The effects of obesity with pregnancy termination: a literature review

Obesity has become a major health problem in the United States as well as globally which may affect the safety of pregnancy termination. Thus, a literature review was conducted to determine the available evidence regarding the effects of obesity with pregnancy termination to assist with patient care and counseling. The available evidence is limited by small numbers and descriptive study design. While pregnancy termination upon obese women may impart additional technical challenges, experienced providers complete procedures upon obese women without statistically significant differences in procedure or patient outcomes compared to normal weight women for first trimester gestations. Pharmacological abortion may be a more practical option in some very obese women

Mapping change in medical student attitudes regarding lesbian, gay and bisexual healthcare

Despite significant social advances among lesbian, gay, bisexual, and transgender (LGBT) individuals, healthcare disparities remain prevalent. Medical education represents a prime opportunity for addressing this need. Thus, we undertook this study to explore second year medical students’ attitudes regarding equal access to healthcare services including erectile dysfunction medication, family planning medications and technology, and partner health insurance coverage. Nearly 1500 allopathic medical students were surveyed from 2006 to 2014 during their second pre-clinical training year. While attitudes regarding care between LGB patients and heterosexual patients were often similar, there was a significant change in favor of providing insurance coverage for in-vitro and assisted reproduction services for lesbian women (increasing from 70% of students in favor in 2008 to 87% of students in 2013). Similarly, the proportion of students in favor of providing health insurance coverage for prescription drugs to same sex partners significantly increased from 2009 to 2013. Additionally, students noted healthcare providers should be required to provide equal access to care for all patients regardless of marital status or sexual practices (96% agreement in 2006 and 98.6% agreement in 2014). Even with this significant increase in medical student approval of certain healthcare services for LGB patients, continuing to integrate LGBT healthcare topics into medical education curriculum remains critically important

Integration of vanHAX downstream of a ribosomal RNA operon restores vancomycin resistance in a susceptible Enterococcus faecium strain

During the genomic characterisation of Enterococcus faecium strains (n = 39) collected in a haematology ward, we identified an isolate (OI25), which contained vanA-type vancomycin resistance genes but was phenotypically susceptible to vancomycin. OI25 could revert to resistance when cultured in the presence of vancomycin and was thus considered to be vancomycin-variable. Long-read sequencing was used to identify structural variations within the vancomycin resistance region of OI25 and to uncover its resistance reversion mechanism. We found that OI25 has a reduced ability to positively regulate expression of the vanHAX genes in the presence of vancomycin, which was associated with the insertion of an IS6-family element within the promoter region and the first 50 bp of the vanR gene. The vancomycin-resistant revertant isolates constitutively expressed vanHAX genes at levels up to 36,000-fold greater than OI25 via co-transcription with a ribosomal RNA operon. The vancomycin-resistant revertants did not exhibit a significant growth defect. During VRE outbreaks, attention should be paid to contemporaneous vancomycin-susceptible strains as these may carry silent vancomycin resistance genes that can be activated through genomic rearrangements

Nurses\u27 Alumnae Association Bulletin - Volume 18 Number 1

Alumnae Notes Central Dressing Room Committee Reports Digest of Alumnae Association Meetings Graduation Awards - 1952 Greetings from Miss Childs Greetings from the President Marriages Modern Trends in Orthopaedic Surgery Necrology New Arrivals Physical Advances at Jefferson Hospital - 1953 Staff Activities - 1952-1953 Student Activities The Artificial Heart Lung Machin

Utility of the new Movement Disorder Society clinical diagnostic criteria for Parkinson's disease applied retrospectively in a large cohort study of recent onset cases

Objective: To examine the utility of the new Movement Disorder Society (MDS) diagnostic criteria in a large cohort of Parkinson's disease (PD) patients. Methods: Recently diagnosed (<3.5 years) PD cases fulfilling United Kingdom (UK) brain bank criteria in Tracking Parkinson's, a UK multicenter prospective natural history study were assessed by retrospective application of the MDS criteria. Results: In 2000 cases, 1835 (91.7%) met MDS criteria for PD, either clinically established (n = 1261, 63.1%) or clinically probable (n = 574, 28.7%), leaving 165 (8.3%) not fulfilling criteria. Clinically established cases were significantly more likely to have limb rest tremor (89.3%), a good l-dopa response (79.5%), and olfactory loss (71.1%), than clinically probable cases (60.6%, 44.4%, and 34.5% respectively), but differences between probable PD and ‘not PD’ cases were less evident. In cases not fulfilling criteria, the mean MDS UPDRS3 score (25.1, SD 13.2) was significantly higher than in probable PD (22.3, SD 12.7, p = 0.016) but not established PD (22.9, SD 12.0, p = 0.066). The l-dopa equivalent daily dose of 341 mg (SD 261) in non-PD cases was significantly higher than in probable PD (250 mg, SD 214, p < 0.001) and established PD (308 mg, SD 199, p = 0.025). After 30 months' follow-up, 89.5% of clinically established cases at baseline remained as PD (established/probable), and 86.9% of those categorized as clinically probable at baseline remained as PD (established/probable). Cases not fulfilling PD criteria had more severe parkinsonism, in particular relating to postural instability, gait problems, and cognitive impairment. Conclusion: Over 90% of cases clinically diagnosed as early PD fulfilled the MDS criteria for PD. Those not fulfilling criteria may have an atypical parkinsonian disorder or secondary parkinsonism that is not correctly identified by the UK Brain Bank criteria, but possibly by the new criteria

A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS)

<p>Abstract</p> <p>Background</p> <p>MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients.</p> <p>Methods/Design</p> <p>The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy.</p> <p>Discussion</p> <p>This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting.</p

Drip Paintings and Fractal Analysis

It has been claimed [1-6] that fractal analysis can be applied to unambiguously characterize works of art such as the drip paintings of Jackson Pollock. This academic issue has become of more general interest following the recent discovery of a cache of disputed Pollock paintings. We definitively demonstrate here, by analyzing paintings by Pollock and others, that fractal criteria provide no information about artistic authenticity. This work has also led to two new results in fractal analysis of more general scientific significance. First, the composite of two fractals is not generally scale invariant and exhibits complex multifractal scaling in the small distance asymptotic limit. Second the statistics of box-counting and related staircases provide a new way to characterize geometry and distinguish fractals from Euclidean objects

Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease

Funded by Parkinson's UK National Institute for Health Research (NIHR) DeNDRoN network NIHR Newcastle Biomedical Research Unit Newcastle University NIHR funded Biomedical Research Centre in CambridgePeer reviewedPublisher PD

Life course longitudinal growth and risk of knee osteoarthritis at age 53 years: evidence from the 1946 British birth cohort study

ObjectiveTo examine the relationship between height gain across childhood and adolescence with knee osteoarthritis in the MRC National Survey of Health and Development (NSHD).Materials and methodsData are from 3035 male and female participants of the NSHD. Height was measured at ages 2, 4, 6, 7, 11 and 15 years, and self-reported at ages 20 years. Associations between (i) height at each age (ii) height gain during specific life periods (iii) Super-Imposition by Translation And Rotation (SITAR) growth curve variables of height size, tempo and velocity, and knee osteoarthritis at 53 years were tested.ResultsIn sex-adjusted models, estimated associations between taller height and decreased odds of knee osteoarthritis at age 53 years were small at all ages - the largest associations were an OR of knee osteoarthritis of 0.9 per 5cm increase in height at age 4, (95% CI 0.7-1.1) and an OR of 0.9 per 5cm increase in height, (95% CI 0.8-1.0) at age 6. No associations were found between height gain during specific life periods or the SITAR growth curve variables and odds of knee osteoarthritis.ConclusionsThere was limited evidence to suggest that taller height in childhood is associated with decreased odds of knee osteoarthritis at age 53 years in this cohort. This work enhances our understanding of osteoarthritis predisposition and the contribution of life course height to this