Pregnancy outcome following prenatal diagnosis of chromosomal anomaly: a record linkage study of 26,261 pregnancies

Previous studies have demonstrated the influence of changes in the age at which women give birth, and of developments in prenatal screening and diagnosis on the number of pregnancies diagnosed and terminated with chromosomal anomalies. However, we are unaware of any population studies examining pregnancy terminations after diagnosis of chromosomal anomalies that has included all aneuploidies and the influence of maternal factors. The aims of this study were to examine the association between results of prenatal tests and pregnancy termination, and the proportion of foetuses with and without chromosomal anomalies referred for invasive diagnostic tests over time. Diagnostic information of 26,261 prenatal invasive tests from all genetic service laboratories in Scotland from 2000 to 2011 was linked to Scottish Morbidity Records to obtain details on pregnancy outcome. Binary logistic regression was carried out to test the associations of year and type of diagnosis with pregnancy termination, while controlling for maternal age, neighbourhood deprivation and parity. There were 24,155 (92.0%) with no chromosomal anomalies, 1,483 (5.6%) aneuploidy diagnoses, and 623 (2.4%) diagnoses of anomaly that was not aneuploidy (including translocations and single chromosome deletions). In comparison with negative test results, pregnancies diagnosed with trisomy were most likely to be terminated (adjusted OR 437.40, 95% CI 348.19–549.46) followed by other aneuploid anomalies (adjusted OR 95.94, 95% CI 69.21–133.01). During the study period, fewer pregnancies that were diagnosed with aneuploidy were terminated, including trisomy diagnoses (adjusted OR 0.44, 95% CI 0.26–0.73). Older women were less likely to terminate (OR 0.35, 95% CI 0.28, 0.42), and parity was also an independent predictor of termination. In keeping with previous findings, while the number of invasive diagnostic tests declined, the proportion of abnormal results increased from 6.09% to 10.88%. Systematic advances in prenatal screening have improved detection rates for aneuploidy. This has been accompanied by a reduction in the rate of termination for aneuploidy. This may reflect societal changes with acceptance of greater diversity, but this is speculation, and further research would be needed to test this

Managing workplace stress in community pharmacy organisations:Lessons from a review of the wider stress management and prevention literature

Abstract Background Workplace stress in community pharmacy is increasing internationally due, in part, to pharmacists’ expanding roles and escalating workloads. Whilst the business case for preventing and managing workplace stress by employers is strong, there is little evidence for the effectiveness of organisational stress management interventions in community pharmacy settings. Aim To identify and synthesise existing evidence for the effectiveness of organisational solutions to workplace stress from the wider organisational literature which may be adaptable to community pharmacies. Method A secondary synthesis of existing reviews. Publications were identified through keyword searches of electronic databases and the internet; inclusion and exclusion criteria were applied; data about setting, intervention, method of evaluation, effectiveness and conclusions (including factors for success) were extracted and synthesised. Findings Eighteen reviews of the stress management and prevention literature were identified. A comprehensive list of organisational interventions to prevent or manage workplace stress, ordered by prevalence of evidence of effectiveness, was produced, together with an ordered list of the benefits both to the individual and employing organisation. An evidence-based model of best practice was derived specifying eight factors for success: top management support, context-specific interventions, combined organisational and individual interventions, a participative approach, clearly delineated tasks and responsibilities, buy-in from middle management, change agents as facilitators and change in organisational culture. Conclusions This literature review provides community pharmacy organisations with evidence from which to develop effective and successful stress management strategies to support pharmacists and pharmacy staff. Well-designed trials of stress management interventions in community pharmacy organisations are still required. </jats:sec

TB16: The Effect of Stress on the Formation of Tissue Lipid from Dietary Protein

Rats were stressed in a black, enclosed, motor-driven drum by being rotated at random intervals during half of a forty-eight hour period. They were stressed for two out of every six days for six weeks, while receiving a casein diet.https://digitalcommons.library.umaine.edu/aes_techbulletin/1176/thumbnail.jp

Razonamiento covariacional aplicado a la modelación de eventos dinámicos: un marco conceptual y un estudio

Se desarrolla la noción de razonamiento covariacional y se propone un marco conceptual para describir las acciones mentales involucradas al aplicar razonamiento covariacional cuando se interpretan y representan funciones asociadas a eventos dinámicos. Se reporta la habilidad para razonar sobre cantidades covariantes en situaciones dinámicas, de estudiantes de alto desempeño en un curso de cálculo. El estudio reveló que ellos eran capaces de construir imágenes de la variable dependiente de una función que cambia simultáneamente con el cambio imaginado de la variable independiente, y en algunas ocasiones eran capaces de construir imágenes de la razón de cambio para intervalos contiguos del dominio de una función. Sin embargo, al parecer, tuvieron dificultad para formar imágenes de una razón cambiante de manera continua y no pudieron representar con exactitud o interpretar los puntos de inflexión ni la razón creciente y decreciente para funciones asociadas a situaciones dinámicas. Estos hallazgos sugieren que el currículo y la instrucción deberían aumentar el énfasis en el cambio que debe darse en los alumnos de una imagen coordinada de dos variables que cambian simultáneamente a una imagen coordinada de razón de cambio instantánea con cambios continuos en la variable independiente para funciones asociadas a situaciones dinámicas

Narrow Gender Gap in Upper Midwest

Much has been made during the 2004 election campaign of the divide between the political parties, with most of the country designated “blue” or “red” states. Geography, however, is not the only cleavage. Gender also has been an important divide since 1980. President Clinton benefited from far more support among women than among men, leading Republican Robert Dole by 16 points among women in 1996. The gender gap dissipated after September 11, 2001. The Humphrey Institute’s survey of likely voters in Minnesota, Wisconsin, and Iowa reveals relatively muted differences between men and women —often times within the margin of error.Center for the Study of Politics and Governance, Humphrey School of Public Affairs, UM

Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: A Congenital Heart Surgeons' Society study

ObjectiveMultiple subsequent procedures directed at the arch and/or the left ventricular outflow tract are frequently required after interrupted aortic arch repair. We the investigated patterns and factors associated with these subsequent procedures and mortality.MethodsWe reviewed the data from 447 patients with interrupted aortic arch at 33 institutions enrolled from 1987 to 1997. We classified the subsequent procedures by type (catheter-based or surgical) and focus (arch, left ventricular outflow tract, and “other” cardiovascular lesions). We used competing risks and modulated renewal analysis to explore subsequent procedures.ResultsThere were 158 subsequent arch and 100 left ventricular outflow tract procedures. Freedom from death at 21 years was 60% overall. The risk of additional subsequent arch procedures decreased after the first subsequent arch procedure in the acute phase, but did not significantly change in the chronic phase. The risk of additional subsequent left ventricular outflow tract procedures increased after the first subsequent left ventricular outflow tract procedure in the chronic phase. The risk factors for subsequent arch procedures and mortality, but not for subsequent outflow track procedures, were related in a complex way to previous procedures and their timing.ConclusionsInterrupted aortic arch is a chronic disease in which patients often undergo multiple subsequent procedures with persistent risk for additional intervention and mortality. The risk factors are related to the nature and timing of previous procedures and to the morphology and details of the index procedure. Interrupted aortic arch should be considered a chronic disorder