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BACKGROUND Resuscitation with fresh whole blood is vital to preserving life on the battlefield. Transfusing low titer O whole blood (LTOWB), defined as anti-A and anti-B titer levels of

To analyze the correlation between TE grading and initial β-hCG serum level after single euploid embryo transfer. Secondarily, to explore the association between TE grading with subsequent IVF outcomes.Retrospective cohort analysis.Single, academic, private infertility and assisted reproductive care institute.Infertility patients who underwent a single euploid embryo transfer that resulted in a positive pregnancy test.β-hCG measurements.Correlation between TE grade with first β-hCG measurement. Second outcome measurements included ongoing pregnancy, biochemical pregnancy loss, and clinical pregnancy loss rates.2,798 cases were analyzed. A significant difference in initial β-hCG measurement among groups (TE A: median 143.4 mIU/mL IQR 79.2-211.2; TE B: 119 mIU/mL IQR 57.1-177.8; TE C: 82.4 mIU/mL IQR 36.3-136.4, p ≤ 0.0001) was observed. There was a significant correlation found between the TE grade and β-hCG measurements (p ≤ 0.0001, rIn patients with euploid embryos, TE grade correlates with the first pregnancy test measurement of β-hCG. We propose this finding helps to appoint a relevant link between morphology assessment and early embryo development in vivo.

The consistent relationship between socioeconomic status (SES) and health has been widely covered in the media and scientific journals, which typically argue that physical-health inequalities are caused by material disadvantage directly or indirectly (e.g., chronic environmental-stress, health care resources, etc.). Such explanations do not explain the finely stratified health differences across the entire range of SES. Recent theories have helped address such limitations, but implicate multiple different explanatory pathways. For example, differential epidemiology articles have argued that individual differences are the "fundamental cause" of the gradient (Gottfredson, 2004). Alternatively, variants of allostatic load theory (McEwen & Stellar, 1993), such as the Risky Families model (Repetti, Taylor, & Seeman, 2002) implicate the early home-environment. These theory-driven pathways align with interpretations associated with biometrical models; yet, little research has applied biometrical modeling to understanding the sources of the gradient. Our study presents several innovations and new research findings. First, we use kinship information from a large national family dataset, the NLSY79, whose respondents are approximately representative of United States adolescents in 1979. Second, we present the first biometrical analysis of the relationships between SES and health that uses an overall SES measure. Third, we separate physical and mental health, using excellent measurement of each construct. Fourth, we use a bivariate biometrical model to study overlap between health and SES. Results suggest divergent findings for physical and mental health. Biometrical models indicate a primarily genetic etiology for the link between SES and physical health, and a primarily environmental etiology for the link between SES and mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Extended maternal age has been suggested as marker of delayed age-associated disabilities. We use the Long Life Family Study (LLFS) offspring generation to investigate the association between extended maternal age at last childbirth and healthy-aging endophenotypes. We hypothesize that women with extended maternal age at last childbirth will exhibit healthier endophenotype profiles compared to younger mothers. The association between maternal age and age-related endophenotypes previously derived in LLFS was assessed using Generalized Estimating Equations to adjust for relatedness. The quartiles of the maternal age at last childbirth were modeled as the independent variables. Univariate analyses tested the association between maternal age at last childbirth and age at clinical assessment, education, field center, Apolipoprotein E (APOE) genotype, depression, stress, smoking and successful pregnancies. Only the variables significantly associated in the univariate analyses were considered in secondary multivariate analyses. Univariate analyses showed that compared to older mothers (age at last birth ≥35), mothers 30 years old or younger at last childbirth are less educated (12 ± 3 years versus 13 ± 3 years) and have a higher frequency of smoking (9% versus 3% for maternal age ≥35). Results showed that older mothers (age at last birth ≥31-34 or ≥ 35) demonstrated significantly better cognitive profiles (p = 0.017 and p = 0.021 respectively) compared with mothers with last childbirth age ≤30. Later maternal age among women from long-life families is associated with a better cognitive profile, supporting the hypothesis that later age at childbirth may be a marker for healthy aging.

Background Grip strength is a popular and valuable measure in studies of physical functional capabilities in old age. The influence of historical trends and differential period-specific exposures can complicate the interpretation of biomarkers of aging and health and requires careful analysis and interpretation of aging, birth cohort, and period effects. This study evaluates the effects of aging, period, and cohort on grip strength in a population of adults and older adults. Methods We use more than 27 000 observations for individuals at least 50 years of age, born in approximately 1910–1960, from the English Longitudinal Study of Ageing to examine a variety of multilevel and cross-classified modeling approaches to evaluate age, period, and cohort effects. Our results extended Hierarchical Age–Period–Cohort modeling and compared our results with a set of 9 submodels with explicit assumptions to determine the most reliable modeling approach. Results Findings suggest grip strength is primarily related to age, with minimal evidence of either period and/or cohort effects. Each year’s increase in a person’s age was associated with a 0.40-kg decrease in grip strength, though this decline differs by gender. Conclusions We conclude that as the population ages, grip strength declines at a systematic and predictable rate equal to −0.40 kg per year (approximately −0.50 kg for men and −0.30 kg for women) in residents of England aged 50 and older. Age effects were predominant and most consistent across methodologies. While there was some evidence for cohort effects, such effects were minimal and therefore indicative that grip strength is a consistent physiological biomarker of aging.

Colleges and universities are increasingly concerned about respect for diversity and tolerance of individual differences on their campuses. Nevertheless, no comprehensive measure of peer victimization has been developed and validated for use with college student populations. The Peer Victimization in College Survey (PVIC) is the first such measure. Study 1 (N = 733) reports how PVIC items were empirically derived to ensure construct coverage. Study 2 (N = 100) reports how intuitive PVIC subscales were established to distinguish between subtypes of college peer victimization. Study 3 (N = 520) provides evidence of convergent, discriminant, and construct validity for the PVIC, including its relations to risk factors and to outcomes such as depressive symptoms, anxiety, stress, and college sense of belonging. Study 4 (N = 633) validates several PVIC scaling methods and provides evidence of incremental validity of the measure over current (unvalidated) measures. The PVIC can assess subtypes of peer victimization on college campuses, evaluate the effectiveness of campus intervention efforts, and test hypotheses about the causes and effects of peer victimization. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cervical cancer is the most common gynecologic cancer in pregnancy. This study aims to evaluate simple trachelectomy and pelvic lymphadenectomy in patients with stage IB1 (≥2 cm) cervical cancer wishing to maintain their pregnancy.We included patients with stage IB1 (≥2 cm) cervical cancer who underwent simple trachelectomy and minimally invasive pelvic lymphadenectomy during pregnancy from January 2004 to August 2016. Data analysis included demographics, perioperative, obstetrics, and oncologic outcomes.A total of 5 patients were included. Median age was 30 years (range; 26-38). Median gestational age (GA) at diagnosis was 12 weeks (range; 7-18) and at treatment intervention 16.5 weeks (range; 12-19). Histologic subtypes included: adenocarcinoma (3 patients) and squamous cell carcinoma (2 patients). Median tumor size by clinical exam was 27 mm (range; 20-40), grade 2 (range; 2-3) and depth of invasion 10 mm (range; 1.5-12). All patients underwent laparoscopic (1) or robotic (4) pelvic lymphadenectomy followed by vaginal simple trachelectomy. Median operative time was 193 min (range; 155-259), estimated blood loss 100 ml (range; 50-550) and length of stay 2 days (range; 1-3). There were no intraoperative or postoperative complications (30 days). Median number of lymph nodes removed was 14 (range; 5-15). One patient had bilateral microscopic positive nodes. The median gestational age at delivery was 39 weeks (range; 28-40.6). After median follow-up of 75 months (range; 18-168), all patients are alive without disease.Simple trachelectomy with pelvic lymph node dissection may be a safe option in pregnant patients with stage IB1 (2 cm) cervical cancer wishing to maintain their pregnancy.

Background Anxiety and depression rates among ED patients are substantially higher than in the general population. Additionally, those with mental health issues often have difficulty accessing care. Unfortunately, issues of anxiety and depression are frequently not addressed in the ED due to competing care priorities. This may lead to increased burden and overcrowding in EDs. Objective This study related anxiety and depression with ED utilization and perceived barriers to care. Methods In order to limit the impact of insurance coverage on ED utilization and access to care, a convenience sample of adults 45-85 years of age in the ED were surveyed. The GAD-7 and PHQ-9 were used to measure anxiety and depression. Results A total of 251 subjects were enrolled. Severe anxiety was observed in 10% of patients, while moderately severe or severe depression was observed in 12%. Patients who were both severely anxious and depressed visited the ED nearly twice as often as non-anxious and non-depressed patients. The majority of patients cited at least one moderate barrier to care, and greater anxiety and depression scores were related to greater perceived barriers to care. Perceived barriers to care were > 3 times higher among patients who were both anxious and depressed compared to in patients who were neither depressed nor anxious and twice as high as in those who were either depressed or anxious (p

INTRODUCTION: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Neurourol. Urodynam. 36:10-34, 2017. © 2016 Wiley Periodicals, Inc., and The International Urogynecological Association.

The univariate bootstrap is a relatively recently developed version of the bootstrap (Lee and Rodgers in Psychol Methods 3(1): 91, 1998). DeFries-Fulker (DF) analysis is a regression model used to estimate parameters in behavioral genetic models (DeFries and Fulker in Behav Genet 15(5): 467-473, 1985). It is appealing for its simplicity; however, it violates certain regression assumptions such as homogeneity of variance and independence of errors that make calculation of standard errors and confidence intervals problematic. Methods have been developed to account for these issues (Kohler and Rodgers in Behav Genet 31(2): 179-191, 2001), however the univariate bootstrap represents a unique means of doing so that is presaged by suggestions from previous DF research (e.g., Cherny et al. in Behav Genet 22(2): 153-162, 1992). In the present study we use simulations to examine the performance of the univariate bootstrap in the context of DF analysis. We compare a number of possible bootstrap schemes as well as more traditional confidence interval methods. We follow up with an empirical demonstration, applying results of the simulation to models estimated to investigate changes in body mass index in adults from the National Longitudinal Survey of Youth 1979 data.

In 1918, Fisher suggested that his research team had consistently found inflated cousin correlations. He also commented that because a cousin sample with minimal selection bias was not available the cause of the inflation could not be addressed, leaving this inflation as a challenge still to be solved. In the National Longitudinal Survey of Youth (the NLSY79, the NLSY97, and the NLSY-Children/Young Adult datasets), there are thousands of available cousin pairs. Those in the NLSYC/YA are obtained approximately without selection. In this paper, we address Fisher’s challenge using these data. Further, we also evaluate the possibility of fitting ACE models using only cousin pairs, including full cousins, half-cousins, and quarter-cousins. To have any chance at success in such a restricted kinship domain requires an available and highly-reliable phenotype; we use adult height in our analysis. Results provide a possible answer to Fisher’s challenge, and demonstrate the potential for using cousin pairs in a stand-alone analysis (as well as in combination with other biometrical designs).

Background Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes.Methods We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18-85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR) 25-75 mL/min per 1.73 m(2) of body surface area, and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0.75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders) were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0.75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for >= 30 days) or end-stage kidney disease (eGFR = 90 days, chronic dialysis for >= 90 days, kidney transplantation, or death from kidney failure) in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials. gov, number NCT01858532.Findings Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325) or placebo group (n=1323). Median follow-up was 2.2 years (IQR 1.4-2.9). 79 (6.0%) of 1325 patients in the atrasentan group and 105 (7.9%) of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR] 0.65 [95% CI 0.49-0.88]; p=0.0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3.5%) of 1325 patients in the atrasentan group and 34 (2.6%) of 1323 patients in the placebo group (HR 1.33 [95% CI 0.85-2.07]; p=0.208). 58 (4.4%) patients in the atrasentan group and 52 (3.9%) in the placebo group died (HR 1.09 [95% CI 0.75-1.59]; p=0.65).Interpretation Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

To determine the frequency of medical problems, reason for referral/primary complaint, products used, medication-related problems, and polypharmacy in patients with spinal cord injury (SCI) seen at an interprofessional primary care mobility clinic.Retrospective review of medical records of patients with SCI for patient visits between August 2012 and March 2013.Data were abstracted from medical records of patients with SCI.Of 74 patients who presented to the clinic, 19 had an SCI. Mean age was 46.7 years and 74% were male. Most frequent medical problems were depression/anxiety (37%), osteoporosis/osteopenia (26%), hypertension (21%), dyslipidemia (21%), and osteoarthritis (21%). Most common presenting complaints were pain (23%) and bowel/bladder issues (13%). Most common medication-related problems were untreated conditions (41%), ineffective medications (21%), adverse drug reactions (18%), and under- and over-dosage (each 9%). Patients with SCI most frequently used products to treat pain (68%), constipation (42%), muscle spasm (42%), hypertension (42%), and depression (37%). When including natural health products, vitamins and minerals, polypharmacy was seen in 74% of patients with SCI (63% when limited to prescription and over-the-counter medications). For patients with SCI in whose care a pharmacist collaborated, a mean of 3.2 medication-related problems per patient were identified compared with 1 per patient when the pharmacist was not involved.This study is the first to describe medication use, polypharmacy and medication-related problems in patients with SCI seen at an interprofessional primary care clinic. Use of high-risk medications, polypharmacy, and medication-related problems in patients with SCI suggest the need for collaborative interprofessional care that includes a pharmacist.

Background Distributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these areas. Little is known about what makes physicians remain in the area in which they train. Objectives To explore the factors that contributed to family physician's decisions to practice in an underserviced area following graduation from a DME programme. Methods Semistructured inperson interviews were conducted with 19 family physicians who graduated from a DME residency training programme. Programme records were reviewed to identify practice location of DME programme graduates. Results Of the 32 graduates to date from this DME programme, 66% (N=21) and all of the interview participants established their practices in this region after completing their residency training. Five key themes were identified from the interview analysis as impacting physicians' decisions to establish their practice in an underserviced area following graduation: familial ties to the region, practice opportunities, positive clerkship and residency experiences, established relationships with specialists and services in the area and lifestyle opportunities afforded by the location. Conclusions This study suggests that DME programmes can be an effective strategy for equalising the distribution of family physicians and highlights the ways in which these programmes can facilitate recruitment and retention in underserviced areas, including being responsive to residents' personal preferences and objectives for learning and shaping their residency experiences to meet to these objectives.

To evaluate outcomes of patients with unexplained infertility who underwent letrozole (LET)- stimulated controlled ovarian stimulation (COS) with timed sexual intercourse (IC) as compared to patients treated with clomiphene citrate (CC) and intrauterine insemination (IUI).A non- randomized, retrospective study where unexplained in- fertility patients (n=7,764). underwent a COS cycle with both LET and timed IC or with CC and IUI from January 2010-June 2014. One group consisted of patients who completed a COS cycle with LET and were instructed to have sexual IC. The other included patients were treated with CC and underwent IUI. Pregnancy rates (PRs) were compared between groups.No statistical difference was observed in each group's age or serum follicule-stimulating hor- mone levels. A statistical significance in LET versus CC-stimulated groups was observed for mean endome- trial thickness (8.3 ± 1.7 vs. 7.9 ± 1.8 mm) and follicular response (2.0 ± 1.0 vs. 2.3 ± 1.3), respectively. Clinical PRs after timed IC were significantly higher in the LET versus CC-stimulated group (15.0% vs 11.8%). Clinical PRs after timed IUI were also significantly higher in the LET versus CC-stimulated group (12.3% vs. 11.5%). Moreover, clinical PRs in LET with IC were significant- ly higher than CC with IUI (15.0% vs. 11.5%).Unexplained infertility patients who underwent LET stimulation with IC werefound to have better pregnancy out- comes as compared to those who underwent timed IC.or IUI with CC stimulation.

OBJECTIVE: To evaluate the correlation between em-bryo morphology and antepartum biomarker levels and obstetric outcomes following single embryo transfers (SETs). STUDY DESIGN: In vitro fertilization patients who delivered at the study site’s partnering hospital were included. Embryo morphology was compared to antepartum biomarkers and pregnancy outcomes. RESULTS: At a single academic reproductive endocrinology/infertility center, 2,882 SETs (day 3, 5, or 6) were performed from July 1, 2001, to June 30, 2013. Embryologic, serologic, and obstetric outcomes were available for 78 patients (cleavage [n=23]; blastocyst [n=55]). Embryos with a lower quality inner cell mass (ICM) demonstrated higher second trimester maternal serum alpha-fetoprotein (AFP) (p=0.0241) and AFP multiple of median (MoM) (p= 0.0036). After adjusting for age, body mass index, parity, and smoking status, this statistical significance remained (p=0.0319 for AFP; p=0.0026 for AFP MoM). CONCLUSION: Embryo morphokinetics did not correlate with perinatal outcome or a majority of placental biomarkers. A low ICM score was associated with higher second trimester maternal serum AFP values. This warrants further investigation, especially due to the risks of potential adverse obstetric outcomes associated with high AFP levels. Despite these findings, no difference in obstetric outcomes between low and high ICM scores was observed after controlling for maternal confounding variables. Patients should be reassured that embryo implantation, regardless of morphological score, results in similar obstetric outcomes.

The incidence and etiology of prosthetic services utilization is poorly understood during the first 90 days post-delivery of the initial lower limb prosthesis. This period is of critical importance, as prevailing policy dictates limits on the reimbursement for certain services provided during this time period. The first step in understanding the financial ramifications of such policy is to examine the taxonomy behind clinical encounters during this tenuous time period.Quantify and categorize clinical encounters by incidence and etiology.Retrospective chart review.A central database containing data on prosthetic services was examined. Incidence and etiology were extracted through independent review of each patient chart.A total of 537 unique patients were identified, with 109 meeting the inclusion criteria. Chi-square testing showed that comfort ( p0.05), cosmesis ( p0.01), and mechanical failure ( p0.001) yielded statistical significance in scheduled versus unscheduled visits. Stepwise regression analysis demonstrated that both sex and K-level were important predictors of unscheduled visits.Taxonomization of clinical encounters experienced during the first 90 days provides a framework for future studies to be conducted. The data provided can serve as a basis for informing reimbursement policy, workforce planning, and advocacy. Clinical relevance Comfort is the most frequent reason for a clinical encounter during the first 90 days after delivering a lower limb prosthesis. The data on the taxonomy behind the clinical encounters can be used to guide workforce planning and advocate for just reimbursement policy that better reflect patient's needs.

Objectives To examine whether perceptions of school safety and neighborhood safety are associated with insufficient sleep during adolescence. Design The Florida Youth Substance Abuse Survey (FYSAS) is a cross-sectional study of adolescents. Setting The state of Florida. Participants Middle-school and high-school students (n = 7,958) attending public schools in 2017. Measurements Based on National Sleep Foundation recommendations, sleep was categorized as insufficient (less than 7 hours) or sufficient (7 or more hours) using self-reports of average sleep duration on school nights. Self-reports of perceived safety at school and perceived safety in one's neighborhood were modeled as predictors of insufficient sleep in logistic regression models when accounting for several covariates. Results Adjusting for model covariates, the odds of insufficient sleep among adolescents who feel unsafe both at school and in their neighborhood are 129% greater relative to adolescents who feel safe in both contexts. In comparison, the odds of insufficient sleep among adolescents who feel unsafe only at school are 39% greater relative to adolescents who feel safe both at school and in their neighborhood, and the odds of insufficient sleep among adolescents who feel unsafe only in their neighborhood are 71% greater relative to adolescents who feel safe both at school and in their neighborhood. Conclusions The findings of this study indicate that efforts to improve the safety of salient social contexts in which adolescents develop may reduce the likelihood of insufficient sleep faced by a large portion of school-aged children.

The most common complaint lower limb prosthesis users report is inadequacy of a proper socket fit. Adjustments to the residual limb-socket interface can be made by the prosthesis user without consultation of a clinician in many scenarios through skilled self-management. Decision trees guide prosthesis wearers through the self-management process, empowering them to rectify fit issues, or referring them to a clinician when necessary. This study examines the development and acceptability testing of patient-centered decision trees for lower limb prosthesis users.Decision trees underwent a four-stage process: literature review and expert consultation, designing, two-rounds of expert panel review and revisions, and target audience testing.Fifteen lower limb prosthesis users (average age 61 years) reviewed the decision trees and completed an acceptability questionnaire. Participants reported agreement of 80% or above in five of the eight questions related to acceptability of the decision trees. Disagreement was related to the level of experience of the respondent.Decision trees were found to be easy to use, illustrate correct solutions to common issues, and have terminology consistent with that of a new prosthesis user. Some users with greater than 1.5 years of experience would not use the decision trees based on their own self-management skills. Implications for Rehabilitation Discomfort of the residual limb-prosthetic socket interface is the most common reason for clinician visits. Prosthesis users can use decision trees to guide them through the process of obtaining a proper socket fit independently. Newer users may benefit from using the decision trees more than experienced users.

The quality of the home environment, as a predictor, is related to health, education, and emotion outcomes. However, factors influencing the quality of the home environment, as an outcome, have been understudied-particularly how children construct their own environments. Further, most previous research on family processes and outcomes has implemented between-family designs, which limit claims of causality. The present study uses kinship data from the National Longitudinal Survey of Youth to construct a maternal sibling-comparison design to investigate how maternal and child traits predict the quality of home environment. Using a standard between-family analysis, we first replicate previous research showing a relationship between maternal intelligence and the quality of the home environment. Then, we reevaluate the link between maternal intelligence and the home environment using differences between maternal sisters on several characteristics to explain differences between home environments for their children. Following, we evaluate whether child intelligence differences are related to home environment differences in the presence of maternal characteristics. Results are compared with those from the between-family analysis. Past causal interpretations are challenged by our findings, and the role of child intelligence in the construction of the home environment emerges as a critical contributor that increases in importance with development. (PsycINFO Database Record

Older adults with amputations secondary to vascular etiologies may additionally present with cognitive impairment. Cognition plays an important role in the adoption of a prosthetic limb, although the degree and type of impact are debated. Previous literature reviews have not been directed at the specific population of older adults who underwent vascular-related lower limb amputation.First, to assess extant literature for relationships between cognitive function and prosthesis-related outcomes in older adults who underwent lower limb amputation for vascular-related etiologies. Second, to perform a critical analysis of prosthesis-related outcomes and cognitive assessments performed in the studies.Systematic literature review.A systematic review of the literature was performed in databases using keyword combinations. A total of nine articles were selected to be included in this review.Seven of the nine included studies found a relationship between decreased cognitive function and reduced performance on a prosthesis-related outcome. There were eight different prosthesis-related outcome measures, with only one study utilizing a comprehensive outcome measure.Cognitive impairment can negatively impact successful prosthesis use in older adults with lower limb amputation secondary to vascular complications. Future studies should utilize comprehensive outcome measures that represent the multifaceted constructs of cognition and prosthesis use. Clinical relevance Cognitive assessment of older adults who have undergone lower limb amputation secondary to diabetes related complications or vascular disease can be used to inform clinical decision-making. Clinicians should consider selecting prosthesis-related outcome measures that capture the full breadth of prosthesis use when evaluating patients with cognitive impairment.

A powerful longitudinal data source, the National Longitudinal Survey of Youth Children data, allows measurement of behavior problems (BP) within a developmental perspective linking them to menarcheal timing (MT). In a preliminary analysis, we evaluate the bivariate relationships between BP measured at different developmental periods and the timing of menarche. Correlations were not consistent with any correlational/causal relationship between BP and MT. In the major part of our study, MT was used to moderate the developmental trajectory of BP, within a genetically-informed design. Girls reaching menarche early had behavior problem variance accounted for by the shared environment; those reaching menarche with average/late timing had behavior problem differences accounted for by genetic variance. Our findings match previous empirical results in important ways, and also extend those results. A theoretical interpretation is offered in relation to a theory linking genetic/shared environmental variance to flexibility and choices available within the family in relation to BP.

A quasi-experimental comparison of cousins differentially exposed to levels of neighborhood disadvantage (ND) was used with extensive measured covariates to test the hypothesis that neighborhood risk has independent effects on youth conduct problems (CPs). Multilevel analyses were based on mother-rated ND and both mother-reported CPs across 4–13 years (n = 7,077) and youth-reported CPs across 10–13 years (n = 4,524) from the Children of the National Longitudinal Survey of Youth. ND was robustly related to CPs reported by both informants when controlling for both measured risk factors that are correlated with ND and unmeasured confounds. These findings are consistent with the hypothesis that ND has influence on conduct problems.

Introduction and hypothesis: A terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery. Methods: This report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus). Results: A terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/complication). Conclusion: A consensus-based terminology and classification report for prosthesis and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research. Neurourol. Urodynam. 30: 2-12, 2011. (C) 2010 Wiley-Liss, Inc.

Children raised without a biological father in the household have earlier average ages of first sexual intercourse than children raised in father-present households. Competing theoretical perspectives have attributed this either to effects of father absence on socialization and physical maturation or to nonrandom selection of children predisposed for early sexual intercourse into father-absent households. Genetically informative analyses of the children of sister dyads (N = 1,382, aged 14-21 years) support the selection hypothesis: This association seems attributable to confounded risks, most likely genetic in origin, which correlated both with likelihood of father absence and early sexual behavior. This holds implications for environmental theories of maturation and suggests that previous research may have inadvertently overestimated the role of family structure in reproductive maturation.

To develop a predictive model of cochlear implant (CI) performance in postlingually deafened adults that includes contemporary speech perception testing and the hearing history of both ears.Retrospective clinical study. Multivariate predictors of speech perception after CI surgery included duration of any degree of hearing loss (HL), duration of severe-to-profound HL, age at implantation, and preoperative Hearing in Noise Test (HINT) sentences in quiet and HINT sentences in noise scores. Consonant-nucleus-consonant (CNC) scores served as the dependent variable. To develop the model, we performed a stepwise multiple regression analysis.Tertiary referral center.Adult patients with postlingual severe-to-profound HL who received a multichannel CI. Mean follow-up was 28 months. Fifty-five patients were included in the initial bivariate analysis.Multichannel cochlear implantation.Predicted and measured postoperative CNC scores.The regression analysis resulted in a model that accounted for 60% of the variance in postoperative CNC scores. The formula is (pred)CNC score = 76.05 + (-0.08 x DurHL(CI ear)) + (0.38 x pre-HINT sentences in quiet) + (0.04 x long sev-prof HL(either ear)). Duration of HL was in months. The mean difference between predicted and measured postoperative CNC scores was 1.7 percentage points (SD, 16.3).The University of Massachusetts CI formula uses HINT sentence scores and the hearing history of both ears to predict the variance in postoperative monosyllabic word scores. This model compares favorably with previous studies that relied on Central Institute for the Deaf sentence scores and uses patient data collected by most centers in the United States.

Objective: This phase I trial was designed to determine the maximal tolerated dose (MTD) of the combination of topotecan and gemcitabine given in a weekly schedule. Materials and Methods: In this single-arm, open label, dose-escalation study, we administered topotecan (0.75–1.5 mg/m2) and gemcitabine (1000 mg/m2) on days 1, 8, and 15 every 4 weeks to 25 patients with advanced solid tumors. Results: The topotecan MTD, when combined with gemcitabine, was 1.25 mg/m2/wk. Dose-limiting toxicities consisted of febrile granulocytopenia in 2 patients at the highest dose level. At the MTD, no episodes of granulocytopenia were observed, whereas 2/9 patients exhibited grade 3 thrombocytopenia. Other common grades 3–4 adverse events across all cohorts included non-neutropenic infections, fatigue, skin reactions, vomiting, and fever. One partial response and 2 stable diseases were observed in patients with nasopharyngeal carcinoma. Disease stabilization was also observed in patients with squamous cell carcinoma of the head and neck (3), nonsmall cell lung cancer (1), and thymoma (1). Conclusions: Topotecan and gemcitabine combined in a weekly schedule exhibit a favorable toxicity profile. Efficacy results support the further evaluation of this regimen in patients with head and neck cancer (particularly nasopharyngeal carcinoma).

Using National Longitudinal Survey of Youth (NLSY) fertility variables, we introduce and illustrate a new genetically-informative design. First, we develop a kinship linking algorithm, using the NLSY79 and the NLSY-Children data to link mothers to daughters and aunts to nieces. Then we construct mother–daughter correlations to compare to aunt–niece correlations, an MDAN design, within the context of the quantitative genetic model. The results of our empirical illustration, which uses DF Analysis and generalized estimation equations (GEE) to estimate biometrical parameters from NLSY79 sister–sister pairs and their children in the NLSY-Children dataset, provide both face validity and concurrent validity in support of the efficacy of the design. We describe extensions of the MDAN design. Compared to the typical within-generational design used in most behavior genetic research, the cross-generational feature of this design has certain advantages and interesting features. In particular, we note that the equal environment assumption of the traditional biometrical model shifts in the context of a cross-generational design. These shifts raise questions and provide motivation for future research using the MDAN and other cross-generational designs.

Inattentive-hyperactive and oppositional behavior have been hypothesized to be developmental precursors to conduct problems. We tested these hypotheses using a longitudinal sample of 6,466 offspring of women selected from nationally-representative U.S. households. Conduct problems across 8–13 years were robustly predicted by conduct problems at 4–7 years, but also were independently predicted to a small extent by both inattentive-hyperactive and oppositional behaviors at 4–7 years. Longitudinal multivariate behavior genetic analyses revealed that the genetic and environmental factors that influence conduct problems at both 4–7 and 8–13 years also influence the putative precursors at 4–7 years. After genetic and environmental influences on conduct problems at 4–7 years were taken into account, however, inattentive-hyperactive and oppositional behavior at 4–7 years shared causal influences with conduct problems 8–13 years to a negligible extent. These findings suggest that after early conduct problems are controlled, little is gained in terms of prediction or understanding genetic and environmental influences on later child conduct problems by treating early inattentive-hyperactive and oppositional behavior as developmental precursors to later conduct problems.

Previous studies have documented that smoking during pregnancy (SDP) is associated with offspring externalizing problems, even when measured covariates were used to control for possible confounds. However, the association may be because of nonmeasured environmental and genetic factors that increase risk for offspring externalizing problems. The current project used the National Longitudinal Survey of Youth and their children, ages 4–10 years, to explore the relations between SDP and offspring conduct problems (CPs), oppositional defiant problems (ODPs), and attention-deficit/hyperactivity problems (ADHPs) using methodological and statistical controls for confounds. When offspring were compared to their own siblings who differed in their exposure to prenatal nicotine, there was no effect of SDP on offspring CP and ODP. This suggests that SDP does not have a causal effect on offspring CP and ODP. There was a small association between SDP and ADHP, consistent with a causal effect of SDP, but the magnitude of the association was greatly reduced by methodological and statistical controls. Genetically informed analyses suggest that unmeasured environmental variables influencing both SDP and offspring externalizing behaviors account for the previously observed associations. That is, the current analyses imply that important unidentified environmental factors account for the association between SDP and offspring externalizing problems, not teratogenic effects of SDP.

Sex differences in the causes of self-reported adolescent delinquency were examined in full and half siblings born to a nationally representative sample of women in the United States. Qualitative sex differences in the genes that influence delinquency were not detected. Similarly, the proportions of variance in both aggressive and nonaggressive delinquency attributable to genetic and environmental influences did not differ significantly between girls and boys. Nonetheless, total variance in delinquency was greater among boys, and a scalar sex-differences model suggested that genetic and environmental influences on delinquency have less effect on population variation in delinquency among girls. Similarly, a test of the polygenic multiple threshold model suggested that girls require greater causal liability for the expression of delinquency than boys.

The catecholamines—dopamine and noradrenaline—play important roles in directing and guiding behavior. Disorders of these systems, particularly within the dopamine system, are associated with several severe and chronically disabling psychiatric and neurological disorders. We used the recently published group independent components analysis (ICA) procedure outlined by Chen et al. (2013) to present the first pharmaco‐EEG ICA analysis of the resting‐state EEG in healthy participants administered 0.45 mg/kg dexamphetamine. Twenty‐eight healthy participants between 18 and 41 were recruited. Bayesian nested‐domain models that explicitly account for spatial and functional relationships were used to contrast placebo and dexamphetamine on component spectral power and several connectivity metrics. Dexamphetamine led to reductions across delta, theta, and alpha spectral power bands that were predominantly localized to Frontal and Central regions. Beta 1 and beta 2 power were reduced by dexamphetamine at Frontal ICs, while beta 2 and gamma power was enhanced by dexamphetamine in posterior regions, including the parietal, occipital‐temporal, and occipital regions. Power–power coupling under dexamphetamine was similar for both states, resembling the eyes open condition under placebo. However, orthogonalized measures of power coupling and phase coupling did not show the same effect of dexamphetamine as power‐power coupling. We discuss the alterations of low‐ and high‐frequency EEG power in response to dexamphetamine within the context of disorders of dopamine regulation, in particular schizophrenia, as well as in the context of a recently hypothesized association between low‐frequency power and aspects of anhedonia. Hum Brain Mapp 37:570–588, 2016. © 2015 Wiley Periodicals, Inc.

Antagonizing glucagon action represents an attractive therapeutic option for reducing hepatic glucose production in settings of hyperglycemia where glucagon excess plays a key pathophysiological role. We therefore generated REGN1193, a fully human monoclonal antibody that binds and inhibits glucagon receptor (GCGR) signaling in vitro. REGN1193 administration to diabetic ob/ob and diet-induced obese mice lowered blood glucose to levels observed in GCGR-deficient mice. In diet-induced obese mice, REGN1193 reduced food intake, adipose tissue mass, and body weight. REGN1193 increased circulating levels of glucagon and glucagon-like peptide 1 and was associated with reversible expansion of pancreatic α-cell area. Hyperglucagonemia and α-cell hyperplasia was observed in fibroblast growth factor 21-deficient mice treated with REGN1193. Single administration of REGN1193 to diabetic cynomolgus monkeys normalized fasting blood glucose and glucose tolerance and increased circulating levels of glucagon and amino acids. Finally, administration of REGN1193 for 8 weeks to normoglycemic cynomolgus monkeys did not cause hypoglycemia or increase pancreatic α-cell area. In summary, the GCGR-blocking antibody REGN1193 normalizes blood glucose in diabetic mice and monkeys but does not produce hypoglycemia in normoglycemic monkeys. Thus, REGN1193 provides a potential therapeutic modality for diabetes mellitus and acute hyperglycemic conditions.

NO and O2compete at cytochrome- c oxidase, thus potentially allowing NO to modulate mitochondrial respiration. We previously observed a decrease of myocardial phosphocreatine (PCr)/ATP during very high cardiac work states, corresponding to an increase in cytosolic free ADP. This study tested the hypothesis that NO inhibition of respiration contributes to this increase of ADP. Infusion of dobutamine + dopamine (DbDp, each 20 μg·kg−1·min−1iv) to more than double myocardial oxygen consumption (MV̇o2) in open-chest dogs caused a decrease of myocardial PCr/ATP measured with31P NMR from 2.04 ± 0.09 to 1.85 ± 0.08 ( P < 0.05). Inhibition of NO synthesis with Nω-nitro-l-arginine (l-NNA), while catecholamine infusion continued, caused PCr/ATP to increase to the control value. In a second group of animals, l-NNA administered before catecholamine stimulation (reverse intervention of the first group) increased PCr/ATP during basal conditions. In these animals l-NNA did not prevent a decrease of PCr/ATP at the high cardiac work state but, relative to MV̇o2, PCr/ATP was significantly higher after l-NNA. In a third group of animals, pharmacological coronary vasodilation with carbochromen was used to prevent changes in coronary flow that might alter endothelial NO production. In these animals l-NNA again restored depressed myocardial PCr/ATP during catecholamine infusion. The finding that inhibition of NO production increased PCr/ATP suggests that during very high work states NO inhibition of mitochondrial respiration requires ADP to increase to drive oxidative phosphorylation.

Background: Environmental mercury levels significantly increased in the past decades following its increase in industrial applications. In spite of an increasing concern on the potential harmful effects of mercury on children, there is no reported data for the Chinese population. The relationship between dietary habit and environmental mercury exposure in Chinese children was studied. Methods: The hair and blood mercury levels of Chinese children aged above 3 years in 2000 March to September, were studied. Sociodemographic data, dietary habits of the past 6 months, and other risk factors for environmental mercury exposure were collected. Those children with blood mercury levels above the toxic range (i.e. > 45 nmol/L) and their family members were further evaluated and their blood and hair mercury levels were monitored before and after Fishing-Moratorium period (June to August 2000) in South China Sea. Results: Altogether, 137 Chinese children (mean age, 7.2 years) were recruited. The mean hair mercury level was 2.2 p.p.m and the mean blood mercury level was 17.6 nmol/L. There was a strong correlation (r = 0.88) between hair and blood mercury levels in our cohort. Frequency of fish consumption correlated with hair (r = 0.51) and blood (r = 0.54) mercury levels. For those children who consumed fish more than 3 times/week, hair and blood mercury levels were twice as high as those who consumed fish l–3 times/week and threefold of those who never consumed fish. Five children and 12 family members had toxic blood mercury levels. Their blood (P

Tuberculosis infection has been a relatively rare complication after lung transplantation. However, as more countries in which Mycobacterium tuberculosis infection remains endemic embark on lung transplant programs, the occurrence of multidrug-resistant tuberculosis after transplantation is a genuine threat. We report the first case of multidrug-resistant tuberculosis in a double-lung transplant recipient who probably acquired the disease from the donor. We discuss the problems in clinical management of post-transplant tuberculosis infection and of drug-resistance.

Previous research has demonstrated that U.S. no-fault divorce laws implemented between 1953 and 1987 resulted in more divorces in some states than would have occurred otherwise. In other states, divorce patterns appeared to follow prevailing trends even after implementation of no-fault divorce legislation. A more distal question is whether implementation of no-fault divorce laws had an effect on birth rates. We analyzed state-level birth data from all 50 states to assess the birth response to the enactment of no-fault divorce law in each state. Results suggested that birth rates decreased significantly two to four years following the enactment of no-fault divorce law for the group of 34 states whose divorce rates responded to no-fault divorce legislation. As predicted, among the 16 states whose divorce rates did not respond to no-fault divorce legislation, the enactment of no-fault divorce law had a small and nonsignificant positive influence on birth rates. Generally, the group of 34 states had lower post no-fault birth rates than the group of 16 states.

We report a case of sternotomy wound infection caused by Paecilomyces variotii in a previously bronchiectatic patient, occurring 10 months after bilateral sequential lung transplantation. The use of prophylactic antifungal therapy, the persistent colonization with Paecilomyces, and sternal instability after clamshell incision may have contributed to the development of delayed deep sternal wound infection. Besides antifungal therapy, vigorous surgical debridement is vital for treatment success. With the more liberal use of early post-transplant fungal prophylaxis, potentially drug-resistant fungi, such as the Paecilomyces species, may be emerging as important opportunistic pathogens after lung transplantation.

This study presents a multivariate behavioural genetic analysis of the relationship between education, intelligence and age of first birth. Analyses investigated the mediational role of education in explaining the relationship between intelligence and age of first birth at both the phenotypic and behavioural genetic level. The data come from the National Longitudinal Survey of Youth (NLSY), a nationally representative survey that included genetically informative full- and half-sibling pairs (n=1423 pairs). Respondents were aged 14 to 22 when contacted in 1979. Heritability estimates were 0·32, 0·50 and 0·06 for IQ, education and age of first birth, respectively. Shared environment estimates were 0·35, 0·23 and 0·20 respectively. Common genetic and shared environmental factors were substantial in explaining the relationship between intelligence and education, and also education and age of first birth. Education partially mediated the relationship between intelligence and age of first birth only in the phenotypic analyses. After considering the genetic and shared environmental factors that influence all three variables, evidence for mediation was less convincing. This pattern of results suggests that the apparent mediational role of education at the phenotypic level is in fact the result of underlying genetic and shared environmental influences that affect education, IQ and age of first birth in common.

Background and objectives Data showing the impact of the robotic simulator on fellowship training are limited. This study was conducted to determine whether simulator scores reflect the experience of the robotic gynecologic surgeon and to develop a simulator curriculum for trainees in gynecologic oncology. Methods All faculty and fellows in the Department of Gynecologic Oncology and Reproductive Medicine were asked to participate. For phase 1, all participants were divided into 2 groups based on robotic surgical experience: beginner (0-50 cases) and experienced (>50 cases). Each participant completed 9 modules 3 times each to establish baseline data. Median module scores for the experienced group defined the benchmarks scores. In phase 2, all trainees who did not meet the benchmark score on a module were asked to repeat the module until they reached the score twice. Results Twenty-four participants were included: 18 beginners and 6 experienced surgeons. For all modules, experienced surgeons received higher median scores than beginners. There was a significant difference between the scores of the 2 groups in the Energy Switching 1 (87.5 vs 92.5; P = .002) and Suture Sponge 2 (75.0 vs 87.3; P = .011) modules. Thirteen trainees participated in phase 2. For 8 of 9 of the modules, >75% of trainees met proficiency, with a median of 3 to 6 attempts (range, 2-24). Conclusion Based on the findings, scores reflected each surgeon's experience. With repetition, most of the trainees were able to reach the benchmark scores. Further study is needed to determine the impact of surgical simulation on true intraoperative performance.

Better understanding risk factors for the development of adolescent emotional and behavioral problems can help with intervention and prevention efforts. Previous studies have found that an early menarcheal age predicts several adolescent problems, including depressive symptoms, delinquency, and early age at first intercourse. Few studies, nevertheless, have explicitly tested (a) whether the associations with menarcheal age vary across racial/ethnic groups or (b) whether the sources of the associations are within-families (i.e., consistent with a direct, causal link) or only between-families (i.e., due to selection or confounding factors). The current study analyzed data from a nationally representative US Sample of females (N = 5,637). We examined whether race/ethnicity moderated the associations between early menarche and several adolescent problems by using multiple-group analyses and we examined the degree to which genetic and environmental factors shared by family members account for the associations by comparing sisters and cousins with differing menarcheal ages. Menarcheal age predicted subsequent depressive symptoms, delinquency, and early age at first intercourse in the population. The magnitudes of the associations were similar across all racial/ethnic groups for all outcomes. The within-family associations (i.e., when comparing siblings and cousins with different menarcheal age) were large and statistically significant when predicting early intercourse, but not the other outcomes. The findings suggest that selection or confounding factors account for the associations between menarcheal age and subsequent depressive symptoms and delinquency, whereas the independent association between menarcheal age and early age at first intercourse is consistent with a direct, causal effect.

There is scanty information on the angiographic and myocardial perfusion correlates of dobutamine-induced ST-segment elevation.We studied 39 patients who exhibited ST-segment elevation during dobutamine perfusion tomography and had recent coronary angiography performed (ie, within 3 months of the dobutamine study). Baseline characteristics, extent of coronary artery disease, relationship of Q waves to ST-segment elevation, ischemic burden, and angiographic findings were assessed. Twenty-nine patients (74%) had prior myocardial infarction, and 77% had abnormal Q waves at baseline. Ninety-three percent of patients had abnormal perfusion imaging. Eighty percent of patients had multivessel coronary artery disease. The left ventricular ejection fraction by contrast ventriculography was 35% +/- 7% (mean +/- SD), the perfusion defect size was 32% +/- 15%, and 73% of patients had some degree of myocardial ischemia. A predominance of ischemia (50% reversibility) occurred in 38% of patients with Q waves and in 70% of those without Q waves. There was also good agreement between the site of ST-segment elevation and the site of ischemia by perfusion imaging (79%) and between the site of ST-segment elevation and the location of the vessel with significant coronary stenosis (95%).Patients with dobutamine-induced ST-segment elevation have a depressed left ventricular ejection fraction, a high frequency of multivessel disease, and markedly abnormal myocardial perfusion tomography. In patients with ST-segment elevation and abnormal Q waves, substantial scarring and superimposed ischemia coexist, whereas in patients without Q waves, ST-segment elevation usually denotes severe ischemia.

Behavior genetic designs and analyses can be used to address issues of central importance to demography. We use this methodology to document genetic influence on human fertility. Our data come from Danish twin pairs born from 1953 to 1959, measured on age at first attempt to get pregnant (FirstTry) and number of children (NumCh). Behavior genetic models were fitted using structural equation modeling and DF analysis. A consistent medium-level additive genetic influence was found for NumCh, equal across genders; a stronger genetic influence was identified for FirstTry, greater for females than for males. A bivariate analysis indicated significant shared genetic variance between NumCh and FirstTry.

This paper examines the seasonality of induced abortion in North Carolina between 1980 and 1993. Distinct seasonal patterns are found, with a peak in February and a valley in September. These patterns correspond to the implicit seasonality of conceptions associated with the seasonality of birth pattern. One notable difference from the general pattern is among unmarried women aged 18 and younger. They have the February peak and an additional peak in August that may be associated with the summer vacation from school.This study examined patterns of seasonality in induced abortion in North Carolina. Data were obtained for 1980 and 1993 from the North Carolina State Center for Health Statistics and reported by providers. Monthly frequencies were adjusted by dividing the number of abortions per month by the expected monthly totals, which were yearly totals multiplied by the ratio of days in a month to days in a year. Analysis relied on plots of the average number of abortions in each month for total population and by age, marital status, and race. Seasonal stability was tested across the years. Dummy variable regressions were estimated for total population and targeted groups for specific months. Regression models testing for seasonality were tested for 3 groups of women. Findings indicate that there were more abortions in winter months, with a peak in February. Abortions declined through April, and stabilized during May through August, at a level that was the stable average for the year. During September through December, abortions were fairly stable and lower. Patterns were similar between married and unmarried women. Almost 70% of abortions occurred between 7-10 weeks gestation. Seasonal patterns for unmarried women aged under 18 years differed. For these women, abortions peaked in August. Tests for stable seasonality revealed lack of uniformity across months. Abortions were higher in August for total population, Blacks and Whites. The seasonal pattern of abortions matched in general the seasonal patterns of conceptions and births in North Carolina and births in the US.

Data on female sexual function after prolapse surgery are conflicting. The aim of the study was to evaluate the change in sexual function and vaginal symptoms using patient reported outcomes following prolapse surgery in addition to the anatomical stage.Prospective observational study of women undergoing pelvic organ prolapse (POP) surgery. The validated International Consultation on Incontinence modular Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was completed preoperatively, 6 and 12 months postoperatively.Ninety-three women participated in the study with 83 (89%) returning the 6 months questionnaire and 80 (86%) the 12 months questionnaire. Twenty-four healthy women without prolapse were included as a control group. The mean vaginal- and sexual-symptom score both improved with a significant decrease at 6 months and 12 months after surgery (P0.001, P0.05, respectively). The POP-Q scores of each compartment also improved significantly after 6 and 12 months (P0.001) with 75% reaching anatomical success. There was no correlation between anatomical success and subjective ICIQ-VS outcomes. The vaginal and sexual matters score had a lesser reduction in women who had additional levator plication sutures during posterior vaginal repair compared to those without. Women with levator plication also showed a significant increase in postoperative dyspareunia.Surgical intervention for POP improved the vaginal and sexual matters scores at 6 and 12 months postoperatively. Levator plication additionally to posterior vaginal repair is associated with an increase in postoperative dyspareunia rates and with decreased sexual function.

Background Tumor necrosis factor-α (TNF-α) is a proinflammatory cytokine that produces negative inotropic effects in the heart. Recently, elevated levels of TNF-α have been reported in patients with advanced congestive heart failure. Although TNF-α is thought to exert its deleterious effects by binding to two cell surface receptors, TNFR1 and TNFR2, the level of expression and regulation of TNF receptors in the heart in cardiac disease states is not known. Methods and Results We examined mRNA and protein levels for TNFR1, TNFR2, and TNF-α in explanted hearts from organ donors as well as in patients with end-stage dilated cardiomyopathy (DCM) and ischemic heart disease (IHD). Northern blot analysis revealed that mRNA for TNFR1 and TNFR2 was present in nonfailing, DCM, and IHD hearts. TNFR1 and TNFR2 receptor protein levels, as measured by ELISA, were decreased 60% in DCM and IHD patients compared with nonfailing hearts ( P P P Conclusions In summary, the results of this study constitute the initial demonstration that TNF receptor proteins are dynamically regulated in patients with advanced congestive heart failure. Moreover, the observation that failing hearts express elevated levels of TNF-α suggests that overexpression of this cytokine may be one of several different maladaptive mechanisms responsible for the progressive cardiac decompensation that occurs in advanced heart failure.

Background Tumor necrosis factor–α (TNF-α), a proinflammatory cytokine with potent negative inotropic properties, is elaborated in septic shock, acute myocarditis, reperfusion injury, and congestive heart failure. TNF-α acts by binding to two specific receptors: TNFR1 and TNFR2. However, neither the presence nor the significance of TNF receptors has been studied in the adult mammalian heart. Methods and Results In the present study, we showed that the adult heart expresses mRNA and receptor proteins for TNFR1 and TNFR2. Moreover, immunohistochemical staining studies localized TNFR1 and TNFR2 to the cardiac myocyte, providing a potential signaling pathway for the deleterious effects of TNF-α. The functional significance of the expression of TNFR1 and TNFR2 was explored with the use of a simple cell motion assay in which we assessed the effect(s) of TNF-α mutants known to bind selectively to human TNFR1 and TNFR2. We showed that the negative inotropic effect of wild-type TNF-α in isolated feline cardiac myocytes was mimicked by the TNF mutant that binds to TNFR1, whereas the TNF mutant that binds to TNFR2 had no significant effect on cell motion. Conclusions Results of the present study show that the adult human heart expresses both mRNA and receptor proteins for TNFR1 and TNFR2; moreover, the negative inotropic effects of TNF-α in adult cardiac myocytes appear to be initiated by activation of TNFR1.

Epidemic Models of the Onset of Social Activities (EMOSA models) describe the spread of adolescent transition behaviors (e.g., sexuality, smoking, and drinking) through an interacting adolescent network. A theory of social contagion is defined to explain how social influence affects sexual development. Contacts within a network can, with some transition rate or probability, result in an increase in level of sexual experience. Five stages of sexual development are posited. One submodel proposes a systematic progression through these stages; a competing submodel treats each as an independent process. These models are represented in sets of dynamically interacting recursive equations, which are fit to empirical prevalence data to estimate parameters. Model adjustments are substantively interpretable and can be used to test for and better understand social interaction processes that affect adolescent sexual behavior.

Urinary incontinence has a high burden of suffering in Australia. There has been a significant shift towards less invasive surgery for stress urinary incontinence (SUI) over the last 15 years. Elderly women are underrepresented in surgical treatment of SUI.To identify patterns in the surgical treatment of women with SUI in Australia from January 1994 to December 2009.Gender- and age-specific data from Medicare Australia between January 1994 and December 2009 were extracted. Surgical procedures were identified using Medicare Benefit Schedules codes. Pattern of SUI surgery was analysed during the 15-year period.Using data from Medicare Australia, we reported trends in female SUI surgery across Australia from 1994 to 2009. The overall number of female SUI operations has increased, almost doubling over a 3-year period following the introduction of the midurethral sling (MUS). The per capita rate increase in all SUI surgery is most prominent in women over the age of 55 years increasing 87%, compared with only 1% in younger women over the 15-year period. MUS have overtaken Burch Colposuspension as the most popular operation for female SUI across all age groups, accounting for 85.5% of all procedures performed in 2009 with 14 MUS for every one colposuspension.Stress incontinence procedures performed in Australia have almost doubled with the introduction of the MUS with the greatest increase in women aged over 55 years. MUS has overtaken the Burch Colposuspension as the most popular operation for stress urinary incontinence for women in Australia.