The use of measurements of hCG and other pregnancy-associated proteins and steroids in the diagnosis of ectopic pregnancy

The measurement of serum of urinary hCG is commonly used to make or exclude the diagnosis of ectopic pregnancy in women presenting with symptoms suspicious of ectopic pregnancy. Detection of depressed hCG levels is indicative of early pregnancy failure. Depressed serum levels of proteins of hormone of trophoblastic, ovarian or endometrial origin make the diagnosis of ectopic gestation more likely, whilst high values are likely to exclude the possibility of this condition.peer-reviewe

Confidentiality Uncovered: Why Peer Supporters Need Protection

The concept of confidentiality arises from legal recognition given to the expectations of parties in a relationship. The party conveying the information has an expectation of privacy and the party hearing the information has an obligation not to disclose. More importantly, the concept of privilege arises when legal recognition is given to those communications. Privilege prevents compelled disclosure in legal settings. There is currently no recognized privilege protection for communications made to researchers absent a Certificate of Confidentiality. With the few exceptions that we will discuss, there is also no recognized privilege for communications made to peer supporters. Peer supporters are becoming increasingly more important in clinical and research settings. For the purposes of this brief, peer supporters are defined as individuals with a history of mental illness or substance abuse who are providing services and/or supports to others diagnosed with a similar illness. The increasing use of peer supporters is largely due to research findings and transformation efforts that suggest that peers are able to easily build effective relationships with clients and help promote recovery. Peers have been shown to have the ability to act as positive role models with personal experiences to share, and are often more empathetic than non-peers. Unfortunately peers may not be protected from the consequences of compelled disclosure of information they gain. In Massachusetts, peers can be subpoenaed by a court to repeat any information they obtain from clients/research subjects. The authors will discuss strategies which could protect peers under these circumstances

Characterisation of the differential expression of marker antigens by normal and malignant endometrial epithelium

In order to examine the production of marker proteins, a reproducible method has been established for culturing purified epithelial cells from normal and malignant endometrium. We have examined the differential expression of secretory proteins using immunohistochemistry in frozen tissue sections, immunocytochemistry in cell cultures derived from the same specimens and protein assays on the culture supernatants. Placental protein 14 (PP14) was produced by normal premenopausal epithelium but not by the post-menopausal or malignant endometrial epithelium. In contrast, placental alkaline phosphatase (PLAP) was produced by endometrial cancers and the endometrial adenocarcinoma-derived cell line Ishikawa, but not by the normal endometrial epithelium. Other markers such as CA-125, which was produced by both normal and malignant endometrium but not by the cell line, and human chorionic gonadotrophin (beta-hCG), which was produced by Ishikawa cells but not by any of the fresh tissues, were less cancer specific. Placental alkaline phosphatase is a direct product of endometrial cancers that can be readily assayed in serum using this two-site assay to test its clinical usefulness in monitoring patients at risk for endometrial cancer

Trajectories of Offending from Childhood to Early Adulthood in Girls With and Without Mental Health System Involvement

Criminology literature is overwhelmingly based in studies of males, though studies of gender differences or of females are rapidly accumulating. Rates of psychiatric disorder are typically higher in females involved with justice systems compared to males. However, the juvenile or criminal justice involvement of girls in mental health systems, or with serious mental health conditions is greatly understudied. Identifying their arrest risk onset, peak, and offset provides practitioners information about when to intervene and with whom. The goal of the present study is to describe within-individual longitudinal arrest patterns from ages 8-24 in this population, and determine whether their arrest patterns differ from general offender females in ways that have practice implications. Methods: Using statewide administrative data from the Massachusetts Department of Mental Health (DMH) and Massachusetts’ juvenile and criminal courts, a database was constructed that contained juvenile and criminal arrest histories to age 25 for females born 1976-79. DMH females were adolescent service users (n=738), Non-DMH females had no DMH database records (n=34,436). Massachusetts Census 2000 provided the size of the general female population. Developmental trajectory modeling was used to group individuals’ patterns of offending over time (trajectories) into “clusters” of those whose trajectories are similar, and describe trajectories. Trajectory comparison methods minimized the greater Non-DMH cohort size. Results: DMH females were far more likely to be arrested by age 25 than Non-DMH females (46% vs. 22%) and to be arrested at multiple ages (28% vs. 7%). Analyses revealed eight justice system trajectories among those with multiple ages of arrest. Trajectories varied on level of involvement and timing of onset/offset/peaks. Non-DMH females comprised at least 93% of each trajectory cluster, though several clusters showed significant over- or under-representation of DMH females. Conclusions: Concern about justice system involvement of female youths in intensive MH services is justified. Among girls with multiple ages with arrest, differences in criminal careers between the mental health and non mental health system users was minimal. Implications of trajectory findings for timing and type of intervention will be presented

Outpatient Commitment: A Competency Based Justification

A recent survey of state statutes for outpatient commitment (Torrey and Kaplan, 1995) indicates that while thirty-five states and the District of Columbia have laws permitting outpatient commitment, Massachusetts is not one of them. Rather, Massachusetts uses a competency-based, substituted-decision-making model for the involuntary administration of medication in the community. To appreciate the Massachusetts model, it is important to understand how this court-ordered involuntary outpatient treatment fits into the overall scheme of outpatient commitment and how it is structured. A review of involuntary outpatient treatment (IOT) literature indicates that it is prudent to distinguish between outpatient commitment, conditional release, and conservatorship-guardianship (Torrey and Kaplan, 1995). Two states whose IOT is based on the guardianship process and is described in the literature are California and New Mexico. Lamb and Weinberger (1992, 1993) have discussed California’s use of guardians for the gravely disabled psychiatric outpatient, and Schneider-Braus (1986) has presented a single case report from New Mexico

Characteristics of populations of granulosa cells from individual follicles in women undergoing 'coasting' during controlled ovarian stimulation (COS) for IVF

BACKGROUND: The aim of this study was to evaluate the functional characteristics of granulosa cell populations of individual follicles of women undergoing controlled ovarian stimulation (COS) for IVF/ICSI in whom gonadotrophin had been withheld (‘coasted’) for the prevention of OHSS. METHODS: Follicular fluid and granulosa cells were isolated from 224 individual follicles in 41 women who had been coasted and from 257 individual follicles in 50 women who had a ‘normal’ response to COS. Cells were cultured at 10 000 cells per well, to evaluate progesterone secretion. Follicular fluid was assayed for progesterone and estradiol (E2). RESULTS: No significant differences were observed between the two groups with respect to granulosa cell number or follicular fluid progesterone and E2 and follicle size, the retrieval of an oocyte and the subsequent fertilization of the oocyte. However, the granulosa cells derived from the coasted group showed a higher rate of progesterone secretion per cell at 72 h which was sustained for longer. Differences were also seen at 72 and 120 h of culture with a loss of correlation between progesterone secretion and follicle diameter in the coasted group. CONCLUSIONS: Our findings suggest that coasting has an effect on the functional capacity of the granulosa cells and the duration of their function. It is likely that in women at risk of OHSS who are not coasted, the granulosa cells have the capacity to produce significantly more chemical mediators per cell and for a more prolonged period of time

Association of Demographic Factors and Comorbid Diagnoses with Crime Typein an Arrest Cohort with Schizophrenia and/or Related Psychosis

The implications of the interface between the criminal justice system and individuals with schizophrenia persist despite decades of research on criminalization and risk of arrest. Research exploring the broader construct of criminality has predominantly focused on individuals with severe mental illness as a collective. This study diverges from others by examining diagnoses comorbid with schizophrenia and related psychoses and their relationships with risk of arrest across a spectrum of criminal categories ranging in severity