First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.

BACKGROUND: The dose of mifepristone approved by most government agencies for medical abortion is 600 mg. Our aim was to summarize extant data on the effectiveness and safety of regimens using the widely recommended lower mifepristone dose, 200 mg, followed by misoprostol in early pregnancy and to explore potential correlates of abortion failure. STUDY DESIGN: To identify eligible reports, we searched Medline, reviewed reference lists of published reports, and contacted experts to identify all prospective trials of any design of medical abortion using 200 mg mifepristone followed by misoprostol in women with viable pregnancies up to 63 days' gestation. Two authors independently extracted data from each study. We used logistic regression models to explore associations between 15 characteristics of the trial groups and, separately, the rates of medical abortion failure and of ongoing pregnancy. RESULTS: We identified 87 trials that collectively included 120 groups of women treated with a regimen of interest. Of the 47,283 treated subjects in these groups, abortion outcome data were reported for 45,528 (96%). Treatment failure occurred in 2,192 (4.8%) of these evaluable subjects. Ongoing pregnancy was reported in 1.1% (499/45,150) of the evaluable subjects in the 117 trial groups reporting this outcome. The risk of medical abortion failure was higher among trial groups in which at least 25% of subjects had gestational age >8 weeks, the specified interval between mifepristone and misoprostol was less than 24 h, the total misoprostol dose was 400 mcg (rather than higher), or the misoprostol was administered by the oral route (rather than by vaginal, buccal, or sublingual routes). Across all trials, 119 evaluable subjects (0.3%) were hospitalized, and 45 (0.1%) received blood transfusions. CONCLUSIONS: Early medical abortion with mifepristone 200 mg followed by misoprostol is highly effective and safe

Plant‐derived differences in the composition of aphid honeydew and their effects on colonies of aphid‐tending ants

In plant–ant–hemipteran interactions, ants visit plants to consume the honeydew produced by phloem‐feeding hemipterans. If genetically based differences in plant phloem chemistry change the chemical composition of hemipteran honeydew, then the plant's genetic constitution could have indirect effects on ants via the hemipterans. If such effects change ant behavior, they could feed back to affect the plant itself. We compared the chemical composition of honeydews produced by Aphis nerii aphid clones on two milkweed congeners, Asclepias curassavica and Asclepias incarnata , and we measured the responses of experimental Linepithema humile ant colonies to these honeydews. The compositions of secondary metabolites, sugars, and amino acids differed significantly in the honeydews from the two plant species. Ant colonies feeding on honeydew derived from A. incarnata recruited in higher numbers to artificial diet, maintained higher queen and worker dry weight, and sustained marginally more workers than ants feeding on honeydew derived from A. curassavica . Ants feeding on honeydew from A. incarnata were also more exploratory in behavioral assays than ants feeding from A. curassavica . Despite performing better when feeding on the A. incarnata honeydew, ant workers marginally preferred honeydew from A. curassavica to honeydew from A. incarnata when given a choice. Our results demonstrate that plant congeners can exert strong indirect effects on ant colonies by means of plant‐species‐specific differences in aphid honeydew chemistry. Moreover, these effects changed ant behavior and thus could feed back to affect plant performance in the field. The role of indirect effects in trait evolution remains poorly understood. We show that plant chemical traits indirectly affect ant colony fitness and behavior via direct interactions with aphids. These plant‐derived effects on ant behavior could feed back to affect plant fitness in the field.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109587/1/ece31277.pd

How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts

We estimate the increment in Massachusetts Medicaid program costs attributable to smoking from December 20, 1991, to 1998. We describe how our methods improve upon earlier estimates of analogous costs at the national level. Current costs to the Massachusetts Medicaid program approximate the payments to Massachusetts under the tobacco settlement of November 1998. Whether these payments are viewed as appropriate compensation for Medicaid costs over time depends upon the rate of increase in future health care costs, the rate of decline in smoking, the proportion of smoking that should be attributed to the actions of the tobacco companies and the liklihood that state would have prevailed at trial. The costs to the Medicaid program are dwarfed by the internal costs to smokers themselves.

Relative impacts of global changes and regional watershed changes on the inorganic carbon balance of the Chesapeake Bay

The Chesapeake Bay is a large coastal-plain estuary that has experienced considerable anthropogenic changeover the past century. At the regional scale, land-use change has doubled the nutrient input from rivers and led to an increase in riverine carbon and alkalinity. The bay has also experienced global changes, including the rise of atmospheric temperature and CO2. Here we seek to understand the relative impact of these changes on the inorganic carbon balance of the bay between the early 1900s and the early 2000s. We use a linked land–estuarine–ocean modeling system that includes both inorganic and organic carbon and nitrogen cycling. Sensitivity experiments are performed to isolate the effect of changes in (1) atmospheric CO2, (2) temperature,(3) riverine nitrogen loading and (4) riverine carbon and alkalinity loading. Specifically, we find that over the past century global changes have increased ingassing by roughly the same amount (∼30 Gg-C yr−1) as has the increased riverine loadings. While the former is due primarily to increases in atmospheric CO2, the latter results from increased net ecosystem production that enhances ingassing. Interestingly, these increases in ingassing are partially mitigated by increase temperatures and increased riverine carbon and alkalinity in-puts, both of which enhance outgassing. Overall, the bay has evolved over the century to take up more atmospheric CO2 and produce more organic carbon. These results suggest that over the past century, changes in riverine nutrient loads have played an important role in altering coastal carbon budgets, but that ongoing global changes have also substantially affected coastal carbonate chemistry

The impact of flooding on aquatic ecosystem services

Flooding is a major disturbance that impacts aquatic ecosystems and the ecosystem services that they provide. Predicted increases in global flood risk due to land use change and water cycle intensification will likely only increase the frequency and severity of these impacts. Extreme flooding events can cause loss of life and significant destruction to property and infrastructure, effects that are easily recognized and frequently reported in the media. However, flooding also has many other effects on people through freshwater aquatic ecosystem services, which often go unrecognized because they are less evident and can be difficult to evaluate. Here, we identify the effects that small magnitude frequently occurring floods (\u3c 10-year recurrence interval) and extreme floods (\u3e 100-year recurrence interval) have on ten aquatic ecosystem services through a systematic literature review. We focused on ecosystem services considered by the Millennium Ecosystem Assessment including: (1) supporting services (primary production, soil formation), (2) regulating services (water regulation, water quality, disease regulation, climate regulation), (3) provisioning services (drinking water, food supply), and (4) cultural services (aesthetic value, recreation and tourism). The literature search resulted in 117 studies and each of the ten ecosystem services was represented by an average of 12 ± 4 studies. Extreme floods resulted in losses in almost every ecosystem service considered in this study. However, small floods had neutral or positive effects on half of the ecosystem services we considered. For example, small floods led to increases in primary production, water regulation, and recreation and tourism. Decision-making that preserves small floods while reducing the impacts of extreme floods can increase ecosystem service provision and minimize losses

Head CT Guidelines Following Concussion Among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury?

Introduction. Recent studies have provided guidelines on the use ofhead computed tomography (CT) scans in pediatric trauma patients.The purpose of this study was to identify the prevalence of theseguidelines among concussed pediatric patients. Methods. A retrospective review was conducted of patients fouryears or younger with a concussion from blunt trauma. Demographics,head injury characteristics, clinical indicators for head CT scan(severe mechanism, physical exam findings of basilar skull fracture,non-frontal scalp hematoma, Glasgow Coma Scale score, loss ofconsciousness, neurologic deficit, altered mental status, vomiting,headache, amnesia, irritability, behavioral changes, seizures, lethargy),CT results, and hospital course were collected. Results. One-hundred thirty-three patients (78.2%) received a headCT scan, 7 (5.3%) of which demonstrated fractures and/or bleeds. Allpatients with skull fractures and/or bleeds had at least one clinicalindicator present on arrival. Clinical indicators that were observedmore commonly in patients with positive CT findings than in thosewith negative CT findings included severe mechanism (100% vs.54.8%, respectively, p = 0.020) and signs of a basilar skull fracture(28.6% vs. 0.8%, respectively, p = 0.007). Severe mechanism alonewas found to be sensitive, but not specific, whereas signs of a basilarskull fracture, headache, behavioral changes, and vomiting were specific,but not sensitive. No neurosurgical procedures were necessary,and there were no deaths. Conclusions. Clinical indicators were present in patients with positiveand negative CT findings. However, severe mechanism of injuryand signs of basilar skull fracture were more common for patients withpositive CT findings. Kans J Med 2018;11(2):38-43

Attitude and Behavior Effects in a Randomized Trial of Increased Access to Emergency Contraception

To explore the effects of providing unrestricted access to emergency contraception in advance of need on various psychosocial outcomes and pregnancy