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Luke B.,Michigan State University | Brown M.B.,University of Michigan | Wantman E.,Redshift Technologies | Lederman A.,Redshift Technologies | And 6 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. METHODS: We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. RESULTS: The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. CONCLUSIONS: Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology). Copyright © 2012 Massachusetts Medical Society. Source


Kennedy S.,Cornell Medical Center | Forman H.P.,Yale University
Radiology | Year: 2012

Purpose: To ascertain the effects of the payment reductions in the Deficit Reduction Act (DRA), which affected only in-office imaging, on the utilization of noninvasive musculoskeletal imaging. Materials and Methods: This study of nonidentifiable aggregate data did not require institutional review board approval. Medicare Part B Physician/Supplier Procedure Summary Files for 2004, 2006, and 2008 were used. By using descriptive statistics and weighted linear regression, all 111 relevant procedure codes were evaluated to measure the effect of the DRA's payment reductions on change in utilization growth rate between the pre-DRA (2004-2006) and post-DRA (2006-2008) periods. Results: Overall, between the pre-DRA and post-DRA periods, the type of imaging studied demonstrated a 2% deceleration (reduction in per capita utilization growth rate) in the office and a 0.7% deceleration in the outpatient hospital setting. However, nonradiologist and radiologist utilization were both still growing, particularly for nonradiographic imaging. In the office, for both nonradiologists and radiologists, larger DRA payment reductions were associated with greater deceleration; deceleration was approximately 0.2% greater for each additional 1% of reimbursement reduction. There was no payment-reduction-size- related acceleration in the outpatient setting. Conclusion: The growth rate of in-office noninvasive musculoskeletal imaging performed by nonradiologists and the growth rate of this type of imaging being referred to radiologists decreased in the period following the implementation of the DRA. Nonetheless, after the DRA, in-office nonradiographic noninvasive musculoskeletal imaging performed by nonradiologists was still growing much more rapidly than that performed by radiologists. © RSNA, 2012. Source


Downs J.A.,New York Medical College | Mguta C.,Health Science University | Kaatano G.M.,National Institute for Medical Research | Mitchell K.B.,Cornell Medical Center | And 6 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

We conducted a community-based study of 457 women aged 18 - 50 years living in eight rural villages in northwest Tanzania. The prevalence of female urogenital schistosomiasis (FUS) was 5% overall but ranged from 0% to 11%. FUS was associated with human immunodeficiency virus (HIV) infection (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.2 - 13.5) and younger age (OR = 5.5 and 95% CI = 1.2 - 26.3 for ages < 25 years and OR = 8.2 and 95% CI = 1.7 - 38.4 for ages 25 - 29 years compared with age > 35 years). Overall HIV prevalence was 5.9% but was 17% among women with FUS. We observed significant geographical clustering of schistosomiasis: northern villages near Lake Victoria had more Schistosoma mansoni infections (P < 0.0001), and southern villages farther from the lake had more S. haematobium (P = 0.002). Our data support the postulate that FUS may be a risk factor for HIV infection and may contribute to the extremely high rates of HIV among young women in sub-Saharan Africa. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene. Source


Desancho M.T.,Cornell University | Desancho M.T.,Cornell Medical Center | Dorff T.,University of Southern California | Rand J.H.,Yeshiva University | Rand J.H.,Montefiore Medical Center
Blood Coagulation and Fibrinolysis | Year: 2010

Thrombophilia contributes to the risk of thrombosis in women using female hormones. The objective of the present study was to evaluate the prevalence of thrombophilia in women with thromboembolic events (TEEs) using oral contraceptives or hormone replacement therapy (HRT) and assess the contribution of a family history and the duration of hormone use in predicting thrombosis. A retrospective analysis was performed of the case records of women who developed a TEE while on oral contraceptives or HRT and were referred for thrombophilia evaluation over a 4-year period. Among 85 women who developed a TEE while on oral contraceptives or HRT, 65 had at least one additional thrombophilia risk factor. Of the 85 cases, 23 tested positive for more than two thrombophilias, 16 had factor V Leiden, five had the prothrombin gene G20210A polymorphism, 26 had antiphospholipid antibodies, 10 had elevated homocysteine, four had protein C deficiency, and seven had protein S deficiency. There were 64 TEE: 16 pulmonary emboli, 17 cerebrovascular events, 11 intra-abdominal thromboses, 13 deep venous thromboses, five cases of superficial thrombophlebitis, and two retinal vein thromboses. Of the 65 women, 37% had a positive family history of thrombosis. Approximately half of the women had been taking oral contraceptives or HRT for more than 1 year. There is a high prevalence of thrombophilia in women who developed a TEE while using oral contraceptives or HRT for more than 1 year. Family and personal history of thrombosis should be carefully evaluated in all women before initiating or continuing oral contraceptives or HRT, and a positive history may warrant a thrombophilia screening. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Jamerson K.A.,University of Michigan | Devereux R.,Cornell Medical Center | Bakris G.L.,University of Chicago | Dahlof B.,Sahlgrenska University Hospital | And 7 more authors.
Hypertension | Year: 2011

The combination of benazepril plus amlodipine was shown to be more effective than benazepril plus hydrochlorothiazide in reducing cardiovascular events in the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial. There was a small difference in clinic systolic blood pressure between the treatment arms favoring benazepril plus amlodipine. Ambulatory blood pressure monitoring provides a more rigorous estimate of blood pressure effects. A subset of 573 subjects underwent ambulatory blood pressure monitoring during year 2. Readings were obtained every 20 minutes during a 24-hour period. Between-treatment differences (benazepril plus amlodipine versus benazepril plus hydrochlorothiazide) in mean values were analyzed using ANOVA. Treatment comparisons with respect to categorical variables were made using Pearson's χ. At year 2, the treatment groups did not differ significantly in 24-hour mean daytime or nighttime blood pressures (values of 123.9, 125.9, and 118.1 mm Hg for benazepril plus amlodipine group versus 122.3, 124.1, and 116.9 for the benazepril plus hydrochlorothiazide group), with mean between-group differences of 1.6, 1.8, and 1.2 mm Hg, respectively. Blood pressure control rates (24-hour mean systolic blood pressure <130 mm Hg on ambulatory blood pressure monitoring) were greater than 80% in both groups. Nighttime systolic blood pressure provided additional risk prediction after adjusting for the effects of drugs. The 24-hour blood pressure control was similar in both treatment arms, supporting the interpretation that the difference in cardiovascular outcomes favoring a renin angiotensin system blocker combined with amlodipine rather than hydrochlorothiazide shown in the ACCOMPLISH trial was not caused by differences in blood pressure, but instead intrinsic properties (metabolic or hemodynamic) of the combination therapies. © 2011 American Heart Association. All rights reserved. Source

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