bluuebunny/crossref_metadata_2025 huggingface dataset:
The Aesthetics of Action and Movement
Authors: Cross Emily S. , Orlandi Andrea
Published: August 2020

The embodied simulation account proposed a pivotal role for the body of an observer in the aesthetic perception of artworks. Beginning with this consideration, this chapter briefly outlines evidence from experimental psychology and cognitive neuroscience that supports this proposed relationship between the human body and motor knowledge and aesthetic appraisal of action. The chapter focuses on the cognitive processes involved in perceiving a moving body and aesthetic estimation. It also discusses the impact of visuomotor expertise in shaping different levels of action representation and relative hedonistic judgment. While this research field remains somewhat in its naissance, alternative accounts have also been proposed to account for the link between embodiment, expertise, and movement aesthetics, which are also considered here. The chapter concludes with some theoretical and methodological considerations, questions, and perspectives that warrant further attention in future studies to expand existing knowledge on the empirical aesthetics of the human body in action.
Political Equality and Turnout
Authors: Blais André , Dassonneville Ruth , Kostelka Filip
Published: August 2020

This chapter examines the relationship between voter turnout and political inequality. It investigates which groups are less (more) likely to vote, whether these groups are less (better) represented in Parliament, and whether their interests and values are less (better) defended in the actual policies that are adopted and implemented by governments. Existing research finds that economically and socially disadvantaged groups are more likely to abstain when voter turnout is low in established democracies. While low voter turnout does not systematically benefit a particular political camp, there is evidence that it produces a bias in public policy and reduces government responsiveness. The chapter concludes by discussing avenues for future research.
Descriptive Representation Revisited
Authors: Phillips Anne
Published: August 2020

Descriptive representation—understood as a concern that the gender and ethnic composition of elected assemblies should roughly correspond to the gender and ethnic composition of their electorate—is increasingly accepted as a legitimate political aim, but also remains contested. This chapter sets out key reasons why this aspect of representation matters, including some reasons why ‘descriptive representation’ may not be the best term. It addresses three perennial concerns: worries about essentialism; disagreements about the extent to which it implies a form of group representation; and questions about whose exclusion matters. In the final section, the chapter considers how the still growing body of initiatives to address political under-representation by gender and ethnicity relates to the populist politics that characterizes many liberal (and other) democracies today.
The Danish People’s Party
Authors: Kosiara-Pedersen Karina
Published: August 2020

The Danish People’s Party is the successful splinter party of the Progress Party. It was created by Pia Kjærsgaard and collaborators in 1996. Traditional party membership, public financing, and a high degree of centralization and party discipline characterize the party organization, while their political programme emphasizes less immigration and integration, less EU integration, more law and order, and welfare chauvinism. Their electoral success has affected government formation and policies. They have provided the parliamentary base for a centre-right government and gained political concessions, particularly on the immigration and integration field. While aiming to become an influential party, they did not enter into government when they became the largest party right of centre in 2015. Their marked electoral decline in 2019 leaves a number of questions concerning their future political position and influence.
Agricultural and Fisheries Policy
Authors: Daugbjerg Carsten , Andersen Peder , Hansen Henning Otte , Jacobsen Brian H.
Published: August 2020

This chapter analyses select national policy fields, demonstrating increased market liberalism in the Danish agricultural sector and in the fisheries sector. Policies aimed at reducing nitrogen leaching from farmland are shifting from reliance on universal measures to more emphasis on site-specific regulation. An important aim of this more differentiated approach is to reduce compliance costs for farmers. The family farm has traditionally been the bedrock of the Danish farm sector. To maintain its viability, restrictions on farm ownership were in place for decades. Most of these have now been dismantled and opened for new ownership models and injection of capital. Danish organic farming and food policy is distinct as it is actively pursuing a market-driven development by facilitating farm conversion, and importantly, supporting various types of initiatives aimed at increasing the demand for organic food. Danish fisheries policy has evolved into a property rights-based and market-based management system for fisheries. The drivers for introducing more market liberalism have been to maintain the international competitiveness of the two industries, and in the farm sector, a realization that incomes must increasingly be derived from the market in the future.
Industrialization and Industrial Hubs in Malaysia
Authors: Rasiah Rajah , Krishnan Gopi
Published: August 2020

Industrial agglomerations have become a major vehicle for stimulating economic growth and structural change in many countries. Malaysia was a pioneer amongst the developing countries that launched industrial hubs. This chapter examines the theoretical rationale, the policies introduced, and the four industrial agglomeration strategies launched by the Malaysian government to stimulate industrialization. The initial objective of developing export processing zones (EPZs) to attract investment, create jobs, and generate exports was successful. Unemployment, poverty rates, and income inequality fell from 1970 till 2017. However, EPZs, and the subsequent attempts to stimulate structural change from low- to high-value activities through science and technology parks and regional corridors, was not successful owing to the lack of human capital and effective technological upgrading policies. Initiatives to galvanize the industrial hubs must address these shortcomings, as well as emphasizing environmental greening and the evolution of an egalitarian economy.
The Economics of Innovation behind Cluster Dynamic Processes
Authors: Best Michael H.
Published: August 2020

Marshallian industrial districts may be an important stage in the emergence of networked groups of SMEs enjoying both Marshallian and Jacobian externalities. But sustainable growth depends upon transitioning to industrial districts within industrial ecosystems in which both local and national governments work together to craft and undertake policy frameworks that combine centralized strategic policy planning at the national level with decentralized authority and accountability at the local level. The concept of the industrial ecosystem is a modern expression of Marshall’s ‘collective organization of the district as a whole’. It is a way to think of a region’s population of specialized and differentiated enterprises and extra-firm, capability development infrastructures as integral to its productive structures and competitive advantage. It extends the policy domain from a market-centric to a production-centric economics perspective that focuses on capabilities and innovation. Major contributors include Adam Smith, Charles Babbage, Marshall, Allyn Young, Edith Penrose, Simon Kuznets and Jane Jacobs.
Industrial Hubs, Urban Systems, and Economic Development
Authors: Yemeru Edlam Abera
Published: August 2020

Urbanization and industrialization have followed interconnected pathways throughout history. In an urban era where cities concentrate the world’s population and economic activity, industrial hubs development will be inextricably associated with urban dynamics. Cities offer specific advantages that enable industrial productivity, but this is differentiated across the urban system. This chapter reviews the relationship between cities and industrialization, with a specific focus on the role of national urban systems in industrial hubs development. In doing so, it makes a case for a focus on cities and urban systems as key determinants of industrial hubs development and outcomes.
Language
Authors: Piergiacomi Enrico
Published: August 2020

The paper reassesses the evidence on the Epicurean analysis of language, which so far has received two kinds of interpretation. One is the “extensionalist” view, which supposes that the Epicureans developed a theory of meaning. The other consists in the “intensionalist” reading, which on the contrary suggests that these philosophers embrace a philosophy of linguistic behavior, where words express things without the medium of signification. The paper will argue that the former interpretation is more plausible, while focusing especially on the following topics: the relationship between words and reality, the natural origin of language, the theory of preconceptions, the ethical aim of Epicurean linguistic analysis as a whole (i.e. the search for the evident meanings of terms, which allow us to make inquiries that lead humans to well-being). At the same time, the paper will reconstruct how the Epicurean linguistic doctrine developed through time, from Epicurus to Diogenianus. This investigation will show that Epicureans did not simply repeat the basic teachings of their master, but improved them and changed some details, without however abandoning its main points. The only possible exception might be Lucretius’ study of poetry, which in his perspective consists precisely in abandoning the proper meanings of words and adopting a beautiful language which in part deliberately conveys falsehood/deception.
Robust Mechanism Design of Exchange
Authors: Andreyanov Pasha , Sadzik Tomasz
Published: August 2020

In this article, we provide mechanisms for exchange economies with private information and interdependent values, which are ex post individually rational, incentive compatible, generate budget surplus, and are ex post nearly efficient, with many agents. Our framework is entirely prior-free, and we make no symmetry restrictions. The mechanisms can be implemented using a novel discriminatory conditional double auction, without knowledge of information structure or utility functions. We also show that no other mechanism satisfying the constraints can generate inefficiency of smaller order.
Public Market Players in the Private World: Implications for the Going-Public Process
Authors: Huang Shiyang , Mao Yifei , Wang Cong (Roman) , Zhou Dexin
Published: August 2020

We investigate the effect of pre-IPO investments by public market institutional investors (institutions) on the exit of venture capitalists (VCs). Results indicate that institutions’ pre-IPO investments reduce IPO underpricing by mitigating VCs’ reliance on all-star analysts to boost market liquidity. We conclude that institutions facilitate VC exits in the secondary market. Supporting this view, our analysis reveals that the presence of institutions allows VCs to exit with a reduced price impact in the secondary market. Consistent with the ease of exit, VCs offer fewer shares at the IPO and are more likely to invest in institutionally backed startups.
Disease frequency, patient characteristics, comorbidity outcomes and immunosuppressive therapy in systemic sclerosis and systemic sclerosis-associated interstitial lung disease: a US cohort study
Authors: Li Qiang , Wallace Laura , Patnaik Padmaja , Alves Margarida , Gahlemann Martina , Kohlbrenner Veronika , Raabe Christina , Wang Jocelyn R , Garry Elizabeth M
Published: August 2020

Objectives

To investigate prevalence estimates and incidence rates (IRs) for SSc and SSc-associated interstitial lung disease (SSc-ILD) cohorts and describe patient characteristics, immunosuppressive therapy (IST) and comorbid outcomes among incident SSc and SSc-ILD cohorts.

Methods

Data were obtained from the US IBM MarketScan (2008–2017) claims database using algorithms developed with expert consultation. For the SSc cohort, newly diagnosed patients (aged ≥18 years) had one or more diagnostic claim for SSc. For the SSc-ILD cohort, patients had an additional ILD claim. Sensitivity analyses using two or more claims or alternative ILD diagnostic codes were also conducted.

Results

When requiring one or more diagnostic claim, the prevalence of SSc and SSc-ILD per 100 000 persons was 72.1 and 19.0. The IR for SSc and SSc-ILD per 100 000 person-years was 18.3 and 4.3. Sensitivity analyses requiring two or more claims yielded much lower prevalence (SSc: 41.5; SSc-ILD: 13.3) and IR (SSc: 8.8; SSc-ILD: 1.6) estimates. Patients with SSc-ILD were older, with increased comorbidities and diagnostic procedures at baseline. MTX and MMF were the most common ISTs; 12.7% of the SSc-ILD cohort received therapy at baseline vs 8.2% for SSc. A total of 42.5% and 45.0% of the SSc and SSc-ILD cohorts, respectively, started a stable IST regimen and 21.7% and 19.4% of these had an escalation. Skin disorders were the most common comorbid outcome in both cohorts during follow-up.

Conclusions

SSc, with or without associated ILD, is a rare disease in the US. Newly diagnosed patients with SSc-ILD had received more IST and had more comorbidities compared with newly diagnosed SSc.
Arthroscopy in rheumatology: where have we been? Where might we go?
Authors: Ike Robert W , Arnold William J , Kalunian Kenneth C
Published: August 2020

The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with ‘needle scopes’ used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features—such as calcinosis—beg further arthroscopic investigation. A new generation of ‘needle scopes’ with far superior optics awaits future investigators.
A Rapid Molecular Detection System for SdhB and SdhC Point Mutations Conferring Differential Succinate Dehydrogenase Inhibitor Resistance in Clarireedia Populations
Authors: Lee Jaemin , Elliott Michaela R. , Kim Minsoo , Yamada Toshihiko , Jung Geunhwa
Published: August 2020

Dollar spot, caused by the ascomycete fungus Clarireedia (formerly Sclerotinia), is one of the most resource-demanding diseases on amenity turfgrasses in North America. Differential resistance to the succinate dehydrogenase inhibitor (SDHI) fungicide class, conferred by singular point mutations on the SdhB, SdhC, and SdhD subunits of the succinate dehydrogenase enzyme (SDH), has been reported in dollar spot as well as many other plant-pathogenic fungal diseases. Four unique mutations were previously reported from Clarireedia field isolates collected from two different cool-season golf courses in Japan and Rhode Island: an amino acid substitution H267Y and a silent mutation (CTT to CTC) at codon 181 on the SdhB subunit gene, and amino acid substitutions G91R and G150R on the SdhC subunit gene. To properly diagnose and monitor SDHI resistance in the field, a rapid detection system for known mutations is crucial. As part of this study, additional SDHI-resistant Clarireedia isolates were collected from Rutgers University research plots and in vitro sensitivity to four SDHI active ingredients was assessed. SdhB, SdhC, and SdhD subunits of these isolates were sequenced to reveal an additional mutation on the SdhB subunit gene, H267R, not previously observed in Clarireedia. Cleaved amplified polymorphic sequence (CAPS) and derived CAPS molecular markers were developed to detect five mutations conferring SDHI resistance in Clarireedia isolates and validated using samples from two additional golf courses in Connecticut and Wisconsin experiencing SDHI field failure. This PCR-based molecular detection system will be useful for continued monitoring, assessment, and delay of SDHI resistance in the field.
Fungal Pathogens Associated With Canker Diseases of Almond in California
Authors: Holland Leslie A. , Trouillas Florent P. , Nouri Mohamed T. , Lawrence Daniel P. , Crespo Maria , Doll David A. , Duncan Roger A. , Holtz Brent A. , Culumber Catherine M. , Yaghmour Mohammad A. , Niederholzer Franz J. A. , Lightle Danielle M. , Jarvis-Shean Katherine S. , Gordon Phoebe E. , Fichtner Elizabeth J.
Published: August 2020

Almond canker diseases are destructive and can reduce the yield as well as the lifespan of almond orchards. These diseases may affect the trunk and branches of both young and mature trees and can result in tree death soon after orchard establishment in severe cases. Between 2015 and 2018, 70 almond orchards were visited throughout the Central Valley of California upon requests from farm advisors for canker disease diagnosis. Two major canker diseases were identified, including Botryosphaeriaceae cankers and Ceratocystis canker. In addition, five less prevalent canker diseases were identified, including Cytospora, Eutypa, Diaporthe, Collophorina, and Pallidophorina canker. Seventy-four fungal isolates were selected for multilocus phylogenetic analyses of internal transcribed spacer region ITS1-5.8S-ITS2 and part of the translation elongation factor 1-α, β-tubulin, and glyceraldehyde 3-phosphate dehydrogenase gene sequences; 27 species were identified, including 12 Botryosphaeriaceae species, Ceratocystis destructans, five Cytospora species, Collophorina hispanica, four Diaporthe species, two Diatrype species, Eutypa lata, and Pallidophorina paarla. The most frequently isolated species were Ceratocystis destructans, Neoscytalidium dimidiatum, and Cytospora californica. Pathogenicity experiments on almond cultivar Nonpareil revealed that Neofusicoccum parvum, Neofusicoccum arbuti, and Neofusicoccum mediterraneum were the most virulent. Botryosphaeriaceae cankers were predominantly found in young orchards and symptoms were most prevalent on the trunks of trees. Ceratocystis canker was most commonly found in mature orchards and associated with symptoms found on trunks or large scaffold branches. This study provides a thorough examination of the diversity and pathogenicity of fungal pathogens associated with branch and trunk cankers of almond in California.
Polysubstance Use Among Pregnant Women With Opioid Use Disorder in the United States, 2007–2016
Authors: Jarlenski Marian P. , Paul Nicole C. , Krans Elizabeth E.
Published: August 2020

OBJECTIVE:

To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States.

METHODS:

We conducted a time trend analysis of pooled, cross-sectional data from the National Inpatient Sample, an annual nationally representative sample of U.S. hospital discharge data. Among 38.0 million females aged 15–44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as at least one co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural compared with urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results.

RESULTS:

Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI 58.3–62.8%) to 64.1% (95% CI 62.8%–65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural compared with urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI 90.5–562.9% and 150.7%; 95% CI 78.2–52.7%, respectively), similarly to tobacco use (30.4%; 95% CI 16.9–45.4% and 23.2%; 95% CI 15.3–31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery in rural (−70.5%; 95% CI −80.4% to −55.5%) and urban (−61.9%; 95% CI −67.6% to −55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined −57% (95% CI −70.8% to −37.7%) in urban counties but did not change among those in rural counties.

CONCLUSION:

Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural compared with urban counties in the United States, with amphetamines and tobacco use increasing most rapidly.
Health-Related Quality of Life Improvements in Patients With Endometriosis Treated With Elagolix
Authors: Taylor Hugh S. , Soliman Ahmed M. , Johns Beverly , Pokrzywinski Robin M. , Snabes Michael , Coyne Karin S.
Published: August 2020

OBJECTIVE:

To evaluate the effects of elagolix on clinically meaningful improvements in health-related quality of life (HRQOL) measured by the EHP-30 (Endometriosis Health Profile-30).

METHODS:

Data from two phase III trials of elagolix for moderate to severe pain associated with endometriosis were pooled and analyzed as three groups: placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily. Patients were administered the EHP-30 questionnaire at baseline, and at months 1, 3, and 6 of treatment. Previously established responder definitions were applied to determine percentages of patients with clinically meaningful EHP-30 improvements. The probability of meeting EHP-30 responder definitions with elagolix compared with placebo at months 3 and 6 was determined by Poisson regression analysis, controlling for baseline scores.

RESULTS:

At month 6, the probabilities of meeting EHP-30 subscale responder definitions for pain, control and powerlessness, self-image, social support, emotional well-being, and sexual intercourse were 169% (adjusted relative risk [aRR]: 2.69, 95% CI 2.26–3.21), 129% (aRR 2.29, 95% CI 1.96–2.67), 80% (aRR 1.80, 95% CI 1.54–2.11), 70% (aRR 1.70, 95% CI 1.47–1.97), 67% (aRR 1.67, 95% CI 1.45–1.92), and 62% (aRR 1.62, 95% CI 1.36–1.92) greater, respectively (all P<.001), in the 200-mg group than in the placebo group. Although lower in magnitude than the 200-mg group, the 150-mg group also had greater probabilities of meeting responder definitions than the placebo group for all subscales except sexual intercourse. The probabilities of meeting responder definitions for pain, control and powerlessness, self-image, social support, and emotional well-being were 75% (aRR 1.75, 95% CI 1.44–2.14), 50% (aRR 1.50, 95% CI 1.25–1.80), 22% (aRR 1.22, 95% CI 1.01–1.47), 30% (aRR 1.30, 95% CI 1.09–1.53), and 35% (aRR 1.35, 95% CI 1.16–1.57) greater, respectively (all P<.05), in the 150-mg group than in the placebo group.

CONCLUSION:

Patients with moderate to severe pain associated with endometriosis and were treated with elagolix experienced clinically meaningful HRQOL improvements.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01620528 and NCT01931670.

FUNDING SOURCE:

AbbVie Inc.
Characteristics Associated With Treatment Failure 1 Year After Midurethral Sling in Women With Mixed Urinary Incontinence
Authors: Sung Vivian W. , Richter Holly E. , Moalli Pamela , Weidner Alison C. , Nguyen John N. , Smith Ariana L. , Dunivan Gena , Ridgeway Beri , Borello-France Diane , Newman Diane K. , Mazloomdoost Donna , Carper Benjamin , Gantz Marie G. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network*
Published: August 2020

OBJECTIVE:

To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence.

METHODS:

Four hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) against midurethral sling alone for mixed incontinence with 1 year of follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective failure, objective failure, or both. Subjective failure was defined as not meeting the minimal clinically important difference for improvement on the UDI (Urogenital Distress Inventory)-total score (26.1 points). Objective failure was not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P<.2). Treatment group interaction effects were evaluated.

RESULTS:

Previous overactive bladder medication use (unadjusted odds ratio [OR] 2.19, adjusted odds ratio [aOR] 1.89, 95% CI 1.10–3.25), detrusor overactivity on cystometrogram (OR 2.25, aOR 2.72, 95% CI 1.53–4.84), body mass index (OR 1.29, aOR 1.27, 95% CI 1.03–1.57), and Valsalva leak point pressure less than 60 cm H2O (OR 1.96, aOR 3.13, 95% CI 1.65–5.94) were associated with overall failure. Worse UDI urgency scores were associated with failure in the midurethral sling–alone group. Sling type (retropubic vs transobturator) was not associated with failure.

CONCLUSION:

Certain clinical and urodynamic variables are associated with treatment failure after midurethral sling among women with mixed urinary incontinence. Women with more severe urgency symptoms at baseline may benefit from perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling. This information is helpful for counseling women with mixed incontinence who are considering surgery.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01959347.
Sexual Activity and Dyspareunia 1 Year After Surgical Repair of Pelvic Organ Prolapse
Authors: Lukacz Emily S. , Sridhar Amaanti , Chermansky Christopher J. , Rahn David D. , Harvie Heidi S. , Gantz Marie G. , Varner R. Edward , Korbly Nicole B. , Mazloomdoost Donna ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network (PFDN)
Published: August 2020

OBJECTIVE:

To describe sexual activity and risks for dyspareunia after pelvic organ prolapse surgery.

METHODS:

This was a secondary analysis of data from four randomized trials conducted between 2002 and 2018. Standard assessments and validated measures of sexual function were assessed at baseline and at 12 months postoperatively. Anterior apical surgeries were grouped by approach: transvaginal native tissue repairs, transvaginal mesh or graft-augmented repairs, and abdominal sacrocolpopexy. Additional surgeries, which included posterior repair, hysterectomy, and slings, were analyzed. Bivariate analyses and logistic regression models identified risk factors for postoperative dyspareunia.

RESULTS:

Of the 1,337 women enrolled in the trials, 932 had sufficient outcome data to determine dyspareunia status. Of these before surgery, 445 (47.8%) were sexually active without dyspareunia, 89 (9.6%) were sexually active with dyspareunia, 93 (10.0%) were not sexually active owing to fear of dyspareunia, and 305 (32.7%) were not sexually active for other reasons. At 12 months, dyspareunia or fear of dyspareunia was present in 63 of 627 (10.0%); occurred de novo in 17 of 445 (3.8%) and resolved in 136 of 182 (74.7%). Multivariable regression demonstrated baseline dyspareunia as the only factor associated with postoperative dyspareunia (adjusted odds ratio 7.8, 95% CI 4.2–14.4). No other factors, including surgical approach, were significantly associated with postoperative dyspareunia. Too few had de novo dyspareunia to perform modeling.

CONCLUSION:

Dyspareunia is common in one in five women before undergoing prolapse surgery. Surgical repair resolves dyspareunia in three out of four women with low rates of de novo dyspareunia at less than 4%. Preoperative dyspareunia appears to be the only predictor of postoperative dyspareunia.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00065845, NCT00460434, NCT00597935, and NCT01802281.
Reducing the Risk for Postpartum Depression in Adolescent Mothers
Authors: Phipps Maureen G. , Ware Crystal F. , Stout Robert L. , Raker Christina A. , Zlotnick Caron
Published: August 2020

OBJECTIVE:

To estimate the effect of an interpersonal therapy-based intervention on reducing the risk of postpartum depression in adolescents.

METHODS:

A randomized controlled trial enrolled 250 pregnant adolescents who were aged 18 years or younger at conception. The initial sample size calculation estimated 276 participants (324 with attrition) were needed to detect a 50% reduction in risk of the primary outcome, postpartum major depressive episode, with an alpha of 0.05% and 80% power. An interim analysis by the Data Safety and Monitoring Committee informed a revision in the sample size target to 250. Participants were randomized to the intervention (n=129) or a time-matched control group (n=121) who attended sessions about pregnancy topics. Each group received five prenatal sessions and a postpartum booster session. A structured diagnostic interview was administered at baseline and specific time points through 12-months postpartum to assess for major depressive episode onset.

RESULTS:

Participants were recruited from December 2011 to May 2016 through urban prenatal care sites in the state of Rhode Island. Of the 250 participants, 58% identified as Hispanic and 20% as black or African American. The rate of major depressive episode by 12 months postpartum was 7.0% (95% CI 2.3–11.7%) in the control group and 7.6% (95% CI 2.5–12.7%) in the intervention group, with no significant difference between groups at any time point (P=.88 by log-rank test).

CONCLUSION:

No benefit was shown between the intervention and control groups in the rates of major depressive episode, which is likely related to a lower than predicted rate of this outcome in the control group (7.6% actual vs 25% predicted). Enhanced local community resources available to pregnant and parenting adolescents during the study period may be an explanation for this result.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01482832.
Opioid Prescription and Persistent Opioid Use After Ectopic Pregnancy
Authors: Wall-Wieler Elizabeth , Shover Chelsea L. , Hah Jennifer M. , Carmichael Suzan L. , Butwick Alexander J.
Published: August 2020

OBJECTIVE:

To evaluate outpatient opioid dispensing and the incidence of persistent opioid use after ectopic pregnancy.

METHODS:

This cohort study used U.S. employer-based claims data to identify opioid-naïve individuals experiencing ectopic pregnancy from November 1, 2008, to September 30, 2015. Treatment was categorized as surgical, medical (using methotrexate), or unknown. New opioid prescriptions were defined as prescriptions filled from 1 week before to 1 week after an ectopic pregnancy treatment. For those who filled a new opioid prescription, we calculated the incidence and risk factors for persistent opioid use, defined as having filled at least one opioid prescription both from 8 to 90 days after treatment and from 91 to 365 days after treatment.

RESULTS:

Of the 15,338 individuals in our study, 7,047 (45.9%, 95% CI 45.2–46.7%) filled an opioid prescription at the time of treatment, of whom 4.1% (95% CI 3.6–4.6%) developed persistent opioid use. The risk of persistent opioid use was lower among those who had surgical compared with medical treatment (3.7% and 6.8%, respectively; relative risk [RR] 0.54, 95% CI 0.38–0.77). Variables most strongly associated with persistent opioid use were a history of benzodiazepine use (RR 1.99; 95% CI 1.43–2.78; adjusted relative risk [aRR] 1.57, 95% CI 1.11–2.22), antidepressant use (RR 1.91, 95% CI 1.45–2.53; aRR 1.53, 95% CI 1.08–2.18), and a pre-existing pain disorder (RR 1.58, 95% CI 1.26–1.99; aRR 1.47, 95% CI 1.16–1.85) in the year before treatment.

CONCLUSION:

New opioid use is common after an ectopic pregnancy; approximately 4% of those with new opioid use develop persistent opioid use, with the rate higher in those treated medically. New pain-management guidelines need to be developed to prevent persistent opioid use after ectopic pregnancy.
An Expanded Obstetric Comorbidity Scoring System for Predicting Severe Maternal Morbidity
Authors: Leonard Stephanie A. , Kennedy Chris J. , Carmichael Suzan L. , Lyell Deirdre J. , Main Elliott K.
Published: August 2020

OBJECTIVE:

To develop and validate an expanded obstetric comorbidity score for predicting severe maternal morbidity that can be applied consistently across contemporary U.S. patient discharge data sets.

METHODS:

Discharge data from birth hospitalizations in California during 2016–2017 were used to develop the score. The outcomes were severe maternal morbidity, defined using the Centers for Disease Control and Prevention index, and nontransfusion severe maternal morbidity (excluding cases where transfusion was the only indicator of severe maternal morbidity). We selected 27 potential patient-level risk factors for severe maternal morbidity, identified using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used a targeted causal inference approach integrated with machine learning to rank the risk factors based on adjusted risk ratios (aRRs). We used these results to assign scores to each comorbidity, which sum to a single numeric score. We validated the score in California and national data sets and compared the performance to that of a previously developed obstetric comorbidity index.

RESULTS:

Among 919,546 births, the rates of severe maternal morbidity and nontransfusion severe maternal morbidity were 168 and 74 per 10,000 births, respectively. The highest risk comorbidity was placenta accreta spectrum (aRR of 30.5 for severe maternal morbidity and 54.7 for nontransfusion severe maternal morbidity) and the lowest was gestational diabetes mellitus (aRR of 1.06 for severe maternal morbidity and 1.12 for nontransfusion severe maternal morbidity). Normalized scores based on the aRR were developed for each comorbidity, which ranged from 1 to 59 points for severe maternal morbidity and from 1 to 36 points for nontransfusion severe maternal morbidity. The overall performance of the expanded comorbidity scores was good (C-statistics were 0.78 for severe maternal morbidity and 0.84 for nontransfusion severe maternal morbidity in California data and 0.82 and 0.87, respectively, in national data) and improved on prior comorbidity indices developed for obstetric populations. Calibration plots showed good concordance between predicted and actual risks of the outcomes.

CONCLUSION:

We developed and validated an expanded obstetric comorbidity score to improve comparisons of severe maternal morbidity rates across patient populations with different comorbidity case mixes.
Two Intraoperative Techniques for Midurethral Sling Tensioning
Authors: Brennand Erin A. , Wu Guosong , Houlihan Sara , Globerman Dobrochna , Gagnon Louise-Helene , Birch Colin , Hyakutake Momoe , Carlson Kevin V. , Al-Shankiti Hanan , Robert Magali , Lazare Darren , Kim-Fine Shunaha ,   for the Calgary Women's Pelvic Health Research Group
Published: August 2020

OBJECTIVE:

To evaluate whether the use of a Mayo Scissor as a suburethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in different rates of abnormal bladder outcomes 12 months after retropubic midurethral sling surgery.

METHODS:

The MUST (Mid-Urethral Sling Tensioning) trial was a block-randomized, double-blind, multicenter clinical trial that allocated women to have their retropubic midurethral slings tensioned by Scissor or Babcock technique. The primary outcome (abnormal bladder) was a composite of persistent stress urinary incontinence (SUI), overactive bladder, and urinary retention. Secondary outcomes included outcomes of the composite, postoperative catheterization, incontinence-related questionnaires, repeat incontinence treatment, and uroflowmetry. Sample size of 159 in each arm (N=318) was planned for a superiority trial, hypothesizing a 10% difference in primary outcome.

RESULTS:

From September 2015 to December 2017, 506 women were screened and 318 were randomized. Baseline characteristics were similar in each arm. At 12 months, 253 (79.6%) women provided information on primary outcome: 40 of 128 (31.3%) patients with midurethral slings tensioned by Scissor experienced abnormal bladder, compared with 23 of 125 (18.4%) of those with midurethral slings tensioned by Babcock (P=.018, relative difference 12.9%). Secondary analyses favored Babcock for median duration of catheterization and the proportions of women experiencing urinary retention requiring sling lysis. Uroflowmetry parameters suggest the Scissor technique is more restrictive. Rates of mesh erosion were lower for the Scissor arm. No differences occurred in proportions of women experiencing patient reported persistent SUI after surgery.

CONCLUSION:

Abnormal bladder outcomes were 12.9% less frequent for women with midurethral slings tensioned by Babcock. Both techniques provided a comparable patient reported cure for SUI at 12 months. Women with midurethral slings tensioned by Scissors experienced more intervention for obstruction, whereas those with midurethral slings tensioned by Babcock experienced higher rates of mesh erosion. This information about how the postoperative courses differ allows surgeons to better counsel patients preoperatively or tailor their choice of technique.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02480231.

FUNDING SOURCE:

Boston Scientific.
The Challenge of Listening at Home: Speech and Noise Levels in Homes of Young Children With Hearing Loss
Authors: Benítez-Barrera Carlos R. , Grantham D. Wesley , Hornsby Benjamin W.Y.
Published: August 2020

Objectives:

The objective of this study was to characterize the acoustics of the home environment of young children with hearing loss. Specifically, we aimed to quantify the range of speech levels, noise levels, and signal-to-noise ratios (SNRs) encountered by children with hearing loss in their homes.

Design:

Nine families participated in the study. The children with hearing loss in these families were between 2 and 5 years of age. Acoustic recordings were made in the children’s homes over one weekend (Saturday and Sunday) using Language ENvironmental Analysis (LENA) recorders. These recordings were analyzed using LENA’s proprietary software to determine the range of speech and noise levels in the child’s home. A custom Matlab program analyzed the LENA output to estimate the SNRs in the children’s homes.

Results:

The average SNR encountered by children with hearing loss in our sample was approximately +7.9 dB SNR. It is important to note that our analyses revealed that approximately 84% of the SNRs experienced by these children with hearing loss were below the +15 dB SNR recommended by the American Speech-Language Hearing Association. Averaged across families, speech and noise levels were 70.1 and 62.2 C-weighted decibels, respectively.

Conclusions:

These data show that, for much of the time, young children with hearing loss are forced to listen under suboptimal conditions in their home environments. This has important implications as listening under these conditions could negatively affect learning opportunities for young children with hearing loss. To mitigate these potential negative effects, the use of assistive listening devices that improve the SNR (e.g., remote microphone systems) should be considered for use at home by young children with hearing loss.
Age and mitochondrial DNA copy number influence the association between outdoor temperature and cognitive function
Authors: Dolcini Jacopo , Kioumourtzoglou Marianthi-Anna , Cayir Akin , Sanchez-Guerra Marco , Brennan Kasey J. , Dereix Alexandra E. , Coull Brent A. , Spiro Avron , Vokonas Pantel , Schwartz Joel , Baccarelli Andrea A.
Published: August 2020

Background:

General cognitive function deteriorates with aging, a change that has been linked to outdoor temperature. Older individuals have reduced ability to adapt to changes in outdoor temperature than younger people. However, to what extent short-term changes in outdoor temperature interact with mitochondria to affect cognition in older people has not yet been determined.

Methods:

Our study included 591 participants of the Normative Aging Study who underwent multiple examinations between 2000 and 2013. Cognitive function was evaluated via the Mini-Mental State Examination. Outdoor temperature was estimated at residential addresses 1 day before the examination using on a validated spatiotemporal temperature model. Mitochondrial DNA copy number (mtDNAcn) was determined using buffy coat samples.

Results:

We found an interaction between temperature, age, mtDNAcn, and cognition. In individuals 84 years of age or older, cooler temperature was associated with low cognition (odds ratio = 1.2; 95% confidence interval = 1.05, 1.35 for a 1°C decrease in temperature; P = 0.007). We found higher odds ratio per 1°C decrease in temperature among individuals with lower mtDNAcn (β3 = 0.12; 95% confidence interval = 0.01, 0.22; P
interaction = 0.02).

Conclusions:

Our findings, albeit potentially underpowered, suggest that older individuals may be more susceptible to the influence of short-term temperature exposure on cognition. Moreover, the level of mtDNAcn may also modify the association between temperature and cognitive function, indicating a possible role of these cellular elements in this relationship.
Genomic variance of Open Reading Frames (ORFs) and Spike protein in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Authors: Tsai Ping-Hsing , Wang Mong-Lien , Yang De-Ming , Liang Kung-How , Chou Shih-Jie , Chiou Shih-Hwa , Lin Ta-Hsien , Wang Chin-Tien , Chang Tai-Jay
Published: August 2020

Background:

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused severe pneumonia at December 2019. Since then, it has been wildly spread from Wuhan, China, to Asia, European, and United States to become the pandemic worldwide. Now coronavirus disease 2019 were globally diagnosed over 3 084 740 cases with mortality of 212 561 toll. Current reports variants are found in SARS-CoV-2, majoring in functional ribonucleic acid (RNA) to transcribe into structural proteins as transmembrane spike (S) glycoprotein and the nucleocapsid (N) protein holds the virus RNA genome; the envelope (E) and membrane (M) alone with spike protein form viral envelope. The nonstructural RNA genome includes ORF1ab, ORF3, ORF6, 7a, 8, and ORF10 with highly conserved information for genome synthesis and replication in ORF1ab.

Methods:

We apply genomic alignment analysis to observe SARS-CoV-2 sequences from GenBank (http://www.ncbi.nim.nih.gov/genebank/): MN 908947 (China, C1); MN985325 (United States: WA, UW); MN996527 (China, C2); MT007544 (Australia: Victoria, A1); MT027064 (United States: CA, UC); MT039890 (South Korea, K1); MT066175 (Taiwan, T1); MT066176 (Taiwan, T2); LC528232 (Japan, J1); and LC528233 (Japan, J2) and Global Initiative on Sharing All Influenza Data database (https://www.gisaid.org). We adopt Multiple Sequence Alignments web from Clustalw (https://www.genome.jp/tools-bin/clustalw) and Geneious web (https://www.geneious.com.

Results:

We analyze database by genome alignment search for nonstructural ORFs and structural E, M, N, and S proteins. Mutations in ORF1ab, ORF3, and ORF6 are observed; specific variants in spike region are detected.

Conclusion:

We perform genomic analysis and comparative multiple sequence of SARS-CoV-2. Large scaling sequence alignments trace to localize and catch different mutant strains in United possibly to transmit severe deadly threat to humans. Studies about the biological symptom of SARS-CoV-2 in clinic animal and humans will be applied and manipulated to find mechanisms and shield the light for understanding the origin of pandemic crisis.
Right–Left Ventricular Interaction in Left-Sided Heart Failure With and Without Venoarterial Extracorporeal Membrane Oxygenation Support—A Simulation Study
Authors: Donker Dirk W. , Sallisalmi Marko , Broomé Michael
Published: August 2020

Left ventricular (LV) dilatation is commonly seen with LV failure and is often aggravated during venoarterial extracorporeal membrane oxygenation (VA ECMO). In this context, the intricate interaction between left and right heart function is considered to be of pivotal importance, yet mechanistically not well understood. We hypothesize that a preserved or enhanced right heart contractility causes increased LV loading both with and without VA ECMO. A closed-loop in-silico simulation model containing the cardiac chambers, the pericardium, septal interactions, and the pulmonary and systemic vascular systems with an option to connect a simulated VA ECMO circuit was developed. Right ventricular contractility was modified during simulation of severe LV failure with and without VA ECMO. Left atrial pressures increased from 14.0 to 23.8 mm Hg without VA ECMO and from 18.4 to 27.0 mm Hg under VA ECMO support when right heart contractility was increased between end-systolic elastance 0.1 and 1.0 mm Hg/ml. Left-sided end-diastolic volumes increased from 125 to 169 ml without VA ECMO and from 150 to 180 ml with VA ECMO. Simulations demonstrate that increased diastolic loading of the LV may be driven by increased right ventricular contractility and that left atrial pressures cannot be interpreted as a reflection of the degree of LV dysfunction and overload without considering right ventricular function. Our study illustrates that modelling and computer simulation are important tools to unravel complex cardiovascular mechanisms underlying the right–left heart interdependency both with and without mechanical circulatory support.
Host metabolic reprogramming in response to SARS-Cov-2 infection
Authors: Moolamalla S T R , Chauhan Ruchi , Deva Priyakumar U , Vinod P K
Published: August 2020

Understanding the pathogenesis of SARS-CoV-2 is important for developing effective treatment strategies. Viruses hijack the host metabolism to redirect the resources for their replication and survival. How SARS-CoV-2 influences the host metabolism is still unclear. In this study, we analyzed transcriptomic data obtained from different human respiratory cell lines and patient samples (Swab, PBMC, lung biopsy, BALF) to understand the metabolic alterations in response to SARS-CoV-2 infection. For this purpose, the expression pattern of metabolic genes in the human genome-scale metabolic network model Recon3D was explored. We identified metabolic genes and pathways and reporter metabolites under each SARS-CoV-2-infected condition and compared them to identify common and unique changes in the metabolism. Our analysis revealed host-dependent dysregulation of glycolysis, mitochondrial metabolism, amino acid metabolism, glutathione metabolism, polyamine synthesis, and lipid metabolism. We observed different metabolic changes that are pro- and antiviral in nature. We generated hypotheses on how antiviral metabolism can be targeted/enhanced for reducing viral titers. These warrant further exploration with more samples and in vitro studies to test predictions.