Current United States stem cell policy considerations and a recommendation for an alternative policy based on guidelines from existing international policies

Embryonic stem cell research is a widely debated topic in modern politics and religion. Differing views on the fetal rights conflict with the rights of an embryo. Those who believe an embryo has the same human qualities as a fetus accordingly believe embryonic stem cell research is unethical because it destroys a potential human life. However, scientists advocate the embryo does not have human qualities and should be used for valuable research in the stem cell field. Stem cell research may lead to vast developments in medical treatments, including cancer and brain conditions and injuries that are currently incurable. ^ The current stem cell policy introduced by President Bush in 2001 in an attempt to balance the moral issues with the need for scientific research has broad negative implications on the furthering of stem cell research. There is a limited diversity of available stem cell lines, there may be constitutional issues, there is an increasing disparity between the public and private research spheres, and the U.S. is struggling to maintain its scientific community. The U.S. must develop a new stem cell research policy that will balance the interest of science and public health with the moral issues that concern the public. ^ The United Kingdom allows researchers great liberty in conducting research, permitting the creation of embryos for the sole purpose of research, while Germany is equally conservative in their laws, as their policies support the philosophy that all embryos deserve the protection of full life. The United States should adopt a policy that takes the "middle ground" approach and permit research on excess embryos created for IVF purposes, rather than simply discarding those potentially valuable research tools. ^

Contraceptive use in women by body mass index categories

The prevalence of obesity has increased sharply in the United States since the mid 1970's. Obese women who become pregnant are at increased risk of pregnancy complications for both mother and fetus. This study assessed whether women in higher body mass index (BMI) categories engage in the preventive behaviors of contraception more frequently than normal weight women. It also evaluated the type of contraception used by both obese and normal weight women. The study used cross-sectional data from 7 states participating in the Family Planning Module of the 2006 Behavioral Risk Factor Surveillance System (BRFSS). The Behavioral Risk Factor Surveillance System survey is an annual random digit dialed telephone survey of the non-institutionalized civilian population aged 18 years and older. The Family Planning Module was administered by Arizona, Kentucky, Minnesota, Missouri, Montana, Oregon, and Wisconsin. Of the 4,757 women who participated in the Family Planning Module, 2,244 (53.2%) were normal weight, 1,202 (25.6%) were overweight, and 1,072 (21.2%) were obese. The majority of these women 4,115 (86.2%) reported using some type of contraception to prevent pregnancy. Six hundred forty two women (13.8%) stated they did not use any type of contraception to prevent pregnancy. Within body mass index categories, 14% of normal weight women, 13% of overweight women, and 13.4% of obese women did not use any type of contraception. Neither the bivariate analysis nor the logistic regressions found body mass index categories to be statistically associated with contraceptive use. The relationship between body mass index categories and contraceptive method was found to be statistically significant. The predictive probability graph found that women at all levels of BMI have a lower probability of using barrier contraception methods as compared to procedural and hormonal methods. Hormonal contraception methods have the highest probability of use for women with a BMI of 15 to 25. In contrast, the probability of using procedural contraception methods is relatively flat and less than hormonal methods for BMI between 15 and 25. However, the probability of using procedural contraception increases dramatically with a BMI greater than 25. At a BMI greater than 42, women have a greater than 50% probability of using procedural contraception. Although a relationship between body mass index and contraception use was not found, contraception method was found to be associated with body mass index. The reasons why normal weight women prefer hormonal contraception while overweight/obese women are more likely to use procedural methods needs to be explored. By understanding the relationship between obesity and contraception, we can hopefully decrease unintended pregnancies and overall improve pregnancy related health outcomes. To determine if relationships between contraception use/type and body mass index exist, further research needs to be conducted on a national level. ^

Systematic review of acceptance of the influenza vaccine among pregnant women

Exposure to influenza places pregnant women at risk for pneumonia and their fetus at risk for premature delivery or fatal stillbirth secondary to maternal hypoxia. Immunization rates are low among pregnant women. Influenza vaccine specific-health belief model constructs, such as cue to action messages from the health care professionals, may increase acceptance of the vaccine and improve immunization rates. A systematic review was conducted to evaluate the impact of physician recommendation upon acceptance of the influenza vaccine by pregnant women. Pregnant women were more likely to accept the influenza vaccine if they received a recommendation from their physician. These women were also more likely to accept the vaccine if they thought the vaccine protected mother and fetus against adverse effects of influenza and were less likely to accept the vaccine if they were concerned about side effects or risk to the fetus from the vaccine.^

Maternal Role & High-Risk Pregnancy Experience with Antepartum Hospitalization

Purpose. The focus of maternal role development, historically, has been on the tasks and processes during pregnancy as they relate to postpartum role transition. The purpose of this study was to investigate how women hospitalized with high-risk pregnancy cognitively construct pregnancy and impending motherhood. ^ Design. The study employed a triangulation design using a convergence model with a dominant focused ethnographic approach. ^ Setting. The antepartum units of two tertiary care centers in a large metropolitan city in southeast Texas. ^ Sample. Data saturation was determined with thirteen (13) primigravid women who had been hospitalized more than 72 hours with preterm labor (PTL) or preterm premature rupture of membranes (PPROM) who subsequently delivered seventeen (17) infants which included 4 sets of twins. ^ Methods. Open-ended, semi-structured interviews and field work were used to explore the development of maternal role in this population. After collecting descriptive data, long individual interviews were conducted and the Prenatal Self Evaluation Questionnaire (PSEQ), an instrument to measure prenatal adaptation to pregnancy, was administered. The interview focused on exploring the woman's experiences of pregnancy and impending motherhood while hospitalized. Interview data and field notes were coded and analyzed using qualitative thematic analytic techniques. The PSEQ was scored and the findings of the qualitative data and PSEQ data were compared. ^ Findings. Thematic analysis of the qualitative data provided an understanding of the cognitive process that occurs as the pregnant woman builds a relationship with the fetus. Thematic analysis resulted in a conceptual model with two complementary components that occur throughout the pregnancy: Establishing a Relationship and Dynamic Equilibrium. Establishing a Relationship includes subthemes of: Courting, Building a Connection, and Engagement. Dynamic equilibrium is the balance between expectations and reality and exists regardless of pregnancy complications. The negotiation of this potential imbalance is triggered by uncertainty, loss of autonomy and control, and isolation and is exacerbated by the high-risk pregnancy and subsequent hospitalization. These triggers can serve as obstacles to maternal role development, but may be mediated by external support from friends and family or health care providers. Support from others may come in the form of anticipatory guidance, presence, or activities that promote self-agency. PSEQ scores were similar to previous reports, but due to the small sample, scores were used primarily for comparison to qualitative data. The qualitative findings were congruent with the PSEQ findings in all of the subscales except in the concern for the well-being of the baby. Interview reports included comments demonstrating significant concern for the well-being of the infant, yet the related subscale did not demonstrate such concern. ^ Conclusions. An understanding of the cognitive process involved in establishing a relationship with the developing fetus related to impending motherhood and the importance of dynamic equilibrium can allow healthcare providers and those who interact with pregnant women to support development of the maternal role and anticipate those barriers that may impede that process. Findings from this study identify those triggers and mediators that influence development of the maternal role and suggest potential intervening strategies for those involved in the care of childbearing families. ^

BENZENE TOXICITY AND THE OCCURRENCE OF BENZENE IN THE AMBIENT AIR OF THE HOUSTON AREA

This study was conducted by either literature review or actual field survey. Results are summarized as follows: (1) Long-term occupational exposure of workers to benzene vapor at levels of 3-7 ppm, 2-3 ppm and 1.6 ppm may result in a decreased level of leucocyte alkaline phosphates, an increased incidence of chromosome aberrations and an increased level of ALA in erythrocytes, respectively; (2) Benzene is capable of causing fetotoxic effects in animals at levels as low as 10 ppm by volume; (3) Exposure of animals to or less than 1 ppm benzene vapor may result in leucopenia, an inverse ratio of muscle antagonist chronaxy and a decreased level of ascorbic acid in fetus's and mother's liver as well as whole embryo; (4) Benzene is causally associated with the increased incidence of pancytopenia, including unicytopenia, bicytopenia and aplastic anemia, and chromosome aberrations in occupational exposure population, and at best benzene must also be considered as a leukemogen; (5) Since it can be emitted into the atmosphere from both man-made and natural sources, benzene in some concentrations is present everywhere in the various compartments of the environment; (6) The findings of the emission of benzene from certain natural sources indicate that reducing benzene to a zero-level of exposure is theoretically impossible; (7) The annual average of benzene concentration detected in the Houston ambient air is 2.50 ppb, which is about 2.4 times higher than the nation-wide annual average exposure level and may have been some health implications to the general public; (8) In the Houston area, stationary sources are more important than mobile sources in contributing to benzene in the ambient air. ^

Two Obstetrical Heresies

Dr. Silas F. Starley deplores what he considered errors generally taught and accepted in the late 19th century in Two Obstetrical Heresies . “The first is the part that membranes containing the amniotic fluid and the foetus play in effecting dilation of the os uteri in the first stage of labor.The second is the supposed necessity for waiting for their rupture and the escape of the waters before applying the forceps, in every case, without exception.” Silas F. Starley (1823-1887) was born in Alabama and moved to Texas with his family in 1837. He graduated from the University of Louisville School of Medicine in 1854 and spent his professional career in Texas, ending his career in Corsicana. He was President of the State Medical Association of Texas (Texas Medical Association) in 1883 and wrote articles in Texas medical journals on various topics including obstetrics, vascular tumor, and pneumonia. Texas State Historical Association, http://www.tshaonline.org/handbook/online/articles/sat05 , accessed 10/16/2012. Texas Physicians Historical Biographical Database, http://www4.utsouthwestern.edu/library/doctors/doctors.cfm?DoctorID=16809 , accessed 10/16/12.

Assessing high-priority mixtures: A review of methanol as influenced by ethanol

The intent of this research was to identify the level of risk methanol posed to a fetus during an ethanol co-exposure. This investigation was prompted by the known competitive inhibition properties of ethanol and the developmental toxicity of methanol. Integrated into this research was the practicality necessitated by regulatory processes, namely: does the risk justify the expense of additional research. To this end, the scope and nature of exposures were summarized to illustrate the ubiquity of these chemicals and the potential for dual exposure. Similarly, severity of outcome was evaluated by systematically reviewing the LOAELs, NOAELs, and statistical significance contained in methanol-induced developmental studies. Results. Blood methanol levels corresponding to developmental effects in laboratory studies were found to be substantially higher than the blood methanol levels predicted in high-risk methanol-ethanol exposure scenarios. This indicates that ethanol would not likely exacerbate methanol toxicity to the point of teratogenicity; however, it is important to note that the developmental toxicity of ethanol—an established human teratogen—was not included in the evaluation. Ethanol's contribution as a developmental toxicant rather than merely as an attenuator of methanol toxicity undermines the severity of effects possible from this chemical combination. Therefore further evaluation is needed to assess the developmental toxicities following dual exposures before rendering methanol and ethanol a high-priority mixture.^

ATTITUDES TOWARD AND UTILIZATION OF NON-INVASIVE PRENATAL TESTING FOR CHROMOSOME ANEUPLOIDY AMONG OB/GYNS

Prenatal diagnosis is traditionally made via invasive procedures such as amniocentesis and chorionic villus sampling (CVS). However, both procedures carry a risk of complications, including miscarriage. Many groups have spent years searching for a way to diagnose a chromosome aneuploidy without putting the fetus or the mother at risk for complications. Non-invasive prenatal testing (NIPT) for chromosome aneuploidy became commercially available in the fall of 2011, with detection rates similar to those of invasive procedures for the common autosomal aneuploidies (Palomaki et al., 2011; Ashoor et al. 2012; Bianchi et al. 2012). Eventually NIPT may become the diagnostic standard of care and reduce invasive procedure-related losses (Palomaki et al., 2011). The integration of NIPT into clinical practice has potential to revolutionize prenatal diagnosis; however, it also raises some crucial issues for practitioners. Now that the test is clinically available, no studies have looked at the physicians that will be ordering the testing or referring patients to practitioners who do. This study aimed to evaluate the attitudes of OB/GYN’s and how they are incorporating the test into clinical practice. Our study shows that most physicians are offering this new, non-invasive technology to their patients, and that their practices were congruent with the literature and available professional society opinions. Those physicians who do not offer NIPT to their patients would like more literature on the topic as well as instructive guidelines from their professional societies. Additionally, this study shows that the practices and attitudes of MFMs and OBs differ. Our population feels that the incorporation of NIPT will change their practices by lowering the amount of invasive procedures, possibly replacing maternal serum screening, and that it will simplify prenatal diagnosis. However, those physicians who do not offer NIPT to their patients are not quite sure how the test will affect their clinical practice. From this study we are able to glean how physicians are incorporating this new technology into their practice and how they feel about the addition to their repertoire of tests. This knowledge gives insight as to how to best move forward with the quickly changing field of prenatal diagnosis.

Characterization of anti -sulfatide autoantibodies in demyelinating diseases

Multiple sclerosis (MS) is the most common autoimmune disease of the central nerve system and Guillain Barré Syndrome (GBS) is an inflammatory neuropathy involving the peripheral nerves. Anti-myelin immunoglobins may play a role in the demyelination processes of the both diseases. Sulfatide is an abundant glycolipid on myelin and is a candidate target antigen for disease related autoantibodies. The objective of this study was to characterize anti-sulfatide antibodies and compare antibodies from GBS and MS patients with fetal antibodies. Our hypothesis is that some B cells producing disease-associated autoantibodies are derived from or related to B cells of the fetal repertoire. Here we report that reactivity of plasma IgM against sulfatide was elevated in twelve MS patients compared with twelve normal subjects. This result implies that anti-sulfatide antibodies are disease-related. A total of sixteen human B lymphocyte clones producing anti-sulfatide autoantibodies were isolated from MS patients, GBS patients and a human fetus. Seven of the clones were from three MS patients, four of the clones were from three GBS patients and five were from the spleen of a twenty-week human fetus. Sequences have been obtained for the heavy and light chain variable regions (VDJ and VJ regions) of all of the anti-sulfatide immunoglobulins. Seven of the sixteen antibodies used VH3 for the variable region gene of the heavy chain consistent with the rate of VH3 usage in randomly selected B cells. Somatic mutations were significantly more frequent in the patient antibodies than in the fetus and somatic mutations in CDR's (Complementarity Determining Region) were significantly more frequent than in framework regions. No significant difference was found between patients and fetus in length of VH CDRIII. However, it is reported that antibodies from randomly selected normal adult B cells have longer CDRIII lengths than those of the fetus (Sanz I, 1991 Journal of Immunology Sep 1;147(5):1720-9). Our results are consistent with derivation of the precursors of B cells producing these autoantibodies from B cells related to those of the fetal repertoire. These findings are consistent with a model in which quiescent B cells from clones produced early in development undergo proliferation in dysregulated disease states, accumulating somatic mutations and increasing in reactivity toward self-antigens. ^ Epitope mapping and molecular modeling were done to elucidate the relationships between antibody structure and binding characteristics. The autoantibodies were tested for binding activity to three different antigens: sulfatide, galactoceramide and ceramide. Molecular modeling suggests that antibodies with positive charge surrounded by or adjacent to hydrophobic groups in the binding pocket bind to the head of sulfatide via the sulfate group through electrostatic interactions. However, the antibodies with hydrophobic groups separated from positive charges appear to bind to the hydrophobic tail of sulfatide. This observation was supported by a study of the effect of NaCl concentration on antigen binding. The result suggested that electrostatic interactions played a major role in sulfate group binding and that hydrophobic interactions were of greater importance for binding to the ceramide group. Our three-dimensional structure data indicated that epitope specificity of these antibodies is more predictable at the level of tertiary than primary structure and suggested positive selection based on structure occurred in the. formation of those autoantibodies. ^

El estetoscopio revoluciona la obstetricia

Con el estetoscopio inventado por su amigo Laennec, el médico francés Kergaradec descubrió en 1821 que podía auscultar el corazón fetal. Él respondió adecuadamente los cuestionamientos sobre la factibilidad y utilidad del descubrimiento. La auscultación obstétrica se desarrolló precozmente en Alemania e Irlanda. En Francia, se revalorizó desde 1835; allí también Pinard inventó el estetoscopio obstétrico en uso hasta hoy. La auscultación del corazón fetal devino el primer signo seguro para diagnosticar el embarazo y evaluar la vitalidad fetal. También hizo tomar conciencia de la responsabilidad del obstetra de cuidar tanto del feto tanto como de la madre.

Practice advisory: interim guidance for care of obstetric patients during a zika virus outbreak

Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection.

Producción ovina extensiva en la Patagonia Austral : El caso de la zona centro de Santa Cruz

El propósito del artículo consiste en analizar la meseta central de Santa Cruz en sus aspectos socioproductivos. El objetivo de la investigación, de la cual este trabajo es una elaboración parcial, se orienta a establecer la viabilidad del modelo vigente en la región -ovino extensivo-, así como las posibilidades de que las prácticas asociativas se constituyan en el eje articulador de un relanzamiento productivo. Aquí presentamos un primer análisis socioeconómico y productivo con la finalidad de definir el escenario en el que actualmente se lleva adelante la producción ovina extensiva. Incluimos una descripción de los nuevos actores que actualmente operan en el centro-norte de la provincia y, especialmente en nuestra área de estudio, destacándose entre ellos las empresas mineras transnacionales.

Análisis y pautas para el mejoramiento socioeconómico de los productores del oeste pampeano

En la zona comprendida entre las isoyetas de 500 mm a 300 mm, perteneciente a la provincia fitogeográfica del Monte, una población rural de 6.845 habitantes, 9 del total provincial, con una densidad de 0,2 hab /km2, habita los cinco departamentos del centro y extremo oeste de La Pampa, cuya superficie abarca el 38 de la provincia. Su economía de subsistencia se desarrolla sobre campos naturales, con una ganadería de bovinos, caprinos, ovinos y equinos. La población presenta un alto grado de dispersión y un significativo aislamiento respecto de los centros más poblados. El objetivo a cumplir, modificar las condiciones de vida de los "crianceros", hace necesaria la aplicación de pautas que permitan convertir estas economías de subsistencia en pequeños emprendimientos ganaderos con aceptables índices de rentabilidad mediante el uso más eficiente del medio y sus recursos. Esta estructura productiva ha de permitir una relación más solidaria entre los ganaderos, una mayor libertad en la toma de decisiones y una mayor independencia económica. La consolidación estable de este proyecto y el logro de sus objetivos redundarán en un mejor manejo del ecosistema, así como en un marcado mejoramiento de la calidad de vida de estos alejados productores rurales.

Producción ovina extensiva en la Patagonia Austral : El caso de la zona centro de Santa Cruz

El propósito del artículo consiste en analizar la meseta central de Santa Cruz en sus aspectos socioproductivos. El objetivo de la investigación, de la cual este trabajo es una elaboración parcial, se orienta a establecer la viabilidad del modelo vigente en la región -ovino extensivo-, así como las posibilidades de que las prácticas asociativas se constituyan en el eje articulador de un relanzamiento productivo. Aquí presentamos un primer análisis socioeconómico y productivo con la finalidad de definir el escenario en el que actualmente se lleva adelante la producción ovina extensiva. Incluimos una descripción de los nuevos actores que actualmente operan en el centro-norte de la provincia y, especialmente en nuestra área de estudio, destacándose entre ellos las empresas mineras transnacionales.

Análisis y pautas para el mejoramiento socioeconómico de los productores del oeste pampeano

En la zona comprendida entre las isoyetas de 500 mm a 300 mm, perteneciente a la provincia fitogeográfica del Monte, una población rural de 6.845 habitantes, 9 del total provincial, con una densidad de 0,2 hab /km2, habita los cinco departamentos del centro y extremo oeste de La Pampa, cuya superficie abarca el 38 de la provincia. Su economía de subsistencia se desarrolla sobre campos naturales, con una ganadería de bovinos, caprinos, ovinos y equinos. La población presenta un alto grado de dispersión y un significativo aislamiento respecto de los centros más poblados. El objetivo a cumplir, modificar las condiciones de vida de los "crianceros", hace necesaria la aplicación de pautas que permitan convertir estas economías de subsistencia en pequeños emprendimientos ganaderos con aceptables índices de rentabilidad mediante el uso más eficiente del medio y sus recursos. Esta estructura productiva ha de permitir una relación más solidaria entre los ganaderos, una mayor libertad en la toma de decisiones y una mayor independencia económica. La consolidación estable de este proyecto y el logro de sus objetivos redundarán en un mejor manejo del ecosistema, así como en un marcado mejoramiento de la calidad de vida de estos alejados productores rurales.