Scale-dependence in elk habitat selection for a reintroduced population in Wisconsin, USA.

Habitat selection is a critical aspect of a species' ecology, requiring complex decision-making that is both hierarchical and scale-dependent, since factors that influence selection may be nested or unequal across scales. Elk () ranged widely across diverse ecoregions in North America prior to European settlement and subsequent eastern extirpation. Most habitat selection studies have occurred within their contemporary western range, even after eastern reintroductions began.

A Prospective Longitudinal Quality Initiative toward Improved Enhanced Recovery after Cesarean Pathways.

Objective: This study aimed to evaluate whether enhanced recovery after cesarean (ERAC) pathways reduces inpatient and outpatient opioid use, pain scores and improves the indicators of postoperative recovery.

Study Design: This is a prospective, longitudinal, quality improvement study of all patients older than 18 undergoing an uncomplicated cesarean delivery (CD) at an academic medical center. We excluded complicated CD, patients with chronic pain disorders, chronic opioid use, acute postpartum depression, or mothers whose neonate demised before their discharge.

Hemoglobin A1c as a Substitute for Oral Glucose Testing in Early Pregnancy Screening.

Objective: Current recommendations for individuals with risk factors for gestational diabetes mellitus (GDM) call for screening in early pregnancy. However, there is currently no clear consensus on a specific screening modality. This study evaluates whether a hemoglobin A1c (HbA1c) screening in individuals with risk factors for gestational diabetes (GDM) could be used instead of an early 1-hour glucose challenge test (GCT).

Maternal and infant cannabis testing and associated birth outcomes.

Objectives: The objective of the study was to determine any identifiable clinical utility of the practice of universal maternal and infant tetrahydrocannabinol (THC) testing at the time of birth.

Methods: This was cross-sectional, retrospective cohort study comparing the following birth outcomes in relation to maternal and infant tetrahydrocannabinol (THC): APGAR scores, cord gases, NICU admission and need for immediate resuscitation. All births at the University of Maryland Medical Center between January 1, 2018 and December 31, 2020 were reviewed.

Prepregnancy Roux-en-Y gastric bypass vs sleeve gastrectomy: a systematic review, pairwise, and network meta-analysis of obstetrical and neonatal outcomes.

Objective: This study aimed to systematically investigate a wide range of obstetrical and neonatal outcomes with respect to 2 types of prepregnancy bariatric surgery, Roux-en-Y gastric bypass and sleeve gastrectomy, through: (1) providing a meta-analysis of the effect of bariatric surgery (Roux-en-Y gastric bypass vs no surgery and, separately, sleeve gastrectomy vs no surgery) on adverse obstetrical and neonatal outcomes, and (2) comparing the relative benefit of Roux-en-Y gastric bypass vs sleeve gastrectomy using both conventional and network meta-analysis.

Data Sources: We searched PubMed, Scopus, and Embase systematically from inception up to April 30, 2021.

Eligibility Criteria: Studies reporting on pregnancies' obstetrical and neonatal outcomes with respect to 2 types of prepregnancy bariatric surgery-Roux-en-Y gastric bypass and sleeve gastrectomy-were included.

Third Trimester Ultrasound Stratifies Risk of Peripartum Complications in Pregnancies Complicated by Impaired Glucose Tolerance.

Objective: The objective of our study was to investigate the effect of impaired glucose metabolism (IGM) and ultrasound (US) findings consistent with hyperglycemia on maternal and neonatal outcomes.

Study Design: This was a retrospective case-control study of singleton, nonanomalous pregnancies with an elevated 1-hour glucose screening test (GST) completed after 23 weeks of gestation. IGM was defined as a 1-hour GST of >130, but less than two abnormal values on 3-hour glucose tolerance test (GTT).

Class III obesity is an independent risk factor for unsuccessful induction of labor.

Background: Although obesity is a known risk factor for cesarean delivery, there is a paucity of data on the course of induction of labor in these patients.

Objective: With emerging data on the safety of 39-week inductions, we aimed to: (1) determine if Class III obesity, including morbid obesity, is an independent risk factor for nonachievement of complete dilation and vaginal delivery after induction of labor, (2) evaluate the characteristics of the induction of labor course and immediate complications, and (3) evaluate the number of induction agents necessary to be associated with vaginal deliveries. We hypothesized that as body mass index increased, it would take longer to achieve complete cervical dilation, more induction agents would be required, and there would be a higher rate of cesarean delivery.

Gestational weight gain below instead of within the guidelines per class of maternal obesity: a systematic review and meta-analysis of obstetrical and neonatal outcomes.

Objective: This study aimed to systematically investigate a wide range of obstetrical and neonatal outcomes as they relate to gestational weight gain less than the current Institute of Medicine and the American College of Obstetricians and Gynecologists guidelines when compared with weight gain within the guideline range and to stratify outcomes by the class of obesity and by the type of study analysis.

Data Sources: We systematically searched studies on PubMed, Scopus, Embase, and the Cochrane Library from 2009 to April 30, 2021.

Study Eligibility Criteria: Studies reporting on obstetrical and neonatal outcomes of singleton pregnancies related to gestational weight gain less than the current Institute of Medicine and the American College of Obstetricians and Gynecologists guidelines in comparison with weight gain within the guidelines among women with obesity overall (body mass index >30 kg/m) and/or a specific class of obesity (I: body mass index, 30-34.

Impact of Obstetric Communication on Decision-to-Delivery Time.

Objective: In obstetric emergencies, care coordination is critical in achieving a "decision-to-delivery" time of 30 minutes. Reliable communication is essential to optimize coordinated care of mother and baby. Clinical mobility (CM) platforms have been shown to improve communication during medical emergencies; however, their impact on improving decision-to-delivery times has not been shown.

Real-world implementation of a vaginal preparation policy prior to cesarean delivery.

Objective: Surgical site infections (SSIs) are a major source of morbidity and mortality for women who undergo cesarean section (c-section). SSIs following c-section include wound infection, infection of the endometrium (endometritis) and intra-abdominal infections. Perioperative interventions to prevent these infections continue to be studied, including the use of vaginal preparation prior to c-section.

Proning modus operandi in pregnancies complicated by acute respiratory distress syndrome secondary to COVID-19.

Introduction: Prone positioning has been widely utilized in ARDS management before and during the COVID-19 pandemic due to its demonstrated mortality benefits. In pregnancy, proning requires careful attention to often overlooked physiologic changes in pregnancy and additional technical challenges accompanying a gravid abdomen. The purpose of this manuscript is to demonstrate a proning technique that was successfully used at our institution to avoid premature delivery of the fetus while improving maternal outcomes.

Opioid prescription-use after cesarean delivery: an observational cohort study.

Objective: To evaluate current opioid prescription practices following a cesarean delivery.

Methods: Women were asked to participate in a prospective observational cohort study following a cesarean delivery. Participants were asked about their opioid use after discharge, amount leftover, subjective pain score, and satisfaction.

Concordance and discordance between maternal and newborn drug test results.

Background: Screening for substance use is recommended during pregnancy, and many clinicians rely on urine drug screening to identify newborns at potential risk for withdrawal.

Objective: This study aimed to determine the concordance and discordance rates between maternal and neonatal drug testing at or near the time of delivery.

Study Design: This retrospective chart review was performed at a single institution that employs universal testing for those who consent.

Effects of ketamine analgesia on cardiorespiratory responses and survival to trauma and hemorrhage in rats.

Ketamine is the recommended analgesic on the battlefield for soldiers with hemorrhage, despite a lack of supportive evidence from laboratory or clinical studies. Hence, this study determined the effects of ketamine analgesia on cardiorespiratory responses and survival to moderate (37% blood volume; = 8/group) or severe hemorrhage (50% blood volume; = 10/group) after trauma in rats. We used a conscious hemorrhage model with extremity trauma (fibular fracture + soft tissue injury) while measuring mean arterial pressure (MAP), heart rate (HR), and body temperature (T) by telemetry, and respiration rate (RR), minute volume (MV), and tidal volume (TV) via whole body plethysmography.

Clinical Outcomes of Pregnant and Postpartum Extracorporeal Membrane Oxygenation Patients.

Background: The use of extracorporeal membrane oxygenation (ECMO) as a rescue therapy for cardiopulmonary failure is expanding in critical care medicine. In this case series, we describe the clinical outcomes of 21 consecutive pregnant or postpartum patients that required venovenous (VV) or venoarterial (VA) ECMO. Our objective was to characterize maternal and fetal survival in peripartum ECMO and better understand ECMO-related complications that occur in this unique patient population.

Preperitoneal insufflation pressure of the abdominal wall in a porcine model.

Background: Most complications and adverse events during laparoscopic surgery occur during initial entry into the peritoneal cavity. Among them, preperitoneal insufflation occurs when the insufflation needle is incorrectly placed, and the abdominal wall is insufflated. The objective of this study was to find a range for static pressure which is low enough to allow placement of a Veress needle into the peritoneal space without causing preperitoneal insufflation, yet high enough to separate abdominal viscera from the parietal peritoneum.

Leveraging Technology to Improve Diabetes Care in Pregnancy.

Pregnant women with diabetes are at higher risk of adverse outcomes. Prevention of such outcomes depends on strict glycemic control, which is difficult to achieve and maintain. A variety of technologies exist to aid in diabetes management for nonpregnant patients.

Research: Replacing Overhead Paging with Smartphones to Reduce Hospital Noise.

Hospital noise is associated with adverse effects on patients and staff. Communication through overhead paging is a major contributor to hospital noise. Replacing overhead paging with smartphones through a clinical mobility platform has the potential to reduce transitory noises in the hospital setting, though this result has not been described.

An initiative to evaluate the safety of maternal bonding in patients with SARS-CoV-2 infection.

Background: In the last two decades, the world faced three epidemics caused by novel coronaviruses, namely, SARS-CoV in 2002, MERS-CoV in 2012, and the ongoing SARS-CoV-2 that started in late 2019. Despite a growing understanding of SARS-CoV-2 virology, epidemiology, and clinical management strategies, other aspects, such as mode of delivery, vertical transmission, and maternal bonding, remain controversial. The question we faced upon the decision to separate the neonates of SARS-CoV-2 positive mother is whether we follow the principle of "do no harm"?

Methods: This is a quality improvement project that analyzed all cases of SARS-CoV-2 positive pregnancies that delivered at a major health care system from March 1, 2020 to June, 1 2020.

Adaptation of labor and delivery to COVID-19.

As the novel coronavirus disease (COVID-19) escalates globally, and no end in sight, we describe an approach for adapting swiftly to the increasing number of COVID-19 parturients admitted into labor and delivery unit. The adaptability includes physical layout, triaging, quick testing, isolating confirmed parturients, access to designated intensive care units, facilitating emergent cesarean deliveries, and educating health care personnel. It is vital that other healthy parturi-ents and healthcare providers must be protected from COVID-19.

Marginal placental cord insertion: the need for follow up?

Objective: The objectives of this study were (1) to estimate the association between marginal placental cord insertion (PCI) and small for gestational age (SGA) and other adverse perinatal outcomes and (2) to determine if pregnancy-associated plasma protein A (PAPP-A) levels was altered in these patients.

Methods: It was a retrospective cohort study of singleton pregnancies undergoing ultrasound between 2016 and 2018. Marginal PCI was defined as a distance of ≤2 cm from placental edge to PCI site, visualized in both sagittal and transverse planes, and diagnosed between 16 and 32 weeks.

Interaction with the justice system and other factors associated with pregnant women's self-report and continuation of use of marijuana.

Background: Marijuana use in pregnancy is common and self-report of use to healthcare providers is variable. This study evaluates the relationship between prior interaction with the justice system as well as other factors associated with self-report and continuation of use of marijuana in pregnancy.

Methods: This retrospective cohort study included women with a positive urine toxicology test for marijuana at their initial prenatal visit.