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author:("schulman, Jay")
1.  Need to know: the need for cognitive closure impacts the clinical practice of obstetrician/gynecologists 
Background
Need for cognitive closure (NFCC) has been shown to be a consistent and measurable trait. It has effects on decision making and has been associated with more rapid decision making, higher reliance on heuristics or biases for decision making, reduced tolerance for ambiguity, and reduced interest in searching for alternatives. In medical practice, these tendencies may lead to lower quality of decision making.
Methods
This study measured NFCC in 312 obstetrician/gynecologists using a survey-style approach. Physicians were administered a short NFCC scale and asked questions about their clinical practice.
Results
Obstetrician/gynecologists with high NFCC were found to be less likely to address a number of clinical questions during well-woman exams, and were more likely to consult a greater number of sources when prescribing new medications.
Conclusions
NFCC of physicians may have an important impact on practice. It is possible that increased training during residency or medical school could counteract the detrimental effects of NFCC, and steps can be taken through increased use of electronic reminder systems could orient physicians to the appropriate questions to ask patients.
Electronic supplementary material
The online version of this article (doi:10.1186/s12911-014-0122-6) contains supplementary material, which is available to authorized users.
doi:10.1186/s12911-014-0122-6
PMCID: PMC4297425
Need for Cognitive Closure; Obstetricians/gynecologists; Medical decision making; Uncertainty
2.  Revisiting shyness and sociability: a preliminary investigation of hormone-brain-behavior relations 
Frontiers in Psychology  2014;5:1430.
Shyness and sociability are two fundamental personality dimensions that are conceptually and empirically orthogonal and are conserved across cultures, development, and phylogeny. However, we know relatively little regarding how shyness and sociability are represented and maintained in the brain. Here we examined neural responses to the processing of different types of social threat using event-related fMRI, the salivary cortisol awakening response (CAR), and sociability in young adults selected for high and low shyness. Shy adults who exhibited a relatively higher CAR displayed neural activity in putative brain regions involved in emotional conflict and awareness, and were more sociable. In contrast, shy adults who displayed a relatively lower CAR exhibited neural activity in putative brain regions linked to fear and withdrawal, and were unsociable. Results revealed no systematic brain responses to social threat processing that correlated with the CAR in non-shy adults. These preliminary results suggest that individual differences in waking morning cortisol levels may influence neural processes that facilitate either social approach or withdrawal among people who are shy. Findings are discussed in relation to their theoretical and clinical implications for moving beyond longstanding descriptive to explanatory models of shyness and sociability and for understanding individual differences in social behavior in general.
doi:10.3389/fpsyg.2014.01430
PMCID: PMC4274875  PMID: 25566117
shyness; sociability; fMRI; temperament; cortisol; partial least squares (PLS)
3.  An anatomically comprehensive atlas of the adult human brain transcriptome 
Nature  2012;489(7416):391-399.
Neuroanatomically precise, genome-wide maps of transcript distributions are critical resources to complement genomic sequence data and to correlate functional and genetic brain architecture. Here we describe the generation and analysis of a transcriptional atlas of the adult human brain, comprising extensive histological analysis and comprehensive microarray profiling of ~900 neuroanatomically precise subdivisions in two individuals. Transcriptional regulation varies enormously by anatomical location, with different regions and their constituent cell types displaying robust molecular signatures that are highly conserved between individuals. Analysis of differential gene expression and gene co-expression relationships demonstrates that brain-wide variation strongly reflects the distributions of major cell classes such as neurons, oligodendrocytes, astrocytes and microglia. Local neighbourhood relationships between fine anatomical subdivisions are associated with discrete neuronal subtypes and genes involved with synaptic transmission. The neocortex displays a relatively homogeneous transcriptional pattern, but with distinct features associated selectively with primary sensorimotor cortices and with enriched frontal lobe expression. Notably, the spatial topography of the neocortex is strongly reflected in its molecular topography— the closer two cortical regions, the more similar their transcriptomes. This freely accessible online data resource forms a high-resolution transcriptional baseline for neurogenetic studies of normal and abnormal human brain function.
doi:10.1038/nature11405
PMCID: PMC4243026  PMID: 22996553
Neuroscience; Genetics; Genomics; Databases
4.  Obstetrician-Gynecologists’ knowledge of sickle cell disease screening and management 
Background
Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs.
Methods
Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training.
Results
A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%.
Conclusions
The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education.
doi:10.1186/1471-2393-14-356
PMCID: PMC4287569  PMID: 25311876
Sickle cell disease; Physician practice patterns; Obstetrics
5.  Statistical Literacy of Obstetrics-Gynecology Residents 
Background
Residents' ability to interpret statistics is important for scholarly pursuits and understanding evidence-based medicine. Yet there is limited research assessing residents' statistical literacy and their training in statistics.
Methods
In 2011 we surveyed US obstetrics-gynecology residents participating in the Council for Resident Education in Obstetrics and Gynecology In-Training Examination about their statistical literacy and statistical literacy training.
Results
Our response rate was 95% (4713 of 4961). About two-thirds (2980 of 4713) of the residents rated their statistical literacy training as adequate. Female respondents were more likely to rate their statistical literacy training poorly, with 25% (897 of 3575) indicating inadequate literacy compared with 17% (141 of 806) of the male respondents (P < .001). Respondents performed poorly on 2 statistical literacy questions, with only 26% (1222 of 4713) correctly answering a positive predictive value question and 42% (1989 of 4173) correctly defining a P value. A total of 51% (2391 of 4713) of respondents reported receiving statistical literacy training through a journal club, 29% (1359 of 4713) said they had informal training, 15% (711 of 4713) said that they had statistical literacy training as part of a course, and 11% (527 of 4713) said that they had no training.
Conclusions
The findings suggest that statistical literacy training for residents could still be improved. A total of 37% (1743 of 4713) of obstetrics-gynecology residents have received no formal statistical literacy training in residency. Fewer residents answered the 2 statistical literacy questions correctly compared with previous studies.
doi:10.4300/JGME-D-12-00161.1
PMCID: PMC3693693  PMID: 24404272
6.  Metabolic consequences of the early onset of obesity in common marmoset monkeys 
Obesity (Silver Spring, Md.)  2013;21(12):10.1002/oby.20462.
Objective
We assess the common marmoset as a model of early obesity. We test the hypotheses that juvenile marmosets with excess adipose tissue will display higher fasting glucose, decreased insulin sensitivity, and decreased ability to clear glucose from the blood stream.
Design and Methods
Normal and Obese (body fat > 14%) common marmoset infants (N = 39) were followed from birth until one year. Body fat was measured by quantitative magnetic resonance. Circulating glucose was measured by glucometer; insulin, adiponenctin and leptin by commercial assays. The QUICKI (a measure of insulin sensitivity) was calculated for subjects with fasting glucose and insulin measures. Oral glucose tolerance tests were conducted at 12 months on 35 subjects.
Results
At 6 months Obese subjects already had significantly lower insulin sensitivity (mean QUICKI = .378±.029 versus .525±.019, N=11, p=.003). By 12 months Obese subjects also had higher fasting glucose (129.3±9.1 mg/dL versus 106.1±6.5 mg/dL, p=.042) and circulating adiponectin tended to be lower (p=.057). Leptin was associated with percent body fat; however, birth weight also influenced circulating leptin. The OGTT results demonstrated that Obese animals had a decreased ability to clear glucose.
Conclusions
Early onset obesity in marmosets results in impaired glucose homeostasis by one year.
doi:10.1002/oby.20462
PMCID: PMC3855166  PMID: 23512966
insulin sensitivity; glucose; leptin; adiponectin
7.  Attitudes and Practices Regarding Late Preterm Birth Among American Obstetrician-Gynecologists 
Journal of Women's Health  2013;22(2):167-172.
Abstract
Background
Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age.
Methods
A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May–July 2010.
Results
Surveys were returned by 520 practicing obstetricians. Two thirds of respondents correctly defined LPTB (34–36 weeks completed gestation). Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34–36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34–36 weeks.
Conclusions
Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed.
doi:10.1089/jwh.2012.3814
PMCID: PMC3573726  PMID: 23350861
8.  The evolution of music and human social capability 
Music is a core human experience and generative processes reflect cognitive capabilities. Music is often functional because it is something that can promote human well-being by facilitating human contact, human meaning, and human imagination of possibilities, tying it to our social instincts. Cognitive systems also underlie musical performance and sensibilities. Music is one of those things that we do spontaneously, reflecting brain machinery linked to communicative functions, enlarged and diversified across a broad array of human activities. Music cuts across diverse cognitive capabilities and resources, including numeracy, language, and space perception. In the same way, music intersects with cultural boundaries, facilitating our “social self” by linking our shared experiences and intentions. This paper focuses on the intersection between the neuroscience of music, and human social functioning to illustrate the importance of music to human behaviors.
doi:10.3389/fnins.2014.00292
PMCID: PMC4166316  PMID: 25278827
music; evolution; social capability; cognitive capability; communication
9.  The development of obesity begins at an early age in captive common marmosets (Callithrix jacchus) 
American journal of primatology  2012;74(3):261-269.
Animal models to study the causes and consequences of obesity during infancy in humans would be valuable. In this study we examine the patterns of fat mass gain from birth to 12 months in common marmosets (Callithrix jacchus). Lean and fat mass was measured by quantitative magnetic resonance at 1, 2, 6, and 12 months for 31 marmosets, 15 considered Normal and 16 considered Fat (>14% body fat) at 12 months. Animals were fed either the regular colony diet mix or a high-fat variation. Subjects classified as Fat at 12 months already had greater lean mass (198.4±6.2g vs 174.0±6.8g, p=.013) and fat mass (45.5±5.0g vs 24.9±3.4g, p=.002) by 6 months. Body mass did not differ between groups prior to 6 months, however, by 1 month Fat infants had greater percent body fat. Percent body fat decreased between 1 and 12 months in Normal subjects; in Fat subjects it increased. The high-fat diet was associated with body fat >14% at 6 months (p=.049), but not at 12 months. This shift was due to 3 subjects on the normal diet changing from Normal to Fat between 6 and 12 months. Although maternal prepregnancy adiposity did not differ, overall, between Normal and Fat subjects, the subjects Normal at 6 and Fat at 12 months all had Fat mothers. Therefore, diet and maternal obesity appear to have potentially independent effects that may also vary with developmental age. Although birth weight did not differ between groups, it was associated with fat mass gain from 1 to 6 months in animals with >14% body fat at 6 months of age (r=.612, p=.026); but not in 6 month old animals with < 14% body fat (r=-.012, p=.964). Excess adiposity in captive marmosets develops by 1 month. Birth weight is associated with adiposity in animals vulnerable to obesity.
PMCID: PMC3767183  PMID: 24006544
Primates; body composition; adiposity; childhood obesity
10.  Paternal deprivation affects the functional maturation of corticotropin-releasing hormone (CRH)- and calbindin-D28k-expressing neurons in the bed nucleus of the stria terminalis (BNST) of the biparental Octodon degus 
Brain Structure & Function  2013;219(6):1983-1990.
While the critical role of maternal care on the development of brain and behavior of the offspring has been extensively studied, our knowledge about the importance of paternal care for brain development of his offspring is still comparatively scarce. The aim of this study in the biparental caviomorph rodent Octodon degus was to analyze the impact of paternal care on the development of corticotropin-releasing hormone (CRH)-expressing neurons in the bed nucleus of the stria terminalis (BNST) and hypothalamic paraventricular nucleus (PVN). Both brain areas are key players in neuronal circuits that regulate hypothalamic–pituitary–adrenal axis (HPA) activity. At the age of postnatal day (PND) 21, we found that paternal deprivation resulted in a decreased density of CRH-containing neurons in the medial, but not in the lateral BNST, whereas no changes were observed in the PVN. These deprivation-induced changes were still prominent in adulthood. At PND 21, the density of Ca-binding protein calbindin D28K (CaBP-D28K)-expressing neurons was specifically increased in the medial, but not lateral BNST of father-deprived animals. In contrast, adult father-deprived animals show significantly decreased density of CaBP-D28K-expressing neurons in the lateral, but not medial BNST. Taken together, these results may have important implications for our understanding of the experience-driven development of neural circuits that regulate HPA activity mediating acute responses to stress and chronic anxiety.
doi:10.1007/s00429-013-0617-4
PMCID: PMC4223576  PMID: 23913254
Parental behavior; Development; Corticotropin-releasing factor; Quantitative immunocytochemistry
11.  Importance of Stress Receptor-Mediated Mechanisms in the Amygdala on Visceral Pain Perception in an Intrinsically Anxious Rat 
Background
Stress worsens abdominal pain experienced by patients with irritable bowel syndrome (IBS), a chronic disorder of unknown origin with comorbid anxiety. We have previously demonstrated colonic hypersensitivity in Wistar-Kyoto rats (WKYs), a high-anxiety strain, that models abdominal pain in IBS. In low-anxiety rats, we have demonstrated that the central nucleus of the amygdala (CeA) regulates colonic hypersensitivity and anxiety induced by selective activation of either glucocorticoid receptors (GR) or mineralocorticoid receptors (MR), which is also mediated by the corticotropin releasing factor (CRF) type-1 receptor. The goal of the present study was to test the hypothesis that the CeA through GR, MR and/or CRF-1R regulates colonic hypersensitivity in WKYs.
Methods
One series of WKYs had micropellets of a GR antagonist, an MR antagonist or cholesterol (control) stereotaxically implanted onto the CeA. Another series were infused in the CeA with CRF-1R antagonist or vehicle. Colonic sensitivity was measured as a visceromotor response (VMR) to graded colorectal distension (CRD).
Key Results
The exaggerated VMR to graded CRD in WKYs was unaffected by GR or MR antagonism in the CeA. In contrast, direct CeA infusion of CRF-1R antagonist significantly inhibited the VMR to CRD at noxious distension pressures.
Conclusions & Inferences
Stress-hormones in the CeA regulate colonic hypersensitivity in the rat through strain-dependent parallel pathways. The colonic hypersensitivity in WKYs is mediated by a CRF-1R mechanism in the CeA, independent of GR and MR. These complementary pathways suggest multiple etiologies whereby stress hormones in the CeA may regulate abdominal pain in IBS patients.
doi:10.1111/j.1365-2982.2012.01899.x
PMCID: PMC3461498  PMID: 22364507
amygdala; corticotropin releasing factor; colon; visceral hypersensitivity; IBS; Wistar-Kyoto rat
12.  A First Look at Chorioamnionitis Management Practice Variation among US Obstetricians 
Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
doi:10.1155/2012/628362
PMCID: PMC3540735  PMID: 23319852
13.  Oxytocin Reduces Background Anxiety in a Fear-Potentiated Startle Paradigm: Peripheral vs Central Administration 
Neuropsychopharmacology  2011;36(12):2488-2497.
Oxytocin is known to have anti-anxiety and anti-stress effects. Using a fear-potentiated startle paradigm in rats, we previously demonstrated that subcutaneously administered oxytocin suppressed acoustic startle following fear conditioning compared with startle before fear conditioning (termed background anxiety), but did not have an effect on cue-specific fear-potentiated startle. The findings suggest oxytocin reduces background anxiety, an anxious state not directly related to cue-specific fear, but sustained beyond the immediate threat. The goal of the present study was to compare the effects of centrally and peripherally administered oxytocin on background anxiety and cue-specific fear. Male rats were given oxytocin either subcutaneously (SC) or intracerebroventricularly (ICV) into the lateral ventricles before fear-potentiated startle testing. Oxytocin doses of 0.01 and 0.1 μg/kg SC reduced background anxiety. ICV administration of oxytocin at doses from 0.002 to 20 μg oxytocin had no effect on background anxiety or cue-specific fear-potentiated startle. The 20 μg ICV dose of oxytocin did reduce acoustic startle in non-fear conditioned rats. These studies indicate that oxytocin is potent and effective in reducing background anxiety when delivered peripherally, but not when delivered into the cerebroventricular system. Oxytocin given systemically may have anti-anxiety properties that are particularly germane to the hypervigilance and exaggerated startle typically seen in many anxiety and mental health disorder patients.
doi:10.1038/npp.2011.138
PMCID: PMC3194076  PMID: 21796104
oxytocin; anxiety; fear; startle; PTSD; mood/anxiety/stress disorders; neuropeptides; learning & memory; animal models; oxytocin; fear; startle; PTSD
14.  Dose-dependent effects of hydrocortisone infusion on autobiographical memory recall 
Behavioral neuroscience  2011;125(5):735-741.
The glucocorticoid hormone cortisol has been shown to impair episodic memory performance. The present study examined the effect of two doses of hydrocortisone (synthetic cortisol) administration on autobiographical memory retrieval.
Healthy volunteers (n=66) were studied on two separate visits, during which they received placebo and either moderate-dose (0.15 mg/kg IV; n=33) or high-dose (0.45 mg/kg IV; n=33) hydrocortisone infusion. From 75 to 150 min post-infusion subjects performed an Autobiographical Memory Test and the California Verbal Learning Test (CVLT).
The high-dose hydrocortisone administration reduced the percent of specific memories recalled (p = 0.04), increased the percent of categorical (nonspecific) memories recalled, and slowed response times for categorical memories (p <0.001), compared to placebo performance (p < 0.001). Under moderate-dose hydrocortisone the autobiographical memory performance did not change significantly with respect to percent of specific or categorical memories recalled or reaction times. Performance on the CVLT was not affected by hydrocortisone.
These findings suggest that cortisol affects accessibility of autobiographical memories in a dose-dependent manner. Specifically, administration of hydrocortisone at doses analogous to those achieved under severe psychosocial stress impaired the specificity and speed of retrieval of autobiographical memories.
doi:10.1037/a0024764
PMCID: PMC3187913  PMID: 21942435
Cortisol; Autobiographical memory; Human; Declarative memory; Depression
15.  Practice patterns and attitudes about treating abnormal uterine bleeding: A national survey of obstetricians and gynecologists 
Objective(s)
To examine the practice patterns and attitudes of obstetricians and gynecologists surrounding treatment of abnormal uterine bleeding (AUB).
Study Design
We conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys, which were distributed using a sequential mixed method (both web-based and mail-based) approach, included questions about practice characteristics, practice patterns, and knowledge about treatment options for AUB.
Results
Four hundred seventeen out of 802 questionnaires were returned (52%). The most commonly selected first line choice for AUB treatment was combined oral contraceptives (97% anovulatory, 98% ovulatory). The levonorgestrel intrauterine system was the next most frequently selected option (63% anovulatory, 53% ovulatory). Respondents did not score high on questions about the effectiveness of treatments for AUB. Only 25% (n=86) answered at least two out of the three questions correctly.
Conclusions
Continued education is necessary to increase the utilization of the most effective treatment options for AUB.
doi:10.1016/j.ajog.2011.05.016
PMCID: PMC3217110  PMID: 21737060
Abnormal uterine bleeding; evidence; attitudes; physician survey; treatment preferences
16.  Physicians' Perceptions of Patients' Knowledge and Opinions Regarding Breast Cancer: Associations with Patient Education and Physician Numeracy 
Breast Care  2011;6(4):285-288.
Summary
Background: The aim of this study was to assess physicians' perception of their patients' knowledge and opinions regarding regular screening, and the association of their perceptions with physician numeracy and patient education level. Methods: We carried out a survey study of 240 obstetrician-gynecologists. Results: Overall, 99.6% physicians perceive that their patients know that breast cancer is hereditary, 86.5% predicted that there is a gene mutation related to breast cancer, and 79.4% predicted that most breast cancer cases occur in women aged 50 years or greater. Physicians with less educated patients thought that their patients would not know about genetic screening, and physicians with more educated patients thought that their patients would know that mammography does not reduce the risk of getting breast cancer. A total of 66.0% of obstetrician-gynecologists answered all 3 numeracy questions correctly. Less numerate physicians were more likely to indicate that their typical patient would agree with the statement about regular mammography screens than the more numerate physicians. Conclusions: Obstetrician-gynecologists expect that their patients know some things about breast cancer and not others. Some of the physicians' perceptions about patients differ based on numeracy.
doi:10.1159/000331284
PMCID: PMC3225213  PMID: 22135626
Breast cancer; Counseling; Health behavior; Physician-patient interaction; Patient education Physician numeracy
17.  Treatment of early pregnancy failure: Does induced abortion training affect later practices? 
Objective
To examine the relationship between induced abortion training and views towards, and use of, office uterine evacuation and misoprostol in early pregnancy failure (EPF) care.
Study Design
We surveyed 308 obstetrician/gynecologists on their knowledge and attitudes toward treatment options for EPF, and previous training in office uterine evacuation.
Results
Sixty-seven percent of respondents reported training in office uterine evacuation and 20.3% reported induced abortion training. Induced abortion training was associated with strongly positive views towards both office-based uterine evacuation and misoprostol as treatment for EPF, as compared to those with office uterine evacuation training in other settings. (OR=2.64, p<0.004 and OR=3.22, p<0.003, respectively.) Further, induced abortion training was associated with use of office uterine evacuation for EPF treatment, as compared to those with office evacuation training in other settings (OR=2.90, p=0.004).
Conclusions
Training experiences, especially induced abortion training is associated with use of office uterine evacuation for EPF.
doi:10.1016/j.ajog.2011.01.052
PMCID: PMC3136580  PMID: 21419385
Early pregnancy failure; treatment patterns; induced abortion; training
18.  Academic workforce trends in community hospitals 
Introduction
Obstetrician-gynecologist faculty workforce studies have been limited to faculty at university training programs. Not much is known about the obstetrician-gynecologist faculty workforce at community programs.
Method
This study assessed the obstetrician-gynecologist faculty workforce in community training programs via administering surveys to the department chairs. The questionnaire assessed number of current faculty by degree, work status (part-time/full-time), rank, and sub-specialty. Out of 125 programs, 65 responded (52% response rate).
Results
The mean number of full-time faculty per department in community hospitals was 17 faculty. Two-thirds of community department chairs anticipated an increase in full-time faculty and 43% anticipated an increase in part-time faculty. Like university programs, sub-specialists and Professors (compared to generalists and assistant professors) were more likely to be male.
Conclusion
There are similarities between the community and university faculty workforce, many of the community program faculty are involved in research. Given the evolving clinical, educational, and research demands on community faculty, it is important to continue to monitor and study community program faculty.
doi:10.3402/jchimp.v2i1.17361
PMCID: PMC3714083  PMID: 23882350
Workforce; community hospital; ob-gyn; faculty; gender; university
19.  Surveying ourselves: Examining the use of a web-based approach for a physician survey 
A survey was distributed, using a sequential mixed-mode approach, to a national sample of obstetrician-gynecologists. Differences between responses to the web-based mode and the on-paper mode were compared to determine if there were systematic differences between respondents. Only two differences in respondents between the two modes were identified. University-based physicians were more likely to complete the web-based mode than private practice physicians. Mail respondents reported a greater volume of endometrial ablations compared to online respondents. The web-based mode had better data quality than the paper-based mailed mode in terms of less missing and inappropriate responses. Together, these findings suggest that, although a few differences were identified, the web-based survey mode attained adequate representativeness and improved data quality. Given the metrics examined for this study, exclusive use of web-based data collection may be appropriate for physician surveys with a minimal reduction in sample coverage and without a reduction in data quality.
doi:10.1177/0163278710391086
PMCID: PMC3108008  PMID: 21190952
survey; online; physician; distribution mode; web-based; internet; questionnaire
20.  Oxytocin Reduces Background Anxiety in a Fear-Potentiated Startle Paradigm 
Neuropsychopharmacology  2010;35(13):2607-2616.
Oxytocin reportedly decreases anxious feelings in humans and may therefore have therapeutic value for anxiety disorders, such as post-traumatic stress disorder (PTSD). As PTSD patients have exaggerated startle responses, a fear-potentiated startle paradigm in rats may have face validity as an animal model to examine the efficacy of oxytocin in treating these symptoms. Oxytocin (0, 0.01, 0.1, or 1.0 μg, subcutaneously) was given either 30 min before fear conditioning, immediately after fear conditioning, or 30 min before fear-potentiated startle testing to assess its effects on acquisition, consolidation, and expression of conditioned fear, respectively. Startle both in the presence and absence of the fear-conditioned light was significantly diminished by oxytocin when administered at acquisition, consolidation, or expression. There was no specific effect of oxytocin on light fear-potentiated startle. In an additional experiment, oxytocin had no effects on acoustic startle without previous fear conditioning. Further, in a context-conditioned test, previous light-shock fear conditioning did not increase acoustic startle during testing when the fear-conditioned light was not presented. The data suggest that oxytocin did not diminish cue-specific conditioned nor contextually conditioned fear, but reduced background anxiety. This suggests that oxytocin has unique effects of decreasing background anxiety without affecting learning and memory of a specific traumatic event. Oxytocin may have antianxiety properties that are particularly germane to the hypervigilance and exaggerated startle typically seen in PTSD patients.
doi:10.1038/npp.2010.155
PMCID: PMC3055566  PMID: 20844476
oxytocin; anxiety; fear; startle; PTSD; neuropeptides; animal models; mood/anxiety/stress disorders; behavioral science; oxytocin
21.  Survey of Obstetrician-Gynecologists in the United States About Chagas Disease 
Chagas disease affects an estimated 300,000 people in the United States, and as many as 300 congenital infections are estimated to occur annually. The level of knowledge about Chagas disease among obstetricians-gynecologists in the United States has not been assessed. The American College of Obstetricians and Gynecologists surveyed a representative sample of 1,000 members about Chagas disease. Among 421 respondents, 68.2% (95% confidence interval [CI] = 63.5–72.6) described their knowledge level about Chagas disease as “very limited.” Only 8.8% (95% CI = 6.2–12.0) knew the risk of congenital infection, and 7.4% (95% CI = 5.1–10.4) were aware that both acute and chronic maternal infections can lead to congenital transmission. The majority of respondents (77.9%; 95% CI = 73.5–81.9) reported “never” considering a diagnosis of Chagas disease among their patients from endemic countries. Most of those who did consider the diagnosis did so “rarely.” Knowledge of Chagas disease among obstetricians-gynecologists in the United States is limited. Greater awareness may help to detect treatable congenital Chagas cases.
doi:10.4269/ajtmh.2010.09-0543
PMCID: PMC2946763  PMID: 20889886
22.  Acute Hydrocortisone Treatment Increases Anxiety but Not Fear in Healthy Volunteers: A Fear-Potentiated Startle Study 
Biological psychiatry  2011;69(6):549-555.
Background
The debilitating effects of chronic glucocorticoids excess are well-known, but comparatively little is understood about the role of acute cortisol. Indirect evidence in rodents suggests that acute cortisone could selectively increase some forms of long-duration aversive states, such as “anxiety,” but not relatively similar, briefer aversive states, such as “fear.” However, no prior experimental studies in humans consider the unique effects of cortisol on anxiety and fear, using well-validated methods for eliciting these two similar but dissociable aversive states. The current study examines these effects, as instantiated with short- and long-duration threats.
Methods
Healthy volunteers (n = 18) received placebo or a low (20 mg) or a high (60 mg) dose of hydrocortisone in a double-blind crossover design. Subjects were exposed repeatedly to three 150-sec duration conditions: no shock; predictable shocks, in which shocks were signaled by a short-duration threat cue; and unpredictable shocks. Aversive states were indexed by acoustic startle. Fear was operationally defined as the increase in startle reactivity during the threat cue in the predictable condition (fear-potentiated startle). Anxiety was operationally defined as the increase in baseline startle from the no shock to the two threat conditions (anxiety-potentiated startle).
Results
Hydrocortisone affected neither baseline nor short-duration, fear-potentiated startle but increased long-duration anxiety-potentiated startle.
Conclusions
These results suggest that hydrocortisone administration in humans selectively increases anxiety but not fear. Possible mechanisms implicated are discussed in light of prior data in rodents. Specifically, hydrocortisone might increase anxiety via sensitization of corticotrophin-releasing hormones in the bed nucleus of the stria terminalis.
doi:10.1016/j.biopsych.2010.12.013
PMCID: PMC3116445  PMID: 21277566
Amygdala; anxiety; BNST; corticotropin-releasing hormone (CRH); cortisol; fear; predictability; startle reflex
23.  Provider knowledge, attitudes and treatment preferences for early pregnancy failure 
Objective
To describe health care provider knowledge, attitudes and treatment preferences for early pregnancy failure (EPF).
Study Design
We surveyed 976 obstetrician/gynecologists, midwives and family medicine practitioners on their knowledge and attitudes toward treatment options for EPF, and barriers to adopting misoprostol and office uterine evacuations. We used descriptive statistics to compare practices by provider specialty and logistic regression to identify associations between provider factors and treatment practices.
Results
Seventy percent of providers have not used misoprostol and 91% have not used an office uterine evacuation to treat EPF in the past 6 months. Beliefs about safety and patient preferences, and prior induced abortion training were significantly associated with use of both of these treatments.
Conclusions
Increasing education and training on the use of misoprostol and office uterine evacuation, and clarifying patient treatment preferences may increase the willingness of providers to adopt new practices for EPF treatment.
doi:10.1016/j.ajog.2010.02.016
PMCID: PMC2878908  PMID: 20227674
Early pregnancy failure; Provider attitudes; treatment patterns
24.  Minimally Invasive Hysterectomies—A Survey on Attitudes and Barriers among Practicing Gynecologists 
Study Objective
To explore attitudes and hysterectomy practices among gynecologists in the United States and to identify potential barriers to offering minimally invasive hysterectomies.
Design
Mixed-mode (online and on-paper) survey of a random sample of 1500 practicing obstetrician-gynecologists.
Setting
Nationwide survey in the United States.
Participants
Nonretired obstetrician-gynecologists identified through a physician list from the American Medical Association.
Interventions
Postal and online survey.
Measurements & Main Results
We received a response from 376 physicians (25.8% response rate). The average age of respondents was 47.9 years, and 87% were generalists. Participants performed on average 4 surgical cases per week and 32 hysterectomies per year, most of which were abdominal hysterectomies. When asked for preferred mode of access for themselves or their spouse, 55.5% chose vaginal hysterectomy (VH), 40.6% chose laparoscopic hysterectomy (LH), and 8% chose abdominal hysterectomy (AH). Younger physicians (<40) and high surgical volume physicians were significantly more likely to chose a laparoscopic approach and identified significantly fewer barriers for performing LH. The main barriers to performing VH were technical difficulty, potential for complications, and caseload of VH. The main barriers for performing LH were training during residency, technical difficulty, personal surgical experience and operating time. The majority of gynecologists wanted to decrease their AH rates and increase their LH rates. The most significant identified contraindications to VH were prior laparotomy, a uterus larger than 12 weeks, narrow introitus, adnexal mass, and minimal uterine descent.
Conclusions
While a large majority of gynecologists would prefer a VH or LH for themselves or their spouse, AH remains the most common hysterectomy method in the United States. A generation gap appears to be brewing with younger gynecologist more in favor of the laparoscopic approach. More emphasis should be placed on training gynecologists in performing minimally invasive hysterectomies, given their desire to change their surgical mode of access.
doi:10.1016/j.jmig.2009.12.017
PMCID: PMC3038434  PMID: 20226403
Minimally; Invasive; Hysterectomy; Barriers
25.  The Neurological Ecology of Fear: Insights Neuroscientists and Ecologists Have to Offer one Another 
That the fear and stress of life-threatening experiences can leave an indelible trace on the brain is most clearly exemplified by post-traumatic stress disorder (PTSD). Many researchers studying the animal model of PTSD have adopted utilizing exposure to a predator as a life-threatening psychological stressor, to emulate the experience in humans, and the resulting body of literature has demonstrated numerous long-lasting neurological effects paralleling those in PTSD patients. Even though much more extreme, predator-induced fear and stress in animals in the wild was, until the 1990s, not thought to have any lasting effects, whereas recent experiments have demonstrated that the effects on free-living animals are sufficiently long-lasting to even affect reproduction, though the lasting neurological effects remain unexplored. We suggest neuroscientists and ecologists both have much to gain from collaborating in studying the neurological effects of predator-induced fear and stress in animals in the wild. We outline the approaches taken in the lab that appear most readily translatable to the field, and detail the advantages that studying animals in the wild can offer researchers investigating the “predator model of PTSD.”
doi:10.3389/fnbeh.2011.00021
PMCID: PMC3084442  PMID: 21629856
animal model of PTSD; indirect predator effects; post-traumatic stress disorder; predation risk; predator stress

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