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Item Impact of the Dobbs Decision on Obstetrics and Gynecology Residency Applications – an Exploratory Survey(The European Society of Medicine, 2025-04-30) Conklin, Alissa M.; Rone, Victoria; Arrocha, Diana; Scott, Nicole P.; Peipert, Jeffrey F.; Shanks, Anthony L.Objective: To evaluate the early impact of the Dobbs v. Jackson Women’s Health Organization decision on Obstetrics and Gynecology (OBGYN) residency applications by analyzing changes in applicant behavior, including application numbers and signal allocation, based on abortion law categories, program prestige, geographic region, and the availability of family planning fellowships. Study Design: This cross-sectional survey assessed 61 medium-to-large OBGYN residency programs to examine application trends before and after the Dobbs decision. Data were collected on residency applications for the 2021–2022 and 2022–2023 application cycles, the number of gold and silver signals received in the 2022 Electronic Residency Application Service (ERAS) cycle, program prestige (US News & World Report and Doximity rankings), geographic region (Center for Disease Control and Prevention (CDC)-defined), and the presence of a family planning fellowship or Ryan Program affiliation. Descriptive statistics, paired t-tests, and analysis of variance (ANOVA) were used to analyze differences in application numbers and signal allocation. Results: Across all abortion law categories, applications declined from the 2021–2022 to the 2022–2023 cycle (mean: 895.9 vs. 856.7, p = 0.02), with the largest decrease in states with abortion restrictions (-7.58%). Programs in states with abortion protections received significantly more gold (p = 0.04) and silver signals (p < 0.001) than those in restrictive states. Programs offering family planning fellowships and those affiliated with the Ryan Program also received more signals (p < 0.05). Conclusion: Programs in abortion-restrictive states received fewer applications and signals, suggesting applicants prioritize abortion training access. These trends may impact the geographic distribution of OBGYNs and reproductive healthcare availability. Implications: Declining applications to restrictive states may exacerbate maternity care shortages. Further research is needed to assess long-term effects on workforce retention and training.Item An Analysis of Obstetrics and Gynecology Medical Student Performance Evaluation Clerkship Narratives: Insights From the PRIME+ Framework(ACGME, 2025-04) Shui, Michelle L.; Armstrong, Weronika; Altendahl, Marie; Shanks, Anthony L.; Sims, Shireen M.; Ratan, Rini B.; Saab, Said S.Background: Despite existing guidelines for writing clerkship summative assessment narratives, their quality, structure, and utility remain variable. Categorizing Medical Student Performance Evaluation (MSPE) narratives using a framework can reveal patterns and gaps in content, offering actionable insights. Objective: This study aimed to (1) categorize MSPE narrative comments using the PRIME+ framework (professionalism, reporting, interpreting, managing, and educating, and areas for improvement [+]), and (2) examine differences in length and content by gender, race, origin of medical school, and final clerkship grade. Methods: Seven hundred twenty applications to our obstetrics and gynecology (OB/GYN) residency program in 2023 were reviewed, focusing on the OB/GYN core clerkship narrative. Narratives were categorized using the PRIME+ framework, and differences in length and content were assessed by gender, race, origin of medical school, and final grade. Differences between groups were evaluated with nonparametric tests. Results: Six hundred fifty-three narratives from 231 medical schools were included. Fifty-one unique grading systems were reported. PRIME+ domains were represented as follows: professionalism (94.8%, 619 of 653), reporter (71.1%, 464 of 653), interpreter (37.5%, 245 of 653), manager (69.1%, 451 of 653), educator (69.7%, 455 of 653), and areas for improvement (3.7%, 24 of 653). For each domain, <13% of narratives included ≥1 specific example. Median word count differed between US-based (155 words; 95% CI, 148-162) and international (61 words; 95% CI, 51-75) applicants (P=.001). Students earning “honors” had longer narratives (median words 149; 95% CI, 131-164 vs 117; 95% CI, 97-134; P=.001) with more specific examples (1.2 examples; 95% CI, 0.97-1.4 vs 0.88; 95% CI, 0.53-1.2; P=.024) and advanced PRIME+ domains, specifically educator (P=.016). The number of specific examples differed by race (P=.02) but not gender. Conclusions: MSPE narratives for the OB/GYN clerkship demonstrate variability in content and length.Item Integration of In Vitro Binding Mechanism Into the Semiphysiologically Based Pharmacokinetic Interaction Model Between Ketoconazole and Midazolam(Wiley, 2013-09-11) Quinney, Sara K.; Knopp, Shawn; Chang, Chien; Hall, Stephen D.; Li, Lang; Obstetrics and Gynecology, School of MedicineIn vitro screening for drug-drug interactions is an integral component of drug development, with larger emphasis now placed on the use of in vitro parameters to predict clinical inhibition. However, large variability exists in Ki reported for ketoconazole with midazolam, a model inhibitor-substrate pair for CYP3A. We reviewed the literature and extracted Ki for ketoconazole as measured by the inhibition of hydroxymidazolam formation in human liver microsomes. The superset of data collected was analyzed for the impact of microsomal binding, using Langmuir and phase equilibrium binding models, and fitted to various inhibition models: competitive, noncompetitive, and mixed. A mixed inhibition model with binding corrected by an independent binding model was best able to fit the data (Kic = 19.2 nmol/l and Kin = 39.8 nmol/l) and to predict clinical effect of ketoconazole on midazolam area under the concentration-time curve. The variability of reported Ki may partially be explained by microsomal binding and choice of inhibition model.Item Dietary Inflammatory Index Is Differentially Associated With Cardiometabolic Health After Pregnancy on the Basis of Adverse Pregnancy Outcome Exposure(American Heart Association, 2024) Jancsura, McKenzie K.; Wirth, Michael D.; Helsabeck, Nathan P.; Mercer, Brian M.; Haas, David M.; Greenland, Philip; McNeil, Rebecca; Levine, Lisa D.; Silver, Robert M.; Yee, Lynn M.; Saade, George R.; Khan, Sadiya S.; Chung, Judith H.; Grobman, William A.; Obstetrics and Gynecology, School of MedicineBackground: Inflammatory diets may influence risk of cardiovascular disease. Subsequent cardiovascular disease is also influenced by adverse pregnancy outcomes (APOs) such as preterm birth, small-for-gestational-age birth, gestational diabetes, and hypertensive disorders of pregnancy. However, the associations between inflammatory diet, APOs, and cardiometabolic health remain unclear. Methods and results: We used data from the nuMoM2b (Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be) HHS (Heart Health Study) to assess the relationship between dietary quality and cardiometabolic health. We calculated Energy-Adjusted Dietary Inflammatory Index scores representing the inflammatory burden in a person's diet. We used linear regression to determine the association between Energy-Adjusted Dietary Inflammatory Index score and cardiometabolic outcomes. We performed stratified analyses for outcomes with a significant interaction between Energy-Adjusted Dietary Inflammatory Index and APO. Data were available from 3249 participants at a median of 3.1 years after delivery. Higher Energy-Adjusted Dietary Inflammatory Index scores were associated with higher body mass index (B=0.29 kg/m2 [95% CI, 0.16-0.42]), waist circumference (0.66 cm [95% CI, 0.39-0.93]), diastolic blood pressure (0.26 mm Hg [95% CI, 0.09-0.44]), mean arterial pressure (0.23 mm Hg [95% CI, 0.06-0.40]), triglycerides (2.11 mg/dL [95% CI, 1.05-3.18]), creatinine (2.78 mg/dL [95% CI, 1.13-4.44]), insulin (exp[B]=1.04 [95% CI, 1.03-1.05]) and C-reactive protein (exp[B]=1.07 [95% CI, 1.04-1.10]), and lower high-density lipoprotein cholesterol (-0.41 mg/dL [95% CI, -0.66 to -0.37]) (all P<0.01). Significant interactions with APO (P<0.05) were identified for body mass index and waist circumference, with stratified analysis revealing stronger associations for individuals with APOs. Conclusions: A more proinflammatory diet was associated with worse cardiometabolic health measures, and these relationships differed by a person's APO history. Further investigation should establish how dietary modifications after pregnancy may potentially mitigate cardiovascular disease risk.Item "I'm supposed to be a helper": Spiritual distress of abortion providers after the Dobbs decision(Elsevier, 2025-02-22) Bode, Leah M.; Kumar, Komal A.; McQuillan, Josie C.; Scott, Nicole P.; Bernard, Caitlin; Obstetrics and Gynecology, School of MedicineBackground: The Dobbs v. Jackson Women's Health Organization decision has undoubtably affected the practice of abortion providers nationally. We hypothesized that Dobbs has also impacted the ways in which providers experience meaning and purpose through their work, which are elements of spirituality. Objective: We sought to describe the spectrum of spirituality of abortion providers and understand whether and how the Dobbs decision caused spiritual distress. Study design: For this qualitative study, we conducted video interviews with 26 abortion providers from 17 states between November 2022 and February 2023. States were classified according to the Guttmacher Institute classifications from most restrictive to very protective as of December 2022. Interviews included questions such as, "Can you describe your own sense of spirituality or spiritual identity?" and "How does your spiritual belief inform your response to the Dobbs decision?" Results: Participants' states of practice were well-distributed across the abortion restrictive-protective spectrum. The majority of participants were spiritual, while less than half identified as part of an organized religion. Many participants felt a spiritual call or obligation to provide abortion care and 46% described abortion as a spiritual act for provider and/or patient. Most participants experienced spiritual distress (74%), including those practicing in states across the restrictive-protective spectrum. Of note, 92% of participants described their spirituality as helpful in coping with the effects of the fall of Roe v. Wade. Sources of strength included advocacy, agency, legislative work, and community; over half specifically cited the abortion provider community. Conclusions: The Dobbs decision-and subsequent state-level abortion restrictions-impacts abortion providers by causing spiritual distress. While many abortion-restrictive laws are influenced by religious or spiritual beliefs, it is important to recognize that abortion providers are also spiritual individuals.Item Perceived benefits and barriers to the use of long-acting injectable antiretroviral treatment among adolescents and young people living with HIV in Western Kenya: qualitative findings from the KuwaFree! LiveFree! Study(Frontiers Media, 2025-03-07) Hassan, Shukri A.; Munyoro, Dennis; Maju, Mehar; Biegon, Whitney; Bakari, Salim; Kaguiri, Eunice; Jumah, Anjellah; Omollo, Mark; Obare, Valerie; Bernard, Caitlin; Apondi, Edith; Were, Edwin; Patel, Rena C.; Obstetrics and Gynecology, School of MedicineIntroduction: Adolescents and young people living with HIV (AYPLHIV) face significant hurdles in adhering to daily oral antiretroviral therapy (ART). Long-acting (LA) ART, such as injectable cabotegravir and rilpivirine, may help overcome these hurdles. However, little is known about the perceived benefits and barriers to LA ART usage by AYPLHIV in resource-limited settings. Methods: We conducted focus group discussions (FGDs) with four target groups of adolescents/youth, providers, policymakers, and other advocates in western Kenya from November 2021 to April 2022. The FGDs elicited participants' thoughts on LA ART implementation in Kenya, particularly the benefits and barriers of LA ART use amongst AYPLHIV. Our analysis combined both inductive and deductive approaches, beginning with open coding of the data, then organizing them in predetermined socio-ecological model (SEM) domains. Results and discussion: We conducted a total of seven FGDs with 58 participants across four stakeholder groups: AYPLHIV (2 FGDs, n = 14), healthcare providers (2 FGDs, n = 19), health/youth advocates (2 FGDs, n = 16), and policymakers (1 FGD, n = 9). We identified several benefits, largely centered around the individual and interpersonal level, as well as barriers, largely centered around the health systems levels. Participants viewed LA ART as a welcome alternative to oral ART due to benefits like improved adherence, reduced pill burden, increased convenience, enhanced privacy, decreased stigma, lower risk of accidental disclosure, and convergence in using LA contraception. At the interpersonal level, LA ART was valued for furthering relationships, especially for AYPLHIV (e.g., dating). At the health systems level, LA ART expanded first-line treatment options. Conversely, barriers to health systems integration included conflicts with service models, increased clinic burden, supply chain issues, and waste disposal. Individual-level barriers included fears of injections, side effects, concerns about a new drug, and reduced effectiveness if mixing LA ART with oral ART. Conclusions: The perceived benefits of LA ART for AYPLHIV, centering on individual and interpersonal levels of positive impacts, appear in tension with the anticipated barriers for health systems readiness in Kenya. While the prospect of offering LA ART is overwhelming positive, country programs will have to invest in health systems readiness before rolling out LA ART.Item Maternal Preconception Omega-6, Omega-3, and Omega-6:Omega-3 Intake and Uterine Artery Indices in Mid-Gestation(Thieme, 2025) Finch, Amara; Joss-Moore, Lisa; Allshouse, Amanda A.; Blue, Nathan; Haas, David M.; Grobman, William; Parry, Samuel; Saade, George; Silver, Robert M.; Obstetrics and Gynecology, School of MedicineObjective: Maternal preconception diet influences pregnancy health and fetal outcomes. We examined the relationship between preconception fatty acid (FA) intake and uterine artery indices in mid-gestation in a large, heterogeneous cohort of nulliparous individuals. Study design: This is a secondary analysis of the nuMom2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be) study. Dietary ω-6 and ω-3 FA intake was assessed with food frequency questionnaires and uterine artery indices were obtained via Doppler studies in the second trimester. For our primary outcome of pulsatility index (PI) > 1.6, we compared proportions by each dichotomous FA exposure and tested differences with chi-square test. Results: For PI > 1.6, odds ratio for the unfavorable FA quartile compared with remaining quartiles for the exposures were 0.96 to 1.25, p = 0.157 (ω-6 FA); 0.97 to 1.26, p = 0.124 (ω-3 FA); 0.87 to 1.14, p = 1.00 (ω-6:ω-3 FA ratio). Conclusion: No significant associations between self-reported maternal preconception ω-6 and ω-3 FA intake and uterine artery Doppler indices measured during the second trimester were observed.Item Facilitating Global Collaborations for Pregnancy and Pediatric Biomarker Research Through a Biobank Database: The COPPER Project(Elsevier, 2024) Faysal, Hani; Quinney, Sara K.; Haas, David M.; Obstetrics and Gynecology, School of MedicineItem Durotaxis and extracellular matrix degradation promote the clustering of cancer cells(Elsevier, 2025-01-24) Potomkin, Mykhailo; Kim, Oleg; Klymenko, Yuliya; Alber, Mark; Aranson, Igor S.; Obstetrics and Gynecology, School of MedicineEarly stages of metastasis depend on the collective behavior of cancer cells and their interaction with the extracellular matrix (ECM). Cancer cell clusters are known to exhibit higher metastatic potential than single cells. To explore clustering dynamics, we developed a calibrated computational model describing how motile cancer cells biochemically and biomechanically interact with the ECM during the initial invasion phase, including ECM degradation and mechanical remodeling. The model reveals that cluster formation time, size, and shape are influenced by ECM degradation rates and cellular compliance to external stresses (durotaxis). The results align with experimental observations, demonstrating distinct cell trajectories and cluster morphologies shaped by biomechanical parameters. The simulations provide valuable insights into cancer invasion dynamics and may suggest potential therapeutic strategies targeting early-stage invasive cells.Item Short-term tocolytics for preterm delivery – current perspectives(Dove Press, 2014-03-27) Haas, David M.; Benjamin, Tara; Sawyer, Renata; Quinney, Sara K.; Obstetrics and Gynecology, School of MedicineAdministration of short-term tocolytic agents can prolong pregnancy for women in preterm labor. Prolonging pregnancy has many benefits because it allows for other proven interventions, such as antenatal corticosteroid administration, to be accomplished. This review provides an overview of currently utilized tocolytic agents and the evidence demonstrating their efficacy for prolonging pregnancy by at least 48 hours. General pharmacological principles for the clinician regarding drugs in pregnancy are also briefly discussed. In general, while the choice of the best first-line short-term tocolytic drug is not clear, it is evident that use of these agents has a clear place in current obstetric therapeutics.