bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Social Determinants of Health and Postpartum Length of Stay During the COVID-19 Pandemic [A139]
Authors: Lewis Ayodele , Bunnell Megan , Easter Sarah Rae , McElrath Thomas , Greenberg James A. 
Published: June 2022

INTRODUCTION:
To determine differences in cesarean postpartum length of stay (pLOS) before and during the COVID-19 pandemic as a function of social determinants of health.

METHODS:
Cesarean birth pLOS data between January 1 and June 30, 2020, were reviewed. Births after March 10, 2020, were considered pandemic births. Primary outcome was early discharge <5,760 minutes (96 hours). Rates of early discharge were analyzed by social determinants of health, with socially vulnerable patients defined as Black or Hispanic, publicly insured, or non-English-speaking. We compared rates of early discharge before and during the pandemic overall and then among socially vulnerable patients using probit regression analysis.

RESULTS:
There were 1,885 eligible deliveries: 694 before the start of the pandemic and 1,171 after. Median pLOS pre-pandemic was 5,696 (IQR, 4,686–6,060) minutes versus 4,655 (IQR, 3,897–5,860) minutes during the pandemic. Of the eligible deliveries, 54% had early discharges pre-pandemic compared to 71% afterwards (P<.01). Overall, we found these variables predictive of early discharge pLOS: socially vulnerable (P<.01), payer type (P<.01), English ability (P<.01), and multiparity (P<.01). Race as a variable alone was not found to be significantly predictive of early discharge.

CONCLUSION:
Socially vulnerable patients are more likely to leave the hospital earlier than their counterparts both before and during the COVID-19 pandemic. Our findings suggest that increased early discharges fall disproportionately on socially vulnerable patients. Further research is needed to determine whether these results are due to provider bias or patient driven.
Experiences of Discrimination Are Associated With Risk for Cesarean Delivery [A157]
Authors: Mulla Yamini , Shepard Samantha , Hux Vanessa J. 
Published: June 2022

INTRODUCTION:
Discrimination is a chronic stressor associated with poor health outcomes and may contribute to persistent disparities in health and pregnancy outcomes. The purpose of this study is to examine the association between discrimination reported in pregnancy and nulliparous, term, singleton, vertex (NTSV) cesarean birth rates.

METHODS:
Participants between the ages of 18 and 39 with singleton pregnancies at 18–27 weeks recruited from obstetrics and gynecology clinics at Tampa General Genesis Health Park and the University of South Florida: South Tampa Center Clinic. Participants completed the Williams Everyday Discrimination Scale (WEDS), Perceived Ethnic Discrimination Questionnaire (PEDQ), and Experiences in Ambivalent Sexism Inventory (EASI). After delivery, pregnancy and delivery outcomes were abstracted from the patient’s electronic medical record. Logistic regression was used to test associations between cesarean delivery and each discrimination measure. Analyses were also adjusted for NTSV status and race.

RESULTS:
A total of 206 participants were recruited; 190 had complete data. The overall cesarean delivery rate was 28.42%. The NTSV cesarean delivery rate was 20.45%. There was a positive association between cesarean delivery rate and both WEDS (P=.049) and PEDQ (P=.029). There was no association between cesarean delivery and EASI.

CONCLUSION:
Lifetime everyday discrimination and ethnic discrimination experiences were associated with higher odds of cesarean delivery. This may reflect that individuals who experience more discrimination may exist in systems with more bias, or that the stress experience of discrimination could affect physiology that leads to increased cesarean rates. More work is needed to further understand how interpersonal, structural, and systemic discrimination influence cesarean delivery rates.
Comparison of the Prevalence of Gestational Diabetes Pre-COVID-19 Pandemic Versus During COVID-19 [A196]
Authors: Mirsky Elizabeth , Mastronardi Alicia , Paudel Alissa M. , Young Megan Lacy , Zite Nikki , Maples Jill M. 
Published: June 2022

INTRODUCTION:
Recent studies suggest that the rate of gestational diabetes (GDM) diagnosis has increased following the onset of the COVID-19 pandemic. This study investigated the prevalence of GDM among patients delivering at a single academic institution, prior to and after the onset of the COVID-19 pandemic.

METHODS:
This was a retrospective study of patients with a singleton, full-term birth who delivered pre-COVID-19 (January 2019–May 2020) and during the COVID-19 pandemic (June 2020–July 2021). Institutional review board approval was obtained. Data collected included diagnosis of GDM, maternal age, prepregnancy BMI, and gestational weight gain (GWG). Chi-square tests assessed the relationship between GDM diagnosis (yes, no) and time (pre-COVID-19, during COVID-19). Binary regression further evaluated this relationship, controlling for confounding factors.

RESULTS:
Among the 7,653 patients included in analysis, 58.6% delivered pre-COVID-19 and 41.1% delivered during COVID-19. During COVID-19, 12.5% of patients were diagnosed with GDM, compared to 9.0% pre-COVID-19 (P<.001). When stratified by prepregnancy weight status, the significantly increased prevalence of GDM during COVID-19 remained among those with a lean, overweight, and obese prepregnancy BMI (underweight, 6.2% versus 3.8%, P=.40; lean, 7.4% versus 5.0%, P<.01; overweight, 10.9% versus 7.4%, P<.01; obese, 21.1% versus 17.2%, P=.02). When controlling for maternal age, prepregnancy BMI, and GWG, time (related to COVID-19) remained a significant predictor of GDM diagnosis (P<.001).

CONCLUSION:
This study demonstrates a 38.9% increase in the prevalence of GDM delivering at a single academic institution during the COVID-19 pandemic, compared to pre-COVID-19. Future research is needed to determine the underlying mechanisms potentially contributing to hyperglycemia in pregnancy.
Random Forests for Accurate Prediction of the Risk of Hypertensive Disorders of Pregnancy at Term [A208]
Authors: Kadambi Adesh , Wen Timothy , Nguyen Eliza , Dolisca Sarah , Ebrahim Senan , Ebrahim Ali 
Published: June 2022

INTRODUCTION:
Hypertensive disorders of pregnancy (HDP) complicate 10% of all pregnancies and confer elevated risks of subsequent conditions, such as chronic hypertension and diabetes. Risk models that accurately predict HDP can improve clinical management by risk stratification, allowing earlier interventions and closer interval follow-up. This study develops and internally validates a risk prediction model for the development of HDP in the third trimester.

METHODS:
This analysis was conducted using the Eunice Kennedy Shriver Institute of Child Health and Human Development / Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) data for approximately 9,000 low-risk nulliparous patients. HDP was the primary outcome for this analysis, defined as gestational hypertension, mild/severe preeclampsia, eclampsia, or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an indication for admission. We included 518 potential covariates of interest, including outpatient vital signs, medication usage, patient and family medical history, and laboratory information. We trained a random forest predictor model on 80% of this dataset, and further refined it using recursive feature elimination to restrict the number of input variables to 20 for a reduced model.

RESULTS:
Our full and reduced models predicted HDP with area under the receiver operating characteristic (AUROC) scores of 0.82 and 0.81 respectively. Performance evaluation of the reduced model by race showed poorer performance for non-Hispanic Black (0.76), Hispanic (0.79), and non-Hispanic White (0.80) patients than overall.

CONCLUSION:
The reduced model has been deployed for demonstration at hypertension.delfina.com. Admission for HDP can be predicted with excellent discriminative ability using random forest prediction modeling. External validation and integration with electronic health records is needed to assist providers in triaging and informing at-risk patients.
Beyond Postpartum Hypertension: Improving Access to Care and Community Resources via Telehealth [A215]
Authors: Fermin Oriana , Huber Kimberly , Ben Khallouq Bee , Boardman Lori 
Published: June 2022

INTRODUCTION:
Telehealth-consolidated referral services may provide a useful tool to address health disparities in the postpartum period.

METHODS:
A telehealth postpartum hypertension program, consisting of two 20-minute visits during the first week following discharge, was begun in September 2020. In addition to managing blood pressure, patients were screened for clinical indications and social determinants of health and appropriate referrals were made as virtual and/or in-person visits.

RESULTS:
In a one-year period (September 4, 2020, to September 2, 2021), 780 patients were enrolled and completed at least one telehealth visit. Demographically, 37% self-identified as non-Hispanic White, 31% non-Hispanic Black, 29% Hispanic, and 3% non-Hispanic Asian, 65% had private insurance, and 31% lived in ZIP codes ≥15% below the poverty level. Of the 780 patients, 147 (19%) received one or more referrals. Privately insured women, compared to those with Medicaid, were more likely to receive referral services (52% versus 48%, P=.03). Of the 170 referrals made, 110 were for clinical indications (lactation support, postpartum depression, wound care), and 60 addressed social determinants of health (economic instability, food insecurity, housing instability, unmet transportation needs). Of the latter, 47% occurred in women living in ZIP codes of ≥15% of poverty level. Non-Hispanic Black and Hispanic women were more likely than non-Hispanic White women to receive referrals related to social determinants of health (76% versus 24%, P=.03).

CONCLUSION:
Maximizing the telehealth platform to include referral services to address social determinants of health has the potential to improve access to much-needed social services, particularly in vulnerable populations.
Barriers and Facilitators of Extended Use of the Contraceptive Arm Implants: A Cross-Sectional Survey of Clinicians [A11]
Authors: Rigler Nicole , Averbach Sarah , Sandoval Selina , Meurice Marielle , Hildebrand Marisa C. , Mody Sheila 
Published: June 2022

INTRODUCTION:
The etonogestrel contraceptive implant has U.S. Food and Drug Administration (FDA) approval for 3 years but is effective up to 5 years. It is not known whether clinicians offer the implant up to 5 years for pregnancy prevention. We aimed to explore whether clinicians offer extended use of the implant and the barriers and facilitators to offering extended use.

METHODS:
We conducted a national cross-sectional survey among a diverse group of reproductive health clinicians. The institutional review board‒approved online survey was distributed through email listservs and social media groups.

RESULTS:
We surveyed 300 clinicians, 32.6% (n=98) family medicine physicians, 24.0% (n=72) obstetrics and gynecology generalists, 22.3% (n=67) advanced practice clinicians, and 19.0% (n=57) complex family planning (CFP) subspecialists. Among respondents, 65.0% (n=195) always, 16.7% (n=50) sometimes, and 18.3% (n=55) never offered extended use. After adjusting for age, race, gender, and clinical setting, CFP subspecialists and family medicine physicians were significantly more likely to recommend extended use compared to ob-gyn generalists (aOR=9.32, 95% CI [1.81-48.03] and 4.37 [1.58-12.10]). Key barriers to offering extended use identified were patient and provider concerns that the FDA approval is only for 3 years and patient concerns about pregnancy risk and bleeding. The key facilitators identified were strong evidence supporting extended use, prior counseling from a provider, and patient request for extended use.

CONCLUSION:
One-third of clinicians in this study do not consistently offer extended use of the contraceptive implant. Thus, there is an opportunity to expand access to extended use by focusing interventions on clinician and patient education and extending the FDA approval.
Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States
Authors: Hasnie Usman A. , Hasnie Ammar A. , Preda-Naumescu Ana , Nelson Benjamin J. , Estrada Carlos A. , Williams Winter L. 
Published: June 2022

Purpose
To explore how school and specialty characteristics impact the geographic match location of U.S. senior medical students.

Method
The authors collected student match data between 2018 and 2020 from U.S. MD-granting medical schools and calculated the distance between students’ medical schools and residency training programs. They use the term “match space” to describe this distance. Match space was codified on a 5-point ordinal scale by where the student matched: 1 = home institution, 2 = home state, 3 = an adjacent state, 4 = the same or adjacent U.S. Census division (and not adjacent state), and 5 = skipped at least one U.S. Census division. Ordinal logistic regression correlated school and specialty characteristics with match space.

Results
During the study period, 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 of National Institutes of Health (NIH) research funding. The match space was higher for students graduating from private institutions (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.06 to 1.22) and matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94) and from schools with a higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77).

Conclusions
School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student’s choice of specialty and medical school may impact subsequent geographic placement for residency training, which should be considered by students and residency programs alike.
Construct Validity of Pediatric PROMIS Computerized Adaptive Testing Measures in Children With Adolescent Idiopathic Scoliosis
Authors: Mitchell Stuart L. , McLaughlin Kevin H. , Bachmann Keith R. , Sponseller Paul D. , Reider Lisa M. 
Published: June 2022

Background:
The use of patient-reported outcome measures, especially Patient-Reported Outcomes Measurement Information System (PROMIS) measures, has increased in recent years. Given this growth, it is imperative to ensure that the measures being used are validated for the intended population(s)/disease(s). Our objective was to assess the construct validity of 8 PROMIS computer adaptive testing (CAT) measures among children with adolescent idiopathic scoliosis (AIS).

Methods:
We prospectively enrolled 200 children (aged 10 to 17 y) with AIS, who completed 8 PROMIS CATs (Anxiety, Depressive Symptoms, Mobility, Pain Behavior, Pain Interference, Peer Relationships, Physical Activity, Physical Stress Experiences) and the Scoliosis Research Society-22r questionnaire (SRS-22r) electronically. Treatment categories were observation, bracing, indicated for surgery, or postoperative from posterior spinal fusion. Construct validity was evaluated using known group analysis and convergent and discriminant validity analyses. Analysis of variance was used to identify differences in PROMIS T-scores by treatment category (known groups). The Spearman rank correlation coefficient (r
s) was calculated between corresponding PROMIS and SRS-22r domains (convergent) and between unrelated PROMIS domains (discriminant). Floor/ceiling effects were calculated.

Results:
Among treatment categories, significant differences were found in PROMIS Mobility, Pain Behavior, Pain Interference, and Physical Stress Experiences and in all SRS-22r domains (P<0.05) except Mental Health (P=0.15). SRS-22r Pain was strongly correlated with PROMIS Pain Interference (r
s=−0.72) and Pain Behavior (r
s=−0.71) and moderately correlated with Physical Stress Experiences (r
s=−0.57). SRS-22r Mental Health was strongly correlated with PROMIS Depressive Symptoms (r
s=−0.72) and moderately correlated with Anxiety (r
s=−0.62). SRS-22r Function was moderately correlated with PROMIS Mobility (r
s=0.64) and weakly correlated with Physical Activity (r
s=0.34). SRS-22r Self-Image was weakly correlated with PROMIS Peer Relationships (r
s=0.33). All unrelated PROMIS CATs were weakly correlated (|r
s|<0.40). PROMIS Anxiety, Mobility, Pain Behavior, and Pain Interference and SRS-22r Function, Pain, and Satisfaction displayed ceiling effects.

Conclusions:
Evidence supports the construct validity of 6 PROMIS CATs in evaluating AIS patients. Ceiling effects should be considered when using specific PROMIS CATs.

Level of Evidence:
Level II, prognostic.
Sestrin2 Is Increased in Calcific Aortic Disease and Inhibits Osteoblastic Differentiation in Valvular Interstitial Cells via the Nuclear Factor E2–related Factor 2 Pathway
Authors: Wang Haixiong , Xi Jicheng , Zhang Zhibiao , Li Jun , Guo Liping , Li Na , Sun Yuehui , Li Xiaofang , Han Xuebin 
Published: June 2022

Abstract:
Sestrin2 (Sesn2) is involved in the progression of cardiovascular diseases, such as hypertension and myocardial infarction. This study aimed to examine Sesn2 expression in human calcific aortic valve disease (CAVD) and explore its possible mechanisms by which Sesn2 participates in this process. CAVD and normal aortic valves were collected. Sesn2 expression and sources were examined, and the results showed that Sesn2 expression was increased in aortic valves from patients with CAVD and was mainly secreted by macrophages. Additionally, U937 macrophages were pretreated with si-Sesn2 or cDNA-Sesn2 and further treated with oxidized low-density lipoprotein (ox-LDL); M1 macrophages and their markers were measured, and we found that pretreatment with si-Sesn2 increased ox-LDL–induced M1 macrophage polarization and marker mRNA levels, whereas pretreatment with cDNA-Sesn2 had the opposite effects. In ox-LDL–treated U937 macrophages, oxidative stress levels were increased in the si-Sesn2 pretreatment group and further increased by si-Nrf2 treatment, whereas oxidative stress levels were decreased in the cDNA-Sesn2 pretreatment group and significantly reversed by ML385, a specific Nrf2 inhibitor. The effects of Sesn2 on ox-LDL-induced oxidative stress and the osteogenic differentiation of ox-LDL-induced valvular interstitial cells (VICs) was examined by down-regulating Nrf2 pathway. When U937 macrophages were co-cultured with VICs, downregulation of Sesn2 increased ox-LDL-induced osteogenic differentiation in VICs, whereas overexpression of Sesn2 exerted the opposite effects. Our study suggests that Sesn2 is increased in CAVD aortic valves and may participate in the development of CAVD by regulating oxidative stress via the Nrf2 pathway.
Puerarin Alleviates LPS-Induced H9C2 Cell Injury by Inducing Mitochondrial Autophagy
Authors: Chang Xiao , He Yanhong , Wang Ling , Luo Chuanjin , Liu Yuntao , Li Rong 
Published: June 2022

Abstract:
Sepsis leads to the damage of multiple organs, and thereby adversely affects the cardiovascular system. At present, no effective method has been found to treat myocardial injury caused by sepsis. Although Puerarin was reported to attenuate lipopolysaccharide (LPS)-induced mitochondrial injury in H9C2 cells, the effects of Puerarin in sepsis-induced myocardial injury remain unclear. In this study, H9C2 cells were stimulated with LPS, CCK-8 assays were performed to assess cell viability, and flow cytometry and TUNEL staining were used to assess cell apoptosis. Levels of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and enzyme activity were investigated using commercial kits. Reactive oxygen species (ROS) levels in H9C2 cells were detected by flow cytometry. Autophagosomes in the mitochondria of H9C2 cells were observed by transmission electron microscope, and protein expression was assessed by western blotting. Furthermore, in vivo experiments were applied to test the function of Puerarin in sepsis. We found that Puerarin significantly reversed LPS-induced decreases in H9C2 cell viability by inhibiting apoptosis. The ROS levels in H9C2 cells were significantly upregulated by LPS, but that effect was markedly reduced by Puerarin. In addition, Puerarin attenuated LPS-induced mitochondrial injury in H9C2 cells by regulating dynamin-related protein 1 (Drp1) and mitofusin 1 (MFN1). LPS decreased enzyme activity and reduced the levels of ADP, ALP, and AMP in mitochondria; however, those effects were reversed by Puerarin. Puerarin and Torin1 reversed LPS-induced inhibition of autophagy in the mitochondria of H9C2 cells via mediation of p62, LC3B, Pink1, and Parkin. Puerarin notably inhibited the progression of sepsis in vivo. Puerarin inhibited LPS-induced H9C2 cell injury by inducing mitochondrial autophagy, which acts as a mechanism for preventing myocardial injury caused by sepsis.
Population Pharmacokinetics of Nivolumab in Japanese Patients with Nonsmall Cell Lung Cancer
Authors: Tohi Makiko , Irie Kei , Mizuno Tomoyuki , Okuyoshi Hiroyuki , Hirabatake Masaki , Ikesue Hiroaki , Muroi Nobuyuki , Eto Masaaki , Fukushima Shoji , Tomii Keisuke , Hashida Tohru 
Published: June 2022

Background:
Nivolumab is an antiprogrammed death-1 (PD-1) antibody used for immuno-oncological therapy of various cancers, including nonsmall cell lung cancer (NSCLC). This study aimed to characterize the real-world population pharmacokinetics (PK) of nivolumab in patients with NSCLC.

Methods:
PK samples were collected by opportunistic sampling of Japanese patients with NSCLC treated with nivolumab monotherapy. Population PK analysis was performed using a two-compartment model in Nonlinear Mixed Effect Model. Patient-specific factors such as body weight, age, sex, serum albumin, estimated glomerular filtration rate, performance status, programmed cell death receptor ligand 1 expression in tumors, and treatment periods were evaluated as potential covariates for clearance.

Results:
A total of 223 serum samples collected from 34 patients were available for analysis. The median (min–max) age and weight were 69 years (38–83 years) and 62.7 kg (36.8–80.5 kg), respectively. The mean (95% confidence interval) clearance estimate was 0.0064 L/h (0.0058–0.0070 L/h). The inclusion of the ALB level, estimated glomerular filtration rate, and treatment period significantly improved the model fit.

Conclusions:
A real-world nivolumab population PK model was developed using an opportunistic sampling strategy in Japanese patients with NSCLC. Further studies are warranted to characterize the exposure–response relationship and determine the optimal dosing regimens for these patients.