Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent

OBJECTIVE: To investigate the human and monetary cost consequences of preterm delivery as related to induced abortion (IA), with its impact on informed consent and medical malpractice. STUDY DESIGN: A review of the literature in English was performed to assess the effect of IA on preterm delivery rates from 24 to 31 6/7 weeks to assess the risk for preterm birth attributable to IA. After calculating preterm birth risk, the increased initial neonatal hospital costs and cerebral palsy (CP) risks related to IA were calculated. RESULTS: IA increased the early preterm delivery rate by 31.5%, with a yearly increase in initial neonatal hospital costs related to IA of > $1.2 billion. The yearly human cost includes 22,917 excess early preterm births (EPB) (< 32 weeks) and 1096 excess CP cases in very-low-birth-weight newborns, <1500 g. CONCLUSION: IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetric care and abortion should be aware of the risk of preterm birth attributable to induced abortion, with its significant increase in initial neonatal hospital costs and CP cases.     

Simian Varicella Virus Pathogenesis in Skin during Varicella and Zoster

Primary simian varicella virus (SVV) infection and reactivation in nonhuman primates is a valuable animal model in the study of varicella zoster virus disease [varicella (chickenpox) and herpes zoster (shingles)]. To understand SVV pathogenesis in skin, we inoculated 10 rhesus macaques with SVV, resulting in varicella rash. After the establishment of latency, eight of the monkeys were immunosuppressed using tacrolimus with or without irradiation and prednisone and two monkeys were not immunosuppressed. Zoster rash developed in all immunosuppressed monkeys and in one non-immunosuppressed monkey. Five monkeys had recurrent zoster. During varicella and zoster, SVV DNA in skin scrapings ranged from 50 to 10⁷ copies/100 ng of total DNA and 2–127 copies/100 ng of total DNA, respectively. Detection of SVV DNA in blood during varicella was more frequent and abundant compared to that of zoster. During varicella and zoster, SVV antigens colocalized with neurons expressing β-III tubulin in epidermis, hair follicles, and sweat glands, suggesting axonal transport of the virus. Together, we have demonstrated that both SVV DNA and antigens can be detected in skin lesions during varicella and zoster, providing the basis for further studies on SVV skin pathogenesis, including immune responses and mechanisms of peripheral spread.     

Round spermatid injection into human oocytes:a systematic review and meta-analysis

Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating o...     

Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows

1. Download : Download high-res image (397KB)
2. Download : Download full-size image

     

Circadian Rhythmicity as a Predictor of Quality of Life in Allogeneic Hematopoietic Cell Transplant Patients

Context

Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.

Stem water cryogenic extraction biases estimation in deuterium isotope composition of plant source water

The hydrogen isotope ratio of water cryogenically extracted from plant stem samples (δ²H_{stem_CVD}) is routinely used to aid isotope applications that span hydrological, ecological, and paleoclimatological research. However, an increasing number of studies have shown that a key assumption of these applications—that δ²H_{stem_CVD} is equal to the δ²H of plant source water (δ²H_source)—is not necessarily met in plants from various habitats. To examine this assumption, we purposedly designed an experimental system to allow independent measurements of δ²H_{stem_CVD}, δ²H_source, and δ²H of water transported in xylem conduits (δ²H_xylem) under controlled conditions. Our measurements performed on nine woody plant species from diverse habitats revealed a consistent and significant depletion in δ²H_{stem_CVD} compared with both δ²H_source and δ²H_xylem. Meanwhile, no significant discrepancy was observed between δ²H_source and δ²H_xylem in any of the plants investigated. These results cast significant doubt on the long-standing view that deuterium fractionation occurs during root water uptake and, alternatively, suggest that measurement bias inherent in the cryogenic extraction method is the root cause of δ²H_{stem_CVD} depletion. We used a rehydration experiment to show that the stem water cryogenic extraction error could originate from a dynamic exchange between organically bound deuterium and liquid water during water extraction. In light of our finding, we suggest caution when partitioning plant water sources and reconstructing past climates using hydrogen isotopes, and carefully propose that the paradigm-shifting phenomenon of ecohydrological separation (“two water worlds”) is underpinned by an extraction artifact.

The analysis of the stable isotope ratios of plant source water (δ_source) is a powerful tool enabling the elucidation of a range of plant physiological, ecological, and hydrological processes from scales ranging from individual plants to the planet. δ_source provides a foundation on which to form isotope signals of transpired water vapor and plant-derived biomarkers (i.e., cellulose and lipids) and thus is of high relevance to studies of terrestrial water fluxes (1, 2) and paleoclimate reconstructions (3, 4). δ_source also contains information on the spatial and temporal origins of water used by plants and so is commonly used for investigating plant water uptake patterns under natural conditions (5, 6). Moreover, dual-isotope (δ²H and δ¹⁸O) analysis of δ_source was critical in formulating the paradigm-shifting “two water worlds” (TWW) hypothesis, whereby ecohydrological separation exists between plant-accessible soil water pools and those recharging streams and groundwater (7, 8).Elucidation of the foregoing processes rest on the assumption that water extracted from plant stems is isotopically identical to water taken up by plant roots. Plant stem water is typically extracted with the cryogenic-vacuum distillation technique; δ generated with this method is hereinafter referred as δ_{stem_CVD} (9). For δ_{stem_CVD} to be an accurate indicator of δ_source (i.e., δ_{stem_CVD} = δ_source), two prerequisites must be met: 1) isotope change does not occur during root uptake and/or xylem transport of the source water (prerequisite I) and 2) stem water cryogenic extraction is a robust approach toward isotope recovery of xylem water (prerequisite II). The “δ_{stem_CVD} = δ_source” assumption is generally valid for oxygen isotopes of water, but numerous studies have used hydrogen isotopes to assess source water, and here this assumption has faced scrutiny, as multiple studies have reported significant depletion in δ²H_{stem_CVD} compared with δ²H_source in plants from various habitats (10–18).A frequently invoked explanation for the observed δ²H_{stem_CVD} depletion is a violation of prerequisite I, as it is believed that symplastic uptake of source water into the root xylem can give rise to hydrogen isotope fractionation (10, 11, 13, 19). The available evidence (10, 11) in support of such an explanation is largely peripheral, because direct, unambiguous confirmation of water uptake/transport-related fractionation would require a comparison of deuterium in source water and water transported within xylem conduits (δ²H_xylem). However, this type of comparison is difficult owing to the technical challenges in obtaining targeted measurements of δ²H_xylem in most plants. Intriguingly, in a field-grown riparian tree species (Populus euphratica) in which δ²H_xylem measurement was made possible with the aid of a syringe-aided xylem sap bleeding technique, no significant difference was observed between δ²H_xylem and δ²H_source (12). This led to the suggestion that, at least for the investigated species, δ²H_{stem_CVD} depletion arises not from a violation of prerequisite I, but rather from a violation of prerequisite II. The violation of prerequisite II has been deemed possible (12, 17) based on the argument that hydrogen isotope heterogeneity could be present within the bulk stem water (i.e., the outside xylem water may carry a metabolism-induced, more-depleted δ²H signature compared with the xylem water), potentially causing the stem water extraction technique to artifactually underestimate δ²H_xylem.Given the controvertible state of knowledge regarding the mechanism driving δ²H_{stem_CVD} depletion, it is imperative for us to build a better and more comprehensive understanding of the isotopic relationships among cryogenic extracted bulk stem water, source water, and xylem water in different plants, so as to put the application of the stem water cryogenic extraction technique in diverse fields on firmer ground. In this context, it should be pointed out that the xylem water direct sampling technique (12) is applicable only to a few riparian tree species. Recently, a new method relying on laser-enabled isotope measurement of water vapor in equilibrium with xylem water has demonstrated potential for in situ continuous monitoring of xylem isotope signatures in trees (20, 21); however, the method needs further development before it becomes broadly applicable to different plant types. Thus, a more generally applicable method is needed for determining xylem water signature across diverse plant types.Toward this goal, and capitalizing on the well-recognized mass balance-dictated principle that the isotopic composition of steady-state (SS) plant transpiration is identical to that of the xylem water supplying the plant canopy, we custom-designed a measurement system to enable independent quantification of xylem water isotope composition through isotope measurement of SS plant transpiration. This measurement system conferred the ability to compare values of δ_{stem_CVD}, δ_source, and δ_xylem across a number of plant species of varying native habitats. The data allowed us to confirm the common presence of δ²H_{stem_CVD} depletion across all plant types measured, and also to demonstrate that this phenomenon is caused by cryogenic extraction-associated artifact and not by water uptake/transport-related fractionation. We also performed a rehydration experiment to illustrate that the extraction artifact is unrelated to within-stem isotope heterogeneity as has been recently suggested, but rather is more likely linked to a deuterium-exchange process that occurs dynamically during cryogenic extraction. Using the TWW hypothesis as an example, we further discuss the ramifications for ecological/hydrological queries that rely on accurate isotopic information on plant source/xylem water.     

The Toxicology Investigators Consortium Case Registry—the 2014 Experience

The Toxicology Investigators Consortium (ToxIC) Case Registry was established in 2010 by the American College of Medical Toxicology. The Registry includes all medical toxicology consultations performed at participating sites. The Registry was queried for all cases entered between January 1 and December 31, 2014. Specific data reviewed for analysis included demographics (age, gender, ethnicity), source of consultation, reasons for consultation, agents involved in toxicological exposures, signs, symptoms, clinical findings, fatalities, and treatment. In 2014, 9172 cases were entered in the Registry across 47 active member sites. Females accounted for 51.1 % of cases. The majority (65.1 %) of cases were adults between the ages of 19 and 65. Caucasians made up the largest identified ethnic group (48.9 %). Most Registry cases originated from the inpatient setting (93.5 %), with a large majority of these consultations coming from the emergency department or inpatient admission services. Intentional and unintentional pharmaceutical exposures continued to be the most frequent reasons for consultation, accounting for 61.7 % of cases. Among cases of intentional pharmaceutical exposure, 62.4 % were associated with a self-harm attempt. Non-pharmaceutical exposures accounted for 14.1 % of Registry cases. Similar to the past years, non-opioid analgesics, sedative-hypnotics, and opioids were the most commonly encountered agents. Clinical signs or symptoms were noted in 81.9 % of cases. There were 89 recorded fatalities (0.97 %). Medical treatment (e.g., antidotes, antivenom, chelators, supportive care) was rendered in 62.3 % of cases. Patient demographics and exposure characteristics in 2014 Registry cases remain similar to prior years. The majority of consultations arose in the acute care setting (emergency department or inpatient) and involved exposures to pharmaceutical products. Among exposures, non-opioid analgesics, sedative/hypnotics, and opioids were the most frequently encountered. A majority of cases required some form of treatment, but fatalities were rare.

Electronic supplementary material

The online version of this article (doi:10.1007/s13181-015-0507-7) contains supplementary material, which is available to authorized users.