Specialty-Based Ambulatory Quality Improvement Program: A Specialty-Specific Ambulatory Metric Project.

Background And Objectives: Healthcare is increasingly being delivered in the outpatient setting, but robust quality improvement programs and performance metrics are lacking in ambulatory care, particularly specialty-based ambulatory care.

Methods: To promote quality improvement in ambulatory care, we developed an infrastructure to create specialty-specific quality measures and dashboards that could be used to display providers' performance across relevant measures to individual providers and institutional leaders.

Results: The products of this program include a governance and infrastructure for specialty-specific ambulatory quality metrics as well as two distinct dashboards for data display.

Seismic magnitude clustering is prevalent in field and laboratory catalogs.

Clustering of earthquake magnitudes is still actively debated, compared to well-established spatial and temporal clustering. Magnitude clustering is not currently implemented in earthquake forecasting but would be important if larger magnitude events are more likely to be followed by similar sized events. Here we show statistically significant magnitude clustering present in many different field and laboratory catalogs at a wide range of spatial scales (mm to 1000 km).

Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor.

Objective: Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied in only term inductions. Our study investigated duration of time in hours for CRB expulsion and vaginal delivery in preterm inductions of labor.

Repetitive catamenial myocardial infarction due to coronary artery spasm: a case report.

Background: Coronary artery spasm is an established mechanism of myocardial infarction with non-obstructive coronary arteries (MINOCA). Various mechanisms have been proposed, ranging from vascular smooth muscle hyperreactivity to endothelial dysfunction, to autonomic nervous system dysregulation.

Case Summary: We report a case of a 37-year-old woman who presented with recurrent non-ST elevation myocardial infarction (NSTEMI), coinciding with her menstrual periods.

Patient Experience with Telehealth Medicine During the Ongoing COVID-19 Pandemic in New York City.

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Screening and Treatment After Implementation of a Universal Perinatal Depression Screening Program.

Objective: To evaluate whether initiation of an institutional policy of universal perinatal depression screening was associated with sustained increases in frequency in screening and of depression treatment subsequent to a positive screen.

Methods: This retrospective cohort study included women receiving prenatal care in outpatient offices at a single academic medical center from 2008 to 2015. In 2009, an institutional policy of universal perinatal depression screening was disseminated in which screening twice antenatally and again postpartum were recommended.

Statistical methods for building better biomarkers of chronic kidney disease.

The last two decades have witnessed an explosion in research focused on the development and assessment of novel biomarkers for improved prognosis of diseases. As a result, best practice standards guiding biomarker research have undergone extensive development. Currently, there is great interest in the promise of biomarkers to enhance research efforts and clinical practice in the setting of chronic kidney disease, acute kidney injury, and glomerular disease.

Ugandan Health Care Professionals' Response to Sexual Violence Survivors: Exploring Local Strategy and International Guidelines.

This survey-based study gathered information on health professionals' attitudes and behaviors regarding victims of sexual assault, focusing on the applicability and utility of best practices put forth by the World Health Organization and the United Nations. This cross-sectional study involved a self-administered, 84-question survey to health care professionals affiliated with Mulago National Referral and Kayunga Hospitals in Uganda. The survey included demographic questions as well as questions about participants' attitudes toward sexual violence and the role of HPs in addressing sexual violence.

Gender Differences in Academic Rank and NIH Funding among Academic Maternal-Fetal Medicine Physicians in the United States.

Objective: This article evaluates gender differences in academic rank and National Institutes of Health (NIH) funding among academic maternal-fetal medicine (MFM) physicians.

Study Design: This was a cross-sectional study of board-certified academic MFM physicians. Physicians were identified in July 2017 from the MFM fellowship Web sites.

Labor Curves in Multiparous Women Related to Interbirth Intervals.

Objective: Previous studies have shown that risk of cesarean section increases among multiparous women as interbirth interval increases. One possibility is that progress of labor may vary with interbirth interval, such that with longer intervals, labor curves of multiparas more closely resemble those of nulliparas. We sought to define labor curves among a cohort of multiparas with varying interbirth intervals.

Overcoming Translational Barriers in Acute Kidney Injury: A Report from an NIDDK Workshop.

AKI is a complex clinical condition associated with high mortality, morbidity, and health care costs. Despite improvements in methodology and design of clinical trials, and advances in understanding the underlying pathophysiology of rodent AKI, no pharmacologic agent exists for the prevention or treatment of AKI in humans. To address the barriers that affect successful clinical translation of drug targets identified and validated in preclinical animal models of AKI in this patient population, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "AKI Outcomes: Overcoming Barriers in AKI" workshop on February 10-12, 2015.

Long-Term Sexual Function After Obstetric Anal Sphincter Injuries.

Objectives: Obstetric anal sphincter injuries (OASIS) are associated with severe short and long-term morbidities, although little is known about the long-term sexual function or satisfaction of women and partners of women with history of OASIS. The objective of this study was to describe the long-term sexual function and satisfaction of women who previously sustained OASIS and to assess sexual satisfaction among their male partners.

Methods: This was a follow-up study of participants enrolled in the For Optimal Recovery: Care After Severe Tears (FORCAST) prospective cohort study of women with a history of OASIS after delivery of a full-term singleton infant between 2011 and 2013.

High-Throughput Processing to Preserve Viable Cells: A Precision Medicine Initiative Cohort Program Workshop.

Conventionally, biobanks supporting clinical research studies have preserved serum, plasma, urine, saliva, a variety of tissue types, and stool. With the emergence of increasingly sophisticated technologies for analyzing single cells, there is growing interest in preserving viable blood cells for future functional studies. The new All of Us Research Program (formerly the Precision Medicine Initiative Cohort Program) biobank plans to house samples from a million or more individuals as part of a cohort with rich phenotypic data and longitudinal follow-up ( www.

(Re)Building a Kidney.

(Re)Building a Kidney is a National Institute of Diabetes and Digestive and Kidney Diseases-led consortium to optimize approaches for the isolation, expansion, and differentiation of appropriate kidney cell types and the integration of these cells into complex structures that replicate human kidney function. The ultimate goals of the consortium are two-fold: to develop and implement strategies for engineering of replacement kidney tissue, and to devise strategies to stimulate regeneration of nephrons to restore failing kidney function. Projects within the consortium will answer fundamental questions regarding human gene expression in the developing kidney, essential signaling crosstalk between distinct cell types of the developing kidney, how to derive the many cell types of the kidney through directed differentiation of human pluripotent stem cells, which bioengineering or scaffolding strategies have the most potential for kidney tissue formation, and basic parameters of the regenerative response to injury.

Multiparameter mechanical and morphometric screening of cells.

We introduce a label-free method to rapidly phenotype and classify cells purely based on physical properties. We extract 15 biophysical parameters from cells as they deform in a microfluidic stretching flow field via high-speed microscopy and apply machine-learning approaches to discriminate different cell types and states. When employing the full 15 dimensional dataset, the technique robustly classifies individual cells based on their pluripotency, with accuracy above 95%.

Predictors of shoulder dystocia at the time of operative vaginal delivery.

Background: It remains uncertain whether clinical factors known prior to delivery can predict which women are more likely to experience shoulder dystocia in the setting of operative vaginal delivery.

Objective: We sought to identify whether shoulder dystocia can be accurately predicted among women undergoing an operative vaginal delivery.

Study Design: This was a case-control study of women undergoing a low or outlet operative vaginal delivery from 2005 through 2014 in a single tertiary care center.

Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy.

Objective: Female sterilization is one of the most prevalent methods of contraception in the United States. Prior studies have shown that nearly half of postpartum tubal ligation (PPTL) requests go unfulfilled. This study seeks to establish whether obstetric or medical risk status influences patients' request for or subsequent completion of PPTL.

Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma.

Objective: To evaluate the association of a forceps simulation training curriculum for obstetrics residents on rates of severe perineal lacerations after forceps deliveries.

Methods: This was a retrospective cohort study. We created a novel simulation curriculum for forceps-assisted vaginal delivery based on the best practices of local experts, and trained all residents beginning in 2013.