bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Monitoring Viral Load and Tracing Patients Lost to Follow-up on the Course of the HIV Epidemic in Malawi: A Mathematical Model
Authors: Estill Janne , Kerr Cliff C , Blaser Nello , Salazar-Vizcaya Luisa , Tenthani Lyson , Wilson David P , Keiser Olivia 
Published: April 2018

Abstract

Background
Antiretroviral therapy (ART) reduces HIV transmission, but treated patients may again become infectious. We used a mathematical model to determine whether ART as prevention is more effective if viral load (VL) is routinely monitored and patients lost to follow-up (LTFU) traced.

Methods
We simulated ART cohorts to parameterize a deterministic transmission model calibrated to Malawi. We investigated the following strategies for improving treatment and retention: monitoring VL every 12 or 24 months, tracing patients LTFU, or a generic strategy leading to uninterrupted treatment. We tested 3 scenarios, where ART scale-up continues at current (Universal ART), reduced (Failed scale-up), or accelerated speed (Test&Treat).

Results
In the Universal ART scenario, between 2017 and 2020 (2050), monitoring VL every 24 months prevented 0.5% (0.9%), monitoring every 12 months prevented 0.8% (1.4%), tracing prevented 0.3% (0.5%), and uninterrupted treatment prevented 5.5% (9.9%) of HIV infections. Failed scale-up resulted in 25% more infections than the Universal ART scenarios, whereas Test&Treat resulted in 7%–8% less.

Conclusions
Test&Treat reduces transmission of HIV, despite individual cases of treatment failure and ART interruption. Whereas viral load monitoring and tracing have only a minor impact on transmission, interventions that aim to minimize treatment interruptions can further increase the preventive effect of ART.
Accuracy of Activity Trackers in Parkinson Disease: Should We Prescribe Them?
Authors: Wendel Nicholas , Macpherson Chelsea E , Webber Karoline , Hendron Kathryn , DeAngelis Tamara , Colon-Semenza Cristina , Ellis Terry 
Published: April 2018

Abstract

Background
Wearable, consumer-grade activity trackers have become widely available as a means of monitoring physical activity in the form of step counts. However, step counts may not be accurate in persons with Parkinson disease (PD) due to atypical gait characteristics.

Objective
This study aimed to investigate the accuracy of 4 consumer-grade activity trackers in individuals with PD while ambulating during continuous and discontinuous walking tasks.

Design
This study used a cross-sectional design.

Methods
Thirty-three persons with PD (Hoehn & Yahr stages 1–3) donned 4 models of activity trackers on the less affected side of their bodies. Participants performed 2 continuous walking tasks (2-minute walk tests at comfortable and fast speeds) and 2 discontinuous walking tasks (a simulated household course and an obstacle negotiation course) in an outpatient setting. Bland-Altman plots and intraclass correlation coefficients [ICC(2,1)] were computed as a measure of agreement between actual steps taken (reference standard: video recording) and steps recorded by each tracker.

Results
The accuracy of the activity trackers varied widely, with ICCs ranging from −0.03 to 0.98. Overall, the most accurate device across all tasks was the Fitbit Zip, and the least accurate was the Jawbone Up Move during the simulated household course. All activity trackers were more accurate for continuous walking tasks compared with discontinuous walking tasks. Waist-mounted devices were more accurate than wrist-mounted devices with continuous tasks. Bland-Altman plots revealed that all activity trackers underestimated step counts.

Limitations
All walking tasks were measured over relatively short distances.

Conclusions
In persons with mild-to-moderate PD, waist-worn activity trackers may be prescribed to monitor bouts of continuous walking with reasonable accuracy; however, activity trackers have little utility in monitoring discontinuous walking common in household settings.
Persistent vs Resolved Intrauterine Growth Restriction: A Retrospective, Cohort Study Assessing Neonatal Outcome [3A]
Authors: Lupea Ilinca , Saeed Haleema , Roberts Robyn 
Published: April 2018

INTRODUCTION:
Intrauterine growth restriction (IUGR) is a common complication of pregnancy that has been shown to be associated with adverse perinatal outcomes. Once the diagnosis is made, antenatal monitoring becomes intensive and can cause parental stress and anxiety. The purpose of this study is to evaluate and compare neonatal outcomes in pregnancies which were diagnosed with IUGR that subsequently resolve in comparison to those with persistent IUGR.

METHODS:
This is a retrospective, cohort of singleton pregnancies complicated by IUGR (EFW < 10th percentile) from 2013 -2017 from Henry Ford Health System in Detroit, MI. There are approximately 1000 new IUGR diagnoses every year at Henry Ford. Neonatal outcomes were compared in pregnancies that IUGR resolved versus those with IUGR persisted throughout the pregnancy.

RESULTS:
The primary neonatal outcomes that will be compared between the two cohorts are: fetal birth weight, fetal APGAR scores (1 and 5 minutes), fetal umbilical cord gases, necrotizing enterocolitis, need for respiratory support, and length of stay in NICU. Secondary outcomes will assess route of delivery and gestational age at delivery. A descriptive analysis of the results obtained will be presented.

CONCLUSION:
Growth restriction has been shown to be a risk factor for adverse perinatal outcomes. Our study aims to analyze if this stands true for those pregnancies that had growth restriction that spontaneously resolved. The results may impact future guidelines in regards to antenatal testing for the pregnancies with spontaneous resolution of the fetal growth restriction.
Gestational Weight Changes in Obese Women: Where Do We Stand? [7A]
Authors: Chavan Niraj R. , McDaniel Honour , Williams Corrine M. 
Published: April 2018

INTRODUCTION:
This study was undertaken to evaluate gestational weight changes among obese women in comparison to the 2009 IOM recommendations for a gestational weight gain (GWG) of 11 – 20 lbs.

METHODS:
Using the 2015 vital statistics (birth) data collected by the National Center for Health Statistics (NCHS) for singleton pregnancies, gestational weight changes were calculated and categorized as GWG of < 11 lbs, 11- 20 lbs (reference group), 21 – 30 lbs, 30 – 40 lbs, > 40lbs and gestational weight loss (GWL) of 0 – 10 lbs, and 11 – 20 lbs for women with class 1, 2 and 3 obesity. Multivariable logistic regression analyses were used to evaluate likelihood of gestational weight changes (GWG/GWL) across obesity classes accounting for age, race/ethnicity, education, marital status, insurance, WIC, prenatal care and smoking status.

RESULTS:
Of 859,996 obese women – 55.28%, 26.54% and 18.18% had class 1, 2 and 3 obesity respectively. Overall – 23.95% obese women achieved recommended GWG of 11 – 20 lbs, with 24.29% having GWG of 21 - 30 lbs and 30.27% having GWG of >30 lbs. While 16.68% obese women had GWG <11 lbs, only 4.79% experienced GWL. Obese women with excess GWG were more likely to be younger (OR = 1.61, 95% CI 1.56 – 1.68), unmarried (OR = 1.43, 95% CI 1.40 – 1.45), and smokers (OR = 1.19, 95% CI 1.16 – 1.22).

CONCLUSION:
Distinct gestational weight changes are seen across the maternal obesity spectrum with several key sociodemographic characteristics associated with excess and inadequate GWG.
Avoiding Hospital Admission for Rupture of Amniotic Membrane (ROM) screening: Role of at Home/Point of Care Testing [8A]
Authors: Bachmann Gloria A. , Lu Chi-Wei , Yeung Percy , Wiita Brinda , Abreu Kenneth 
Published: April 2018

INTRODUCTION:
Rising health care costs are a major focus today. We examined the costs incurred in pregnant women presenting to a perinatal center to rule out rupture of membranes and the potential savings that would have occurred if this condition 1) could have been assessed at home or 2) inexpensively and quickly at the medical center site where they present.

METHODS:
A WIRB approved, retrospective review of medical records was performed in obstetrical patients presenting to rule out spontaneous rupture of membranes, in order to evaluate potential cost savings by screening at home prior to hospital admission. Hospital billing records and medical records were utilized to assess overall costs, including ancillary testing, incurred.

RESULTS:
Preliminary data indicates that 1) 50% of obstetrical patients presenting at a medical center have intact membranes and sent home undelivered and 2) 25% who are negatively screened come to L&D via the emergency department, increasing overall costs. From 214 records analyzed to date, admissions of women without ruptured membranes cost the health care system $359,315.59 dollars, or $1473.45 dollars per hospital encounter.

CONCLUSION:
These preliminary findings confirm data from other countries including England, that home/point of care testing for amniotic fluid leakage with a consumer-friendly diagnostic would be a cost-effective addition to healthcare. In addition to reducing costs by decreasing hospital encounters, this may alert women with ruptured membranes to appropriately visit the hospital for assessment and care and not assume urinary leakage as the cause.
Racial Disparities in Severe Maternal Morbidities Across the Pregnancy Continuum in the United States [17A]
Authors: Liese Kylea L. , Mogos Mulubrhan , Abboud Sarah , DeCocker Karen , Geller Stacie 
Published: April 2018

INTRODUCTION:
This study investigates racial disparities in severe maternal morbidities (SMM) among antepartum (AP), intrapartum (IP) and postpartum (PP) U.S. hospital admissions between 2002 and 2014.

METHODS:
AP, IP and PP hospitalizations were identified in the National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project for 2002-2014. ICD-9 codes indicating severe complications were used to identify hospitalizations with SMM. Individual-level co-morbidities, sociodemographic and behavioral characteristics were extracted from the NIS databases. The distribution of sociodemographic, behavioral, hospital characteristics, insurance, and comorbidities by whether a SMM occurred was summarized using descriptive statistics across the pregnancy continuum. Joinpoint regression was used to examine temporal trends of SMM during the study period by timing of hospitalization and stratified by race. Multivariate logistic regression was used to assess the association between race and SMM.

RESULTS:
Compared to Non-Hispanic White women, Black women hospitalized during the AP period are 70% more likely to experience SMM after adjusting for demographic, behavioral, hospital characteristics, insurance, and comorbidities (aOR = 1.7, 95% CI: [1.6-1.8]). The increased risk among Black women persisted during IP (aOR= 1.4, 95% CI: [1.3-1.5] and PP hospitalizations (aOR = 1.2, 95% CI: [1.1-1.2]. Hispanic women demonstrated comparable SMM risk during AP and slightly higher SMM risk during IP (aOR- 1.2 (1.1-1.3) to Non-Hispanic Whites. Interestingly, they had 20% less risk of SMM during PP hospitalization when compared to Non-Hispanic White women.

CONCLUSION:
Race significantly impacts both the timing and type of SMM a woman may experience, implicating further research on mechanisms and interventions to address disparities.
Outcomes of Robotic vs. Total Abdominal Hysterectomy Stratified by Age Group for Patients with Endometrial Cancer [19A]
Authors: Javadian Pouya , Juusela Alexander , Anderson Patrick 
Published: April 2018

INTRODUCTION:
To compare clinical and pathologic features, surgical morbidity, and outcomes stratified by age in patients with endometrial cancer who underwent Robotic-assisted laparoscopic total hysterectomy (RALTH) vs. Total Abdominal Hysterectomy

METHODS:
All women with surgically treated endometrial cancer at the Newark Beth Israel Medical Center between January 2004 and December 2015 were eligible; 353 patients met criteria and underwent retrospective chart review. Patients were stratified into 3 groups based on age the ranges <45, 46-64 and >65 years. Demographic data, pathologic, surgical treatment and complications were retrospectively reviewed. Statistical analysis was performed by SPSS.

RESULTS:
There were no statistically significant differences regarding operation characteristics and complications in patients with age <45 years. In patients of age between 46-64 years, there was a statistically significant increased estimated blood loss (EBL), median (range), (400 (50-6000) cc vs. 100 (20-7000) cc, p: <0.001) and length of stay (LOS) 4 (1-51) vs. 1.5 (1-41) days, p: <0.001 in the TAH group compared to the RALTH group. Patients who underwent RALTH experienced longer operative time than the TAH group (234.3±81.2 vs. 259.5±68.4, p:0.039). In patients with age >65 years, LOS [7 (2-39) vs. 2 (1-43) days, p<0.001] and intra-operative hemorrhage [14/79 (17.7%) vs. 1/78 (1.2%), p<0.001] were significantly higher in TAH than the RALTH patients.

CONCLUSION:
Older patients with endometrial cancer benefit from the lower rate of postoperative complications with RALTH than TAH. Patients undergoing RALTH benefit from decreased postoperative morbidity.
Effect of Peri-Operative Selective and Nonselective Beta Blocker Use on Survival in Ovarian Cancer Patients [20A]
Authors: Mattappally Nidha , Korets Sharmilee , Hughes Sarah , Zweizig Susan , Bradford Leslie 
Published: April 2018

INTRODUCTION:
Preclinical studies have demonstrated that adrenergic agonists mediate tumor growth and invasiveness in ovarian cancer models via the beta-2 adrenergic receptor. Studies have also investigated the clinical impact of beta blocker use on epithelial ovarian cancer (EOC) survival with conflicting results. We aim to understand the association between peri-operative beta blockade and clinical outcomes in EOC patients.

METHODS:
We conducted an institutional retrospective chart review and examined the effects of beta blocker use on overall survival (OS) and progression free survival (PFS) when looking at peri-operative timing of beta blocker use in EOC.

RESULTS:
In a cox survival model, women who took a selective beta blocker (SBB) in the peri-operative period were four times more likely to die compared to nonusers when looking at OS (adjusted SBB HR 5.82, 95% CI 1.17-28.91, p=0.031). Although there was no difference in PFS between nonselective beta blocker (NSBB) users and nonusers (adjusted NSBB HR 1.88, 95% CI 0.41-8.60, p=0.414), SBB users were four times more likely to have recurrence of disease compared to nonusers (adjusted SBB HR 4.24, 95% CI 1.23-14.55, p=0.022).

CONCLUSION:
Compared to never use, SBB use peri-operatively was associated with poorer OS and ever SBB use was associated with poorer PFS in patients with EOC. This is an area that warrants further investigation as preclinical studies would suggest a potential survival benefit, but reports in the literature are conflicting and our data seem to suggest a potential harm with SBB use.
Impact of a Documentation Intervention on Health-Assessment Metrics on an Inpatient Gynecologic Oncology Service [24A]
Authors: Marquiette Jaclyn , Moss Haley , Truong Tracy , Havrilesky Laura 
Published: April 2018

INTRODUCTION:
Severity of illness (SOI) and risk of mortality (ROM) scores are determined from specific medical diagnoses and procedures during admission; without proper documentation, scores may not accurately reflect patients’ medical complexity. Our quality improvement study aimed to improve the accuracy of SOI and ROM capture within the electronic medical record (EMR) through implementation of documentation initiatives.

METHODS:
Documentation interventions were introduced on an inpatient gynecologic oncology service in January 2017 as follows: educational in-service for faculty and residents; introduction of problem-based assessment/plans in EMR progress notes; distribution of a documentation tip badge to residents and fellows; production of a high-yield documentation tip video. Admission/discharge SOI and ROM (scaled 1 to 4) and admission type/diagnosis were collected from gynecologic oncology inpatients pre-(2015) and post-(2017) intervention. 528 inpatient encounters from 349 unique patients were queried. A one-sided Wilcoxon rank sum test queried the hypothesis that SOI and ROM scores were higher post- compared to pre-intervention.

RESULTS:
Among 349 included patients, 254 (72.8%) were admitted in 2015 and 95 (27.2%) in 2017. Median admission and discharge SOIs each increased from 2 to 3 after intervention; P=0.002 and P=0.002, respectively. Median admission and discharge ROMs each remained at 2 but with improvement in the IQR following intervention; P=0.005 and P=0.02, respectively. Stratified by admission type, a significant increase was observed in scores for surgical, but not medical, admissions.

CONCLUSION:
A robust educational intervention to improve physician coding accuracy resulted in higher SOI and ROM scores for surgical admissions.
Is There a Synthetic Lethality Between FANCM-U and SMARCAL1? [27A]
Authors: Sabet Liliya , Zhang Dong 
Published: April 2018

INTRODUCTION:
Our oncology lab recent results showed that there is a strong synthetic lethal interaction between BRCA1 and FANCM. We observed a similar synthetic lethal interaction between BLM, a DNA helicase, and FANCM, albeit somewhat weaker than that of BRCA1 and FANCM. Furthermore we showed that BRCA1 recruits BLM to the replication stress sites induced by the depletion of FANCM. Our data suggest that a FANCM inhibitor may be used to potentially kill cancers with BRCA1 mutations. Most recently another DNA helicase, SMARCAL1, was shown to resolve replication stress.

METHODS:
We proposed to test whether there is a synthetic lethal interaction between SMARCAL1 and FANCM-U by performing a Crystal Violet Cell Viability Assay. We transfected U2-OS, a human osteosarcoma cell line, with siRNA targeting Luciferase (serves as the negative control siRNA), FANCM-U, SMARCAL1, and both FANCM-U and SMARCAL1. Then we seeded 4,000 cells per well on a 12-well plate. 7 to 10 days later we stained the cells with Crystal Violet, a blue dye, to visualize viable cells. Finally we quantitated the amount of viable cells with a spectrometer. We repeated the Crystal Violet Cell Viability Assay three times to obtain a reproducible result.

RESULTS:
Based on spectrometer results the amount of viable cells or intensity of light detected in the control and FANCM-U and SMARCAL1 wells were similar.

CONCLUSION:
This study did not show synthetic lethal interaction between FANCM-U and SMARCAL1. Further research is ongoing to support or oppose our hypothesis.
High Risk Anal and Cervical HPV Infections Among Sexual Minority Women [28A]
Authors: Forner Elizabeth , Combs Shanna , Felini Martha 
Published: April 2018

INTRODUCTION:
To examine anal and cervical high-risk HPV (hr-HPV) infections among women having sex with women, and women having sex with men and women.

METHODS:
We conducted a cross-sectional study of women ages 18-70 in treatment at the largest substance use disorders center in North Texas who participated in a cancer prevention program providing well woman exams. Demographics, past trauma, sexual practices, and risky behaviors were collected using self-administered questionnaires. Chi-square tests and logistic regression controlling for age (AOR) were used to compare hr-HPV infection prevalence rates by sexual minority status.

RESULTS:
A total of 757 women with histories of trauma were included in this study; 84% were smokers, 53% self-reported previous incarceration and 25% traded sex for drugs. Nearly one-quarter reported having oral, vaginal, or anal sex with women only, or with men and women. Among this sexual minority group, 40% tested positive for anal hr-HPV vs 34% of heterosexual women (P=.18). Cervical hr-HPV was present in 31% of sexual minority women and 27% of heterosexual women (P=.20). Sexual minority status was not significantly associated with anal hr-HPV (AOR 1.23 95% CI .85-1.77) or cervical hr-HPV (AOR 1.09 95% CI .76-1.55) compared to heterosexual women. Cervical hr-HPV was significantly associated with anal hr-HPV among both groups (P<.01). Nearly 20% of sexual minority women tested positive for both anal and cervical hr-HPV.

CONCLUSION:
These findings inform providers about HPV infections among sexual minority women, and the appropriateness of anal pap and HPV co-testing exams in this population.
Pathogenic Variants Identified in Women with Epithelial Ovarian Cancer Diagnosed Before Age 31 [35A]
Authors: Marshall Megan , Carter Natalie J. , Murphy Patricia D. , Fagbemi Adebanke , Klein Rachel T. , Hruska Kathleen S. 
Published: April 2018

INTRODUCTION:
Ten to 18% of ovarian cancer (OC) can be attributed to a hereditary predisposition. The frequency of pathogenic variants (PVs) among women with epithelial ovarian cancer (EOC) diagnosed at an early age has not been well-described. We present the yield of PVs in women with EOC diagnosed ≤30 years (y) who have undergone genetic testing at a commercial laboratory.

METHODS:
Results for women with OC submitted for multi-gene hereditary cancer panel testing of at least ATM, BRCA1/2, BRIP1, CHEK2, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, RAD51C, and RAD51D were reviewed. Yields were compared using two-tailed Fisher exact test.

RESULTS:
One hundred fifty-three women with OC were diagnosed ≤30y, and 65 (42%) had EOC. Family history of OC was reported for 35 women (26.9%). Five PVs, in BRIP1, CHEK2 (3) and PALB2, were identified in the women with EOC for a positive yield of 7.7%, which is similar to the yield in all women with OC diagnosed ≤30y regardless of histopathologic subtype (5.9%, 9/153, P=.77; ATM, BRIP1, CHEK2 (6), PALB2). The yield of PVs in women with OC diagnosed >30y was significantly higher than either yield in the early-onset group (14.7%, 546/3,704, P<.0013).

CONCLUSION:
Women with early-onset OC were less likely to have a PV than those diagnosed >30y, though the detected yield was still appreciable. No PVs were identified in BRCA1/2 or the Lynch syndrome genes, highlighting the utility of panel testing and including genes beyond BRCA1/2 for women with OC regardless of age and histopathology.