Severe Preeclampsia in the Setting of Myasthenia Gravis.

Myasthenia gravis (MG) is a rare autoimmune disease that leads to progressive muscle weakness and is common during female reproductive years. The myasthenic mother and her newborn must be observed carefully, as complications during all stages of pregnancy and the puerperium may arise suddenly. Preeclampsia is a common obstetrical condition for which magnesium sulfate is used for seizure prophylaxis.

A Practical Approach to Address Uncertainty in Stakeholder Deliberations.

This article addresses the difficulties of incorporating uncertainty about consequence estimates as part of stakeholder deliberations involving multiple alternatives. Although every prediction of future consequences necessarily involves uncertainty, a large gap exists between common practices for addressing uncertainty in stakeholder deliberations and the procedures of prescriptive decision-aiding models advanced by risk and decision analysts. We review the treatment of uncertainty at four main phases of the deliberative process: with experts asked to describe possible consequences of competing alternatives, with stakeholders who function both as individuals and as members of coalitions, with the stakeholder committee composed of all stakeholders, and with decisionmakers.

Decision strategies to reduce teenage and young adult deaths in the United States.

This article uses decision analysis concepts and techniques to address an extremely important problem to any family with children, namely, how to avoid the tragic death of a child during the high-risk ages of 15-24. Descriptively, our analysis indicates that of the 35,000 annual deaths among this age group in the United States, approximately 20,000 could be avoided if individuals chose readily available alternatives for decisions relating to these deaths. Prescriptively, we develop a decision framework for parents and a child to both identify and proactively pursue decisions that can lower that child's exposure to life-threatening risks and positively alter decisions when facing such risks.

A value model for evaluating homeland security decisions.

One of the most challenging tasks of homeland security policymakers is to allocate their limited resources to reduce terrorism risks cost effectively. To accomplish this task, it is useful to develop a comprehensive set of homeland security objectives, metrics to measure each objective, a utility function, and value tradeoffs relevant for making homeland security investments. Together, these elements form a homeland security value model.

Modeling values for anti-terrorism analysis.

Decisions are made to achieve objectives. A qualitative list of the objectives for a decision is the foundation for a value model that unambiguously represents objectives in a quantitative manner. The objectives guide thinking and the value model provides a basis for analyzing alternatives to best meet the desired objectives.

Development of a Cl-impregnated activated carbon for entrained-flow capture of elemental mercury.

Efforts to discern the role of an activated carbon's surface functional groups on the adsorption of elemental mercury (Hg0) and mercuric chloride demonstrated that chlorine (Cl) impregnation of a virgin activated carbon using dilute solutions of hydrogen chloride leads to increases (by a factor of 2-3) in fixed-bed capture of these mercury species. A commercially available activated carbon (DARCO FGD, NORITAmericas Inc. [FGD])was Cl-impregnated (Cl-FGD) [5 lb (2.

A framework to guide thinking and analysis regarding climate change policies.

The potential impacts from climate change, and climate change policies, are massive. Careful thinking about what we want climate change policies to achieve is a crucial first step for analysts to help governments make wise policy choices to address these concerns. This article presents an adaptive framework to help guide comparative analysis of climate change policies.

The hidden traps in decision making.

Bad decisions can often be traced back to the way the decisions were made--the alternatives were not clearly defined, the right information was not collected, the costs and benefits were not accurately weighed. But sometimes the fault lies not in the decision-making process but rather in the mind of the decision maker. The way the human brain works can sabotage the choices we make.

The hidden traps in decision making.

Bad decisions can often be traced back to the way the decisions were made--the alternatives were not clearly defined, the right information was not collected, the costs and benefits were not accurately weighted. But sometimes the fault lies not in the decision-making process but rather in the mind of the decision maker. The way the human brain works can sabotage the choices we make.

Even swaps: a rational method for making trade-offs.

Making wise trade-offs is one of the most important and difficult challenges in decision making. Needless to say, the more alternative you're considering and the more objectives you're pursuing, the more trade-offs you'll need to make. The sheer volume of trade-offs, however, is not what makes decision making so hard.

A prescriptive risk framework for individual health and safety decisions.

A conceptual framework is developed for the prescriptive evaluation of health and safety risks to an individual. This framework allows one to compare chronic vs. acute health risks, accidents vs.

Purification of the IL-2 receptor (TAC) by ligand-affinity chromatography and utilization of the immobilized receptor for receptor-affinity chromatography (RAC) purification of IL-2, mutant IL-2, and IL-2 fusion proteins.

Recombinant technology has facilitated the production of two soluble forms of human p55 interleukin-2 receptor (IL-2R) in Chinese hamster ovary cells. We have developed a ligand-affinity method for the medium-scale purification of these two soluble forms of the IL-2R, based on the biochemical interactions between the matrix-bound ligand (interleukin-2) and its soluble receptor. The affinity-purified IL-2R is further purified by anion-exchange chromatography followed by gel filtration.

Mortality risks induced by economic expenditures.

Existing evidence shows that lower incomes are associated with higher mortality risks. This paper examines the implications for fatalities when the relationship is interpreted as an induced relationship, meaning that lower incomes will on average lead to higher mortality risks. A model is developed for estimating the number of fatalities possibly induced by economic expenditures.

Medium-scale ligand-affinity purification of two soluble forms of human interleukin-2 receptor.

Recombinant technology has facilitated the production of two soluble forms of human interleukin-2 receptor (IL-2R) in Chinese hamster ovary cells. We have developed a ligand-affinity method for the medium-scale purification of these two IL-2Rs, based on the biochemical interactions between the matrix-bound ligand (interleukin-2) and its soluble receptor. The affinity-purified IL-2R is further purified by anion-exchange chromatography followed by gel filtration.

Chronic suppression for six months compared with intermittent lesional therapy of recurrent genital herpes using oral acyclovir: effects on lesions and nonlesional prodromes.

Forty-seven patients with frequently recurrent genital herpes were treated with 200 mg of acyclovir or placebo capsules taken orally three times daily for six months; the drug was then withdrawn. Active lesional events were treated with open-labeled 200-mg acyclovir capsules five times daily for five days during the six months of suppression and for six months thereafter if the patient returned to the clinic for culture and treatment. During the six months of treatment, seven of 24 acyclovir recipients and none of 23 placebo recipients reported no lesions (P less than 0.

An analysis of the portfolio of sites to characterize for selecting a nuclear repository.

The U.S. Department of Energy has selected three sites, from five nominated, to characterize for a nuclear repository to permanently dispose of nuclear waste.

A multiattribute utility analysis of alternative sites for the disposal of nuclear waste.

Five potential sites nominated for the Nation's first geologic repository for disposing of nuclear waste are evaluated using multiattribute utility analysis. The analysis was designed to aid the Department of Energy in its selection of 3 sites for characterization, a detailed data-gathering process that will involve the construction of exploratory shafts for underground testing and that may cost as much as $1 billion per site. The analysis produced insights into the relative advantages and disadvantages of the nominated sites and clarified current uncertainties regarding repository performance.

Improving risk communication.

This paper explores reasons for difficulties in communicating risks among analysts, the laypublic, media, and regulators. Formulating risk communication problems as decisions involving objectives and alternatives helps to identify strategies for overcoming these difficulties. Several strategies are suggested to achieve risk communication objectives like improving public knowledge about risks and risk management, encouraging risk reduction behavior, understanding public values and concerns, and increasing trust and credibility.

Infections caused by herpes simplex virus in the immunocompromised host: natural history and topical acyclovir therapy.

Sixty-three immunocompromised patients with infections caused by herpes simplex virus were evaluated in a double-blind, placebo-controlled study of topical acyclovir therapy; 33 patients received acyclovir and 30 received the placebo. The two populations of patients were balanced in terms of age, race, sex, underlying disease, preceding chemotherapy, and site, size, and duration of lesions. Acyclovir recipients experienced an acceleration in the clearance of virus (P = .

Treatment of varicella-zoster meningoencephalitis with acyclovir--demonstration of virus in cerebrospinal fluid by electron microscopy.

Disseminated varicella-zoster (V-Z) infection developed in three immunocompromised patients, with direct invasion of the central nervous system by virus. For two of these patients, diagnosis was confirmed by electron microscopic examination of cerebrospinal fluid (CSF) and detection of viral particles. Extensive immunologic evaluation demonstrated impairment of cellular immune function.

Acyclovir halts progression of herpes zoster in immunocompromised patients.

We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures.

Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir. A randomized double-blind controlled trial in normal subjects.

We performed a double-blind placebo-controlled trial of oral acyclovir in the treatment of first episodes of genital herpes simplex virus infections in 48 young adults (31 women and 17 men). Subjects were randomized to receive either placebo or acyclovir (200 mg per dose) five times daily for 10 days; they were examined on at least eight visits until healed and at monthly visits thereafter. Acyclovir treatment, as compared with placebo, significantly reduced virus shedding, new lesion formation after 48 hours, and the duration of genital lesions in both men and women.