia Regum, and the Lorsch Annals, that survive in a contemporary manuscript, which describe the making of the epitaph in Francia and the mourning for the pope. Letters from Alcuin enrich the evidence base for understanding reactions within and beyond Rome to the death of Pope Hadrian.
Music Theory in Ethnomusicology
Authors: Blum Stephen
Published: May 2023

Music theory’s presence in ethnomusicology comes from the socialization and theorizing of participants in the world’s musical practices and of ethnomusicologists themselves. Results of processes of theorizing focused on musical activity differ greatly in scope, make-up, and uses. During the 1960s and 1970s, ethnomusicologists who formed relationships with music-makers and ritual specialists attempted to interpret their understandings of musical actions. Subsequently ethnomusicologists have studied roles of explicit and implicit theory in communication of musical knowledge, with attention to aural learning and relevant techniques of the body. They have observed the production of music theory in institutions of modern nation-states and have sought out groups and individuals whose theorizing is not constrained by projects of existing institutions. They are assessing the ways in which musical terminologies in diverse languages can be related to general concepts without imposing assumptions of one approach to music theory on all others. That exercise is increasingly recognized as a necessary effort of decolonization: the heritage of ethnomusicology encompasses all the world’s music-theoretical practices, and no formulation of Western music theory should be used as a standard against which to judge other ways of theorizing and making use of the results. The best future for ethnomusicological engagement with music theory would expand the situations and media of communication along with the topics and viewpoints in play. This book reviews existing work on music theory by ethnomusicologists and others, highlighting potentially productive insights that could inspire and guide future work.
Actors, Actions, and Outcomes
Authors: Blum Stephen
Published: May 2023

Exploration of how people attempt to understand actions and results of musicking is a major contribution of ethnomusicologists toward development of music theory as a general discipline. Music theorists will not be able to identify universals of human musicality without concerted efforts at overcoming the cultural biases strengthened by colonialism and imperialism (including the “internal colonialism” of the United States) through sustained attention to local practices that remain unstudied or poorly interpreted. Multimedia ethnography, and research on music cognition conducted with culturally diverse subjects, should yield insights that so far have eluded us. Among the topics of considerable significance in cross-cultural studies are multipart music making, dialogic exchange, ritual and ceremony, and how creative processes are represented (and misrepresented). Studies of how music is now produced in much of the world are increasingly concerned with numerous interactions of participants with one another and with technologies.
The Lure of the Russian Revolution
Authors: Kolb-Neuhaus Roberto
Published: May 2023

In the 1920s, composers such as Honegger in France, Antheil and Carpenter in the United States, and Prokofiev and Shostakovich in Russia wrote “machinist” works as futuristic symbols of progress. But musical machinism is semantically ambiguous: “progress” is variously defined, depending on the associated ideology. The Russians put the symbol in the service of their Revolution, and this idea influenced the Mexican Stridentist Germán List Arzubide, who used the image of a robot to create a hero character for didactic children’s tales. “Troka” was then used by Revueltas to compose a “danceable children’s pantomime” celebrating the death of imperialism as achieved by the gigantic robot and his young followers. Musical machinism is used here to celebrate this triumph. Earlier on, Carlos Chávez had composed the H.P. ballet, in which machinism seems to represent not progress but capitalist decay. In works such as his Energía, however, his machinism does seem to respond to a progressive futuristic agenda. This chapter tells the story of the making (and unmaking) of Troka—it did not make it to a premiere—comparing it with Chávez’s various appropriations of the symbol, representing at first a common political agenda between Chávez and Revueltas, but thereafter a growing distance.
Janitzio (1933/1936)
Authors: Kolb-Neuhaus Roberto
Published: May 2023

If one score, in particular, has been historicized as a prominent example of Revueltas’ presumed Mexicanist nationalism, it is his symphonic poem Janitzio, named after the tourist attraction, already popular at the time, in the state of Michoacán. The composer, however, accompanied the premiere with a description that satirically undermines this reception, describing the lake surrounding the touristy island as “ugly” and ironically describing his contribution as a further example of “postcard” music in an effort to “promote tourism.” Irony and satire are, in fact, also present in the music from the outstart: an intentionally clumsy pastiche accumulation of folkloric music referents is sabotaged through distortions of each referent. Nationalist “postcard” music is further undermined through Revueltas’ usual means: an aggressive, metrically, and harmonically incongruent juxtaposition of musicalized street insults, foregrounding the voice of the non-picturesque Lumpenproletariat. As also typical in Revueltas’ early works, the angry anti-nationalist stance is counteracted by slow movements lacking satirical intent and seeking ways to embody the voice of the oppressed through deeply moving polyphonic constructs drawn from the soundscape of the streets. Here it is a “Lento espressivo (molto sostenuto e cantabile)” that articulates a highly expressive counterpoint of two melodies created by Revueltas, which both freely recall pregón (street cry) gestures, rather than folkloric referents.
Nostalgia of the Future
Authors: Kolb-Neuhaus Roberto
Published: May 2023

Based on the poem by Cuban poet Nicolás Guillén, Sensemayá: Canto parar matar una culebra (Song for the Killing of a Snake, first composed for small orchestra 1937 and reorchestrated for symphony orchestra in 1938), Revueltas’ work by the same title embodies his desire to express political passion through music alone, setting aside the poetic word to communicate its message. Although the music is strongly associated with Guillén’s verses, they are not included in the score. It is not so much the communication of the verbally expressed imagery that concerns Revueltas, but the sounding of feelings associated with it. His choice of poem is significant for various reasons. Although drawn from a strongly political collection of Guillén’s poetry, West Indies, Ltd. in particular expresses its possible political intent in a non-programmatic, poetic way. The Cuban’s negrista poetry was also attractive for Revueltas because it is itself strongly inspired by musical language. Coauthored with Susana González-Aktories, this chapter queries first the musical identity in Guillén’s poetry, and then, in the case of “Sensemayá,” its “transition back to music,” and its possible interpretation as a musical allegory of liberation.
Aberrant Reception Yesterday
Authors: Kolb-Neuhaus Roberto
Published: May 2023

Judging by the music chronicler’s reactions at the time, it quickly becomes evident that Revueltas’ attempts at building an alternative soundscape, one not concerned with cultural but with social-political identity, went completely unnoticed both at home and abroad. Or even worse, that his music was taken to represent something that it manifestly targeted: a Mexicanistic agenda. Regarding his musical aesthetics, his struggle against dependence on Eurocentric models by attempting to articulate a kind of politically grounded peripheral ontology by musically echoing visual and poetic avant-garde techniques mainly built on montage and collage was never seen in this light. Rather, the free and daring assemblages were qualified, both locally and among his US critics, as immature, or in the best of cases (mis)interpreted as primitive or exotic. This chapter explores the reception of Revueltas’ music in Mexico (Salomón Kahan, Hugo Conzatti) and among US composers and conductors (Nicolas Slonimsky, Aaron Copland, Virgil Thomson, Henry Cowell, Paul Bowles) as well as, in some cases, the Mexican’s mostly ironic or humorous reactions to it. It also speculates about a potential kinship with the ideology and music of certain US composers such as Alex North and George Antheil. Revueltas established a personal friendship with the former, but there is no evidence of this in the composer’s archive in the form of letters. Antheil is never mentioned by the Mexican, and there is no way to corroborate if he was aware of the daring early avant-garde work of the American.
An Eighteenth-Century Satirist
Authors: Molteno Marion
Published: May 2023

The poet Sauda features in Russell’s well-known book Three Mughal Poets. This article appeared separately before the book’s publication and introduces readers to his work and attitudes, through extensive examples. It gives insight into the role of a satirist at a time when the Mughal Empire was in catastrophic decline. Poets depended on patronage from the wealthy noble class, but despite this Sauda exercised considerable independence in expressing his views. The translations from his poems include attacks on incompetent self-seekers who controlled the empire; their extravagance; gluttony; meanness; the self-appointed censors of others’ morals; an exploitative hakim (practitioner of a traditional system of medicine). These poems reflect the fact that a certain licence was conventionally allowed to poets. Other poems reflect his deep despair at the fate of Delhi, his native city.
How Not to Write the History of Urdu Literature
Authors: Molteno Marion
Published: May 2023

Russell discusses the limitations of the histories of Urdu literature by Ram Babu Saksena (1927) and T Graeme Bailey (1932) (the only ones available when he was a student) and later by Muhammad Sadiq (1965). They talk of the ‘limitations’ of Urdu poetry, comparing it and other genres unfavourably to English or classical European models, rather than considering it on its own terms. He gives many examples of this from all three writers. He gives as a particular example their description of the marsiya. They describe what they consider its limitations, without giving any sense of the power a marsiya has over listeners within that culture. His guidance for would-be historians of literature is to only embark on it if you feel enthusiastic about the literature, then to consider what readers from another culture need to have explained to them so that they can enter into it.
A Streptomyces Consortium Contributes Distinct Microbial Interactions During Arabidopsis thaliana Microbiome Assembly
Authors: Gates Alexandra D. , French Austin M. , Demetros Alexander A. , Kelley Brittni R. , Lebeis Sarah L.
Published: May 2023

Although plant microbiome assembly involves a series of both plant–microbe and microbe–microbe interactions, the latter is less often directly tested. Here, we investigate a role for Streptomyces strains to influence assembly of other bacteria into root microbiomes through the use of two synthetic communities (SynComs): a 21-member community including four Streptomyces strains and a 17-member community lacking those Streptomyces strains. Following inoculation with these SynComs on wild-type Arabidopsis thaliana Col-0, differential abundance modeling on root endosphere 16S ribosomal RNA gene amplicon sequencing data revealed altered abundance of four diverse SynCom members: Arthrobacter sp. 131, Agrobacterium sp. 33, Burkholderia sp. CL11, and Ralstonia sp. CL21. Modeling results were tested by seedling coinoculation experiments with the four Streptomyces strains and differentially abundant members, which confirmed the predicted decreased abundance for Arthrobacter sp. 131, Agrobacterium sp. 33, and Ralstonia sp. CL21 when Streptomyces strains were present. We further characterized how the phytohormone salicylic acid (SA) mediates Streptomyces strains’ influence over Agrobacterium sp. 33 and Burkholderia sp. CL11 seedling colonization. Although decreased colonization of Ralstonia sp. CL21 and Arthrobacter sp. 131 when Streptomyces spp. are present were not influenced by SA, direct antibiosis of Arthrobacter sp. 131 by Streptomyces was observed. These results highlight a role for Streptomyces-mediated microbial interactions during plant root microbiome assembly as well as distinct mechanisms that mediate them. Understanding the role of microbial interactions during microbiome assembly will inform the production of beneficial microbial treatments for use in agricultural fields.
Unravelling the Bacterial Community Composition of Valerianella locusta, A Cold-Tolerant Plant
Authors: Garcia Mendez Sonia , Persyn Antoine , De Tender Caroline , Goormachtig Sofie , Willems Anne
Published: May 2023

Low temperatures greatly affect plant growth. In addition to the development of its own protection mechanisms, plants may rely on microorganisms to help them cope with cold. Because Valerianella locusta (lamb's lettuce) is a cold-adapted plant, it represents an interesting plant to understand how cold affects the root bacteriome. By means of amplicon sequencing of 16S ribosomal RNA genes, we identified the taxa forming the main cold root bacteriome of lamb's lettuce. The analysis of the root microbiome of a naturally growing V. locusta population and the study of the changes in the root microbiome of cultivated V. locusta grown under cold and ambient conditions allowed us to detect four cold-responsive families, of which Oxalobacteraceae presented the strongest shift under chilling temperatures. Moreover, the plant genotype had a small but significant effect on the response of the root bacteriome to cold. Finally, several bacterial candidates were discovered that may possibly alleviate the effect of low temperatures on plant fitness; namely, Massilia ASV2, Flavobacterium ASV5 and ASV11, or Acidovorax ASV20. However, currently, only 10 cold-enriched isolates could be obtained in cultivation, of which Flavobacterium R-83141; Polaromonas R-83176, R-83177, and R-83175; and Acidovorax R-83129 were able to increase either the root, shoot, or total fresh weight of a cold-sensitive ecotype of Arabidopsis thaliana (Cvi-0). Our results provide an overview of the taxa forming the root microbiome of this species and of the compositional shift that occurs under cold temperature treatment, demonstrating the impact of low temperatures on the composition of the root microbiome.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Medical Mistrust Among Pregnant Women During the COVID-19 Pandemic [ID: 1376909]
Authors: Wang Runzhi , Coleman Jenell , Izadi Lillee , Sao Saumya
Published: May 2023

INTRODUCTION:

Medical mistrust has exacerbated health care inequities, especially amidst the COVID-19 pandemic. We sought to assess the effect of the COVID-19 pandemic on medical mistrust among pregnant women, including attitudes toward vaccines.

METHODS:

An electronic survey was distributed among pregnant women aged 15–45 who were engaged in prenatal care at a medical institution in Baltimore, Maryland. Medical mistrust was evaluated by a validated survey using a five-item scale with a higher score indicating more mistrust. Another three questions assessed the effect of the COVID-19 pandemic on attitudes toward health care workers. Multiple linear regression models were used to compare scores by sociodemographic characteristics.

RESULTS:

Of 303 pregnant participants, the mean age was 31.4±6.2 years. The mean medical mistrust scale score was 1.67 (SD 0.76), range 1.0–4.2 (median 1.4). Higher scores were reported among self-identified Black/African-American participants compared to White/Caucasian (difference 0.55, 95% CI 0.31–0.80) and among participants with a history of illicit drug use (difference 0.23, 95% CI 0.01–0.45). 24.4% of participants reported they trusted health care providers less after the pandemic, and 13.6% became more suspicious of information they received from health care providers. Black/African American pregnant participants were more likely to agree that the pandemic increased medical mistrust than White/Caucasian pregnant participants (P<.05). Over 46% of pregnant participants reported the pandemic made them more aware of vaccines, and less than 17% became more hesitant.

CONCLUSION:

Nearly a quarter of participants trusted health care providers less after the COVID-19 pandemic. Black/African American pregnant women and those with a history of drug use have greater medical mistrust than White/Caucasian women.
The HPV at the Abortion Visit: The Utility of Video Education [ID: 1377357]
Authors: McLaren Hillary , Farley Brianna
Published: May 2023

INTRODUCTION:

The human papillomavirus (HPV) vaccine is an important component of comprehensive sexual and reproductive health care and has the potential to completely eradicate cervical cancer. However, many women make it to adulthood without receiving a single vaccine. The abortion visit is an important health care access point for high-risk, unvaccinated individuals.

METHODS:

Patients (N=20) were recruited from the waiting room at a Chicago Planned Parenthood. Phase 1 included participants completing a 29-question assessment on HPV knowledge, HPV testing, and HPV vaccination. Phase 2 consisted of a randomized control trial of English-speaking patients, aged 18–26, presenting for a medication abortion (N=50). Primary outcome was uptake of vaccine; secondary was HPV knowledge via the same knowledge assessment tool used in phase 1. Patients were randomized to the interventional video or “usual care.” All patients were offered an HPV vaccine during medication abortion counseling.

RESULTS:

Knowledge scores significantly improved from preintervention (0.68 [±0.06]) to postintervention (0.77±0.05) (P=.03). Patients from the video intervention group demonstrated higher vaccine uptake (16%) compared to the “usual-care” group (0%) (P=.04). HPV knowledge assessment was significantly different between arms, with usual-care patients scoring 60% versus video intervention patients at 72%.

CONCLUSION:

There was significant improvement in knowledge assessment scores and vaccine uptake among the video intervention group. Video education is an effective tool in increasing HPV knowledge and uptake.
Physician Characteristics Associated With Bias in Contraceptive Recommendations [ID: 1349236]
Authors: DiCenzo Natalie , Brandi Kristyn , Getz Kylie , Matthews Glenmarie
Published: May 2023

INTRODUCTION:

We sought to determine the effect of obstetrician–gynecologist characteristics on contraceptive recommendations for patients of various racial and socioeconomic backgrounds.

METHODS:

U.S. obstetrician–gynecologists were administered an online survey depicting photographic scenarios of reproductive-aged women of differing races (White, Black, Latina, Asian) and described socioeconomic status (SES) (high versus low), with all other factors identical, and asked to provide contraceptive recommendations. We used logistic regression to analyze recommendation differences based on physician and patient characteristics. Institutional review board approval was obtained.

RESULTS:

One hundred thirty-five total respondents were included: 55% attending physicians, 45% trainees (residents/fellows); 73% White, 27% non-White. Among all patients: Non-White physicians had significantly lower odds of recommending tubal (odds ratio [OR] 0.493), vaginal ring (OR 0.401), and patch (OR 0.513) compared to White physicians. Non-White physicians had significantly higher odds of recommending any long-acting reversible contraception (LARC) (OR 1.846) and condoms (OR 1.438) compared to White physicians. Trainees had significantly lower odds of recommending tubal (OR 0.632), condoms (OR 0.595), pills (OR 0.428), vaginal ring (OR 0.326), and patch (OR 0.536) compared to attendings. Trainees had significantly higher odds of recommending any LARC (OR 18.374) and medroxyprogesterone injection (OR 1.797) compared to attendings. All physicians had a significantly lower odds of recommending any self-administered contraceptive method to Black high-SES patients compared to White high-SES patients (OR 0.418). Other variations were noted but did not reach statistical significance.

CONCLUSION:

In our study, contraceptive recommendations differed by race and training level of the recommending physician and by patients' perceived race and SES. This suggests that physician bias contributes to contraceptive recommendations.
Introducing Men to Digital Birth Control [ID: 1372011]
Authors: Acuna Juan , Armbruster Magda , Scherwitzl Elina Berglund , Gemzell-Danielsson Kristina , Gemzell-Danielsson Kristina , Pearson Jack , Scherwitzl Raoul
Published: May 2023

INTRODUCTION:

As women increasingly take charge of their reproductive health through knowledge and thus informed contraceptive choice, some would like to share this responsibility with their male partners. Digital U.S. Food and Drug Administration-cleared birth control is now on the birth control market where a user inputs basal body temperature into an app and a daily fertility status is calculated by an algorithm.

METHODS:

In July 2022, a partner mode of the app was launched to all active users. Partner mode can be revoked at any time. We summarize metrics and feedback collected on the feature gaining valuable insights into how involving a partner in birth control can alter the overall experience.

RESULTS:

All active users have been informed about the new feature through an in-app message. A substantial fraction of them have enabled the partner view and sent invites to their partners, resulting in around 13,000 partners being active in the app on a monthly basis. Fifty-five percent of partners have enabled push notifications within their app, opting to receive these as insights into their partners' cycle. Eighty-five percent of users like the partner mode and 99% of those that use it said that they would continue to do so. Eighty-eight percent of users said that partner mode had enabled them to talk about their cycle and fertility journey with their partner.

CONCLUSION:

Partners found knowing where the user was in their cycle, daily fertility status, and period predictions the most valuable information presented to them in partner mode. Introducing men to digital birth control appears to be well received by both partners and users. It has the potential to broaden partners' understanding of female reproductive health and share the responsibility of preventing pregnancy.
Cancellation of Postpartum Tubal Ligations During COVID-19 and Alternative Contraceptive Methods in Women With Public Insurance: A 2-Year Update [ID: 1373829]
Authors: Park Selena , Elwood Adam , Matthews Glenmarie , Sauer Mark
Published: May 2023

INTRODUCTION:

During the COVID-19 pandemic, postpartum bilateral tubal ligations (ppBTLs) were deemed “elective” and cancelled from March through June 2020. For patients with public insurance, the postpartum represents a brief interval in which contraception is covered and access to surgery is readily available.

METHODS:

We reviewed publicly insured patients who consented for ppBTLs after vaginal deliveries at our institution from March to June 2020 in whom procedures were cancelled. We analyzed alternative contraception chosen at discharge and up to 6 months postpartum. Two years later, we reviewed the same patients to evaluate contraceptive practice and pregnancy outcomes.

RESULTS:

After 275 vaginal deliveries, 25 ppBTLs were cancelled. Subsequently, 12 (48%) women were discharged without contraception. Seven (28%) and 14 (56%) women were not using contraception 6 weeks and 6 months postpartum, respectively. Two years later, six (24%) women returned pregnant; three without contraception, one using oral contraceptive pills, one using condoms, and one with a perforated intrauterine device (IUD). Two are currently pregnant and one underwent abortion with IUD placement. Three experienced uncomplicated vaginal deliveries, after which two received ppBTLs and one did not return for follow-up.

CONCLUSION:

As a result of pandemic policy, many women were unable to access ppBTLs and failed alternative means of contraception. As a result, nearly one-quarter of these patients became pregnant. Obstetrician–gynecologists should ensure that contraception counseling and pregnancy intention are addressed at each prenatal appointment. Physicians must also lobby for an expansion of postpartum insurance coverage and better advocate for services that provide women reproductive autonomy.
Long-Acting Reversible Contraception Continuation After Management of a Malpositioned Intrauterine Device [ID: 1376021]
Authors: Young Riley , Fadadu Priyal , Green Isabel , Yang Catherine
Published: May 2023

INTRODUCTION:

Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD.

METHODS:

After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging.

RESULTS:

Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P<.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging.

CONCLUSION:

Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.
The Association Between BMI and Adherence After the Insertion of Etonogestrel-Releasing Implant [ID: 1376766]
Authors: Mohr-Sasson Aya , Bhalwal Asha , Dalal Leanne
Published: May 2023

INTRODUCTION:

The aim of this study is to learn the association between body mass index (BMI) to the incidence of side effects and adherence to treatment of etonogestrel-releasing implant.

METHODS:

This is a retrospective cohort study, conducted at a single university-affiliated medical clinic, including all women that underwent etonogestrel-releasing implant (Nexplanon, Merck and Co.) insertion between January 2019 to December 2021. Information on patients’ demographic, medical history, obstetrical and gynecological history, and follow-up were collected from women’s electronic medical files. Primary outcome was defined as the rate of implant removal in the obesity classes. The study was IRB approved.

RESULTS:

Study population included 1,318 women; of them, 466 (35%) requested early removal of the implant. Women’s demographic and clinical characteristics were comparable between women who requested early removal to those with full-length treatment. The median time for removal was 12 (6–20) months from insertion. Irregular bleeding was the most frequent reason for early removal in both groups and more prevalent in the early removal group (239 [51.29%] versus 193 [22%], P=.001). The rate of women with obesity (BMI ≥30 kg/m2) was found lower in the early removal group (163 [35%] versus 350 [41.1%], P=.03) with comparable rates between the groups in class 3 obesity (BMI ≥40 kg/m2) (P=.68). Side effects rate as a compound parameter (including irregular bleeding, heavy bleeding, weight gain, and mood changes) was higher in the group who didn’t have obesity (39.1% versus 32.7%, P=.02). Multi-regression logistic analysis including age, BMI, parity, and side effects found the presence of side effects as the only independent predictor significantly associated with early implant removal (B=1.74, P=.04).

CONCLUSION:

Adherence to etonogestrel-releasing implant contraception treatment is associated to the presence of side effects that is reported more often in women who do not have obesity. Body mass index was not found to be a significant factor influencing adherence to treatment.
Unmet Need for Safe Contraceptive Use Among Hypertensive Women at Risk for Unintended Pregnancy [ID: 1376928]
Authors: Panushka Katherine , Danvers Antoinette , Evans Thomas , Gurney Elizabeth , Peskin Melissa
Published: May 2023

INTRODUCTION:

The prevalence of hypertension among reproductive-aged women in the United States is increasing, and hypertension increases risks of adverse pregnancy and fetal outcomes. Cardiovascular events are the leading cause of pregnancy-related death in the United States. Therefore, contraceptive counseling should be an essential aspect of hypertension management. Our objective was to compare contraceptive counseling and use among hypertensive and nonhypertensive people at risk of unintended pregnancy.

METHODS:

Using the 2015–2017 and 2017–2019 National Survey of Family Growth (NSFG) Female Respondent Files, we compared contraceptive counseling and contraceptive use in the previous 12 months among people with and without hypertension. Linear probability models were used to estimate the adjusted probability of receiving contraceptive counseling and using contraception.

RESULTS:

Among 8,625 participants, 771 (8.7%) were hypertensive. 26.2% (95% CI 20.4–31.9) with hypertension and 20.7% (95% CI 19.3–22.2) without hypertension reported receiving contraceptive counseling. 39.8% (95% CI 33.2–46.5) with and 35.3% (95% CI 33.3–37.2) without hypertension reported using contraception. Adjusted results indicate hypertensive participants were 8.0% (95% CI 2.4–13.6) more likely to receive counseling, and 9.4% (95% CI 2.7–16.1) more likely to receive birth control. The most used contraceptive method by hypertensive participants was combined oral contraceptive pills (54.0% [95% CI 44.3–63.5%]).

CONCLUSION:

Among people at risk for unintended pregnancy, only 26.2% with hypertension received contraceptive counseling, and less than 40% used a contraceptive method. These results illuminate a large, unmet need for contraceptive access. Given the association of hypertension and maternal health, improving contraceptive delivery to this group provides an opportunity to prevent pregnancy-related morbidity.
Prescribing Patterns for Postpartum Contraception Among Breastfeeding Patients Insured Under Medicaid [ID: 1375071]
Authors: Whelan Anna , Amanullah Siraj , Gjelsvik Annie
Published: May 2023

INTRODUCTION:

The United States has a long history of reproductive coercion with people of color and lower socioeconomic status more likely to receive contraception/sterilization counseling than White, affluent patients. Contraceptive choice is important postpartum, particularly among people who plan to breastfeed. This study assessed postpartum contraception/sterilization prescription among breastfeeding people in Rhode Island insured under Medicaid compared to other insurances.

METHODS:

Secondary analysis of data from the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2019 was performed. Participants who answered yes to “having ever breastfed” were included and dichotomized based on insurance into “Medicaid” or “other insurances.” Primary outcome was postpartum contraception/sterilization prescription. Stata 15 was used to perform multivariable logistic regression accounting for complex survey design and weighting.

RESULTS:

Of 3,686 participants, 868 (24.4%) were insured under Medicaid. Medicaid participants were younger, had higher body mass indexes, and were more likely to identify as Black or mixed race or Hispanic ethnicity than those with other insurers. Those insured under Medicaid were 1.5 times more likely to be prescribed postpartum contraception than those with other insurers (95% CI: 1.26, 1.78). After adjusting for race and ethnicity, education level, marital status, and preterm delivery, those with Medicaid were 1.34 times more likely to be prescribed contraception (95% CI: 1.05, 1.72). Postpartum contraception prescription was inversely related to length of breastfeeding (P<.04).

CONCLUSION:

In this study, breastfeeding participants with Medicaid were more likely to be prescribed postpartum contraception than those with other insurances. Future research should be focused on assessing provider bias and initiatives to provide equitable and patient-centered counseling in this population.
Fezolinetant Treatment of Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: Effect of Intrinsic and Extrinsic Factors in Two Phase 3 Studies [ID: 1356963]
Authors: Santoro Nanette , King Deanna , Nappi Rossella , Neal-Perry Genevieve , Ottery Faith , Yamaguchi Yusuke
Published: May 2023

INTRODUCTION:

Fezolinetant was well tolerated and effective in reducing the frequency and severity of menopause-associated, moderate-to-severe vasomotor symptoms (VMSs) in SKYLIGHT 1 and 2. This analysis investigated the relationship between intrinsic (individual-related) and extrinsic (outside-influence) factors and fezolinetant efficacy.

METHODS:

In these phase 3, double-blind, placebo-controlled, IRB-approved studies (NCT04003155 and NCT04003142), women aged 40 through 65 years with moderate-to-severe VMSs (seven or more hot flushes/day) were randomized to once-daily placebo, fezolinetant 30 mg, or fezolinetant 45 mg. For this pooled analysis, the influence of intrinsic and extrinsic factors on change from baseline to week 12 in the frequency of moderate-to-severe VMSs was assessed by subgroups using a mixed model for repeated measurement.

RESULTS:

One thousand twenty-two women took one or more dose (placebo, n=342; fezolinetant 30 mg, n=339; fezolinetant 45 mg, n=341). Consistent improvements in VMS frequency over placebo were observed across subgroups with fezolinetant 45 mg. For intrinsic factors, least-square mean differences (95% CI) between fezolinetant 45 mg and placebo were as follows: age less than 55 years, −2.78 (−3.74, −1.82); 55 years or older, −2.24 (−3.23, −1.24); White race, −2.17 (−2.93, −1.41); Black race, −3.67 (−5.32, −2.01); and body mass index of 30 kg/m2 or higher, −2.87 (−4.11, −1.63). Extrinsic factors showed the following differences: current smoker, −3.48 (−5.19, −1.77); former/never smoker, −2.32 (−3.08, −1.57); European resident, −1.50 (−2.73, −0.26); and North American resident, −2.95 (−3.78, −2.13). Similar efficacy trends were observed with fezolinetant 30 mg.

CONCLUSION:

Fezolinetant was efficacious in treating moderate-to-severe VMSs associated with menopause across the intrinsic and extrinsic factors investigated, demonstrating its potential utility in a broad population.
Long-Term Safety of Elagolix With Add-Back in Women With Endometriosis-Associated Pain: 36-Month Results [ID: 1368036]
Authors: Simon James , Kim Jin Hee , Miller Paul , Ng Juki , Snabes Michael , Thomas James
Published: May 2023

INTRODUCTION:

Herein, we report updated safety results to 36 months from an ongoing phase 3, 48-month study evaluating the long-term safety of elagolix (ELA) with add-back (AB) for endometriosis-associated pain (EAP) (NCT03213457).

METHODS:

Premenopausal women with moderate-to-severe EAP were randomized in this IRB-approved study 4:1:2 to receive 12-month blinded treatment with ELA 200 mg twice daily (BID)+AB, ELA 200 mg BID for 6 months followed by 6-month ELA+AB, or placebo; followed by open-label ELA+AB for all patients for 36 months. This 36-month analysis assessed long-term safety, including bone mineral density (BMD).

RESULTS:

Throughout the open-label treatment period up to 36 months, BMD mean percent change from baseline measurements remained relatively stable at the total hip and lumbar spine and showed a decrease between 1% and 2% in the femoral neck over the open-label period. At 36 months, mean percent change from baseline in BMD for patients treated with ELA+AB throughout the study was −0.77% (spine, n=94); −0.36% (total hip, n=92); and −1.39% (femoral neck, n=92). The overall safety profile of ELA+AB, including AEs and SAEs, observed up to 36 months of treatment continues to be consistent with that previously observed at 12 and 24 months.

CONCLUSION:

This was the longest evaluation of ELA+AB to date. ELA+AB continued to maintain a favorable safety profile with minimal long-term effect on BMD and no newly identified safety events to 36 months. Combined with previously reported efficacy data, these safety data suggest ELA+AB may provide a long-term therapeutic option for women with EAP beyond 24 months.
Efficacy of Gonadotropin-Releasing Hormone Agonist (GnRH-a) in Ovarian Preservation in Females With Systemic Lupus Erythematosus (SLE) Receiving Cyclophosphamide (CYC) [ID: 1375370]
Authors: Abid Dania , Chu Jun , Hasni Sarfaraz , Manna Zerai , Abbas Naqvi Syed Ali
Published: May 2023

INTRODUCTION:

Systemic lupus erythematosus (SLE) female patients with severe disease manifestations are treated with cyclophosphamide (CYC), which causes ovarian cytotoxicity. Gonadotropin-releasing hormone agonist (GnRH-a) is often co-administered with CYC to preserve ovarian function and reproductive potential. However, there is a lack of evidence to support this use of GnRH-a. We conducted a retrospective study and questionnaire of SLE patients who received CYC with or without GnRH-a to evaluate its efficacy in preserving ovarian function.

METHODS:

This study was approved by the IRB of the National Institutes of Health (IRB#:001011). Review of medical records resulted in 50 female SLE patients treated with CYC who were less than 40 year old at the time of treatment: CYC only (n=20, group 1), CYC and GnRH-a (n=30, group 2). These patients were age/gender-matched with 50 SLE patients not treated with CYC (group 3). Data about demographics, SLE disease activity, damage accrual, cumulative CYC exposure, and pregnancy outcomes were collected by chart review. Self-reported questionnaires were used to collect data assessing menses cycles, pregnancies and their outcome, or infertility.

RESULTS:

There was no significant difference in SLE disease activity, baseline demographics, total damage accrual, or other clinical parameters between groups 1 and 2. The mean cumulative CYC dose was 1.2 g (group 1) and 1.5 g (group 2) (P=.16). Number of pregnancies were similar: mean (SD) group 1=2 (1.6); group 2=1.2 (1.4); group 3=1.3 (1.4) (P=.18). There were more miscarriages in group 1 compared to groups 2 and 3 (P=.015).

CONCLUSION:

Our data suggest use of GnRH-a improves pregnancy outcomes in SLE patients on CYC, but prospective studies are needed to establish its safety and efficacy.
Comparing Early COVID-19 Abortion Care Innovations in Hospital Versus Nonhospital Clinics: Data From a Nationwide Survey of Abortion Providers [ID: 1370918]
Authors: Silva Luisa , Lee Jessica
Published: May 2023

INTRODUCTION:

We examined differences between hospital-affiliated clinics and non-hospital-affiliated (independent of Planned Parenthood) clinics regarding abortion service innovation in response to the early COVID-19 pandemic.

METHODS:

We analyzed data from the third phase of a longitudinal nationwide survey of abortion providers conducted by the Society of Family Planning (collected August to October 2020). We analyzed adoption of abortion service innovation, comparing hospital-affiliated clinics to non-hospital-affiliated clinics that included adoption of no- or low-test or low-touch practices for medication abortion and first-trimester surgical abortion.

RESULTS:

Sixty-one clinics completed the survey (30 hospital affiliated, 31 non-hospital affiliated). We found hospital-affiliated clinics were more likely to be in the Northeast and West (P<.01). We found evidence of adoption, but no significant difference between clinic type in changes in gestational limit, changes in Rh testing policy, or adoption or expansion of telehealth services for pre-abortion counseling. Hospital-affiliated clinics were more likely to have reported making any change to abortion services in response to the pandemic (100% versus 87%, P<.04). Hospital-affiliated clinics were also significantly more likely to start/expand telemedicine visits for follow-up visits for medication abortion (odds ratio [OR] 6.63, 95% CI 1.6–26.8) and first-trimester surgical abortion (OR 12.75, 95% CI 3.1–51.9).

CONCLUSION:

Abortion care changed quickly, regardless of setting, when the stresses of COVID-19 hit the U.S. health care system. System-wide abortion care changes suggest successful information sharing regarding best practices and recommendations in abortion provision, which should continue to be promoted as the pandemic continues.
Racial Disparities in National Emergency Department Utilization and Admissions for Pelvic and Perineal Pain (2016–2019) [ID: 1376522]
Authors: Richardson Darington , Caldwell Martina , Jiang Charley , Lim Courtney , Marsh Erica , Mehari Kathleen
Published: May 2023

INTRODUCTION:

Pelvic/perineal pain encompasses a wide spectrum of diseases. Despite its high prevalence, there are little national data on emergency department utilization for its management.

METHODS:

Analysis of data from the Nationwide Emergency Department Sample from 2016 to 2019 was performed. Women between 15 and 44 year old with a primary diagnosis of pelvic/perineal pain (PPP) were included (ICD-10 R10.2). Race was available for 2019 only. This study was deemed exempt by the University of Michigan IRB.

RESULTS:

There were 923,300 ED visits for PPP (0.672% of all ED visits) with an admission rate of 0.16% versus 6.60% for all other diagnoses (P<.001). ED visits for PPP cost $4.7 billion USD over the 4 years. The average cost per visit was $5,136, compared to $4,143 for other diagnoses (P<.001). Patients from the lowest income quartile by zip code accounted for 37% of ED visits. Medicaid was the largest single payment type representing 44.4% of visits. In 2019, White women represented 47% of visits but accounted for 69.4% of admissions. Admission rates were 0.2% for White patients and 0.1% for Black patients (P<.001).

CONCLUSION:

While visits for PPP represent a small percentage of total ED visits, they reveal potential racial disparities with White women being admitted at twice the rate of Black women. Studies are needed to elucidate the etiologies of pelvic pain within different demographic groups and the potential contributions of structural inequities so that a goal of equitable care for all patients can be achieved.