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The Association Between Maternal-Fetal Medicine Physician Density And Pregnancy Outcomes, Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.

Study Design

This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (< 30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.

Results

Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The …

Association Between Neighborhood Social Determinants Of Health And Stillbirth, Tetsuya Kawakita, Misa Hayasaka, Ann M. Harper, John Brush, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To examine the association between neighborhood-level social determinants of health and stillbirth.

METHODS:

We performed a retrospective cohort study of deliveries that occurred at a gestational age of at least 20 weeks within a five-hospital system (2012-2022). Electronic health record data mapped to the Observational Medical Outcomes Partnership Common Data Model were geocoded using addresses at the time of delivery and linked to neighborhood health indices, which included the Area Deprivation Index (ADI), Maternal Vulnerability Index (MVI), and Social Vulnerability Index (SVI) at the Census tract level. Stillbirths were adjudicated by medical record review. Modified Poisson regression generated relative …

Mediating Effect Of Social Determinants Of Health Between Race And Phthalate Biomarkers In Pregnancy, Tetsuya Kawakita, Misa Hayasaka, Carole Barake, Trinity Soto, Jillian Fleming, Amir Lueth, Stevens Danielle, Alfred Abuhamad, Ann Pryzybylska, Elena Sinkovskaya, Kelly K. Ferguson, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Prenatal phthalate exposure is linked to adverse reproductive and developmental outcomes and is consistently higher among non‐Hispanic Black compared to non‐Hispanic White pregnant individuals, yet the factors responsible for these disparities are poorly characterized. We sought to quantify Black–White differences in repeated urinary concentrations of phthalate biomarkers during pregnancy and to estimate the extent to which neighborhood‐level social determinants of health (SDoH) mediate these disparities.

Methods

This secondary analysis used data from the Human Placenta Project Study, a prospective observational cohort study conducted at two academic institutions between 2016 and 2018. Eligible participants had singleton pregnancies, were recruited before …

Contribution Of Comorbidities And Pregnancy Complications To Severe Maternal Morbidity In The United States, Tetsuya Kawakita, Sora A. Jones, Natsume Furukawa, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective: To quantify the extent to which rising rates of severe maternal morbidity (SMM) in the United States from 2016 to 2022 are attributable to increasing prevalence of maternal risk factors, including advanced maternal age, obesity, pregestational diabetes mellitus, gestational diabetes, chronic hypertension, and hypertensive disorders of pregnancy (HDP).

Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022, representing more than 25 million weighted delivery hospitalizations. The primary outcome of SMM was identified with the Centers for Disease Control and Prevention's 21-condition algorithm; a secondary outcome excluded transfusion to improve specificity. Temporal trends …

Biomechanical Integrity Of The Female Pelvic Floor: A Comparison Of Military And Civilian Women, Vladimir Egorov, Peter Takacs, Vincent Lucente, Heather Van Raalte, Joy A. Greer, Noune Sarvazyan

Department of Obstetrics & Gynecology Faculty Publications

Introduction

The health of the pelvic floor depends on the integrity of its muscles, connective tissue, ligaments, and their innervation. The female pelvic floor may be more vulnerable to repetitive heavy loads in a military environment than the male pelvic floor because of anatomical and physiological differences. The study aim was to identify and explore possible differences in the female pelvic floor conditions between active military and civilian women with similar demographics.To identify and explore possible differences in the conditions of the female pelvic floor between active military women and civilian women with similar demographics.

Materials and Methods

Military active …

Consensus And Controversies Of International Guidelines For The Diagnosis, Surveillance, And Management Of Fetal Growth Restriction: An Updated Comparison, Daniele Diane Mascio, Suneet P. Chauhan, Tullio Ghi, Asma Khalil, Juliana G. Martins, Sara Sorrenti, Tamara Stampalija, Fabrizio Zullo, Francesc Figueras

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE: To compare areas of consensus and disagreements across contemporary international and national guidelines on the diagnosis, surveillance, and management of fetal growth restriction (FGR).

DATA SOURCES: Electronic searches of MEDLINE from database inception up to March 2026 using MeSH terms and keywords related to FGR and guidelines. STUDY ELIGIBILITY CRITERIA: Critical, structured comparison of national or international guidelines on FGR published since 2010. Final inclusion required unanimous agreement from all authors.

STUDY APPRAISAL AND SYNTHESIS METHODS: Pre-specified extraction across domains: definition; prediction/prevention; surveillance tools and frequency; delivery timing and mode; and labor induction methods. Dual data …

The Taper Sign: Sonographic Representation Of Uterine Dehiscence In Severe Cases Of Placenta Accreta Spectrum, Uma Deshmukh, Anna M. Modest, Alfred Abuhamad, Alireza A. Shamshirsaz, Jonathan L. Hecht, Scott A. Shainker

Department of Obstetrics & Gynecology Faculty Publications

Introduction: Prenatal diagnosis of placenta accreta spectrum (PAS) depends on reliable ultrasound markers and skilled image interpretation. Existing PAS markers emphasize placental features suggestive of abnormal adherence and require advanced image optimization. However, emerging hypotheses suggest that uterine dehiscence—not placental invasion—is the central mechanism underlying PAS, particularly in severe (Grade 3) disease. Despite this, few established ultrasound markers address this uterine dehiscence. We describe a novel ultrasound marker, the taper sign, which uniquely represents the uterine dehiscence in severe PAS with anterior placenta previa, and outline a standardized technique for image acquisition and interpretation.

Methods: This descriptive report details the …

Hungarian Validation Of The Pelvic Floor Distress Inventory - 20 (Pfdi-20) Questionnaire And The Pelvic Floor Impact Questionnaire - 7 (Pfiq - 7), Barbara Kozma, Bence Kozma, Peter Takacs, Dávid Rátonyi, Nelli Farkas, Attila G. Sipos, Balint Farkas

Department of Obstetrics & Gynecology Faculty Publications

Introduction and Hypotheses

Pelvic floor disorders (PFDs) affect women's quality of life through physical, psychological, and social domains. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) are validated tools for assessing symptom severity and quality of life impact. The current study aim to investigate the reliability and validity of the Hungarian versions of these questionnaires in women with PFD symptoms.

Methods

This validation study was carried out at the University of Debrecen among women with clinically confirmed pelvic floor disorders. The PFDI-20 and PFIQ-7 questionnaires were translated into Hungarian using independent native English speaker in …

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

Sleepiness In Pregnancy And Adverse Perinatal Outcomes, Rachel Friedlander, Xiaoning Huang, Phyllis Zee, Sadiya S. Khan, Philip Greenland, Francesca L. Facco, Judith Chung, William A. Grobman, Shalini Manchanda, Uma M. Reddy, George R. Saade, Robert M. Silver, Lynn M. Yee

Department of Obstetrics & Gynecology Faculty Publications

Background

Sleep disorders in pregnancy have been associated with adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm birth, and gestational diabetes mellitus, yet these findings are largely from retrospective studies. Using data from a prospective study that used validated tools to assess sleepiness in pregnancy, we aimed to assess the association of sleepiness in pregnancy with adverse pregnancy outcomes.

Methods

In this secondary analysis of data from a large, diverse prospective cohort of nulliparous individuals conducted at eight United States medical centers, those with self-reported sleep data were included. Sleepiness was evaluated in early (6-13 weeks) and mid-pregnancy (22-29 …

The Association Between The Degree Of Social Vulnerability And Maternal Anemia And Other Adverse Perinatal Outcomes, Rubymel J. Knupp, Christina T. Blanchard, Ariann Nassel, Ashley Shea, Lindsay S. Robbins, Jeff M. Szychowski, Ashley N. Battarbee, Akila Subramaniam

Department of Obstetrics & Gynecology Faculty Publications

Objective

Maternal anemia in pregnancy is associated with many adverse maternal, fetal, and neonatal outcomes. The role of social determinants of health (SDOH) in the development of maternal anemia and other adverse outcomes is continually evolving. One such newer tool, the Social Vulnerability Index (SVI), measures an individual's community-level SDOH, with higher SVI denoting higher vulnerability. Our objective was to evaluate the association between SVI, maternal anemia, and other adverse perinatal outcomes.

Methods

Retrospective cohort study of pregnant individuals delivering singletons at a gestational age ≥23 weeks at a single center from 2014 to 2018. Patients with sickle cell disease, …

The Association Between Social Vulnerability And Racial Disparities In Preterm Birth, Anita Pershad, Gabby Adams, Lindsay Robbins, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the association between county-level social vulnerability and preterm birth and assess whether racial disparities vary across levels of vulnerability.

Methods

This cross-sectional study utilized restricted Centers for Disease Control and Prevention natality data from 2023. We included Black or White births with singleton pregnancies across 3123 US counties from 50 US states and the District of Columbia. Participants were grouped into quartiles based on the county-level Social Vulnerability Index (SVI), with quartile 4 representing the most socially vulnerable populations. The primary outcome was preterm birth, defined as delivery before 37 weeks. Secondary outcomes included small for gestational …

Low-Lying Placenta Is Associated With Increased Risk Of Hemorrhage And Severe Maternal Morbidity: A Nationwide Analysis, May Abiad, Giulia Bonanni, Nikan Zargarzadeh, Ali Javinani, Scott A. Shainker, Anna M. Modest, George R. Saade, Kjersti Aagaard, Alireza A. Shamshirsaz

Department of Obstetrics & Gynecology Faculty Publications

Background

Placenta previa (PP) is a well-recognized obstetric complication with established maternal risks, particularly hemorrhage, that contribute significantly to maternal morbidity. In contrast, low-lying placenta (LLP) has historically been grouped with previa in both coding and clinical practice, limiting our ability to study its imparted associated outcomes as a distinct entity. However, in 2017, coding revisions allowed for a parsed diagnosis of LLP and PP and enabled the current study of differentiated associated outcomes.

Objectives

To describe and compare the independent rates of hemorrhage and severe maternal morbidity (SMM) associated with LLP and PP relative to normal placentation.

Methods

We …

The American Anomaly: Feasibility Of Universal Healthcare, William Bernstein

Student Research and Publications

No abstract provided.

A Tribute To Professor Marie Failinger

Mitchell Hamline Law Review

No abstract provided.

The Role Of Soil In Historical Warfare: A Review, Gian Franco Capra, T. A.R. Nogueira, Cassio Hamilton Abreu-Junior, Arun Dilipkumar Jani, Rafael Barroca Silva, Eleonora Grilli, Alessandro Auzzas, Antonio Ganga

Biology, Agriculture and Chemistry Faculty Publications and Presentations

Soil has played a fundamental yet undervalued role in shaping the fate of historical warfare. While the effects of war on the soil environment have been thoroughly investigated, the impact of soil on military strategies and battle outcomes remains poorly understood. This review aims to: i) explore the multifaceted role of soil in warfare, focusing on its impact on several aspects (mobility, fortifications, camouflage, health, geopolitical strategy, etc.); ii) identify which soil types were usually most associated with conflicts, and iii) how soil features influenced military decision-making. A dataset of over 17,000 recorded battles (1468 BCE–2003) was …

A Multifaceted Innovation To Support Student Nurse Writing Self-Efficacy, Lila De Tantillo, Lauren Holloway

Faculty Publications

Background: Supporting academic writing is a critical pathway for professional development in nursing. More knowledge is needed about fostering student confidence in writing and self-efficacy in the writing process. Innovation: The purpose was to implement a multifaceted program to expand writing resources and support writing self-efficacy among nursing students. Course-specific instruction and an online learning platform were provided to support student writing and critical thinking. Implications: Students noted the need for additional preparation in the initial stages or prewriting components of writing-based assignments. We determined that building academic literacy and confidence in writing is vital to support critical thinking in …

Developing A System Dynamics Framework For Sustained Digital Transformation, Quintal Battle

Graduate Studies Theses and Dissertations 2026

Despite significant organizational investments, more than 70% (Ellmer et al., 2025) of digital transformation initiatives fail. The existing literature evaluates transformation mechanisms as separate factors rather than as interacting, evolving feedback systems. This dissertation addresses this gap by developing and validating a system dynamics framework for sustained digital transformation. Guided by three research questions, the study examined the mechanisms that enable or constrain transformation, identified mechanisms distinctive to digital transformation contexts, and evaluated how existing change management frameworks guide transformation efforts. The study followed a six-phase methodology that combined a systematic literature review of peer-reviewed studies, empirical cases, causal loop …

An Examination Of The Impact Of School Context And Socioeconomic Status On Agency And Creative Productivity In Gifted High School Students, Elizabeth Bronson

Graduate Studies Theses and Dissertations 2026

This explanatory sequential mixed methods study investigated gifted high school students’ perception of the agency afforded them within school settings, and the relationship between these perceptions and their creative productivity. A sample of 140 students was drawn from a population of 966 identified gifted high school students. These students were contacted via their parents and asked to complete the Agentic Engagement Scale (AES) questionnaire which provided gifted high school students’ perceptions of the agency afforded at school. No significant differences in perceived agency were found across demographic variables, including socioeconomic status and school type. Of the respondents, 10 students were …

Non-Gaussian Phenomena In Light Scattering And Applications, Shubham Atul Dawda

Graduate Studies Theses and Dissertations 2026

Physical reality is rarely deterministic; which, when probed by electromagnetic fields that also fluctuate, leads to observables that are most efficiently modelled as statistical processes. At equilibrium, this is usually achieved by invoking the Gaussian statistics of underlying physical processes, however, in practice, one often encounters out-of-equilibrium conditions where Gaussian descriptions may not suffice. Such situations are plentiful in nature– from biology to astronomy. This dissertation addresses several non-Gaussian phenomena associated with light scattering, and includes specific models’ derivations, experimental techniques developments, and demonstrations of potential applications. The systematic presentation will consider circumstances that infringe upon specific assumptions of the …

Stolen Childhood: Picture Book Stories Of Indian Residential Schools, Maughn Rollins Gregory

Picture Books

In the nineteenth and twentieth centuries American and Canadian government agencies and Christian churches established Indian residential schools where hundreds of thousands of children were “reeducated” in English and Christianity. They were not allowed to use their native languages or given names, to practice their religions, or to communicate with their siblings or parents. They were made to work in crop fields, kitchens, laundries, and industrial workshops. Many were physically and sexually abused. Many never saw their families again. The nine picture books reviewed here are accounts of survivors of residential schools from eight different Indigenous nations. In addition to …

Shin-Chi’S Canoe (2008) By Nicola Campbell, Maughn Rollins Gregory

Picture Books

In the nineteenth and twentieth centuries American and Canadian government agencies and Christian churches established Indian residential schools where hundreds of thousands of children were “reeducated” in English and Christianity. They were not allowed to use their native languages or given names, to practice their religions, or to communicate with their siblings or parents. They were made to work in crop fields, kitchens, laundries, and industrial workshops. Many were physically and sexually abused. Many never saw their families again. The nine picture books reviewed here are accounts of survivors of residential schools from eight different Indigenous nations. In addition to …

The Effects Of Systematic Instructional Interventions On Functional Communication, Vocational Independence, And Academic Performance For High School Students With Autism In A Self-Contained Special Education Setting, Sarah O. Shalash

University of Kentucky Master's Theses

This project evaluated the effects of systematic instruction on functional communication, vocational independence, and functional mathematics for three high school students with autism in a self-contained special education classroom using three A–B single-case designs. Interventions included a system of least prompts for AAC requesting and vocational task completion and constant time delay for a functional timer-setting task. Student performance was measured as the percentage of independently completed responses across instructional sessions. Student T demonstrated meaningful improvement in independent AAC requesting and reached 75% independence in the final session. Student B demonstrated emerging improvement in timer-setting performance and reached 60% independence …

17Β Estradiol Protection Against Medium-Change Neurotoxicity In Organotypic Hippocampal Slice Cultures, Autumn B. Stage

University of Kentucky Master's Theses

Medium change neurotoxicity can disrupt glutamate homeostasis and promote excitotoxic neuronal injury through excessive NMDA receptor activation. 17β estradiol (E2) has demonstrated neuroprotective effects in models of neuronal injury and may regulate glutamatergic signaling through metabotropic glutamate receptors (mGluR2/3). This study investigated whether E2 protects against medium change associated neurotoxicity in organotypic hippocampal slice cultures whether responses differed by sex or hippocampal region. Hippocampal slices from postnatal day 8 male and female Sprague Dawley rats were maintained in culture and exposed to 1, 10, or 100 nM E2 for 24 hours following a five day recovery period. Propidium iodide (PI) …

Frontline Aspiration Versus Stent Retriever Thrombectomy For M2 Occlusions: Insights From The Star Registry, Michael Gaub, Joshua Osbun, Et Al.

2020-Current year OA Pubs

BACKGROUND: Recent trials have furthered uncertainty regarding the endovascular benefit for medium vessel occlusions (MeVO). Stent retrievers (SR) were employed in the first attempt in most interventional arm participants. We sought to compare outcomes in acute MCA M2 occlusions between frontline aspiration and SR, and to delineate procedural and anatomical covariates associated with differential treatment effect.

METHODS: Retrospective analysis of a multicenter stroke thrombectomy cohort identified cases of MT for M2 occlusions. Unmatched and propensity score-matched (PSM) cohorts were generated comparing frontline aspiration to standalone and combined SR. The primary outcome was functional independence (mRS 0-2) at 90 days. Recanalization, …

The Classical Limit In Geometric Quantization By Group Extension, Paul Bracken

School of Mathematical & Statistical Sciences Faculty Publications

Physical systems as a rule are associated with a symmetry group. The group approach to geometric quantization makes use of this to introduce a quantization by means of group extension. This procedure is discussed and applied to a physical system whose group law has its origin with the Galilean group. The main intention is to investigate the classical limit and its relationship under this approach to geometric quantization. The classical quantization conditions are obtained based on a deeper foundation.

Locating Radical Institutionalism: Reviving A Critical Tradition, Beliza Borba De Almeida, Jacob Powell

Working Papers

No abstract provided.

Toward An Analytical Radicalism: Revisiting Radical Institutionalism’S Basic Concepts, Beliza Borba De Almeida, Jacob Powell

Working Papers

No abstract provided.

Beyond Green Scarcity: Ecological Economics, Demand-Led Growth, And The External Constraint, Matias Vernengo

Working Papers

No abstract provided.

Gpu And Pso Accelerated Low-Latency Fully-Coherent All-Sky Search For Compact Binary Coalescences, Soumya D. Mohanty

Physics & Astronomy Faculty Publications

The fully-coherent all-sky (FCAS) search, which combines data from a gravitational wave detector network into a single likelihood function, is the preferred method prescribed by statistical theory for Gaussian noise. However, so far, its exorbitant computational cost has blocked its use for compact binary coalescence searches. We introduce a solution combining Particle Swarm Optimization with Graphics Processing Unit (GPU) acceleration that is ≈ 50-fold faster than real-time analysis. This transforms the prospect of a low-latency FCAS search on all GW data into a practical reality for the first time. With large-scale simulations enabled by this speedup, we examine the issue …