Comparative efficacy of combined oral contraceptives and the levonorgestrel 52 mg IUD.

The relative risk of pregnancy with the levonorgestrel 52 mg IUD is 3 times lower than with optimal combined oral contraceptive use.

The Relationship between Body Mass Index and Operative Complications in Patients undergoing Immediate Postpartum Tubal Ligation.

OBJECTIVE: The objective of this study is to examine the relationship between body mass index (BMI) and complications for patients undergoing postpartum permanent contraception. STUDY DESIGN: Retrospective cohort study of patients aged 18 or older who had a vaginal delivery at an academic hospital between 2011 and 2016 and underwent a postpartum tubal ligation during the delivery admission. There were three comparative groups: nonobese (BMI ≤ 29 kg/m2), obese (BMI 30-39 kg/m2), and morbidly obese BMI (≥40 kg/m2). The outcome of interest was composite operative complications which included any occurrence of an intraoperative, postoperative, or anesthesia complication. RESULTS: A total of 921 patients were included for analysis. Average operative time was statistically longer for patients in the morbidly obese group (33 minutes) vs. the nonobese (25 minutes) and obese (29 minutes) groups (p < 0.0001). Composite complications were greater for the obese groups, but not statistically significant (5.1 vs. 6 vs. 16%, p = 0.06). Wound complications were significantly greater for the obese groups (0.8 vs. 1.5 vs. 5.5%, p = 0.01). A logistic regression model demonstrated that only operative time was predictive of operative complications. CONCLUSION: Overall complications of postpartum tubal complications are low; however, our study did demonstrate significantly longer operative time and wound complications for patients with obesity. The findings of our study indicate that postpartum permanent contraception can remain as an option for these patients. Further studies may help identify the best practices to decrease operative time and subsequent wound complications. This study contributes to the limited data regarding obesity and postpartum permanent contraception. We found increased operative time and wound complications for obese patients. Additional studies may identity best practices to decrease these complications. Given our findings of overall low operative complications, postpartum permanent contraception can remain an option for obese patients.

Special report: implementing immediate postpartum LARC in Florida.

Women are often highly motivated to obtain contraception during the immediate postpartum period. However, not all women receive contraception, particularly long-acting reversible contraceptive methods, during this time. One barrier to immediate postpartum contraception is the cost of placing long-acting reversible contraceptives, because such devices have a large upfront cost and historically could not be charged separately from the global delivery fee. In 2017, Florida Medicaid unbundled the fee for the long-acting reversible contraceptive device and insertion from the Diagnosis Related Group and encouraged Medicaid Managed Care plans to do the same. The Florida Perinatal Quality Collaborative, in recognition of guidance put forth by other states, designed the Access LARC initiative to have 2 phases: the preimplementation phase and the implementation phase. After completing all steps in the preimplementation phase, 1 pilot hospital placed 195 long-acting reversible contraceptives during the first 5 months of the initiative. During this trial period, setbacks in the reimbursement process occurred for both the hospital and payer groups. The Agency for Health Care Administration was instrumental in providing assistance to overcome these setbacks. Although there were obstacles and setbacks along the way, this initiative was finally a success for our providers and patients. We encourage other hospitals and states to implement their own postpartum long-acting reversible contraceptive initiative with the use of the guidelines set forth by Florida's Access LARC initiative.

Neonatal Abstinence Syndrome among Infants Born to Mothers with Sickle Cell Hemoglobinopathies.

OBJECTIVE: The objective of this study is to examine risk factors for neonatal abstinence syndrome (NAS) among infants born to mothers with sickle cell hemoglobinopathies (SCH). STUDY DESIGN: Retrospective cohort study of nonanomalous, singleton infants born to mothers with laboratory confirmed SCH. Infants were included if they were diagnosed with NAS prior to hospital discharge. The outcome of interest was the association of maternal variables with NAS. RESULTS: Of 131 infants born to mothers with SCH, 4% (n = 5) were diagnosed with NAS. Mothers of infants with NAS were more likely to have SC disease (80%) compared with other SCH (20%), p = 0.001. Fifteen women had antepartum (AP) admissions for pain and/or sickle crisis. Of these patients, four infants (29%) were diagnosed with NAS. The median (5th and 95th percentile) maternal AP length of stay for women with infants diagnosed with NAS to mothers with sickle cell disease was 132 (5, 180) days (p = 0.02). CONCLUSION: Incidence of NAS among mothers with SCH is low; severe disease characterized by AP sickle cell crisis requiring prolonged AP admission for pain control significantly increases the risk of NAS. Further studies are needed to investigate the association of maternal opioid dose and NAS.

Genomic Analysis of Spontaneous Abortion in Holstein Heifers and Primiparous Cows.

BACKGROUND: The objectives of this study were to identify loci, positional candidate genes, gene-sets, and pathways associated with spontaneous abortion (SA) in cattle and compare these results with previous human SA studies to determine if cattle are a good SA model for humans. Pregnancy was determined at gestation day 35 for Holstein heifers and cows. Genotypes from 43,984 SNPs of 499 pregnant heifers and 498 pregnant cows that calved at full term (FT) were compared to 62 heifers and 28 cows experiencing SA. A genome-wide association analysis, gene-set enrichment analysis-single nucleotide polymorphism, and ingenuity pathway analysis were used to identify regions, pathways, and master regulators associated with SA in heifers, cows, and a combined population. RESULTS: Twenty-three loci and 21 positional candidate genes were associated (p < 1 × 10-5) with SA and one of these (KIR3DS1) has been associated with SA in humans. Eight gene-sets (NES > 3.0) were enriched in SA and one was previously reported as enriched in human SA. Four master regulators (p < 0.01) were associated with SA within two populations. CONCLUSIONS: One locus associated with SA was validated and 39 positional candidate and leading-edge genes and 2 gene-sets were enriched in SA in cattle and in humans.

Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in Bangladesh.

This cross sectional prospective study was carried out in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Microbiology, University of Dhaka from July 2012 to June 2013. The objectives of this study were to identify the common microorganisms involved and the antibiograms of chronic suppurative otitis media (CSOM) patients in this tertiary care hospital in Bangladesh. A total of 117 patients clinically diagnosed of CSOM were enrolled in the study. They had chronic ear discharge & had not received any topical or systemic antibiotics for the previous five days. Swabs was taken and cultured for bacteria. The standard of isolation and identification was followed. Antimicrobial susceptibility of all aerobic bacterial isolates was performed by using modified Kirby Bauer Disk diffusion method. There were 186 positive cultures for organism from 117 patients. The most common causal organisms isolated were S. aureus (47.30%) and Pseudomonas spp. (27.40%) followed by S. epidermidis (16.10%), Klebsiella spp. (8.10%) and Escherichia coli. (1.10%). Gentamicin showed the highest sensitivity (89.8%) to S. aureus whereas erythromycin showed the lowest sensitivity (14.8%) with highest resistance (67%) to S. aureus. Pseudomonas spp. showed highest sensitivity against ciprofloxacin (78.4%) and highest resistance against cloxacillin (96.1%). Novobiocin showed the highest sensitivity (100%) followed by chloram phenicol (94.1%) to S. epidermidis. Klebsiella spp. and E. coli showed highest sensitivity against chloram phenicol. This study suggests that Staphylococcus aureus and Pseudomonas are the commonest bacteria involved in CSOM in Bangladesh and Ciprofloxacin is an important tool in the management of active CSOM.

Digital phase-shifting point diffraction interferometer.

A digital phase-shifting (PS) point diffraction interferometer is demonstrated with a transmitting liquid crystal spatial light modulator. This novel wavefront sensor allows tunability in the choice of pinhole size and eliminates the need for mechanically moving parts to achieve PS. It is shown that this wavefront sensor is capable of sensing Zernike aberrations introduced with a deformable mirror. The results obtained are compared with those of a commercial Hartmann-Shack wavefront sensor.

Magnetic resonance or computerized tomography imaging to predict difficulty of robotic surgery for endometrial cancer.

To determine if the difficulty of a robotic hysterectomy for endometrial cancer can be predicted by MRI, CT or other methods. All robotic cases from 1 August 2006 through 30 July 2009 were identified. Data collected prospectively included co-morbidities, body mass index, surgical times, estimated blood loss (EBL), uterine weight, and pre- and postoperative complications. Those patients who received an MRI or CT scan prior to robotic hysterectomy had additional data gathered from imaging, including uterine volume, pelvic measurements and abdominal wall thickness. Cases were labeled difficult for the following reasons: outliers greater than 2 SD from the mean EBL, hysterectomy time and total console time. Additional factors identifying difficult cases included the need to undock to remove the specimen or conversion to laparotomy. Data were analyzed for their possible role in causing difficulty in a robotic hysterectomy. Comparative statistics utilized included chi-square and t-test, ANOVA and logistic regression analysis.From 2 August 2006 through 30 July 2009, 119 patients underwent robotic surgery for endometrial cancer and are included in this study. Of these patients, 25/119 (20.0%) were identified as difficult cases. Difficulty was found in those patients with greater than 2 SD from the mean for hysterectomy time, >90.9 min (n = 3, 2.5%), total console time of >178.1 min (n = 6, 5.0%), EBL >232 cc (n = 7, 5.9%) and undocking to remove the uterine specimen in 8 (6.7%) cases; 1/119 (0.8%) was converted to laparotomy. Lymphadenectomy (P = 0.005) was associated with case difficulty. In a logistic regression analysis CT/MRI measurements of uterine volume greater than 793 cm³ and CT/MRI pelvimetry, as well as abdominal wall thickness were independent predictors of a difficult case (P = 0.0116). MRI and CT scans can detect the probability that a robotic surgery will be difficult by determining uterine volume and pelvimetry; however, these were not the strongest predictors in our study. A narrow pelvic outlet as measured on CT/MRI and uterine volume of greater than 793 cc should raise a flag of caution when planning robotic hysterectomy for endometrial cancer.

Virologic and immunologic outcome of treatment of HIV infection with a herbal concoction, α-Zam, among clients seeking herbal remedy in Nigeria.

This study was to determine the effectiveness (CD4 count and viral load) of a safe herbal concoction, α-Zam used by clients seeking herbal remedy for treatment of HIV infection in Nigeria. 51 patients taking α-Zam as complementary and alternative therapy through the herbal therapist were studied for a period of 16 months. Preliminary medical and laboratory examinations using WHO and CDC criteria were done after confirmation of HIV infection by Western blotting in the nearest teaching hospitals to the residence of the patients. Regular visits were paid to the patients after commencement of the α-Zam to assess the side-effects, drug interactions, toxicity and effectiveness of the herbal remedy. There was a statistical significance (P<0.05) between pre-treatment and post-treatment CD4 count. 4 (7.8%) of the patients had average increase in CD4 count of 262±16 cell/µL, 23 (45.1%) patients with average increase 310±16 cell/µL, 16 (31.4%) patients with average increase 456±25 cell/µL and 8 (15.7%) patients with average increase 510±36 cell/µL( %) were at WHO staging I , II, III and IV respectively within 4 months on herbal therapy. There was very marked reduction in viral (HIV-RNA) load with 41 (80.4%) and10 (19.6%) HIV infected patients had undetectable viral load and <1000 copies/ml respectively after the therapy. All symptoms and signs associated with HIV infection in all patients fully subsided within 4 weeks of commencement of α-Zam therapy and there was no evidence of negative drug interaction in those HIV patients using both the herbal and highly active anti-retroviral therapy (HAART). The study is in progress to determine periodic immunological outcomes of post therapy in all patients.

Electrochemical treatment of Orange II dye solution--use of aluminum sacrificial electrodes and floc characterization.

Electrocoagulation (EC) of Orange II dye in a flow through cell with aluminum as sacrificial electrodes was carried out under varying conditions of dye concentration, current density, flow rate, conductivity, and the initial pH of the solution in order to optimize the operating parameters for maximum benefits. Maximum removal efficiency of 94.5% was obtained at the following conditions: dye concentration=10 ppm, current density=160 A/m(2), initial pH 6.5, conductance=7.1 mS/cm, flow rate=350 mL/min, and concentration of added NaCl=4.0 g/L of dye solution. The EC-floc was characterized using Fourier transform infrared spectroscopy, scanning electron microscopy/energy dispersive X-ray spectroscopy, and powder X-ray diffraction techniques. The removal mechanism has been proposed that is in compliance with the Pourbaix diagram, solubility curve of aluminum oxides/hydroxides, and physico-chemical properties of the EC-floc.

Arsenic removal by electrocoagulation using combined Al-Fe electrode system and characterization of products.

Combination of electrodes, such as aluminum and iron in a single electrochemical cell provide an alternative method for removal of arsenic from water by electrocoagulation. The removal process has been studied with a wide range of arsenic concentration (1-1000 ppm) at different pH (4-10). Analysis of the electrochemically generated by-products by XRD, XPS, SEM/EDAX, FT-IR, and Mössbauer Spectroscopy revealed the expected crystalline iron oxides (magnetite (Fe3O4), lepidocrocite (FeO(OH)), iron oxide (FeO)) and aluminum oxides (bayerite (Al(OH)3), diaspore (AlO(OH)), mansfieldite (AlAsO(4).2(H2O)), as well as some interaction between the two phases. The amorphous or very fine particular phase was also found in the floc. The substitution of Fe3+ ions by Al3+ ions in the solid surface has been observed, indicating an alternative removal mechanism of arsenic in these metal hydroxides and oxyhydroxides by providing larger surface area for arsenic adsorption via retarding the crystalline formation of iron oxides.

Eliminating gene conversion improves high-throughput genetics in Saccharomyces cerevisiae.

Synthetic genetic analysis was improved by eliminating leaky expression of the HIS3 reporter and gene conversion between the HIS3 reporter and his3Delta1. Leaky expression was eliminated using 3-aminotriazole and gene conversion was eliminated by using the Schizosaccharomyces pombe his5+ gene, resulting in a 5- to 10-fold improvement in the efficiency of SGA.

Diverse functions of spindle assembly checkpoint genes in Saccharomyces cerevisiae.

The spindle assembly checkpoint regulates the metaphase-to-anaphase transition from yeast to humans. We examined the genetic interactions with four spindle assembly checkpoint genes to identify nonessential genes involved in chromosome segregation, to identify the individual roles of the spindle assembly checkpoint genes within the checkpoint, and to reveal potential complexity that may exist. We used synthetic genetic array (SGA) analysis using spindle assembly checkpoint mutants mad1, mad2, mad3, and bub3. We found 228 synthetic interactions with the four spindle assembly checkpoint mutants with substantial overlap in the spectrum of interactions between mad1, mad2, and bub3. In contrast, there were many synthetic interactions that were common to mad1, mad2, and bub3 that were not shared by mad3. We found shared interactions between pairs of spindle assembly checkpoint mutants, suggesting additional complexity within the checkpoint and unique interactions for all of the spindle assembly checkpoint genes. We show that most genes in the interaction network, including ones with unique interactions, affect chromosome transmission or microtubule function, suggesting that the complexity of interactions reflects diverse roles for the checkpoint genes within the checkpoint. Our analysis expands our understanding of the spindle assembly checkpoint and identifies new candidate genes with possible roles in chromosome transmission and mitotic spindle function.

Experimental and theoretical study of the atmospherically important O2-H2O complex.

The theoretically predicted water-oxygen van der Waals adduct has been experimentally confirmed by vibrational characterization using matrix isolation spectroscopic studies at 10 K. Vibrational bands for asymmetric and symmetric OH-stretching for this adduct have been found at 3728 cm(-1) and 3639 cm(-1), respectively. Theoretical calculations performed with Gaussian 98 software at the MP2/6-311++G(2d,2p) level of theory support the alternative structure of the hydrated complex proposed by this study.

Arsenic removal via electrocoagulation from heavy metal contaminated groundwater in La Comarca Lagunera México.

Arsenic contamination is an enormous worldwide problem. A large number of people dwelling in Comarca Lagunera, situated in the central part of northern México, use well water with arsenic in excess of the water standard regulated by the Secretary of Environment and Natural Resources of México (SEMARNAT), to be suitable for human health. Individuals with lifetime exposure to arsenic develop the classic symptoms of arsenic poisoning. Among several options available for removal of arsenic from well water, electrocoagulation (EC) is a very promising electrochemical treatment technique that does not require the addition of chemicals or regeneration. First, this study will provide an introduction to the fundamental concepts of the EC method. In this study, powder X-ray diffraction, scanning electron microscopy, transmission Mössbauer spectroscopy and Fourier transform infrared spectroscopy were used to characterize the solid products formed at iron electrodes during the EC process. The results suggest that magnetite particles and amorphous iron oxyhydroxides present in the EC products remove arsenic(III) and arsenic(V) with an efficiency of more than 99% from groundwater in a field pilot scale study.

Fourier transform infrared-probed O(3P) microreactor: demonstration with ethylene reactions in argon matrix.

To demonstrate the development of an oxygen atom microreactor in the form of liquid-helium-cooled solid argon matrix deposited on an infrared (IR) window, the oxidation of ethylene by mobile O atoms has been investigated. O atom diffusion through the argon matrix is confirmed and used to examine ethylene-oxygen atom reactions. In a bench-scale matrix isolation system probed with a Fourier transform infrared (FT-IR) spectrometer, matrices of solid Ar at 8-10 K doped with NO2 and ethylene have been prepared on a ZnSe window within an evacuated cryostat. The matrices have been photolyzed using 350-450 nm photons, and the reaction products resulting from the reaction of O(3P), one of the photolysis products of NO2, with ethylene have been identified using FT-IR and a Gaussian 98W simulation program. These products include oxirane, acetaldehyde, ethyl nitrite radical, and ketene. The temperature effect in the range of 10-30 K on the products formed has also been investigated. The reaction mechanisms are discussed and the viability of the solid Ar matrix being a low temperature microreactor to examine reaction mechanisms of mobile oxygen atoms is elaborated.

Fundamentals, present and future perspectives of electrocoagulation.

Electrocoagulation is an electrochemical wastewater treatment technology that is currently experiencing both increased popularity and considerable technical improvements. There has been relatively little effort to better understand the fundamental mechanisms of the processes, particularly those that could provide design parameters to optimize the performances of this relatively simple and inexpensive technique. In a research programme to delineate the mechanisms of the fundamental processes involved in, the authors have realized that the technology has been insufficiently reviewed with emphasis on the fundamentals and their relationship to the performance of this technology. This paper presents an in-depth discussion and consideration of the factors that need to be addressed for optimum performance of this technology. Recent improvements of this technique and the theoretical model studies are also reviewed.

Treatment of orange II azo-dye by electrocoagulation (EC) technique in a continuous flow cell using sacrificial iron electrodes.

This paper describes the EC treatment of orange II dye solution in a flow cell using sodium chloride as an internal electrolyte. In this technique dye solutions were passed through a flow-through EC apparatus consisting of a flow-through cell, the electrode assembly, the feed pump and the DC power supply unit. The cell contained five parallel iron electrodes, which form four parallel cells. Experiments were run at 25 degrees C under various electrolyte concentrations, dye concentrations, current density, flow rate of the solution, and pH at dc current range of 2-5A. Various number of recycles of the treated dye solution were also performed at the same dc current range. Optimum conditions to get high removal efficiency were experimentally determined. It was found that 98.5% of the dye was removed from the solution under the optimum conditions. The residue from a blank run (pH = 7.3) and a dye added run (pH = 8.5) were collected by vacuum filtration and analyzed by XRD after drying in a vacuum desiccator. The XRD data indicated the presence of mainly maghemite (gamma-Fe2O3) and magnetite (Fe3O4) in the residue. However, there is not much difference between the X-ray diffractograms of the blank sample and the dye-containing residue to warrant any conclusions therefrom with regard to the interactions between the oxides and the dye molecules.

Water-related matrix isolation phenomena during NO2 photolysis in argon matrix.

Photolysis (350-450 nm) of NO(2) molecules trapped in argon matrices at 10 K has been studied using Fourier transform infrared (FTIR) spectroscopy to examine the mobility of the photolysis products, O((3)P) and NO, and their subsequent reactions. The formation of N(2)O(5) and N(2)O(3) from reactions of these mobile species with immobilized NO(2) and N(2)O(4) is confirmed. Water molecules from the background gases in the vacuum have been found to be isolated in the argon matrix during deposition of diluted NO(2) in Ar. The entrapped water molecules along with some of their NO(2) adducts have been characterized. Exposure of the matrix to photons to photolyze NO() resulted in not only internal matrix reactions, but also an enhanced deposition of ice over the surface of the argon matrix. This is caused by photodesorption of water molecules from the walls of the matrix isolation chamber and their subsequent condensation on the matrix surface. This ice overlayer has been found to give a very significant dangling OH band and a substantial librational band in the FT-IR spectra, indicating substantial surface area and internal porosity, respectively. The potential of using photodesorbed water to establish high surface area ice interfaces with dangling OH groups for heterogeneous photoreaction studies is discussed.

Differential kinetochore requirements for establishment and maintenance of the spindle checkpoint are dependent on the mechanism of checkpoint activation in Saccharomyces cerevisiae.

The spindle checkpoint in the yeast Saccharomyces cerevisiae is an intracellular signal transduction pathway comprised of two branches that inhibit two different mitotic transitions in cells treated with benzimidazole drugs such as nocodazole. The kinetochore is an integral component of the MAD2 branch of the spindle checkpoint pathway. Current models propose that the kinetochore is required for both the establishment and maintenance of the spindle checkpoint but a role for the kinetochore in the maintenance of spindle checkpoint in yeast has never been directly tested. We used a temperature sensitive ndc10-1 mutant to inactivate kinetochores before and after arresting cells in mitosis to determine the role of kinetochores in the establishment and maintenance of the spindle checkpoint. We show that both establishment and maintenance requires kinetochore function in response to spindle damage induced by benzimidazole drugs. Excess expression of the Mps1 protein kinase causes wild type cells and ndc10-1 cells to arrest in mitosis. Unlike the spindle checkpoint arrest activated by benzimidazoles, this arrest can be maintained independently of kinetochores. The arrest induced by excess Mps1p is independent of BUB2. Therefore, mitotic arrest induced by excess Mps1p expression is due to the action of the MAD2 branch of the spindle checkpoint pathway and excess Mps1p acts downstream of the kinetochore.