Screening for Down's syndrome. Biochemical screening offers advantages.
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Biomedical subjects
Publications and source records attributed to M Jefferies.
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Different measures of raised blood pressure were analysed in 16,211 singleton pregnancies to determine the most effective way of identifying pre-eclampsia. Increments from baseline in the first half of pregnancy were considered as well as absolute levels. A combination of a high maximum diastolic pressure with a large increase from baseline was better for identifying a group with pre-eclamptic features than either measurement on its own. A first diastolic pressure below 90 mm Hg, a subsequent increase of at least 25 mm Hg, and a maximum reading of at least 90 mm Hg gave appropriate criteria. These were applied to a second set of 15,624 singleton pregnancies and successfully identified a group with pre-eclamptic features. Fewer women were identified as pre-eclamptic than with criteria modified from an existing definition widely used in Britain. The women excluded by the new criteria had the features of mild chronic hypertension rather than pre-eclampsia. The new definition is simple to use but like all other definitions of pre-eclampsia cannot be precise.
We have surveyed all community mental health centers (CMHC's), state departments of mental health, and university departments of psychiatry in the country to ascertain the status of their relationships with one another. The response rate to a one page questionnaire was 33%. An overwhelming percentage, 88%, of CMHC's have relationships with state hospitals and/or academia. Most often they consist of a service relationship. The control for such relationships is most often shared or there is no one controlling organization. The benefits of such relationships include improved communication, improved access to state hospitals, and improved quality of inpatient and outpatient care. CMHC's who responded to our survey did not think that relationships with the state or academia resulted in improved recruitment of psychiatrists and improved residency training--but state and academic respondents did. All, however, agreed that research, long-term care, and recruitment of other staff are minimally improved by collaborative relationships.
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In the adult case presented, inhibitory casting proved successful in decreasing the positive support reaction. When casting was discontinued, the positive reaction returned. To provide a long-term solution for this problem, a polypropylene tone-inhibiting AFO was fabricated. It incorporated the same principles as the casts. The success achieved with casting was rapidly regained and then surpassed with the use of the tone-inhibiting AFO. Natural recovery might be cited by some as the cause for improvement in the patient presented. However, the loss of improvement during the interval between the removal of the inhibitory casts and the initiation of the use of the tone-inhibiting AFO demonstrates that the casting and the position provided by the casts had a positive effect on our patient. This notion is further supported by the fact that our patient still required use of the tone-inhibiting AFO as late as March 1980. We have no explanation for the rapid improvement following the cranioplasty. Suggestions for further research would include a similar study with a larger number of subjects and the use of cinematography and kinesiological EMG during walking with and without tone-inhibiting casts and orthoses to determine the effect of the devices on spastic muscle groups and gait patterns.
Serum and milk alkaline phosphatase (AP) values are reported for the first 16 weeks of lactation. Serum levels at all stages are elevates above normal-pregnant controls. Sequential milk AP values are reported for the first time. Heat inactivation and phenylalanine inhibition studies would suggest that serum AP in lactation is composed of bone and liver isoenzymes, but it shows an increase in the rate at which enzymatic activity is lost when frozen, indicating that lactation serum AP is largely a different isoenzyme. Electrophoresis demonstrates several AP "slow" bands of unknown origin in lactation serum.
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