bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Emotional Distress on Sleep Physiology in Underserved Pregnant Women [ID: 1381497]
Authors: Guo Yuqing , Jimah Tamara , Narvaez Laura 
Published: May 2023

INTRODUCTION:
Pregnancy is characterized by an altered pattern of emotions and sleep. The aim of this study was to examine the effect of emotional distress on objective sleep parameters in underserved pregnant women during the COVID-19 pandemic.

METHODS:
Institutional review board approval was obtained for the study. This was a longitudinal observation study in which we administered weekly validated self-reported surveys (Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, COVID-19-related anxiety, and life-related stressors) to consented pregnant women over the course of their second and third trimesters (n=13). The independent variable, subjective emotional distress, was derived from a sum score of these weekly surveys. A wearable device was used to measure objective sleep physiological data, such as the rapid eye movement (REM), deep, and light sleep stages. The dependent variables were obtained from weekly average scores of the sleep data. Multilevel analysis was conducted, controlling for relevant covariates.

RESULTS:
Adjusting for gestational age, maternal age at enrollment, and prepregnancy body mass index, higher emotional distress was associated with a shorter duration of deep sleep (b=−.65, P<.05) and longer duration of REM sleep (b=.79, P<.01). There was no significant relationship between emotional distress and light sleep.

CONCLUSION:
Our study appears to be the first to provide preliminary evidence that emotional distress negatively affects sleep in terms of decreased deep sleep and increased REM sleep during pregnancy. Findings suggest that further research is needed to understand the role of sleep in the relationships between emotional distress and adverse maternal and infant health outcomes.
Elagolix Plus Add-Back Consistently Improves Uterine Fibroids-Associated Bleeding and Nonbleeding Symptoms Across Subpopulations [ID: 1368059]
Authors: Simon James , Jewell Susan , Li Moming , Ng Juki , Pinsky Brett 
Published: May 2023

INTRODUCTION:
Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited.

METHODS:
This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7).

RESULTS:
By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months.

CONCLUSION:
ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.
Novel Method for Management of Bothersome Bleeding Associated With Etonogestrel Drug Implant [ID: 1380127]
Authors: Gray Jordan , Bates G. Wright , Carlson Alexandra , Stacey Joanna 
Published: May 2023

INTRODUCTION:
Nexplanon (etonogestrel drug implant [EDI]) is an effective, implantable subdermal contraceptive that releases progestin over 3 years for suppression of ovulation and thickening of cervical mucus. A significant portion of EDI patients will remove their device prematurely because of bothersome episodes of frequent/prolonged bleeding. In patients with abnormal uterine bleeding, induction of a withdrawal bleed, with the goal of reducing excessive bleeding, is a common approach. There is no standard approach to treating prolonged and/or excessive bleeding with EDI in place.

METHODS:
This is a randomized double-blinded placebo-controlled trial of 51 patients desiring EDI for contraception. Patients received norethindrone (NTA) 5 mg or placebo daily for 1 week every 4 weeks for a total of 6 months.

RESULTS:
No patients in the treatment arm requested removal because of bothersome bleeding as defined by International Federation of Gynecology and Obstetrics/World Health Organization criteria. In contrast, 24% of the placebo group participants requested removal of the device at or before 6 months from placement for a variety of reasons including bothersome bleeding. 9% from the treatment group requested early removal; however, none for bothersome bleeding. 80% of the treatment group participants had a satisfactory bleeding pattern. One participant in the treatment arm complained of unsatisfactory amenorrhea.

CONCLUSION:
We propose a novel method to manage bothersome bleeding associated with EDI. Our data suggest that cyclic NTA is an effective method to treat bothersome bleeding in patients using etonogestrel implants for contraception and warrants further study.
Self-Assessment and Modulation of Applied Force During Shoulder Dystocia Simulation Training [ID: 1376207]
Authors: Islam Rushnan , Allen Robert , Allen Edith Gurewitsch , Sant'Anna Marinho Caio 
Published: May 2023

INTRODUCTION:
Diagnosis of shoulder dystocia (SD) relies on clinicians' subjective assessment of the need to apply “more-than-usual” traction. We sought to determine whether providers' diagnostic traction (DT) for SD in a simulated setting is modifiable by force training.

METHODS:
As part of an IRB-approved study, we tethered a fetal mannequin with embedded force sensors to a simulated pelvis such that it would not deliver. We asked participants to apply their DT for SD, and then stop. We then asked them to apply their own estimate of 20 lb of traction, which is below the published 22-lb threshold for brachial plexus injury. Blinded from participants' view, we recorded the actual force applied at each attempt and asked each participant to estimate in pounds the DT they perceived to have applied. We then revealed actual force applied and allowed participants to practice with actual force measurements in view; this was followed by another blinded sequence of traction applications and estimations. Differences between actual and estimated DT pretraining and posttraining, were compared using t test, with significance at P less than .05.

RESULTS:
The mean DT among 103 participants decreased from 15.3 to 12.3 lb posttraining (P<.0001). Pretraining, participants underestimated their own applied traction by an average of 30% (9.3±5.2 versus 15.3±7.9 lb, P<.001); accuracy of self-assessment improved to 100% post-training (12.1±5.5 versus 12.3±5.0 lb, P=.66).

CONCLUSION:
With force training, accuracy of self-assessment of DT improves significantly; and applied force to diagnose SD decreases significantly below injury threshold.
Effects of Abstinence From Opioid on Neuropsychological Performance in Men With Opioid Use Disorder: A Longitudinal Study
Authors: Kaur Gurneet , Sidana Ajeet , Singh Swarndeep , Gupta Aarzoo 
Published: May 2023

Objectives
Impairments in neuropsychological functioning (mainly memory, learning, attention, and executive functioning) among persons with long-term opioid use disorder (OUD) have been widely reported, with few studies suggesting that these are not permanent and can improve with abstinence. Thus, present study aimed to evaluate the neuropsychological functioning in persons with OUD and examine the effects of abstinence on the same over a period 8 weeks.

Methods
A total of 50 patients with diagnosis of OUD as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria underwent serial longitudinal neuropsychological assessments for executive functioning, attention and concentration, and verbal and nonverbal memory at baseline, 2 weeks, and 8 weeks of abstinence.

Results
The mean performance scores representative of attention, concentration, verbal memory, and nonverbal memory showed significant improvement in the initial 2 weeks, and executive functioning showed significant improvement by 8 weeks of abstinence (all P’s < 0.01). A significant negative correlation was found between the duration of opioid use and performance on verbal memory tests (0.014), the frequency of intake per day and performance on nonverbal memory and executive functioning tests, and the severity of opioid dependence and performance on nonverbal memory test (0.019).

Conclusions
Neuropsychological functioning in certain domains was associated with the duration of opioid use, the frequency of daily opioid intake, and the severity of opioid dependence among persons with OUD at baseline. It showed significant improvement in domains of attention, concentration, verbal and nonverbal memory, and executive functions over a period of 8 weeks of abstinence.
Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail
Authors: Bailey Amelia , Senthilkumar Rithika , Evans Elizabeth A. 
Published: May 2023

Objectives
Little is known about the correlates of use of medications to treat opioid use disorder (MOUD, ie, buprenorphine, methadone, naltrexone) offered in jails. We evaluated the implementation and outcomes of a MOUD program offered by 2 of the first jails nationwide to provide access to such care.

Methods
We examined use of MOUD among adults with opioid use disorder (n = 347) incarcerated by 2 rural jails in Massachusetts (2018–2021). We examined MOUD transitions from intake to during incarceration. Using logistic regression, we examined factors associated with in-jail use of MOUD.

Results
At jail entry, 48.7% of individuals with opioid use disorder were being treated with MOUD. During incarceration, 65.1% received MOUD, attributable to a 9.2% increase in use of methadone (from 15.9% to 25.1%) and a 10.1% increase in use of buprenorphine (from 28.5% to 38.6%). During incarceration, 32.3% of individuals were continued on the same MOUD from the community, 25.4% were started, 8.9% stopped, and 7.5% switched type. A total of 25.9% entered jail not on any MOUD and were not started on it. Use of MOUD during incarceration was positively associated with having received MOUD in the community (odds ratio, 12.2; 95% confidence interval, 5.8–25.5) and incarceration at site 1 compared with site 2 (OR, 24.6; 95% CI, 10.9–54.4).

Conclusions
Expanded access to MOUD in jails can engage an at-risk population with treatment. Understanding factors related to this population’s use of MOUD may aid efforts to optimize care during incarceration and after community re-entry.
Cesarean Delivery Rate in Nulliparous Women in the Second Stage of Labor When Using Zhang Compared With Friedman Labor Curves
Authors: Limas Maria M. , Shah Sohum C. , Turrentine Mark A. 
Published: May 2023

OBJECTIVE:
To estimate the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve by performing a systematic review and meta-analysis.

DATA SOURCES:
We explored MEDLINE, EMBASE, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve.

METHODS OF STUDY SELECTION:
Two reviewers separately ascertained studies, obtained data, and gauged study quality. The cesarean delivery rate was compared, and odds ratios (ORs) with 95% CIs were estimated.

TABULATION, INTEGRATION, AND RESULTS:
Five retrospective cohort studies and two randomized controlled trials were identified with 20,165 nulliparous women (10,861 with the Zhang labor curve vs 9,304 with the Freidman labor curve). Studies evaluated women with delivery from June 2010 to May 2017. Two studies were from the United States; two were from Israel; and one each was from China, France, and Norway. The median point prevalence of cesarean delivery in the second stage was 4.0% (95% CI 2.1–14.5%) in cases managed with the Zhang labor curve compared with 5.6% (95% CI 1.8–28.6%) in cases managed with the Friedman labor curves. The overall cesarean delivery rate in the second stage of labor was similar when the Zhang labor curve compared with the Friedman labor curve was used (pooled OR 0.86, 95% CI 0.47–1.57, I
2=93%). When the two randomized controlled trials were excluded, the results of the cohort studies continued to demonstrate that the overall cesarean delivery rate in the second stage of labor was similar (pooled OR 0.84, 95% CI 0.42–1.69, I
2=92%).

CONCLUSION:
Nulliparous women have similar cesarean delivery rates in the second stage of labor when either the Zhang or Friedman labor curve is used.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42022346425.
The Influence of Fetal Sex on Antepartum Treatments in a Murine Model of Preterm Birth [ID: 2369702]
Authors: Ligon Sarah E. , Dornisch Elisabeth M. , Howitz Kamy J. , Talley Rebecca L. , Damicis Jennifer R. , Napolitano Peter G. , Pates Jason A. , Ieronimakis Nicholas 
Published: May 2023

INTRODUCTION:
Preterm neonates exposed to magnesium sulfate (MgSO4) and corticosteroids such as betamethasone (BMTZ) in utero have a lower incidence of neurodevelopmental disability, specifically cerebral palsy. The efficacy of MgSO4/BMTZ remains poor, particularly in male offspring. The mechanisms by which MgSO4/BMTZ confer “neuroprotection” in only some patients and in relation to fetal sex, remain unknown. Our objective was to examine sex-specific responses to MgSO4/BMTZ in a murine model of fetal neuroinflammatory injury.

METHODS:
Utilizing an established murine model of preterm birth, dams were injected intrauterine with either phosphate-buffered saline or bacterial endotoxin (lipopolysaccharide [LPS]) on embryonic day 15.5 to induce fetal inflammation. Thereafter, dams received MgSO4/BMTZ or the vehicle. Fetal brains and placentas were collected 6 hours postinjection for gene expression analysis of key inflammatory cytokines: Il1b, Il6, and Tnf.

RESULTS:
Irrespective of sex, LPS exposure up-regulated all three cytokines. With MgSO4/BMTZ, Il1b expression was significantly lower in female, but not male brains. In contrast, MgSO4/BMTZ lowered Il6 expression in placentas from males, but not females. No sex differences were observed with Tnf expression.

CONCLUSION:
Within the context of LPS-mediated in utero inflammation, fetal sex influenced the efficacy of MgSO4/BMTZ. The anti-inflammatory effect of MgSO4/BMTZ also appeared tissue specific, with protection shown in female brains and male placentas. These results suggest that the neuroprotective effects of MgSO4/BMTZ are more robust in females, whereas placental inflammation is more affected in males. Further investigation is warranted to determine whether these sex-specific patterns govern fetal outcomes.
Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial
Authors: Ihejirika-Lomedico Rivka , Solasz Sara , Lorentz Nathan , Egol Kenneth A. , Leucht Philipp ,   and NYU Hip Fracture Research Group
Published: May 2023

Objective:
To determine whether a perioperative pain cocktail injection improves postoperative pain, ambulation distance, and long-term outcomes in patients with hip fracture.

Design:
Prospective, single-blinded, randomized controlled trial.

Setting:
Academic Medical Center.

Patients/Participants:
Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty.

Intervention:
Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI).

Main Outcome Measurements:
Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, postoperative ambulation, Short Musculoskeletal Function Assessment.

Results:
Seventy-five patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared with the control group on postoperative day (POD) 0 (P < 0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 (P < 0.01). Patient ambulation distance was greater on POD 2 (P < 0.01) and POD 3 (P < 0.05) in the HiFI group. The control group experienced more major complications (P < 0.05). At 6-week postop, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The Short Musculoskeletal Function Assessment bothersome index was also significantly lower for patients in the HiFI group, P < 0.05.

Conclusions:
Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health-related quality of life after discharge.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory
Authors: McMains Kevin C. , Durning Steven J. , Norton Candace , Meyer Holly S. 
Published: May 2023

Introduction:
Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators?

Methods:
The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators.

Results:
Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct.

Discussion:

The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.
Curriculum Evaluation and Alignment of Core Ideals
Authors: Burris Valerie F. , Owens Jacqueline K. 
Published: May 2023

ABSTRACT:
Curriculum evaluation, including alignment of concepts, is an ongoing challenge for nurse educators. Nursing curricular frameworks encompass varied concepts, guided by professional standards. This article examines a conceptual model, the Globe Framework, for BSN generalist practice including initial development, implementation, and evaluation. Evaluation at one school, driven by new AACN Essentials in 2021, spans from 2008 to 2020, reviewing three data points: meeting minutes, master syllabi from baccalaureate coursework, and accreditation documents. Challenges included merging two nursing departments with collaboration to reach consensus. Framework strengths include local practice environment values and multiple concepts. Findings and recommendations can inform nurse educators as they consider program evaluation and upcoming accreditation standards.
Developing a Method for Quantifying Meropenem in Children—Volumetric Adsorptive Microsampling Versus Plasma Sampling
Authors: Ramadan Ola , Schatz Lea Marie , van den Heuvel Ingeborg , Masjosthusmann Katja , Groll Andreas H. , Hempel Georg 
Published: May 2023

Background:
Meropenem is a carbapenem antibiotic often used in pediatric intensive care units due to its broad spectrum of activity. Therapeutic drug monitoring (TDM) is a useful tool to increase the effectiveness of meropenem by adjusting the dose based on plasma levels; however, the relatively large sample volume required for TDM can limit its use in children. Therefore, this study aimed to determine meropenem concentrations and consequently perform TDM effectively using the smallest possible sample volume. Volumetric absorptive microsampling (VAMS) is a sampling technology developed to collect a small, precise volume of blood. For the applicability of VAMS in TDM, plasma concentrations must be reliably calculated from whole blood (WB) collected by VAMS.

Methods:
VAMS technology using 10 µL of WB was evaluated and compared with EDTA-plasma sampling. High-performance liquid chromatography with UV detection was applied to quantify meropenem in VAMS and plasma samples after the removal of proteins by precipitation. Ertapenem was used as the internal standard. Samples were collected simultaneously from critically ill children receiving meropenem using VAMS and traditional sampling.

Results:
It was found that no consistent factor could be determined to calculate meropenem plasma concentrations from the WB, indicating that VAMS was not reliable in the TDM of meropenem. Therefore, to reduce the required sample amount in pediatric patients, a method for quantifying meropenem from 50 µL of plasma with a lower limit of quantification of 1 mg/L was developed and successfully validated.

Conclusions:
A simple, reliable, and low-cost method was established using high-performance liquid chromatography–UV to determine the concentration of meropenem in 50 µL of plasma. VAMS using WB does not seem to be suitable for TDM of meropenem.