bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity
Authors: Lisonkova S. , Muraca G.M. , Potts J. , Liauw J. , Chan W.S. , Skoll A. , Lim K.I. 
Published: August 2018

(JAMA 2017;318(18):1777–1786)
Overweight and obesity are associated with increased risks of adverse maternal and neonatal events such as preterm birth, stillbirth, and neonatal or infant death; underweight is also associated with adverse outcomes. However, it is unclear if the risk of severe maternal morbidity increases as body mass index (BMI) increases. This study aimed to determine the association between prepregnancy BMI and severe maternal morbidity or mortality.
Prepregnancy Obesity and Severe Maternal Morbidity: What Can Be Done?
Authors: Caughey A.B. 
Published: August 2018

(JAMA 2017;318(18):1765–1766)
In the United States, approximately half of all pregnant women were overweight or obese in 2014, which increases the risk of maternal and fetal complications. Obesity may contribute to the recent increase in maternal mortality in the US, but the cause of this relationship is unknown. It is not clear if mortality is caused by comorbid events in obese women or if the care of obese women is more difficult to manage. Since severe maternal morbidity in obese women may contribute to and precede mortality, studying the associations between obesity and severe maternal morbidity in pregnancy may shed additional light on this connection.
Pregnancy Outcomes After ZIKV Infection in French Territories in the Americas
Authors: Hoen B. , Schaub B. , Funk A.L. , Ardillon V. , Boullard M. , Cabié A. , Callier C. , Carles G. , Cassadou S. , Césaire R. , Douine M. , Herrmann-Storck C. , Kadhel P. , Laouénan C. , Madec Y. , Monthieux A. , Nacher M. , Najioullah F. , Rousset D. , Ryan C. , Schepers K. , Stegmann-Planchard S. , Tressières C. , Voluménie J.L. , Yassinguezo S. , Janky E. , Fontanet A. 
Published: August 2018

(N Engl J Med 2018;378:985–994)
It is well recognized that Zika virus (ZIKV) infection during pregnancy can cause severe birth defects. Fortunately, the presence of centralized maternal care facilities in French territories in the Americas (French Guiana, Guadeloupe, and Martinique) allowed for enhanced surveillance of all pregnancies during the 2016 ZIKV epidemic. The authors of the present study present pregnancy outcomes in a cohort of women living in these territories who had symptomatic, laboratory-confirmed ZIKV infection during pregnancy (ZIKA-DFA-FE cohort study).
Are Anesthesia and Surgery During Infancy Associated With Decreased White Matter Integrity and Volume during Childhood?
Authors: Block R.I. , Magnotta V.A. , Bayman E.O. , Choi J.Y. , Thomas J.J. , Kimble K.K. 
Published: August 2018

(Anesthesiology. 2017;127(5):788–799)
In the United States, >250,000 infants are exposed to anesthesia each year. While general anesthesia causes functional and histopathologic changes in the central nervous systems (CNS) of late fetal and neonatal animals, it is not clear if these findings apply to humans. This study assessed possible associations of surgery and anesthesia in infants with later brain structure abnormalities in children who have no potential confounding risk factors. They hypothesized anesthesia and surgery may be associated with decreased white and gray matter volumes and and white matter integrity.
Effect of Post-cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial
Authors: Valent A.M. , DeArmond C. , Houston J.M. , Reddy S. , Masters H.R. , Gold A. , Boldt M. , DeFranco E. , Evans A.T. , Warshak C.R. 
Published: August 2018

(JAMA 2017;318(11):1026–1034)
Previous studies estimated 3% to 12% of all cesarean deliveries in the United States are complicated by surgical site infection (SSI). This risk increases as maternal weight increases, and despite preoperative antibiotic regimens, obesity is an independent risk factor for SSI. While standard care has been the use of preoperative cephalosporin antibiotics, other antibiotic combinations have been studied. However, conflicting benefits have been found and none of these studies focused specifically on obese women. In this study, the effects of an additional 48-hour course of postoperative prophylactic oral cephalexin plus metronidazole was compared with the current standard of care (preoperative intravenous cephalosporin alone) in obese women who delivered via cesarean section.
Effects of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-ischemic Encephalopathy
Authors: Laptook A.R. , Shankaran S. , Tyson J.E. , Munoz B. , Bell E.F. , Goldberg R.N. , Parikh N.A. , Ambalavanan N. , Pedroza C. , Pappas A. , Das A. , Chaudhary A.S. , Ehrenkranz R.A. , Hensman A.M. , Van Meurs K.P. , Chalak L.F. , Hamrick S.E.G. , Sokol G.M. , Walsh M.C. , Poindexter B.B. , Faix R.G. , Watterberg K.L. , Frantz I.D. , Guillet R. , Devaskar U. , Truog W.E. , Chock V.Y. , Wyckoff M.H. , McGowan E.C. , Carlton D.P. , Harmon H.M. , Brumbaugh J.E. , Cotten C.M. , Sánchez P.J. , Hibbs A.M. , Higgins R.D. 
Published: August 2018

(JAMA 2017;318(16):1550–1560)
Previous trials have shown therapeutic hypothermia reduces death or disability when infants with hypoxic-ischemic encephalopathy are treated within 6 hours after birth. Getting infants treated in this window can be difficult when transportation is necessary or when encephalopathy is not recognized within 6 hours. This study aimed to determine whether hypothermia treatment can reduce the risk of death or disability due to hypoxic-ischemic encephalopathy at 18 months when treatment is initiated between 6 and 24 hours after birth.
The Analgesic Effect of Ultrasound-guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial
Authors: Krohg A. , Ullensvang K. , Rosseland L.A. , Langesæter E. , Sauter A.R. 
Published: August 2018

(Anesth Analg. 2018;126:559–565)
Ultrasound (US)-guided transversus abdominis plane (TAP) blocks, although widely used for postoperative analgesia in inferior abdominal wall incision surgeries, are known to provide inferior analgesia when compared to neuraxial morphine and other multimodal regimens. A modified quadratus lumborum (QL) block technique, with injection at the posterior border of the QL muscle, may provide better and longer lasting analgesia compared with US-guided anterior TAP blocks. The authors of the present study evaluated the postcesarean analgesic effects of US-guided lateral bilateral QL block with ropivacaine compared with bilateral placebo injections with saline.
Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-blinded, Randomized Controlled Trial
Authors: Munday J. , Osborne S. , Yates P. , Gosden E. 
Published: August 2018

(Anesth Analg. 2018;126:183–189)
In women undergoing cesarean delivery, a cooling of core temperature to below 36°C during surgery and the postoperative phase is associated with detrimental physiological effects and adverse neonatal outcomes. The rates of perioperative hypothermia in this population range from 32% to 80%. Although current guidelines advise 30 minutes of preoperative warming as a prophylactic measure, there have been studies showing that that 15 minutes plus continuation of forced air warming during surgery has efficacy. The authors of the present study compared the effects of a 20-minute preoperative period of forced air warming plus intraoperative intravenous (IV) fluid warming on women receiving intrathecal morphine during elective cesarean delivery to that of women receiving IV fluid warming alone.
Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function
Authors: Murphy Glenn S. , Szokol Joseph W. , Avram Michael J. , Greenberg Steven B. , Shear Torin D. , Deshur Mark , Benson Jessica , Newmark Rebecca L. , Maher Colleen E. 
Published: August 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade.

Methods
Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOF-Watch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland–Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved).

Results
Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and −0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and −0.097 to 0.126, respectively.

Conclusions
Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.
Neonatal Morbidity in the Offspring of Obese Women Without Hypertension or Diabetes
Authors: Polnaszek Brock E. , Raghuraman Nandini , Lopez Julia D. , Frolova Antonina L. , Wesevich Victoria , Tuuli Methodius G. , Cahill Alison G. 
Published: August 2018

OBJECTIVE:
To compare the independent risk of neonatal morbidity between the offspring of obese and nonobese women without hypertension or diabetes.

METHODS:
This is a secondary analysis of a prospective single-center cohort study of singleton deliveries at or beyond 37 weeks of gestation from 2010 to 2014. Women with diabetes (pregestational or gestational) and hypertensive disorders were excluded. The primary outcomes were 1) a composite neonatal morbidity including death, mechanical ventilation, respiratory distress, meconium aspiration, suspected sepsis, confirmed sepsis, hypoxic–ischemic encephalopathy, therapeutic hypothermia, or seizures; and 2) a composite of neonatal neurologic morbidity including hypoxic–ischemic encephalopathy, therapeutic hypothermia, or seizures. The primary outcomes were compared between the offspring of obese (body mass index 30 or greater) and nonobese women. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression.

RESULTS:
Of 6,458 women without diabetes or hypertensive disorders, 3,311 (51%) were obese. After adjusting for race, neonates of obese patients were at significantly increased risk for the composite neonatal morbidity (9.2% vs 7.2%, adjusted OR 1.39, 95% CI 1.15–1.67) and neurologic neonatal morbidity (0.7% vs 0.3%, adjusted OR 2.84, 95% CI 1.22–6.65). Specifically, neonates of obese patients were more likely to have hypoxic–ischemic encephalopathy (0.5% vs 0.2%, adjusted OR 2.80, 95% CI 1.02–7.68), hypothermia treatment (0.6% vs 0.2%, adjusted OR 2.92 95% CI 1.17–7.30), and suspected sepsis (7.6% vs 5.8%, adjusted OR 1.45, 95% CI 1.18–1.79).

CONCLUSION:
In patients who labor, maternal obesity is an independent risk factor for significant neonatal morbidity, even in the absence of hypertensive disorders or diabetes.
Clinical Assessment of Functional Hearing Deficits: Speech-in-Noise Performance
Authors: Phatak Sandeep A. , Brungart Douglas S. , Zion Danielle J. , Grant Ken W. 
Published: August 2018

Objective:
The clinical evaluation of hearing loss, using a pure-tone audiogram, is not adequate to assess the functional hearing capabilities (or handicap) of a patient, especially the speech-in-noise communication difficulties. The primary objective of this study was to measure the effect of elevated hearing thresholds on the recognition performance in various functional speech-in-noise tests that cover acoustic scenes of different complexities and to identify the subset of tests that (a) were sensitive to individual differences in hearing thresholds and (b) provide complementary information to the audiogram. A secondary goal was to compare the performance on this test battery with the self-assessed performance level of functional hearing abilities.

Design:
In this study, speech-in-noise performance of normal-hearing listeners and listeners with hearing loss (audiometric configuration ranging from near-normal hearing to moderate-severe hearing loss) was measured on a battery of 12 different tests designed to evaluate speech recognition in a variety of speech and masker conditions, and listening tasks. The listening conditions were designed to measure the ability to localize and monitor multiple speakers or to take advantage of masker modulation, spatial separation between the target and the masker, and a restricted vocabulary.

Results:
Listeners with hearing loss had significantly worse performance than the normal-hearing control group when speech was presented in the presence of a multitalker babble or in the presence of a single competing talker. In particular, the ability to take advantage of modulation benefit and spatial release from masking was significantly affected even with a mild audiometric loss. Elevated thresholds did not have a significant effect on the performance in the spatial awareness task. A composite score of all 12 tests was considered as a global metric of the overall speech-in-noise performance. Perceived hearing difficulties of subjects were better correlated with the composite score than with the performance on a standardized clinical speech-in-noise test. Regression analysis showed that scores from a subset of these tests, which could potentially take less than 10 min to administer, when combined with the better-ear pure-tone average and the subject’s age, accounted for as much as 93.2% of the variance in the composite score.

Conclusions:
A test that measures speech recognition in the presence of a spatially separated competing talker would be useful in measuring suprathreshold speech-in-noise deficits that cannot be readily predicted from standard audiometric evaluation. Including such a test can likely reduce the gap between patient complaints and their clinical evaluation.
Service Preferences of Parents of Children With Mild Bilateral or Unilateral Hearing Loss: A Conjoint Analysis Study
Authors: Fitzpatrick Elizabeth M. , Coyle Doug , Gaboury Isabelle , Durieux-Smith Andrée , Whittingham JoAnne , Grandpierre Viviane , Na Eunjung , Salamatmanesh Mina 
Published: August 2018

Objective:
Universal newborn hearing screening results in substantially more children with mild bilateral and unilateral hearing loss identified in the early years of life. While intervention services for children with moderate loss and greater are generally well-established, considerable uncertainty and variation surrounds the need for intervention services for children with milder losses. This study was undertaken with parents of young children with permanent mild bilateral and unilateral hearing loss to examine their preferences for characteristics associated with intervention services.

Design:
Conjoint analysis, a preference-based technique, was employed to study parents’ strength of preferences. Using a cross-sectional survey that consisted of eight hypothetical clinic scenarios, we invited parents to make a discrete choice (to select one of two or more different services) between available services with different characteristics. The survey was informed by qualitative interviews conducted for this purpose. The questionnaire was administered to parents receiving intervention services in the province of Ontario, Canada, who were enrolled in a mixed-methods longitudinal study examining outcomes in early-identified children with mild bilateral/unilateral hearing loss. Data were analyzed using a generalized linear model (probit link) to identify attributes of interest for the respondents. Characteristics of the children were entered into the model to control for differences in age of diagnosis, sex, laterality of hearing loss, and hearing aid use.

Results:
A total of 51 of 62 invited parents completed the questionnaire. All four attributes of care that were included in the survey were found to be statistically significant, that is, parents valued support for amplification, support for speech-language development, emotional support, and communication from professionals. Analysis showed greater preference for enhanced levels relating to support for speech-language development than for support for amplification. Preference for attributes relating to emotional support and communication were also greater than for support for amplification use.

Conclusions:
Conjoint analysis was used to quantify parents’ preferences for service attributes. Parents’ values provide insights into the aspects of a service model that should receive consideration in the development of intervention programs for young children with mild bilateral or unilateral hearing loss and their families. Although parents of young children with mild bilateral or unilateral hearing loss valued several components of care, they indicated a clear preference for speech-language support compared with support for amplification use.
Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes
Authors: Fishman Felicity G. , Barber Jarrad , Lourie Gary M. , Peljovich Allan E. 
Published: August 2018

Background:
Triangular fibrocartilage complex (TFCC) tears have been treated with increasing frequency in pediatric and adolescent patients over the past decade. There is little information on these injuries in young athletes and a scarcity of data regarding their ability to return to preinjury levels of athletic participation. The purpose of this study was to review the outcomes of pediatric and adolescent athletes with operatively treated TFCC tears with or without a concurrent ulnar shortening osteotomy and to determine their ability to return to their preoperative level of activity.

Methods:
A retrospective chart review was performed for all patients who underwent operative treatment of TFCC tears between 2006 and 2012 within one Upper Extremity practice. Patients were included if they were high-level athletes, unable to participate in their sport secondary to wrist pain and desired to return to their sport. All operative patients had imaging studies and clinical findings consistent with TFCC injury as the primary source of their activity-limiting pain and had failed nonoperative management prior to surgery. Patients without at least 3 months of documented postoperative follow up were excluded.

Results:
In total, 22 patients were included in the chart review with 20 patients willing to participate in a telephone survey and PODCI. Eighty percent of patients returned to their sport following operative treatment of their injury at an average of 4.8 months. Seven of the 22 patients underwent a concurrent ulnar shortening osteotomy for ulnar positive variance. All 20 patients reported satisfaction with the outcomes of their surgery and treatment.

Conclusions:
Operative treatment of TFCC injuries in adolescent and pediatric athletes after failure of conservative treatment allowed return to sport at the previous level of participation. Concurrent ulnar shortening osteotomy in the setting of ulnar positive variance did not prohibit return to high-level athletic participation.

Level of Evidence:
Level IV.
Youth Baseball Coach Awareness of Pitch Count Guidelines and Overuse Throwing Injuries Remains Deficient
Authors: Knapik Derrick M. , Continenza Sara M. , Hoffman Kyle , Gilmore Allison 
Published: August 2018

Background:
Baseball is one of the most popular youth sporting activities. Youth pitchers remain at high risk for shoulder and elbow overuse injuries despite well-established recommendations on pitch count limits. The purpose of this investigation was to conduct surveys of youth baseball coaches evaluating the current state of understanding and compliance with youth pitch count guidelines and risk factors for overuse injuries.

Methods:
A total of 82 youth baseball coaches in surrounding suburban areas outside 2 separate Midwestern metropolitan cities were asked to answer an anonymous 13-question survey. Survey questions solicited demographic information of youth athletes coached, while assessing for incidence, knowledge of, and compliance with established recommendations on pitch count limits and upper extremity overuse injuries in youth pitchers.

Results:
In total, 61 of 82 (74%) coaches returned surveys. The majority of coaches reported coaching male athletes (89%, n=54) primarily between the ages of 11 to 12 years (51%, n=31). A total of 56% (n=34) of coaches reported “always” keeping track of pitch counts; however, 92% (n=56) reporting not keeping track of pitches based on established recommendations by the American Sports Medicine Institute, whereas 56% were noncompliant with age appropriate pitch count recommendations as established by the 2006 US Baseball Medical and Safety Advisory Committee. Only 13% (n=8) of coaches were able to correctly identify risk factors for overuse injuries while acknowledging the necessity of off-season strengthening. Thirty-eight percent (n=23) of coaches reported sitting out an athlete because of overuse injury, with the highest rates found in those coaching the youngest (≤8 and younger) and oldest (≥17 and older) age groups. Meanwhile, 15% (n=9) of coaches were noncompliant with age-based recommendations against throwing breaking pitches.

Conclusions:
Knowledge regarding pitch count guidelines established to prevent overuse injuries to the shoulder and elbow in youth pitchers remains deficient in the cohort of coaches surveyed.

Level of Evidence:
Level IV—Case Series.