bluuebunny/crossref_metadata_2025_split huggingface dataset:
LB18. Understanding Zika-Specific Immunity for Prevention and Protection
Authors: Espinoza Daniel , Zhu Yerun , Collins Matthew H 
Published: October 2019

Abstract

Background
Flavivirus infection represents a major public health problem, with over 2 billion people at risk for one or more infections each year. There are no licensed antiviral treatments for flaviviruses, and effective vaccines are lacking for several. Accurate diagnosis of flaviviruses is also complicated by serologic cross-reactivity. Thus, there is an urgent need to develop public health tools and interventions to reduce the burden of flavivirus infection worldwide.

Methods
We recently isolated two potently neutralizing human monoclonal antibodies (NmAb) against Zika, which exhibit activity against multiple strains of Zika but do not bind the closely related dengue virus. Mapping studies revealed that the NmAb target distinct epitopes on the envelope protein (E). A competition ELISA (ZE-BOB) was developed with the two NmAb to test the hypotheses that neutralizing Ab responses in the general population would target the same epitopes on Zika E as the novel NmAb.

Results
We found that competitive Ab responses were detected in 19 of 19 (100%) convalescent sera from travelers with confirmed Zika infection. We tested a panel of 20 sera from individuals with either primary or secondary prior dengue infection and found that 18/20 (90%) contained IgG reactive with Zika virus; however, 0/20 (0%) exhibited ZE-BOB activity. These results indicate that the epitopes targeted by these two Zika NmAb are consistently immunogenic humans infected by Zika. Additionally, these epitopes elicit type-specific Ab to Zika, providing a basis for development of simple serodiagnostic assays with utility in epidemiologic studies as well as in the clinical setting. Because NAb are key determinants of long-term protection against future flavivirus infection, we further hypothesized that the results of the ZE-BOB assay may simultaneously provide a correlate of immunity, which would be a critical tool for vaccine development. In comparing the 50% neutralization titer against Zika with the magnitude of competition by ZE-BOB, there was no correlation in these values, but sera tended to be positive in both or neither assay.

Conclusion
Therefore, the ZE-BOB assay constitutes a novel tool that is widely deployable for purposes ranging from clinical diagnosis to epidemiologic monitoring to vaccine development for Zika.

Disclosures
All authors: No reported disclosures.
Pharmacokinetics and Pharmacodynamics of Conventional-Dose vs Triple-Dose Oseltamivir in Severely Immunocompromised Children With Influenza
Authors: Bautista Francisco , Engelhard Dan , Rizzari Carmelo , Baka Margarita , Saavedra-Lozano Jesús , Lopez-Medina Eduardo , Nasmyth-Miller Clare , Hernández-Sánchez Jules , Sturm Stefan 
Published: October 2019

Abstract
This randomized phase 1b study evaluated the pharmacokinetics/pharmacodynamics of conventional-dose (30–75 mg twice daily [BID]) vs triple-dose (90–225 mg BID; weight-adjusted) oseltamivir for treatment of influenza in severely immunocompromised children &lt;13 years. Oseltamivir carboxylate (OC) Cmax and AUC0-12h were ~2-fold higher with triple-dose vs conventional-dose oseltamivir. Increased dose/exposure of oseltamivir/OC did not improve virological outcomes or reduce viral resistance. Median time to cessation of viral shedding was similar with triple-dose and conventional-dose oseltamivir (150.7 vs 157.1 hours, respectively); median time to alleviation of baseline fever was longer with conventional-dose oseltamivir (28.4 vs 11.3 hours). No new safety signals were identified.
Aerococcus urinae Aortitis: A Case Report
Authors: Chhibber Aakash Varun , Muttaiyah Sharmini , Hill Andrew A , Roberts Sally A 
Published: October 2019

AbstractBackgroundAerococcus urinae is a Gram-positive coccus that is increasingly recognized as a urinary pathogen since the introduction of mass spectrometry for identification of bacteria. We report a case of abdominal aortitis (with aneurysm) caused by A urinae in a male with recurrent urinary tract infections and recently treated A urinae bacteremia. A 63-year-old gentleman with a history of A urinae urosepsis 7 weeks prior, presented to the Emergency Department with thoracolumbar back pain radiating bilaterally into the groin. Radiological and surgical findings were consistent with infective infrarenal aortitis with aneurysm.MethodsThe patient successfully underwent open surgical debridement and reconstruction of the infrarenal aorta with autologous vein graft.ResultsAerococcus urinae was isolated from excised tissue. The patient completed a 4-week course of intravenous antimicrobial therapy.ConclusionsAurinae is a urinary pathogen with the ability to cause severe invasive disease including endovascular infections.
Translocation of AMPA Receptors in the Dorsal Horn of the Spinal Cord Corresponding to Long-term Depression Following Pulsed Radiofrequency Stimulation at the Dorsal Root Ganglion
Authors: Cho Jang Hyuk , Lee Dong Gyu 
Published: October 2019

Abstract

Objective
Pulsed radiofrequency stimulation at the dorsal root ganglion is used for treatment of radicular pain; however, its mechanism for neuropathic pain treatment has not been fully elucidated. Here, we investigated whether pulsed radiofrequency stimulation affects the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, which play a critical role in synaptic plasticity.

Methods
Neuropathic pain was studied using a radicular neuropathic pain model (43 female Sprague-Dawley rats; 200–250 g). In total, 28 rats were assigned to the following groups for fraction analysis: a control group, a control + pulsed radiofrequency stimulation group, a disc pain group, and a disc pain + pulsed radiofrequency stimulation group. For nonfraction analysis of Glutamate A1 (GluA1) and GluA2 subunits, a total of 15 female Sprague-Dawley rats were assigned to a control group, a disc pain group, and a disc pain + pulsed radiofrequency stimulation group. Pulsed radiofrequency stimulation and subsequent analysis were conducted three days after surgery.

Results
AMPA receptor subunits, GluA1 and GluA2, in the radicular neuropathic pain model were upregulated compared with those in the control group three days after surgery. Pulsed radiofrequency stimulation induced the translocation of GluA1 and GluA2 subunits from the synaptosome to cytosol without a change in the total amount of AMPA receptors in the dorsal horn.

Conclusions
Our results demonstrated that pulsed radiofrequency stimulation affected the synaptic plasticity corresponding to long-term depression. Thus, we show that long-term depression from pulsed radiofrequency stimulation is associated with analgesic effects in the radicular neuropathic pain model following peripheral inflammation.
The relationship of pork carcass weight and leanness parameters in the Ontario commercial pork industry
Authors: Barducci Robson S , Zhou Ziyu Y , Wormsbecher Lisa , Roehrig Colleen , Tulpan Dan , Bohrer Benjamin M 
Published: October 2019

Abstract
This study aimed to examine the correlation of carcass weight, fat depth, muscle depth, and predicted lean yield in commercial pigs. Data were collected on 850,819 pork carcasses from the same pork processing facility between October 2017 and September 2018. Hot carcass weight was reported following slaughter as a head-on weight; while fat and muscle depth were measured with a Destron PG-100 probe and used for the calculation of predicted lean yield based on the Canadian Lean Yield (CLY) equation [CLY (%) = 68.1863 − (0.7833 × fat depth) + (0.0689 × muscle depth) + (0.0080 × fat depth2) − (0.0002 × muscle depth2) + (0.0006 × fat depth × muscle depth)]. Descriptive statistics, regression equations including coefficients of determination, and Pearson product moment correlation coefficients (when assumptions for linearity were met) and Spearman’s rank-order correlation coefficients (when assumptions for linearity were not met) were calculated for attributes using SigmaPlot, version 11 (Systat Software, Inc., San Jose, CA). Weak positive correlation was observed between hot carcass weight and fat depth (r = 0.289; P &lt; 0.0001), and between hot carcass weight and muscle depth (r = 0.176; P &lt; 0.0001). Weak negative correlations were observed between hot carcass weight and predicted lean yield (r = −0.235; P &lt; 0.0001), and between fat depth and muscle depth (r = −0.148; P &lt; 0.0001). Upon investigation of relationships between fat depth and predicted lean yield, and between muscle depth and predicted lean yield using scatter plots, it was determined that these relationships were not linear and therefore the assumptions of Pearson product moment correlation were not met. Thus, these relationships were expressed as nonlinear functions and Spearman’s rank-order correlation coefficients were used. A strong negative correlation was observed between fat depth and predicted lean yield (r = −0.960; P &lt; 0.0001), and a moderate positive correlation was observed between muscle depth and predicted lean yield (r = 0.406; P &lt; 0.0001). Results from this dataset revealed that hot carcass weight was generally weakly correlated (r &lt; |0.35|) with fat depth, muscle depth, and predicted lean yield. Therefore, it was concluded that there were no consistent weight thresholds where pigs were fatter or heavier muscled.
Music to Their Ears: Improving Feedback Students Receive on Written Documentation
Authors: Wagoner Krista , Dempsey Angela , Friesinger Michele 
Published: October 2019

PURPOSE:
Improve feedback on student notes in the electronic health record (EHR).

BACKGROUND:
Clinical documentation is a core entrustable professional activity. Feedback on written notes is necessary for skill development. Rapid spread of EHR technology and regulations limits use of student documentation, creating impediments to regular review of student notes.

METHODS:
As part of a multi-phase quality improvement project, medical students were surveyed at the conclusion of the obstetrics and gynecology clerkship regarding their experience writing notes in the EHR. The proportion of students who received feedback on inpatient and outpatient notes and rated the feedback as meaningful was determined at baseline and after implementation of a required formative feedback card. Following student and faculty feedback, we randomized students to utilize a simplified version versus the original detailed formative card and compared outcome measures.

RESULTS:
The response rate was 99%. Baseline data revealed 23% and 38% of clerkship students received no feedback on written notes in the inpatient and outpatient settings, respectively, while 44% of students reported that feedback did not improve documentation skills. Use of the formative card increased feedback (p<0.0001); 98% and 92% of students received feedback in the inpatient and outpatient settings, respectively, and 88% rated it as meaningful. There was no difference (p=0.3) in outcomes between the simplified or detailed cards.

DISCUSSION:
Implementation of a formative card increased the quantity and quality of written note feedback clerkship students received in all settings. A less detailed card achieved comparable outcomes and increased faculty satisfaction.
Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?
Authors: Smith Brentley , Woelfel Ingrid , Salani Ritu , Hartzman Alan , Chen Xiaodong 
Published: October 2019

PURPOSE:
The goal of this study was to identify the definition and expectations of autonomy from residents’ perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures.

BACKGROUND:
Entrustment in the operating room (OR) is a two-way street. Resident self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons determined and entrusted OB/GYN residents in the OR. There is little to no data, however, in examining these issues from the resident perspective.

METHODS:
We conducted three focus group interviews with 20 OB/GYN residents across four post-graduate year (PGY) levels. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method.

RESULTS:
A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and twelve senior residents (PGY3-4) participated. Our data illustrated that 1) the definition of autonomy shifted significantly throughout residency training; 2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; 3) case volume, modalities of OR teaching (e.g., teaching style, attending experience, rotation site) and mutual communication are three factors influencing resident self-entrustment of their surgical competencies.

DISCUSSION:
Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the three influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.
RAD Times in the Big Easy: Race, Access, and Diversity in Abortion Training
Authors: Brown Katherine , Turk Jema , Jackson Andrea , Steinauer Jody 
Published: October 2019

PURPOSE:
To explore residents’ interest in doing abortions with a focus on ethnic diversity.

BACKGROUND:
Abortion training is critical to increase access for the 39% of US women who live in the 90% of counties with no abortion care. Racial/ethnic minority physicians are more likely than white physicians to care for poor and minority patients and practice in underserved areas. We explored racial and ethnic differences in residents’ interest in providing abortions in ob/gyn, the most racially diverse ACGME residency.

METHODS:
Using Ryan Residency Program post-rotation survey data collected in 2015-2018, we assessed intention to provide abortion and training participation by resident race/ethnicity.

RESULTS:
The majority of residents (658, 79%) completed surveys. Respondents were: 412 (65%) white, 50 (8%) black, 27 (4%) Hispanic/Latino, 118 (19%) Asian, and 24 (4%) other. Overall, 57% intended to provide abortion for all indications and 82% for pregnancy complications. The proportions that planned to provide abortions by race/ethnicity were: 70% of Asian, 63% of Latino, 54% of white and 48% of black. While in bivariate analysis Asians were more likely than whites to intend provision (p 0.003), there were no difference by race/ethnicity when controlling for religion and abortion attitudes, which were both associated with intention (p<0.05). There was also no difference in training participation by race/ethnicity.

DISCUSSION:
The majority of residents overall planned to include abortion in their practice. Increasing resident diversity may close the abortion access gap in the US by providing care in underserved areas.
A Randomized Trial to Improve Clinical Estimation of Fetal Weight Through Self-Evaluations via Text Messages
Authors: Morales Pedro , Legg Avery , Connelly Emma 
Published: October 2019

PURPOSE:
To evaluate if weekly text messages with self-evaluations improve the accuracy of clinical fetal weight estimation in OB GYN interns.

BACKGROUND:
Estimation of fetal weight by palpation is a basic and very important skill that can influence the mode of delivery in laboring patients. Research in this area has focused almost exclusively on clinical factors that influence the accuracy of this method but little is known about ways to improve this important skill. The purpose of this study is to improve the accuracy of this estimation in OB GYN interns with a simple and inexpensive intervention.

METHODS:
We randomized the incoming intern class to either an intervention group that received weekly text messages with self-evaluations of their weight estimations or a control group that received self-evaluations of unrelated aspects of their performance. The primary outcome was accuracy of weight estimates within 10% of the actual birth weight. A sample of 100 estimates for each group was calculated in order to find a 20% (40 to 60%) difference. Chi-square was used to determine difference in proportions of this outcome between the study groups.

RESULTS:
Clinical factors that could influence fetal weight estimation by palpation (Age, BMI, cervical dilation, fetal weight distribution, parity, and recent ultrasound) were similar between the groups (P>.05). Accuracy in the intervention group was 63% vs 42% in the control group (p<.05).

DISCUSSION:
The accuracy of clinical fetal weight estimates by OBGYN interns can be significatively improved by reminding them to self-evaluate the progression of their skills through text messages.
Addressing Patient Fears in Perinatal Substance Use Treatment
Authors: Mullins Nathan , Ramage Melinda , Ostrach Bayla , Leiner Catherine 
Published: October 2019

PURPOSE:
To inform obstetricians of potential barriers to engagement in perinatal substance use treatment, as reported by patients in a comprehensive program.

BACKGROUND:
Opioid use disorder in pregnancy diagnoses have rapidly increased, 127% from 1998 to 2011. Comprehensive perinatal substance use treatment including medication-assisted treatment (MAT) is recommended to reduce risks for the mother-baby dyad: however, access to this treatment remains limited. While OUD is a pervasive perinatal health issue, Ob/Gyns may lack awareness of their patients’ needs and concerns related to it.

METHODS:
This qualitative study combined semi-structured interviews and participant-observation with patients in a comprehensive perinatal substance use treatment program, in a largely rural Appalachian region. Sampling was opportunistic and purposive; all data were analyzed using modified Grounded Theory.

RESULTS:
Twenty-seven MAT patients participated in prenatal and/or postpartum interviews, and were observed (along with a larger cohort in care during the four-month study period) in the clinical setting. Participants described the importance of receiving supportive care in a non-judgmental clinical setting, in contrast with past experiences of stigmatizing treatment. Many participants reported concerns about social services involvement with the current pregnancy or existing children, as a factor influencing their comfort seeking substance use treatment during pregnancy.

DISCUSSION:
Concerns about the external consequences of substance use treatment shape women’s experience seeking clinical care. Clinicians addressing patient concerns about social services involvement and a non-judgmental approach overall facilitate engagement with care. With the increase of OUD in pregnancy, obstetric faculty benefit from understanding patient perspectives on barriers to care.
An Intervention to Improve CREOG Scores
Authors: Das Anita , Robinson Christopher 
Published: October 2019

PURPOSE:
To examine the effect of an educational intervention on OB/GYN CREOG in-training exam (ITE) scores.

BACKGROUND:
Recent reports have correlated performance on the ITE to passing the qualifying board exam (QBE). Residents at risk for failing may benefit from an educational intervention to increase their chance of successfully passing their QBE.

METHODS:
A retrospective pretest/posttest paired subject intervention study was conducted. Residents selected for inclusion were those with an ITE score of < 200 on their most recent attempt. The educational intervention was a four hour test taking strategy workshop completed two months prior to the ITE. Validation of proper implementation of the method was verified with follow up performance reports. Following completion of the intervention, the next ITE score was obtained and recorded. The statistical analysis was completed for non-parametric matched pairs with Wilcoxon Signed Rank testing with alpha set at 0.05.

RESULTS:
21 PGY-3 and 4 residents met inclusion criteria for enrollment. The mean ITE baseline score was 192.4. Following the educational intervention, the mean ITE score was 212.4. The mean difference between groups was 19.9 points + 2.29 (p<0.001). All but one resident demonstrated improvement in all subjects. All of the residents subsequently passed their QBE.

DISCUSSION:
Our findings suggest that this particular test taking strategy augments CREOG ITE scores by 20 points in residents who score below 200. This pilot study demonstrates that a concentrated two month effort can lead to significant improvements for residents at risk of failing their qualifying board exam in OB/GYN.
Impact of Shortened Obstetrics and Gynecology Clerkship on Medical Student Grades, Shelf Scores, and Satisfaction
Authors: Hutto Sarah , Mackenthun Stephanie , Tessier Katelyn , Egger-Smith Deborah 
Published: October 2019

PURPOSE:
To determine if shortening the length of an obstetrics and gynecology clerkship impacts medical student grades, shelf scores, and satisfaction with the clerkship.

BACKGROUND:
The obstetrics and gynecology clerkship at the University of Minnesota was shortened from 6 to 4 weeks to allow third year medical students to complete all required clerkships. Studies examining clerkships decreased from 8 to 6 weeks suggest a decline in student shelf scores. There are no studies to date evaluating the impact a 4 week clerkship has on student grades, shelf scores or student satisfaction.

METHODS:
Two-sample t-tests were performed to evaluate the difference in Clerkship grades and shelf exam scores between the 6 and 4 week clerkships. Chi-square tests were completed to test association between satisfaction survey responses and clerkship length.

RESULTS:
There were significant differences in mean clerkship grades and shelf scores (p<0.01, p0.02), and mean satisfaction scores (p<0.01) between students completing 6 versus 4 week clerkships. The difference in mean satisfaction scores between 6 and 4 week clerkships included satisfaction of learning environment, organization, educational value, teaching, feedback, experience as team member, balance of supervision versus autonomy and recommending the clerkships to others.

DISCUSSION:
Shortening the obstetrics and gynecology clerkship had a significant negative impact on student performance and satisfaction. This along with the low national rating of obstetrics and gynecology clerkships compared to other specialties may affect how students perceive women’s health as a specialty and recruitment to residency programs. Further studies examining this question are underway.