1
|
Sheldon S. Beyond the Tram Lines: Disability Discrimination, Reproductive Rights and Anachronistic Abortion Law. Oxf J Leg Stud 2023; 44:104-132. [PMID: 38463213 PMCID: PMC10921270 DOI: 10.1093/ojls/gqad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This article takes as its starting point the recent case of Crowter, which challenged the law permitting provision of abortion on the grounds of fetal anomaly. It begins by briefly locating the case within a longer 'biography' of the Abortion Act 1967, casting important light on the issue raised within it. It then focuses in detail on the claims made in Crowter, exploring how important moral, social and political concerns with disability discrimination were refracted through an anti-abortion lens as they were translated into legal argument. As a result, the legal remedies sought were simultaneously disproportionate and insufficient to address the harms described. Whilst agreeing that the Abortion Act reflects anachronistic and discriminatory understandings of disability and is overdue reform, the article argues that a response that fully reflects modern ethical values will require more radical change than envisaged in Crowter, and that this must refuse an opposition between the rights of pregnant and disabled people.
Collapse
|
2
|
Sheldon S, Lord J. Care not criminalisation: reform of British abortion law is long overdue. J Med Ethics 2023; 49:523-524. [PMID: 37451854 DOI: 10.1136/jme-2023-109405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Sally Sheldon
- University of Bristol School of Law, Bristol, UK
- University of Technology Sydney Law School, Sydney, New South Wales, Australia
| | - Jonathan Lord
- MSI Reproductive Choices UK, London, UK
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospitals NHS Trust, Treliske, UK
| |
Collapse
|
3
|
Bonnechère B, Bier JC, Van Hove O, Sheldon S, Samadoulougou S, Kirakoya-Samadoulougou F, Klass M. Age-Associated Capacity to Progress When Playing Cognitive Mobile Games: Ecological Retrospective Observational Study. JMIR Serious Games 2020; 8:e17121. [PMID: 32530432 PMCID: PMC7320308 DOI: 10.2196/17121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background The decline of cognitive function is an important issue related to aging. Over the last few years, numerous mobile apps have been developed to challenge the brain with cognitive exercises; however, little is currently known about how age influences capacity for performance improvement when playing cognitive mobile games. Objective The objective of this study was to analyze the score data of cognitive mobile games over a period of 100 gaming sessions to determine age-related learning ability for new cognitive tasks by measuring the level of score improvement achieved by participants of different ages. Methods Scores from 9000 individuals of different ages for 7 cognitive mobile games over 100 gaming sessions were analyzed. Scores from the first session were compared between age groups using one-way analysis of variance. Mixed models were subsequently used to investigate the progression of scores over 100 sessions. Results Statistically significant differences were found between age groups for the initial scores of 6 of the 7 games (linear trend, P<.001). Cognitive mobile game scores increased for all participants (P<.001) suggesting that all participants were able to improve their performance. The rate of improvement was, however, strongly influenced by the age of the participant with slower progression for older participants (P<.001). Conclusions This study provides evidence to support two interesting insights—cognitive mobile game scores appear to be sensitive to the changes in cognitive ability that occur with advancing age; therefore, these games could be a convenient way to monitor cognitive function over long-term follow-up, and users who train with the cognitive mobile games improve regardless of age.
Collapse
Affiliation(s)
- Bruno Bonnechère
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.,Department of Psychiatry and Behavioural and Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jean-Christophe Bier
- Department of Neurology, Hôpital Érasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Van Hove
- Department of Chest and Thoracic Surgery, Hôpital Érasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Centre, Quebec City, QC, Canada
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Malgorzata Klass
- Laboratory of Applied Biology and Neurophysiology, Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
4
|
Jazayeri MA, Mohammed M, Mastoris I, Sheldon S, Reddy M, Haglund N, Sauer A, Shah Z. P4171Population characteristics, interventions and outcomes in hospitalized orthotopic heart transplant patients with sudden cardiac arrest: a nationwide United States analysis from 2007 to 2015. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sudden cardiac arrest (SCA) is a leading cause of death in the United States (US), claiming up to 450,000 lives annually and accounting for ∼25% of deaths following orthotopic heart transplantation (OHT),
Purpose
We sought to characterize OHT patients suffering SCA and their subsequent management, in comparison to the general, native heart (NH) population, using a large national inpatient database.
Methods
A cross-sectional analysis was performed among US OHT & NH patients hospitalized with incident SCA or ventricular fibrillation/flutter. We analyzed demographics, baseline characteristics, procedural utilization and outcomes. Groups were compared with standard statistical techniques. A P-value <0.05 was considered significant.
Results
From 2007–2015, 920 SCA admissions were identified among 121,083 (0.8%) OHT hospitalizations, compared to 1,731,658 (0.6%) in the general population (P<0.001). OHT patients were younger (P<0.001) and predominantly men (P<0.001). More OHT patients had diabetes (P=0.01), while the NH group had more coronary disease (P=0.01). Mechanical circulatory support use was similar in both groups overall, and OHT patients were more likely to undergo transplantation (P=0.015). Pacemaker/defibrillator implants were more common in NH than OHT patients (P<0.001). Acute kidney injury and in-hospital mortality were significantly greater in OHT patients.
Table 1. SCA in OHT & general populations Orthotopic Heart Transplant General Population P-value (N=121,083) (N=278,463,550) Sudden cardiac arrest (SCA) events, n (%) 920 (0.8%) 1,731,658 (0.6%) <0.001 Age, mean (SD) 57 (17) 66 (16) <0.001 Male sex, n (%) 644 (72%) 1,004,362 (58%) <0.001 Coronary artery disease, n (%) 275 (30%) 675,908 (39%) 0.012 Mechanical circulatory support, n (%) 64 (7%) 104,151 (6%) 0.230 Repeat heart transplantation, n (%) 5 (0.5%) 1199 (0.1%) 0.015 Pacemaker or defibrillator implant, n (%) 45 (5%) 136,314 (8%) <0.001 In-hospital mortality, n (%) 555 (60%) 932,812 (54%) 0.014 Cardiogenic shock, n (%) 78 (8%) 208,778 (12%) <0.001 Acute kidney injury, n (%) 418 (45%) 608,035 (35%) 0.003
Conclusions
SCA hospitalizations occur more often and with higher mortality in OHT patients compared to the general population. Earlier recognition of at-risk patients may result in improved utilization of potentially life-saving therapies.
Collapse
Affiliation(s)
- M.-A Jazayeri
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - M Mohammed
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - I Mastoris
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - S Sheldon
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - M Reddy
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - N Haglund
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - A Sauer
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| | - Z Shah
- University of Kansas Medical Center, Department of Cardiovascular Medicine, Kansas City, United States of America
| |
Collapse
|
5
|
Johnson BR, Norman WV, Keogh L, Sheldon S. Decriminalisation of abortion in New Zealand and Australia. N Z Med J 2019; 132:93-95. [PMID: 31465334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Wendy V Norman
- CIHR-PHAC Chair, Family Planning Public Health Research; Associate Professor, Dept of Family Practice, University of British Columbia; Honorary Associate Professor, London School of Hygiene & Tropical Medicine; Scholar, Michael Smith Foundation for Health Research; Vancouver, Canada
| | - Louise Keogh
- Associate Professor, Health Sociology, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Sally Sheldon
- Professor of Law, Kent Law School, Kent University, Kent, UK; Law School, University of Technology Sydney, Australia
| |
Collapse
|
6
|
Abstract
This paper analyses an important set of legal issues raised by the telemedical provision of abortion pills. Focusing on the case of European Union (EU) law, it suggests that a properly accredited doctor seeking to treat a patient with abortion pills is entitled, in principle, to rely on EU rules of free movement to protect their access to patients in other member states, and women facing unwanted pregnancies likewise have legal rights to access the services thus offered. EU countries seeking to claim an exception to those rules on the basis of public health or the protection of a fundamental public policy interest (here, the protection of fetal life) will face significant barriers.
Collapse
Affiliation(s)
- Tamara Hervey
- Jean Monnet Professor of European Union Law, School of Law, Sheffield University, Sheffield, UK
| | | |
Collapse
|
7
|
Lee E, Sheldon S, Macvarish J. The 1967 Abortion Act fifty years on: Abortion, medical authority and the law revisited. Soc Sci Med 2018; 212:26-32. [PMID: 30005221 DOI: 10.1016/j.socscimed.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/01/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
Abstract
The recent 50th anniversary of the 1967 Abortion Act provides the opportunity to revisit what has been termed the 'remarkable authority' this Act ascribes to doctors. This paper does so using as its starting point a seminal commentary on this question by the renowned medical sociologist Sally Macintyre, published in this journal in 1973 as 'The Medical Profession and the 1967 Abortion Act in Britain'. We revisit themes from that paper through an analysis of the findings of interviews with 14 doctors who, throughout lengthy careers, have provided abortions and led the development of the abortion service in England and Wales. We contrast our findings with Macintyre's, and argue that our interviews highlight the shifting meaning of medical authority and medical professionalism. We show that those doctors most involved in providing abortions place moral value on this work; uphold the authority of women (not doctors) in abortion decision-making; view nurses and midwives as professional collaborators; and consider their professional and clinical judgement impeded by the present law. We conclude that medical sociologists have much to gain by taking abortion provision as a focus for the further exploration of the shifting meaning of medical authority.
Collapse
Affiliation(s)
- Ellie Lee
- School of Sociology, Social Policy and Social Research, Cornwallis East, University of Kent, Canterbury, CT2 7NY, England, UK.
| | - Sally Sheldon
- Kent Law School, Eliot College, University of Kent, Canterbury, CT2 7NS, England, UK.
| | - Jan Macvarish
- School of Sociology, Social Policy and Social Research, Cornwallis East, University of Kent, Canterbury, CT2 7NY, England, UK
| |
Collapse
|
8
|
Sheldon S. Empowerment and Privacy? Home Use of Abortion Pills in the Republic of Ireland. Signs: Journal of Women in Culture and Society 2018. [DOI: 10.1086/696625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
9
|
McGee A, Jansen M, Sheldon S. Abortion law reform: Why ethical intractability and maternal morbidity are grounds for decriminalisation. Aust N Z J Obstet Gynaecol 2018; 58:594-597. [PMID: 29681079 DOI: 10.1111/ajo.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/22/2018] [Indexed: 12/13/2022]
Abstract
In this paper, we present two grounds for arguing that abortion should be decriminalised. First, we consider the implications of the fact that the long-standing ethical debate concerning the morality of abortion has to date proven intractable. We maintain that because the philosophical literature has failed to demonstrate conclusively that views either for or against abortion's moral acceptability are false, the matter remains at a stalemate in terms of rational debate, contributing to the ongoing absence of political and popular consensus about the issue in our society. In these circumstances, we argue, the law should adopt a minimalist position by not imposing criminal sanctions for abortion. Second, we present evidence, often neglected in the moral debates about abortion, that the risks of carrying a fetus to term and of delivery are substantial for a woman. Most laws recognise that, should her life be endangered by her pregnancy, a woman's right to life shall prevail. However, the impacts of carrying a fetus to term and delivery on a woman are not restricted to the risks to her life, but extend to significant permanent changes to her body, and include risks of injury that are not negligible. We argue that a woman should not be compelled to take these risks by laws prohibiting abortion, when no conclusive argument exists against the morality of abortion. We also address, albeit briefly, the issue of late-term abortion.
Collapse
Affiliation(s)
- Andrew McGee
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melanie Jansen
- Intensive Care, Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | |
Collapse
|
10
|
Mercer P, Sheldon S, Kotsos T, O’Neill W. Detection of Juvenile Sleep Deprivation by Stochastic Optimization of Pupillographic Records. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objective: To address the challenging problem of measuring juvenile sleep deprivation, we test the hypothesis that a pupillographic method found successful for adult narcoleptics might also discriminate between sleep deprived juveniles acting as their own controls.
Methods: A linear, nonstationary model relating pupillary diameter and a random photic stimulus are estimated by recursive regressions from pupillographic records of 8 juveniles of median age 7 years acting as their own rested controls. The estimated pupillary impulse response noise functions are stochastically optimized using the Kullback divergence measure to maximally separate the sleep deprived records from the control records.
Results: Both the average and covariance statistics of the estimated pupillary noise functions exhibit statistically significant differences between sleep deprived and rested subjects. The main result is that sleep deprivation decreases pupillary noise variance; a finding consistent with a previous study of adult narcoleptics. Further, it was found that virtually the same stochastic parameters were optimal for the juvenile sleep deprived data and for the previous adult narcoleptic study.
Conclusions: Although our results are preliminary, the consistent reduction of pupillary noise appears to justify a comprehensive clinical trial across a broad range of age classes. In addition, the finding that the same parameters stochastically optimze both juvenile and adult recordings suggests the procedure holds promise as a clinical test which could produce sleep deprivation measures simultaneous with data collection.
Collapse
|
11
|
Maiman M, Del BV, Farrell E, MacAllister W, Vaurio L, LeMonda B, Sheldon S, Slugh M, Arce RM, Barr W. A-60Examining the Clinical Utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for Characterizing Seizure Lateralization in Adults with Temporal Lobe Epilepsy. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Maiman M, Del BV, Farrell E, MacAllister W, Vaurio L, LeMonda B, Sheldon S, Slugh M, Arce RM, Barr W. A-59Association of Epilepsy Severity Factors with Performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in Adults with Temporal Lobe Epilepsy. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Stefek H, Zee P, Yob J, Sheldon S, Fishbein A. 0946 RETROSPECTIVE CHART REVIEW DEFINING CHARACTERISTICS OF LIMB MOVEMENTS ON POLYSOMNOGRAPHY IN CHILDREN WITH ATOPIC DERMATITIS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Simakajornboon N, Melendres C, Sheldon S, Super E, Naqvi K, Brockbank J, Beckerman R, Amin R, Lew J, Malow B, Marcus C, Mason A, Chervin R, Kheirandish-Gozal L, Mignot E. 0947 CLINICAL CHARACTERISTICS OF CHILDHOOD NARCOLEPSY FOLLOWING THE H1N1 PANDEMICS: PRELIMINARY DATA FROM THE PEDIATRIC WORKING GROUP OF THE SLEEP RESEARCH NETWORK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Sheldon S, Fletcher J. Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives. ACTA ACUST UNITED AC 2017; 43:260-264. [PMID: 28100470 PMCID: PMC5749305 DOI: 10.1136/jfprhc-2016-101542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/01/2016] [Accepted: 12/05/2016] [Indexed: 11/30/2022]
Abstract
Background Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. Aim and design This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption. Conclusions A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients.
Collapse
Affiliation(s)
- Sally Sheldon
- Professor of Law Kent Law School, Eliot College, Kent University, Canterbury, UK
| | - Joanne Fletcher
- Consultant Nurse in Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
16
|
Affiliation(s)
- Sally Sheldon
- Professor of Law, Kent Law School, Eliot College, Kent University, Canterbury, UK
| |
Collapse
|
17
|
Sugrue A, Kremen V, Qiang B, Sheldon S, DeSimone C, Asirvatham S, Friedman P, Ackerman M, Noseworthy P. 10 Electrocardiographic predictors of torsadogenic risk during dofetilide or sotalol initiation: utility of a novel T wave analysis programme. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
18
|
Maiman M, Sheldon S, Vasserman M, Murphy H, MacAllister W. B-57Sensitivity and Inter-rater Reliability of the Behavior Rating Inventory of Executive Function-Preschool Version in Children with Epilepsy. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Sheldon S. The regulatory cliff edge between contraception and abortion: the legal and moral significance of implantation. J Med Ethics 2015; 41:762-5. [PMID: 26085334 PMCID: PMC4552905 DOI: 10.1136/medethics-2015-102712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/28/2015] [Accepted: 05/13/2015] [Indexed: 05/17/2023]
Abstract
In regulating the voluntary interruption of pregnancy, English law has accorded particular significance to two biological events. First, 'viability', the moment when a fetus is said to acquire the capacity for independent life, plays an important role in grounding restrictions on access to legal abortion later in pregnancy. Second, equally significantly but far less frequently discussed, 'implantation' marks the point in pregnancy from which abortion laws apply. This paper focuses on this earlier biological event. It suggests that an unquestioning reliance on implantation as marking an appropriate moment of transition between two radically different legal frameworks is deeply problematic and is rendered still less sustainable in the light of the development of new technologies that potentially operate shortly after the moment of implantation.
Collapse
MESH Headings
- Abortion, Induced/ethics
- Abortion, Induced/legislation & jurisprudence
- Abortion, Legal/legislation & jurisprudence
- Beginning of Human Life
- Contraception/ethics
- Contraception/methods
- Contraceptive Agents, Female/administration & dosage
- Contraceptives, Oral/administration & dosage
- Contraceptives, Postcoital/administration & dosage
- Embryo Implantation
- Female
- Fetal Viability
- History, 19th Century
- History, 20th Century
- Humans
- Legislation, Medical/history
- Legislation, Medical/trends
- Menstruation-Inducing Agents/administration & dosage
- Moral Obligations
- Pregnancy
- United Kingdom
Collapse
|
20
|
Margaria A, Sheldon S. Parenting post IVF: is age not so relevant after all? Reprod Biomed Online 2014; 29:10-3. [DOI: 10.1016/j.rbmo.2014.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
|
21
|
Lee E, Macvarish J, Sheldon S. Assessing child welfare under the Human Fertilisation and Embryology Act 2008: a case study in medicalisation? Sociol Health Illn 2014; 36:500-515. [PMID: 24386909 DOI: 10.1111/1467-9566.12078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article reports on a study with staff working in assisted conception clinics in the UK about making welfare of the child (WOC) assessments pre-conception. This aspect of infertility treatment is obligatory under section 13(5) of the Human Fertilisation and Embryology Act, which was amended in 2008. The aim of the study was to find out how this change to the law had impacted on practice. In describing what we found, we also make a contribution to scholarship about the medicalisation of reproduction. S13(5) has often been discussed as a prime example of medicalisation, giving clinics power to grant or deny access to treatment on child welfare grounds, encompassing far more than purely clinical considerations. Yet, while such medicalisation may be entrenched in the law, our findings suggest this power is used with a very light touch. Further, while our interviewees offered near-universal support for the need to consider child welfare, this is now justified by concerns that address not only family form (e.g. the need for a father figure) but also the quality of interactions between parents and children. In this light we suggest that the concept of medicalisation may offer a rather blunt tool for understanding a far more complex reality.
Collapse
Affiliation(s)
- Ellie Lee
- School of Social Policy, Sociology and Social Research (SSPSSR), University of Kent
| | | | | |
Collapse
|
22
|
Abstract
In 1997, Margaret Brazier was asked by the then Government to chair a review of the laws regulating surrogacy. The subsequent Brazier Report made a number of recommendations, including the need for greater regulation and the tightening of 'expenses' payments. Fifteen years on, the limitations in the legal regulation of surrogacy have become increasingly clear. Yet, none of Brazier's recommendations have been adopted, despite the clear opportunity for revisiting the regulation of surrogacy offered during the passage of the Human Fertilisation and Embryology Act (2008). In this paper, we revisit the Brazier Report in the light of subsequent developments and assess to what extent its key findings remain salient. Brazier's recommendations will thus provide a jumping off point for a critical analysis of the current state of the law regarding surrogacy.
Collapse
|
23
|
Sheldon S. Only skin deep? The harm of being born a different colour to one's parents: A (a minor) and B (a minor) by C (their mother and next friend) v A Health and Social Services Trust [2010] NIQB 108; [2011] NICA 28. Med Law Rev 2011; 19:657-668. [PMID: 22096128 DOI: 10.1093/medlaw/fwr029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
24
|
Stoffers D, Sheldon S, Kuperman JM, Goldstein J, Corey-Bloom J, Aron AR. Contrasting gray and white matter changes in preclinical Huntington disease: an MRI study. Neurology 2010; 74:1208-16. [PMID: 20385893 DOI: 10.1212/wnl.0b013e3181d8c20a] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In Huntington disease (HD), substantial striatal atrophy precedes clinical motor symptoms. Accordingly, neuroprotection should prevent major cell loss before such symptoms arise. To evaluate neuroprotection, biomarkers such as MRI measures are needed. This requires first establishing the best imaging approach. METHODS Using a cross-sectional design, we acquired T1-weighted and diffusion-weighted scans in 39 preclinical (pre-HD) individuals and 25 age-matched controls. T1-weighted scans were analyzed with gross whole-brain segmentation and voxel-based morphometry. Analysis of diffusion-weighted scans used skeleton-based tractography. For all imaging measures, we compared pre-HD and control groups and within the pre-HD group we examined correlations with estimated years to clinical onset. RESULTS Pre-HD individuals had lower gross gray matter (GM) and white matter (WM) volume. Voxel-wise analysis demonstrated local GM volume loss, most notably in regions consistent with basal ganglia-thalamocortical pathways. By contrast, pre-HD individuals showed widespread reductions in WM integrity, probably due to a loss of axonal barriers. Both GM and WM imaging measures correlated with estimated years to onset. CONCLUSIONS Using automated, observer-independent methods, we found that GM loss in pre-HD was regionally specific, while WM deterioration was much more general and probably the result of demyelination rather then axonal degeneration. These findings provide important information about the nature, relative staging, and topographic specificity of brain changes in pre-HD and suggest that combining GM and WM imaging may be the best biomarker approach. The empirically derived group difference images from this study are provided as regions-of-interest masks for improved sensitivity in future longitudinal studies.
Collapse
Affiliation(s)
- D Stoffers
- Department of Psychology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0109, USA
| | | | | | | | | | | |
Collapse
|
25
|
Sozou PD, Sheldon S, Hartshorne GM. Consent agreements for cryopreserved embryos: the case for choice. J Med Ethics 2010; 36:230-233. [PMID: 20338935 PMCID: PMC2921283 DOI: 10.1136/jme.2009.033373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 12/16/2009] [Accepted: 12/22/2009] [Indexed: 05/29/2023]
Abstract
Under current UK law, an embryo cannot be transferred to a woman's uterus without the consent of both of its genetic parents, that is both of the people from whose gametes the embryo was created. This consent can be withdrawn at any time before the embryo transfer procedure. Withdrawal of consent by one genetic parent can result in the other genetic parent losing the opportunity to have their own genetic children. We argue that offering couples only one type of consent agreement, as happens at present, is too restrictive. An alternative form of agreement, in which one genetic parent agrees to forego the right to future withdrawal of consent, should be available alongside the current form of agreement. Giving couples such a choice will better enable them to store embryos under a consent agreement that is appropriate for their circumstances. Allowing such a choice, with robust procedures in place to ensure the validity of consent, is the best way to respect patient autonomy.
Collapse
Affiliation(s)
- Peter D Sozou
- Clinical Sciences Research, Institute, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | | |
Collapse
|
26
|
Affiliation(s)
- Peter D Sozou
- Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, London WC2A 2AE.
| | | | | |
Collapse
|
27
|
Stoffers D, Kuperman J, Sheldon S, Hagler DJ, Goldstein J, Poldrack RA, Dale AM, Corey-Bloom J, Aron AR. Structural imaging in presymptomatic Huntington's disease confirms that the degree of atrophy of striatum and pallidum strongly predicts years to clinical onset. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
28
|
Abstract
Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-associated mortality. The inadvertent transfusion of neutrophil antibodies can cause pulmonary transfusion reactions and TRALI. However, not all patients transfused with neutrophil antibodies experience transfusion reactions. A 22-year-old man with severe aplastic anaemia (SAA) experienced TRALI after a platelet transfusion. The donor was found to be alloimmunized to human neutrophil antigen (HNA)-3a, an antigen expressed by neutrophils from approximately 90% of Caucasians. Eleven other platelet components from this donor were transfused prior to this event and two caused reactions: one chills and one TRALI. Both episodes of TRALI occurred in the same male patient with SAA. The fact that one patient experienced TRALI following both exposures to anti-HNA-3a from the same donor whereas nine other recipients did not adds evidence to the observation that patient factors make a significant contribution to neutrophil antibody-mediated transfusion reactions.
Collapse
Affiliation(s)
- M Muniz
- Department of Transfusion Medicine Clinical Center, National Institutes of Health, Bethesda, MD 20892-1184, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Fadeyi EA, Adams S, Sheldon S, Leitman SF, Wesley R, Klein HG, Stroncek DF. A preliminary comparison of the prevalence of transfusion reactions in recipients of platelet components from donors with and without human leucocyte antigen antibodies. Vox Sang 2008; 94:324-8. [PMID: 18282262 DOI: 10.1111/j.1423-0410.2008.01041.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human leucocyte antigen (HLA) antibodies have been implicated in transfusion-related acute lung injury, but the probability that the transfusion of a blood component containing HLA antibodies will cause a reaction is not known. This study compared the prevalence of reactions associated with the transfusion of platelet components with and without HLA antibodies. STUDY DESIGN AND METHODS This retrospective study tested 96 consecutive apheresis platelet donors for HLA class I and II antibodies. Matched control donors without HLA antibodies were selected and records were reviewed to determine the proportion of components from each group that caused reactions. In addition, all apheresis platelet donors involved with two or more reactions were identified and tested for HLA class I antibodies. RESULTS Five of the 96 donors had antibodies to class I or class II antigens and, of these, four had components transfused. The prevalence of reactions to components from these four donors with HLA antibodies and the 12 matched control donors without antibodies was similar (three reactions to 167 transfusions or 1.8% vs. three to 295 or 1.0%, respectively, P = 0.32). A retrospective review of the transfusion records from all platelet donors found that components from 22 caused two or more reactions and three (13.6%) had antibodies to HLA class I compared to 4.2% of the consecutively selected donors (P = 0.12). None of the patients experienced transfusion-related acute lung injury. CONCLUSION Reactions associated with transfusion of apheresis platelets containing HLA antibodies are unusual.
Collapse
Affiliation(s)
- E A Fadeyi
- Department of Transfusion Medicine, National Institutes of Health, Warren G. Magnuson Clinical Center, Bethesda, MD 20892-1184, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Sheldon S. Comment on Komenda et al., Clin Nephrol 2007; 68: 151-158. Clin Nephrol 2007; 68:428. [PMID: 18184529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
|
31
|
Abstract
By using tissue typing in conjunction with preimplantation genetic diagnosis doctors are able to pick a human embryo for implantation which, if all goes well, will become a "saviour sibling", a brother or sister capable of donating life-saving tissue to an existing child. This paper addresses the question of whether this form of selection should be banned and concludes that it should not. Three main prohibitionist arguments are considered and found wanting: (a) the claim that saviour siblings would be treated as commodities; (b) a slippery slope argument, which suggests that this practice will lead to the creation of so-called "designer babies"; and (c) a child welfare argument, according to which saviour siblings will be physically and/or psychologically harmed.
Collapse
Affiliation(s)
- S Sheldon
- Centre for Professional Ethics, Keele University, ST5 5BG, UK.
| | | |
Collapse
|
32
|
|
33
|
O'Neill W, Mercer P, Sheldon S, Kotsos T. Detection of juvenile sleep deprivation by stochastic optimization of pupillographic records. Methods Inf Med 2003; 42:282-6. [PMID: 12874663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To address the challenging problem of measuring juvenile sleep deprivation, we test the hypothesis that a pupillographic method found successful for adult narcoleptics might also discriminate between sleep deprived juveniles acting as their own controls. METHODS A linear, nonstationary model relating pupillary diameter and a random photic stimulus are estimated by recursive regressions from pupillographic records of 8 juveniles of median age 7 years acting as their own rested controls. The estimated pupillary impulse response noise functions are stochastically optimized using the Kullback divergence measure to maximally separate the sleep deprived records from the control records. RESULTS Both the average and covariance statistics of the estimated pupillary noise functions exhibit statistically significant differences between sleep deprived and rested subjects. The main result is that sleep deprivation decreases pupillary noise variance; a finding consistent with a previous study of adult narcoleptics. Further, it was found that virtually the same stochastic parameters were optimal for the juvenile sleep deprived data and for the previous adult narcoleptic study. CONCLUSIONS Although our results are preliminary, the consistent reduction of pupillary noise appears to justify a comprehensive clinical trial across a broad range of age classes. In addition, the finding that the same parameters stochastically optimize both juvenile and adult recordings suggests the procedure holds promise as a clinical test which could produce sleep deprivation measures simultaneous with data collection.
Collapse
Affiliation(s)
- W O'Neill
- Bioengineering Department, University of Illinois at Chicago, Chicago, IL 60607, USA.
| | | | | | | |
Collapse
|
34
|
Worthington JE, Robson AJ, Sheldon S, Langton A, Martin S. A comparison of enzyme-linked immunoabsorbent assays and flow cytometry techniques for the detection of HLA specific antibodies. Hum Immunol 2001; 62:1178-84. [PMID: 11600227 DOI: 10.1016/s0198-8859(01)00282-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
LATM, Quikscreen (QS), and B-Screen (QSB) are ELISA-based tests for the detection of HLA specific antibodies. FlowPRA beads are microparticles coated with HLA antigens for the detection of HLA specific antibodies by flow cytometry. The aim of this study was to evaluate the sensitivity and specificity of the LATM, QS, QSB, and FlowPRA screening tests. One hundred sixty-three sera from renal transplant patients were tested using LATM, FlowPRA, QS, and QSB. Discrepant results were further investigated using complement dependent cytotoxicity, QuikID, and PRA-STAT. When QS was compared with LATMI and FlowPRAI for the detection of HLA class I specific antibodies the overall concordance was 82.8% with no particular specificity missed by any one test. Comparing QSB with LATMII and FlowPRAII, for the detection of HLA class II specific antibodies, there was 90.7% concordance. Although the overall concordance was better for class II specific antibodies, QSB failed to detect antibodies to HLA-DQ in a number of samples from different patients. Of the methods tested, flow cytometry using FlowPRA beads appeared to be the most sensitive and specific, missing the least number of specificities. However, the ELISA methods offer the advantage of being more suitable for testing large numbers of samples in a more time- and cost-effective manner.
Collapse
Affiliation(s)
- J E Worthington
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom.
| | | | | | | | | |
Collapse
|
35
|
Martin DM, Sheldon S, Gorski JL. CHARGE association with choanal atresia and inner ear hypoplasia in a child with a de novo chromosome translocation t(2;7)(p14;q21.11). Am J Med Genet 2001; 99:115-9. [PMID: 11241468 DOI: 10.1002/1096-8628(2000)9999:999<00::aid-ajmg1126>3.0.co;2-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 3-year-old boy was diagnosed with CHARGE association on the basis of bilateral choanal atresia, absence of the semicircular canals, hypoplastic cochleae, genital hypoplasia, growth and developmental delays, cranial nerve dysfunction, and facial anomalies. Ophthalmologic and cardiac evaluations were normal. He was found to have an apparently balanced t(2;7)(p14;q21.11) chromosomal translocation. Parental karyotypes were normal. Although there is evidence suggesting a genetic basis for CHARGE association, individuals with chromosomal abnormalities and CHARGE are rare. In the described patient, the presence of characteristic CHARGE features suggests that the t(2;7)(p14;q21.11) translocation breakpoints may cause a deletion or disruption of genes within the involved regions that are involved in the generation of the CHARGE association phenotype.
Collapse
MESH Headings
- Abnormalities, Multiple/genetics
- Central Nervous System/abnormalities
- Child, Preschool
- Choanal Atresia/diagnostic imaging
- Choanal Atresia/genetics
- Chromosomes, Human, Pair 2
- Chromosomes, Human, Pair 7
- Coloboma
- Ear, Inner/abnormalities
- Genitalia, Male/abnormalities
- Growth Disorders
- Heart Defects, Congenital
- Humans
- Karyotyping
- Male
- Tomography, X-Ray Computed
- Translocation, Genetic
Collapse
Affiliation(s)
- D M Martin
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
| | | | | |
Collapse
|
36
|
Sheldon S, Wilkinson S. Termination of pregnancy for reason of foetal disability: are there grounds for a special exception in law? Med Law Rev 2001; 9:85-109. [PMID: 12778928 DOI: 10.1093/medlaw/9.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- S Sheldon
- Department of Law, Keele University, UK.
| | | |
Collapse
|
37
|
Sheldon S, Wilkinson S. 'On the sharpest horns of a dilemma': Re A (conjoined twins). Med Law Rev 2001; 9:201-207. [PMID: 14696612 DOI: 10.1093/medlaw/9.3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- S Sheldon
- Law Department, Keele University, UK
| | | |
Collapse
|
38
|
Dewald G, Stallard R, Alsaadi A, Arnold S, Blough R, Ceperich TM, Rafael Elejalde B, Fink J, Higgins JV, Higgins RR, Hoeltge GA, Hsu WT, Johnson EB, Kronberger D, McCorquodale DJ, Meisner LF, Micale MA, Oseth L, Payne JS, Schwartz S, Sheldon S, Sophian A, Storto P, Van Tuinen P, Wenger GD, Wiktor A, Willis LA, Yung JF, Zenger-Hain J. A multicenter investigation with D-FISH BCR/ABL1 probes. Cancer Genet Cytogenet 2000; 116:97-104. [PMID: 10640140 DOI: 10.1016/s0165-4608(99)00120-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twenty-eight laboratories evaluated a new fluorescence in situ hybridization (FISH) strategy for chronic myeloid leukemia. In a three-part study, bcr/abl1 D-FISH probes were used to study bone marrow specimens. First, laboratories familiarized themselves with the strategy by applying it to known normal and abnormal specimens. Then, collectively the laboratories studied 20 normal and 20 abnormal specimens blindly and measured workload. Finally, each laboratory and two experts studied six serial dilutions with 98-0% abnormal nuclei. Using the reported normal cutoff of < 1% abnormal nuclei, participants reported no false-negative cases and 15 false-positive cases (1-6.6% abnormal nuclei). Results provided by participants for serial dilutions approximated the expected percentages of abnormal nuclei, but those from the experts exhibited greater precision. The clinical sensitivity, precision, nomenclature, workload, recommendations for training, and quality assurance in methods using D-FISH in clinical practice are discussed.
Collapse
MESH Headings
- Bone Marrow/pathology
- Clinical Laboratory Techniques/standards
- Fluorescent Dyes
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence/instrumentation
- In Situ Hybridization, Fluorescence/methods
- In Situ Hybridization, Fluorescence/standards
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Quality Control
- Sensitivity and Specificity
- Workload
Collapse
Affiliation(s)
- G Dewald
- Cytogenetics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
El-Gamel A, Sim E, Hasleton P, Hutchinson J, Yonan N, Egan J, Campbell C, Rahman A, Sheldon S, Deiraniya A, Hutchinson IV. Transforming growth factor beta (TGF-beta) and obliterative bronchiolitis following pulmonary transplantation. J Heart Lung Transplant 1999; 18:828-37. [PMID: 10528744 DOI: 10.1016/s1053-2498(99)00047-9] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Obliterative bronchiolitis (OB) characterised by small-airway fibrosis is a major cause of morbidity and mortality after lung transplantation. TGF-beta has been implicated in the pathogenesis of fibrosis. METHODS We immunohistochemically examined 380 transbronchial biopsies (from 91 pulmonary transplants) using TGF-beta polyclonal antibodies. OB and interstitial fibrosis were diagnosed and graded in all biopsies. Other potential histologic and clinical risk factors for OB were analysed. RESULTS Procedures were heart and lung (n = 32), bilateral sequential lung (n = 18), and single lung transplantation (n = 41). The incidence of OB in this group was 28.5%. In all patients with OB, TGF-beta was immunolocalized in the airways and lung parenchyma. TGF-beta expression was greater in OB patients (median score 8, range 5-12) in comparison to patients without OB (median score 4, range 1-13), p < .0001. Positive TGF-beta staining preceded the histologic confirmation of OB by 6 to 18 months. The development of OB was associated with two HLA mismatches at the A locus (p = .02); recurrent acute rejection episodes (p < .0005); lymphocytic bronchiolitis (p = .0001); and tissue eosinophilia, regardless of the rejection grade (p < .0001). CONCLUSIONS Increased expression of TGF-beta is a risk factor for the development of OB. Other risk factors are recurrent acute rejection, lymphocytic bronchiolitis, tissue eosinophilia, and two mismatches at the HLA-A locus. This suggests that the pathogenesis of progressive small airway fibrosis characteristic of OB may be inflammatory damage, followed by an aberrant repair process due to excessive TGF-beta production following allograft injury. Hence, modulation of TGF-beta levels or function by antagonists may represent an important approach to control OB.
Collapse
Affiliation(s)
- A El-Gamel
- Cardiothoracic Transplant Unit, Wythenshawe Hospital, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sheldon S, Yonan NA, Aziz TN, Hasleton PS, Rahman AN, Deiraniya AK, Campbell CS, Dyer PA. The influence of histocompatibility on graft rejection and graft survival within a single center population of heart transplant recipients. Transplantation 1999; 68:515-9. [PMID: 10480409 DOI: 10.1097/00007890-199908270-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a consecutive single center series of 261 patients who received first orthotopic heart transplants from 1986 to 1997. The 1- and 5-year graft survivals were 78 and 68%. The influence of histocompatibility was investigated by comparing graft survival and numbers of treated rejection episodes with HLA-A, -B, and -DR mismatches over different time periods. FINDINGS Recipients with six mismatches for HLA-A+-B+-DR combined (13.4%) had reduced survival at 7 years (47%) when compared with other recipients (64%). In the first year of transplant, recipients with four HLA-A+-B mismatches had significantly reduced actuarial graft survival (P=0.03) with the greatest influence apparent at 6 months [0-3 mismatches (n=193) 85% versus 4 mismatches (n=68) 69%; P=0.005, OR=2.1]. For 182 recipients with functioning hearts at 1 year, the number of rejection episodes treated within this time was strongly influenced by HLA-DR mismatch [0 DR mismatch (n=15) mean 1.2 rejection episodes versus 1 DR mismatch (n=76) mean 2.7 rejection episodes versus 2 DR mismatches (n=91) mean 3.8 rejection episodes: P=0.0002]. Of these 182 transplants, recipients who had more than four treated rejection episodes during the first year had a significantly reduced 7- year survival [<5 rejection episodes (n=133) 85% versus more than four rejection episodes (n=49) 66%; P=0.02, OR=3.4], as did those with two HLA-DR mismatches [0+1 mismatch (n=91) 87% versus 2 mismatches (n=91) 70%; P<0.05, OR=2.4]. INTERPRETATION We show that graft loss in the first 6 months of transplant is significantly influenced by four HLA-A+-B mismatches. HLA-DR mismatch significantly increases the number of rejection episodes within the first year, without influencing graft survival. After 12 months both >4 rejection episodes in the first year and two HLA-DR mismatches are markers for late graft loss. We postulate that immunological graft loss in the first 6 months is dominated by the direct allorecognition pathway driven by HLA-DR mismatch. This mechanism is later lost or suppressed. Our data highlight HLA-DR mismatch as a marker for late graft loss and we show an advantage to avoiding transplanting hearts with six HLA-A+-B+-DR mismatches and to minimizing HLA-DR mismatches whenever possible.
Collapse
Affiliation(s)
- S Sheldon
- Transplantation Laboratory, Manchester Royal Infirmary, UK
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Zhou M, Sheldon S, Akel N, Killeen AA. Chromosomal aneuploidy in leukemic blast crisis: a potential source of error in interpretation of bone marrow engraftment analysis by VNTR amplification. Mol Diagn 1999; 4:153-7. [PMID: 10462630 DOI: 10.1016/s1084-8592(99)80039-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Polymerase chain reaction (PCR) amplification of polymorphic microsatellite or minisatellite DNA markers has proven to be a fast, sensitive, and specific technique in post-transplantation monitoring of bone marrow engraftment, as well as early detection of residual disease and relapse. Deletion or amplification of chromosomal segments carrying marker loci, as can occur in leukemia and other hematologic malignancies, may result in loss or increased dosage of marker alleles. Examination of these marker alleles by PCR therefore may give aberrant results, which might lead to misinterpretation of bone marrow transplantation (BMT) engraftment studies. METHODS AND RESULTS We report a case of chronic myelogenous leukemia treated by BMT. PCR amplification of the minisatellite at the apoB locus on chromosome 2 was used to monitor the donor bone marrow engraftment. The patient experienced relapse in blast crisis with a near-haploid karyotype with loss of recipient-specific apoB allele causing an aberrant PCR result for bone marrow engraftment that mimicked full donor engraftment. CONCLUSIONS Loss or gain of polymorphic DNA markers because of chromosomal losses or gains in some hematologic malignancies may affect the interpretation of bone marrow engraftment studies by PCR. When choosing polymorphic markers for such studies, it is important to avoid those that will be affected by expected chromosomal alteration, if possible. In addition, any abberant post-transplantation typing should prompt further investigation to rule out the possibility of chromosomal aberration. Review of all pertinent laboratory studies is important to avoid misinterpretation of results from a single test for engraftment analysis.
Collapse
Affiliation(s)
- M Zhou
- Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-0602, USA
| | | | | | | |
Collapse
|
42
|
Abstract
In the UK, female genital mutilation is unlawful, not only when performed on minors, but also when performed on adult women. The aim of our paper is to examine several arguments which have been advanced in support of this ban and to assess whether they are sufficient to justify banning female genital mutilation for competent, consenting women. We proceed by comparing female genital mutilation, which is banned, with cosmetic surgery, towards which the law has taken a very permissive stance. We then examine the main arguments for the prohibition of the former, assessing in each case both (a) whether the argument succeeds in justifying the ban and, if so, (b) whether a parallel argument would not also support a ban on the latter. We focus on the following arguments. Female genital mutilation should be unlawful because: (1) no woman could validly consent to it; (2) it is an oppressive and sexist practice; (3) it involves the intentional infliction of injury; (4) it causes offence. Our view is that arguments (3) and (4) are unsound and that, although arguments (1) and (2) may be sound, they support not only a ban on female genital mutilation, but also one on (some types of) cosmetic surgery. Hence, we conclude that the present legal situation in the UK is ethically unsustainable in one of the following ways. Either the ban on female genital mutilation is unjustified because arguments (1) and (2) are not in fact successful; or the law's permissive attitude towards cosmetic surgery is unjustified because arguments (1) and (2) are in fact successful and apply equally to female genital mutilation and (certain forms of) cosmetic surgery. The people of the countries where female genital mutilation is practised resent references to 'barbaric practices imposed on women by male-dominated primitive societies', especially when they look at the Western world and see women undergoing their own feminization rites intended to increase sexual desirability: medically dangerous forms of cosmetic plastic surgery, for instance....
Collapse
|
43
|
Abstract
OBJECTIVES/HYPOTHESIS To determine the mode of inheritance of familial nonsyndromic Mondini dysplasia. STUDY DESIGN Correlative clinical genetic analysis of a single kindred. METHODS Clinical history, physical examination, audiologic analysis, computed tomography of the temporal bones, and cytogenetic analysis. RESULTS The male proband, three affected sisters, and an affected brother are offspring of unaffected parents. The mother and an unaffected brother have audiologic findings suggestive of heterozygous carrier status for a recessive hearing loss gene. CONCLUSIONS Pedigree analysis indicates autosomal recessive inheritance in this family. The observed inheritance and clinical, audiologic, and radiologic findings are different from those previously described for another family with nonsyndromic Mondini dysplasia. The phenotype in this study family therefore represents a distinct subtype, indicating clinical and genetic heterogeneity of this disorder. This information should facilitate future molecular linkage analyses and genetic counselling of patients with inner ear malformations.
Collapse
Affiliation(s)
- A J Griffith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Aziz TM, Sheldon S, el-Gamel A, Krysiak P, Campbell C, Rahman A, Dyer P, Yonan N, Deiraniya A. Implication of HLA mismatch in the clinical outcome of orthotopic heart transplantation. Transplant Proc 1998; 30:1917-9. [PMID: 9723332 DOI: 10.1016/s0041-1345(98)00481-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- T M Aziz
- Department of Transplantation Surgery, Wyhenshawe Hospital, Manchester, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
OBJECTIVE To describe the myelodysplastic syndromes (MDS) and cytogenetic abnormalities that occur in patients who have been treated with alkylating drugs for their rheumatic disease. METHODS Patients with rheumatic disease who developed MDS after current or previous treatment with alkylating drugs were selected for evaluation by chart review and cytogenetic studies. RESULTS Eight patients with rheumatic disease (mean age 56.9 years) developed MDS over the study period. Seven had received oral cyclophosphamide and 1 chlorambucil as their main immunosuppressive drug. The mean total cumulative dose of cyclophosphamide or chlorambucil was 118 gm and 6.5 gm, respectively, over a period of 2-10 years. The cytogenetic abnormalities included a deletion of all or part of chromosome 7 in 5 patients, while 4 had a deletion of part of the long arm of chromosome 5. Six of the patients have since died. CONCLUSION Large cumulative doses of cyclophosphamide and chlorambucil were associated with the development of MDS, the occurrence of abnormalities of chromosome 5 and/or chromosome 7 deletions, and a poor prognosis.
Collapse
Affiliation(s)
- C J McCarthy
- University of Michigan Medical Center, Ann Arbor, USA
| | | | | | | |
Collapse
|
46
|
Kroft SH, Finn WG, Singleton TP, Ross CW, Sheldon S, Schnitzer B. Follicular large cell lymphoma with immunoblastic features in a child with Wiskott-Aldrich syndrome: an unusual immunodeficiency-related neoplasm not associated with Epstein-Barr virus. Am J Clin Pathol 1998; 110:95-9. [PMID: 9661927 DOI: 10.1093/ajcp/110.1.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients with Wiskott-Aldrich syndrome, a severe inherited immunodeficiency disorder, have a markedly increased risk of developing non-Hodgkin's lymphoma compared with the general population. These are uniformly diffuse aggressive B-cell neoplasms that resemble those seen in AIDS and the posttransplantation setting and also may be associated with Epstein-Barr virus. We report what to our knowledge is the first case of follicular lymphoma in a 14-year-old child with Wiskott-Aldrich syndrome. The neoplasm was composed predominantly of large cells with immunoblastic features, and it possessed light chain-restricted surface immunoglobulin, clonal immunoglobulin gene rearrangements, and a t(14;18). The tumor lacked Epstein-Barr virus sequences by in situ hybridization and Southern blot terminal repeat analysis. Interestingly, however, the tumor contained c-myc gene rearrangement.
Collapse
MESH Headings
- Blotting, Southern
- Gene Rearrangement
- Genes, Immunoglobulin
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunocompromised Host
- Immunophenotyping
- In Situ Hybridization
- Infant
- Karyotyping
- Lymph Nodes/pathology
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Large-Cell, Immunoblastic/complications
- Lymphoma, Large-Cell, Immunoblastic/genetics
- Lymphoma, Large-Cell, Immunoblastic/pathology
- Male
- Proto-Oncogene Proteins c-myc/genetics
- Wiskott-Aldrich Syndrome/complications
Collapse
Affiliation(s)
- S H Kroft
- University of Michigan Medical School, Ann Arbor, USA
| | | | | | | | | | | |
Collapse
|
47
|
Su LD, Atayde-Perez A, Sheldon S, Fletcher JA, Weiss SW. Inflammatory myofibroblastic tumor: cytogenetic evidence supporting clonal origin. Mod Pathol 1998; 11:364-8. [PMID: 9578087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The inflammatory myofibroblastic tumor (IMT) is a distinctive but controversial lesion, usually occurring during childhood, composed of fascicles of bland myofibroblastic cells admixed with a prominent inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. Often affecting the lung and associated with constitutional symptoms, this lesion has been variously termed plasma cell granuloma, inflammatory pseudotumor, inflammatory myofibrohistiocytic proliferation, and inflammatory fibrosarcoma to reflect divergent views concerning its pathogenesis and level of malignancy. Cytogenetic analysis of an intra-abdominal myxoid hamartoma, a probable variant of this lesion, and a pulmonary IMT demonstrated clonal chromosomal abnormalities, lending support to the view that the IMT might be a neoplasm. There have been few cases studied to date, however, and the extent of cytogenetic anomalies in IMTs is not known. Karyotype analyses were performed on IMTs showing typical histologic features from three children. In addition, one case was studied by fluorescence in situ hybridization. Seventeen of 20 metaphase cells examined from a pulmonary IMT in a 5.5-year-old girl had an abnormal 47,XX+r(ring) karyotype. Fluorescence in situ hybridization studies demonstrated that the ring chromosome contained sequences of chromosome 8. Of 40 metaphase cells studied from a mesenteric IMT in an 8-month-old boy, 12 showed clonal aberrations, characterized as 43,XY,add(1)(p36),add(2)(p24),-6,der(14,22)(q10;q10),-19. Each of 20 metaphase cells examined from a retroperitoneal IMT in a 14-year-old girl contained complex clonal and nonclonal aberrations, characterized as 46-47,X,-X,add(2)(p22),add(2)(q13),+add(2)(q13),+5,-6,+i(7)(p10),add(8)( p11.2),+del(9)(p13),add(11)(p11.2)add(11)(q25),-13,-16,-18,add(19)(q13.1 ),add(19)(q13.1),+20,-21,-22,+mar1,+1-2mars. The presence of clonal chromosomal aberrations in all of the three tumors indicates that the IMT is a neoplastic proliferation.
Collapse
Affiliation(s)
- L D Su
- Department of Pathology, University of Michigan Hospitals, Ann Arbor 48105-0054, USA
| | | | | | | | | |
Collapse
|
48
|
Weidmer-Mikhail E, Sheldon S, Ghaziuddin M. Chromosomes in autism and related pervasive developmental disorders: a cytogenetic study. J Intellect Disabil Res 1998; 42 ( Pt 1):8-12. [PMID: 9534109 DOI: 10.1046/j.1365-2788.1998.00091.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Few studies have examined the occurrence of chromosome abnormalities in a large sample of patients with autism and related pervasive developmental disorders (PDDs). In the present report, the authors examined a consecutive series of 92 children with PDDs (DSM-III-R; 75 males and 17 females). A cytogenetic examination, including growth in folate deficient medium, was performed in all cases. Three patients (3.2%) (two females and one male) showed chromosome abnormalities: deletion of the long arm of chromosome 8; tetrasomy of chromosome 15; and XYY syndrome. Only the subject who had tetrasomy 15 met the criteria for autistic disorder, while the other were diagnosed as suffering from a PDD not otherwise specified (PDDNOS). Another patient showed an abnormal fragile site at Xq27 in three out of 100 cells. However, subsequent molecular studies did not confirm the presence of fragile-X syndrome. These results suggest that chromosome abnormalities are uncommon in traditional autism and may be relatively more common in people with PDDNOS.
Collapse
|
49
|
McDonald MT, Flejter W, Sheldon S, Putzi MJ, Gorski JL. XY sex reversal and gonadal dysgenesis due to 9p24 monosomy. Am J Med Genet 1997; 73:321-6. [PMID: 9415692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe a case of XY sex reversal, gonadal dysgenesis, and gonadoblastoma in a patient with a deletion of 9p24 due to a familial translocation. The rearranged chromosome 9 was inherited from the father; the patient's karyotype was 46,XY,der(9)t(8;9) (p21;p24)pat. A review shows that 6 additional patients with 46,XY sex reversal associated with monosomy of the distal short arm of chromosome 9 have been observed. The observation that all 7 patients with sex reversal share a deletion of the distal short arm of chromosome 9 is consistent with the hypothesis that the region 9p24 contains a gene or genes necessary for male sex determination. This present case narrows the chromosome interval containing a critical sex determination gene to the relatively small region 9p24. A molecular analysis of this region will provide a means to identify a gene involved in male sex determination.
Collapse
Affiliation(s)
- M T McDonald
- Department of Pediatrics, University of Michigan, Ann Arbor 48109-0688, USA.
| | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Allograft rejection is mediated by cytokines. As polymorphism in cytokine genes can result in interindividual differences in cytokine production, we hypothesize that some patients may have an increased risk of rejection. METHODS We have related polymorphisms that influence cytokine production in the tumor necrosis factor (TNF)-A and interleukin (IL)-10 genes to early graft rejection in 115 heart transplant recipients. RESULTS Certain combinations of TNF-A and IL-10 gene polymorphisms are associated with rejection. Five of 19 patients who had high levels of rejection typed as high TNF-alpha/low IL-10 producers compared with 4 of 96 patients with lower levels of rejection (P<0.005). CONCLUSIONS We have identified a particular cytokine genotype that may confer susceptibility to increased levels of early rejection. Patients with a worse prognosis may be able to be identified pretransplant by DNA analysis of TNF-A, IL-10, and other gene polymorphisms.
Collapse
Affiliation(s)
- D Turner
- Tissue Typing Laboratory, St. Mary's Hospital, Manchester, United Kingdom
| | | | | | | | | | | | | |
Collapse
|