Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning

Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman’s confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women’s involuntary bearing down sensations that can serve to guide her behaviors

Transits of Earth-Like Planets

Transmission spectroscopy of Earth-like exoplanets is a potential tool for habitability screening. Transiting planets are present-day "Rosetta Stones" for understanding extrasolar planets because they offer the possibility to characterize giant planet atmospheres and should provide an access to biomarkers in the atmospheres of Earth-like exoplanets, once they are detected. Using the Earth itself as a proxy we show the potential and limits of the transiting technique to detect biomarkers on an Earth-analog exoplanet in transit. We quantify the Earths cross section as a function of wavelength, and show the effect of each atmospheric species, aerosol, and Rayleigh scattering. Clouds do not significantly affect this picture because the opacity of the lower atmosphere from aerosol and Rayleigh losses dominates over cloud losses. We calculate the optimum signal-to-noise ratio for spectral features in the primary eclipse spectrum of an Earth-like exoplanet around a Sun-like star and also M stars, for a 6.5-m telescope in space. We find that the signal to noise values for all important spectral features are on the order of unity or less per transit - except for the closest stars - making it difficult to detect such features in one single transit, and implying that co-adding of many transits will be essential.Comment: 17 pages, 3 figures, 6 tables, to appear in ApJ (accepted) V2: corrected transit times, corrected values for M4 star radiu

Chitotriosidase as a biomarker of cerebral adrenoleukodystrophy

<p>Abstract</p> <p>Background</p> <p>Adrenoleukodystrophy (ALD) is an X-linked peroxisomal disorder characterized by the abnormal beta-oxidation of very long chain fatty acids (VLCFA). In 35-40% of children with ALD, an acute inflammatory process occurs in the central nervous system (CNS) leading to demyelination that is rapidly progressive, debilitating and ultimately fatal. Allogeneic hematopoietic stem cell transplantation (HSCT) can halt disease progression in cerebral ALD (C-ALD) if performed early. In contrast, for advanced patients the risk of morbidity and mortality is increased with transplantation. To date there is no means of quantitating neuroinflammation in C-ALD, nor is there an accepted measure to determine prognosis for more advanced patients.</p> <p>Methods</p> <p>As cellular infiltration has been observed in C-ALD, including activation of monocytes and macrophages, we evaluated the activity of chitotriosidase in the plasma and spinal fluid of boys with active C-ALD. Due to genotypic variations in the chitotriosidase gene, these were also evaluated.</p> <p>Results</p> <p>We document elevations in chitotriosidase activity in the plasma of patients with C-ALD (n = 38; median activity 1,576 ng/mL/hr) vs. controls (n = 16, median 765 ng/mL/hr, p = 0.0004), and in the CSF of C-ALD patients (n = 38; median activity 4,330 ng/mL/hr) vs. controls (n = 16, median 0 ng/mL/hr, p < 0.0001). In addition, activity levels of plasma and CSF chitotriosidase prior to transplant correlated with progression as determined by the Moser/Raymond functional score 1 year following transplantation (p = 0.002 and < 0.0001, respectively).</p> <p>Conclusions</p> <p>These findings confirm elevation of chitotriosidase activity in patients with active C-ALD, and suggest that these levels predict prognosis of patients with C-ALD undergoing transplantation.</p

Molecular evolution of dengue type 2 virus in Thailand

Dengue is a mosquito-borne viral infection that in recent years has become a major international public health concern. Dengue hemorrhagic fever (DHF), first recognized in Southeast Asia in the 1950s, is today a leading cause of childhood death in many countries. The pathogenesis of this illness is poorly understood, mainly because there are no laboratory or animal models of disease. We have studied the genetic relationships of dengue viruses of serotype 2, one of four antigenically distinct dengue virus groups, to determine if viruses obtained from cases of less severe dengue fever (DF) have distinct evolutionary origins from those obtained from DHF cases. A very large number (73) of virus samples from patients with DF or DHF in two locations in Thailand (Bangkok and Kamphaeng Phet) were compared by sequence analysis of 240 nucleotides from the envelope/nonstructural protein 1 (E/NS1) gene junction of the viral genome. Phylogenetic trees generated with these data have been shown to reflect long-term evolutionary relationships among strains. The results suggest that 1) many different virus variants may circulate simultaneously in Thailand, thus reflecting the quasispecies nature of these RNA viruses, in spite of population immunity; 2) viruses belonging to two previously distinct genotypic groups have been isolated from both DF and DHF cases, supporting the view that they arose from a common progenitor and share the potential to cause severe disease; and 3) viruses associated with the potential to cause DHF segregate into what is now one, large genotypic group and they have evolved independently in Southeast Asia for some time

Fast Domain Growth through Density-Dependent Diffusion in a Driven Lattice Gas

We study electromigration in a driven diffusive lattice gas (DDLG) whose continuous Monte Carlo dynamics generate higher particle mobility in areas with lower particle density. At low vacancy concentrations and low temperatures, vacancy domains tend to be faceted: the external driving force causes large domains to move much more quickly than small ones, producing exponential domain growth. At higher vacancy concentrations and temperatures, even small domains have rough boundaries: velocity differences between domains are smaller, and modest simulation times produce an average domain length scale which roughly follows $L \sim t^{\zeta}$, where $\zeta$ varies from near .55 at 50% filling to near .75 at 70% filling. This growth is faster than the $t^{1/3}$ behavior of a standard conserved order parameter Ising model. Some runs may be approaching a scaling regime. At low fields and early times, fast growth is delayed until the characteristic domain size reaches a crossover length which follows $L_{cross} \propto E^{-\beta}$. Rough numerical estimates give $\beta= >.37$ and simple theoretical arguments give $\beta= 1/3$. Our conclusion that small driving forces can significantly enhance coarsening may be relevant to the YB$_2$Cu$_3$O$_{7- \delta}$ electromigration experiments of Moeckly {\it et al.}(Appl. Phys. Let., {\bf 64}, 1427 (1994)).Comment: 18 pages, RevTex3.

Mandatory Disclosure of Pharmaceutical Industry-Funded Events for Health Professionals

David Henry and colleagues examine compliance with new disclosure requirements of Medicines Australia, the pharmaceutical industry representative body, and argue that they fall short and instead more comprehensive reporting standards are needed

Color-Coding Improves Parental Understanding of Body Mass Index Charting

To assess parental understanding of body mass index (BMI) and BMI percentiles using standard versus color-coded charts and investigate how parental literacy and/or numeracy (quantitative skills) impacts that understanding

Comparison of the sensitivity of the UKCAT and A levels to sociodemographic characteristics: a national study

Background: The UK Clinical Aptitude Test (UKCAT) was introduced to facilitate widening participation in medical and dental education in the UK by providing universities with a continuous variable to aid selection; one that might be less sensitive to the sociodemographic background of candidates compared to traditional measures of educational attainment. Initial research suggested that males, candidates from more advantaged socioeconomic backgrounds and those who attended independent or grammar schools performed better on the test. The introduction of the A* grade at A level permits more detailed analysis of the relationship between UKCAT scores, secondary educational attainment and sociodemographic variables. Thus, our aim was to further assess whether the UKCAT is likely to add incremental value over A level (predicted or actual) attainment in the selection process. Methods: Data relating to UKCAT and A level performance from 8,180 candidates applying to medicine in 2009 who had complete information relating to six key sociodemographic variables were analysed. A series of regression analyses were conducted in order to evaluate the ability of sociodemographic status to predict performance on two outcome measures: A level ‘best of three’ tariff score; and the UKCAT scores. Results: In this sample A level attainment was independently and positively predicted by four sociodemographic variables (independent/grammar schooling, White ethnicity, age and professional social class background). These variables also independently and positively predicted UKCAT scores. There was a suggestion that UKCAT scores were less sensitive to educational background compared to A level attainment. In contrast to A level attainment, UKCAT score was independently and positively predicted by having English as a first language and male sex. Conclusions: Our findings are consistent with a previous report; most of the sociodemographic factors that predict A level attainment also predict UKCAT performance. However, compared to A levels, males and those speaking English as a first language perform better on UKCAT. Our findings suggest that UKCAT scores may be more influenced by sex and less sensitive to school type compared to A levels. These factors must be considered by institutions utilising the UKCAT as a component of the medical and dental school selection process