Acute effects of air pollutants on spontaneous pregnancy loss: a case-crossover study

OBJECTIVE

To investigate the relationship between acute exposure to air pollutants and spontaneous pregnancy loss.

DESIGN

Case-crossover study from 2007 to 2015.

SETTING

An academic emergency department in the Wasatch Front area of Utah.

PATIENT(S)

A total of 1,398 women who experienced spontaneous pregnancy loss events.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Odds of spontaneous pregnancy loss.

RESULT(S)

We found that a 10-ppb increase in 7-day average levels of nitrogen dioxide was associated with a 16% increase in the odds of spontaneous pregnancy loss (odds ratio [OR] = 1.16; 95% confidence interval [CI] 1.01-1.33; P=.04). A 10-μg/m³ increase in 3-day and 7-day averages of fine particulate matter were associated with increased risk of spontaneous pregnancy loss, but the associations did not reach statistical significance (OR_{3-day average} = 1.09; 95% CI 0.99-1.20; P=.05) (OR_{7-day average} = 1.11; 95% CI 0.99-1.24; P=.06). We found no evidence of increased risk for any other metrics of nitrogen dioxide or fine particulate matter or any metric for ozone.

CONCLUSIONS

We found that short-term exposure to elevated levels of air pollutants was associated with higher risk for spontaneous pregnancy loss.

Early Pregnancy Losses: Review of Nomenclature, Histopathology, and Possible Etiologies

Miscarriage is a frequent complication of human pregnancy: ∼50% to 70% of spontaneous conceptions are lost prior to the second trimester. Etiology of miscarriage includes genetic abnormalities, infections, immunological and implantation disorders, uterine and endocrine abnormalities, and lifestyle factors. Given such variability, knowledge regarding causes, pathophysiological mechanisms, and morphologies of primary early pregnancy loss has significant gaps; often, pregnancy losses remain unexplained. Pathologic evaluation of miscarriage tissue is an untapped source of knowledge. Although miscarriage specimens comprise a significant part of pathologists' workload, information reported from these specimens is typically of minimal clinical utility for delineating etiology or predicting recurrence risk. Standardized terminology is available, though not universally used. We reintroduce the terminology and review new information about early pregnancy losses and their morphologies. Current clinical terminology is inconsistent, hampering research progress. This review is a resource for diagnostic pathologists studying this complex problem.

The Effect of Intermittent Illumination on the Visual Acuity Threshold

Senders (1949) reported that with intermittent illumination short flashes needed less energy than larger ones to make a visual acuity target visible. This apparent breakdown of the reciprocal relationship between time and intensity, which has been found almost universally by earlier workers under a very wide range of experimental conditions, raised a number of interesting theoretical issues such as the relationship between visual acuity and intensity discrimination thresholds, and the plausible importance of eye movements in each. Unfortunately we have been unable to repeat Senders' result in spite of the most determined efforts to reproduce her experimental conditions. We are unable to suggest why our results differ from hers, but feel that our experiments at least show that her data are very difficult to reproduce and hence no general theoretical argument can be based on them.

In view of this we felt at liberty to predict results on the basis of a model, we had tentatively constructed, which we regarded as integrating Bloch's and Talbot's laws. This enabled us to make predictions about the effect of frequency of repetitive stimulation on thresholds. Experiments were carried out to ascertain how far these predictions were substantiated. Agreement was remarkably good.

Obstetric and perinatal outcomes in subfertile patients who conceived following low technology interventions for fertility enhancement: a comprehensive review

PURPOSE

Low technology interventions for fertility enhancement (LTIFE) are strategies that avoid retrieval, handling, and manipulation of female gametes. The definition of LTIFE is yet to be widely accepted and clarified, but they are commonly used in milder cases of infertility and subfertility. Based on these considerations, the aim of the present study was comprehensively to review and investigate the obstetric and perinatal outcomes in subfertile patients who underwent LTIFE.

METHODS

A literature search up to May 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science, and Google Scholar. An evidence-based hierarchy was used according to The Oxford Centre for Evidence-Based Medicine to determine which articles to include and analyze, and to provide a level of evidence of each association between intervention and outcome.

RESULTS

This analysis identified preliminary and low-grade evidence on the influence of LTIFE on obstetric and perinatal outcomes in subfertile women.

CONCLUSIONS

LTIFE women should deserve major consideration from Clinicians/Researchers of Reproductive Medicine, because these treatments could be potentially responsible for mothers' and babies' complications. So far, the lack of well-designed and unbiased studies makes further conclusions difficult to be drawn.

A Reply to John W. Senders and Virginia L. Senders (Quart. J. exp. Psychol., 14, 176–7)

Senders has put forward a very relevant criticism of our experiments in so far as they are attempts to reproduce her findings. It is fair to say, however, that our primary interest was to discover whether the “Senders' effect” is a common one likely to turn up and confuse the results of any unwary research worker. This it would seem is now obviously not the case.

The apparently convincing argument, however, about the effect of fixation does not appear to hold. In February 1960 a simple experiment was carried out to test just this point. The equipment used was that described in Experiment 3 with repetition rate of 5.26 cps., except that:—

The fixation system was a sheet of glass reflecting an illuminated “cross” with the centre removed in which lay the rectangular grill, the subject being told to fixate the point where the centre of the cross should be. The open cross was used rather than crossed hairs or a point source as it was thought that these might interfere with the stimulus light at the point of fixation. A chin rest was used and the subject was fitted into a “skin diving mask” from which the face plate had been removed and replaced with a piece of wood with a hole opposite the left eye and the whole of the contraption was attached very firmly to a retort stand, which in turn was clamped to the bench. A cylindrical tube fitted into the hole in the mask and this again was attached to the bench via supports. Into the tube was let in the “fixation” glass reflector.

Pregnancy complications in spontaneous and assisted conceptions of women with infertility and subfertility factors. A comprehensive review

In the literature, there is growing evidence that assisted reproductive techniques increase the risk of pregnancy complications in subfertile couples. Moreover, many concomitant preconception risk factors for subfertility are frequently present in the same subject and increase the risk of pregnancy complications. This review aimed to summarize in a systematic fashion the best current evidence regarding the effects of preconception maternal factors on maternal and neonatal outcomes. A literature search up to March 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. An evidence-based hierarchy was used to determine which articles to include and analyse. Available data show that the risk of pregnancy complications in spontaneous and assisted conceptions is likely multifactorial, and the magnitude of this risk is probably very different according specific subgroups of patients. Notwithstanding the only moderate level and quality of the available evidence, available data suggest that the presence and the treatment of specific preconception cofactors of subfertility should be always taken into account both in clinical practice and for scientific purposes.

Surgical Treatments for Vulvar and Vaginal Dysplasia

OBJECTIVE

To compare pain, adverse effects and recurrence of dysplasia in patients with vaginal intraepithelial neoplasia or vulvar intraepithelial neoplasia prospectively treated by carbon dioxide laser or ultrasonic surgical aspiration.

METHODS

Patients were randomly assigned to receive treatment by laser or ultrasonic surgical aspiration from 2000-2005. Preoperative biopsy was done to confirm presence of dysplasia. Patients completed a visual analog scale regarding pain and were evaluated at 2-4 weeks to assess scarring, wound healing, and adverse effects. Patients returned every 3 months for 1 year for pelvic examination and cytology to assess recurrence. Follow-up colposcopy and biopsy were used at the discretion of the treating physician. Student t test, chi2, analysis of variance and multiple logistic regression were used for analysis.

RESULTS

One hundred ten patients were randomly assigned. Ninety-six (87.3%) patients completed 1 year follow-up. Mean age of patients was 48.5 years. Mean visual analog scale score was significantly lower in patients treated by ultrasonic surgical aspiration (20.7 compared with 35.1; P=.032). For patients with vulvar lesions, there was less scarring with ultrasonic surgical aspiration (P<.01). Recurrence overall was 25% and was similar for ultrasonic surgical aspiration compared with laser (relative risk 0.96, 95% confidence interval 0.64-1.50, number needed to treat 95.6). Recurrence was associated with younger age (P<.01).

CONCLUSION

Patients treated with ultrasonic surgical aspiration for vulvar and vaginal dysplasia reported less postoperative pain. Vulvar scarring was more common in patients treated by the laser. There was no difference in recurrence of dysplasia during a 1-year follow-up period between the two surgical modalities.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00394758

LEVEL OF EVIDENCE

I.

Social roles, social norms, and self-presentation in the quiz effect of Ross, Amabile, and Steinmetz

The quiz effect describes the tendency of contestants, but not questioners, in a quiz-game setting to discount the arbitrary nature of their roles in over-attributing cleverness to the questioner. This tendency is generally viewed as an example of the fundamental attribution error and is usually explained in terms of cognitive processes. An alternative explanation is proposed that suggests that the effect reflects impression-management tactics, especially compliance to the norm of modesty. In the present Australian study, the quiz effect was replicated when questioners and answerers rated past behaviors. However, when future performance in a quiz-game setting was predicted, there was no evidence of the effect. These results are consistent with a normative, not cognitive, explanation of the effect.

Inadequacy of voice recognition as a demonstration of self-deception

Gur and Sackeim (1979) argued that subjects deceived themselves when they failed to recognize their own voices on playback from a tape recorder. This claim is based primarily on the observation that subjects showed a heightened galvanic skin response when their own voices were present regardless of whether recognition took place. The authors suggest that even though subjects may not consciously recognize their own voices, a heightened physiological response implies that true recognition did in fact occur at some other level of cognitive processing. This article describes an experiment demonstrating that results similar to those arrived at by Gur and Sackeim can also be produced when subjects attempt to recognize the voice of a familiar "other." These results suggest that self-deception is not the main factor operating to produce the heightened physiological response.