bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of macronutrient intake in obesity: a meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome
Authors: Willems Anouk E M , Sura–de Jong Martina , van Beek André P , Nederhof Esther , van Dijk Gertjan 
Published: May 2020

AbstractThe metabolic syndrome (MetS) comprises cardiometabolic risk factors frequently found in individuals with obesity. Guidelines to prevent or reverse MetS suggest limiting fat intake, however, lowering carbohydrate intake has gained attention too. The aim for this review was to determine to what extent either weight loss, reduction in caloric intake, or changes in macronutrient intake contribute to improvement in markers of MetS in persons with obesity without cardiometabolic disease. A meta-analysis was performed across a spectrum of studies applying low-carbohydrate (LC) and low-fat (LF) diets. PubMed searches yielded 17 articles describing 12 separate intervention studies assessing changes in MetS markers of persons with obesity assigned to LC (&lt;40% energy from carbohydrates) or LF (&lt;30% energy from fat) diets. Both diets could lead to weight loss and improve markers of MetS. Meta-regression revealed that weight loss most efficaciously reduced fasting glucose levels independent of macronutrient intake at the end of the study. Actual carbohydrate intake and actual fat intake at the end of the study, but not the percent changes in intake of these macronutrients, improved diastolic blood pressure and circulating triglyceride levels, without an effect of weight loss. The homeostatic model assessment of insulin resistance improved with both diets, whereas high-density lipoprotein cholesterol only improved in the LC diet, both irrespective of aforementioned factors. Remarkably, changes in caloric intake did not play a primary role in altering MetS markers. Taken together, these data suggest that, beyond the general effects of the LC and LF diet categories to improve MetS markers, there are also specific roles for weight loss, LC and HF intake, but not reduced caloric intake, that improve markers of MetS irrespective of diet categorization. On the basis of the results from this meta-analysis, guidelines to prevent MetS may need to be re-evaluated.
The Gendered Relationship between Parental Religiousness and Children’s Marriage Timing
Authors: Brauner-Otto Sarah R , Pearce Lisa 
Published: May 2020

AbstractIn this article, we examine whether mother’s and father’s self-reported religiousness relates differently to the timing of their children’s marriages. Conceptualizing religion as one source of cultural schema about marriage that is likely to conflict with other schemas for living, and theorizing that women are more likely to experience structured ambivalence over religious schema and their enactment than men, we predict father’s religiousness will be associated with children’s marriage in accordance with religious dogma, whereas the experience of structured ambivalence yields a more complex relationship between mother’s religiousness and their children’s marriage. Using longitudinal data from the Chitwan Valley Family Study in Nepal, a primarily Hindu and Buddhist setting, we find contrasting associations between son’s marriage timing and mothers’ and fathers’ religiousness. This provides empirical support for theoretical frameworks that emphasize the gendered nature of religious identity and suggests the influence of religion on other aspects of life is gendered.
Update on HIV prevention and preexposure prophylaxis
Authors: Baker Jonathan , Rolls Joanne 
Published: May 2020

ABSTRACT
HIV preexposure prophylaxis (PrEP) is an opportunity for clinicians to curb the 40,000 HIV infections occurring annually in the United States. PrEP is medication used by HIV-negative patients to reduce their risk of acquiring the virus. This article provides a baseline understanding of PrEP indications, prescribing, and monitoring, including a review of previously approved medication and an update on newly approved drugs, including emtricitabine/tenofovir alafenamide (F/TAF). Sexual and gender minorities are often underrepresented in the literature about PrEP, but clinicians should address risk focused on specific behaviors rather than population-level characteristics. As one of few professions with prescriptive authority, PAs have an obligation to understand and manage PrEP.
Uncovering the Process of Reasonable Academic Accommodations for Prelicensure Nursing Students With Learning Disabilities
Authors: Yarbrough Amy E. , Welch Susan R. 
Published: May 2020

Abstract

AIM
The purpose of the study was to explore the process by which nursing faculty make reasonable academic accommodations in the classroom setting for students with learning disabilities.

BACKGROUND
Nursing students with identified learning disabilities require academic accommodations. The process of reasonable academic accommodations for nursing students with learning disabilities has not been examined within nursing education literature and clarification is needed.

METHOD
Constructivist grounded theory methods, as described by Charmaz, guided data collection and analysis.

RESULTS
Literature supports the categories, themes, and subthemes of the academic accommodations process found in this investigation. However, further research is necessary regarding the academic accommodations process and faculty development to support nursing students with identified learning disabilities.

CONCLUSION
Nursing education needs standards of academic accommodations for students with learning disabilities.
Encouraging Entrustment: A Qualitative Study of Resident Behaviors That Promote Entrustment
Authors: Pingree Elizabeth W. , Huth Kathleen , Harper Beth D. , Nakamura Mari M. , Marcus Carolyn H. , Cheston Christine C. , Schumacher Daniel J. , Winn Ariel S. 
Published: May 2020

Purpose
To explore resident and attending physician perceptions of resident behaviors and skills that demonstrate trustworthiness and promote entrustment by supervisors.

Method
Using grounded theory methodology, the authors conducted 3 focus groups with pediatric residents from the Boston Combined Residency Program and 3 focus groups with attending physicians who were either general pediatric hospitalists or other pediatric subspecialists at Boston Children’s Hospital and Boston Medical Center in Boston, Massachusetts, from May to December 2018. Data were collected and analyzed iteratively until theoretical saturation was achieved. Three independent reviewers coded each transcript. Codes were grouped into dominant themes to develop a conceptual model.

Results
Twelve residents and 18 attending physicians participated in the focus groups. Participants described actions that they felt actively demonstrated residents’ trustworthiness within previously described domains of trustworthiness. Four modifiers emerged that affect a resident’s progression from trustworthiness to entrustment: (1) self-management, (2) relationships, (3) self-advocacy, and (4) patient-centeredness. Findings were synthesized into a conceptual model depicting how trainees can promote their own entrustment by supervisors.

Conclusions
Trainees must actively demonstrate their trustworthiness to be entrusted. This study proposes that trainees can further gain entrustment through self-management, relationships, self-advocacy, and patient-centeredness. When they understand the actions and behaviors that promote entrustment, trainees may be better able to foster autonomy and progress toward more independent clinical practice. These findings add to existing evidence regarding entrustment and provide a novel, actionable framework for trainees to increase their own entrustment.
Following the Script: An Exploratory Study of the Therapeutic Reasoning Underlying Physicians’ Choice of Antimicrobial Therapy
Authors: Abdoler Emily A. , O’Brien Bridget C. , Schwartz Brian S. 
Published: May 2020

Purpose
Physicians frequently prescribe antimicrobials inappropriately, leading to an increase in the rate of resistance, which in turn, harms patients. To better understand why physicians prescribe specific antimicrobials in particular cases, the authors investigated the decision-making processes underlying physicians’ antimicrobial choice (i.e., their antimicrobial reasoning).

Method
Applying a clinical reasoning framework, the authors conducted semi-structured, qualitative interviews with a purposive sample of attending physicians in infectious diseases and hospital medicine at 2 hospitals in fall 2018. An interviewer asked participants to describe how they would choose which antimicrobial to prescribe in 3 clinical vignettes, to recall how they chose an antimicrobial in an example from their own practice, and to indicate their steps in antimicrobial selection generally. The authors identified steps and factors in antimicrobial reasoning through thematic analysis of interviews and the note cards that participants used to delineate their general antimicrobial reasoning processes.

Results
Sixteen participants described 3 steps in the antimicrobial reasoning process: naming the syndrome, delineating pathogens, and selecting the antimicrobial (therapy script). They mentioned 25 different factors in their reasoning processes, which the authors grouped into 4 areas: preexisting patient characteristics, current case features, provider and health care system factors, and treatment principles. Participants used antimicrobial (therapy) scripts that included 14 different drug characteristics. The authors present the steps and factors in a framework for antimicrobial reasoning.

Conclusions
Through this exploratory study, the authors identified steps and factors involved in physicians’ antimicrobial reasoning process, as well as the content of their antimicrobial (therapy) scripts. They organized all these findings into a framework for antimicrobial decision making. This information may ultimately be adapted into educational tools to improve antimicrobial prescribing across the spectrum of learners and practicing physicians.
Delayed Diagnosis in Esophageal Atresia and Tracheoesophageal Fistula
Authors: Scott Joanne E. , Hawley Alisa , Brooks Jo-Anne 
Published: May 2020

Background:
Timely identification of esophageal atresia is challenging. Diagnosis may be suspected antenatally with a combination of polyhydramnios, associated with a small or absent stomach bubble or other anomalies. Esophageal atresia can be suspected postnatally in the presence of tachypnea, increased oral secretions, and an inability to advance an orogastric tube. Failure to recognize an esophageal atresia can have life-threatening implications.

Clinical Findings:
A 5-day-old infant with a history of failure to thrive and respiratory distress presented in a community emergency department following a prolonged apnea associated with a breastfeed.

Primary Diagnosis:
Delayed postnatal diagnosis of esophageal atresia and tracheoesophageal fistula.

Interventions:
During stabilization in the emergency department, a nasogastric tube was placed to decompress the stomach. A subsequent chest and abdominal radiograph identified the nasogastric tube curled in the upper esophagus, confirming an esophageal atresia. The abdominal radiograph demonstrated gaseous distension, suggesting the presence of a distal tracheoesophageal fistula.

Outcomes:
The neonate had a primary esophageal anastomosis and fistula ligation in a surgical neonatal unit. He was discharged home at 29 days of life.

Practice Recommendations:
Understanding the challenges of an antenatal diagnosis and awareness of postnatal presentation with a view to improving postnatal recognition and better-quality outcomes for infants with an esophageal atresia and tracheoesophageal fistula.
Singleton, Term, Vertex Cesarean Delivery on a Midwife Service Compared With an Obstetrician Service
Authors: Damiano Ella A. , Auty Samantha G. , Von Mertens Jaylon , Gerjevic Kristen A. 
Published: May 2020

OBJECTIVE:
To evaluate the difference in odds of cesarean delivery in term, singleton, vertex pregnancies between the midwife and obstetrician-led services at the same rural tertiary care center.

METHODS:
A retrospective cohort study of term, singleton, and vertex deliveries in patients without a history of cesarean delivery was performed. Patients self-selected a delivery service. The primary outcome was the odds of cesarean delivery between midwife and obstetrician-led services. After propensity score matching, logistic regression was performed on the matched sample to assess the adjusted odds of cesarean delivery.

RESULTS:
From January 2015 to December 2017, 1,787 (80.2% of total) deliveries were analyzed with management of 956 (53.5%) by the midwife service and 831 (46.5%) by the obstetrician-led service. The rate of cesarean delivery was 20.7% (n=172) in the obstetrician-led service and 13.1% (n=125) in the midwife service. In the matched sample, the odds of cesarean delivery were lower in the midwife service compared with the obstetrician-led service in unadjusted and adjusted analyses (odds ratio [OR] 0.62, 95% CI 0.47–0.81; adjusted odds ratio [aOR] 0.58, 95% CI 0.44–0.80). Older maternal age (OR 1.02, 95% CI 1.00–1.06; aOR 1.07, 95% CI 1.04–1.10) and higher delivery body mass index (OR 1.06, 95% CI 1.04–1.08; aOR 1.07, 95% CI 1.04–1.09) were associated with higher odds of cesarean delivery. Increased parity was associated with decreased odds of cesarean delivery (OR 0.41, 95% CI 0.31–0.55; aOR 0.35, 95% CI 0.26–0.48). There were no differences in neonatal outcomes.

CONCLUSION:
At a single rural tertiary care center, patients on the midwife service have significantly lower adjusted odds of cesarean delivery than patients on the obstetrician-led service.
Association of Immediate Postpartum Etonogestrel Implant Insertion and Venous Thromboembolism
Authors: Floyd Jessica L. , Beasley Anitra D. , Swaim Laurie S. , Turrentine Mark A. , Nijjar J. Biba 
Published: May 2020

OBJECTIVE:
To estimate the rate of readmissions for postpartum venous thromboembolism (VTE) during the first 30 days postdelivery between women with and without the immediate postpartum insertion of the etonogestrel contraceptive implant.

METHODS:
The Nationwide Readmissions Database from 2016 was used to identify women with a singleton delivery, immediate postpartum insertion of the etonogestrel contraceptive implant, and readmission for VTE within 30 days of discharge. Those with a prior history of VTE or anticoagulant therapy were excluded. These women were compared with the number of women readmitted within 30 days for VTE who did not have the contraceptive implant placed during delivery admission.

RESULTS:
Of 3,387,120 deliveries, 8,369 women underwent etonogestrel contraceptive implant placement during the delivery admission. There was no difference identified in the rate of readmission for VTE between exposed and unexposed women. Of these, seven had received a postpartum etonogestrel contraceptive implant (0.85/1,000; 95% CI 0.22–1.45/1,000 deliveries), compared with 1,192 without an etonogestrel contraceptive implant (0.35/1,000; 95% CI 0.33–0.37/1,000 deliveries); odds ratio (OR) 2.41; 95% CI 0.58–9.89. The rates of diabetes, thrombophilia, systemic lupus erythematosus, and cesarean birth did not differ between groups. Women who underwent etonogestrel contraceptive implant placement were younger and were more likely to have government-sponsored health insurance, a smoking history, hypertension, peripartum infection, or postpartum hemorrhage than women who did not receive an etonogestrel contraceptive implant (P<.001). After adjusting for these confounders, there remained no difference in rates of VTE, adjusted OR 1.81; 95% CI 0.44–7.45.

CONCLUSION:
The immediate postpartum placement of the etonogestrel contraceptive implant was not associated with an increased rate of VTE; however, our sample size was underpowered to determine no difference.
Mild Thrombocytopenia and Postpartum Hemorrhage in Nulliparous Women With Term, Singleton, Vertex Deliveries
Authors: Govindappagari Shravya , Moyle Kimberly , Burwick Richard M. 
Published: May 2020

OBJECTIVE:
To assess whether mild thrombocytopenia (platelet count 100–149 k/microliter) is associated with an increased risk of postpartum hemorrhage.

METHODS:
Nulliparous women with term, singleton, vertex pregnancies undergoing labor at our institution between August 2016 and September 2017 were included. The primary exposure was mild thrombocytopenia, defined as platelet count 100–149 k/microliter, and the comparator was normal platelet count (150 k/microliter or greater). Those with severe thrombocytopenia (platelet count less than 100 k/microliter) were excluded from analysis. The primary outcome was postpartum hemorrhage, determined by International Classification of Diseases, Tenth Revision codes and the hospital discharge problem list. Secondary outcomes included use of uterotonic agents (methylergonovine maleate or carboprost tromethamine), total blood loss 1,000 mL or greater, and blood transfusion. Data were analyzed by t test, χ2 or Fisher exact test, and multivariable logistic regression, with significance at α <0.05.

RESULTS:
We evaluated 2,845 eligible women, of whom 2,579 (90.2%) had normal platelet count 150 k/microliter or greater, 266 (9.3%) had platelet count 100–149 k/microliter (mild thrombocytopenia), and 13 (0.5%) had platelet count less than 100 k/microliter (severe thrombocytopenia). Compared with women with normal platelet count, those with mild thrombocytopenia had a higher rate of postpartum hemorrhage (16.9% vs 8.5%, P<.001) and were more likely to have total blood loss 1,000 mL or greater (4.5% vs 1.7%, P=.002) and receive methylergonovine maleate (10.5% vs 5.9%, P=.003) or carboprost tromethamine (6.0% vs 1.6%, P<.001) or both (3.8% vs 1.0%, P<.001), but rates of blood transfusion were no different (1.9% vs 1.5%, P=.59). The association between mild thrombocytopenia and postpartum hemorrhage persisted after multivariable adjustment for potential confounders (adjusted odds ratio 2.2, 95% CI 1.5–3.2, P<.001).

CONCLUSION:
Among nulliparous women with term, singleton, vertex pregnancies undergoing labor, those with mild thrombocytopenia (platelet count 100–149 k/microliter) had a twofold greater likelihood of postpartum hemorrhage compared with those with normal platelet count.
Fetal Bradycardia in Response to Maternal Hypothermia
Authors: Spires Benjamin P. , Towers Craig V. 
Published: May 2020

BACKGROUND:
Fetal tachycardia can occur with maternal fever (hyperthermia); therefore, a low maternal temperature (hypothermia) might produce fetal bradycardia.

CASES:
Five cases of fetal bradycardia are presented in gestations complicated by maternal hypothermia. The fetal heart rate (FHR) tracings demonstrated stable baselines of 88–96 beats per minute with moderate variability and accelerations. All baselines returned to normal after maternal warming measures.

CONCLUSION:
A possible cause for fetal bradycardia with a stable baseline and moderate variability is maternal hypothermia, a pattern not indicative of fetal hypoxia. Delivery is not indicated, and maternal warming results in FHR baseline normalization.
Abortion Policies in U.S. Teaching Hospitals
Authors: Zeldovich Varvara B. , Rocca Corinne H. , Langton Callie , Landy Uta , Ly Elizabeth S. , Freedman Lori R. 
Published: May 2020

OBJECTIVE:
To evaluate the prevalence and features of policies regulating abortion in U.S. teaching hospitals.

METHODS:
In this mixed-methods study, we conducted a national survey of obstetrics and gynecology teaching hospitals (2015–2016) and qualitative interviews (2014 and 2017) with directors at obstetrics and gynecology residency programs. We asked participants about hospital regulations on abortion and their perceptions of the nature and enforcement of these policies. Interview analysis was conducted with a grounded theoretical approach and informed development of the survey. The prevalence of policies was described using survey data; differences in policy structures by region were analyzed using a series of logistic regression models.

RESULTS:
Directors from 169 of 231 eligible training programs responded to the survey (73%). Institutional policies limited abortion beyond state law in 57% of teaching hospitals, most commonly in the Midwest and South (odds ratio [OR] 4.3, P<.01 for Midwest; OR 4.0, P=.001 for South vs Northeast). Policies varied in form (written and unwritten) and restricted abortion based on the indication for the procedure and gestational age. Nonmedically indicated, or “elective” procedures were more commonly restricted (48% of sites reporting any policy and 25% prohibiting these abortions altogether) than medically indicated ones (28% of sites reporting any policy.) Policies were created by those with institutional power, including hospital leadership and obstetrics and gynecology department chairs, and were perceived to be motivated by personal beliefs and a desire to avoid controversy. Rules were commonly enforced by medical specialists, hospital ethics committees, and department chairs. Qualitative data highlighted the convoluted nuances of these policies, which often put clinicians at odds with their professional mandates.

DISCUSSION:
Reportedly driven by broader institutional interests, obstetrics and gynecology teaching hospital policies often restricted abortion beyond state law to the detriment of abortion access and training opportunities. Vague or unwritten abortion policies, although difficult to navigate, gave health care providers some agency and flexibility over their practices.
Acute Respiratory Distress Syndrome in a Preterm Pregnant Patient With Coronavirus Disease 2019 (COVID-19)
Authors: Blauvelt Christine A. , Chiu Catherine , Donovan Anne L. , Prahl Mary , Shimotake Thomas K. , George Ronald B. , Schwartz Brian S. , Farooqi Naghma A. , Ali Syed S. , Cassidy Arianna , Gonzalez Juan M. , Gaw Stephanie L. 
Published: May 2020

BACKGROUND:
Data suggest that pregnant women are not at elevated risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or developing severe disease compared with nonpregnant patients. However, management of pregnant patients who are critically ill with coronavirus disease 2019 (COVID-19) infection is complicated by physiologic changes and other pregnancy considerations and requires balancing maternal and fetal well-being.

CASE:
We report the case of a patient at 28 weeks of gestation with acute respiratory distress syndrome (ARDS) from COVID-19 infection, whose deteriorating respiratory condition prompted delivery. Our patient's oxygenation and respiratory mechanics improved within hours of delivery, though she required prolonged mechanical ventilation until postpartum day 10. Neonatal swabs for SARS-CoV-2 and COVID-19 immunoglobulin (Ig) G and IgM were negative.

CONCLUSION:
We describe our multidisciplinary management of a preterm pregnant patient with ARDS from COVID-19 infection and her neonate.