85 results on '"K. Kiefer"'
Search Results
2. Interventions of Postpartum Hemorrhage
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Sara E. Post, Kara M. Rood, and Miranda K. Kiefer
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Obstetrics and Gynecology - Published
- 2023
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3. Prediction of large‐for‐gestational‐age infant by fetal growth charts and hemoglobin A1c level in pregnancy complicated by pregestational diabetes
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M. K. Kiefer, M. M. Finneran, C. A. Ware, P. Foy, S. F. Thung, S. G. Gabbe, M. B. Landon, W. A. Grobman, and K. K. Venkatesh
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Glycated Hemoglobin ,Fetal Growth Retardation ,Radiological and Ultrasound Technology ,Pregnancy Trimester, Third ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational Age ,General Medicine ,Ultrasonography, Prenatal ,Infant, Newborn, Diseases ,Fetal Macrosomia ,Fetal Development ,Fetal Weight ,Reproductive Medicine ,Pregnancy ,Infant, Small for Gestational Age ,Diabetes Mellitus ,Humans ,Birth Weight ,Female ,Radiology, Nuclear Medicine and imaging ,Growth Charts ,Child ,Retrospective Studies - Abstract
To compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity-specific) to predict large-for-gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts.This was a retrospective analysis of individuals with Type-1 or Type-2 diabetes with a singleton pregnancy that resulted in a non-anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90Of 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74-0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68-0.77); P 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70-0.79); P 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81-0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73-0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76-0.86)) growth charts.The FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity-specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in ObstetricsGynecology published by John WileySons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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- 2022
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4. Genome-wide association and HLA region fine-mapping studies identify susceptibility loci for multiple common infections
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Chao Tian, Bethann S. Hromatka, Amy K. Kiefer, Nicholas Eriksson, Suzanne M. Noble, Joyce Y. Tung, and David A. Hinds
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Science - Abstract
Susceptibility to infectious diseases is, among others, influenced by the genetic landscape of the host. Here, Tian and colleagues perform genome-wide association studies for 23 common infections and find 59 risk loci for 17 of these, both within the HLA region and non-HLA loci.
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- 2017
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5. Association of initial <scp>COVID</scp> ‐19 vaccine hesitancy with subsequent vaccination among pregnant and postpartum individuals
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Katherine Germann, Miranda K. Kiefer, Kara M. Rood, Rebecca Mehl, Jiqiang Wu, Radhika Pandit, Courtney D. Lynch, Mark B. Landon, William A. Grobman, Maged M. Costantine, and Kartik K. Venkatesh
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Parents ,Vaccines ,COVID-19 Vaccines ,Postpartum Period ,Vaccination ,COVID-19 ,Obstetrics and Gynecology ,Cross-Sectional Studies ,Pregnancy ,Urogenital Abnormalities ,Humans ,Female ,Prospective Studies ,Vaccination Hesitancy - Abstract
To examine the association between initial COVID-19 vaccine hesitancy and subsequent vaccination among pregnant and postpartum individuals.Prospective cohort.A Midwestern tertiary-care academic medical center. Individuals completed a baseline vaccine hesitancy assessment from 22 March 2021 to 2 April 2021, with subsequent ascertainment of vaccination status at 3-6 months follow-up.We used multivariable Poisson regression to estimate the relative risk of vaccination by baseline vaccine hesitancy status, and then characteristics associated with vaccination.Self-report of COVID-19 vaccination, and secondarily, consideration of COVID-19 vaccination among those not vaccinated.Of 456 individuals (93% pregnant, 7% postpartum) initially surveyed, 290 individuals (64%; 23% pregnant, 77% postpartum) provided subsequent vaccination status (median = 17 weeks). Of these 290 individuals, 40% (116/290) reported COVID-19 vaccine hesitancy upon enrolment, of whom 52% reported subsequent vaccination at follow-up. Few individuals transitioned during the study period from vaccine hesitant to vaccinated (10%); in comparison, 80% of those who were not vaccine hesitant were vaccinated at follow-up (aRR 0.19, 95% CI 0.11-0.33). Among those who remained unvaccinated at follow-up, 38% who were vaccine hesitant at baseline were considering vaccination, compared with 71% who were not vaccine hesitant (aRR 0.48, 95% CI 0.33-0.67). Individuals who were older, parous, employed and of higher educational attainment were more likely to be vaccinated, and those who identified as non-Hispanic black, were Medicaid beneficiaries, and were still pregnant at follow-up were less likely to be vaccinated.COVID-19 vaccine hesitancy persisted over time in the peripartum period, and few individuals who reported hesitancy at baseline were later vaccinated. Interventions that address vaccine hesitancy in pregnancy are needed.
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- 2022
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6. Pregnant women with immune mediated inflammatory diseases who discontinue biologics have higher rates of disease flare
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Kenneth D. Allen, Miranda K. Kiefer, Madalina Butnariu, and Anita Afzali
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Obstetrics and Gynecology ,General Medicine - Published
- 2022
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7. Characteristics and perceptions associated with COVID‐19 vaccination hesitancy among pregnant and postpartum individuals: A cross‐sectional study
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Miranda K. Kiefer, Rebecca Mehl, Maged M. Costantine, Alyson Johnson, Jessica Cohen, Taryn L. Summerfield, Mark B. Landon, Kara M. Rood, and Kartik K. Venkatesh
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COVID-19 Vaccines ,Cross-Sectional Studies ,Pregnancy ,Whooping Cough ,Postpartum Period ,Vaccination ,COVID-19 ,Humans ,Obstetrics and Gynecology ,Female ,Vaccination Hesitancy ,Diphtheria-Tetanus-acellular Pertussis Vaccines - Abstract
To assess the frequency and associated characteristics of COVID-19 vaccine hesitancy among pregnant and postpartum individuals.Cross-sectional study.Prenatal care at a single academic tertiary care centre.Pregnant and postpartum individuals enrolled in prenatal care at a single academic tertiary care centre from 22 March 2021 to 2 April 2021, concurrent with state guidelines recommending COVID-19 vaccination in pregnancy.We used logistic regression to identify characteristics associated with COVID-19 vaccine hesitancy, and adjusted for: age, parity, race, trimester of pregnancy, and chronic comorbidities.COVID-19 vaccine hesitancy, defined as uncertainty or refusal of the vaccine, despite the availability of vaccine services, in accordance with the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on vaccine hesitancy.Of the 485 individuals screened and approached, 456 (94%) enrolled and completed the survey (435/456, 95% pregnant). The frequency of COVID-19 vaccine hesitancy was 46% (95% CI 41%-51%). Sociodemographic characteristics, including non-Hispanic Black race, younger age, lower education, public health insurance receipt, parity1, and reported substance use, were associated with a higher odds of COVID-19 vaccine hesitancy, but not clinical risk conditions. Individuals who had a family or friend vaccinated for COVID-19, prior or planned vaccination for tetanus, diphtheria and acellular pertussis (Tdap) and/or influenza, and who perceived that vaccination benefited the baby were less likely to express COVID-19 vaccine hesitancy.COVID-19 vaccine hesitancy was frequent among pregnant and postpartum individuals. Those who may face barriers to accessing healthcare services were more likely to report vaccine hesitancy. These results can inform interventions to increase COVID-19 vaccine uptake in pregnancy.COVID-19 vaccination hesitancy is frequent among pregnant and postpartum individuals, and those who face barriers to accessing healthcare services are more likely to report COVID-19 vaccine hesitancy.
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- 2022
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8. Gestational Weight Gain and Adverse Maternal and Neonatal Outcomes for Pregnancies Complicated by Pregestational and Gestational Diabetes
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Erin M. Cleary, Miranda K. Kiefer, Steven G. Gabbe, Mark A. Klebanoff, Mark B. Landon, Heather A. Frey, Kartik K. Venkatesh, Adesomo Adebayo, and Maged M. Costantine
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medicine.medical_specialty ,Perinatal Death ,Weight Gain ,Body Mass Index ,Fetal Macrosomia ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,Diabetes mellitus ,medicine ,Humans ,Child ,Fetal Growth Retardation ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Stillbirth ,medicine.disease ,Gestational Weight Gain ,Gestational diabetes ,Diabetes, Gestational ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Small for gestational age ,Gestation ,Female ,business ,Body mass index - Abstract
OBJECTIVE This study aimed to investigate the association between excess and less than recommended gestational weight gain (GWG) and adverse maternal and neonatal outcomes in women with pregestational and gestational diabetes. STUDY DESIGN We conducted a secondary analysis of the National Institute of Child Health and Human Development (NICHD) Consortium on Safe Labor (CSL) study. We included deliveries >23 weeks of nonanomalous singletons with either pregestational or gestational diabetes. The exposure was GWG greater than or less than compared with the U.S. Institute of Medicine recommendations for total pregnancy weight gain per prepregnancy body mass index. Consistent with the 2020 Delphi outcome for diabetes in pregnancy, maternal outcomes included cesarean delivery and preeclampsia and neonatal outcomes included small for gestational age (SGA), large for gestational age (LGA), macrosomia >4,000 g, preterm birth
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- 2021
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9. The pelagic habitat analysis module for ecosystem‐based fisheries science and management
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Daniel P. Harrison, Michael G. Hinton, Suzanne Kohin, Edward M. Armstrong, Stephanie Snyder, Frank O'Brien, and Dale K. Kiefer
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- 2017
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10. Association between community-level political affiliation and peripartum vaccination
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Sara Post, Courtney D. Lynch, Maged M Costantine, Brandon Fox, Jiqiang Wu, Miranda K Kiefer, Kara M Rood, Mark B Landon, William A Grobman, and Kartik K Venkatesh
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Obstetrics and Gynecology ,General Medicine - Published
- 2023
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11. High frequency of posttraumatic stress symptoms among US obstetrical and gynecologic providers during the coronavirus disease 2019 pandemic
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Kartik K. Venkatesh, Rebecca R Mehl, Miranda K. Kiefer, Maged M. Costantine, and Kara M. Rood
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Adult ,Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Stress Disorders, Post-Traumatic ,Physicians ,Obstetrics and Gynaecology ,Pandemic ,Research Letter ,medicine ,Humans ,Aged ,SARS-CoV-2 ,business.industry ,COVID-19 ,Obstetrics and Gynecology ,Middle Aged ,Obstetrics ,Posttraumatic stress ,Gynecology ,Emergency medicine ,Female ,business - Published
- 2021
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12. Association between community-level political affiliation and Tdap, influenza, and COVID-19 vaccination in the peripartum period
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Sara Post, Brandon Fox, Courtney Denning-Johnson Lynch, Miranda K. Kiefer, Maged M. Costantine, Kara M. Rood, Mark B. Landon, William A. Grobman, and Kartik Kailas Venkatesh
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Obstetrics and Gynecology - Published
- 2023
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13. Effect of Fasting on Total Bile Acid Levels in Pregnancy
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Alan J. Lee, Miranda K. Kiefer, Sarah B Davis, Mark B. Landon, Taryn Summerfield, Devin D. Smith, and Kara M. Rood
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Pregnancy Trimester, Third ,Cholestasis, Intrahepatic ,Gastroenterology ,Asymptomatic ,Bile Acids and Salts ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cholestasis ,Pregnancy ,Interquartile range ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Meal ,030219 obstetrics & reproductive medicine ,Bile acid ,business.industry ,Obstetrics and Gynecology ,Fasting ,medicine.disease ,Pregnancy Complications ,Pregnancy Trimester, Second ,Cohort ,Female ,medicine.symptom ,business - Abstract
OBJECTIVE To evaluate differences between fasting and nonfasting bile acid levels in asymptomatic and symptomatic pregnant women. METHODS This is a report of two prospective cohort studies describing bile acid levels in the fasting and nonfasting state in pregnancy. The first cohort included asymptomatic women with singleton pregnancies. Women with a diagnosis of cholestasis, symptoms of cholestasis, or intolerance to components of a standardized meal were excluded. Bile acid levels were measured during the second and third trimesters after fasting and again 2 hours after a standardized meal. The second cohort included symptomatic women with singleton pregnancies in whom fasting and nonfasting bile acid levels were measured at the time of symptom evaluation. A cutoff of 10 micromoles/L was used for diagnosis. RESULTS A total of 27 women were included in the asymptomatic cohort. Median [interquartile range] fasting bile acid levels were significantly lower than nonfasting levels in both the second trimester (4.65 micromoles/L [1.02-29.57] vs 13.62 micromoles/L [2.03-40.26]; P
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- 2020
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14. Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals
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Miranda K. Kiefer, Rebecca Mehl, Kara M. Rood, Katherine Germann, Divya Mallampati, Tracy Manuck, Maged M. Costantine, Courtney D. Lynch, William A. Grobman, and Kartik K. Venkatesh
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Vaccines ,COVID-19 Vaccines ,Social Vulnerability ,General Veterinary ,General Immunology and Microbiology ,Vaccination ,Postpartum Period ,Public Health, Environmental and Occupational Health ,COVID-19 ,Infectious Diseases ,Pregnancy ,Molecular Medicine ,Humans ,Female ,Prospective Studies ,Vaccination Hesitancy - Abstract
To evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals.Prospective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey.Of 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56).Pregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.
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- 2022
15. Association between social vulnerability and influenza and tetanus-diphtheria-acellular pertussis vaccination in pregnant and postpartum individuals
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Miranda K. Kiefer, Rebecca Mehl, Maged M. Costantine, Mark B. Landon, Anna Bartholomew, Divya Mallampati, Tracy Manuck, William Grobman, Kara M. Rood, and Kartik K. Venkatesh
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Diphtheria-Tetanus Vaccine ,Social Vulnerability ,Tetanus ,Whooping Cough ,Postpartum Period ,Vaccination ,Obstetrics and Gynecology ,Diphtheria ,General Medicine ,Diphtheria-Tetanus-acellular Pertussis Vaccines ,Cross-Sectional Studies ,Influenza Vaccines ,Pregnancy ,Influenza, Human ,Humans ,Female - Abstract
Despite current guidelines recommending universal vaccination, the frequency of vaccination in pregnancy for influenza and tetanus-diphtheria-acellular pertussis remains low.This study aimed to evaluate the association between community-level social vulnerability and influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations among pregnant and postpartum individuals.We conducted a cross-sectional survey of vaccine hesitancy in the peripartum period among pregnant and postpartum participants enrolled in prenatal care at a single tertiary care center from March 22, 2021, to April 02, 2021. Participant addresses were geocoded using ArcGIS and linked at the census tract level. The primary exposure was community-level social vulnerability as measured by the US Centers for Disease Control and Prevention's Social Vulnerability Index. This index incorporates 15 census variables to produce a composite score and subscores across 4 major thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The scores range from 0 to 1, with higher values indicating greater social vulnerability. The primary outcomes were self-reported influenza vaccination during the current influenza season and having received or planning to receive the tetanus-diphtheria-acellular pertussis vaccination in pregnancy. We used multivariable logistic regression and adjusted for age, self-reported race and ethnicity, parity, trimester of pregnancy, and chronic comorbid conditions.Of 456 assessed individuals (95% pregnant individuals and 5% postpartum individuals), the frequency of influenza vaccination was 58% (95% confidence interval, 53-62), and the anticipated tetanus-diphtheria-acellular pertussis vaccination was 72% (95% confidence interval, 68-76). Individuals from communities with a higher Social Vulnerability Index were less likely to report vaccination in pregnancy than those from communities with a lower Social Vulnerability Index. Specifically, for each 0.1-unit increase in the Social Vulnerability Index, the odds of influenza vaccination (adjusted odds ratio, 0.23; 95% confidence interval, 0.11-0.46) and anticipated tetanus-diphtheria-acellular pertussis vaccination (adjusted odds ratio, 0.24; 95% confidence interval, 0.11-0.53) decreased by70%. By domain, the Social Vulnerability Index subscores of socioeconomic status (influenza adjusted odds ratio, 0.20 [95% confidence interval, 0.10-0.40]; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.25 [95% confidence interval, 0.12-0.53]) and housing type and transportation (influenza adjusted odds ratio, 0.41 [95% confidence interval, 0.19-0.84; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.39 [95% confidence interval, 0.18-0.87) were inversely associated with a lower odds of influenza and tetanus-diphtheria-acellular pertussis vaccinations.Pregnant and postpartum individuals living in areas with higher social vulnerability were less likely to report influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations in pregnancy. The Social Vulnerability Index could be used as a tool to improve vaccine equity and address disparities in vaccination in pregnancy.
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- 2022
16. Modelling Post-Plasma Quenching Nozzles for Improving the Performance of Co2 Microwave Plasmas
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Senne Van Alphen, Ante Hecimovic, Christian K. Kiefer, Ursel Fantz, Rony Snyders, and Annemie Bogaerts
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History ,Polymers and Plastics ,General Chemical Engineering ,Environmental Chemistry ,General Chemistry ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
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17. Association of change in haemoglobin A1c with adverse perinatal outcomes in women with pregestational diabetes
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Miranda K. Kiefer, Matthew M. Finneran, Courtney A. Ware, Naleef Fareed, Joshua Joseph, Stephen F. Thung, Maged M. Costantine, Mark B. Landon, Steven G. Gabbe, and Kartik K. Venkatesh
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Glycated Hemoglobin ,Endocrinology, Diabetes and Metabolism ,Infant, Newborn ,Pregnancy Outcome ,Pregnancy in Diabetics ,Hypoglycemia ,Infant, Newborn, Diseases ,Diabetes, Gestational ,Endocrinology ,Pregnancy ,Internal Medicine ,Diabetes Mellitus ,Humans ,Premature Birth ,Female ,Retrospective Studies - Abstract
To determine whether a net decline in glycosylated haemoglobin (HbAA retrospective analysis from 2012 to 2016 at a tertiary care centre. The exposure was the net change in HbAAmong 347 women with pregestational diabetes, HbAWomen with pregestational diabetes with a reduction in HbA
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- 2021
18. Does self-identified race and ethnicity affect rates of child protective services (CPS) referrals following delivery?
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Sara Post, Miranda K. Kiefer, Madeleine Caplan, Jamie Cowen, Paige Cackovic, Audra Jordan, and Kara M. Rood
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Obstetrics and Gynecology - Published
- 2023
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19. Risk factors associated with CPS referral in pregnancies complicated by positive urine drug screen
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Madeleine Caplan, Miranda K. Kiefer, Sara Post, Paige Cackovic, Jamie Cowen, Audra Jordan, and Kara M. Rood
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Obstetrics and Gynecology - Published
- 2023
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20. Decline in Sars‐CoV‐2 antibodies over 6‐month follow‐up in obstetrical healthcare workers
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Jessica R. Russo, Stephen E. Gee, Marwan Ma'ayeh, Miranda K. Kiefer, Doug Kniss, Kenneth D Allen, Maged M. Costantine, Michael Cackovic, and Kara M. Rood
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Adult ,medicine.medical_specialty ,COVID19 ,Health Personnel ,Immunology ,Antibodies, Viral ,Immunoglobulin G ,COVID-19 Testing ,Seroepidemiologic Studies ,Internal medicine ,Pandemic ,Prevalence ,medicine ,antibodies ,Humans ,Immunology and Allergy ,Prospective Studies ,Prospective cohort study ,Sars‐CoV‐2 ,biology ,healthcare workers ,SARS-CoV-2 ,business.industry ,COVID-19 ,Obstetrics and Gynecology ,Original Articles ,Middle Aged ,Obstetrics ,Vaccination ,Immunoglobulin M ,Reproductive Medicine ,Cohort ,biology.protein ,vaccine hesitancy ,Original Article ,Antibody ,business ,Follow-Up Studies ,Blood drawing - Abstract
Problem Limited data exists on the temporal trend of the Sars‐CoV‐2 immunologic response and duration of protection following natural infection. We sought to investigate the presence and duration of Sars‐CoV‐2 serum antibodies in obstetrical healthcare workers (HCW) on serial assessments over a 6‐month period, and to assess rates of vaccine acceptance and reported vaccine side effects among this cohort. Method of study A prospective cohort study of a convenience sample of obstetrical HCWs at a tertiary hospital. Serum Sars‐CoV‐2 antibodies for Immunoglobulin G (IgG) and Immunoglobulin M (IgM) were measured longitudinally at four intervals: baseline, 4 weeks, 12 weeks, and 6 months. Participants completed voluntary surveys on COVID19 testing, high‐risk exposures, vaccine acceptance, and vaccine side effects. Results One hundred twenty‐six of 150 (84%) HCWs who volunteered for participation completed all four blood draws. Prevalence of seropositive HCWs based on positive Sars‐CoV‐2 IgG antibodies increased from 2% at baseline to 31% at 12 weeks but declined to 21% by 6 months. Forty‐two percent (19/43) of the participants considered seropositive for Sars‐CoV‐2 IgG antibodies at any of the initial three blood draws converted to seronegative status at the 6‐month follow‐up. Eighty‐seven percent (72/83) of participants who responded to a follow‐up survey were willing to accept the COVID19 vaccine. Rates of acceptance did not differ by participant antibody status. Those that experienced symptoms with the first injection were more likely to have positive Sars‐CoV‐2 IgG antibodies (36.8% vs. 9.6%, p = .01). Conclusion Sars‐CoV‐2 IgG antibodies wane over time and may not provide prolonged and robust immune protection. This underscores the importance of vaccination and continued research in this area while the COVID19 pandemic continues.
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- 2021
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21. Impacts of average illuminance, spectral distribution, and uniformity on brightness and safety perceptions under parking lot lighting
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Jeremy D Snyder, John D. Bullough, and K Kiefer
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Transport engineering ,Brightness ,Spectral power distribution ,Computer science ,Perception ,media_common.quotation_subject ,Visibility (geometry) ,Parking lot ,Illuminance ,Electrical and Electronic Engineering ,media_common - Abstract
In addition to supporting visibility, parking lot lighting should enable people to feel safe and secure while they are walking through a parking lot at night. Previously published research has indicated that perceptions of safety and security under outdoor illumination are correlated with perceptions of scene brightness, which in turn are influenced by the light level in the lot, by the spectral distribution of the illumination, and the uniformity of illumination. However, the interactions and interplay among these factors are not well understood. To address this knowledge gap, two laboratory experiments were conducted using a scale model parking lot scene and a controllable light-emitting diode (LED) lighting system that allowed parametric variations in light level, spectrum and uniformity. From the results, a mathematical model of overall brightness and safety perceptions was developed to predict how different lighting configurations are perceived. The model can be used to help specifiers select lighting systems for parking lot illumination that meet the objectives of reinforcing sensations of personal safety while balancing energy use and cost concerns.
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- 2019
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22. Association of change in Hemoglobin A1C with adverse perinatal outcomes in individuals with prepregnancy diabetes
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Miranda K. Kiefer, Matthew M. Finneran, Courtney Abshier Ware, Stephen Thung, Maged M. Costantine, Mark B. Landon, Steven Gabbe, and Kartik K. Venkatesh
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Obstetrics and Gynecology - Published
- 2022
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23. Validation of quasi-linear turbulent transport models against plasmas with dominant electron heating for the prediction of ITER PFPO-1 plasmas
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G. Tardini, Th. Pütterich, Nicola Bonanomi, P. A. Schneider, Christian K. Kiefer, Benedikt Geiger, E. Fable, C. Angioni, EUROfusion Mst Team, P. Mantica, Jet Contributors, ASDEX Upgrade Team, Max Planck Institute for Plasma Physics, Max Planck Society, EUROfusion MST1 Team, and JET Contributors
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Physics ,Nuclear and High Energy Physics ,Tokamak ,Field (physics) ,Turbulence ,Plasma ,Condensed Matter Physics ,01 natural sciences ,010305 fluids & plasmas ,law.invention ,Computational physics ,Physics::Plasma Physics ,law ,0103 physical sciences ,Quasi linear ,Electron heating ,010306 general physics ,tokamakturbulent transportITER prefusion power operationvalidation quasi-linear models - Abstract
Kinetic profile predictions of ITER PFPO-1 plasmas require high accuracy in the central electron temperatures to be applied to the calculation of third harmonic electron cyclotron absorption. Correctly predicting the transition from L-mode to H-mode further requires precise estimates of the ion heat flux in the periphery of the plasma. Recent versions of the quasi-linear transport models TGLF and QuaLiKiz were tested against an extensive set of experimental results from ASDEX Upgrade (AUG) and JET-ILW, where the focus was put on AUG plasmas heated by ECRH. Spectra obtained from TGLF are compared to a set of linear gyrokinetic simulations performed with GKW. Electron and ion temperature profiles obtained with TGLF-SAT1geo show good agreement with the experimental profiles, but there is a slight tendency to underpredict central T e and T i at high ratios T e/T i. QuaLiKiz yields reasonable results for T e and T i profiles in plasmas where the ion temperature gradient mode is dominant, but predicts a significantly too weak transport in the presence of dominant trapped electron modes in conditions of strong central electron heating.
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- 2021
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24. Application of Dynamic Multi-Step Performance Loss Algorithm
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Björn Müller, K. Kiefer, David Moser, Marko Topič, and Sascha Lindig
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010302 applied physics ,Series (mathematics) ,Computer science ,Work (physics) ,Photovoltaic system ,02 engineering and technology ,Filter (signal processing) ,021001 nanoscience & nanotechnology ,01 natural sciences ,Correlation ,Position (vector) ,0103 physical sciences ,Time series ,0210 nano-technology ,Algorithm ,Degradation (telecommunications) - Abstract
In this work we present the application of a novel multi-step performance loss algorithm for PV systems and its practical implications. We try to better understand performance impairing effects and common occurrence patterns. The algorithm automatically detects the amount and position of breakpoints in non-linear performance ratio time series of PV systems, divides the time series into sub-parts and evaluates them independently in a linear fashion. Afterwards, based on the position of the breakpoints, system inspection data are used to find root causes for related changes in performance. The methodology is applied to two systems with an overall linear performance loss clearly below 1%/a. The results show similar performance loss patterns. The systems are two medium sized non-residential plants. After applying tailored data filter both systems experience a nearly linear performance loss over time with a slight performance fluctuation at the beginning of operation. This work focuses on system data and issues on system level. The study of the breakpoint-root causes correlation highlighted the necessity of tailoring the initial data filtering to the final objective of the analysis. It has been shown, that the presented algorithm simplifies the detection of performance instances which deviate from the norm.
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- 2020
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25. Prediction of Large-for-Gestational-Age Infants by Growth Standards and Hemoglobin A1C in Individuals with Prepregnancy Diabetes
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Miranda K. Kiefer, Matthew M. Finneran, Courtney Abshier Ware, Pamela Foy, Stephen Thung, Maged M. Costantine, Steven Gabbe, Mark B. Landon, and Kartik K. Venkatesh
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Obstetrics and Gynecology - Published
- 2022
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26. Association between Social Vulnerability and Influenza and Tdap Vaccination Uptake in Pregnant and Postpartum Individuals
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Rebecca Mehl, Miranda K. Kiefer, Maged M. Costantine, Mark B. Landon, Divya Mallampati, Tracy A. Manuck, Kara Rood, and Kartik K. Venkatesh
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Obstetrics and Gynecology - Published
- 2022
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27. Comparing performance of self-reported cases against an automated electronic dashboard for severe perinatal hypertension episodes
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Michelle R. Petrich, Miranda K. Kiefer, Maged M. Costantine, Keiko Smith, Keri Cooper, Cynthia Shellhaas, and Patrick Schneider
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Obstetrics and Gynecology - Published
- 2022
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28. Change in Hemoglobin A1C during pregnancy between Non-Hispanic Black versus White women with prepregnancy diabetes
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Kartik K. Venkatesh, Miranda K. Kiefer, Naleef Fareed, Courtney Abshier Ware, Stephen Thung, Mark B. Landon, Maged M. Costantine, Steven Gabbe, and Joshua Joseph
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Obstetrics and Gynecology - Published
- 2022
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29. Association between Social Vulnerability and Achieving Glycemic Control among Pregnant Women with Pregestational Diabetes
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Kartik K. Venkatesh, Katherine Germann, Joshua Joseph, Miranda K. Kiefer, Stephen Thung, Maged M. Costantine, Mark B. Landon, Steven Gabbe, and Naleef Fareed
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Obstetrics and Gynecology - Published
- 2022
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30. 242 Gestational weight gain recommendations and perinatal outcomes for patients with gestational and pregestational diabetes
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Adesomo Adebayo, Kartik K. Venkatesh, Steven G. Gabbe, Maged M. Costantine, Heather A. Frey, Miranda K. Kiefer, Mark A. Klebanoff, Mark B. Landon, and Erin M. Cleary
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medicine.medical_specialty ,business.industry ,Obstetrics ,Pregestational Diabetes ,Obstetrics and Gynecology ,Medicine ,Gestation ,medicine.symptom ,business ,Weight gain - Published
- 2021
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31. Improvements in world-wide intercomparison of PV module calibration
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Carl R. Osterwald, Dean H. Levi, Hironori Ohshima, S. Rummel, Kengo Yamagoe, M. Field, F. Neuberger, K Kiefer, Elena Salis, Harald Müllejans, Diego Pavanello, U. Kräling, Masahiro Yoshita, Yoshihiro Hishikawa, and Publica
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Value (computer science) ,Photovoltaische Module und Kraftwerke ,02 engineering and technology ,01 natural sciences ,intercomparison ,photovoltaic ,010309 optics ,0103 physical sciences ,Statistics ,photovoltaisches Modul ,Calibration ,Electrical performance ,General Materials Science ,Crystalline silicon ,uncertainty ,Mathematics ,Renewable Energy, Sustainability and the Environment ,Photovoltaic system ,Photovoltaische Kraftwerke ,calibration ,021001 nanoscience & nanotechnology ,World wide ,Photovoltaik ,Outlier ,Measurement uncertainty ,System und Zuverlässigkeit ,0210 nano-technology - Abstract
The calibration of the electrical performance of seven photovoltaic (PV) modules was compared between four reference laboratories on three continents. The devices included two samples in standard and two in high-efficiency crystalline silicon technology, two CI(G)S and one CdTe module. The reference value for each PV module parameter was calculated from the average of the results of all four laboratories, weighted by the respective measurement uncertainties. All single results were then analysed with respect to this reference value using the En number approach. For the four modules in crystalline silicon technology, the results agreed in general within ±0.5%, with all values within ±1% and all En numbers well within [−1, 1], indicating further scope for reducing quoted measurement uncertainty. Regarding the three thin-film modules, deviations were on average roughly twice as large, i.e. in general from ±1% to ±2%. A number of inconsistent results were observable, although within the 5% that can be statistically expected on the basis of the En number approach. Most inconsistencies can be traced to the preconditioning procedure of one participant, although contribution of other factors cannot be ruled out. After removing these obvious inconsistent results, only two real outliers remained, representing less than 2% of the total number of measurands. The results presented show improved agreement for the calibration of PV modules with respect to previous international exercises. For thin-film PV modules, the preconditioning of the devices prior to calibration measurements is the most critical factor for obtaining consistent results, while the measurement processes seem consistent and repeatable.
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- 2017
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32. Entwicklung, Charakterisierung und biologische Testung von neuen Glas-artigen Beschichtungen für kardiovaskuläre Implantate
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P.W. de Oliveira, K. Kiefer, M. Amlung, and Hashim Abdul-Khaliq
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Pulmonary and Respiratory Medicine ,Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
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33. The use of longitudinal hemoglobin A1c values to predict adverse obstetric and neonatal outcomes in pregnancies complicated by pregestational diabetes
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Miranda K. Kiefer, Matthew M. Finneran, Elizabeth O. Buschur, Courtney A. Ware, Mark B. Landon, Stephen F. Thung, and Steven G. Gabbe
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Glycated Hemoglobin ,Pregnancy ,medicine.medical_specialty ,Neonatal intensive care unit ,business.industry ,Obstetrics ,Cesarean Section ,Infant, Newborn ,Gestational age ,Retrospective cohort study ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Interquartile range ,Diabetes Mellitus ,Medicine ,Humans ,Female ,business ,Glycemic ,Maternal Age ,Ohio ,Retrospective Studies - Abstract
Background Although an elevated early pregnancy hemoglobin A1c has been associated with both spontaneous abortion and congenital anomalies, it is unclear whether A1c assessment is of value beyond the first trimester in pregnancies complicated by pregestational diabetes. Objective We sought to investigate the prognostic ability of longitudinal A1c assessment to predict obstetric and neonatal adverse outcomes based on degree of glycemic control in early and late pregnancy. Materials and Methods This was a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016 at The Ohio State University Wexner Medical Center with both an early A1c ( 26 weeks’ gestation) available for analysis. Patients were categorized by good (early and late A1c 6.5% and late A1c 6.5%) glycemic control. A multivariate regression model was used to calculate adjusted odds ratios for each identified obstetric and neonatal outcome, controlling for maternal age, body mass index, race/ethnicity, type of diabetes, and gestational age at delivery compared to good control as the referent group. Results A total of 341 patients met inclusion criteria during the study period. The median A1c values improved from early to late gestation in the good (5.7% [interquartile range, 5.4−6.1%] versus 5.4%; [interquartile range, 5.2−5.7%]), improved (7.5% [interquartile range, 6.7−8.5] versus 5.9% [interquartile range, 5.6−6.1%]) and poor (8.3% [interquartile range, 7.1−9.6%] versus 7.3% [interquartile range, 6.8−7.9%]) glycemic control groups. There were no statistically significant differences in the rate of adverse outcomes between the good and improved groups except for an increased rate of neonatal intensive care unit (NICU) admissions in the improved group (adjusted odds ratio, 3.7; confidence interval, 1.9−7.3). In contrast, the poor control group had an increased rate of shoulder dystocia (adjusted odds ratio, 6.8; confidence interval, 1.4−34.0), preterm delivery (adjusted odds ratio, 3.9; confidence interval, 2.1−7.3), neonatal intensive care unit admission (adjusted odds ratio, 2.8; confidence interval, 1.4−5.3), respiratory distress syndrome (adjusted odds ratio, 3.0; confidence interval, 1.1−8.0), hypoglycemia (adjusted odds ratio, 3.2; confidence interval, 1.5−6.9), large for gestational age weight at birth (adjusted odds ratio, 2.5; confidence interval, 1.4−4.4), neonatal length of stay >4 days (adjusted odds ratio, 4.2; confidence interval, 1.9−9.6) and preeclampsia (adjusted odds ratio, 2.4; confidence interval, 1.2−4.6). There were no differences in rates of cesarean delivery, umbilical artery pH Conclusion Antenatal hemoglobin A1c values are useful for objective risk stratification of patients with pregestational diabetes. Strict glycemic control throughout pregnancy with a late pregnancy A1c target of
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- 2019
34. The Accuracy and Cost-Effectiveness of Selective Fetal Echocardiography for the Diagnosis of Congenital Heart Disease in Patients with Pregestational Diabetes Stratified by Hemoglobin A1c
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Elizabeth O. Buschur, Pamela Foy, Miranda K. Kiefer, Mark B. Landon, Matthew M. Finneran, Steven G. Gabbe, Courtney A. Ware, and Stephen F. Thung
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Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,Cost effectiveness ,Cost-Benefit Analysis ,Elevated hemoglobin A1c ,Pregnancy in Diabetics ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Fetal Heart ,Pregnancy ,medicine ,Humans ,Mass Screening ,Retrospective Studies ,Glycated Hemoglobin ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Ultrasound ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,Regimen ,Echocardiography ,Pediatrics, Perinatology and Child Health ,Female ,business ,Fetal echocardiography - Abstract
Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resulted in a sensitivity and specificity of 60.0 and 99.4%, respectively. The use of selective fetal echocardiography for an A1c > 7.7% or abnormal detailed anatomy ultrasound would result in a 63.3% reduction in cost per each additional minor CHD diagnosed (ICER: $18,290.52 vs. $28,875.67). Conclusion Fetal echocardiography appears to have limited diagnostic value in women with pregestational diabetes. However, these results may not be generalizable outside of a high-volume academic setting.
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- 2019
35. Exposure and seroconversion to severe acute respiratory syndrome coronavirus 2 among obstetrical healthcare providers following a contained outbreak
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Mark B. Landon, Michael Cackovic, Jessica R. Russo, Marwan Ma'ayeh, Miranda K. Kiefer, Douglas A. Kniss, Stephen E. Gee, Kara M. Rood, Maged M. Costantine, Monique McKiever, and Devin D. Smith
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Adult ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Health Personnel ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,MEDLINE ,Antibodies, Viral ,Polymerase Chain Reaction ,Article ,Disease Outbreaks ,Betacoronavirus ,Health personnel ,Obstetrics and Gynaecology ,medicine ,Humans ,Prospective Studies ,Seroconversion ,Prospective cohort study ,Pandemics ,SARS-CoV-2 ,business.industry ,COVID-19 ,Obstetrics and Gynecology ,Outbreak ,Middle Aged ,Obstetrics ,Emergency medicine ,Female ,Coronavirus Infections ,business ,Healthcare providers - Published
- 2020
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36. Sa1854 WOMEN WITH IMMUNE MEDIATED INFLAMMATORY DISEASES WHO USE BIOLOGICS DURING PREGNANCY HAVE A HIGHER RISK FOR POSTPARTUM FLARE
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Miranda K. Kiefer, Kenneth D. Allen, Madalina Butnariu, and Anita Afzali
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Pregnancy ,Hepatology ,business.industry ,Immunology ,Gastroenterology ,Medicine ,Immune-mediated inflammatory diseases ,business ,medicine.disease - Published
- 2020
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37. 724: Effect of fasting versus postprandial state on total bile acid levels in pregnancy
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Sarah Davis, Mark B. Landon, Miranda K. Kiefer, Alan J. Lee, Devin D. Smith, Taryn Summerfield, and Kara M. Rood
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medicine.medical_specialty ,Pregnancy ,Postprandial ,Endocrinology ,Bile acid ,business.industry ,medicine.drug_class ,Internal medicine ,Obstetrics and Gynecology ,Medicine ,business ,medicine.disease - Published
- 2020
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38. Yield predictions for photovoltaic power plants: empirical validation, recent advances and remaining uncertainties
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K. Kiefer, Christian Reise, Björn Müller, Alfons Armbruster, and Laura Hardt
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Meteorology ,Renewable Energy, Sustainability and the Environment ,020209 energy ,Yield (finance) ,Photovoltaic system ,Irradiance ,Magnitude (mathematics) ,02 engineering and technology ,Condensed Matter Physics ,Solar irradiance ,Electronic, Optical and Magnetic Materials ,Photovoltaic power plants ,Performance ratio ,Solar Resource ,0202 electrical engineering, electronic engineering, information engineering ,Environmental science ,Electrical and Electronic Engineering - Abstract
Yield predictions are performed to predict the solar resource, the performance and the energy production over the expected lifetime of a photovoltaic (PV) system. In this study, we compare yield predictions and monitored data for 26 PV power plants located in southern Germany and Spain. The monitoring data include in-plane irradiance for comparison with the estimated solar resource and energy yield for comparison with predicted performance. The results show that because of increased irradiance in recent years (‘global brightening’) the yield predictions systematically underestimate the energy yield of PV systems by about 5%. Because common irradiance databases and averaging times were used for the yield predictions analysed in this paper, it is concluded that yield predictions for areas where the global brightening effect occurred in general underestimated the energy yield by the same magnitude. Using recent satellite-derived irradiance time series avoids this underestimation. The observed performance ratio of the analysed systems decreases by 0.5%/year in average with a relatively high spread between individual systems. This decrease is a main factor for the combined uncertainty of yield predictions. It is attributed to non-reversible degradation of PV cells or modules and to reversible effects, like soiling. Based on the results of the validation, the combined uncertainty of state of the art yield predictions using recent solar irradiance data is estimated to about 8%. Copyright © 2015 John Wiley & Sons, Ltd.
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- 2015
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39. NORTHERN SAN ANDREAS FAULT SLIP RATES ON THE SANTA CRUZ MOUNTAIN SECTION: 10BE DATING OF AN OFFSET ALLUVIAL FAN COMPLEX, SANBORN COUNTY PARK, SARATOGA, CA
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K. Kiefer, C. S. Prentice, S. B. DeLong, K. Blisniuk, R. Burgmann, and K. A. Guns
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geography ,geography.geographical_feature_category ,biology ,San andreas fault ,Tectonophysics ,Alluvial fan ,Slip (materials science) ,Saratoga ,Structural geology ,biology.organism_classification ,Archaeology ,Seismology ,Geology - Published
- 2018
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40. 182: Screening for fetal growth restriction in women of advanced maternal age
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Matthew M. Finneran, Miranda K. Kiefer, Kara B. Markham, and Alexa P. Henderson
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medicine.medical_specialty ,business.industry ,Obstetrics ,Fetal growth ,Obstetrics and Gynecology ,Medicine ,Advanced maternal age ,business - Published
- 2019
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41. 438: Accuracy of selective fetal echocardiography for the diagnosis of congenital heart disease in patients with pregestational diabetes stratified by hemoglobin A1c
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Miranda K. Kiefer, Mark B. Landon, Courtney A. Ware, Matthew M. Finneran, Stephen F. Thung, and Steven G. Gabbe
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medicine.medical_specialty ,medicine.diagnostic_test ,Heart disease ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,Pregestational Diabetes ,In patient ,Hemoglobin ,business ,Fetal echocardiography - Published
- 2018
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42. Differences in Obstetric and Neonatal Outcomes in Pregnancies Complicated by Type 1 and Type 2 Diabetes Mellitus [21H]
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Stephen F. Thung, Miranda K. Kiefer, Matthew M. Finneran, Steven G. Gabbe, Courtney A. Ware, and Mark B. Landon
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Pediatrics ,medicine.medical_specialty ,Neonatal outcomes ,business.industry ,Obstetrics and Gynecology ,Type 2 Diabetes Mellitus ,Medicine ,business - Published
- 2018
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43. On-site performance verification to reduce yield prediction uncertainties
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K. Kiefer, Boris Farnung, Julian Zenke, Björn Müller, and N.H. Reich
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Computer science ,business.industry ,media_common.quotation_subject ,Yield (finance) ,Reliability engineering ,Term (time) ,Electricity generation ,Range (statistics) ,Performance monitoring ,Quality (business) ,business ,Quality assurance ,Pv power ,media_common - Abstract
In this paper, we describe a number of quality assurance procedures for PV performance evaluations using data that has been acquired with commercially operating PV power plants. Summarized under the term “performance verification”, these procedures aim to make reliable use of data gathered by PV operators, despite inaccuracies in such data. To this end, short-term measurements with independent equipment and/or data sources are factored in. This ensures both meteorological and PV performance data gathered by operators have sufficient quality. Given a sufficient quality, site-adaptation of satellite based solar irradiation time series and optimizations of PV models may allow for significantly reduced uncertainties of yield predictions. This we anticipate to be of great interest to a broad range of PV stakeholders. The prerequisite for this, however, are appropriate quality of on-site sensors and strict maintenance of the PV performance monitoring systems in place.
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- 2015
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44. 963: The use of hemoglobin a1c values to predict adverse obstetric and neonatal outcomes in pregnancies complicated by pregestational diabetes
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Mark B. Landon, Stephen F. Thung, Miranda K. Kiefer, Matthew M. Finneran, Steven G. Gabbe, and Courtney A. Ware
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medicine.medical_specialty ,Neonatal outcomes ,Obstetrics ,business.industry ,Pregestational Diabetes ,medicine ,Obstetrics and Gynecology ,Hemoglobin ,business - Published
- 2018
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45. Critical exponents and intrinsic broadening of the field-induced transition in NiCl2 center dot 4SC(NH2)(2)
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E.Wulf, D. Huvonen, R. Schonemann, H. Kuhne, T. Herrmannsdorfer, I. Glavatskyy, S. Gerischer, K. Kiefer, S. Gvasaliya, and A. Zheludev
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- 2015
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46. Physical Review Letters
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Gonzalez-Arraga L.A., Lado J.L., Guinea F., San-Jose P., Gonzalez-Arraga Luis A. 1 Lado J.?L. 2 Guinea Francisco 1,3 San-Jose Pablo 4 1 IMDEA Nanociencia , Calle de Faraday, 9, Cantoblanco, 28049 Madrid, Spain QuantaLab, 2 International Iberian Nanotechnology Laboratory (INL) , Avenida Mestre Jose Veiga, 4715-330 Braga, Portugal School of Physics and Astronomy, 3 University of Manchester , Oxford Road, Manchester M13 9PL, United Kingdom 4 Instituto de Ciencia de Materiales de Madrid (ICMM-CSIC) , Cantoblanco, 28049 Madrid, Spain 5 September 2017 8 September 2017 119 10 107201 27 March 2017 6 July 2017 © 2017 American Physical Society 2017 American Physical Society Twisted graphene bilayers develop highly localized states around A A -stacked regions for small twist angles. We show that interaction effects may induce either an antiferromagnetic or a ferromagnetic (FM) polarization of said regions, depending on the electrical bias between layers. Remarkably, FM-polarized A A regions under bias develop spiral magnetic ordering, with a relative 120° misalignment between neighboring regions due to a frustrated antiferromagnetic exchange. This remarkable spiral magnetism emerges naturally without the need of spin-orbit coupling, and competes with the more conventional lattice-antiferromagnetic instability, which interestingly develops at smaller bias under weaker interactions than in monolayer graphene, due to Fermi velocity suppression. This rich and electrically controllable magnetism could turn twisted bilayer graphene into an ideal system to study frustrated magnetism in two dimensions. Marie-Curie-ITN 607904-SPINOGRAPH Ministerio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 Ministry of Economy and Competitiveness MINECO http://sws.geonames.org/2510769/ FIS2015-65706-P Ramon y Cajal RYC-2013-14645 Magnetism in 2D electronic systems is known to present a very different phenomenology from its three-dimensional counterpart due to the reduced dimensionality and the increased importance of fluctuations. Striking examples are the impossibility of establishing long range magnetic order in a 2D system without magnetic anisotropy [1] or the emergence of unique finite-temperature phase transitions that are controlled by the proliferation of topological magnetic defects [2] . In the presence of magnetic frustration, in, e.g., Kagome [3,4] or triangular lattices [5–8] , 2D magnetism may also lead to the formation of remarkable quantum spin-liquid phases [3,9,10] . The properties of these states remain under active investigation, and have recently been shown to develop exotic properties, such as fractionalized excitations [11] , long-range quantum entanglement of their ground state [12,13] , topologically protected transport channels [14] , or even high- T C superconductivity upon doping [4,15,16] . The importance of 2D magnetism extends also beyond fundamental physics into applied fields. One notable example is data storage technologies. Recent advances in this field are putting great pressure on the magnetic memory industry to develop solutions that may remain competitive in speed and data densities against new emerging platforms. Magnetic 2D materials are thus in demand as a possible way forward [17] . Of particular interest for applications in general are 2D crystals and van der Waals heterostructures. These materials have already demonstrated a great potential for a wide variety of applications, most notably nanoelectronics and optoelectronics [18–20] . Some of them have been shown to exhibit considerable tunability through doping, gating, stacking, and strain. Unfortunately, very few 2D crystals have been found to exhibit intrinsic magnetism [21,22] , let alone magnetic frustration and potential spin-liquid phases. In this work we predict that twisted graphene bilayers could be a notable exception, realizing a peculiar magnetism on an effective triangular superlattice, and with exchange interactions that may be tuned by an external electric bias. We show that, at a mean-field level, spontaneous magnetization of two different types may develop for small enough twist angles ? ? 2 ° as a consequence of the moiré pattern in the system. This effect is a consequence of the high local density of states generated close to neutrality at moiré regions with A A stacking, triggering a Stoner instability when electrons interact. The local order is localized at A A regions but may be either antiferromagnetic (AFM) or ferromagnetic (FM). The two magnetic orders can be switched electrically by applying a voltage bias between layers. Interestingly, the relative ordering between different A A regions in the FM ground state is predicted to be spiral, despite the system possessing negligible spin-orbit coupling. This type of magnetism combines a set of unique features: electric tunability, magnetic frustration, the interplay of two switchable magnetic phases with zero net magnetization, spatial localization of magnetic moments, and an adjustable period of the magnetic superlattice. Finally, we show that our mean-field treatment allows us to cast the system into an effective spin Hamiltonian that could be tackled beyond the mean-field level to evaluate the effects of spin fluctuations. The type of frustrated spin Hamiltonian obtained suggests that twisted graphene bilayers should be a prime playground for studies of spin-liquid phases. We discuss some of these possibilities in our concluding remarks. Description of the system.— Twisted graphene bilayers are characterized by a relative rotation angle ? between the two layers [23] . The rotation produces a modulation of the relative stacking at each point, following a moiré pattern of period L M ? a 0 / ? at small ? , where a 0 = 0.24 ? ? nm is graphene’s lattice constant [24] . The stacking smoothly interpolates between three basic types, A A (perfect local alignment of the two lattices), and A B or B A (Bernal stackings related by point inversion) [25] . The stacking modulation leads to a spatially varying coupling between layers. This results in a remarkable electronic reconstruction [26,27] , particularly at small angles ? ? 1 ° – 2 ° [28,29] , for which the interlayer coupling ? 1 ? 0.3 ? ? eV exceeds the moiré energy scale ? M = ? v F ? K [here, ? K = 4 ? / ( 3 L M ) is the rotation-induced wave vector shift between the Dirac points in the two layers, and v F ? 10 6 ? ? m / s is the monolayer Fermi velocity]. It was shown [24,29–33] that in such a regime the Fermi velocity of the bilayer becomes strongly suppressed, and the local density of states close to neutrality becomes dominated by quasilocalized states in the A A regions [28] . The confinement of these states is further enhanced by an interlayer bias V b , which effectively depletes the A B and B A regions due to the opening of a local gap [34,35] . At sufficiently small angles this was also shown to result in the formation of a network of helical valley currents flowing along the boundaries of depleted A B and B A regions [36] . The quasilocalized A A states form a weakly coupled triangular superlattice of period L M , analogous to a network of quantum dots. Each A A 'dot' has space for eight degenerate electrons, due to the sublattice, layer, and spin degrees of freedom. A plot of their spatial distribution under zero and large bias V b = 300 ? ? meV is shown in Figs. 1(a) and 1(b) , respectively. These A A states form an almost flat band at zero energy [37] , see Figs. 1(c) and 1(d) , which gives rise to a zero-energy peak in the DOS. The small but finite width of this zero-energy A A resonance represents the residual coupling between adjacent A A dots due to their finite overlap. A comparison of Figs. 1(a) and 1(b) shows that a finite interlayer bias leads to a suppression of said overlap and a depletion of the intervening A B and B A regions, as described above. The electronic structure presented here was computed using the tight-binding approach described in the Supplemental Material [38] , which includes a scaling approximation that allows the accurate and efficient computation of the low-energy band structure in low-angle twisted bilayers [compare the solid and dashed curves in Figs 1(c) and 1(d) ]. Our scaling approach makes the problem much more tractable computationally, which is a considerable advantage when dealing with the interaction effects, discussed below. 1 10.1103/PhysRevLett.119.107201.f1 FIG. 1. Zero-energy local density of states in real space (a),(b), band structure (c),(d), and density of states (e),(f) for a ? = 1.5 ° twisted graphene bilayer. The left column has no interlayer bias, and the right column has a bias V b = 300 ? ? meV . This enhances the localization of the A A quasibound states, red in (a) and (b). The said states arise from almost flat subbands at zero energy, which show up as large DOS peaks in (e) and (f). The solid (dashed) lines in (c) and (d) correspond to a scaled (unscaled) tight-binding model, see the main text. Moiré-induced magnetism.— It is known that in the presence of sufficiently strong electronic interactions, a honeycomb tight-binding lattice may develop a variety of ground states with spontaneously broken symmetry [42–46] . The simplest one is the lattice antiferromagnetic phase in the honeycomb Hubbard model. The Hubbard model is a simple description relevant to monolayer graphene with strongly screened interactions (the screening may arise intrinsically at high doping or, e.g., due to a metallic environment). Above a critical value of the Hubbard coupling, U > U c ( 0 ) ? 5.7 ? ? eV (value within the mean-field), the system favors a ground state in which the two sublattices are spin polarized antiferromagnetically. This is known as lattice-AFM (or Néel) order. In the absence of adsorbates [47] , edges [48] , vacancies [49] , or magnetic flux [50] isolated graphene monolayers, with their vanishing density of states at low energies, are known experimentally not to suffer any interaction-induced magnetic instability. In contrast, Bernal ( ? = 0 ) bilayer graphene and A B C trilayer graphene have been suggested [51–54] to develop magnetic order, due to their finite low-energy density of states, although some controversy remains [55–60] . Twisted graphene bilayers at small angles exhibit an even stronger enhancement of the low-energy density of states associated with A A confinement and the formation of quasiflat bands. It is thus natural to expect some form of interaction-induced instability in this system with realistic interactions, despite the lack of magnetism in the monolayer [61] . By analyzing the Hubbard model in twisted bilayers we now explore this possibility, and describe the different magnetic orders that emerge in the U , V b parameter space. We consider the Hubbard model in a low angle ? ? 1.5 ° twisted bilayer for a moderate [62] value of U = 3.7 , quite below the monolayer lattice-AFM critical interaction U c ( 0 ) . We use a self-consistent mean-field approximation to compute the system’s ground state, and use the same parameters of Fig. 1 . Self-consistency involves the iterative computation of charge and spin density on the moiré supercell, integrated over Bloch momenta, see the Supplemental Material [38] for details. Since U is repulsive we neglect superconducting symmetry breaking, and concentrate on arbitrary normal solutions instead [63] . In Fig. 2 we show the resulting real-space distribution of the ground-state spin polarization M ( r ? ) of the converged solution. The top and bottom rows correspond, respectively, to the lattice-FM and lattice-AFM components M A + M B and M A - M B , where the polarization density is defined as M ? = ? ? ? n ? ? ? ( r ? ) - n ? ? ? ( r ? ) ? . Here, ? = A , B are the two sublattices and ? = ± are the two layers. 2 10.1103/PhysRevLett.119.107201.f2 FIG. 2. Spatial distribution of the magnetic moment in the ground state of an interacting twisted bilayer with Hubbard U = 3.7 ? ? eV . In the first row (a),(b) we show the ferromagnetic component of the two sublattices, M A + M B , in units of electrons per (monolayer) unit cell, both for zero interlayer bias V b = 0 (a) and V b = 200 ? ? meV (b). Analogous plots of the lattice-AFM component M A - M B are shown in (c) and (d). The scale in all color bars is expressed in units of one electron spins per supercell. Panels (e) and (f) show the variation of the total electronic energy per supercell as a function of the angle ? M between polarizations of adjacent A A regions, indicating parallel alignment of the lattice-AFM order (e), and a spiral misalignment of 120° for the lattice-FM case (f). We obtain two distinct solutions for the magnetization, depending on the interlayer bias V b . At small interlayer bias and for the chosen U = 3.7 ? ? eV we see that the ferromagnetic polarization [Fig. 2(a) ] is small and collinear, and spatially integrates to zero. Thus, the unbiased bilayer remains nonferromagnetic in the small V b case. However, the lattice-AFM component of the polarization, Fig. 2(c) , is large and integrates to a nonzero value of around 0.5 electron spins per unit cell. This is the analogue of the monolayer lattice-AFM phase, with two important differences. On the one hand, we find that the lattice-AFM density is strongly concentrated at the A A regions instead of being spatially uniform like in the monolayer. On the other hand the lattice-AFM ground state is found to arise already for U ? 2 ? ? eV , i.e., for much weaker interactions than in the monolayer. The reason for the reduction of U c can be traced to the suppression of the Fermi velocity v F at small twist angles [29,32] , which controls the critical U for the lattice-AFM instability. The dependence of U c and v F as a function of angle ? is shown in Fig. 3(a) . This result already points to strong magnetic instabilities of twisted graphene bilayers as the angle falls below the 1°–2° threshold. 3 10.1103/PhysRevLett.119.107201.f3 FIG. 3. (a) Critical value U c of the Hubbard U beyond which the twisted bilayer develops lattice-AFM order at the mean-field level. The red dots show U c as a function of the twist angle ? , and the dashed line shows the corresponding Fermi velocity at the Dirac point, normalized to the monolayer value v F 0 . At high twist angles both U c and v F converge to the monolayer values, while they become strongly suppressed at smaller angles. (b) Phase diagram for the ground state magnetic order in a ? = 1.5 ° twisted bilayer as a function of Hubbard U and interlayer bias V b . The blue and red regions denote the spatial integral of the lattice-AFM and spiral-FM polarizations, respectively, while the yellow region is nonmagnetic. Under a large electric bias between layers, the ground state magnetization for the same U is dramatically different, see Figs. 2(b) and 2(d) . In this case, the lattice-AFM polarization, Fig. 2(d) , is strongly suppressed and integrates to zero spatially, while the lattice-FM component, Fig. 2(b) , becomes large around the A A regions, and integrates to a finite value of approximately four electron spins per moiré supercell. The A A regions are thus found to become ferromagnetic under sufficient interlayer bias. This type of magnetic order is the result of the increased confinement of A A states at high V b , and can be interpreted as an instance of flat-band ferromagnetism driven by the Stoner mechanism. The lattice-AFM and lattice-FM states are also different when comparing the relative orientations of neighboring A A regions. By computing the total energy per supercell in each case as a function of the polarization angle ? M between adjacent regions [Figs. 2(e) and 2(f) ], we find that the energy is minimized for ? M = 0 ° in the lattice-AFM case (parallel alignment), but for ? M = 12 0 ° in the lattice-FM case (spiralling polarization). The equilibrium polarization is depicted by white arrows in Figs. 2(c) and 2(b) . The depth of the energy minimum, ranging from ? 2 – 100 ? ? K in our simulations, represents the effective exchange coupling of neighboring A A regions, which is ferromagnetic for lattice-AFM states and antiferromagnetic for lattice-FM states (see the Supplemental Material [38] for the next-nearest neighbor exchange). In the lattice-FM phase, which from now on we denote the spiral-FM phase, the spiral order arises as a result of the triangular symmetry of A A regions that frustrates a globally antiferromagnetic A A alignment. The same spiral order has been described in studies of the Hubbard model in the triangular lattice. It is a rather remarkable magnetic state, as the polarization at different points becomes noncollinear [7,64,65] despite the complete absence of spin-orbit coupling in the system. To better understand the onset of the spiral magnetism, we have computed the integrated FM and AFM polarization across the U , V b plane. We find first-order phase transitions separating the two types of ground states. The result is shown in Fig. 3 . The regions in red and blue denote, respectively, a finite spatial integral of the ferro M A + M B and lattice-AFM M A - M B polarizations. It is apparent that an electric interlayer bias of around 120 meV is able to switch between the lattice-AFM and spiral-FM orders for values of U between 2 and 3 eV. The precise thresholds for such electric switching of magnetic order depend on the specific twist angle and on other details not considered in this work (longer-range interactions, spontaneous deformations, or interlayer screening), although our simulations suggest they are likely within reach of current experiments for sufficiently small ? . Our mean-field analysis neglects thermal and quantum spin fluctuations around the mean-field solution. Thermal spin excitations in the magnetically isotropic case under study (from gapless Goldstone modes) are expected to destroy long-range spiral order, which then survives only locally, in keeping with the Mermin-Wagner theorem [1] . Breaking the magnetic isotropy (by allowing for a hard magnetic axis due to, e.g., spin-orbit coupling or coupling to a suitable magnetic substrate) gaps the Goldstone modes and stabilizes the mean-field solution. Otherwise, even at zero temperature, quantum spin fluctuations are known to produce spin-liquid-like ground states [5–8] . An efficient way to explore such nontrivial effects in this moiré system is to cast our mean-field results into an effective spin Hamiltonian on the triangular A A moiré pattern, which could be tackled using more sophisticated approaches (e.g., matrix-product states). The procedure is described in the Supplemental Material [38] . Conclusion.— For a long time unmodified graphene was thought to be relatively uninteresting from the point of view of magnetism. Twisted graphene bilayers, however, could prove to be a surprisingly rich playground for nontrivial magnetic phases. We have shown that two different types of mean-field magnetic solutions arise in twisted graphene bilayers at small angles. The two types of magnetic order, lattice antiferromagnetism and spiral ferromagnetism, are both concentrated at A A -stacked regions. The spiral-FM phase is favored over the lattice-AFM phase when applying a sufficient electric bias between layers. This phase constitutes a form of electrically controllable, noncollinear, and spatially nonuniform magnetism in a material with a negligible spin-orbit coupling. This possibility is of fundamental interest, as it realizes electrically tunable 2D magnetism on a triangular superlattice, a suitable platform to explore spin-liquid phases. Indeed, it is known that next-nearest neighbor interactions in a magnetic triangular lattice should transform spiral order into a spin-liquid phase [5–8] , as long as the system remains magnetically isotropic. Moreover, in the spin-liquid state, electronic doping can give rise to high T C superconductivity [66,67] . The possibility of modifying the electronic filling of our emergent frustrated triangular lattice by means of an electric gate offers a unique platform to realize this possibility, avoiding the detrimental effects of chemical doping in conventional compounds [68] . 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We acknowledge financial support from the Marie-Curie-Initial Training Networks (ITN) program through Grant No. 607904-SPINOGRAPH, and the Spanish Ministry of Economy and Competitiveness through Grants No. FIS2015-65706-P (MINECO/FEDER) and No. RYC-2013-14645 (Ramon y Cajal program). L.?A.?G.-A. is grateful for the hospitality of the Applied Physics Department in the University of Alicante and to N. Garcia for useful discussions. We specially thank J. Fernandez Rossier for his help settling the environment and the initial idea for this work.
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- 2017
47. An ultra-low field SQUID magnetometer for measuring antiferromagnetic and weakly remanent magnetic materials at low temperatures.
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Paulsen M, Lindner J, Klemke B, Beyer J, Fechner M, Meier D, and Kiefer K
- Abstract
A novel setup for measuring magnetic fields of antiferromagnets (i.e., quadrupolar or higher-order magnetic fields) and generally weakly remanent magnetic materials is presented. The setup features a highly sensitive superconducting quantum interference device magnetometer with a magnetic field resolution of ∼ 10 fT and non-electric temperature control of the sample space for a temperature range of 1.5-65 K with a non-electric sample movement drive and optical position encoding. To minimize magnetic susceptibility effects, the setup components are degaussed and realized with plastic materials in sample proximity. Running the setup in magnetically shielded rooms allows for a well-defined ultra-low magnetic background field well below 150 nT in situ. The setup enables studies of inherently weak magnetic materials, which cannot be measured with high field susceptibility setups, optical methods, or neutron scattering techniques, giving new opportunities for the research on, e.g., spin-spiral multiferroics, skyrmion materials, and spin ices., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)
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- 2023
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48. Organ Protection by Caloric Restriction Depends on Activation of the De Novo NAD+ Synthesis Pathway.
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Späth MR, Hoyer-Allo KJR, Seufert L, Höhne M, Lucas C, Bock T, Isermann L, Brodesser S, Lackmann JW, Kiefer K, Koehler FC, Bohl K, Ignarski M, Schiller P, Johnsen M, Kubacki T, Grundmann F, Benzing T, Trifunovic A, Krüger M, Schermer B, Burst V, and Müller RU
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- Humans, Mice, Animals, NAD metabolism, Caloric Restriction, Hypoxia, Reperfusion Injury prevention & control, Acute Kidney Injury metabolism
- Abstract
Significance Statement: AKI is a major clinical complication leading to high mortality, but intensive research over the past decades has not led to targeted preventive or therapeutic measures. In rodent models, caloric restriction (CR) and transient hypoxia significantly prevent AKI and a recent comparative transcriptome analysis of murine kidneys identified kynureninase (KYNU) as a shared downstream target. The present work shows that KYNU strongly contributes to CR-mediated protection as a key player in the de novo nicotinamide adenine dinucleotide biosynthesis pathway. Importantly, the link between CR and NAD+ biosynthesis could be recapitulated in a human cohort., Background: Clinical practice lacks strategies to treat AKI. Interestingly, preconditioning by hypoxia and caloric restriction (CR) is highly protective in rodent AKI models. However, the underlying molecular mechanisms of this process are unknown., Methods: Kynureninase (KYNU) knockout mice were generated by Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and comparative transcriptome, proteome and metabolite analyses of murine kidneys pre- and post-ischemia-reperfusion injury in the context of CR or ad libitum diet were performed. In addition, acetyl-lysin enrichment and mass spectrometry were used to assess protein acetylation., Results: We identified KYNU as a downstream target of CR and show that KYNU strongly contributes to the protective effect of CR. The KYNU-dependent de novo nicotinamide adenine dinucleotide (NAD+) biosynthesis pathway is necessary for CR-associated maintenance of NAD+ levels. This finding is associated with reduced protein acetylation in CR-treated animals, specifically affecting enzymes in energy metabolism. Importantly, the effect of CR on de novo NAD+ biosynthesis pathway metabolites can be recapitulated in humans., Conclusions: CR induces the de novo NAD+ synthesis pathway in the context of IRI and is essential for its full nephroprotective potential. Differential protein acetylation may be the molecular mechanism underlying the relationship of NAD+, CR, and nephroprotection., (Copyright © 2023 by the American Society of Nephrology.)
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- 2023
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49. Caloric restriction reduces the pro-inflammatory eicosanoid 20-hydroxyeicosatetraenoic acid to protect from acute kidney injury.
- Author
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Hoyer-Allo KJR, Späth MR, Brodesser S, Zhu Y, Binz-Lotter J, Höhne M, Brönneke H, Bohl K, Johnsen M, Kubacki T, Kiefer K, Seufert L, Koehler FC, Grundmann F, Hackl MJ, Schermer B, Brüning J, Benzing T, Burst V, and Müller RU
- Subjects
- Animals, Caloric Restriction, Hydroxyeicosatetraenoic Acids metabolism, Hydroxyeicosatetraenoic Acids pharmacology, Kidney metabolism, Male, Mice, Acute Kidney Injury etiology, Acute Kidney Injury metabolism, Acute Kidney Injury prevention & control, Reperfusion Injury metabolism, Reperfusion Injury prevention & control
- Abstract
Acute kidney injury is a frequent complication in the clinical setting and associated with significant morbidity and mortality. Preconditioning with short-term caloric restriction is highly protective against kidney injury in rodent ischemia reperfusion injury models. However, the underlying mechanisms are unknown hampering clinical translation. Here, we examined the molecular basis of caloric restriction-mediated protection to elucidate the principles of kidney stress resistance. Analysis of an RNAseq dataset after caloric restriction identified Cyp4a12a, a cytochrome exclusively expressed in male mice, to be strongly downregulated after caloric restriction. Kidney ischemia reperfusion injury robustly induced acute kidney injury in male mice and this damage could be markedly attenuated by pretreatment with caloric restriction. In females, damage was significantly less pronounced and preconditioning with caloric restriction had only little effect. Tissue concentrations of the metabolic product of Cyp4a12a, 20-hydroxyeicosatetraenoic acid (20-HETE), were found to be significantly reduced by caloric restriction. Conversely, intraperitoneal supplementation of 20-HETE in preconditioned males partly abrogated the protective potential of caloric restriction. Interestingly, this effect was accompanied by a partial reversal of caloric restriction--induced changes in protein but not RNA expression pointing towards inflammation, endoplasmic reticulum stress and lipid metabolism. Thus, our findings provide an insight into the mechanisms underlying kidney protection by caloric restriction. Hence, understanding the mediators of preconditioning is an important prerequisite for moving towards translation to the clinical setting., (Copyright © 2022 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
50. Usefulness of Serum Biomarkers of Endothelial Glycocalyx Damage in Prognosis of Decompensated Patients with Heart Failure with Reduced Ejection Fraction.
- Author
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Kim YH, Kitai T, Morales R, Kiefer K, Chaikijurajai T, and Tang WHW
- Subjects
- Biomarkers, Glycocalyx, Heparitin Sulfate, Humans, Hyaluronic Acid, Prognosis, Stroke Volume, Syndecan-1, Heart Failure, Ventricular Dysfunction, Left complications
- Abstract
The surface layer of endothelium contains the endothelial glycocalyx (eGC), consisting of proteoglycan polymers. Syndecan-1, heparan sulfate, and hyaluronic acid are major constituents of eGC, and their increasing detection in serum represents active degradation of eGC. Serum was obtained from patients with no heart failure (non-HF) and with HF with reduced ejection fraction (HFrEF) of <40%, either stable chronic HF (CHF) or acute decompensated HF (ADHF). Syndecan-1, heparan sulfate, and hyaluronic acid were measured for comparisons in the groups, adjusting for clinical and laboratory values. In our study cohort, 51 non-HF, 66 ADHF, and 72 patients with CHF were enrolled. Between ADHF and CHF, left ventricular (LV) mass index, LV ejection fraction, and pulmonary capillary wedge pressure did not differ. Patients with ADHF had significantly higher levels of eGC constituents compared with CHF and non-HF. During follow-up, 21 patients with HF died, and the mortality rate was higher in patients with higher serum syndecan-1 or heparan sulfate (log-rank p = 0.007 and 0.016, respectively). In multivariate analysis, a doubling of serum heparan sulfate concentration amounted to a 31.5% increase in all-cause mortality (hazard ratio = 1.315, confidence interval = 1.012-1.709, p = 0.040). In conclusion, serum biomarkers of eGC were elevated in ADHF (but not in CHF) in patients with HFrEF, suggesting the potential roles of eGC degradation and endothelial dysfunction in HF decompensation. Only elevated heparin sulfate was associated with higher all-cause mortality after adjusting for traditional risk variables in patients with HFrEF., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
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