bluuebunny/crossref_metadata_2025_split huggingface dataset:
Induction of Labor versus Scheduled Cesarean in Morbidly Obese Women: A Cost-Effectiveness Analysis
Authors: Grotegut Chad , Swamy Geeta , Myers Evan , Havrilesky Laura , Hopkins Maeve 
Published: August 2018

Objective To assess the costs, complication rates, and harm-benefit tradeoffs of induction of labor (IOL) compared to scheduled cesarean delivery (CD) in women with class III obesity.
Study Design We conducted a cost analysis of IOL versus scheduled CD in nulliparous morbidly obese women. Primary outcomes were surgical site infection (SSI), chorioamnionitis, venous thromboembolism, blood transfusion, and readmission. Model outcomes were mean cost of each strategy, cost per complication avoided, and complication tradeoffs. We assessed the costs, complication rates, and harm-benefit tradeoffs of IOL compared with scheduled CD in women with class III obesity.
Results A total of 110 patients underwent scheduled CD and 114 underwent IOL, of whom 61 (54%) delivered via cesarean. The group delivering vaginally experienced fewer complications. SSI occurred in 0% in the vaginal delivery group, 13% following scheduled cesarean, and 16% following induction then cesarean. In the decision model, the mean cost of induction was $13,349 compared with $14,575 for scheduled CD. Scheduled CD costs $9,699 per case of chorioamnionitis avoided, resulted in 18 cases of chorioamnionitis avoided per additional SSI and 3 cases of chorioamnionitis avoided per additional hospital readmission. In sensitivity analysis, IOL is cost saving compared with scheduled CD unless the cesarean rate following induction exceeds 70%.
Conclusion In morbidly obese women, induction of labor remains cost-saving until the rate of cesarean following induction exceeds 70%.
How to survive a crisis: reclaiming philosophy as a public practice
Authors: Burroughs Michael D. 
Published: August 2018

AbstractPhilosophy is often understood as an isolated discipline in higher education, as a form of study removed from the concerns of everyday life and the majority of the public. Although philosophy is, in one sense, a professional discipline in higher education, this conception is limiting and severely underdetermines possibilities for philosophy as apublic practice. As a public practice, philosophy and those who practice it can engage with pressing problems and collaborate with stakeholders beyond the academy toward the end of improving our communities. Practicing and supporting philosophy as a public practice is important both for our communities and, ultimately, for greater understanding and appreciation of professional philosophy. Doing so, however, requires significant changes in conceptions of legitimate philosophical practice and, in turn, systems of evaluation and support for publicly engaged philosophers in our institutions and departments.
Accrual to Clinical Trials (ACT): A Clinical and Translational Science Award Consortium Network
Authors: Visweswaran Shyam , Becich Michael J , D’Itri Vincent S , Sendro Elaina R , MacFadden Douglas , Anderson Nicholas R , Allen Karen A , Ranganathan Dipti , Murphy Shawn N , Morrato Elaine H , Pincus Harold A , Toto Robert , Firestein Gary S , Nadler Lee M , Reis Steven E 
Published: August 2018

Abstract
The Accrual to Clinical Trials (ACT) network is a federated network of sites from the National Clinical and Translational Science Award (CTSA) Consortium that has been created to significantly increase participant accrual to multi-site clinical trials. The ACT network represents an unprecedented collaboration among diverse CTSA sites. The network has created governance and regulatory frameworks and a common data model to harmonize electronic health record (EHR) data, and deployed a set of Informatics for Integrating Biology and the Bedside (i2b2) data repositories that are linked by the Shared Health Research Information Network (SHRINE) platform. It provides investigators the ability to query the network in real time and to obtain aggregate counts of patients who meet clinical trial inclusion and exclusion criteria from sites across the United States. The ACT network infrastructure provides a basis for cohort discovery and for developing new informatics tools to identify and recruit participants for multi-site clinical trials.
Labor Analgesia Onset With Dural Puncture Epidural Versus Traditional Epidural Using a 26-G Whitacre Needle and 0.125% Bupivacaine Bolus: A Randomized Clinical Trial
Authors: Wilson S.H. , Wolf B.J. , Bingham K. , Scotland Q.S. , Fox J.M. , Woltz E.M. , Hebbar L. 
Published: August 2018

(Anesth Analg. 2018;126:545–551)
Lumbar epidural (LE) and combined spinal epidural are 2 techniques commonly used for labor analgesia. However, they are not without their disadvantages. An alternative may be the dural puncture epidural (DPE) technique, which allows medication to migrate into the intrathecal space via the epidural space. In the present study, the authors evaluated neuraxial labor analgesia onset following epidural bolus with a dilute local anesthetic solution (0.125% bupivacaine with 50 μg fentanyl) in active laboring parturients with and without DPE. The primary outcome of this study was the percentage of parturients in each group with adequate analgesia during active contraction 10 minutes after administering the epidural bolus.
Does Place and Attendance at Birth Improve Early Neonatal Mortality? Secondary Analysis of 9 Demographic and Health Surveys
Authors: Bellizzi S. , Sobel H.L. , Mathai M. , Temmerman M. 
Published: August 2018

(BJOG 2017;124:1558–1565)
While child mortality worldwide has decreased in recent decades, neonatal deaths are expected to increase from 41.6% of under-5 deaths in 2013 to 52% in 2030. Many births in developing countries still occur at home without a skilled birth attendant (SBA). Prior studies did not show a strong association between lower neonatal mortality and place of birth nor type of attendance, although this may not account for the late referral of women for whom serious complications arise during home birth. This study aimed to determine the beneficial effects of facility births by examining the association between birth place/attendance and early neonatal mortality while adjusting for reported complications at birth.
Physical Activity and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of Epidemiological Studies
Authors: Aune D. , Schlesinger S. , Henriksen T. , Saugstad O.D. , Tonstad S. 
Published: August 2018

(BJOG 2017;124:1816–1826)
Preterm birth, which is associated with neonatal morbidity and many adverse neonatal outcomes, is associated with smoking as well as maternal obesity. The association between physical activity and preterm birth is not clear. A significant inverse relationship has been shown in several randomized trials, cohort studies and case-control studies, while others have shown no significant association. This systematic review aimed to clarify whether physical activity before or during pregnancy was associated with risk of preterm birth.
Effect of Severity of Illness on Cesarean Delivery Rates in Washington State
Authors: Hitti J. , Walker S. , Benedetti T.J. 
Published: August 2018

(Am J Obstet Gynecol 2017;217:474.e1–e5)
Perinatal quality initiatives, including proposed national benchmarks for acceptable cesarean delivery rates, have aimed to design best practices to reduce cesarean delivery rates and obtain optimal outcomes for mothers and infants. However, whether all hospitals can be held to the same benchmark for an acceptable cesarean delivery rate regardless of patient acuity is debatable, and the reasons for between-hospital variation in cesarean rates are not clear. The aim of this study was to evaluate the association between the severity of illness at admission and the primary term singleton vertex (TSV) cesarean delivery rates in Washington State. The authors hypothesized that hospitals with higher patient acuity would have higher term TSV cesarean delivery rates and that this relationship would persist despite temporal trends.
Thombocalc: Implementation and Uptake of Personalized Postpartum Venous Thromboembolism Risk Assessment in a High-throughput Obstetric Environment
Authors: O’Shaughnessy F. , Donnelly J.C. , Cooley S.M. , Deering M. , Raman A. , Gannon G. , Hickey J. , Holland A. , Hayes N. , Bennett K. , Ainle F.N. , Cleary B.J. 
Published: August 2018

(Acta Obstet Gynecol Scand 2017;96:1382–1390)
There is a critical need to improve recognition of women at risk of obstetric venous thromboembolism (VTE), which is a leading cause of maternal morbidity and mortality. While venous thromboembolism risk assessment (VTERA) is recommended internationally for all pregnant and postpartum women, VTERA compliance is reportedly poor due to a lack of validated tools for VTERA, unclear optimal thresholds for the initiation of thromboprophylaxis as evidenced by significant variation in guidelines from various organizations, and challenges of assessing women individually in high-throughput environments. This study aimed to develop, pilot and implement an electronic tool for VTERA in a high-throughput setting, and assess compliance with the risk assessment tool. It did not assess clinical outcomes.
Maternal and Perinatal Outcomes After Laparoscopic Sleeve Gastrectomy
Authors: Rottenstreich A. , Elchalal U. , Kleinstern G. , Beglaibter N. , Khalaileh A. , Elazary R. 
Published: August 2018

(Obstet Gynecol 2018;131:451–456)
Bariatric surgery has been shown to improve fertility in women. In recent years, laparoscopic sleeve gastrectomy, a restrictive procedure, has become the most frequently utilized bariatric procedure. However, current recommendations regarding the care of pregnant women after bariatric surgery are based on studies with patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Therefore, the authors of the present study performed a review of pregnancies among patients who underwent laparoscopic sleeve gastrectomy and related maternal and perinatal outcomes.
Epidural Labor Analgesia: Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial
Authors: Lee A.I. , McCarthy R.J. , Toledo P. , Jones M.J. , White N. , Wong C.A. 
Published: August 2018

(Anesthesiology 2017;127:614–624)
Breastfeeding incurs substantial long-term and short-term health benefits to the infant and mother and is also an important public health concern. Prior studies provided conflicting results regarding the effects of neuraxial analgesia for labor, particularly with fentanyl, on postpartum breastfeeding. This double-blind, randomized controlled clinical trial aimed to evaluate the impact of intrapartum epidural fentanyl on breastfeeding success in the initial postpartum period, as well as at 6 weeks and 3 months postpartum. Self-reported breastfeeding at 6 weeks postpartum was the primary outcome of this study, whereas 1-minute Apgar scores <7, day-1 LATCH (Latch, Audible swallowing, Type of nipple, Comfort, and Hold/help) breastfeeding assessments, the rate of mothers who discontinued breastfeeding at 3 months, and the reasons stated for discontinuation of breastfeeding were the secondary outcomes.
Uterine Artery Doppler Velocimetry During Individually Prescribed Exercise in Pregnancy
Authors: Szymanski Linda M. , Kogutt Benjamin K. 
Published: August 2018

OBJECTIVE:
To evaluate uterine artery blood flow in response to typical exercise sessions performed in pregnancy in accordance with the current recommendations from the American College of Obstetricians and Gynecologists and the U.S. Department of Health and Human Services.

METHODS:
This prospective cross-sectional study measured uterine artery Doppler velocimetry in healthy pregnant women after individually prescribed exercise, including 1) moderate-intensity exercise (40–59% of heart rate reserve) in both nonexercisers and regular exercisers and 2) vigorous-intensity exercise (60–84% of heart rate reserve) in women who regularly engage in exercise. Resting uterine artery Doppler measures were obtained after a 20-minute fetal heart tracing; then the exercise session was performed. Immediately after the exercise session ended, the participants returned to the semirecumbent, leftward tilt position for ultrasound examination. Uterine artery measures were obtained 3.4±0.9 minutes (mean±SD) postexercise.

RESULTS:
Forty-five healthy pregnant women participated in the study: 30 regular exercisers and 15 nonexercisers. For the moderate-intensity session, mean gestational age was 31.1 and 31.7 weeks for the exercisers and nonexercisers, respectively. Mean uterine artery Doppler indices (pulsatility index, resistance index, systolic/diastolic ratio) did not significantly change with exercise. For the vigorous-intensity session, the average gestational age was 31.5 weeks. After vigorous activity, all mean uterine artery Doppler indices showed reductions postexercise, for example, pulsatility index decreased from 0.63±0.12 to 0.58±0.12 (P=.04).

CONCLUSION:
Individually prescribed exercise according to guidelines for pregnant women does not adversely alter uterine artery Doppler values, suggesting that uterine blood flow is not reduced as a result of exercise.
Long-Term Costs of Maximum Nonoperative Treatments in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis that Ultimately Required Surgery
Authors: Adogwa Owoicho , Davison Mark A. , Vuong Victoria D. , Khalid Syed , Lilly Daniel T. , Desai Shyam A. , Moreno Jessica , Cheng Joseph , Bagley Carlos 
Published: August 2018

Study Design.
Retrospective cohort study.

Objective.
The purpose of this study is to characterize the utilization and costs of MNTs prior to spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.

Summary of Background Data.
The costs and utilization of long-term maximal nonoperative therapy (MNT) can be substantial, and in the current era of bundled payments, the duration of conservative therapy trials should be reassessed.

Methods.
A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Only patients with lumbar stenosis or spondylolisthesis and those continuously active within the insurance system for at least 5 years prior to the index operation were eligible.

Results.
A total of 4133 out of 497,822 (0.8%) eligible patients underwent 1, 2, or 3-level posterior lumbar instrumented fusion. 20.8% of patients were smokers, 44.5% had type II DM, and 38.2% were obese (body mass index [BMI] >30 kg/m2). Patient MNT utilization was as follows: 66.7% used nonsteroidal anti-inflammatory drugs (NSAIDs), 84.4% used opioids, 58.6% used muscle relaxants, 65.5% received lumbar epidural steroid injections (LESI), 66.6% attended 21.1% presented to the emergency department (ED), and 24.9% received chiropractor treatments. The total direct cost associated with all MNT prior to index spinal fusion was $9,000,968; LESI comprised the largest portion of the total cost of MNT ($4,094,646, 45.5%), followed by NSAIDS ($1,624,217, 18.0%) and opioid costs ($1,279,219, 14.2%). At the patient level, when normalized per patient utilizing therapy, an average $4010 was spent on nonoperative treatments prior to index lumbar surgery.

Conclusion.
Assuming minimal improvement in pain and functional disability after maximum nonoperative therapies, the incremental cost-effectiveness ratio (ICER) for MNTs could be highly unfavorable.

Level of Evidence: 3
The opioid receptor mu 1 (OPRM1) rs1799971 and catechol-O-methyltransferase (COMT) rs4680 as genetic markers for placebo analgesia
Authors: Aslaksen Per M. , Forsberg June T. , Gjerstad Johannes 
Published: August 2018

AbstractThe placebo effect is considered the core example of mind–body interactions. However, individual differences produce large placebo response variability in both healthy volunteers and patients. The placebo response in pain, placebo analgesia, may be dependent on both the opioid system and the dopaminergic system. Previous studies suggest that genetic variability affects the function of these 2 systems. The aim of this study was therefore to address the interaction between the single nucleotide polymorphisms opioid receptor mu 1 (OPRM1) rs1799971 and catechol-O-methyltransferase (COMT) rs4680 on placebo analgesia. Two hundred ninety-six healthy volunteers participated in a repeated-measures experimental design where thermal heat pain stimuli were used as pain stimuli. Participants were randomized either to a placebo group receiving placebo cream together with information that the cream would reduce pain, or to a natural history group receiving the same pain stimuli as the placebo group without any application of cream or manipulation of expectation of pain levels. The results showed that the interaction betweenOPRM1rs1799971 andCOMTrs4680 was significantly associated with the placebo analgesic response. Participants withOPRM1Asn/Asn combined withCOMTMet/Met and Val/Met reported significant pain relief after placebo administration, whereas those with other combinations of theOPRM1andCOMTgenotypes displayed no significant placebo effect. NeitherOPRM1norCOMThad any significant influence on affective changes after placebo administration. As shown in this study, genotyping with regard toOPRM1andCOMTmay predict who will respond favorably to placebo analgesic treatment.
Quality indicators to assess quality of pain clinic care from the perspective of patients with chronic pain: development, usability, comprehensibility, and psychometric quality of the QiPPP questionnaire
Authors: de Meij Nelleke , Köke Albère , Thomassen Ilona , Kallewaard Jan-Willem , van Kleef Maarten , van der Weijden Trudy 
Published: August 2018

Abstract
To address the lack of appropriate patient-defined quality indicators (QIs) for assessment of pain clinic care in the Netherlands, we developed the “Quality Indicators Pain Patients' Perspective” (QiPPP) questionnaire. Quality indicators are widely used to measure the quality of the structure, process, and outcome of health care. The Pain Patient United Consortium, together with the University Pain Centre of Maastricht, developed QIs for assessment of care. The aim of this study was to develop QIs from the perspective of patients with chronic pain for assessment of the care provided by a pain clinic, and to validate them on usability, comprehensibility, and psychometric quality in daily pain practice. Quality as defined by patients with chronic pain (in survey and focus groups) was prioritized by consensus and transformed into QI. A first set was tested and fine-tuned, resulting in the QiPPP questionnaire. Five participating pain clinics distributed 200 questionnaires among consecutive patients with chronic pain under treatment. To examine the dimensionality of the QIs, patient responses were analyzed on the basis of reporting frequencies and findings of principal component analysis. For construct validation, the influence of patient characteristics was observed in 3 components. A total of 547 (54.7%) populated QiPPP questionnaires (response rate, 58.9%) were analyzed. The mean score for patient comprehensibility was 8.6 ± 1.4. The final QiPPP questionnaire included 21 QIs (18 process; 3 outcome) distributed over 7 domains. The QiPPP questionnaire was of sufficient psychometric quality and found to be useful and understandable by patients with chronic pain.
Serum biomarkers of fibrosis and extracellular matrix remodeling in patients with nonalcoholic fatty liver disease: association with liver histology
Authors: Yilmaz Yusuf , Eren Fatih 
Published: August 2018

Background
We sought to explore the interplay of multiple serum biomarkers of fibrosis and extracellular matrix remodeling with the results of liver histology in patients with nonalcoholic fatty liver disease (NAFLD).

Patients and methods
Venous blood samples were collected from 80 patients with biopsy-proven NAFLD and 59 age-matched and sex-matched healthy controls. Serum levels of transforming growth factor (TGF)-β1, TGF-β2, matrix metalloproteinases (MMP)-1, MMP-2, MMP-7, MMP-9, MMP-10, tissue inhibitors of metalloproteinase (TIMP)-1, and TIMP-2 were determined by using the Luminex MagPix technology on a MAGPIX analyzer.

Results
We documented significant differences in the levels of TGF-β1, TGF-β2, MMP-2, MMP-7, MMP-9, TIMP-1, and TIMP-2 between NAFLD patients and controls. However, none of these biomarkers was able to distinguish between nonalcoholic steatohepatitis and nonalcoholic fatty liver. TIMP-1 levels were significantly higher in patients with significant fibrosis (fibrosis stage ≥2; 2624±1261 pg/ml) than in those without (fibrosis stage 0−1; 2096±906 pg/ml; P=0.03). Moreover, serum levels of TIMP-1 were identified as the only independent predictor of histological fibrosis (β=0.298, t=2.7, P=0.007).

Conclusion
Our study provides insights into the association of multiple serum biomarkers of fibrosis and extracellular matrix remodeling with NAFLD histology. Notably, serum levels of TIMP-1 were identified as a clinically useful marker for distinguishing NAFLD patients with and without significant fibrosis.
Treatment of Low Back Pain With Opioids and Nonpharmacologic Treatment Modalities for Army Veterans
Authors: Vanneman Megan E. , Larson Mary Jo , Chen Cheng , Adams Rachel Sayko , Williams Thomas V. , Meerwijk Esther , Harris Alex H.S. 
Published: August 2018

Background:
In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use.

Objectives:
To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA for LBP, either alone or as adjuncts to opioid medications, and to understand associations between veterans’ clinical and demographic characteristics and type of treatment.

Research Design:
This retrospective cohort study examined use of opioids and 21 specific NPT modalities used by veterans.

Subjects:
VHA-enrolled Iraq and Afghanistan veterans who utilized care in (“linked” to) 130 VHA facilities within 12 months after their separation from the Army between fiscal years 2008–2011, and who were diagnosed with LBP within 12 months after linkage (n=49,885).

Measures:
Measures included per patient: days’ supply of opioids, number of visits for NPT modalities, and pain scores within one year after a LBP diagnosis.

Results:
Thirty-four percent of veterans filled a prescription for opioids, 35% utilized at least 1 NPT modality, and 15% used both within the same year. Most patients with LBP receiving NPT, on average, had moderate pain (36%), followed by low pain (27%), severe pain (15%), and no pain (11%). Eleven percent had no pain scores recorded.

Conclusions:
About 65% of VHA patients with a LBP diagnosis did not receive NPT, and about 43% of NPT users also were prescribed an opioid. Understanding utilization patterns and their relationship with patient characteristics can guide pain management decisions and future study.