bluuebunny/crossref_metadata_2025_split huggingface dataset:
The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains—phenotypic, genetic and reference genome characterization
Authors: Unemo Magnus , Sánchez-Busó Leonor , Golparian Daniel , Jacobsson Susanne , Shimuta Ken , Lan Pham Thi , Eyre David W , Cole Michelle , Maatouk Ismael , Wi Teodora , Lahra Monica M 
Published: June 2024

Abstract

Objectives
MDR and XDR Neisseria gonorrhoeae strains remain major public health concerns internationally, and quality-assured global gonococcal antimicrobial resistance (AMR) surveillance is imperative. The WHO global Gonococcal Antimicrobial Surveillance Programme (GASP) and WHO Enhanced GASP (EGASP), including metadata and WGS, are expanding internationally. We present the phenotypic, genetic and reference genome characteristics of the 2024 WHO gonococcal reference strains (n = 15) for quality assurance worldwide. All superseded WHO gonococcal reference strains (n = 14) were identically characterized.

Material and Methods
The 2024 WHO reference strains include 11 of the 2016 WHO reference strains, which were further characterized, and four novel strains. The superseded WHO reference strains include 11 WHO reference strains previously unpublished. All strains were characterized phenotypically and genomically (single-molecule PacBio or Oxford Nanopore and Illumina sequencing).

Results
The 2024 WHO reference strains represent all available susceptible and resistant phenotypes and genotypes for antimicrobials currently and previously used (n = 22), or considered for future use (n = 3) in gonorrhoea treatment. The novel WHO strains include internationally spreading ceftriaxone resistance, ceftriaxone resistance due to new penA mutations, ceftriaxone plus high-level azithromycin resistance and azithromycin resistance due to mosaic MtrRCDE efflux pump. AMR, serogroup, prolyliminopeptidase, genetic AMR determinants, plasmid types, molecular epidemiological types and reference genome characteristics are presented for all strains.

Conclusions
The 2024 WHO gonococcal reference strains are recommended for internal and external quality assurance in laboratory examinations, especially in the WHO GASP, EGASP and other GASPs, but also in phenotypic and molecular diagnostics, AMR prediction, pharmacodynamics, epidemiology, research and as complete reference genomes in WGS analysis.
Mechanical and structural properties of articular cartilage and subchondral bone in human osteoarthritic knees
Authors: Hu Yizhong Jenny , Yu Y Eric , Cooper Herbert J , Shah Roshan P , Geller Jeffrey A , Lu X Lucas , Shane Elizabeth , Bathon Joan , Lane Nancy E , Guo X Edward 
Published: June 2024

AbstractKnee osteoarthritis (OA), characterized by multiple joint tissue degenerations, remains a significant clinical challenge. Recent evidence suggests that crosstalk within the osteochondral unit may drive OA progression. Although structural-biomechanical properties of bone and cartilage have been studied, potential interaction within the osteochondral unit in the context of OA has yet to be investigated. We performed comprehensive structural and biomechanical quantification of the cartilage, subchondral bone plate (SBP), and subchondral trabecular bone (STB) using 101 osteochondral cores collected from tibial plateaus of 12 control human cadavers (CT, 5 male/7 female) and 19 patients undergoing total knee replacement (OA, 6 male/13 female). For each sample, we quantified SBP microstructure, plate-and-rod morphological properties of the STB using individual trabecula segmentation, and morphological and compositional properties of the articular cartilage. We also performed indentation testing on each compartment of the osteochondral unit to extract the respective structural-mechanical properties. Cartilage thickness was lower in moderate and severe OA regions, while Osteoarthritis Research Society International score was higher only in severe OA regions. GAG content did not change in any OA region. Aggregate and shear moduli were lower only in severe OA regions, while permeability was lower only in moderate OA regions. In the SBP, thickness and tissue mineral density were higher in moderate and severe OA regions. Tissue modulus of STB was lower in moderate OA regions despite a thicker and more mineralized SBP; this deterioration was not observed in severe OA regions. Regression analysis revealed strong correlations between cartilage and STB properties in CT; these correlations were also found in moderate OA regions but were not observed in severe OA regions. In summary, our findings comprehensively characterize the human OA osteochondral unit. Importantly, uncoupling cartilage and subchondral bone structural-mechanical properties may be a hallmark of OA.
(034) EDI QUALITY IMPROVEMENT IN REPRODUCTIVE MEDICAL EDUCATION: A WORKED MODEL
Authors: Bailey K , Kostov S 
Published: June 2024

Abstract

Introduction
Countless patients face challenges obtaining holistic generalist care and experience health disparities related to race/ethnicity and social structural determinants of health (SSDOH). Revisions to medical curriculum are necessary to ensure that graduates can competently provide care that is socially accountable and aligns with the needs of patients. Evidence supports the inclusion of generalist and equity, diversity and inclusion (EDI) content in curriculum to foster such competency. However, a 2022 study conducted at our medical school revealed a lack of generalism and EDI content in the case based learning (CBL) curriculum. An evidence-based process for assessing existing CBL curriculum for generalist content exists, but no process for revision has been described. While a process to revise EDI content in CBL curriculum exists, no studies to date have focused on reproductive medicine and urology content and the unique challenges associated with this area of medicine, such as the additional impact of stigma, trauma and discrimination related to pregnancy-related choice, sexual orientation or gender diversity.

Objective
To enhance generalist and EDI content within the Reproductive Medicine and Urology Course (RMUC) CBL curriculum. Further, to develop a worked model for enhancing generalist and EDI content in an existing CBL reproductive medicine and urology curriculum. Lastly, to provide medical graduates with the tools to provide care that is socially accountable and aligns with the current needs of patients.

Methods
We evaluated and revised five CBL cases in our medical school’s RMUC curriculum. We employed the Toronto Generalism Assessment Tool (T-GAT) to assess generalism, and adapted guidelines from Krishnan et al. to assess and implement the necessary changes related to EDI. Upon completion, we re-evaluated the RMUC CBL curriculum to ensure the incorporation of generalism and EDI content. We also used existing revision processes described by Bruner et al. to guide our overall approach.

Results
RMUC CBL cases were modified and our methods documented. Through this process, several challenges were identified and include difficulties with: (1) obtaining images due to lack of commercially available content that includes members of equity-deserving groups, (2) the time needed to appropriately incorporate SDOH already present in the cases, and (3) detecting content that was subtly paternalistic or missing a trauma-informed approach.

Conclusions
Generalism and EDI were lacking within the RMUC curriculum. Development of a worked model, accompanied by reflections on navigating encounters challenges, is underway. This will serve as a guide to others wishing to incorporate generalism and EDI into their reproductive medicine education programs.

Disclosure
No.
(049) HOW MUCH OF THE GENITAL AREA CAN WOMEN ACTUALLY SEE DIRECTLY WITH THEIR OWN EYES? AN ASSESSMENT OF GENITAL VISUAL FIELDS IMPORTANT FOR CIS-GENDER AND TRANS-GENDER WOMEN
Authors: Sandhu S , Smith S , Mallavarapu S , Stelmar J , Yuan N , Garcia M 
Published: June 2024

Abstract

Introduction
Many urologic surgeries and urologic conditions that urologists manage (e.g. STD’s, genital pain and injury, wound care) involve the genital area. Throughout the process of urologic care, urologists depend on patients to be able to assess the appearance of their genital area so that they can alert their urologist of worrisome changes. Urologists assume that patients can see their genital areas clearly. However, there is no literature to date that assesses how reliable this assumption is. That is, to date, we do not know how much of the genital area is commonly visible to people with female genital anatomy.

Objective
In the present work, we ask adult women to indicate how far posteriorly in their genital area they can see. We also query whether patient age and BMI predict visibility in genital sub-fields.

Methods
A total of 82 cis-gender and 12 transgender women participated in our study. No subjects had visual or ambulation deficits. Each was shown an anatomic illustration with genital anatomy subdivided into various subfields (anterior to posterior). Subjects were asked to circle each field that they are able to see with their own eyes, on their body, without the aid of a camera or mirror. Age, height, and weight were recorded. Logistic regression was performed for visibility by age and BMI.

Results
Average visibility decreased the more posteriorly the visual field was located. Visibility decreased precipitously for all fields posterior to the clitoris. For cis-gender women, 44-91% could not see their vulva below their clitoris (i.e. peri-urethral area, vaginal introitus, majority of their Labia, and anus. These results were more extreme for transgender women who have undergone vaginoplasty surgery. Interestingly, BMI was not a significant predictor of field-visibility.

Conclusions
Visibility of the genital areas posterior to the clitoris is limited among cis and transgender women. Visibility decreases the more posterior a visual field is, and elevated BMI significantly reduces genital visibility. Providers should bear in mind that many women cannot directly see a significant portion of their genital area. This is especially important during monitoring after genital area surgery, and may other urologic, primary, and gynecologic care conditions. This is the first study to describe how much of the genital area is directly visible to patients.

Disclosure
No.
(058) HAVING SEX OUT OF A SENSE OF DUTY: THE INFLUENCE OF NONCONSENSUAL SEXUAL EXPERIENCES AND SEXUAL FUNCTIONING
Authors: Metcalfe K , Kilimnik C , Meston C 
Published: June 2024

Abstract

Introduction
Pleasure and emotional bonding are two motives for why women have sex that are commonly discussed in the literature. Less commonly reported, but frequently endorsed by women, is the motive “duty sex,” in which an individual engages in sex out of a sense of obligation to maintain a relationship or their partner’s feelings towards them, to ensure their partner will not leave them, or to avoid conflict. Engaging in duty sex can yield negative outcomes such as emotional discomfort and lower relationship satisfaction, although there have been some reports of positive outcomes, including feelings of closeness (O’Sullivan & Allgeier, 1998). Women with a history of nonconsensual sexual experiences (NSEs) show high rates of sexual dysfunction (Pulverman et al., 2018), and sexual dysfunction in women has been linked to a higher tendency to engage in duty sex (Meston & Stanton, 2017).

Objective
This study aimed to investigate the potential connections between sexual dysfunction and the frequency of duty sex in women with NSE histories.

Methods
Women (N = 820; mean age = 35.36, SD = 11.32) completed the Nonconsensual Sexual Experiences Inventory (NSEI; Kilimnik & Meston, 2017), the Female Sexual Function Index (FSFI; Rosen et al., 2000), items indicative of duty sex from the Sexual Motivations Scale (Cooper et al., 1998), as well as other measures not reported here.

Results
Women were categorized as either having NSE history (n = 465) or not (n = 355) based on the NSEI. FSFI total scores predicted duty sex such that women with lower sexual functioning reported engaging in more duty sex, R2 = .18, F(1, 654) = 147.30, p &lt; .01, and higher levels of duty sex predicted lower sexual satisfaction, R2 = .057, F(1, 807) = 50.13, p &lt; .01. Results from a multiple linear regression revealed that NSE history significantly predicted engagement in duty sex after controlling for sexual function, R2 = .19, F(2, 653) = 77.06, p &lt; .01.

Conclusions
The results suggest that women with NSE histories endorse a higher frequency of duty sex motives compared to women without NSE histories that cannot be explained by variability in sexual functioning. That is, women with NSE histories were more likely to engage in sex out of fear that their partner would love them less, be angry with them, or leave them if they refused to engage in sex, and this effect was over and above the relationship of these motives with sexual dysfunction. As engaging in these duty sex motives was linked to overall sexual dissatisfaction, future research that examines the cognitive mechanisms by which having a history of NSE leads women to feel obligated to have sex out of a sense of duty would help enhance the sex lives of women with NSE histories.

Disclosure
No.
(064) DIFFERENCES IN EROGENOUS SENSATION AND SEXUAL SATISFACTION BETWEEN PRE- VERSUS POSTMENOPAUSAL CISGENDER WOMEN
Authors: Stelmar J , Zaliznyak M , Isaacson D , Duralde E , Gaither T , Topp K , Garcia M 
Published: June 2024

Abstract

Introduction
Menopause has been associated with a myriad of genitourinary and sexual function symptoms that revolve around changes to the vulva and vagina. The medical literature at present primarily assesses genitourinary syndromes of menopause, with limited focus on how these physiological changes to the vulva and vagina may impact sexual function and satisfaction.

Objective
To describe differences that exist between pre- versus postmenopausal women in erogenous sensation zone (ESZ) maps of the vulva and measured satisfaction with partnered sex.

Methods
Sexually active cisgender women were recruited via Qualtrics and completed an anonymous, online questionnaire. Respondents viewed anatomic illustrations of the vulva with nine predefined areas and were instructed to select structures that bring them pleasure when touched during sex with a partner. A map of erogenous sensation of the vulva was then created based on the number of respondents selecting each structure. Respondents also completed the New Sexual Satisfaction Scale (NSSS), a 20-item psychometric survey that assesses sexual satisfaction with partnered sex on a 5-point Likert scale, with potential scores ranging from 20 (minimal sexual satisfaction) to 100 (maximum sexual satisfaction).

Results
Pre- and postmenopausal women were equally as likely to select at least one ESZ of the vulva (77% premenopausal women vs 81% postmenopausal women, p=0.4). The vaginal introitus, peri urethra, and clitoris were the three most frequently selected structures out of the nine ESZs of the vulva out of all respondents (Figure 1). Assessment for differences in selection between pre- and postmenopausal women for each structure revealed that significantly more premenopausal women selected the clitoris as erogenous (43% vs 32%, p&lt;0.03). There was no statistically significant difference in the other vulvar ESZs. With respect to partnered sexual satisfaction (as measured by the NSSS), there was no statistically significant difference between groups. Premenopausal women reported an average NSSS score of 69 out of 100 and postmenopausal women 67 out of 100 (p=0.3).

Conclusions
While premenopausal women were significantly more likely to report the clitoris as erogenous as compared to postmenopausal women, there was no significant difference between groups in erogenous mapping of the eight other vulvar structures. This finding of reduced clitoral erogeneity is supported by the phenomenon of vulvovaginal atrophy, which is associated with the reduction in estrogen and other sex steroids that occurs during menopause. While menopause has been associated with sexual dysfunction, we found no statistically significant difference in self-reported satisfaction with partnered sexual activities.

Disclosure
No.
(068) VAGINAL ESTROGEN PRESCRIPTION COVERAGE IN THE MID-ATLANTIC: A CROSS-SECTIONAL STUDY
Authors: Clarke B , Vallabhaneni S , Gaddam N , Davenport A 
Published: June 2024

Abstract

Introduction
Vaginal estrogen is an essential medication for many post-menopausal women. However, cost can be prohibitive for patients and insurance coverage can be difficult to predict.

Objective
The objective of this study was to describe the insurance coverage of vaginal estrogen formulations in terms of overall coverage score and cost across the Mid-Atlantic for 2024 insurance plans.

Methods
This is a cross-sectional study examining coverage scores, tiers, and cost of vaginal estrogen formulations (generic estradiol cream and tablets, Premarin, Imvexxy, Femring, Estring, Estrace cream and tablets, Vagifem, Yuvafem) in the mid-Atlantic states (Delaware, District of Columbia, Maryland, New York, New Jersey, Pennsylvania, Virginia, and West Virginia). Census data was used to identify the most populous three districts in each state. All insurance plans for the top ten insurers in each district were then reviewed for the tier and cost of vaginal estrogen formulations. A weighted coverage score ranging from 0.2 to 1.0 was then adopted based on the proportion of tier coverage for each formulation, with lower tiers (and thus better prescription coverage) conferring a greater weight in the calculation of the score. Analyses were performed using STATA. Fisher’s exact test and chi-squared tests were used where appropriate. Medians were used as the distribution of cost was non-parametric. Multivariate regression including formulation, location, and insurer was also performed.

Results
Three-hundred and forty-two insurance plans were ultimately included in the analysis. The median cost of tier 1 formulations was $0 (IQR $0 to $0) while the median cost of tier 4 formulations was $100 (IQR $36 to $226). Non-formulary medications were much more expensive with a median cost of $413 (IQR $204 to $413). Estradiol tablets overall had the best coverage score of 0.75 compared to Estrace tablets and Vagifem which had coverage scores of 0.2. On initial analysis by high ($150 or greater) or low (&lt;$150) cost formulations, prescriptions from Delaware made up a greater percentage of higher compared to lower cost (14% vs 9%, p&lt;0.001), while formulations from Virginia made up a greater percentage of lower compared higher cost (24% vs 18%, p=0.02). Insurer impacted cost and this persisted on regression analysis when controlling for location and tier, with Aetna (aOR 1.18, p=0.048) and Kaiser (aOR 2.9, p&lt;0.001) remaining predictive for higher cost.

Conclusions
High costs of vaginal estrogen may be prohibitive to patients using these medications. Living in Delaware or having Aetna or Kaiser insurance may result in higher costs.

Disclosure
No.
(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP
Authors: Mannion S , Cyriac J , Nordhues H 
Published: June 2024

Abstract

Introduction
Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions.

Objective
Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop.

Methods
We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop.

Results
Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice.

Conclusions
This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs.

Disclosure
No.
(087) SMALL FIBER NEUROPATHY AND FEMALE SEXUAL FUNCTION
Authors: Pollard J , De E , Walia J , Feustel P , Patel S 
Published: June 2024

Abstract

Introduction
Small fiber neuropathy (SFN) can result in a variety of pain and autonomic symptoms due to its impact on small-diameter somatic and autonomic unmyelinated C-fibers and/or thinly myelinated A-delta (Aδ) fibers. It has been identified in 66% of patients with complex (refractory or multisystem) pelvic pain.

Objective
The objective of this study was to characterize the differences between sexual symptoms in patients with and without SFN.

Methods
This was a retrospective case control study involving patients seen at a subspecialty Urogynecology and Reconstructive Surgery clinic between January 2023 and October 2023. All patients presenting for evaluation were offered an electronic pre-visit intake form inclusive of the PISQ-IR (evaluation tool validated by the IUGA for sexual dysfunction symptoms). The primary outcome measured was self-reported quality of sexual function, represented by PISQ-IR score. Secondary outcomes included comparisons of survey scores for arousal, orgasm, and dyspareunia between SFN and non-SFN patients.

Results
A total of 89 patients were analyzed, 11 with definitive SFN and 78 without SFN. Results were compared between these two groups using chi-square tests and Mann-Whitney U tests. PISQ-IR scores were significantly different between SFN and non-SFN patients. Mean scores of 2.9 (SD 0.6) and 3.5 (SD 0.6) were calculated, respectively, indicating worse overall sexual function in SFN patients (p = 0.01). Secondary outcomes analyzed were significant for lower orgasm intensity scores in SFN patients (median of 2 vs 3 in non-SFN patients, p = 0.02 Mann-Whitney test). Arousal scores and pain scores were not significantly different between the two patient populations.

Conclusions
SFN is associated with worse sexual function and decreased orgasm intensity in the subspecialty Urogynecology and Reconstructive Surgery population.

Disclosure
No.