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Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).
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What Is Post Traumatic Stress Disorder? What Is PTSD? What Causes PTSD?
PTSD (Post-Traumatic Stress Disorder) is triggered by a traumatic event - it is a kind of anxiety. The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness. Most of us experience a brief period of difficulty adjusting and coping with traumatic events. However, we gradually get better with time and healthy coping methods. On the other hand, there are times when symptoms get worse and may last for several months, or years. This study explains how PTSD can surface two years after a traumatic event. Another study found that one in eight Lower Manhattan residents likely had PTSD two to three years after the 9/11 attacks.
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New Isotope Cluster Could Lead To Better Understanding Of Atmospheric Carbon Dioxide
A team of researchers has discovered an unexpected concentration of a certain isotopic molecule in parts of the stratosphere that could have implications for understanding the carbon cycle and its response to climate change.
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Barriers Hinder EMS Workers From Using Best Resuscitation Practices

Local laws, insurance reimbursement and public misperceptions impede emergency medical services (EMS) workers from using best resuscitation practices, according to a study reported in Circulation: Cardiovascular Quality and Outcomes. Less than half of local EMS systems follow national guidelines on transporting cardiac arrest patients and terminating unsuccessful out-of-hospital resuscitation efforts, said researchers who conducted three small focus groups at the 2008 National Association of Emergency Medical Services Physicians meeting in Jacksonville, Fla. Each focus group had four to 12 participants. The majority (79.1 percent) were physicians, and 66.7 percent were EMS directors at a wide variety of practice settings. Based on the focus group analysis, researchers identified three key areas where policies or perceptions may impede local efforts to follow the guidelines for terminating unsuccessful resuscitation efforts: * private insurers and Medicare who provide higher reimbursement to EMS for patient transport, regardless of whether the cardiac arrest victim is successfully resuscitated in the field or not; * state legislation that requires transport to hospitals and restricts the ability of responders to follow do-not-resuscitate (DNR) orders; and * community members who overestimate the chance for survival and believe a hospital can provide better care than responders on site. "If an EMS team spends 30 minutes and can"t get a patient"s pulse back, they will not be reimbursed by Medicare for the level of care they have provided, or the time the ambulance was out of service," said Comilla Sasson, M.D., M.S., Robert Wood Johnson Clinical Scholar and a clinical lecturer in the department of Emergency Medicine at the University of Michigan Medical School in Ann Arbor. "However, transporting a patient before a full attempt at resuscitation reduces the chance of survival - getting a pulse prior to transport is really important. Paramedics can"t provide good CPR in the back of an ambulance while flying down the road at 90 miles an hour, with lights and sirens blazing, to the hospital." The American Heart Association recommends that paramedics on the scene administer good-quality CPR, shock the heart to try to re-establish a normal heart rhythm and provide appropriate advanced cardiovascular life support. The final decision to stop resuscitation efforts must be based on clinical judgment and respect for human dignity. Cessation of efforts in the out-of-hospital setting, following system-specific criteria and under direct medical control, should be standard practice in all EMS systems. "The point at which we"re talking about terminating resuscitation is when you"ve done everything you can and there is virtually no chance of survival," said Sasson, lead author of the study. "Unfortunately, the current public policies for reimbursement, state laws and public perceptions, do not allow EMS providers to do the appropriate thing for the patient." Each year in the United States, EMS treats nearly 300,000 out-of-hospital cardiac arrests, according to the American Heart Association. Less than 8 percent of out-of-hospital cardiac arrest victims survive to hospital discharge. While participants provided key insights into barriers to implementing national guidelines, researchers said a larger study may discover additional detail and variation. Notes: Co-authors are: Jane Forman, Sc.D., M.H.S.; David Krass, B.A.; Michelle Macy, M.D., M.S.; Arthur L. Kellermann, M.D., M.P.H.; and Bryan F. McNally, M.D., M.P.H. Individual author disclosures are available on the manuscript. The Robert Wood Johnson Foundation Clinical Scholars Program funded the study. Kate Lino American Heart Association


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