Placenta previa percreta left in situ - management by delayed hysterectomy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Placenta percreta is an obstetric emergency often associated with massive hemorrhage and emergency hysterectomy.</p> <p>Case presentation</p> <p>We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left <it>in situ</it>, methotrexate was administered, and a delayed hysterectomy was successfully performed.</p> <p>Conclusions</p> <p>Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.</p

Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/BPH patients with moderate-to-severe symptoms at risk of disease progression

Purpose: To evaluate the effect of delayed start of combination therapy (CT) with dutasteride 0.5 mg and tamsulosin 0.4 mg on the risk of acute urinary retention or benign prostatic hyperplasia (BPH)-related surgery (AUR/S) in patients with moderate-to-severe lower urinary tract symptoms (LUTS) at risk of disease progression. Methods: Using a time-to-event model based on pooled data from 10,238 patients from Phase III/IV dutasteride trials, clinical trial simulations (CTS) were performed to assess the risk of AUR/S up to 48 months in moderate-to-severe LUTS/BPH patients following immediate and delayed start of CT for those not responding to tamsulosin monotherapy. Simulation scenarios (1300 subjects/arm) were investigated, including immediate start (reference) and alternative delayed start (six scenarios 1–24 months). AUR/S incidence was described by Kaplan–Meier survival curves and analysed using log-rank test. The cumulative incidence of events as well as the relative and attributable risks were summarised stratified by treatment. Results: Survival curves for patients starting CT at month 1 and 3 did not differ from those who initiated CT immediately. By contrast, significant differences (p < 0.001) were observed when switch to CT occurs ≥ 6 months from the initial treatment. At month 48, AUR/S incidence was 4.6% vs 9.5%, 11.0% and 11.3% in patients receiving immediate CT vs. switchers after 6, 12 and 24 months, respectively. Conclusions: Start of CT before month 6 appears to significantly reduce the risk of AUR/S compared with delayed start by ≥ 6 months. This has implications for the treatment algorithm for men with LUTS/BPH at risk of disease progression

Single-shot qubit readout in circuit Quantum Electrodynamics

The future development of quantum information using superconducting circuits requires Josephson qubits [1] with long coherence times combined to a high-fidelity readout. Major progress in the control of coherence has recently been achieved using circuit quantum electrodynamics (cQED) architectures [2, 3], where the qubit is embedded in a coplanar waveguide resonator (CPWR) which both provides a well controlled electromagnetic environment and serves as qubit readout. In particular a new qubit design, the transmon, yields reproducibly long coherence times [4, 5]. However, a high-fidelity single-shot readout of the transmon, highly desirable for running simple quantum algorithms or measur- ing quantum correlations in multi-qubit experiments, is still lacking. In this work, we demonstrate a new transmon circuit where the CPWR is turned into a sample-and-hold detector, namely a Josephson Bifurcation Amplifer (JBA) [6, 7], which allows both fast measurement and single-shot discrimination of the qubit states. We report Rabi oscillations with a high visibility of 94% together with dephasing and relaxation times longer than 0:5 \mu\s. By performing two subsequent measurements, we also demonstrate that this new readout does not induce extra qubit relaxation.Comment: 14 pages including 4 figures, preprint forma

Psychosocial and physiological risks of shift work in nurses: a cross-sectional study

Objectives: Many jobs are associated with psychological or social risk factors. Knowledge of occupational diseases is essential for adopting rational control measures. The aim was to study and describe frequent social, psychological and physiological risk factors for nurses. Methods: Psychological and social risks were evaluated in nurses with regular or irregular shifts. In addition, differences between nurses or nursing assistants were studied. The Copenhagen Psychosocial Questionnaire, Eating Attitudes Test, Profile of Mood State, Athens Insomnia Scale, Trait Anxiety Inventory, and Minnesota Leisure Time were administered. Results: Nursing assistants presented higher levels of body mass index and food restriction than nurses, nevertheless, nurses showed increasing tension in work. In nursing, shift work increases psychosocial risks, insomnia, eating disorders, and trait anxiety. Conclusions: In conclusion, nurses and nursing assistants in health centres and hospitals show high levels of exposure to psychological and psychosocial risks that are unfavourable to their health

"I am your mother and your father!": In vitro derived gametes and the ethics of solo reproduction

In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men’s non-reproductive cells and sperm from women’s. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: ‘solo reproduction’. We will consider what might motivate people to reproduce in this way, and the implications that solo reproduction might have for ethics and policy. We suggest that such an innovation is unlikely to revolutionise reproduction and parenting. Indeed, in some respects it is less revolutionary than in vitro fertilisation as a whole. Furthermore, we show that solo reproduction with in vitro created gametes is not necessarily any more ethically problematic than gamete donation—and probably less so. Where appropriate, we draw parallels with the debate surrounding reproductive cloning. We note that solo reproduction may serve to perpetuate reductive geneticised accounts of reproduction, and that this may indeed be ethically questionable. However, in this it is not unique among other technologies of assisted reproduction, many of which focus on genetic transmission. It is for this reason that a ban on solo reproduction might be inconsistent with continuing to permit other kinds of reproduction that also bear the potential to strengthen attachment to a geneticised account of reproduction. Our claim is that there are at least as good reasons to pursue research towards enabling solo reproduction, and eventually to introduce solo reproduction as an option for fertility treatment, as there are to do so for other infertility related purposes

Problems with studying wolf predation on small prey in summer via global positioning system collars

We attempted to study predation on various-sized prey by a male and female wolf (Canis lupus) with global positioning system (GPS) collars programmed to acquire locations every 10 min in the Superior National Forest of Minnesota. During May to August 2007, we investigated 147 clusters of locations (31% of the total) and found evidence of predation on a white-tailed deer (Odocoileus virginianus) fawn and yearling, a beaver (Castor canadensis), ruffed grouse (Bonasa umbellus), and fisher (Martes pennanti) and scavenging on a road-killed deer and other carrion. However, we missed finding many prey items and discuss the problems associated with trying to conduct such a study

From presence to consciousness through virtual reality

Immersive virtual environments can break the deep, everyday connection between where our senses tell us we are and where we are actually located and whom we are with. The concept of 'presence' refers to the phenomenon of behaving and feeling as if we are in the virtual world created by computer displays. In this article, we argue that presence is worthy of study by neuroscientists, and that it might aid the study of perception and consciousness