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Purpose: The primary objective of this systematic review was to determine if frenotomy for ankyloglossia improves breastfeeding or speech outcomes in infants and children ages birth to 12.Method: L...

Objective To investigate the association of maternal body mass index (BMI) and recurrent pregnancy loss (RPL). Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) A total of 3,833 women with RPL and 4,083 women as controls. Intervention(s) Studies were identified through a search of PubMed, Embase, Scopus, and Cochrane. Main Outcome Measure(s) The primary outcome of interest was RPL using the mean differences in maternal BMI as the predictor variable. The results of the meta-analysis were reported as the mean difference with a 95% confidence interval. Result(s) In total, 892 studies were reviewed. Pooled data from 25 studies suggested that the maternal BMI of women with a history of recurrent pregnancy loss was significantly higher than the BMI of controls, mean difference 0.7 kg/m2 [95% confidence interval 0.2–1.3]. Conclusion(s) These findings supported an association between maternal BMI and RPL. Large prospective studies are needed to evaluate the influence of maternal BMI on pregnancy outcomes in women with RPL.

The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province's largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all of their 7-day ones with sentinel diagnoses (ie, acute myocardial infarction, subarachnoid hemorrhage, and pediatric sepsis), and submit their findings to a governmental agency. This provides an opportunity to identify possible adverse events and quality issues, which hospitals can then address through quality improvement initiatives. A group of emergency physicians with quality improvement expertise analyzed the submitted audits and accompanying narrative templates, using a general inductive approach to develop a novel classification of recurrent quality themes. Since the Return Visit Quality Program launched in 2016, 125,698 return visits with admission have been identified, representing 0.93% of the 86 participating EDs' 13,559,664 visits. Overall, participating hospitals have conducted 12,852 detailed chart audits, uncovering 3,010 (23.4%) adverse events/quality issues and undertaking hundreds of quality improvement provincewide projects as a result. The inductive analysis revealed 11 recurrent themes, classified into 3 groupings: patient characteristics (ie, patient risk profile and elder care), ED team actions or processes (ie, physician cognitive lapses, documentation, handover/communication between providers, radiology, vital signs, and high-risk medications or medication interactions), and health care system issues (ie, discharge planning/community follow-up, left against medical advice/left without being seen, and imaging/testing availability). The Return Visit Quality Program is the largest mandatory audit program for EDs and provides a novel approach to identify local adverse events/quality issues to target for improved patient safety and quality of care. It provides a blueprint for health system leaders to enable clinicians to develop an approach to organizational quality, as well as for teams to construct an audit system that yields defined issues amenable to improvement.

Glioma stem cells (GSCs), with neural stem cell (NSC) like properties are key factors behind therapeutic resistance in pediatric high-grade gliomas (HGG), the second most formidable childhood cancers. Targeting GSCs is a promising pathway for enhancing therapeutic effect and improving patient outcomes. Histone post-translational modifications (PTMs) regulate gene expression patterns dictate stem cell fate and regulate drug resistance. Tri-methylation on histone 3 lysine 4 (H3K4me3) has been associated with human NSCs and GSCs, with its reduction results in cell differentiation and increases chemotherapeutic efficacy in pediatric HGGs. Human SETD1A facilitates H3K4me3 on active gene promoters. Levels of SETD1A and H3K4me3 are high in NSCs and malignant gliomas, highlighting potentially novel treatment targets. BMP4 increases cell sensitivity to cytotoxic therapies. However, BMP4 effects on H3K4me3 in human NSCs and pediatric HGGs are unknown. In this study, cellular phenotype, levels of H3K4me3 and SETD1A following BMP4 treatment in human NSC and pediatric HGGs are investigated. The results indicate BMP4 promotes differentiation and decreases H3K4me3 and SETD1A levels, as well as H3K4me3 occupancy on stemness and drug resistant genes’ promoters decreased in NSC and pediatric HGGs, respectively. BMP4 also increases chemosensitivity in pediatric HGGs. The results demonstrate that BMP4 differentiates human NSCs and increases chemotherapy sensitivity through regulation of SETD1A by altering H3K4me3 levels at key stemness and drug resistance genes’ promoter. Subsequently, targeting SETD1A concomitantly with conventional chemotherapy may provide novel therapeutic strategies to improve prognosis for children with HGGs.

States' role in payment as well as coverage will be subject to debate as the administration and the Congress decide how to address the Affordable Care Act (ACA) and otherwise reshape the nation's health policies. Acting as stewards of health care for the entire state population and stimulated by concern about rising costs and federal support under the ACA, the elected and administrative leaders of some states have been using their political influence and authority to improve their state's overall systems of care regardless of who pays the bill. In early 2015 we conducted on-site interviews with key stakeholders in five states to explore their strategies for payment and delivery reform. We found that despite these states' similar goals, differences in their statutory authority and purchasing power, along with their leaders' willingness to use them, significantly influence a state's ability to achieve reform objectives. We caution federal and state policy makers to recognize the reality that state leaders' political desire to exercise stewardship may not be enough to achieve it.

Objective: Our aim was to assess the impact of creating a female-only area within a mixed-gender inpatient psychiatry service, on female patient safety and experience of care. Method: The Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area. Documented incidents compromising the safety of women on each ward in the 6 months following the refurbishment were compared. Further, a questionnaire assessing perceived safety and experience of care was administered to female inpatients on both wards, and staff feedback was also obtained. Results: The occurrence of documented incidents compromising females’ safety was found to be significantly lower on the ward containing a female-only area. Women staying on this ward rated their perceived safety and experience of care significantly more positively than women staying where no such gender segregation was available. Further, the female-only area was identified by the majority of surveyed staff to provide a safer environment for female patients. Conclusions: Establishing female-only areas in psychiatry wards is an effective way to improve the safety and experience of care for female patients.

This article investigates the lantern slide collections of the London Royal Geographical Society (RGS), a prominent British society dedicated to the promotion of geographical exploration and science, across the period of the First World War. It outlines some of the salient features of the lantern slide collections and how they evidence the changing purposes of the RGS, conceptualizations of space and geography and their communities of producers and consumers from 1914 to 1918. The inclusion of illustrated war propaganda lectures in the Society’s popular evening meetings is discussed. The full admission to the Society in 1913 of women and their coming to prominence within RGS activities during the conflict is also explored. The use of lantern slides by female lecturers is investigated, as is the acquisition of their slides by the RGS. The focus in this period on subjects of aviation and human geography in the RGS Research Department lectures is also examined in relation to changing practices of exploration...

A 34-year-old female community nurse in her first trimester of pregnancy presented with a 2-week history of a tender, swollen and hyperkeratotic lesion on her chest with no history of trauma. The lesion started as a red ‘spot’, became crusted, pustular and formed an eschar. A generous incisional biopsy was taken. Review the high-quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2017-204459 and consider your diagnosis. 1. Anthrax 2. Cowpox 3. Orf 4. Pseudocowpox (Milker’s nodule) 5. Varicella zoster The correct answer is after the discussion. Histopathology shows superficial ulceration, …

Summary Background About 47% of preschool children worldwide are anaemic. Daily oral iron supplementation is a commonly recommended intervention for treatment and prevention of anaemia, but the efficacy and safety of iron supplementation programmes is debated. Thus, we systematically reviewed the evidence for benefit and safety of daily iron supplementation in children aged 4–23 months. Methods We searched Scopus and Medline, from inception to Feb 5, 2013, WHO databases, theses repositories, grey literature, and references. Randomised controlled trials that assigned children 4–23 months of age to daily oral iron supplementation versus control were eligible. We calculated mean difference (MD) or standard MD (SMD) for continuous variables, risk ratios for dichotomous data, and rate ratios for rates. We quantified heterogeneity with the I 2 test and synthesised all data with a random-effects model. This review is registered with the International Prospective Register of Systematic Reviews, number CRD42011001208. Findings Of 9533 citations identified by the search strategy, 49 articles from 35 studies were eligible; these trials included 42 306 children. Only nine studies were judged to be at low risk of bias. In children receiving iron supplements, the risk ratio for anaemia was 0·61 (95% CI 0·50–0·74; 17 studies, n=4825), for iron deficiency was 0·30 (0·15–0·60; nine studies, n=2464), and for iron deficiency anaemia was 0·14 (0·10–0·22; six studies, n=2145). We identified no evidence of difference in mental (MD 1·65, 95% CI −0·63 to 3·94; six studies, n=1093) or psychomotor development (1·05, −1·36 to 3·46; six studies, n=1086). We noted no significant differences in final length or length-for-age, or final weight or weight-for-age. Children randomised to iron had slightly lesser length (SMD −0·83, −1·53 to −0·12; eight studies, n=868) and weight gain (–1·12, −1·19 to −0·33) over the course of the studies. Vomiting (risk ratio 1·38, 95% CI 1·10–1·73) and fever (1·16, 1·02–1·31) were more prevalent in children receiving iron. Interpretation In children aged 4–23 months, daily iron supplementation effectively reduces anaemia. However, the adverse effect profile of iron supplements and effects on development and growth are uncertain. Adequately powered trials are needed to establish the non-haematological benefits and risks from iron supplementation in this group. Funding Victoria Fellowship (Government of Victoria, Australia); CRB Blackburn Scholarship (Royal Australasian College of Physicans); Overseas Research Experience Scholarship, University of Melbourne.

Schizophrenia is a debilitating and pervasive mental illness with devastating effects on many aspects of psychological, cognitive and social wellbeing. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women, suggesting that estrogen plays a “protective” role . Adjunctive estrogen therapy has been shown to be effective in enhancing the treatment of schizophrenia in women. In men, consideration of estrogen therapy has been impacted by concerns of feminisation, however, clinical trials using estrogen to treat prostate cancer, bone density loss and even aggression in men with dementia or traumatic brain injury, show estrogen to be a safe and effective therapy. Findings do, however, suggest that further exploration of a therapeutic role for adjunctive estradiol treatment in men with schizophrenia is warranted. The development of the new estrogen compounds - Selective Estrogen Receptor Modulators (SERMs) which do not cause feminisation - opens up the possibility of using a different type of estrogen for a longer period of time at higher doses. Estrogen could therefore prove to be an important component in the treatment of psychotic symptoms in men with schizophrenia. This review explains the scientific rationale behind the estrogen hypothesis and how it can be clinically utilised to address concerns unique to the care of men with schizophrenia.

Increasing evidence from epidemiological, preclinical and clinical studies suggests that estrogens may exert psychoprotective effects in schizophrenia. Observations of gender differences in the onset and course of schizophrenia have prompted exploration of the effects of estrogen on the CNS. The aim of this paper is to provide an overview of different applications of adjunctive estrogen as a possible treatment for symptoms of schizophrenia in both men and women. Recent trials have suggested that estrogen augmentation therapy may be able to enhance the management of schizophrenia; however, the clinical application of estrogen as a treatment has been limited by potential side effects, the most worrying being breast and uterine cancer in women, and feminization in men. Selective estrogen receptor modulators (SERMs), however, may offer therapeutic benefits for both men and women with schizophrenia without posing threat to breast and uterine tissue and without feminizing effects. The use of estrogen opens up new possibilities for both men and women in the treatment of severe mental illnesses such as schizophrenia. With further preclinical and clinical research, it is hoped that this promising field of hormone modulation can continue to evolve and eventually be translated into real therapeutic potential.

The theory that many serious mental illnesses, in particular psychoses such as schizophrenia, may have a significant hormonal aetiological component is fast gaining popularity and the support of scientific evidence. Oestrogen in particular has been substantially investigated as a potential mediator of brain function in schizophrenia. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women suggests a protective role of oestrogen.In vitroandin vivopreclinical research confirms oestradiol’s interactions with central neurotransmitter systems implicated in the pathogenesis of schizophrenia, while results from randomised controlled trials investigating the antipsychotic potential of oestrogen have been positive. Research into other neuroactive hormones with possible effects on mental state is a rapidly evolving field that may hold new promise. Given that schizophrenia and related psychoses are pervasive and debilitating conditions for which currently available treatments are often only partially effective and entail a high risk of serious side-effects, novel therapeutic strategies are needed. The literature reviewed in this paper suggests that hormones such as oestrogen could be a viable option, and it is hoped that with further research and larger trials, the oestrogen hypothesis can be translated into effective clinical practice.