Indigenous uses of wild and tended plant biodiversity maintain ecosystem services in agricultural landscapes of the Terai Plains of Nepal.

Background: Despite a rapidly accumulating evidence base quantifying ecosystem services, the role of biodiversity in the maintenance of ecosystem services in shared human-nature environments is still understudied, as is how indigenous and agriculturally dependent communities perceive, use, and manage biodiversity. The present study aims to document traditional ethnobotanical knowledge of the ecosystem service benefits derived from wild and tended plants in rice-cultivated agroecosystems, compare this to botanical surveys, and analyze the extent to which ecosystem services contribute social-ecological resilience in the Terai Plains of Nepal.

Method: Sampling was carried out in four landscapes, 22 Village District Committees, and 40 wards in the monsoon season.

Applying the robust adaptation planning (RAP) framework to Ghana's agricultural climate change adaptation regime.

This paper introduces a five-step framework, namely the Robust Adaptation Planning (RAP) framework, to plan and respond to the 'grand challenge' of climate change. RAP combines, under a unified framework, elements from robust action, participatory planning and network theory to capture the different motives, perception, and roles of actors that are important for climate change adaptation. RAP leverages existing structures and networks and involves diverse actors to plan, sequence and time strategies across multiple levels (i.

Society for maternal-fetal medicine (SMFM) special report: the maternal-fetal medicine subspecialists' role within a health care system.

A maternal-fetal medicine (MFM) subspecialist has advanced knowledge of the medical, surgical, obstetrical, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. MFM subspecialists are complementary to obstetric care providers in providing consultations, co-management, or transfer of care for complicated patients before, during, and after pregnancy. The MFM subspecialist provides peer and patient education and performs research concerning the most recent approaches and treatments for obstetrical problems, thus promoting risk-appropriate care for these complicated pregnancies.

The patient-centered medical home and accountable care organizations: an overview.

Purpose Of Review: As the crisis regarding the cost of medical care in the United States continues to spiral out of control, new models of care are being touted as a means to fix the economics of healthcare. This review will examine newly proposed models of healthcare.

Recent Findings: The patient-centered medical home (PCMH) and accountable care organizations (ACOs) are two models that have leapt to the forefront of healthcare reform.

Antenatal diagnosis and perinatal management of extremely giant fetal cervicopharyngeal teratoma resulting in impossible fetal intubation: a case report.

We report the case of an extremely large giant neck teratoma diagnosed on routine sonogram and confirmed by 3-D and 4-D sonography and MRI in a 19-year-old primigravida at 18 weeks. Rapid growth, polyhydramnios, premature contractions and premature rupture of membranes necessitated delivery at 28 weeks. Under general anesthesia, with a multidisciplinary team attendant, efforts by the otolaryngologist to establish an airway during an EXIT (ex utero intrapartum treatment) procedure failed as did subsequent attempts by the neonatologist, leading to an early neonatal death.

Adaptive management of the Great Barrier Reef and the Grand Canyon world heritage areas.

Conventional perceptions of the interactions between people and their environment are rapidly transforming. Old paradigms that view humans as separate from nature, natural resources as inexhaustible or endlessly substitutable, and the world as stable, predictable, and in balance are no longer tenable. New conceptual frameworks are rapidly emerging based on an adaptive approach that focuses on learning and flexible management in a dynamic social-ecological landscape.

Lemierre's syndrome complicating pregnancy.

Lemierre's syndrome is an anaerobic suppurative thrombophlebitis involving the internal jugular vein secondary to oropharyngeal infection. There is only one previous case report in pregnancy which was complicated by premature delivery of an infant that suffered significant neurological damage. We present an atypical case diagnosed in the second trimester with a live birth at term.

Cocaine body packing in pregnancy.

Ingesting multiple packets of drugs ("body packing") is a well-described method of smuggling. Although older reports suggested that body packers were mostly young men, the demographics of this group may be changing because children, older patients, and pregnant women may be involved. Pregnant patients represent a challenge in management, particularly in the event of package rupture.

Maternal death after second-trimester genetic amniocentesis.

Background: We report a maternal death after a second-trimester amniocentesis.

Case: An uncomplicated amniocentesis was performed using sterile technique and ultrasound guidance. A refrigerated amniotic fluid specimen demonstrated negative leukocyte esterase activity, negative Gram stain for bacteria and white blood cells, and normal glucose and interleukin-6.

The effect of a single remote course versus weekly courses of antenatal corticosteroids on functional residual capacity in preterm infants: a randomized trial.

Objective: There are no randomized data on the effect of repeat courses of corticosteroids during pregnancy on newborn pulmonary function. Our objective was to compare the effect of a single remote course of antenatal steroids (AS) with weekly courses of AS on functional residual capacity (FRC) and respiratory compliance in preterm infants.

Study Design/methods: Pregnant women 25 to 33 weeks' gestation, who remained undelivered 1 week after their first course of antenatal corticosteroids (two 12-mg doses of betamethasone) were randomized to weekly courses of corticosteroids versus weekly placebo until delivery or 34 weeks' gestation.

A study to determine the incidence and prevalence of newly discovered human immunodeficiency virus infection during the prenatal care period.

Objectives: This study asked the following questions: 1) Does HIV testing in pregnancy identify women who previously were not known to be HIV positive? 2) When in pregnancy are women identified as HIV infected? 3) Does HIV seroconversion occur during the prenatal care period?

Methods: Medical records of 97 women from two primarily indigent care hospitals in Houston, TX who were found to be HIV positive at delivery were reviewed to determine if they had tested positive during the prenatal care period. Demographics and time of gestation of the prenatal testing also were recorded. The outcome measures were: 1) number of women found positive during prenatal care; 2) week of gestation at discovery of HIV positivity; and 3) number of women seroconverting between the initiation of prenatal care and delivery.

Vaginal infections in human immunodeficiency virus-infected women.

Objective: This study was undertaken to compare the frequencies of vaginal infections among human immunodeficiency virus-infected women with those among human immunodeficiency virus-seronegative women.

Study Design: Human immunodeficiency virus-seropositive women attending a comprehensive care center for human immunodeficiency virus disease at the outpatient department of an inner-city hospital in Houston underwent rigorous gynecologic evaluation for sexually transmitted diseases, including evidence of vaginal infections such as bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Demographic information was collected, as was information regarding disease classification and degree of immunosuppression.

Synthesis of IFN-gamma by CD8(+) T cells is preserved in HIV-infected women with HPV-related cervical squamous intraepithelial lesions.

Objective: The aim of this study was to investigate whether coinfection with HIV affects the synthesis of Th1 and Th2 cytokines by peripheral blood T cells of women infected with human papillomavirus (HPV).

Methods: Cervical swabs and peripheral blood were obtained from women referred for colposcopy. HPV DNA by Digene's hybrid capture assay, HIV RNA by Roche's Amplicor assay, and cytokine synthesis of T-cell subsets by flow cytometry were assessed.

Routine use of episiotomy in modern obstetrics. Should it be performed?

Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. Although episiotomy does decrease the occurrence of anterior lacerations, it fails to accomplish the majority of goals stated as reasons for its use. Episiotomy does not decrease damage to the perineum but rather increases it.

Ultrasound evaluation of the fetal heart: is it possible?

Ultrasound evaluation of the fetal heart can be performed. Knowledge of the embryology, anatomy, and function of the heart have led us to understand the pathophysiology of congenital heart disease. In this review we discuss the indications as well as some basic principles of fetal echocardiography.

TORCH testing in HIV-infected women.

The issue of TORCH testing in pregnant women infected with the HIV virus remains confusing, even more so than it is in the non-HIV-infected gravida. Unfortunately, the data presented in this article make the recommendations of how to test for these various infections in pregnancy that much more difficult. Patients who are newly diagnosed as being HIV-infected and referred for prenatal care or who have not had TORCH testing probably should be tested.

Legal considerations in screening pregnant women for human immunodeficiency virus.

This article examines the legal implications of studies showing that the probability of maternal-to-infant human immunodeficiency virus transmission can be reduced by physician interventions. These interventions require knowledge of a pregnant woman's human immunodeficiency status. Hence the offering of human immunodeficiency virus testing has become a standard of care in pregnancy.

Compliance with universal precautions: knowledge and behavior of residents and students in a department of obstetrics and gynecology.

Objectives: To assess the knowledge of universal precautions for the delivery and operating rooms by residents and students and to evaluate their use of universal precautions.

Study Design: Obstetrics and gynecology (ob/gyn) residents (n = 30) and students (n = 31) from an inner-city, teaching hospital were polled by anonymous questionnaire to assess their knowledge of the appropriate barrier equipment for certain ob/gyn procedures. To determine actual compliance with universal precautions, 459 ob/gyn procedures were observed.

Cutaneous anergy in pregnant and nonpregnant women with human immunodeficiency virus.

Objective: To determine the prevalence of cutaneous anergy in pregnant and nonpregnant women who are seropositive for human immunodeficiency virus.

Methods And Materials: The medical records of 159 women seropositive for human immunodeficiency virus were reviewed. Demographic characteristics and tuberculin skin test results were abstracted from the chart.

Inflammatory cytokine expression is correlated with the level of human immunodeficiency virus (HIV) transcripts in HIV-infected placental trophoblastic cells.

The inflammatory cytokines interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor alpha (TNF-alpha) have been associated with increased human immunodeficiency virus (HIV) expression and enhanced lymphocyte adhesion to trophoblastic cells in experimental systems. To determine if there is a correlation between the expression of these cytokines and the levels of HIV transcripts in trophoblasts of term placentas from HIV-infected women, we studied the placentae of 30 HIV-positive and 13 control gravidae. Twenty-three of the HIV-positive women received zidovudine (ZDV) as prophylaxis against HIV vertical transmission; only one of the seven women who did not receive ZDV was a transmitter, for an overall vertical transmission rate of 3.

Quality of life assessment in pregnant women with the human immunodeficiency virus.

Objective: To describe the perceived quality of life and functional status of women with human immunodeficiency virus (HIV) during the antenatal, perinatal, and postpartum periods.

Methods: Medical Outcome Survey-Short Form questionnaires were completed during antenatal visits, 24 hours after delivery, and 6 months postpartum by 21 HIV-positive women and 21 HIV-negative controls matched for age, race, parity, and education. The Medical Outcome Survey-Short Form measures subject perceptions of overall health, pain, physical role, social and cognitive function, mental health, energy/fatigue, health distress, quality of life, and health transition.

Prenatal sonographic diagnosis of a third ventricle choroid plexus papilloma.

We report a case of fetal hydrocephalus secondary to a third ventricle choroid plexus papilloma detected by ultrasound at 33 weeks' gestation. The prenatal sonographic and colour flow Doppler findings of this rare fetal intracranial tumour are discussed.