bluuebunny/crossref_metadata_2025_split huggingface dataset:
Machine Learning Algorithms Successfully Identify the Quality of Lay-Person Directed Articles Online [37T]
Authors: Dallas Kai B. , Rogo-Gupta Lisa , Elliott Christopher 
Published: May 2019

INTRODUCTION:
Many patients (over 80%) research their medical condition online, but there is very little available to guide patients in assessing the quality/accuracy of the information encountered online. We applied machine learning algorithms to online material pertaining to the controversial topic of vaginal mesh, with the goal of creating a tool to assess article quality.

METHODS:
The complete text of the first 200 hits in Google for “vaginal mesh” (ie articles, blogs, advertisements etc.) were independently assessed by two FPMRS fellowship trained academicians for content quality. The Naïve Bayes algorithm was applied to predict the quality of the article. The articles were randomly partitioned into a training and testing subsets, with the models performance evaluated by its accuracy in assessing the quality of the test subset.

RESULTS:
Overall 70% of the sources were determined to be of poor quality and reviewers independently agreed 88% of the time on article quality. There was interesting difference in the frequency of commonly used words between the article types. The algorithm correctly classified quality 88% of the time with a 6% “false-negative” and “false-positive” rate. The PPV, NPV, sensitivity and specificity were 91%, 84%, 91% and 84%, respectively.

CONCLUSION:
We demonstrate that machine learning algorithms can accurately assess the quality of online articles related to vaginal mesh. This is a promising start in the development of tools to guide patients in their independent research. Future directions will be to refine our current machine learning algorithms and to expand the learning to a greater breadth of medical topics.
Young Adult Males' Perspectives of Male Hormonal Contraception [9S]
Authors: Sax Megan , Hurley Emily , Rossi Rocco , Thakore Suruchi , Hasija Abhinav , Sroga-Rios Julie 
Published: May 2019

INTRODUCTION:
There is an interest and willingness among men in the United States to use Male Hormonal Contraception (MHC), however, data is limited among younger men (18 to 35 years old). Our objective is to evaluate the willingness of young males to use MHC and to determine which method (pill, injection, or transdermal gel) is most desirable.

METHODS:
An IRB-approved survey measuring willingness to use MHC was dispersed to two distinct populations: University of Cincinnati post-graduate programs (UC) and Cincinnati Health Department (CHD) clinics. Results were reported as frequencies in each population and chi-square analyses were performed to compare groups. P-values <.05 were considered significant.

RESULTS:
Of 162 total survey participants, 45% would use MHC while 30.9% were unsure and 23.5% would not use MHC. Overall, the UC survey population was more likely to be interested in using MHC than the CHD population (P<.05). The majority of both populations were most interested in using the injection form. Cited concerns deterring participants from using MHC were different between these two populations, with UC participants having concern about possible failure of contraceptive method, while CHD participants had concern about potential side effects (P<.001).

CONCLUSION:
This study suggests that there is a significant interest among young adult males to use various forms of MHC, especially in injection or pill form. Interest in MHC is more common among individuals with an advanced educational background, employed, or in a relationship. With further research and funding, MHC may serve as a significant way to decrease unintended pregnancies in the future.
Unintended Pregnancy Among People With Sickle Cell Disease or Sickle Cell Trait [5S]
Authors: Piper Kendra , McLemore Morgan , El Rassi Fuad , Kottke Melissa Jo 
Published: May 2019

INTRODUCTION:
The Centers for Disease Control recognizes sickle cell disease (SCD) as a disease for which unintended pregnancy poses an unacceptable health risk. However there is a limited research on the reproductive behaviors of people with SCD and sickle cell trait (SCT).

METHODS:
Participants 18 years and older with SCD and sickle cell trait (SCT) were recruited from a sickle cell clinic in Atlanta, Georgia. We administered surveys to quantify contraceptive use and pregnancy experiences. IRB approval was obtained.

RESULTS:
The sample consisted of 271 people (49.4% male; 50.6% female). The average age was 33.4 years (SD 11.8). Over half of participants reported ever being pregnant or getting someone pregnant. Two thirds of the pregnancies (66.4%) were unplanned. There were 277 pregnancies reported which resulted in 208 live births (75.1%). The sample also reported a history of 21 abortions (7.6%), 35 miscarriages (12.6%), 9 stillbirths (3.2%) and 4 ectopic pregnancies (1.4%). For 23.1% of births, both partners had SCD or SCT, and for 16.3% of births, the partner's sickle status was unknown. There were 30 infants (14.4%) born with SCD and 111 infants (53.4%) born with SCT. Almost 50% of participants reported condom use at last sex and 21.7% reported using birth control other than condoms at last sex.

CONCLUSION:
This study found low use of condoms and hormonal birth control and a high number of unplanned pregnancies. Prevention of SCD is possible and may require increased sexual health education and service delivery to meet the unique needs of people with SCD and SCT.
The Impact of Intrauterine Lidocaine on Perceived Pain During Intrauterine Device Insertion [2S]
Authors: Grajkowski Alison , Scribner Alicia Nicole , Jasaitis Carol , Szekely Daniel 
Published: May 2019

INTRODUCTION:
Intrauterine devices (IUDs) are highly effective, long-term, reversible forms of contraception that have increased in use in the United States. Many women experience significant pain during the insertion process, which can deter placement. There is evidence of decreased pain during endometrial biopsy after intrauterine insertion of 100 mg of lidocaine. The intent of this trial was to determine if intrauterine instillation of 100 mg of lidocaine decreased patient discomfort during IUD insertion.

METHODS:
In this single-blinded, randomized, controlled trial, 150 women eligible for IUD insertion were randomly assigned into 3 arms. The arms included standard IUD placement (control), pretreatment with 2.5 ml of intrauterine normal saline (placebo), and pretreatment with 2.5 ml of intrauterine 4% lidocaine solution, equating to 100 mg of lidocaine (treatment). All participants took 800 mg of ibuprofen prior to IUD insertion. Pain was assessed on an unmarked 10 cm visual analog scale before, during, and after IUD insertion. The data was evaluated using simple statistics and univariate analysis.

RESULTS:
Women who received intrauterine lidocaine had no significant difference in pain scores between the control and the placebo group both during IUD placement (P = 0.927) and after completion of the procedure (P = 0.961). Factors that were significantly associated with decreased pain scores included being postpartum, defined as less than 8 weeks since delivery, and placement of the copper IUD.

CONCLUSION:
Intrauterine lidocaine solution did not demonstrate significant improvement in pain scores during or after IUD placement.
Short Interpregnancy Interval and Desired Contraception at the Preceding Delivery: A Missed Opportunity? [1S]
Authors: Ho Stephanie , Myo Melissa Grace 
Published: May 2019

INTRODUCTION:
The majority of short interpregnancy interval (IPI) pregnancies are unintended. Our study aimed to describe contraceptive desires and outcomes in women with short IPI.

METHODS:
Women with a pregnancy conception date less than 18 months after delivery of the preceding live birth were identified. We reviewed charts to determine desired contraception at time of the preceding delivery and whether patients received desired method postpartum.

RESULTS:
Overall, 334 women had IPI <18 months. 57% were Hispanic, 10% Asian, 7% black, and 18.6% white. 243 (73%) desired hormonal birth control, LARC, or sterilization at preceding delivery; 129 (39%) wanted LARC specifically. Follow-up attendance was 76%. Women who wanted LARC did not vary significantly from women who did not want LARC by race/ethnicity or parity, but were younger (25 vs 28.1, P<.01) and less likely to attend their follow-up visit (69 vs 81%, P=.03). Only 28% of women who desired LARC and attended follow-up ultimately received LARC. Reasons for not receiving LARC included: patient selected a different method, postpartum provider did not routinely place LARCs, or patient was asked to return for placement and did not.

CONCLUSION:
In our ethnically diverse, low-income, county hospital population, the majority of women with short IPI desired birth control, particularly LARC, at time of the preceding delivery. Most women who desired LARC did not receive it, despite attending postpartum follow-up. Continued efforts should be made to increase availability of contraception and LARC immediately postpartum and at postpartum visits to increase access to desired contraception and reduce unintended pregnancy.
Physical Activity, Nutrition and Hormone Levels of Postmenopausal Women With and Without Endometrial Cancer [40R]
Authors: Podwika Sarah , Gabel Anne , Slack-Davis Jill , Shupnik Margaret , Hoehn Kyle , Modesitt Susan Carnall 
Published: May 2019

INTRODUCTION:
This prospective study evaluated anthropometric data, reported physical activity, nutrition, and hormone levels between postmenopausal women undergoing hysterectomy for endometrial cancer and benign disease.

METHODS:
After IRB approval, participants completed questionnaires on physical activity, nutrition, menstrual history and hormone use, and provided preoperative blood samples.

RESULTS:
Of the 77 participants, mean age was 64.5 years, mean BMI was 35.0 kg/m2, and 80.5% had endometrial cancer. Few women (20.8%) achieved recommended weekly exercise and 47.2% did not exercise. Only 44.9% of women ate recommended servings of fruits and vegetables and 55.6% ate fast food weekly. Comparing women with and without cancer, a trend towards higher BMI (36.0 vs 31.1 kg/m2, P=.071) was noted but no significant differences with regard to gravidity, exercise, nutrition, glucose or hormone levels except that estradiol level was significantly lower in women with cancer (45.2 vs 53.8 pg/mL, P=.041). Obese women were significantly less likely to rate their health as excellent/very good (28.6% vs 56.5%, P=.022) and had statistically significant lower FSH (P=.021) and SHBG (P<0.001) but higher C-peptide (P=.019) compared to lean patients. Women were divided into 4 groups (obese or lean with and without cancer) with significant differences found in age (lean women with cancer were older, P=.006), FSH (obese women with cancer had lower levels, P=.012), SHBG (highest in lean women without cancer, P=.02) but not estradiol, androstenedione, C-peptide or diet/exercise.

CONCLUSION:
Estradiol levels in postmenopausal women with cancer were lower than benign patients and did not correlate with obesity or other diet/exercise habits.
Impact of Histology on Racial Disparities in Epithelial Ovarian Cancer Patients [39R]
Authors: Craig Eric R. , Tarney Christopher , Tian Chunqiao , Casablanca Yovanni , Darcy Kathleen 
Published: May 2019

INTRODUCTION:
Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. Racial disparities between non-Hispanic white (NHW) and non-Hispanic black (NHB) patients with EOC has been documented, but data on the existence of disparities among other races is lacking. The objective of this study was to investigate the relationship between race, histology, and survival in EOC.

METHODS:
Data from women diagnosed with invasive EOC including serous, endometrioid, clear cell, and mucinous histology from 1990-2013 from the Surveillance, Epidemiology, and End Results (SEER) Program were used for analysis.

RESULTS:
A total of 68,206 patients were included. NHB patients had higher cancer-related mortality (CRM) than NHW patients in all histological classifications. Hispanic (HSP) and Asian Pacific Islander (API) patients had decreased risk of CRM for serous histology. API patients also had lower CRM for clear cell histology. Hazard ratio (HR) for NHB vs. NHW patients was the smallest in serous histology (HR 1.18, 95% Confidence Interval (CI) 1.12-1.26) and largest for mucinous histology (HR 1.54, 95% CI 1.34 -1.78). HSP (HR 0.91, 95% CI 0.87-0.96, P=0.0005) and API (HR 0.87, 95% CI 0.82-0.93, P<0.0001) patients had decreased risk of CRM for serous histology. API patients also had lower CRM for clear cell histology (HR 0.83, 95% CI 0.71-0.97, P<0.021).

CONCLUSION:
There are significant histologic differences among races. NHB patients have an increased risk for CRM in all histological subtypes. Recognizing these histological differences may allow for tailored therapy, which may reduce racial survival disparities observed in EOC.
Risk Factors for Inverted T Hysterotomy Incision at the Time of Cesarean Delivery [35R]
Authors: Kawakita Tetsuya , Huang Jim , Landy Helain J. 
Published: May 2019

INTRODUCTION:
We sought to examine those for an inverted T hysterotomy.

METHODS:
This was a retrospective study of all women undergoing cesarean delivery at 23 weeks' gestation or greater between 2012 and 2017. We only included cases in which the hysterotomy incision was either low transverse or inverted T hysterotomy. Risk factors included age, race, repeat cesarean, gestational age, fetal presentation, large fibroid >10 cm, emergency cesarean, second stage cesarean, previa or accreta, general anesthesia, and multiple gestations. Outcomes were compared between cases with low transverse and inverted T hysterotomy. Multivariable logistic regression to obtain adjusted odds ratios (aOR) and 95% confidence interval (95% CI). MedStar Institutional Review Board approved this analysis.

RESULTS:
Of 6,608 women undergoing cesarean delivery, inverted T hysterotomy incisions occurred in 68 (1.0%). In multivariable logistic regression, risk factors for inverted T hysterotomy included non-Hispanic black (aOR 4.85; 95%CI 1.14-20.60), repeat cesarean (aOR 1.81; 95%CI 1.04-3.16), preterm delivery (23 0/7-31 6/7 weeks' gestation [aOR 7.58; 95%CI 3.59-16.00]; 32 0/7-36 6/7 weeks' gestation [aOR 2.08; 95%CI 1.06-4.07]), malpresentation (transverse [aOR 22.29; 95%CI 9.77-50.82]; breech [aOR 2.91; 95%CI 1.49-5.67]), fibroid >10 cm (aOR 7.77; 95%CI 1.95-30.88), emergency cesarean (aOR 3.17; 95%CI 1.53-6.58), and second stage cesarean delivery (aOR 2.98; 95%CI 1.32-6.74).

CONCLUSION:
We identified independent risk factors for an inverted T hysterotomy. These findings will help clinicians identify and counsel high-risk women regarding potential implications of having a cesarean delivery.
Cesarean Section Incision Length and Post-Operative Pain [34R]
Authors: Nicholls-Dempsey Laura , Abenhaim Haim 
Published: May 2019

INTRODUCTION:
Cesarean sections are a common surgical procedure and are associated with post-operative pain. The objective of this study is to describe the variability in cesarean section incision length and its association with post-operative pain, scar satisfaction and analgesia use.

METHODS:
After approval from the Institutional Review Board, we conducted a hospital-based study on women from a tertiary care center's post-partum unit who delivered by cesarean section. Written informed consent was obtained. Post-operative pain was measured using a visual analog scale from 0 to 10 at the first post-operative day. Cesarean section incision length was measured on the second post-operative day. Descriptive analyses were used to describe incision lengths and pain levels.

RESULTS:
We recruited 107 women having delivered by cesarean section. The mean incision length was 16.39 cm (SD ± 1.78 cm), ranging from 13 to 22 cm, and skewed towards longer incisions, with 20.6% having an incision ≥ 18 cm. The mean pain level on the first post-operative day was 5.7/10 (SD = ± 2.6), 4.4/10 (SD = ± 2.3) on the second day, and 1.9/10 (SD = ± 2.2) at 6 weeks post-partum. There was no significant difference in pain level according to incision length at the first (P=0.224), second (P=0.350), and 6 week (P=0.904) post-operative mark

CONCLUSION:
There is considerable variability in cesarean delivery incision length. We did not identify any significant predictor for larger incisions. Incision length was found to have no impact on the post-operative pain level at one day, two days or six weeks after cesarean delivery.
Pulse Pressure and Postepidural Complications in Women With Hypertensive Disorders of Pregnancy [33R]
Authors: Kazzi Nayla George , Triebwasser Jourdan , Kobernik Emily , Langen Elizabeth Suzanne 
Published: May 2019

INTRODUCTION:
Normotensive women with narrow pulse pressure have increased risk of postepidural complications and benefit from additional fluid volume. We hypothesized that narrow pulse pressure in hypertensive women was associated with increased postepidural intervention.

METHODS:
Single-center prospective cohort study of women with singleton pregnancies and diagnosis of gestational hypertension (gHTN) or preeclampsia admitted for delivery between December 2016 and January 2018. Mean pulse pressure in the 3 hours prior to test dose was calculated (narrow defined as <45 mm Hg). Primary outcome was a composite of postepidural resuscitative measures including fluid bolus, vasopressors, supplemental oxygen, or intentional maternal position changes. Secondary outcomes included hypotension, defined as a decrease in blood pressure (BP) of 20% from baseline, or fetal heart rate (FHR) decelerations compared to 1 hour prior to epidural bolus.

RESULTS:
67 women with hypertensive disorders of pregnancy were included, with 15 (22.4%) having a narrow pulse pressure. Average systolic and diastolic BP prior to epidural for those with narrow vs. normal pulse pressure was 125 Â± 11 vs. 137 Â± 10 mm Hg (P<.001) and 86 Â± 11 vs. 81 Â± 8 mm Hg (P=.05), respectively. No observed difference in the need for postepidural resuscitation 13.3 vs. 38.5% (P=.12) or any component of the composite outcome. No observed increased risk of systolic (RR 0.74 [95%CI 0.25-2.25]) or diastolic hypotension (RR 0.89 [95%CI 0.53-1.51]) with narrow pulse pressure, nor were abnormal FHR patterns more frequent (P=.72).

CONCLUSION:
Narrow pulse pressure was not predictive of postepidural complications or resuscitation in women with gHTN or preeclampsia.
Prolonged Second Stage in the First Pregnancy and Risk of Subsequent Spontaneous Preterm Birth [30R]
Authors: Sobhani Nasim C. , Cassidy Arianna G. , Rosenstein Melissa G. , Zlatnik Marya G. 
Published: May 2019

INTRODUCTION:
Preterm birth (PTB) is the leading cause of neonatal morbidity/mortality. Although some risk factors for spontaneous PTB (sPTB) are known, sPTB often occurs without identifiable risk factors. A prolonged second stage may increase sPTB risk via mechanical trauma that disrupts cervical integrity. This study examines the association between second stage length and subsequent sPTB.

METHODS:
This retrospective study included women with two consecutive singleton deliveries at one institution from 07/2012-06/2018, with the first delivery occurring at term. Prolonged second stage (PSS) was defined as 4 hours or more, based on this cohort's 75th percentile and on national recommendations. Very prolonged second stage (VPSS) was defined as 7 hours or more, based on this cohort's 95th percentile. The primary outcome was subsequent sPTB before 37 weeks. Fisher exact test, Kruskal-Wallis test, and logistic regression were used for statistical analysis.

RESULTS:
Among 1,032 included women, the overall subsequent sPTB rate was 3.1%. Identified in 24.4%, PSS was not associated with increased rate of sPTB (4.4% with PSS vs 2.7% without PSS, p=0.21). Identified in 4.3%, VPSS was associated with a higher rate of sPTB (9.1% with VPSS vs 2.8% without VPSS, p=0.04, OR 3.4, 95% CI 1.1-10.2).

CONCLUSION:
When dichotomized using the nationally-accepted cutoff of 4 hours, prior second stage length was not associated with subsequent sPTB. However, there was an association between increased risk of sPTB and second stage length when using a higher cutoff of 7 hours. Because that population's sample size was small, larger studies are required to confirm this association.
Progesterone Use and Regional Variation of Practice in a Nationwide Cohort [29R]
Authors: Ruma Michael S. ,   On behalf of the EQUATE Consortium
Published: May 2019

INTRODUCTION:
To determine the rate of progesterone use among women with a history of prior sPTB.

METHODS:
This study is a secondary analysis of the EQUATE trial, a prospective, observational study performed at 16 US sites designed to evaluate the utility of quantitative fetal fibronectin for predicting the risk of sPTB in a high-risk asymptomatic population. All patients with a history of sPTB and singleton pregnancy were included in this analysis. The primary outcome assessed the rate and form of progesterone use to reduce the rate of recurrent sPTB. Descriptive statistics were calculated to report the use and regional differences in practice.

RESULTS:
Of the 1546 women in the EQUATE trial, 862 (55.8%) met the inclusion criteria for this secondary analysis. Of these, 36.5% (315/862) received 17-P therapy, 17.4% (150/862) received vaginal progesterone, 1.3% (11/862) received both, while 44.8% (386/862) did not receive any progesterone during their pregnancy. Significant regional differences were noted in the cohort for progesterone use and agent selection (p-value < 0.00001).

CONCLUSION:
17-P is FDA approved and ACOG recommended for the prevention of recurrent sPTB in women with a prior sPTB. In this cohort, nearly half of patients (44.8%) - all of whom were candidates for 17-P - did not receive this intervention. Whether this is related to results of recent trials which call into question the efficacy of this intervention or challenges related to the availability and affordability of 17-P is not clear. Further studies are needed to better understand this pattern of progesterone use across the United States.
Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis [27R]
Authors: Cahill Patrick J. , Hilmara Didja , Flynn John M. , Ho Michelle 
Published: May 2019

INTRODUCTION:
The current body of knowledge of pregnancy and childbirth in patients with adolescent idiopathic scoliosis treated with a spinal fusion relies on data from patients treated with outdated spinal fusion techniques. The study seeks to understand the effects of spinal fusion on pregnancy and childbirth for AIS patients.

METHODS:
Retrospective and prospective surveys were distributed to patients enrolled in a multi-center AIS study. The survey addressed the entire pregnancy experience (e.g., type of delivery, anesthesia use during labor, and post-partum recovery). Descriptive statistics were used to summarize the findings. IRB approval and informed consent was granted for all study procedures.

RESULTS:
A total of 54 babies were born to 54 patients during the study. As part of their prenatal care, only 24% of patients reported meeting with an anesthesiologist prior to delivery. The most common type of delivery was spontaneous vaginal (53%). Of the women who had spontaneous vaginal births (25 of 53 pregnancies), 12 did not receive anesthesia, 6 received intravenous intermittent narcotics, and 9 had regional anesthesia. Of 54 patients, 2 were told by their perinatal providers that anesthesia use was precluded by previous spine surgery.

CONCLUSION:
The majority of AIS patients reported not meeting with an anesthesiologist prior to giving birth. Those who had a planned C-section did so under obstetrician recommendation. Although the presence of spinal instrumentation is an important consideration, it should not dictate a patient's delivery. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon may provide the most comprehensive patient education regarding pregnancy and childbirth.