A Guide to the Cost of Progesterone for Prevention of Preterm Labor

Progesterone, in various forms, has been the sole pharmacologic weapon against preterm labor supported by randomized controlled trials since the early 2000s. Nightly vaginal suppositories and weekly injections were the first forms of progesterone proved to be effective in preventing preterm labor. The effectiveness of nightly vaginal gel was then demonstrated. These options are all relatively affordable. Suppositories and gel are only available in branded forms and until recently the intramuscular injection form was only available from compounding pharmacies. Several factors must be considered when choosing a product for a patient. These include route of administration, patient preference, local availability and cost

Vaginal cancer in patient presenting with advanced pelvic organ prolapse: case report and literature review

Background: Vaginal cancer presenting concurrently with stage 4 uterovaginal prolapse is a rare occurrence, representing less than 1% of all gynecologic malignancies. Case: We review the case of an 82-year-old woman who presented for care of prolapse. Examination demonstrated complete uterovaginal prolapse and a vaginal ulcer, later confirmed to be vaginal cancer. Conclusion: The management of these complicated patients is limited by a lack of data available to guide treatment. This case and the literature review highlight the need for a multi-disciplinary approach to treatment and a high level of clinical suspicion for diagnosis of these very challenging cases

Factors associated with long-term pessary use

Vaginal pessary is a well-established pelvic organ prolapse (POP) treatment, but little evidence about long-term use is available. Our aim was to report the duration of use and investigate predictors of long-term pessary use for POP. We hypothesized that younger, healthier women and women who experienced complications would have shorter duration of use

Management of pregnancy in patients with exstrophy-epispadias sequence: a case series and literature review

Exstrophy-epispadias sequence is an uncommon diagnosis in which surgical reconstruction has increased quality of life for these patients. As they are entering the reproductive phase of their life, consideration must be made for management of their pregnancies in the context of their genitourinary reconstruction. There have been few case reports of patients with cloacal exstrophy conceiving; therefore, information to guide management of their pregnancies is limited. Here we describe a patient with Omphalocele-Exstrophy-Imperforate Anus-Spinal defects (OEIS) and a patient with a history of bladder exstrophy both with spontaneous pregnancy managed by a multidisciplinary approach and primary cesarean delivery

Flow mediated vasodilation predicts the development of gestational diabetes mellitus

To prospectively measure flow mediated vasodilation (FMD) in a cohort of women with risk factors for preeclampsia and to identify poor obstetrical outcomes associated with changes in FMD

Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury

Objective: To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death.Participants: The sample involved 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014.Design: Head CT variables for each person were fit into adapted Marshall CT classification categories I through IV.Main Measures: Prediction models were developed to determine the amount of variability explained by the CT classification categories compared with commonly used predictors, including a clinical indicator of injury severity.Results: The adapted Marshall classification categories aided only in the prediction of craniotomy or craniectomy during acute hospitalization, otherwise making no meaningful contribution to variance in the multivariable models predicting outcomes at any time point after injury.Conclusion: Results suggest that head CT findings classified in this manner do not inform clinical discussions related to functional prognosis or rehabilitation planning after TBI

Limits on the high-energy gamma and neutrino fluxes from the SGR 1806-20 giant flare of December 27th, 2004 with the AMANDA-II detector

On December 27th 2004, a giant gamma flare from the Soft Gamma-ray Repeater 1806-20 saturated many satellite gamma-ray detectors. This event was by more than two orders of magnitude the brightest cosmic transient ever observed. If the gamma emission extends up to TeV energies with a hard power law energy spectrum, photo-produced muons could be observed in surface and underground arrays. Moreover, high-energy neutrinos could have been produced during the SGR giant flare if there were substantial baryonic outflow from the magnetar. These high-energy neutrinos would have also produced muons in an underground array. AMANDA-II was used to search for downgoing muons indicative of high-energy gammas and/or neutrinos. The data revealed no significant signal. The upper limit on the gamma flux at 90% CL is dN/dE < 0.05 (0.5) TeV^-1 m^-2 s^-1 for gamma=-1.47 (-2). Similarly, we set limits on the normalization constant of the high-energy neutrino emission of 0.4 (6.1) TeV^-1 m^-2 s^-1 for gamma=-1.47 (-2).Comment: 14 pages, 3 figure

Detection of Atmospheric Muon Neutrinos with the IceCube 9-String Detector

The IceCube neutrino detector is a cubic kilometer TeV to PeV neutrino detector under construction at the geographic South Pole. The dominant population of neutrinos detected in IceCube is due to meson decay in cosmic-ray air showers. These atmospheric neutrinos are relatively well-understood and serve as a calibration and verification tool for the new detector. In 2006, the detector was approximately 10% completed, and we report on data acquired from the detector in this configuration. We observe an atmospheric neutrino signal consistent with expectations, demonstrating that the IceCube detector is capable of identifying neutrino events. In the first 137.4 days of livetime, 234 neutrino candidates were selected with an expectation of 211 +/- 76.1(syst.) +/- 14.5(stat.) events from atmospheric neutrinos

Calibration and Characterization of the IceCube Photomultiplier Tube

Over 5,000 PMTs are being deployed at the South Pole to compose the IceCube neutrino observatory. Many are placed deep in the ice to detect Cherenkov light emitted by the products of high-energy neutrino interactions, and others are frozen into tanks on the surface to detect particles from atmospheric cosmic ray showers. IceCube is using the 10-inch diameter R7081-02 made by Hamamatsu Photonics. This paper describes the laboratory characterization and calibration of these PMTs before deployment. PMTs were illuminated with pulses ranging from single photons to saturation level. Parameterizations are given for the single photoelectron charge spectrum and the saturation behavior. Time resolution, late pulses and afterpulses are characterized. Because the PMTs are relatively large, the cathode sensitivity uniformity was measured. The absolute photon detection efficiency was calibrated using Rayleigh-scattered photons from a nitrogen laser. Measured characteristics are discussed in the context of their relevance to IceCube event reconstruction and simulation efforts.Comment: 40 pages, 12 figure

The IceCube Neutrino Observatory: Instrumentation and Online Systems

The IceCube Neutrino Observatory is a cubic-kilometer-scale high-energy neutrino detector built into the ice at the South Pole. Construction of IceCube, the largest neutrino detector built to date, was completed in 2011 and enabled the discovery of high-energy astrophysical neutrinos. We describe here the design, production, and calibration of the IceCube digital optical module (DOM), the cable systems, computing hardware, and our methodology for drilling and deployment. We also describe the online triggering and data filtering systems that select candidate neutrino and cosmic ray events for analysis. Due to a rigorous pre-deployment protocol, 98.4% of the DOMs in the deep ice are operating and collecting data. IceCube routinely achieves a detector uptime of 99% by emphasizing software stability and monitoring. Detector operations have been stable since construction was completed, and the detector is expected to operate at least until the end of the next decade.Comment: 83 pages, 50 figures; updated with minor changes from journal review and proofin