Healthcare resource utilization and direct costs associated with frequent nausea in episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study

BACKGROUND

Nausea is a common migraine symptom that is associated with impaired quality-of-life and functional disability. In this study, population-based data were used to elucidate the relationship between nausea frequency and headache-related healthcare utilization and costs in persons with migraine.

RESEARCH DESIGN AND METHODS

Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention (AMPP) Study survey rated their headache-related nausea as occurring never, rarely, <half the time, or ≥half the time with their headaches, and completed questions on symptom frequency and healthcare resource utilization.

MAIN OUTCOME MEASURES

Ordinal logistic regression models were used to assess the association between nausea frequency and headache-related healthcare utilization. Healthcare cost equivalents were calculated.

RESULTS

Among the 6488 respondents with episodic migraine, the number of respondents observed across headache-related nausea frequency strata were 6.9% for never, 14.5% for rarely, 29.1% for <half the time, and 49.5% for ≥half the time. In unadjusted models, the odds of having ≥1 healthcare encounter for headache in the preceding year increased with frequency of nausea for primary care/obstetrics-gynecology visits (OR = 1.41; 95% CI = 1.30-1.52, p < 0.001), nurse practitioner/physician assistant visits (OR = 1.52; 95% CI = 1.25-1.85, p < 0.001), neurology/headache clinic visits (OR = 1.33, 95% CI = 1.18-1.51, p < 0.001), pain clinic visits (OR = 1.31, 95% CI = 1.01-1.71, p < 0.05), emergency department visits (OR = 1.85; 95% CI = 1.56-2.19, p < 0.01), and overnight hospital stays (OR = 1.50, 92% CI = 1.12-2.00, p < 0.01). The odds of having ≥1 lifetime CT scan or MRI also increased with the frequency of nausea (p < 0.001 for both). Results remained significant in these analyses when controlling for sociodemographics and overall symptom severity except in the case of pain clinic visits (p < 0.107). Visits for Mental Health and visits for Chiropractic/Alternative care did not differ significantly by nausea group in unadjusted or adjusted models. Mean estimated direct headache-related healthcare cost equivalents per person per year generally increased with increasing headache-related nausea frequency across categories of healthcare utilization. Average per person healthcare cost for nausea ≥half the time vs nausea never was $179 and $49 yearly for outpatient services, $183 vs $20 yearly for overnight hospital stays, and $314 vs $257 for lifetime diagnostic services/imaging.

CONCLUSIONS

Direct costs of migraine increase with increasing frequency of migraine-associated nausea. Both frequency and severity of headache-related nausea should be monitored as part of ongoing care of persons with migraine. Headache-related nausea, like headache pain, should be considered an area of central concern during clinical, diagnostic, and treatment optimization assessments.

STUDY LIMITATIONS

This study relied on self-reported headache frequency and healthcare costs which are subject to recall bias and under-reporting; however, reporting bias is unlikely to be different as a function of nausea frequency. In addition, medication use costs and indirect costs (which may be higher than direct costs for migraine) were not assessed.

Cost and predictors of lost productive time in chronic migraine and episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study

OBJECTIVE

To quantify the cost differences and predictors of lost productive time (LPT) in persons with chronic migraine (CM) and episodic migraine (EM).

METHODS

The American Migraine Prevalence and Prevention (AMPP) study is a US national longitudinal survey of severe headache. Cost estimates were obtained via U.S. Census income data. To elucidate the unique predictors of LPT, the optimal distribution for modeling was determined. Zero inflation models for LPT were predicted from sociodemographics, headache features, characteristics and disability, medication use, and depression. The interaction between headache status and age was the primary effect of interest.

RESULTS

The eligible sample included 6329 persons with EM and 374 persons with CM. Men with CM aged 45 to 54 years cost employers nearly $200 per week more than do their EM counterparts. Likewise, for women, costs were higher for CM, with the cost differential between EM and CM being $90 per week. After comprehensive adjustment, increases in LPT with age were significantly higher in CM than in EM (rate ratio 1.03; 95% confidence interval 1.01-1.05). When age was recoded to a decade, metric rates of LPT increased 25% more per decade for CM than for EM (rate ratio 1.25; 95% confidence interval 1.004-1.5).

CONCLUSIONS

LPT is more costly and increases more rapidly for those with CM than for those with EM as age increases.

The Effect of Light on Embryos and Embryo Culture

In oviparous animals, the egg hatches outside of the body and is exposed to light; in some cases throughout the development of the fetus. In mammals, fertilization and the growth of embryos in vivo occurs in the dark but in human IVF, these embryos are exposed to variable light sources and intensities. Light can affect embryonic development in some species via either a direct toxic effect on the embryo, or indirectly via photo-oxidation of components in the media or oil. Although data regarding the effect of light on human embryos is lacking, it is prudent to take appropriate steps to minimize the potential harmful effects of both ambient and microscopic light on embryos.

Frequency and burden of headache-related nausea: results from the American Migraine Prevalence and Prevention (AMPP) study

BACKGROUND

While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. Population-based data were used to elucidate the relative frequency and burden of migraine-associated nausea in persons with migraine.

METHODS

Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention survey rated their headache-related nausea as occurring none of the time, rarely, <half the time, or ≥half the time with their headaches. They also completed headache symptom severity and occupation/work status questions, the Headache Impact Test-6, and treatment attitude items that were part of the 2009 survey. Regression models that adjusted for both sociodemographic characteristics and symptom severity were used to assess the influence of nausea frequency on outcome measures. Partial and semipartial correlational analyses were used to estimate the influence of nausea alone and in combination with other headache symptoms on headache-related impact.

RESULTS

Among the 6488 respondents with episodic migraine, approximately half (49.5%) reported high-frequency nausea (ie, ≥half the time) with headache. High-frequency nausea was more common in females than males (adjusted odds ratio 1.35, 95% confidence interval 1.26-1.44). Persons with high-frequency nausea, compared with the no/rare or less than half the time nausea groups, reported significantly more headache symptoms and more headache-related impact as measured by the Headache Impact Test-6. High-frequency nausea was also associated with being occupationally disabled or on medical leave, and more self-reported financial burden of headache medications, worry about running out of headache medication(s), and that headache medications interfered with work or school work, household work, and family/leisure activities. Regression-based correlational analyses indicated that nausea contributes significantly and independently to headache-related impact.

CONCLUSIONS

High-frequency migraine-associated nausea is common and is a marker for severe, debilitating migraine. Nausea makes an independent contribution to migraine-associated disability and impact. Management strategies that take nausea into account could reduce the burden of migraine. Nausea is an important target for monitoring and treatment.

Barriers to the diagnosis and treatment of migraine: effects of sex, income, and headache features

BACKGROUND

US Headache Consortium Guidelines state that persons with migraine with headache-related disability should receive certain acute treatments including migraine-specific and other medications. However, many eligible individuals do not receive these therapies. Individuals with migraine may experience barriers to receiving minimal appropriate care. We aimed to identify barriers to care in a population sample of individuals with episodic migraine. We assessed barriers at 3 levels: medical consultation, diagnosis, and acute pharmacologic therapy use and assessed the contribution of socioeconomic, demographic, and headache-specific variables to these barriers.

METHODS

We identified 3 steps that were minimally necessary to achieve guideline-defined appropriate acute pharmacologic therapy as: (1) consulting a prescribing health care professional; (2) receiving a migraine diagnosis; and (3) using migraine-specific or other appropriate acute treatments. We used data from the 2009 American Migraine Prevalence and Prevention study sample to identify persons with episodic migraine with unmet treatment needs, defined by a Migraine Disability Assessment Scale (MIDAS) score corresponding to Grade II (mild), III (moderate), or IV (severe) headache-related disability. We determined whether these individuals had consulted a health care professional for headache over the previous year, if they ever received a medical diagnosis of migraine from a health care professional, and whether they were currently using appropriate acute treatment for migraine (ie, a triptan, prescription non-steroidal anti-inflammatory drug, or an isometheptene-containing agent). We analyzed several socioeconomic, demographic, and headache-specific variables to determine if they were related to barriers in any of the 3 defined steps.

RESULTS

Of 775 eligible participants with episodic migraine and headache-related disability, 45.5% (n = 353/775) had consulted health care professional for headache in the preceding year. Among those individuals, 86.7% (n = 306/353) reported receiving a medical diagnosis of migraine. Among the diagnosed consulters, 66.7% (204/306) currently used acute migraine-specific treatments. Only 204 (26.3%) individuals successfully completed all 3 steps. Multivariate logistic regression models revealed that the strongest predictors of current consulting for headache were having health insurance {odds ratio (OR) = 1.73 (95% confidence interval [CI], 1.07-2.79)}, high headache-related disability (OR = 1.06 [95% CI, 1.0-1.14] for a 10-point change in MIDAS score), and a high composite migraine symptom severity score (OR = 1.19 [95% CI, 1.05-1.36]). Among consulters, diagnosis was much more likely in women than men (OR = 4.25 [95% CI, 1.61-11.2]) and became increasingly likely with increasing average headache pain severity (OR = 1.44 [95% CI, 1.12-1.87]) and migraine symptom severity score. Among those who were diagnosed, annual household income was the strongest predictor of currently using guideline-defined appropriate acute treatment (OR = 1.44 [95% CI, 1.07-1.93]) followed by a 10-point change in MIDAS score (OR 1.16 [95% CI, 1.02-1.35]).

CONCLUSIONS

Among persons with migraine in need of medical care (MIDAS Grade II or greater), only one quarter traversed the 3 steps we proposed to be necessary to achieving minimally appropriate care (consulting, diagnosis, and treatment/medication use). Health insurance status was an important predictor of consulting. Among consulters, women were far more likely to be diagnosed than men, suggesting that gender bias in diagnosis may be an important barrier for men. There were economic barriers related to use of appropriate prescription medications. Public health efforts should focus on improving consultation rates, particularly in the uninsured and diagnostic rates particularly in males with migraine.

Depression and risk of transformation of episodic to chronic migraine

The aim of this study was to assess the role of depression as a predictor of new onset of chronic migraine (CM) among persons with episodic migraine (EM). The American Migraine Prevalence and Prevention (AMPP) study followed 24,000 persons with severe headache identified in 2004. Using random-effects logistic regression, we modeled the probability that persons with EM in 2005 or 2006 would develop CM in the subsequent year. Depression was assessed in two ways, using a validated questionnaire (PHQ-9 score ≥15) and based on self-reported medical diagnosis. Analyses were adjusted for multiple covariates including sociodemographics, body mass index, headache pain intensity, headache frequency, migraine symptom severity, cutaneous allodynia, acute medication overuse, anti-depressant use and anxiety. Of 6,657 participants with EM in 2005, 160 (2.4 %) developed CM in 2006. Of 6,852 participants with EM in 2006, 144 (2.2 %) developed CM in 2007. In fully adjusted models, PHQ-9 defined depression was a significant predictor of CM onset [odds ratio (OR) = 1.65, 95 % CI 1.12-2.45]. There was a depression-dose effect; relative to participants with no depression or mild depression, those with moderate (OR = 1.77, 95 % CI 1.25-2.52), moderately severe (OR = 2.35, 95 % CI 1.53-3.62), and severe depression (OR = 2.53, 95 % CI 1.52-4.21) were at increased risk for the onset of CM. Among persons with EM, depression was associated with an increased risk of CM after adjusting for sociodemographic variables and headache characteristics. Depression preceded the onset of CM and risk increased with depression severity suggesting a potentially causal role though reverse causality cannot be excluded.

Rate and risk predictors for development of self-reported type-2 diabetes mellitus over a 5-year period: the SHIELD study

AIMS

This investigation determined the proportion of adults newly diagnosed as having type-2 diabetes mellitus (T2DM), and ascertained risk predictors for development of self-reported T2DM.

METHODS

The US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) survey was a 5-year longitudinal study of adults with and without diabetes mellitus. Adults completed a baseline health questionnaire in 2004 and ≥1 annual follow-up survey through 2009. Respondents with no self-reported diagnosis of diabetes at baseline were followed to measure rate of and assess risk factors for development of T2DM over 5 years.

RESULTS

Among 8582 respondents without diabetes at baseline, 622 (7.2%) reported a diagnosis of T2DM over the subsequent 5 years. Increasing age, family history of T2DM, body mass index ≥30 kg/m(2), abdominal obesity, excessive thirst, asthma, gestational diabetes and 'high blood sugar without diabetes' significantly increased the risk of developing T2DM (p < 0.05 for each). Good to excellent health status and self-reported circulatory problems decreased the risk (p < 0.05 for each).

CONCLUSIONS

Among this representative US adult population, the rate of developing T2DM was 7.2% over 5 years. Predictors of T2DM diagnosis identified in this analysis were readily obtainable via self-report.

Opioid use and dependence among persons with migraine: results of the AMPP study

OBJECTIVE

To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health-care resource utilization (HRU), comorbidities and probable dependence within a large, US population-based sample of persons with migraine.

BACKGROUND

Opioids are used in the acute treatment of migraine. However, their use is controversial.

METHODS

Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no-use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders-4th edition. All opioid-use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire-9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and cardiovascular events and risk factors), and headache-related HRU.

RESULTS

In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache-related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache-related HRU were higher for all opioid-use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers.

CONCLUSIONS

Opioid use for migraine is associated with more severe headache-related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined.

Do mood instability symptoms in epilepsy represent formal bipolar disorder?

We aimed to assess rates of bipolar symptoms versus bipolar disorder in epilepsy, and the effect of bipolar symptoms on quality of life (QOL) in epilepsy. Bipolar, disability, and QOL instruments were administered to 99 tertiary epilepsy center patients. Patients who scored positive on the Mood Disorder Questionnaire (MDQ) also completed depression scales and a structured psychiatric interview. Results indicated MDQ+ patients (10.1%) had worse QOL and more work, social, and family life disruptions. Most MDQ+ patients did not have bipolar disorder. There was close overlap between depressive and bipolar symptomatology. Based on results of this study, bipolar symptom is not synonymous with bipolar disorder. Symptoms picked up by the MDQ may be epilepsy-related depressive symptoms. Bipolar symptoms are associated with more disability, worse QOL, and may have treatment implications.

Culture systems: embryo density

Embryo density is defined as the embryo-to-volume ratio achieved during in vitro culture; in other words, it is the number of embryos in a defined volume of culture medium. The same density can be achieved by manipulating either the number of embryos in a given volume of medium, or manipulating the volume of the medium for a given number of embryos: for example, a microdrop with five embryos in a 50 μl volume under oil has the same embryo-to-volume ratio (1:10 μl) as a microdrop with one embryo in a 10 μl volume under oil (1:10 μl). Increased embryo density can improve mammalian embryo development in vitro; however, the mechanism(s) responsible for this effect may be different with respect to which method is used to increase embryo density.Standard, flat sterile plastic petri dishes are the most common, traditional platform for embryo culture. Microdrops under a mineral oil overlay can be prepared to control embryo density, but it is critical that dish preparation is consistent, where appropriate techniques are applied to prevent microdrop dehydration during preparation, and results of any data collection are reliable, and repeatable. There are newer dishes available from several manufacturers that are specifically designed for embryo culture; most are readily available for use with human embryos. The concept behind these newer dishes relies on fabrication of conical and smaller volume wells into the dish design, so that embryos rest at the lowest point in the wells, and where putative embryotrophic factors may concentrate.Embryo density is not usually considered by the embryologist as a technique in and of itself; rather, the decision to culture embryos in groups or individually is protocol-driven, and is based more on convenience or the need to collect data on individual embryos. Embryo density can be controlled, and as such, it can be utilized as a simple, yet effective tool to improve in vitro development of human embryos.

Single or Group Culture of Mammalian Embryos: The Verdict of the Literature

During infertility treatment with IVF, embryos are cultured either in groups or individually. Each approach has potential benefits and detriments, and the purpose of this review is to try to come to a consensus based on the literature as to which approach yields superior results. Group culture of embryos may produce better quality embryos via secretion of embryotrophic factors, while opponents of the approach argue that embryos cultured together may either deplete the media of substrates or negatively affect nearby embryos via the transmission of other secreted factors. In these cases, quantity of embryos, volume of media and proximity and quality of companion embryos are also important factors to consider. While it has long been accepted that group culture is beneficial for embryos from various animal species, emerging data also suggest a similar benefit in the human. Conversely, embryos cultured individually avoid potential substrate depletion, negative impact from factors secreted from companion embryos, while more practically permitting the ability to monitor and track the embryo for identification via morphology or molecular analysis to select and transfer potentially superior embryos. Importantly, advancements in embryo culture platforms now permit tracking of individual embryos, while also offering ability to reap the benefits of group culture. These approaches utilize confined microenvironments immediately surrounding the embryos that may be conducive for periodic sampling/analysis, while also allowing access to a larger media reservoir to avoid substrate depletion. Thus, though questions remain as to optimal embryo density and volume of culture media, group embryo culture in the correct culture platform is likely to be superior to individual embryo culture.

Microfabrication of Crevice Corrosion Samples

A major challenge in developing computer models for crevice corrosion lies in fabricating appropriate experimental crevice samples. The geometry and dimensions of these samples must be controlled to a high order of precision in order to be amenable for comparison to computational models. In this work we report an effort to construct crevice samples with rigorously defined dimensions by using microfabrication techniques developed for microelectromechanical systems (MEMS). These techniques include microfabrication with SU- 8, electroplating, and other standard semiconductor device fabrication techniques as well. The crevice substrates contain one-dimensional arrays of metal electrodes to be studied, which are isolated by walls of SU-8. The electrodes have individual electrical connections so that spatial information of the in-situ corrosion process can be obtained. The crevice formers with SU-8 posts were coupled to crevice substrates to maintain a uniform crevice gap. Further, crevice formers with regular rectangular subcrevices were fabricated to study the roles of subcrevices in crevice corrosion.

Submicron Patterned Anodic Oxidation of Aluminum Thin Films

Alumina formed by the electrochemical anodization of bulk aluminum has a regular porous structure [1]. Sub-100 nm pores with aspect ratios as high as 1000:1 can easily be formed [2] without elaborate processing. Anodization of aluminum thus provides the basis for the inexpensive, high throughput microfabrication of structures with near vertical sidewalls [2]. In this work we explore the patterned anodic oxidation of deposited aluminum thin films, facilitating the integration of this technique with established microfabrication tools. An anodization barrier of polymethylmethacrylate (PMMA) is deposited onto 300 nm thick aluminum films. The barrier film is subsequently patterned and the exposed aluminum anodized in a 10% sulfuric acid solution. Barrier patterning techniques utilized in this study include optical exposure, ion-beam milling and nano-imprint lithography. Sharp edge definition on micron scale patterns has been achieved using optical methods. Extension of this technique to smaller dimensions by ion-beam milling and nano-imprint lithography is presented. We further report on the observation of contrast reversal of anodization with very thin PMMA barriers, which provides a novel means of pattern transfer. Potential applications and challenges will be discussed.

Kinetic Studies of Silicon - Silicon Dioxide Interface Trap Annealing Using Rapid Thermal Processing

Rapid thermal processing is a promising tool for studying the kinetics of interface state annealing and other process phenomena on short time scales. We have studied the decay of interface states with a variety of ambients, temperatures, and oxide thicknesses. Annealing kinetics appear to be controlled by a surface reaction process, and not hydrogen diffusion through the oxide. The annealing behavior depends strongly on temperature but less so on other process parameters. Our experimental methodology for temporal process modeling is discussed.

Fabrication of a Conductometric Sensor for Crevice Corrosion Studies

Microfabricated crevice corrosion samples have been employed in experiments that provided important information necessary for developing an accurate, comprehensive, and reliable crevice corrosion model. Acquiring real-time spatial information of crevice corrosion is also essential in analyzing corrosion processes. Integration of arrays of solid-state microsensors, such as conductometric sensors, pH and other ion concentration potentiometric sensors, into the crevice corrosion samples will allow for in-situ real-time data acquisition. In the present work, crevice corrosion samples with conductometric sensor arrays are made using the techniques developed for thin film semiconductor processing and microelectromechanical systems (MEMS) fabrication. The crevice corrosion testing sample is constructed by coupling a crevice former to a crevice substrate and has a uniform crevice gap. A conductometric sensor array built on a silicon wafer is incorporated into the crevice former. Each of these sensors is composed of a pair of thin film gold electrodes, which enables in-situ spatial conductivity analysis of crevice corrosion. Information about metal ion concentration and active chemistry inside the crevice can also be obtained.

Comorbidities of epilepsy: results from the Epilepsy Comorbidities and Health (EPIC) survey

PURPOSE

To estimate the prevalence of neuropsychiatric and pain disorders in adults with epilepsy in the United States.

METHODS

In 2008, an 11-item survey including validated questions to screen for a lifetime history of epilepsy was mailed to 340,000 households from two national panels selected to be generally representative of the noninstitutionalized U.S. population. Information on epilepsy and other disorders was collected from 172,959 respondents aged 18 or older. Propensity scoring was used to match respondents with and without epilepsy on baseline characteristics and risk factors for epilepsy. Prevalence ratios (PRs) of comorbidities in respondents with epilepsy were calculated using log-binomial generalized linear models. Comorbidities were categorized as neuropsychiatric (anxiety, depression, bipolar disorder, attention-deficit/hyperactivity disorder, sleep disorder/apnea, and movement disorder/tremor), pain (migraine headache, chronic pain, fibromyalgia, neuropathic pain), and other (asthma, diabetes, and high blood pressure).

KEY FINDINGS

Two percent (3,488) of respondents reported ever having been told they had epilepsy or a seizure disorder. Respondents with self-reported epilepsy were more likely (p < 0.001) than those without epilepsy to report all six neuropsychiatric disorders (PR from 1.27-2.39), all four pain disorders (PR 1.36-1.96), and asthma (PR 1.25).

SIGNIFICANCE

Neuropsychiatric conditions and pain disorder comorbidities were reported more often in individuals with self-reported epilepsy than in those without epilepsy. Identification of these conditions is an important consideration in the clinical management of epilepsy.

Live birth after anonymous donation of twice-cryopreserved embryos that had been stored in liquid nitrogen for a cumulative storage time of approximately 13.5 years

OBJECTIVE

To report a live birth after transfer of anonymously donated, twice-cryopreserved embryos that had been stored in liquid nitrogen for approximately 13.5 years.

DESIGN

Case report.

SETTING

A private assisted reproduction center.

PATIENT(S)

A 44-year-old recipient of donated cryopreserved embryos.

INTERVENTION(S)

Anonymous donation of cryopreserved blastocysts for procreation.

MAIN OUTCOME MEASURE(S)

Live birth after thawing and replacement of re-cryopreserved blastocysts.

RESULT(S)

Fourteen pronuclear-stage embryos and four cleavage-stage embryos were cryopreserved during a primary IVF cycle. In two separate cycles, one cycle for the primary patient and a subsequent cycle for the first embryo donor recipient, the 18 embryos were thawed and grown to the blastocyst stage for transfer. Supernumerary blastocysts (n = 5) not replaced at either of these two thaw cycles were re-cryopreserved and subsequently donated to another embryo donor recipient. Five blastocysts survived the thaw and three were transferred, resulting in a live birth. The embryos were cryopreserved for a cumulative storage time of approximately 4,909 days (13.4 years).

CONCLUSION(S)

The longevity (viability) of cryopreserved embryos maintained in liquid nitrogen remains to be determined; cryopreserved embryo donation for procreation should not be overlooked, regardless of the length of time that embryos remain in cryostorage.

The fabrication of low-impedance nanoporous gold multiple-electrode arrays for neural electrophysiology studies

Neural electrodes are essential tools for the study of the nervous system and related diseases. Low electrode impedance is a figure of merit for sensitive detection of neural electrical activity and numerous studies have aimed to reduce impedance. Unfortunately, most of these efforts have been tethered by a combination of poor functional coating adhesion, complicated fabrication techniques, and poor fabrication repeatability. We address these issues with a facile method for reliably producing multiple-electrode arrays with low impedance by patterning highly adherent nanoporous gold films using conventional microfabrication techniques. The high surface area-to-volume ratio of self-assembled nanoporous gold results in a more than 25-fold improvement in the electrode-electrolyte impedance, where at 1 kHz, 850 kOmega impedance for conventional Au electrodes is reduced to 30 kOmega for nanoporous gold electrodes. Low impedance provides a superior signal-to-noise ratio for detection of neural activity in noisy environments. We systematically studied the effect of film morphology on electrode impedance and successfully recorded field potentials from rat hippocampal slices. Here, we present our fabrication approach, the relationship between film morphology and impedance, and field potential recordings.

Psychiatric comorbidity in pediatric patients with demyelinating disorders

Little is known about psychiatric aspects of pediatric demyelinating conditions. A total of 23 youths (6-17 years) with demyelinating conditions underwent semistructured psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Adolescents and parents completed the Child Symptom Inventory-4 and the Youth's Inventory-4. Fears and conceptions of their neurological problems were elicited. In all, 48% (n = 11) met criteria for current psychiatric diagnoses, including 27% (n = 3) with depressive disorders and 64% (n = 7) with anxiety disorders. Fears and conceptions of the illness were severe and diverse. Depressive and anxiety disorders are common in pediatric demyelinating disease. Clinicians should therefore screen for psychiatric comorbidity symptoms as part of the routine evaluation of such patients.

The status of asthma control in the U.S. adult population

Treatment guidelines recognize the importance of achieving and maintaining asthma control. This study was designed to assess the prevalence of asthma control in a representative U.S. population. A survey regarding asthma and associated symptoms was sent to a representative national sample of 134,401 households managed by the National Family Opinion WorldGroup from May to July 2007. Subjects >or=18 years with current asthma were identified and completed the Asthma Control Test (ACT), a brief validated self-administered survey that assesses asthma control. Subjects with an ACT score of >19 have been defined as having well-controlled asthma (WCA) and those with a score of <or=19 were defined as having not well-controlled asthma (NWCA). The prevalence of WCA was identified for the total population as well as subjects who currently were only using albuterol to control asthma symptoms. In addition, the frequency of past asthma exacerbations was studied and correlated with ACT. Surveys were returned by 81,505 households (61% return rate). A total of 10,139 adults self-reported having asthma and completed the ACT. Forty-one percent of these had NWCA and 39% of the subjects using albuterol as the only asthma medication had NWCA. Fifty-eight percent of subjects with NWCA in the total population had an asthma-related exacerbation (asthma-related oral corticosteroid use, emergency department, or hospitalization) in the previous year compared with 24% of subjects with WCA. This large representative national asthma sample using a validated asthma control instrument identified >40% of subjects with NWCA. In addition, subjects using albuterol monotherapy, who would be expected to have mild asthma and thus be well controlled, had a similar high prevalence of NWCA.

Soy lecithin replaces egg yolk for cryopreservation of human sperm without adversely affecting postthaw motility, morphology, sperm DNA integrity, or sperm binding to hyaluronate

Semen specimens (one ejaculate from each of 20 consenting study participants) were subjected to routine semen analysis, an in vitro sperm binding assay (HBA), and a sperm chromatin dispersion assay (HaloSperm), both before and after cryopreservation using cryoprotectant media supplemented with either egg yolk or soy lecithin. Comparing the equivalency of the two phospholipid cryopreservation supplements with regard to postthaw functional parameters demonstrated that there were no statistically significant differences between the two supplements for [1] recovery of motile sperm, [2] maintenance of sperm cell morphology, [3] maintenance of the ability of sperm to bind to hyaluronate in vitro, or [4] maintenance of sperm DNA integrity.