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Genetic testing and spending on that testing have grown rapidly since the mapping of the human genome in 2003. However, it is not widely known how many tests there are, how they are used, and how they are paid for. Little evidence from large data sets about their use has emerged. We shed light on the issue of genetic testing by providing an overview of the testing landscape. We examined test availability and spending for the full spectrum of genetic tests, using unique data sources on test availability and commercial payer spending for privately insured populations, focusing particularly on tests measuring multiple genes in the period 2014–17. We found that there were approximately 75,000 genetic tests on the market, with about ten new tests entering the market daily. Prenatal tests accounted for the highest percentage of spending on genetic tests, and spending on hereditary cancer tests accounted for the second-highest. Our results provide insights for those interested in assessing genetic testing markets, test usage, and health policy implications, including current debates over the most appropriate regulatory and payer coverage mechanisms.

Objective To report a case of acute abdomen secondary to torsion of uterine remnant leiomyoma and ipsilateral adnexa in a woman with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and known history of bilateral uterine remnant leiomyomas. Design Case report. Setting Tertiary care center. Patient(s) A 40-year-old nulligravid woman with MRKH syndrome and a known history of bilateral uterine remnant leiomyomas with a surgical abdomen. Intervention(s) Surgery: right salpingo-oopherectomy, excision of right and left hemiuteri with pedunculated leiomyomas, and left salpingectomy. Main Outcome Measure(s) Definitive therapy with preservation of premenopausal state. Result(s) First known case of acute surgical presentation secondary to torsion of uterine remnant leiomyoma and ipsilateral adnexa in a woman with MRKH syndrome and bilateral voluminous uterine remnant leiomyomas without any plan for elective surgical intervention. Conclusion(s) Elective surgical removal of uterine remnant leiomyoma for women with MRKH syndrome can prevent the complication of torsion as well as prevent ovarian resection in premenopausal women. Torsion should be considered in the differential diagnosis in a woman with MRKH syndrome and known history of leiomyomas who presents with acute abdomen.

Fewer than 1 in 5 patients comply with the established follow-up protocol to treat presumed ectopic pregnancy medically in an urban clinic population. Institutions should consider tracking their patient compliance with follow-up to determine the efficacy of their treatment decisions.

Prematurity continues to be the major source of neonatal morbidity and mortality. Efforts to decrease the risk of prematurity in the past have focused on preventing contractions with tocolytics, early identification of contractions with home uterine monitoring, and predicting preterm delivery through history and biochemical evaluations. The Institute of Medicine estimated in 2005 that the average direct medical care costs for a preterm infant in the United States is $33,200, with the majority (85%) of this cost occurring in the first year of life. 1 The cost per infant increases to $51,600 when maternal medical care costs ($3800), early intervention costs ($1203), special education costs ($2150), and lost household productivity costs ($11,215) are considered. The only markers for increased risk of preterm delivery that have reasonable positive predictive values in the asymptomatic patient are a history of preterm delivery and the finding on transvaginal ultrasound of a shortened cervix

The purpose of this study was to test whether treating periodontal disease (PD) in pregnancy will reduce the incidence of spontaneous preterm delivery (SPTD) ator = 35 weeks of gestation.A multicenter, randomized clinical trial was performed. Subjects with PD were randomized to scaling and root planing (active) or tooth polishing (control). The primary outcome was the occurrence of SPTD at35 weeks of gestation.We screened 3563 subjects for PD; the prevalence of PD was 50%. Seven hundred fifty-seven subjects were assigned randomly; 378 subjects were assigned to the active group, and 379 subjects were assigned to the placebo group. Active treatment did not reduce the risk of SPTD at35 weeks of gestation (relative risk, 1.19; 95% confidence interval [CI], 0.62-2.28) or composite neonatal morbidity (relative risk, 1.30; 95% CI, 0.83-2.04). There was a suggestion of an increase in the risk of indicated SPTD at35 weeks of gestation in those subjects who received active treatment (relative risk, 3.01; 95% CI, 0.95-4.24).Treating periodontal disease does not reduce the incidence of SPTD.

We interviewed 61 housed and 79 homeless adults aged 55 and over about disability; economic, human and social capital; and stressful life events prior to becoming homeless. Over half of the homeless group had previously led conventional lives. Human capital, social capital and life events were more important than disability or economic capital in predicting homelessness. The homeless adults were younger, more likely to be male and better educated than housed adults, but had shorter job tenure and fewer social ties. Homeless adults faced multiple, cascading risks, including job loss and housing loss. Implications for prevention are discussed.

Pregnancy is associated with altered liver function, particularly in serum enzymes. Anabolic steroids are responsible to some degree in mediating the physiologic and biochemical changes that occur during an uncomplicated pregnancy. However, several liver disorders are unique to pregnancy and include intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, and hepatic dysfunction associated with pre-eclampsia and eclampsia. It is imperative for the clinician to diagnose these liver disorders in a timely manner and to institute appropriate management as maternal and fetal outcome are affected in an adverse manner if these conditions are left untreated.

A Monitoring System is described for reporting, in a timely and comprehensive fashion, the important aspects of the development and utilization of geothermal energy in the United States. The Federal program for geothermal energy addresses technological, environmental, institutional, economic and financial problems. The system for monitoring geothermal resource development has been designed to measure progress in developing geothermal energy online and progress in enabling geothermal resources for development, thereby increasing the potential for future exploitation of geothermal resources, as a consequence of successes in the Federal program in solving technological, environmental, institutional, economic and financial problems that currently impede exploitation of geothermal resources. The key indicator of progress in the development of geothermal energy will be ''power online''. Projections of power online will signal deviations from national goals with sufficient warning time to effect corrective action. Correlation of Federal programs with national progress indicators will show where corrective action is needed. Preliminary indicators of geothermal resource development, based on very limited data, are presented. The analyses are illustrative rather than definitive. Some conclusions are drawn from these analyses.

During the past decade there have been innumerable studies dealing with the use of psychotropic medication in childhood psychiatric disorders. The classification of medication, the clinical pharmacology, the clinical effects, and the underlying central nervous system effects of the psychotropic agents are discussed in the literature, for example, Weiner (1977). White (1977) discusses the specific psychopharmacological agents, side effects, adverse effects, clinical indications, and dosage range for medications that have been used for controlling psychiatric symptoms in childhood.