Not just “bodies with vaginas”: A Kantian defense of pelvic exam consent laws

Medical students commonly learn how to administer pelvic exams by practicing on unconscious patients, often without first obtaining explicit consent from patients to do so. While twenty-one states currently have laws that require teaching hospitals to obtain consent from patients to participate in this educational experience, opposition from the medical community has stymied legislative progress. In this paper, I respond to the two most common reasons offered to oppose legislation, which appeal to (1) the educational benefits of these exams, or (2) protecting institutional autonomy. Kantian ideas about autonomy help to illuminate the problematic ways in which these arguments supplant the importance of women’s choices over how their bodies are used while seeking medical treatment. Ultimately, neither argument offers sufficient reason to oppose laws that require explicit consent before administering training pelvic exams

First trimester fetal heart rate as a predictor of newborn sex

OBJECTIVE: To predict the sex of newborns using first trimester fetal heart rate (FHR). METHODS: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student\u27s t-tests while categorical variables were compared using Chi-square test. RESULTS: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0 +/- 9.1 bpm and for male fetuses 167.3 +/- 10.1 bpm (p = 0.62). There was no significant difference in crown rump length between female and male fetuses (4.01 +/- 1.7 versus 3.98 +/- 1.7 cm; p = 0.78) or in gestational age at birth (38.01 +/- 2.1 versus 38.08 +/- 2.1 weeks; p = 0.67). The males were significantly heavier than females (3305.3 +/- 568.3 versus 3127.5 +/- 579.8 g; p \u3c 0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants. CONCLUSIONS: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns

Non-Newtonian fluid flow through three-dimensional disordered porous media

We investigate the flow of various non-Newtonian fluids through three-dimensional disordered porous media by direct numerical simulation of momentum transport and continuity equations. Remarkably, our results for power-law (PL) fluids indicate that the flow, when quantified in terms of a properly modified permeability-like index and Reynolds number, can be successfully described by a single (universal) curve over a broad range of Reynolds conditions and power-law exponents. We also study the flow behavior of Bingham fluids described in terms of the Herschel-Bulkley model. In this case, our simulations reveal that the interplay of ({\it i}) the disordered geometry of the pore space, ({\it ii}) the fluid rheological properties, and ({\it iii}) the inertial effects on the flow is responsible for a substantial enhancement of the macroscopic hydraulic conductance of the system at intermediate Reynolds conditions. This anomalous condition of ``enhanced transport'' represents a novel feature for flow in porous materials.Comment: 5 pages, 5 figures. This article appears also in Physical Review Letters 103 194502 (2009

Galerkin FEM for fractional order parabolic equations with initial data in H−s, 0<s≤1H^{-s},~0 < s \le 1

We investigate semi-discrete numerical schemes based on the standard Galerkin and lumped mass Galerkin finite element methods for an initial-boundary value problem for homogeneous fractional diffusion problems with non-smooth initial data. We assume that $\Omega\subset \mathbb{R}^d$, $d=1,2,3$ is a convex polygonal (polyhedral) domain. We theoretically justify optimal order error estimates in $L_2$- and $H^1$-norms for initial data in $H^{-s}(\Omega),~0\le s \le 1$. We confirm our theoretical findings with a number of numerical tests that include initial data $v$ being a Dirac $\delta$-function supported on a $(d-1)$-dimensional manifold.Comment: 13 pages, 3 figure

Calcitonin gene-related peptide promotes cellular changes in trigeminal neurons and glia implicated in peripheral and central sensitization

<p>Abstract</p> <p>Background</p> <p>Calcitonin gene-related peptide (CGRP), a neuropeptide released from trigeminal nerves, is implicated in the underlying pathology of temporomandibular joint disorder (TMD). Elevated levels of CGRP in the joint capsule correlate with inflammation and pain. CGRP mediates neurogenic inflammation in peripheral tissues by increasing blood flow, recruiting immune cells, and activating sensory neurons. The goal of this study was to investigate the capability of CGRP to promote peripheral and central sensitization in a model of TMD.</p> <p>Results</p> <p>Temporal changes in protein expression in trigeminal ganglia and spinal trigeminal nucleus were determined by immunohistochemistry following injection of CGRP in the temporomandibular joint (TMJ) capsule of male Sprague-Dawley rats. CGRP stimulated expression of the active forms of the MAP kinases p38 and ERK, and PKA in trigeminal ganglia at 2 and 24 hours. CGRP also caused a sustained increase in the expression of c-Fos neurons in the spinal trigeminal nucleus. In contrast, levels of P2X₃in spinal neurons were only significantly elevated at 2 hours in response to CGRP. In addition, CGRP stimulated expression of GFAP in astrocytes and OX-42 in microglia at 2 and 24 hours post injection.</p> <p>Conclusions</p> <p>Our results demonstrate that an elevated level of CGRP in the joint, which is associated with TMD, stimulate neuronal and glial expression of proteins implicated in the development of peripheral and central sensitization. Based on our findings, we propose that inhibition of CGRP-mediated activation of trigeminal neurons and glial cells with selective non-peptide CGRP receptor antagonists would be beneficial in the treatment of TMD.</p

Circuit dissection of the role of somatostatin in itch and pain

Stimuli that elicit itch are detected by sensory neurons that innervate the skin. This information is processed by the spinal cord; however, the way in which this occurs is still poorly understood. Here we investigated the neuronal pathways for itch neurotransmission, particularly the contribution of the neuropeptide somatostatin. We find that in the periphery, somatostatin is exclusively expressed in Nppb+ neurons, and we demonstrate that Nppb+somatostatin+ cells function as pruriceptors. Employing chemogenetics, pharmacology and cell-specific ablation methods, we demonstrate that somatostatin potentiates itch by inhibiting inhibitory dynorphin neurons, which results in disinhibition of GRPR+ neurons. Furthermore, elimination of somatostatin from primary afferents and/or from spinal interneurons demonstrates differential involvement of the peptide released from these sources in itch and pain. Our results define the neural circuit underlying somatostatin-induced itch and characterize a contrasting antinociceptive role for the peptide

Human Mas-related G protein-coupled receptors-X1 induce chemokine receptor 2 expression in rat dorsal root ganglia neurons and release of chemokine ligand 2 from the human LAD-2 mast cell line

Primate-specific Mas-related G protein-coupled receptors-X1 (MRGPR-X1) are highly enriched in dorsal root ganglia (DRG) neurons and induce acute pain. Herein, we analyzed effects of MRGPR-X1 on serum response factors (SRF) or nuclear factors of activated T cells (NFAT), which control expression of various markers of chronic pain. Using HEK293, DRG neuron-derived F11 cells and cultured rat DRG neurons recombinantly expressing human MRGPR-X1, we found activation of a SRF reporter gene construct and induction of the early growth response protein-1 via extracellular signal-regulated kinases-1/2 known to play a significant role in the development of inflammatory pain. Furthermore, we observed MRGPR-X1-induced up-regulation of the chemokine receptor 2 (CCR2) via NFAT, which is considered as a key event in the onset of neuropathic pain and, so far, has not yet been described for any endogenous neuropeptide. Up-regulation of CCR2 is often associated with increased release of its endogenous agonist chemokine ligand 2 (CCL2). We also found MRGPR-X1-promoted release of CCL2 in a human connective tissue mast cell line endogenously expressing MRGPR-X1. Thus, we provide first evidence to suggest that MRGPR-X1 induce expression of chronic pain markers in DRG neurons and propose a so far unidentified signaling circuit that enhances chemokine signaling by acting on two distinct yet functionally co-operating cell types. Given the important role of chemokine signaling in pain chronification, we propose that interruption of this signaling circuit might be a promising new strategy to alleviate chemokine-promoted pain

Neurotensin receptor 1 facilitates intracellular and transepithelial delivery of macromolecules

G protein-coupled receptors are expressed on the surface of eukaryotic cells and internalise in response to ligand binding. The actions of the hormone and neurotransmitter neurotensin (NT) are predominantly mediated by specific interactions with one such receptor. Neurotensin receptor 1 (NTS1), which is upregulated in a variety of cancers, including pancreatic and breast tumours. NTS1 could therefore serve as a target for selective delivery of therapeutics. This study characterised the expression of NTS1 in HEK293 cells, as well as both polarised and non-polarised intestinal epithelial Caco-2 cells. NT-conjugated fluorophores were internalised in NTS1-expressing HEK293 and Caco-2 cells in a receptor-mediated fashion. Confocal microscopy revealed fluorophore localisation in the perinuclear region. Cell uptake and transport across the Caco-2 intestinal model of two NT-conjugated fluorophores (GFP and fluorescein) were compared to evaluate the effect of cargo size on cellular uptake. This work demonstrates that NT ligand conjugation is able to deliver relatively large macromolecular cargoes selectively into cells overexpressing NTS1 and the system is able to effectively translocate macromolecules across an intestinal epithelial model. NTS1 therefore shows potential as a drug delivery target not only for targeted but also non-invasive (oral) delivery of biotherapeutics for cancer

How Low Can You Go?: Widespread Challenges in Measuring Low Stream Discharge and a Path Forward

Low flows pose unique challenges for accurately quantifying streamflow. Current field methods are not optimized to measure these conditions, which in turn, limits research and management. In this essay, we argue that the lack of methods for measuring low streamflow is a fundamental challenge that must be addressed to ensure sustainable water management now and into the future, particularly as climate change shifts more streams to increasingly frequent low flows. We demonstrate the pervasive challenge of measuring low flows, present a decision support tool (DST) for navigating best practices in measuring low flows, and highlight important method developmental needs