Pipeline emergency preparedness in Nebraska: Identifying interagency preparedness gaps and proposing solutions.

In Nebraska, there are over 28,000 miles of pipelines that carry various materials, which could impact human health and the natural environment in the event of a leak or spill. Nebraska is heavily reliant on its expansive groundwater supply from the large High Plains aquifer system as well as smaller secondary aquifers. Eighty-eight percent of Nebraska's population utilizes groundwater for personal use, and the state's agricultural sector depends on it for irrigation and livestock care.

The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review.

Background: Adults undergoing spine surgery often have underlying osteoporosis, which may be a risk factor for postoperative complications. Although these associations have been described, osteoporosis remains profoundly underdiagnosed and undertreated in the spine surgery population. A thorough, comprehensive systematic review summarizing the relationships between bone mineral density (BMD) and specific complications of lumbar fusion surgery could be a valuable resource for raising awareness and supporting clinical practice changes.

Male contraception: narrative review of ongoing research.

Background: Since the release of the combined oral contraceptive pill in 1960, women have shouldered the burden of contraception and family planning. Over 60 years later, this is still the case as the only practical, effective contraceptive options available to men are condoms and vasectomy. However, there are now a variety of promising hormonal and non-hormonal male contraceptive options being studied.

Burnout Among South Dakota-Licensed Physicians.

Introduction: Physician well-being is a topic of increasing attention nationwide. In collaboration with the South Dakota Board of Osteopathic and Medical Examiners and the South Dakota State Medical Association, we undertook an anonymous, web-based survey of all licensed physicians to assess the current baseline level of physician burnout.

Methods: The survey consisted of demographic questions and a single, validated burnout question that correlates with the lengthier Maslach Burnout Index.

COVID-19 Vaccine Hesitancy in Rural Midwestern Infertility Patients: A Cross-Sectional Survey.

Background: Pregnant patients with COVID-19 experience higher rates of maternal mortality, pregnancy loss, and other severe comorbidities. Despite these well-characterized risks, this group displayed a high level of vaccine hesitancy that contributed to their slow acceptance of the COVID-19 vaccinations and greater maternal mortality during the pandemic. The rural Midwest was no exception to this unfortunate trend, so here we sought to determine attitudes, beliefs, and perceptions in these women and their partners associated with vaccine hesitancy to better address uncertainties and improve vaccination rates.

Isthmoceles: A Growing Concern.

An isthmocele is described as a pouch-like defect in the uterus with a thin roof formed by inadequate healing of the smooth muscle of the anterior uterine wall at the site of a hysterotomy. With increased rates of deliveries by cesarean section, isthmoceles are becoming a more common cause of gynecologic and obstetric complications. Gynecologic issues include pelvic pain, postmenstrual bleeding, and reduced fertility or infertility.

Tranexamic Acid in the Prevention and Treatment of Postpartum Hemorrhage: A Review.

Postpartum hemorrhage (PPH) continues to be one of the leading causes of maternal morbidity and mortality worldwide. The four main causes of PPH are uterine atony, lacerations, retained placenta, and bleeding diathesis. In the patient with PPH, immediate evaluation is needed to diagnose and treat the underlying cause of hemorrhage.

Effects of alcohol use on sperm chromatin structure, a retrospective analysis.

Background: The evaluation of the infertile couple is often complex as multiple factors in both the male and female can contribute, including social history. Previous studies have displayed that male ethanol consumption can disturb sperm motility, nuclear maturity, and deoxyribonucleic acid (DNA) integrity. The main purpose of this study is to evaluate the effects of male alcohol use on sperm chromatin structure analysis (SCSA®).

Preventing Unintended Pregnancies: A Review of Long-Acting Reversible Contraception.

With increasing uncertainty surrounding female reproductive rights, patient education about contraceptive options is of paramount importance. Although traditional oral contraceptive pills (OCP) are often used to prevent pregnancy, they require precise, daily effort and have continual monetary maintenance costs for patients. Long-acting reversible contraceptives (LARCs) - intrauterine devices and the contraceptive implant - are effective and reliable alternatives to OCPs that are gaining popularity in the U.

Nonalcoholic Fatty Liver Disease in Women with Polycystic Ovarian Syndrome: A Narrative Review.

Polycystic ovarian syndrome (PCOS) has been estimated to affect 10-15 percent of women in the U.S. Emerging research has found higher rates of nonalcoholic fatty liver disease (NAFLD) among PCOS individuals.

Snowed In: A Case Report on the Utilization of Ultrasound in the Diagnosis of Fractures.

The standard convention for diagnosing bone fractures is through radiography. However, radiography can miss fractures depending on the type of injury or if human error is present. This may be due to improper patient positioning leading to superimposing bones being captured in the image, obscuring pathology.

Vitamin D levels and human sperm DNA fragmentation: a prospective, cohort study.

Background: Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of couples with male factor infertility but results remain suboptimal and suggest the need for further investigation into the molecular biology of spermatozoa. Vitamin D has been implicated in spermatogenesis and sperm function. Hypovitaminosis D has been associated with abnormal testicular function, including elevated sperm DNA fragmentation in a murine model.

Pancreas Transplantation for Type 2 Diabetes: A Systematic Review, Critical Gaps in the Literature, and a Path Forward.

Pancreas transplantation in patients with type 2 diabetes (T2D) remains relatively uncommon compared with pancreas transplantation in patients with type 1 diabetes (T1D); however, several studies have suggested similar outcomes between T2D and T1D, and the practice has become increasingly common. Despite this growing interest in pancreas transplantation in T2D, no study has systematically summarized the data to date. We systematically reviewed the literature on pancreas transplantation in T2D patients including patient and graft survival, glycemic control outcomes, and comparisons with outcomes in T2D kidney transplant alone and T1D pancreas transplant recipients.

Developing a Rapid Response Single IRB Model for Conducting Research During a Public Health Emergency.

Research is foundational for evidence-based management of patients. Clinical research, however, takes time to plan, conduct, and disseminate-a luxury that is rarely available during a public health emergency. The University of Nebraska Medical Center (UNMC) developed a single institutional review board (IRB), with a vision to establish a rapid review resource for a network focused on clinical research of emerging pathogens in the United States.

Menstrual Migraines: Diagnosis, Evidence, and Treatment.

"Menstrual" or "catamenial" migraine (MM) is separated into two categories in the International Classification of Headache Disorders pure menstrual migraine and menstrually-related migraine. Pure menstrual migraine is defined as a migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other time in the cycle. Menstrually-related migraine is defined as the same but may occur at other times in the menstrual cycle, not just around menstruation.

Complementary and Alternative Treatments for Postpartum Depression.

Complementary and alternative treatments are commonly requested as treatment options for depression. This article provides a review of evidence for complementary and alternative therapies (doula support, saffron, yoga, aromatherapy, placentophagy, mindfulness, probiotics and wake therapy) in the treatment of postpartum depression. The included studies, mainly randomized control trials, focus on the efficacy of these interventions as compared to standard pharmacotherapy and or no treatment.

The Female Athlete Triad - What it is and Why it is Important in Primary Care.

The female athlete triad (FAT) is a disorder involving greater energy expenditure than energy consumption leading to 1) low energy availability (EA) with or without disordered eating 2) menstrual irregularities or amenorrhea and 3) low bone mineral density. Consequences of FAT include osteoporosis, stress fractures, increased cardiovascular risk, infertility, and negative psychological effects. The key risk factor for FAT is inadequate caloric intake when compared to the amount and intensity of exercise.

Relationship between body mass index and malignancy rates of MRI-guided breast biopsies: impact of clinicodemographic factors.

Purpose: To determine the positive predictive value (PPV) of magnetic resonance imaging (MRI)-guided breast biopsy stratified by body mass index (BMI). Secondary endpoints include evaluation of indications for breast MRI and identification of factors associated with malignant biopsy.

Methods: We retrospectively analyzed results of MRI-guided breast biopsies in a consecutive cohort of women at a single institution between 2014 and 2019.

A Case of Uterine Arteriovenous Malformation Treated With Uterine Artery Embolization.

Uterine arteriovenous malformation (AVM) is a rare condition that is potentially life-threatening. There are limited published reports on this condition. This is a case report of a 25-year-old woman who presented with a symptomatic AVM.

A world-wide survey on kidney transplantation practices in breast cancer survivors: The need for new management guidelines.

Kidney transplantation reduces mortality in patients with end stage renal disease (ESRD). Decisions about performing kidney transplantation in the setting of a prior cancer are challenging, as cancer recurrence in the setting of immunosuppression can result in poor outcomes. For cancer of the breast, rapid advances in molecular characterization have allowed improved prognostication, which is not reflected in current guidelines.