Low-Serum Media and Dynamic Deformational Loading in Tissue Engineering of Articular Cartilage

High-serum media have been shown to produce significant improvement in the properties of tissue-engineered articular cartilage when applied in combination with dynamic deformational loading. To mitigate concerns regarding the culture variability introduced by serum, we examined the interplay between low-serum/ITS-supplemented media and dynamic deformational loading. Our results show that low serum/ITS supplementation does not support the same level of tissue formation as compared to high serum controls. In free-swelling culture, using a combination of ITS with concentrations of FBS above 2% negated the beneficial effects of ITS. Although there were beneficial effects with loading and 0.2%FBS + ITS, these constructs significantly underperformed relative to 20%FBS constructs. At 2%FBS + ITS, the free-swelling construct stiffness and composition approached or exceeded that of 20%FBS constructs. With dynamic loading, the properties of 2%FBS + ITS constructs were significantly lower than free-swelling controls and 20%FBS constructs by day 42. By priming the chondrocytes in 20%FBS prior to exposure to low-serum/ITS media, we observed that low-serum/ITS media produced significant enhancement in tissue properties compared to constructs grown continuously in 20%FBS.     

Lessons learned: Illinois providers’ perspectives on implementation of Medicaid coverage for abortion

ObjectiveOn January 1, 2018, Illinois became the first Midwestern state to cover abortion care for Medicaid enrollees. This study describes state implementation of the policy, the impact on abortion providers, and lessons learned.Study DesignWe documented abortion providers’ perspectives on the service delivery consequences of Medicaid coverage for abortion in Illinois. We conducted in-depth interviews with clinicians and administrators (N = 23) from 15 Illinois clinics, including clinics that provided other services and those primarily providing abortion. We conducted interviews in person or by phone between April and October 2019. They lasted ≤100 minutes, were audio-recorded, transcribed, and coded in Dedoose. We developed code summaries to identify salient themes across interviews.ResultsAll participants supported the law and expected benefits to patients. Many struggled to implement the policy because of difficulties obtaining certification to bill the state Medicaid program, confusing and cumbersome paperwork requirements, reimbursement delays, confusing claim denials, and uncertain protocols for Medicaid patients covered under the exceptions defined by the Hyde Amendment. Nearly all participants expressed concern that low reimbursement rates were insufficient to cover costs. Implementation was easier for multiservice clinics and those nested in larger institutions. Several clinics closed during implementation; one clinic opened. Clinics leveraged internal resources, external funding, and technical assistance to ensure that Medicaid enrollees could receive care without costs.ConclusionsImplementing Medicaid coverage for abortion requires proactive and responsive state institutions, improvements to reimbursement processes, and adequate reimbursement rates. In Illinois, successful implementation depended on clinic adaptability, external support, and advocacy.ImplicationsOur research suggests that successful, sustainable implementation of Medicaid coverage for abortion depends on state policies that allow clinics to enroll patients, process claims in 30 to 90 days, and receive reimbursements covering the cost of care. Without these measures, ensuring immediate patient access may depend upon clinics mobilizing resources and external transitional support.     

Sequence and Seasonal Effects of Salivary Cortisol

Abstract

Assessments of cortisol levels in saliva have been widely used by both researchers and clinicians as an index of adrenal functioning. Quarterly measurements of morning and evening cortisol levels were determined in a longitudinal study of 147 participants (72 women and 75 men) followed for I year each. The analysis of salivary cortisol revealed no significant gender or age differences in the sample. There was a sequence effect in quarterly cortisol values with a progressive decrease in serial measurements, especially notable in the morning values, as well as a seasonal variation in cortisol levels with significantly higher levels found in winter and fall, compared with spring and summer. The findings in this study suggest that repeated saliva sampling and seasonal variation in cortisol levels may independently affect adrenal response and, therefore, need to be accounted for in longitudinal studies.     

Dental Cleaning Before and During Pregnancy Among Maryland Mothers

Despite increasing recognition of the importance of oral health to overall health, dental care utilization remains low in the US. Given the established link between maternal oral health and child oral health, this study examined factors related to preventive dental care utilization at two critical time points, before and during pregnancy. Data were obtained from a sample of 6,171 women who delivered a live birth during 2004–2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System postpartum survey. Multinomial logistic analyses examined associations between predisposing and enabling factors with dental cleaning before and during pregnancy. Women with less than a high school education or a history of physical abuse and non-Hispanic black and Hispanic women were less likely to report teeth cleaning before and during pregnancy. Having no insurance at the start of pregnancy was associated with significantly lower risk of teeth cleaning before pregnancy and both before and during pregnancy. Receipt of oral health counseling during pregnancy was positively related to teeth cleaning during pregnancy. Dental cleaning is associated with insurance, oral health counseling and maternal factors such as race, ethnicity, education and history of physical abuse. Better integration of oral health into prenatal health care, particularly among ethnic and racial minority groups, may be beneficial to maternal and infant well-being. Oral health promotion, disease prevention and health care should be a part of the local, state and national health policy agendas.     

Anthropometric measurements in the diagnosis of pelvic size: an analysis of maternal height and shoe size and computed tomography pelvimetric data

Background To determine whether measurements of maternal height and shoe size are predictors of pelvic size, using erect lateral computerized tomography (CT) pelvimetry as gold standard. Materials and methods Three hundred and fifty three obstetric patients out of a sequential population of 6112 (5.8%) had CT pelvimetry performed between January 1990 and December 1991 at the Department of Obstetrics and Gynecology, York District Hospital, United Kingdom. Multivariable logistic regression models were built using maternal height (n = 322), shoe size (314) and weight at last clinic visit (n = 318). The reference standard for pelvic size was CT Pelvimetry. Pelvic adequacy was defined as an anterior-posterior diameter of the inlet of ≥11 cm and an anterior-posterior diameter of the outlet ≥10 cm on erect lateral CT pelvimetry. Women with values lower than these were regarded as having an inadequate pelvis. The diagnostic accuracy of the models was determined by the area under the receiver operating characteristic curve (AUC). Results The area under the curve (AUC) for maternal height (0.768) was not significantly greater than that for shoe size (0.686, p = 0.163 for the difference in AUC’s) and weight at the last clinic visit (0.655, p = 0.057 for the difference in the AUCs). The change in the AUC for each of the models (the full model with height, shoe size and weight [0.769]; model for height and shoe size [0.767] model for just height [0.768]) was also not significantly different. Conclusions Measurements of maternal height, shoe size and weight at the last clinic visit are not useful for the identification of women with inadequate pelvis.     

Predictors of Colorectal Cancer Screening Among African American Men Living with HIV

Journal of Community Health - African American men living with HIV are at high risk of colorectal cancer (CRC). Screening to detect CRC is associated with a reduced risk of CRC mortality. However,...     

Multicenter evaluation of a new ultrasound-guided biopsy device: Improved ergonomics, sampling and rebiopsy rates

The purpose of this study was to evaluate performance, ergonomics, and immediate rebiopsy rate of a new vacuum-assisted biopsy (VAB) device for ultrasound-guided breast biopsies. Between December 2002 and April 2003, 113 patients meeting study criteria were biopsied at four centers using the new 9 gauge VAB device. The device has a radiofrequency-tipped probe, 360 degrees vacuum, a circumferential cutter, and a coaxial cannula for multiple sampling. Patient and procedural data included breast composition, lesion characteristics, number of samples, procedure time, and complications. Quality of samples, lesion access, and ergonomic features were assessed qualitatively and compared with prior experience with other biopsy devices. Immediate rebiopsy rate included high-risk lesions requiring surgical excision (obligate rebiopsy) and lesions requiring rebiopsy due to discordance or insufficient samples yielding nondiagnostic material. Data were analyzed using the Wilcoxon signed-rank test. One hundred thirteen patients aged 20-83 years (mean 52) were successfully biopsied with dense/fibrous breast tissue in 60% and dense/fibrous lesions in 49%. Lesions measured 6-63 mm (mean 17); 97% were masses. Five circumferential specimens (range 2-19) were obtained in 6 minutes (range 2-20). Operators rated safety and comfort comparable with existing devices and rated sample quality, breast/lesion penetration, and positioning ease/accuracy superior (p < 0.01). Diagnoses included 37 cancers, 70 benign, and six high-risk lesions with one upgrade from atypical ductal hyperplasia to ductal carcinoma in situ at surgery. Excluding obligate excision in high-risk diagnoses, the immediate rebiopsy rate was 2%. No complications required intervention. The new VAB device provides diagnostic samples and reduces sampling error defined by immediate rebiopsy rate. Compared with other devices, it is more ergonomic to target and position for sampling, particularly in dense breast tissue or lesions.     

Obstetricians, health attorneys, and court-ordered cesarean sections.

PURPOSE: Despite court rulings suggesting that court-ordered cesarean sections should rarely be undertaken, they are performed. Our objective was to determine those characteristics of providers and patients that make their use more likely. METHODS: A convenience sample of obstetricians attending the annual meeting of the American College of Obstetricians and Gynecologists (n=229) and lawyers attending the annual meeting of the American Health Lawyers Association (n=126) read a vignette describing a woman who refused a cesarean section after being told that her fetus would die unless she received the operation. Several different scenarios were then described (e.g., the mother refused on religious grounds). For each scenario, participants were asked to rate the likelihood that they would support a court-ordered cesarean section. Participants then described their own characteristics. RESULTS: Respondents were more likely to support a court order if the woman was described as a being "high on drugs" (p<.001). Respondents were significantly less likely to use a court order (p<.01) if the woman was described as a lawyer, the child had Down syndrome, the husband agreed with her decision, the mother refused on religious grounds, or the operation was associated with a 10-fold increased risk to the mother's life. People who described themselves as more religious, Republican, or "pro-life" were significantly more likely to utilize court orders in several scenarios. In an ordinal regression model, the degree of pro-life was the only variable consistently associated with obtaining a court order for the healthy mother-healthy child. CONCLUSIONS: The perceived likelihood of performing a court-ordered cesarean section varies with characteristics of the patient and the provider.     

A layered agarose approach to fabricate depth-dependent inhomogeneity in chondrocyte-seeded constructs.

Inspired by the depth-dependent inhomogeneity of articular cartilage, it was hypothesized that a novel layered agarose technique, using a 2% (wt/vol) top and a 3% (wt/vol) bottom layer, would create an inhomogenous tissue construct with distinct material properties in conjoined regions. The biochemical and mechanical development of these constructs was observed alongside uniform 2% and 3% constructs. Initially, uniform 3% agarose disks had the highest bulk Young's modulus (E(Y) approximately 28 kPa) of all groups. After 28 days of culture in 20% FBS-containing media, however, uniform 2% chondrocyte-seeded constructs achieved the highest Young's modulus compared to bilayered and 3% agarose disks. Though all three groups contained similar GAG content ( approximately 1.5% ww), uniform 2% agarose disks on day 28 possessed the highest collagen content ( approximately 1% ww). Unlike in either homogeneous construct type, microscopic analysis of axial strain fields in bilayered constructs in response to applied static compression revealed two mechanically disparate regions on day 0: a softer 2% layer and a stiffer 3% layer. With time in culture, this inhomogeneity became less distinct, as indicated by increased continuity in both the local displacement field and local E(Y), and depended on the level of FBS supplementation of the feed media, with lower FBS concentrations (10%) more closely maintaining the original distinction of material properties. These results shed positive light on a layered agarose technique for the production of inhomogeneous bilayered chondrocyte-seeded agarose constructs with applications for investigations of chondrocyte mechanotransduction and for possible use in the tissue engineering of inhomogeneous articular cartilage constructs.