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"Ness, Roberta B"
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Innovation generation : how to produce creative and useful scientific ideas
\"Innovation Generation presents a fascinating new approach to creative thinking. Using a system of idea-generating methods honed over her illustrious career as a physician, researcher, professor, teacher, and Dean, Roberta Ness provides all the tools needed to learn how to cast aside habitual cognitive maps called frames and draw insights from other fields.
Book
Risk of Sequelae after Chlamydia trachomatis Genital Infection in Women
Chlamydia trachomatis infection, the most common reportable disease in the United States, can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Although C. trachomatis is identified among many women who receive a diagnosis of PID, the incidence and timing of PID and longterm sequelae from an untreated chlamydial infection have not been fully determined. This article examines evidence reviewed as part of the Centers for Disease Control and Prevention Chlamydia Immunology and Control Expert Advisory Meeting; 24 reports were included.We found no prospective studies directly assessing risk of long-term reproductive sequelae, such as infertility, after untreated C. trachomatis infection. Several studies assessed PID diagnosis after untreated chlamydial infection, but rates varied widely, making it difficult to determine an overall estimate. In high-risk settings, 2%–5% of untreated women developed PID within the ∼2-week period between testing positive for C. trachomatis and returning for treatment. However, the rate of PID progression in the general, asymptomatic population followed up for longer periods appeared to be low. According to the largest studies, after symptomatic PID of any cause has occurred, up to 18% of women may develop infertility. In several studies, repeated chlamydial infection was associated with PID and other reproductive sequelae, although it was difficult to determine whether the risk per infection increased with each recurrent episode. The present review critically evaluates this body of literature and suggests future research directions. Specifically, prospective studies assessing rates of symptomatic PID, subclinical tubal damage, and long-term reproductive sequelae after C. trachomatis infection; better tools to measure PID and tubal damage; and studies on the natural history of repeated chlamydial infections are needed.
Journal Article
Prepregnancy Body Mass Index and the Occurrence of Severe Hypertensive Disorders of Pregnancy
Background: Prepregnancy overweight is a risk factor for mild preeclampsia and mild transient hypertension of pregnancy. Its association with severe subtypes of these disorders has received less attention. Methods: To assess the association of prepregnancy body mass index (BMI) with severe and mild preeclampsia and transient hypertension of pregnancy, we used data from a 1958-1964 prospective cohort study of 38,188 pregnant women receiving care at 12 U.S. hospitals. Results: There was a monotonic, dose-response relation between prepregnancy BMI and risk of both severe and mild preeclampsia, as well as the risk of severe and mild transient hypertension of pregnancy. Compared with white women with a BMI of 20, the odds ratios for severe preeclampsia at BMI values of 25 and 30 in white women were 1.7 (95% confidence interval = 1.1-2.5) and 3.4 (2.1-5.6), respectively, and 2.1 (1.4-3.2) and 3.2 (2.1-5.0) in black women. The effect of BMI on risk of severe preeclampsia was similar to its effect on mild disease. Compared with the same referent, odds ratios for severe transient hypertension of pregnancy at BMI values of 25 and 30 in white women were 3.6 (2.0-6.5) and 8.8 (4.4-18), respectively, and 3.0 (1.6-5.8) and 4.9 (2.5-9.6) in black women. Overweight was a stronger risk factor for severe than for mild transient hypertension. Conclusions: Incidence of both mild and severe hypertensive disorders of pregnancy rises with increasing BMI. Escalating obesity rates may increase pregnancy hypertensive disorders and ensuing perinatal morbidity.
Journal Article
The creativity crisis : reinventing science to unleash possibility
\"Every day we hear about some fascinating new discovery. Yet anemic progress toward addressing the greatest risks to humankind -- clean energy, emerging infections, and cancer -- warns us that science may not be meeting its potential. Indeed, there is evidence that advances are slowing. Science is costly and can hurt people; thus it must be pursued with caution. Yet, excessive caution stifles the very thing that powers inventiveness: creation. In her boldest book yet, Roberta Ness argues that the system of funding agencies, universities, and industries designed to promote innovation has come to impede it. The Creativity Crisis strips away the scientific enterprise's veil of mystique to reveal the gritty underbelly of university research. America's economic belt-tightening discourages long-term, risky investments in revolutionary advances and elevates short-term projects with assured outcomes. The pursuit of basic research insights, with the greatest power to transform but little ability to enrich, is being abandoned. The social nature of academia today also contributes to the descent of revolutionary discovery. In academia, which tends to be insular, hierarchical, and tradition-bound, research ideas are \"owned\" and the owners gain enormous clout to decide what is accepted. Communalism is antithetical to idea ownership. Thus science has not embraced the Web-based democratic sharing of ideas called crowdsourcing, one of the greatest tools for creativity and social change in our age. A final battleground between creation and caution is within the sphere of ethics. Scientists are typically altruistic but sometimes have all-too-human inclinations toward avarice and conceit. The most original thinkers are most likely to flout convention. This tendency can pull them across the lines of acceptable behavior. Caution is a necessary check on the destructive potential of amoral creation. Yet, when every individual and institution is considered a priori to be a threat, adventuresome invention is squelched. Creation and caution in science should be in balance, but they are not. For possibilities to unlock, the ecosystem in which science is done must be fundamentally rebalanced\"-- Provided by publisher.
Book
Bacterial Vaginosis and Anaerobic Bacteria Are Associated with Endometritis
Background. Chlamydia trachomatis and/or Neisseria gonorrhoeae account for approximately one-third to one-half of pelvic inflammatory disease (PID) cases. Thus, up to 70% of cases have an unknown, nongonococcal/nonchlamydial microbial etiology. Methods. We investigated the associations of N. gonorrhoeae, C. trachomatis, bacterial vaginosis, anaerobic bacteria, facultative bacteria, and lactobacilli with endometritis among 278 women with complete endometrial histology and culture from the PID Evaluation and Clinical Health Study. Results. Women with acute endometritis were less likely to have H2O2-producing Lactobacillus species (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.01–0.8) and more likely to be infected with C. trachomatis (OR, 16.2; 95% CI, 4.6–56.6), N. gonorrhoeae (OR, 11.6; 95% CI, 4.5–29.9), diphtheroids (OR, 5.0; 95% CI, 2.1–12.2), black-pigmented gram-negative rods (OR, 3.1; 95% CI, 1.4–7.0), and anaerobic gram-positive cocci (OR, 2.1; 95% CI, 1.0–4.3) and to have bacterial vaginosis (OR, 2.4; 95% CI, 1.3–4.3). Conclusions. We conclude that bacterial vaginosis—associated organisms are frequent among women with PID. Because these organisms were strongly associated with endometritis, we recommend that all women with PID be treated with regimens that include metronidazole.
Journal Article
Clinical Presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae Infection among Women with Pelvic Inflammatory Disease
Background. Women with pelvic inflammatory disease (PID) often present with a spectrum of symptoms. The characteristics of nongonococcal, nonchlamydial PID have not been well described. Our objective was to examine the characteristics of Mycoplasma genitalium infection among women with clinically suspected PID. Methods. We evaluated 722 women who were enrolled in the PID Evaluation and Clinical Health study. Women with M. genitalium monoinfection were compared with women with Neisseria gonorrhoeae monoinfection or Chlamydia trachomatis monoinfection. Results. Compared with women with gonococcal PID, women with M. genitalium infection were less likely to have elevated systemic inflammatory markers, including an erythrocyte sedimentation rate >15 mm/h (5 [22.7%] of 22 patients vs. 45 [60.8%] of 74 patients; P=.002), a white blood cell count >10,000 cells/mL (4 [28.6%] of 14 patients vs. 42 [64.6%] of 65 patients; P=.018), and an oral temperature ⩾38.3°C (0 [0.0%] of 22 patients vs. 10 [13.9%] of 72 patients; P=.085). In addition, they were less likely to present with mucopurulent cervicitis (9 [47.4%] of 19 patients vs. 60 [83.3%] of 72 patients; P=.001), elevated vaginal pH (P=.018), and high pelvic pain score (P=.014). In contrast, women with chlamydial PID had signs and symptoms that were similar to those in women with M. genitalium infection. Conclusions. Because symptoms might be mild, women with M. genitalium infection might not seek PID treatment. Further studies are needed to assess the potential reproductive tract sequelae of M. genitalium infection of the upper genital tract.
Journal Article
Promoting Innovative Thinking
Innovation is the engine of scientific progress, yet we do not train public health students to think creatively. I present the key concepts within an evidence-based method currently taught at the University of Texas. Habitual thought patterns involve deeply held framed expectations. Finding alternatives generates originality. Because frame breaking is difficult, a series of innovation heuristics and tools are offered including enhancing observation, using analogies, changing point of view, juggling opposites, broadening perspective, reversal, reorganization and combination, and getting the most from groups. Gaining cognitive attributes such as nonjudgment, willingness to question, mindfulness, and plasticity is also emphasized. Students completing the class demonstrate substantial increases on a standardized test of idea fluency and originality, more joyful attitudes toward science, and more pluralistic approaches.
Journal Article
Identification of novel microbes associated with pelvic inflammatory disease and infertility
ObjectivesAs pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae.MethodsFastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia amnionii, Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility.ResultsPersistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RRadj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RRadj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RRadj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest.ConclusionsTo our knowledge, this is the first prospective study to demonstrate that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.
Journal Article