bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceiving actions before they happen: psychological dimensions scaffold neural action prediction
Authors: Thornton Mark A , Tamir Diana I
Published: September 2020

The social world buzzes with action. People constantly walk, talk, eat, work, play, snooze and so on. To interact with others successfully, we need to both understand their current actions and predict their future actions. Here we used functional neuroimaging to test the hypothesis that people do both at the same time: when the brain perceives an action, it simultaneously encodes likely future actions. Specifically, we hypothesized that the brain represents perceived actions using a map that encodes which actions will occur next: the six-dimensional Abstraction, Creation, Tradition, Food(-relevance), Animacy and Spiritualism Taxonomy (ACT-FAST) action space. Within this space, the closer two actions are, the more likely they are to precede or follow each other. To test this hypothesis, participants watched a video featuring naturalistic sequences of actions while undergoing functional magnetic resonance imaging (fMRI) scanning. We first use a decoding model to demonstrate that the brain uses ACT-FAST to represent current actions. We then successfully predicted as-yet unseen actions, up to three actions into the future, based on their proximity to the current action’s coordinates in ACT-FAST space. This finding suggests that the brain represents actions using a six-dimensional action space that gives people an automatic glimpse of future actions.
Inferring the Effect of Species Interactions on Trait Evolution
Authors: Xu Liang , Van Doorn Sander , Hildenbrandt Hanno , Etienne Rampal S
Published: September 2020

Models of trait evolution form an important part of macroevolutionary biology. The Brownian motion model and Ornstein–Uhlenbeck models have become classic (null) models of character evolution, in which species evolve independently. Recently, models incorporating species interactions have been developed, particularly involving competition where abiotic factors pull species toward an optimal trait value and competitive interactions drive the trait values apart. However, these models assume a fitness function rather than derive it from population dynamics and they do not consider dynamics of the trait variance. Here, we develop a general coherent trait evolution framework where the fitness function is based on a model of population dynamics, and therefore it can, in principle, accommodate any type of species interaction. We illustrate our framework with a model of abundance-dependent competitive interactions against a macroevolutionary background encoded in a phylogenetic tree. We develop an inference tool based on Approximate Bayesian Computation and test it on simulated data (of traits at the tips). We find that inference performs well when the diversity predicted by the parameters equals the number of species in the phylogeny. We then fit the model to empirical data of baleen whale body lengths, using three different summary statistics, and compare it to a model without population dynamics and a model where competition depends on the total metabolic rate of the competitors. We show that the unweighted model performs best for the least informative summary statistic, while the model with competition weighted by the total metabolic rate fits the data slightly better than the other two models for the two more informative summary statistics. Regardless of the summary statistic used, the three models substantially differ in their predictions of the abundance distribution. Therefore, data on abundance distributions will allow us to better distinguish the models from one another, and infer the nature of species interactions. Thus, our framework provides a conceptual approach to reveal species interactions underlying trait evolution and identifies the data needed to do so in practice. [Approximate Bayesian computation; competition; phylogeny; population dynamics; simulations; species interaction; trait evolution.]
Analysis of the different locomotive wireless multi-traction synchronous control systems for heavy-haul combined trains and their performance
Authors: Li Wei , Chen Chunyang , Li Hui , Wang Kai , Xie Liang , Zhang Wenlu
Published: September 2020

This paper looks at the heavy-haul combined train composed of different types of locomotives and its distributed power control system with a combination of 800 MHz and TD-LTE wireless communication. It analyses some key characteristic parameters that affect the synchronism and communication of the differential wireless multi-traction synchronous control systems for heavy-haul combined trains. At the same time, in order to reduce the latency of instruction and information transfer between different types of locomotives, improve the time-limit certainty of wireless transmission and optimize the control quality of multi-traction control systems for heavy-haul combined trains, a synchronism optimization strategy based on the Markov decision process on the basis of Petri networkconstruction is proposed. Relevant experiments and tests are carried out to verify the effectiveness of the synchronism optimization of the control system, which provides a guarantee for improving the differential wireless multi-traction synchronous control system for combined trains and optimizing train control.
Potato Cyst Nematode Egg Viability Assessment and Preparasitic Juvenile Screening Using a Large Particle Flow Cytometer and Sorter
Authors: Sivasankara Pillai Syamkumar , Dandurand Louise-Marie
Published: September 2020

Potato cyst nematode (PCN) cysts consist of heterogenous populations of eggs, juveniles, and eggshells that make manual sorting of individual life stages cumbersome. The number of viable PCN eggs is a major determinant of crop damage. An accurate high-throughput PCN egg viability assay is useful for developing effective management and eradication plans. In this study, we present a method for rapid and precise enumeration and sorting of PCN eggs and juveniles, along with an egg viability assessment by staining eggs with the fluorescent stain, acridine orange, and sorting with the Complex Object Parametric Analyzer and Sorter (COPAS) system, a large particle flow cytometer. Both size sorting and fluorescent sorting capabilities of the COPAS were explored. By using the COPAS, sorting efficiency for eggs and preparasitic second-stage juveniles (J2s) was 97.6 and 97.2%, respectively, with 99% recovery at a flow rate of 15 events/s. Purity of sorted live and dead eggs was 95.5 and 94.1%, respectively. Sorting of J2s by size indicated that 15 to 16.4% of Globodera ellingtonae or G. pallida had an average body length of 436.1 ± 3.4 µm compared with an average size of 512.9 ± 4.4 µm for the majority of the J2 population for both species. A red autofluorescing J2 population was also identified through sorting. Sorting of eggs by flow cytometry did not significantly affect hatching (55.1 ± 1.2 and 53.9 ± 1.6%, respectively, for sorted or nonsorted eggs) or juvenile motility (91.3 ± 1.0 or 90.1 ± 1.1%, respectively), thus confirming that the method does not impair the biological activity of the nematode.
Climate Change and the Practice of Medicine: Essentials for Resident Education
Authors: Philipsborn Rebecca Pass , Sheffield Perry , White Andrew , Osta Amanda , Anderson Marsha S. , Bernstein Aaron
Published: September 2020

Despite calls for including content on climate change and its effect on health in curricula across the spectrum of medical education, no widely used resource exists to guide residency training programs in this effort. This lack of resources poses challenges for training program leaders seeking to incorporate evidence-based climate and health content into their curricula. Climate change increases risks of heat-related illness, infections, asthma, mental health disorders, poor perinatal outcomes, adverse experiences from trauma and displacement, and other harms. More numerous and increasingly dangerous natural disasters caused by climate change impair delivery of care by disrupting supply chains and compromising power supplies. Graduating trainees face a knowledge gap in understanding, managing, and mitigating these many-faceted consequences of climate change, which—expected to intensify in coming decades—will influence both the health of their patients and the health care they deliver. In this article, the authors propose a framework of climate change and health educational content for residents, including how climate change (1) harms health, (2) necessitates adaptation in clinical practice, and (3) undermines health care delivery. The authors propose not only learning objectives linked to the Accreditation Council for Graduate Medical Education core competencies for resident education but also learning formats and assessment strategies in each content area. They also present opportunities for implementation of climate and health education in residency training programs. Including this content in residency education will better prepare doctors to deliver anticipatory guidance to at-risk patients, manage those experiencing climate-related health effects, and reduce care disruptions during climate-driven extreme weather events.
Dismantling Structural Racism in Academic Medicine: A Skeptical Optimism
Authors: Shim Ruth S.
Published: September 2020

Structural racism is pervasive in U.S. society, and academic medicine is not immune to the effects of this disease. The social determinants of health have been implicated as the main drivers of health disparities and inequities in society, and racism has been well established as a social determinant of health. Research consistently highlights poor health outcomes for Black populations and other communities of color compared with White populations across a variety of conditions. Medical students, residents, and faculty of all backgrounds regularly experience the destructive effects of structural racism in medicine. Renewed attention to the problem is encouraging, but, if it is consistent with history, transient. If academic medicine can arrive at a place of discarding the shackles of biological determinism, perhaps the field can begin to take initial steps toward dismantling the structural racism that drives health inequities. To make true headway, academic medicine must be willing to make bold strategic and financial commitments to do more. This work will not be easy, and there will be great resistance to the type of change that is needed. It is time to ask whether the leaders of academic institutions have the will to act and to continue to push forward in the face of opposition. The author is skeptical—because of the scope of the work that needs to be done and because it feels as if society has been here many times before—and, yet, remains optimistic.
“There Is a Lot of Change Afoot”: A Qualitative Study of Faculty Adaptation to Elimination of Tiered Grades With Increased Emphasis on Feedback in Core Clerkships
Authors: McDonald Jordan A. , Lai Cindy J. , Lin Matthew Y.C. , O’Sullivan Patricia S. , Hauer Karen E.
Published: September 2020

Purpose

Medical schools responding to challenges with fairness, equity, learning environments, and student wellness have reconsidered clerkship grades. This study used the Concerns-Based Adoption Model (CBAM) to explore how faculty responded to a change in the approach to assessment from focus on grades toward focus on feedback.

Method

This qualitative study used an inductive approach to analyze data from semistructured interviews with teaching faculty and education leaders at University of California, San Francisco, School of Medicine 6 months following the elimination of traditional tiered clerkship grades. Participants were recruited in 2019 using purposive sampling. Interview questions addressed participants’ perceptions of the new approach to assessment and grading that emphasizes assessment for learning, including advantages and concerns. The authors analyzed data using thematic analysis informed by sensitizing concepts from CBAM.

Results

Nineteen faculty participated (11 medicine, 8 surgery). Faculty expressed optimism about the impact of the change on their clinical educator roles and sought faculty development to enhance feedback and assessment skills. Perceived benefits to students addressed learning and wellness, with concern for students’ motivation and professional development. Faculty shared uncertainty about their roles and larger systemic consequences involving the residency match and institutional reputation. Participants acknowledged that traditional grading is imperfect, yet felt a departure from this system represented significant culture change.

Conclusions

Faculty perceptions of the assessment and grade change in 2 large departments demonstrated tensions around grading. Their descriptions of change as an ongoing process aligned with CBAM and required them to consider new approaches and perspectives. While discourse about assessment and grading frequently focuses on learners, these findings support institutional consideration of the impact of changes in assessment on teaching faculty.
Teaching Public and Population Health in Medical Education: An Evaluation Framework
Authors: Johnson Sherese B. , Fair Malika A. , Howley Lisa D. , Prunuske Jacob , Cashman Suzanne B. , Carney Jan K. , Jarris Yumi Shitama , Deyton Lawrence R. , Blumenthal Daniel , Krane N. Kevin , Fiebach Nicholas H. , Strelnick Alvin H. , Morton-Eggleston Emma , Nickens Chloe , Ortega LaVonne
Published: September 2020

Curriculum models and training activities in medical education have been markedly enhanced to prepare physicians to address the health needs of diverse populations and to advance health equity. While different teaching and experiential learning activities in the public health and population health sciences have been implemented, there is no existing framework to measure the effectiveness of public and population health (PPH) education in medical education programs. In 2015, the Association of American Medical Colleges established the Expert Panel on Public and Population Health in Medical Education, which convened 20 U.S. medical faculty members whose goal was to develop an evaluation framework adapted from the New World Kirkpatrick Model. Institutional leaders can use this framework to assess the effectiveness of PPH curricula for learners, faculty, and community partners. It may also assist institutions with identifying opportunities to improve the integration of PPH content into medical education programs. In this article, the authors present outcomes metrics and practical curricular or institutional illustrations at each Kirkpatrick training evaluation level to assist institutions with the measurement of (1) reaction to the PPH education content, (2) learning accomplished, (3) application of knowledge and skills to practice, and (4) outcomes achieved as a result of PPH education and practice. A fifth level was added to measure the benefit of PPH curricula on the health system and population health. The framework may assist with developing a locally relevant evaluation to further integrate and support PPH education at U.S. medical schools and teaching hospitals.
Learning Alone or Learning Together: Is It Time to Reevaluate Teacher and Learner Responsibilities?
Authors: Prober Charles G. , Norden Justin G.
Published: September 2020

Medical schools across the United States and Canada constantly consider how to improve their curricula and their pedagogical strategies. The authors found it informative to compare how students in 2 professional schools, medicine and business, are taught. The authors believe that creating the best future physicians requires students and faculty to be physically together to learn essential skills. Increasing student interactions with peers and faculty enhances learning, and the classroom is a natural place for these interactions to take place. Requiring medical students to attend teaching sessions in the preclinical curriculum should help foster their development of core competencies, including critical decision making, clinical reasoning, and patient-centered care.
Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management
Authors: Lindsay Dawn L. , Freedman Kenneth , Jarvis Margaret , Lincoln Piper , Williams Jessica , Nelson Lewis S. , Safarian Taleen
Published: September 2020

The American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management provides guidance on the identification and management of alcohol withdrawal in adults with varying degrees of syndrome severity. The guideline addresses both ambulatory and inpatient care and considers special patient populations. The Guideline was primarily developed following the RAND/UCLA Appropriateness Method (RAM), a process to determine the appropriateness of a set of clinical procedures. This process included a review of gray and empirical literature published between January 2012 and October 2017. Nineteen existing guidelines, 112 reviews, and 150 research studies were used to develop draft guideline statements that were assessed by a panel of physicians experienced in withdrawal management and representing a diverse range of settings and patient populations. Recommendations were included in the Guideline where consensus on appropriate clinical practice was identified by the panel. Areas where additional research would provide valuable information for determining best practices were highlighted.
Standardized Criteria for Review of Perinatal Suicides and Accidental Drug-Related Deaths
Authors: Smid Marcela C. , Maeda Jewel , Stone Nicole M. , Sylvester Heidi , Baksh Laurie , Debbink Michelle P. , Varner Michael W. , Metz Torri D.
Published: September 2020

OBJECTIVE:

To estimate the proportion of accidental drug-related deaths and suicides classified as pregnancy-related from 2013 to 2014 (preimplementation of standardized criteria) and 2015 to 2016 (postimplementation).

METHODS:

Based on Centers for Disease Control and Prevention pregnancy-related death criteria, the Utah Perinatal Mortality Review Committee developed a standardized evaluation tool to assess accidental drug-related death and suicide beginning in 2015. We performed a retrospective case review of all pregnancy-associated deaths (those occurring during pregnancy or 1 year postpartum for any reason) and pregnancy-related deaths (those directly attributable to the pregnancy or postpartum events) evaluated by Utah's Perinatal Mortality Review Committee from 2013 to 2016. We compared the proportion of accidental drug-related deaths and suicides meeting pregnancy-related criteria preimplementation and postimplementation of a standardized criteria checklist tool using Fisher’s exact test. We assessed the change in pregnancy-related mortality ratio in Utah from 2013 to 2014 and 2015 to 2016 using test of trend.

RESULTS:

From 2013 to 2016, there were 80 pregnancy-associated deaths in Utah (2013–2014: n=40; 2015–2016: n=40), and 41 (51%) were pregnancy-related (2013–2014: n=15, 2015–2016: n=26). In 2013–2014 (preimplementation), 12 women died of drug-related deaths or suicides, and only two of these deaths were deemed pregnancy-related (17%). In 2015–2016 (postimplementation), 18 women died of drug-related deaths or suicide, and 94% (n=17/18) of these deaths met one or more of the pregnancy-related criteria on the checklist (P<.001). From 2013 to 2014 to 2015–2016, Utah's overall pregnancy-related mortality ratio more than doubled, from 11.8 of 100,000 to 25.7 of 100,000 (P=.08).

CONCLUSION:

After application of standardized criteria, the Utah Perinatal Mortality Review Committee determined that pregnancy itself was the inciting event leading to the majority of accidental drug-related deaths or suicides among pregnant and postpartum women. Other maternal mortality review committees may consider a standardized approach to assessing perinatal suicides and accidental drug-related deaths.
Characteristics Associated With Consent and Reasons for Declining in a Randomized Trial in Pregnancy
Authors: Mallett Gail , Hill Kim , de Voest Jessica , Bousleiman Sabine Z. , Allard Donna , Harris Stacy , Salazar Ashley , Clark Kelly , Ortiz Felecia , Bartholomew Anna , Dalton Wendy , Craig Jennifer , Bickus Melissa ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: September 2020

OBJECTIVE:

To evaluate the maternal characteristics associated with consent to a randomized trial of labor induction in pregnancy.

METHODS:

This is a secondary analysis of low-risk nulliparous women randomized to induction of labor at 39 weeks or expectant management. During the trial, the Data and Safety Monitoring Committee requested additional fields on the screening log, which already included race and ethnicity: maternal age, type of insurance, and the reason for declining consent if declined.

RESULTS:

From August 2016 (start of additional data collection) to August 2017, 1,965 (28%) of the 7,112 eligible women consented to the trial. Consent was more likely for Black women (41%, adjusted odds ratio [aOR] 1.47, 95% CI 1.24–1.74), and less likely for Asian women (15%, aOR 0.64, 95% CI 0.48–0.84), compared with White women (24%). Women without private insurance were more likely to consent (38%, aOR 1.55, 95% CI 1.34–1.79), compared with those with private insurance (22%). Younger women were also more likely to consent. Among eligible women who declined participation and provided a reason (68%), preference to be expectantly managed (85%) was most common, a response more common in Asian women (aOR 1.75, 95% CI 1.31–2.33) and less common in women without private insurance (aOR 0.60, 95% CI 0.51–0.70). Not wanting to participate in research was more common in Asian women (aOR 2.41, 95% CI 1.44–4.03). Declining consent because family or friends objected was more common in Asian women (aOR 2.51, 95% CI 1.27–4.95) and women without private insurance (aOR 1.68, 95% CI 1.10–2.59).

CONCLUSION:

Frequency of consent and reasons for declining consent were associated with age, type of insurance, and race and ethnicity. These findings should be considered when developing recruitment strategies that promote diverse participant representation.

CLINICAL TRIAL REGISTRATION:

ClinialTrials.gov, NCT01990612.
Externally Validated Prediction Model of Vaginal Delivery After Preterm Induction With Unfavorable Cervix
Authors: Kawakita Tetsuya , Reddy Uma M. , Huang Jim C. , Auguste Tamika C. , Bauer David , Overcash Rachael T.
Published: September 2020

OBJECTIVE:

To create and externally validate a predictive model to calculate the likelihood of vaginal delivery after preterm induction with unfavorable cervix.

METHODS:

This was a retrospective cohort study of women with a singleton gestation from a single academic institution who underwent an induction of labor at less than 37 weeks of gestation from January 2009 to June 2018. Women with contraindications for vaginal delivery were excluded. Analyses were limited to women with unfavorable cervix (both simplified Bishop score [dilation, station, and effacement: range 0–9] less than 6 and cervical dilation less than 3 cm). A stepwise logistic regression analysis was used to identify the factors associated with vaginal delivery by considering maternal characteristics and comorbidities as well as fetal conditions. The final model was validated using an external data set of the Consortium on Safe Labor after applying the same inclusion and exclusion criteria. We compared the area under the curve (AUC) of our predictive model and the simplified Bishop score.

RESULTS:

Of the 835 women, 563 (67%) had vaginal delivery. Factors associated with vaginal delivery included later gestational age at delivery, higher parity, more favorable simplified Bishop score, and preterm prelabor rupture of membranes. Factors including older maternal age, non-Hispanic Black race, higher body mass index, and abruption were associated with decreased likelihood of vaginal delivery. In the external validation cohort, 1,899 women were analyzed, of whom 1,417 (75%) had vaginal delivery. The AUCs of simplified Bishop score and the final model were 0.65 (95% CI 0.59–0.66) and 0.73 (95% CI 0.72–0.79), respectively, for the external validation cohort. The online calculator was created and is available at www.medstarapps.org/obstetricriskcalculator/ and in the Obstetric Risk Calculator mobile application in the Apple App Store and Google Play Store.

CONCLUSION:

Our externally validated model was efficient in predicting vaginal delivery after preterm induction with unfavorable cervix.
Outcomes of Subsequent Births After Placenta Accreta Spectrum
Authors: Baldwin Heather J. , Nippita Tanya A. , Torvaldsen Siranda , Ibiebele Ibinabo , Ford Jane B. , Patterson Jillian A.
Published: September 2020

OBJECTIVE:

To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta).

METHODS:

A population-based record linkage study of women who had a first, second, or third birth in New South Wales from 2003 to 2016 was conducted. Data were obtained from birth and hospital records and death registrations. Women with a history of placenta accreta spectrum were matched to women without, on propensity score and parity, to compare outcomes with women who had similar risk profiles. Modified Poisson regression models were used to calculate adjusted relative risk (aRR) for a range of maternal and neonatal outcomes.

RESULTS:

We identified recurrent placenta accreta spectrum in 27/570 (4.7%, 95% CI 3.0–6.5%) of second and 9/119 (7.6%, 95% CI 2.8–12.3%) of third pregnancies after placenta accreta spectrum in the preceding birth, with an overall recurrence rate of 38/689 (5.5%, 95% CI 3.9–7.5%, compared with the population prevalence of 25.5/10,000 births (95% CI 24.6–26.4). Subsequent births after placenta accreta spectrum had higher risk of postpartum hemorrhage (aRR 1.51, 95% CI 1.19–1.92), transfusion (aRR 2.13, 95% CI 1.17–3.90), cesarean delivery (aRR 1.19, 95% CI 1.02–1.37), manual removal of placenta (aRR 6.92, 95% CI 3.81–12.55), and preterm birth (aRR 1.43, 95% CI 1.03–1.98), with lower risk of small for gestational age (aRR 0.64, 95% CI 0.43–0.96), compared with similar-risk births.

CONCLUSION:

Women with a history of placenta accreta spectrum have increased risk of maternal morbidity, preterm birth, and placenta accreta spectrum in the subsequent pregnancy compared with similar-risk women with no previous placenta accreta spectrum, although the absolute risks are generally low. These findings may be used to inform counseling of women on the risks of future pregnancies.
Elective Labor Induction at 39 Weeks of Gestation Compared With Expectant Management
Authors: El-Sayed Yasser Y. , Rice Madeline Murguia , Grobman William A. , Reddy Uma M. , Tita Alan T.N. , Silver Robert M. , Mallett Gail , Hill Kim , Thom Elizabeth A. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Chien Edward K. , Casey Brian M. , Gibbs Ronald S. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. , Macones George A. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*
Published: September 2020

OBJECTIVE:

To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management.

METHODS:

We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliveries before 39 weeks of gestation and those not adherent to study protocol or with fetal anomalies were excluded. A composite of adverse outcomes (perinatal death or severe neonatal complications), third- or fourth-degree lacerations, and postpartum hemorrhage were evaluated. Log binomial regression models estimated relative risks and 95% CIs for associations of outcomes with patient characteristics including randomly assigned treatment group. Interactions between patient characteristics and treatment group were tested.

RESULTS:

Of 6,096 women with outcome data, 5,007 (82.1%) met criteria for inclusion in this analysis. Frequency of the perinatal composite was 252 (5.0%), 166 (3.3%) for third- or fourth-degree perineal laceration, and 237 (4.7%) for postpartum hemorrhage. In multivariable analysis, intended labor induction at 39 weeks of gestation was associated with a reduced perinatal composite outcome (4.1% vs 6.0%; adjusted relative risk [aRR] 0.71; 95% CI 0.55–0.90), whereas increasing body mass index (BMI) was associated with an increased perinatal composite outcome (aRR 1.04/unit increase; 95% CI 1.02–1.05). Decreased risk of third- or fourth-degree perineal laceration was observed with increasing BMI (aRR 0.96/unit increase; 95% CI 0.93–0.98) and in Black women compared with White women (1.2% vs 3.9%; aRR 0.34; 95% CI 0.19–0.60). Increased risk of postpartum hemorrhage was observed in Hispanic women compared with White women (6.3% vs 4.0%; aRR 1.64; 95% CI 1.18–2.29). Patient characteristics associated with adverse outcomes were similar between treatment groups (P for interaction >.05).

CONCLUSION:

Compared with expectant management, intended induction at 39 weeks of gestation was associated with reduced risk of adverse perinatal outcome. Patient characteristics associated with adverse outcomes were few and similar between groups.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.
Lessons Learned Serving on a Long-Standing Maternal Mortality Review Committee
Authors: Anderson Frank W. J. , Sokol Robert J.
Published: September 2020

The maternal mortality ratio in the United States is increasing; understanding the significance of this change and developing effective responses requires a granular analysis of the contributing factors that a well-informed maternal mortality review committee can provide. Data collection and analysis, clinical factors, preventability, social determinants of health, and racial inequities combine to affect this outcome, and each factor must be considered individually and in combination to recommend a robust response. Obstetrician–gynecologists formed the State of Michigan's Maternal Mortality Review Committee (the Committee) in 1950 to identify gaps in care that needed to be systematically addressed at the time. In the early years, the Committee witnessed a reduction in the number of maternal deaths; over time, prioritization of maternal mortality decreased, yet the Committee witnessed changing patterns of death, varied data collection and evaluation processes, delayed reviews, and unimplemented recommendations. The calculation of the maternal mortality ratio was not informed by the outcomes of Committee reviews. Today, the Committee, with increased support from the Michigan Department of Health & Human Services, can clearly identify and report preventable pregnancy-related mortality along with its causes and is close to achieving a near real-time surveillance system that allows the development of timely clinical and policy recommendations and interventions. The Committee’s adaptations in response to the rise in maternal mortality have resulted in several lessons learned that may be helpful for currently operating committees and in the formation of new ones.
Incidence and Prediction of Immune Checkpoint Inhibitor-related Nephrotoxicity
Authors: Sorah Jonathan D. , Rose Tracy L. , Radhakrishna Roshni , Derebail Vimal K. , Milowsky Matthew I.
Published: September 2020

Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events that can affect any organ system, including the kidneys. Our study aimed to better characterize the incidence of and predictive factors for immune-related acute kidney injury (irAKI) and evaluate steroid responsiveness. An institutional database (Carolina Data Warehouse) was queried for patients who received ICIs and subsequently had substantial AKI, defined as a doubling of baseline creatinine. A retrospective chart review was performed to determine the cause of AKI. AKI events determined to be immune-related were further analyzed. A total of 1766 patients received an ICI between April 2014 and December 2018. A total of 123 (7%) patients had an AKI within 1 year of the administration of the first ICI dose. 14 (0.8% of all patients who received ICIs) of the AKI events were immune-related. History of an autoimmune disease (N=2, 14%, P=0.04) or history of other immune-related adverse events (irAEs) (N=8, 57%, P=0.01) was a significant predictor of irAKI. Of 14 irAKI patients, 9 received steroids with renal function improving to baseline in 5 patients, improving but not to baseline in 2, and 2 without improvement in renal function, including 1 becoming dialysis-dependent. Age, sex, urinalysis findings, and primary tumor site were not associated with irAKI. irAKI is relatively uncommon but likely under-recognized. Underlying autoimmune disease and history of nonrenal ICI-related irAEs are associated with irAKI. Early recognition and steroid administration are important for a positive outcome.
Neonatal exposure to genistein affects reproductive physiology and behavior in female and male Long-Evans rats
Authors: Ali Maryam , Broyles Timothy Michael , Davis Lourdes K. , Gonzalez Chantal M.F. , Lucero Devon , Stary Lainey , Guarraci Fay A.
Published: September 2020

The present study was designed to examine the effects of neonatal genistein exposure on measures of reproductive physiology and behavior. Approximately 24 h after birth, female and male Long-Evans rat pups were injected daily with genistein (150 µg, subcutaneous; n = 29) or olive oil (n = 23) between postnatal days 1 and 5. After weaning, we examined all subjects daily until they reached puberty (i.e. vaginal opening in female rats and preputial separation in male rats). For all female subjects, we also examined vaginal cytology. After monitoring estrous cyclicity, the female subjects were given the opportunity to interact with a gonadally intact male or a sexually receptive female rat on the day of behavioral estrus to assess sexual motivation (i.e. partner-preference test with and without physical contact), which has never been evaluated before. For all male subjects, we assessed the development of copulatory behavior and sexual motivation (partner-preference test without physical contact). Consistent with previous findings, we found that neonatal exposure to genistein did not affect puberty onset in female or male rats. However, female rats exposed to genistein displayed significantly more irregular estrous cycles than controls. Neonatal genistein exposure also altered the development of male copulatory behavior, as indicated by an increase in mount frequency and intromission frequency and shorter interintromission intervals. We extended previous findings confirming that neither female nor male sexual motivation was affected by neonatal genistein. The results of the present study have important implications for the development of reproductive physiology and behavior in human neonates exposed to genistein in soy-based baby formula.
INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE
Authors: Rush Ryan B. , Del Valle Penella Agustin , Reinauer Robert M. , Rush Sloan W. , Bastar Pedro Gomez
Published: September 2020

Purpose:

To evaluate the benefits of internal limiting membrane peeling in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the treatment of vitreous hemorrhage.

Methods:

Two hundred and fifty-eight proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage were enrolled into the trial. Patients were randomized into one of two cohorts: Group A patients underwent internal limiting membrane peeling, whereas Group B patients did not undergo internal limiting membrane peeling. The main outcome was best-corrected visual acuity at 6 months. Secondary outcomes were optical coherence tomography central macular thickness at 6 months, incidence of diabetic macular edema treatment during the postoperative trial period, and incidence of epiretinal membrane at 6 months.

Results:

Two hundred and seven patients were randomized and completed 6 months follow-up. Group A had better best-corrected visual acuity at 6 months than Group B (P < 0.01). Group A had a lower incidence of diabetic macular edema treatment during the postoperative trial period and a lower incidence of epiretinal membrane at 6 months than Group B (P = 0.02 and P < 0.001, respectively). There was a trend toward lower central macular thickness on optical coherence tomography in Group A than Group B (P = 0.09). There were no significant differences in baseline details or complications intraoperatively or postoperatively between cohorts.

Conclusion:

This trial demonstrated better vision, fewer postoperative diabetic macular edema treatments, and a lower incidence of epiretinal membrane at 6 months when internal limiting membrane peeling was performed. Internal limiting membrane peeling may be considered a vital maneuver to perform in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage.
SPONTANEOUS LAMELLAR MACULAR HOLES CLOSURE
Authors: Chehaibou Ismael , Manoharan Niranjan , Govetto Andrea , Tsui Irena , Hubschman Jean-Pierre
Published: September 2020

Purpose:

To report two cases of spontaneous closure of lamellar macular holes with epiretinal proliferation (ERP).

Methods:

Observational cases report.

Results:

Two patients affected with lamellar macular hole showed progressive and spontaneous closure of the hole associated with ERP development. At presentation, both patients presented with irregular foveal contour, and foveal cavitation with apparent loss of retinal tissue. In both cases, ERP, also called “lamellar hole-associated epiretinal proliferation”, was present and increased in size over time. This proliferation progressively developed across the hole with apparent restoration of the foveal contour and preservation of visual acuity.

Conclusion:

This report describes two cases of lamellar macular hole in which ERP increased over time, resulting in lamellar macular hole closure. Such observations may suggest a spontaneous healing process driven by glial cell proliferation.
UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A PATIENT WITH HAND-FOOT-MOUTH DISEASE: A CASE REPORT
Authors: Falk Zachary E. , Malik Khurram J.
Published: September 2020

Purpose:

To demonstrate a rare cause of acute, focal chorioretinitis.

Methods:

Review of slit-lamp fundoscopy, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography.

Results:

Slit-lamp examination revealed parafoveal microaneurysms, parafoveal intraretinal hemorrhages, and outer segment irregularity in the left eye. Fundus photographs demonstrated retinal hemorrhages and a greyish-whitish sheen in the central parafoveal area. Optical coherence tomography was notable for a small pocket of outer segment and retinal pigment epithelium disruption and irregularity in the central foveal area of the left eye. Fluorescein angiography revealed increased focal macular leakage within a larger central area of leakage and staining.

Conclusion:

Unilateral acute idiopathic maculopathy and, specifically, coxsackievirus-related chorioretinitis should be considered in the differential diagnosis of atypical maculopathy.
Corneal Ectasia Induced by Prostaglandin Analogues
Authors: Rodrigo-Rey Sara , Bolívar Gema , Arranz-Marquez Esther , Cañones-Zafra Rafael , Teus Miguel A.
Published: September 2020

Our purpose is to document the first case of unilateral mild corneal ectasia developed in an apparently nonpredisposed cornea after topical latanoprost treatment, and its regression after treatment withdrawal. We describe a 44-year-old man with visual impairment in his left eye (OS) and a past medical history of myopic refraction and ocular hypertension with latanoprost treatment, the rest of ocular examination was normal. A decrease in visual acuity was observed with a refractive change. Corneal tomography showed features of mild corneal ectasia in his OS. Topical prostaglandin analogue therapy was removed and replaced by other antiglaucoma topical treatment. Corneal tomography returned to normal, an improvement in the quality of vision was observed and refractive astigmatism recovered to baseline values. This case illustrates that topical latanoprost does affect the matrix metalloproteinases balance in corneal extracellular matrix, and subsequently may produce a corneal weakening. Corneal biomechanical features and corneal stiffness do probably recover after topical prostaglandin analogues withdrawal.
The Effects of Carbon and Plastic Ankle-Foot Orthoses on Gait, Balance, and Mobility in Persons with Multiple Sclerosis: A Pilot Study
Authors: Jackson Kurt , Bigelow Kimberly Edginton , Hollis Sarah
Published: September 2020

Introduction

Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait in individuals with multiple sclerosis (MS). However, there is currently little research to support their use or guide clinicians in the prescription process in this population. The purpose of this pilot study was to compare the effects of carbon and plastic AFOs on measures of gait, balance, and mobility in persons with MS.

Materials and Methods

Ten individuals with MS who had not used an AFO previously had their gait, balance, mobility, and perception of benefit assessed under three different AFO conditions: no AFO, carbon AFO (C-AFO), and plastic AFO (P-AFO), on separate days. Gait was assessed using an instrumented 10-m walk, a 6-minute walk, the physiological cost index (PCI), and a visual analog fatigue rating scale. Static balance was assessed using posturography under different sensory conditions and dynamic balance using the limits of stability (LOS) test. Mobility was assessed using the timed up and go (TUG) test. The perceived benefit of using the AFO was measured with an eight-item Likert scale survey.

Results

No significant differences were identified between the C-AFO and P-AFO conditions for any of the gait, balance, and mobility measures. Both AFO types tended to improve static balance but negatively impacted dynamic balance and mobility when compared with no AFO. There was no significant difference in the perceived benefit between the AFO types. However, there were differences in the PCI and perception of benefit for individual subjects that could be clinically meaningful.

Conclusions

There were no differences in gait, balance, and mobility measures or perception of benefit between C-AFO and P-AFO in persons with MS. However, there were differences in individual performance that may warrant consideration when prescribing AFOs. Therefore, clinicians should consider using appropriate standardized assessment tools that measure various aspects of gait, balance, and mobility when evaluating individual responses to AFOs.
Myoelectric Elbow-Wrist-Hand Orthosis for an Adolescent with Hemiparesis: A Case Report
Authors: Constantino Christopher , May Elizabeth , Flanagan Ann , Altiok Haluk , Harris Gerald
Published: September 2020

Introduction

Robot-assisted therapy is an innovative approach to upper-limb rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning. An example of upper-limb robot-assisted therapy is the myoelectric orthosis MyoPro (Myomo Inc, Cambridge, USA). It is a custom-fabricated myoelectric elbow-wrist-hand orthosis (MEWHO) with built-in surface sensors that detect the user's electromyographic (EMG) signals during muscle contraction. Studies on the MEWHO have focused mostly on elderly chronic stroke patients. None have discussed its use on the adolescent population and the considerations they face in wearing the orthosis.

Case Presentation

A 15-year-old male 10th grade student with a diagnosis of right spastic hemiplegia secondary to cerebral palsy was prescribed a MEWHO because of muscle weakness of his right upper extremity, decreased functional status, and fine motor skills deficits.

Results

After two occupational therapy cycles, the patient demonstrated improvements in functional strength and performance of physical activities. Despite these improvements, the patient only used the MEWHO during therapy and was less engaged with its use at home and school.

Discussion

This case report presents insights on why the patient was not as proficient and interested in using the orthosis at home and school. Recommendations to address these issues include peer modeling, community outings, early intervention, and the use of family-centered approaches. Future studies are also suggested to further understand MEWHO use and the considerations for successful orthotic management in this group of patients.
Capacitive and resistive electric transfer therapy in rehabilitation: a systematic review
Authors: Beltrame Raffaello , Ronconi Gianpaolo , Ferrara Paola Emilia , Salgovic Ludovit , Vercelli Stefano , Solaro Claudio , Ferriero Giorgio
Published: September 2020

Capacitive and resistive electric transfer (CRET) therapy is a physical treatment modality commonly used to treat musculoskeletal pain. It normally uses a longwave radiofrequency of ~0.5 MHz. The system consists of a neutral plate and two different electrodes that can transfer energy in two modalities: capacitive and resistive. The aim of this systematic review was to identify and summarize the available data in the literature on this physical modality. From a search of articles published before December 2019 in MEDLINE and Scopus indexed journals, we retrieved 276 articles, 13 of which met the inclusion criteria for this review. Most articles dealt with musculoskeletal disorders, mainly spine disorders and knee osteoarthritis. More than 75% of the studies used a similar range of frequency (440–600 KHz). Almost all described an improvement in strength and function and reduced pain intensity after the treatment. Although nine of the 13 studies (70%) were randomized controlled trials, only two had a low risk of bias according to the Cochrane library assessment tool. CRET seems to be an effective therapy to decrease pain, and improve the quality of life and disability of patients affected by musculoskeletal disorders. There is no study on symptoms of patients with neurological disorders. Further research is necessary to standardize the therapeutic protocols across different orthopedic diseases, and to assess the benefits of CRET in other fields such as neurological or rheumatologic disorders.
Suicide Clusters Among Top 10 High-Risk Occupations
Authors: Too Lay San , Spittal Matthew J.
Published: September 2020

A number of studies have demonstrated elevated risk of suicide in certain occupational groups. We seek to understand a possible new risk factor: suicide contagion, as demonstrated through a suicide cluster analysis. National-level coronial data and census population data were used for the study. We calculated suicide rates to identify “risky” occupations. SaTScan v9.4.1 was used to perform Poisson discrete scan statistic. Suicides occurring in arts and media professionals, construction, manufacturing, and skilled animal and horticultural workers seemed to cluster in time and/or space. Those working in construction settings were at risk of being in both time and space clusters.