bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient early life growth hormone exposure permanently alters brain, muscle, liver, macrophage, and adipocyte status in long‐lived Ames dwarf mice
Authors: Li Xinna , McPherson Madaline , Hager Mary , Fang Yimin , Bartke Andrzej , Miller Richard A. 
Published: June 2022

AbstractThe exceptional longevity of Ames dwarf (DF) mice can be abrogated by a brief course of growth hormone (GH) injections started at 2 weeks of age. This transient GH exposure also prevents the increase in cellular stress resistance and decline in hypothalamic inflammation characteristic of DF mice. Here, we show that transient early‐life GH treatment leads to permanent alteration of pertinent changes in adipocytes, fat‐associated macrophages, liver, muscle, and brain that are seen in DF mice. Ames DF mice, like Snell dwarf and GHRKO mice, show elevation of glycosylphosphatidylinositol specific phospholipase D1 in liver, neurogenesis in brain as indicated by BDNF and DCX proteins, muscle production of fibronectin type III domain‐containing protein 5 (a precursor of irisin), uncoupling protein 1 as an index of thermogenic capacity in brown and white fat, and increase in fat‐associated anti‐inflammatory macrophages. In each case, transient exposure to GH early in life reverts the DF mice to the levels of each protein seen in littermate control animals, in animals evaluated at 15–18 months of age. Thus, many of the traits seen in long‐lived mutant mice, pertinent to age‐related changes in inflammation, neurogenesis, and metabolic control, are permanently set by early‐life GH levels.
A Novel Damage-Control Abdomino-Pelvic Packing Simulation for Obstetrician–Gynecologist Trainees [A338]
Authors: Brown Kathryn , Kaiser Jennifer E. , Einerson Brett 
Published: June 2022

INTRODUCTION:
Diffuse, uncontrolled hemorrhage following postpartum hysterectomy is an uncommon situation, but one that obstetrician–gynecologists (ob-gyn) should be equipped to handle. Simulation is effective at increasing participant skill and confidence at procedures that are rarely encountered yet require practice to complete well. We devised a model to simulate "damage-control" abdomino-pelvic packing for diffuse hemorrhage after postpartum hysterectomy.

METHODS:
We created a low-fidelity, low-cost simulation for abdomio-pelvic packing using a clear plastic shower curtain, painters' towels, plastic tubing, three-quarter inch elastic, contact paper, and a vaginal delivery pelvic model. A short lecture explaining the rationale and process of abdomino-pelvic packing was given, followed by hands-on simulation of damage-control packing. Residents rotated through the simulation in pairs and performed the packing under supervision of a faculty expert. Six weeks following the simulation, a short survey was emailed to all participants to evaluate pre- and post-simulation task confidence and educational value of the model. We analyzed the results using comparative statistics.

RESULTS:
Of 19 residents participating in the simulation, 12 (63%) completed the survey. Average resident confidence performing abdomino-pelvic packing prior to the simulation was 1.7 on a 5-point Likert scale, with 5 being very confident, compared to 3.9 after the simulation (P<.001). Most respondents (58%) were able to list all supplies necessary for packing without prompting. One hundred percent of respondents “strongly agreed” the simulation was a valuable learning experience.

CONCLUSION:
We created a highly effective low-cost simulation of abdomino-pelvic packing for hemorrhage following postpartum hysterectomy that significantly increased resident confidence and knowledge in performing the procedure.
Maternal Superobesity and Visualization of Fetal Anatomy [A344]
Authors: McElwee Eliza R. , Peneva Ralitza , Dunn Faith , Singleton Aleah , Ryan Kelly M. , Head Barbara 
Published: June 2022

INTRODUCTION:
Obesity rates continue to increase in reproductive age women. It is well described that obesity impairs adequate image acquisition on sonographic fetal anatomic survey. However, there are limited data regarding rates of anatomic survey completion in women with superobesity (BMI≥50). We sought to investigate adequacy of fetal anatomic visualization in women with superobesity.

METHODS:
Retrospective chart review of women with singleton nonanomalous pregnancies presenting for fetal anatomic survey from 18 0/7 to 21 6/7 weeks’ gestation between January 1, 2019 and December 30, 2020. The primary outcome was rate of total anatomic survey completion stratified by BMI category. Secondary outcomes were scan duration, number of images, and complete visualization of grouped organ systems. Results were analyzed using Chi-square and Kruskal Wallis tests where appropriate.

RESULTS:
Of 2,719 ultrasounds, 9% of patients were normal weight, 31% overweight, 55% obese, and 5% superobese. Rates of anatomic survey completion were highest in normal-weight women, and lowest in women with superobesity (67.6% vs. 4.4%, P<.001). When grouped by organ system, superobesity impacted all organ system completion rates, with cardiac structures the most affected (75% vs. 8%, P<.001). The median exam duration and number of images decreased with increasing BMI category (range 33.5-28.4 minutes and 86-63 images, respectively).

CONCLUSION:
Women with weight classifying as superobese had extremely low rates of completed anatomic survey on first attempt. Examination duration and number of images were lower for superobese patients, which may represent sonographer assessment of futility. This has important implications for anomaly detection and resource utilization.
Bladder HOTline: The Impact of COVID-19 and Telemedicine on Empiric Urinary Tract Infection Treatment in Women [A345]
Authors: Epsten Madeline J. , Ferraro Jennifer , Khan Fareesa , Brincat Cynthia , Jacobs Kristin 
Published: June 2022

INTRODUCTION:
Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment.

METHODS:
This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients.

RESULTS:
The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%.

CONCLUSION:
COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition.
Pregnant Women's Opinions on the COVID-19 Vaccination in Pregnancy [A301]
Authors: DesJardin Marcia , Raff Edward , Baranco Nicholas , Mastrogiannis Dimitrios 
Published: June 2022

INTRODUCTION:
Pregnant women are at increased risk of severe disease with COVID-19. Despite strong recommendations from ACOG and the Society for Maternal-Fetal Medicine for vaccination, COVID-19 vaccination hesitancy persists. With this study, we aim to evaluate opinions about the COVID-19 vaccine in a cohort of high-risk pregnant patients.

METHODS:
Institutional review board approval was obtained. Patients attending a regional Maternal-Fetal Medicine clinic were surveyed about the COVID-19 vaccine using a standardized questionnaire. Demographic, obstetrical, and medical information were abstracted using medical records. The vaccinated and unvaccinated groups were evaluated using student t-tests and a hierarchical Bayesian logistic regression.

RESULTS:
Among the 157 participants, 38.2% received the vaccine. There were no significant differences between the groups in age, BMI, employment, race and ethnicity, gestational age, or gravity. There was no correlation with influenza or Tdap vaccination rates, nor tobacco or alcohol use. Education level was negatively correlated with vaccination status and had the largest effect size. Those with education at or less than eighth grade level were least likely to be vaccinated (95% CI, −4.46 to −0.41). Those with children in the home were less likely to be vaccinated (95% CI, −1.36 to −0.59). Unvaccinated patients chose lack of data in pregnancy (66%) as their primary concern. Most patients prefer to learn about vaccines via conversation with their doctor (46.7% for vaccinated and 59.8% for unvaccinated).

CONCLUSION:
The vaccination rate is low in our population. A provider-initiated conversation about COVID-19 vaccination included with routine prenatal care could increase the vaccination rate.
A Simulation Model of the Effects of Tailored Prenatal Care Delivery on Care Access [A308]
Authors: Zacharek Nicholas , Hocher Samuel , Kandiraju Meghana , Dawson Claire , Cohn Amy , Peahl Alex F. 
Published: June 2022

INTRODUCTION:
New national prenatal care delivery guidance, the Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), recommends tailoring the prenatal visit number, with 8-9 visits for low-risk patients and 12-14 visits for high-risk patients. We used simulation to explore how tailored prenatal care recommendations affect care access.

METHODS:
To evaluate the operational effects of tailored recommendations compared to usual care, a discrete event simulation was developed in C++. This model simulates dynamic patient arrivals, heterogeneous patient classifications, tailored pathways, and patient flow through the system until the end of each patient's care pathway (e.g., delivery). Patients were assigned to medically low-risk (9 visit) and high-risk (12 visit) groups based on the presence or absence of any medical conditions. Metrics captured included patient delays, overbooked appointments, and utilization. Simulation parameters were derived from a 1-year–long historical data set from a single institution. The model was run for a 52-week horizon for 1,000 replications. This study of de-identified data was deemed exempt by the institutional review board.

RESULTS:
The majority of patients in the parent dataset were medically high risk (3,527/4,968; 71%). Transitioning to the new prenatal care delivery model reduced mean delay to appointment per patient by 1 week. The percentage of patients overbooked was reduced from 27% to 24%. The average percent capacity utilized by each clinic decreased from 74% to 71%.

CONCLUSION:
In this dataset with many high-risk patients, tailoring prenatal care to medical risk factors modestly improved access parameters. Tailoring prenatal care is operationally feasible and may facilitate more equitable distribution of services.
Robotic Surgery for Endometrial Cancer Increases Intraocular Pressure: A Pilot Study [A314]
Authors: Cardenas Joel , Algarra Nelson N. , Shoraka Massoud , Mehta Sonia , Rodriguez Daniel 
Published: June 2022

INTRODUCTION:
To evaluate changes in intraocular pressure (IOP) during robotic surgery for endometrial cancer.

METHODS:
A prospective study in which IOP was measured in the left and right eyes before surgery (PACU), before induction head of bed 30°, after induction 0°, after pneumoperitoneum at 14-mm Hg at 0°, after robot docking at 30° Trendelenburg, after undocking at 30°, and on supine position before extubation. IOP for each patient was averaged between the left and right eyes. Wilcoxon signed-rank tests were performed to evaluate whether IOP changed significantly between baseline (PACU) and the other time points.

RESULTS:
A total of 15 patients were included. The average IOP before surgery was 15.4±5.45 mm Hg (mean±standard deviation). The intraocular pressure increased significantly after docking the robot (average IOP increase of 9.43 mm Hg; P=.001091), after undocking (average IOP increase of 11.5 mm Hg; P=.0001; Age was 64.27 years old; BMI 38.98 Kg/m2. Tumor grade 1 (60%). Stage IA 67%. Operative time 149.53 minutes. EBL 68.3 mL. There were no intraoperative complications or readmission.

CONCLUSION:
The intraocular pressure significantly increased during robotic surgery. Caution should be exercised during surgery on patients with glaucoma or increased intracranial pressure as baseline.
Human Papillomavirus Knowledge, Vaccine Uptake, and Educational Interventions in Health Professions Students: A Systematic Review [A315]
Authors: Levy Morgan S. , Finch Lindsey , Lindsay Kara A. , Jeudin Patricia , Huang Marilyn 
Published: June 2022

INTRODUCTION:
Strong recommendation of human papillomavirus (HPV) vaccination by healthcare providers increases vaccine uptake, but gaps in knowledge persist among health professional students (HPS) in professions including medicine, dentistry, dental hygiene, nursing, pharmacy, and physician assistants. Ensuring proper education of HPS as the next generation of providers can increase vaccine uptake. The purpose of this systematic review was to evaluate HPV vaccination uptake, knowledge, comfort with counseling, and educational interventions to increase knowledge in HPS.

METHODS:
A systematic literature search for articles on HPV vaccine uptake, knowledge, counseling, and educational interventions in HPS was performed in PubMed, Embase, Web of Science, CINAHL, and Scopus from January 1, 2006–July 21, 2021. Studies were screened for inclusion by two independent reviewers (disagreements were resolved by a third reviewer) and evaluated for risk of bias. PRISMA guidelines for reporting were followed.

RESULTS:
The initial search contained 6,684 articles, and 5,206 duplicates were removed. A total of 1,459 studies were screened by title and abstract, and 1,372 studies did not meet inclusion criteria. Eighty three articles underwent full-text review. A total of 23 studies were included in analysis. Gaps in knowledge surrounding HPV vaccination and low rates of vaccine uptake were consistent across professions. Educational interventions were effective in increasing knowledge levels and comfort with counseling.

CONCLUSION:
This systematic review identified low rates of HPV vaccination amongst HPS, gaps in knowledge, and discomfort with counseling on HPV vaccination. Education on HPV vaccination must be provided in all health professional programs of potential vaccine providers to increase vaccine uptake and prevent cancer.
Focal-Occult Placenta Accreta Spectrum: A Clandestine Source of Maternal Morbidity [A268]
Authors: Larish Alyssa , Norgan Andrew , Schenone Mauro , Branda Megan , Horst Kelly , Theiler Regan 
Published: June 2022

INTRODUCTION:
While focal-occult placenta accreta spectrum (PAS) is known to lead to adverse outcomes, little is known of the morbidity in comparison to previa-associated PAS.

METHODS:
After IRB approval, retrospective review was conducted of pathologically confirmed (decidual layer absence or basal-plate myometrial fibers) PAS from 2018 to 2021 at a tertiary care center. Baseline characteristics and surgical, obstetric, and subsequent pregnancy outcomes were recorded. Focal-occult PAS was compared with previa-associated PAS using Kruskal-Wallis/Chi-square tests; P<.05 was considered significant.

RESULTS:
A total of 56 cases were identified: 22 previa-associated and 34 focal-occult PAS. All patients with previa-associated and 26.5% of those with focal-occult PAS underwent hysterectomy. Of the previa-associated PAS patients, 20 of 22 were diagnosed antenatally, as was 1 of 34 focal-occult PAS patients. Mean maternal age (32.5 vs. 33.1 year), number of previous dilation and curettage procedures (0.4 vs. 0.3), and in vitro fertilization rates (4.5% vs. 23.5%) were not significantly different between groups. Mean parity (3.7 vs. 1.4), gestational age at delivery (34.3 vs. 35.7 weeks), any previous cesarean delivery (95.5% vs. 29.4%), mean number of previous cesareans (2.5 vs. 0.5), and placental locations were significantly different between groups. All measures of morbidity, including postpartum hemorrhage rates (81.0% vs. 75.8%), median qualitative blood loss (1,500cc, range: 500–9,516cc vs. 1,660cc, range: 350–12,220cc), mean units of red blood cells transfused (1.8 vs. 1.9), massive transfusion (9.1% vs. 20.6%), ICU admission (9.1% vs. 14.7%), and reoperation rates (9.1% vs. 32.4%) were similar between groups. Six focal-occult PAS patients had a subsequent pregnancy, and two had recurrent PAS.

CONCLUSION:
Despite representing lower grade PAS, focal-occult PAS has similar measures of morbidity when compared to previa-associated PAS, potentially attributable to lack of antenatal detection.
Gestational Weight Gain in Patients With Obesity and Diabetes: A Comparison of 2009 Institute of Medicine Versus 2019 JAMA Recommendations [A270]
Authors: Han Joan , Ohaegbulam Gail , Yan Fengxia , Lindsay Michael , Geary Franklyn H. , Lee Regina 
Published: June 2022

INTRODUCTION:
Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes.

METHODS:
IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used.

RESULTS:
Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates.

CONCLUSION:
For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.
A Quality-Improvement Project to Improve Diagnosis and Management of Chorioamnionitis on Labor and Delivery [A274]
Authors: Neuhoff Barbara K. , Wells Joshua , Tufton Anne , Heath Maya , Olister Staci , Holman Stacey L. 
Published: June 2022

INTRODUCTION:
Chorioamnionitis is an intraamniotic infection and inflammation that is associated with significant neonatal and maternal morbidity. However, diagnostic criteria can vary greatly among providers, leading to unnecessary antibiotic administration and interventions in the mother and neonate. An interdisciplinary quality-improvement team sought to standardize diagnostic criteria for chorioamnionitis on labor and delivery. Previous analysis identified that 60% of chorioamnionitis diagnoses at our institution did not meet ACOG diagnostic guidelines.

METHODS:
The following interventions were implemented: 1) dissemination of data regarding over-diagnosis and treatment, 2) department-wide educational sessions, and 3) publication of diagnostic guidelines at work stations and on a hospital shared drive. After IRB approval, a before-and-after retrospective cohort study was carried out from 4/1/2018 to 9/30/2021 (intervention: 11/2019) to determine the interventions' impact on compliance with recommended ACOG-supported diagnosis and management of chorioamnionitis. Relevant morbidity rates for patients and neonates with an ICD-9/10 code related to peripartum infections were also analyzed.

RESULTS:
Patients received the diagnosis of chorioamnionitis significantly less frequently after interventions (pre: 145 of 4,515, 3.21% of deliveries; post: 101 of 5,085, 1.99% of deliveries, P<.0002). The incidence of charted diagnoses that did not meet ACOG criteria significantly decreased after interventions (55.86–28.71%, P<.0001). The differences in maternal endometritis as well as maternal and neonatal sepsis were not statistically significant in the pre- and post-intervention groups (P<.0501, P<.1548, P<.0933).

CONCLUSION:
Guideline-based diagnosis of chorioamnionitis can be successfully implemented on labor and delivery, leading to less antibiotic use and fewer maternal and neonatal interventions. Implementation was also completed without an increase in maternal or neonatal morbidity.
Length of Maternity Leave and Breastfeeding Outcomes Among Physicians [A284]
Authors: Awomolo Adeola , Louis-Jacques Adetola , Eischen Emily , Jones Laurie , Braden Andrea L. , Crowe Susan 
Published: June 2022

INTRODUCTION:
Physicians face unique challenges in the postpartum period, including limited maternity leave. We aim to determine the relationship between length of maternity leave and breastfeeding outcomes.

METHODS:
Physicians who had a singleton pregnancy during the most strenuous time of their career were included in the cross-sectional survey. Questions were adapted from the CDC's Infant Feeding Practices Study and Pregnancy Risk Assessment Monitoring System, along with investigator-developed questions. Surveys were distributed through social-media physician groups and email listservs. Descriptive and bivariate analyses were completed via STATA version 17.

RESULTS:
Of the 807 responses, 637 were eligible and complete. The most strenuous time identified was during residency (36%). Greater than 30 specialties and subspecialties were represented, and the most common were pediatrics (37%), obstetrics and gynecology (18%), and family medicine (16%). There were associations between medical specialty (P=.006) and birth year (P<.0001) and length of maternity leave. The average maternity leave duration was 10±0.4 weeks. Maternity leave >6 weeks was associated with meeting personal breastfeeding goals compared to ≤6 weeks (80% vs 71%, P=.02). The mean duration of breastfeeding for respondents with ≤6 weeks maternity leave was 15±1.7 months while the mean duration for those with >6 weeks was 17±1.4 months (P=.01). There was a positive correlation between breastfeeding duration and maternity leave (R
2=0.12, P=.01).

CONCLUSION:
There is a relationship between length of maternity leave and breastfeeding outcomes. Supporting adequate maternity leave for physicians, especially those in training, is important for breastfeeding outcomes.