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Jacques FH, Apedaile BE, Danis I, Sikati-Foko V, Lecompte M, Fortin J. Motor Evoked Potential-A Pilot Study Looking at Reliability and Clinical Correlations in Multiple Sclerosis. J Clin Neurophysiol 2024; 41:357-364. [PMID: 36943437 PMCID: PMC11060055 DOI: 10.1097/wnp.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) is a clinically heterogeneous disease. Biomarkers that can assess pathological processes that are unseen with conventional imaging remain an unmet need in MS disease management. Motor evoked potentials (MEPs) could be such a biomarker. To determine and follow longitudinal MEP reliability and correlations with clinical measures in MS patients. METHODS This is a single-center study in alemtuzumab-treated MS patients to evaluate temporal reliability of MEPs, identify MEP minimum detectible differences, and explore correlations with existing clinical scales. Ten MS patients recently treated with alemtuzumab were evaluated every 6 months over 3 years. Clinical evaluations consisted of expanded disability status scale, timed 25-foot walk, 6-minute walk, and nine-hole peg test. MEPs were measured twice, 2 weeks apart, every 6 months. RESULTS Eight patients completed all 3 years of study. The intraclass correlation coefficient for MEP parameters ranged from 0.76 to 0.98. TA latency and amplitude with facilitation significantly and strongly correlated with all clinical measures, whereas the MEP duration modestly correlated. Biceps latency with facilitation significantly and moderately correlated with 9-hole peg test. Longitudinal correlations demonstrated good predictive values for either clinical deterioration or improvement. CONCLUSIONS MEPs have excellent intrapatient and intrarater reliability, and TA MEPs significantly and strongly correlated with expanded disability status scale, 6-minute walk, and timed 25-foot walk, whereas biceps MEPs significantly and moderately correlated with nine-hole peg test. Further studies using larger cohorts of MS patients are indicated. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02623946.
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Affiliation(s)
- F H Jacques
- Clinique Neuro-Outaouais, Gatineau, Quebec, Canada
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Bharadwa S, Fulcher I, Fortin J, Pocius KD, Goldberg AB. hCG trends after mifepristone and misoprostol for undesired pregnancy of unknown location. Contraception 2024; 131:110343. [PMID: 38008304 DOI: 10.1016/j.contraception.2023.110343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES To describe human chorionic gonadotropin (hCG) trends for patients with a pregnancy of unknown location (PUL) presenting for medication abortion by management strategy and outcome. STUDY DESIGN This retrospective cohort study included patients presenting for medication abortion with a PUL at ≤42 days gestation managed with either (1) immediate mifepristone with serial hCG follow-up (same-day-start) or (2) hCG testing every 48 to 72 hours ± ultrasonography to confirm pregnancy location followed by treatment (delay-for-diagnosis). The primary outcome was percent hCG change over time between presentation and diagnosis, summarized using a multivariate regression model. RESULTS Of the 55 same-day-start patients, none were treated for ectopic. The eight who eventually required suction curettage had median hCG percent changes (interquartile range) on days 3, 4, and 5 of +57% (-14 to 127; n = 2), +292% (226-353; n = 4), and +392% (n = 1), while the 41 successful medication abortions had declines of -64% (n = 1), -65% (-75 to -27; n = 17), and -77% (-85 to -68; n = 13). Of the 380 delay-for-diagnosis patients, the 30 ectopic pregnancies had day 3, 4, and 5 changes of +38% (-17 to 56; n = 14), +50% (17-71; n = 7), and +115% (87-177; n = 4). None of the ectopic pregnancies declined ≥50% by days 3 to 5. The hCG trend for ectopic pregnancies differed from successful medication abortions (p < 0.01), but not medication abortions with retained intrauterine pregnancies (p = 0.41). CONCLUSIONS Serum hCG trends can help differentiate ectopic pregnancy from successful medication abortion, but cannot distinguish between ectopic and retained intrauterine pregnancy. IMPLICATIONS Serial serum hCG testing is effective for confirming successful medication abortion and identifying patients requiring further follow-up among patients undergoing medication abortion for an undesired PUL.
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Affiliation(s)
- Sonya Bharadwa
- Harvard Medical School, Boston, MA, United States; Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, United States.
| | - Isabel Fulcher
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, United States; The Planned Parenthood League of Massachusetts, Boston, MA, United States
| | - Jennifer Fortin
- The Planned Parenthood League of Massachusetts, Boston, MA, United States
| | - Katherine D Pocius
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - Alisa B Goldberg
- Harvard Medical School, Boston, MA, United States; Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, United States; The Planned Parenthood League of Massachusetts, Boston, MA, United States
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Allen RH, Fortin J, Maurer R, Bartz D, Goldberg AB, Edelman A, Clark MA. Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation. Contraception 2024; 130:110323. [PMID: 37918648 DOI: 10.1016/j.contraception.2023.110323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES This study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting. STUDY DESIGN In this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group. RESULTS We enrolled 149 patients in the local anesthesia group and 155 in the moderate IV sedation group. The mean procedure pain scores were 6.9 (±2.1) out of 10 in the local group and 4.0 (±2.7) in the IV group (p < 0.0001). More women in the IV group (92%) were satisfied or very satisfied with the amount of pain relief they experienced compared to the local group (66%; p < 0.0001). In the univariable model, only being afraid of a minor medical procedure was predictive of less satisfaction with local anesthesia for pain control (relative risk 0.8 [95% CI, 0.6-0.9]). Age, gestational age, anticipated pain, self-reported pain tolerance, self-reported anxiety, discomfort with the abortion decision, and history of prior vaginal or cesarean delivery or induced abortion did not predict satisfaction levels. CONCLUSIONS Fear of minor medical procedures was the only variable that predicted decreased satisfaction with local anesthesia alone for procedural abortion under 12 weeks. IMPLICATIONS Reliable predictors for satisfaction with local anesthesia alone for procedural abortion in the outpatient setting remain elusive. Fear of minor medical procedures may serve as an indicator of decreased satisfaction and could be incorporated into patient counseling. Moderate IV sedation is associated with high satisfaction levels.
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Affiliation(s)
- Rebecca H Allen
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA.
| | | | | | - Deborah Bartz
- Planned Parenthood League of Massachusetts, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alisa B Goldberg
- Planned Parenthood League of Massachusetts, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Melissa A Clark
- Brown University School of Public Health, Providence, RI, USA
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Newton-Hoe E, Lee A, Fortin J, Goldberg AB, Janiak E, Neill S. Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use. Womens Health Issues 2023:S1049-3867(23)00208-6. [PMID: 38129219 DOI: 10.1016/j.whi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We estimated the prevalence of mifepristone use for evidence-based indications among obstetricians-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use. METHODS We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training. RESULTS A total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications. CONCLUSIONS Sufficient medication abortion training during residency significantly predicts whether obstetricians-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of Roe v. Wade will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.
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Affiliation(s)
- Emily Newton-Hoe
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Alice Lee
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, Boston, Massachusetts
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Janiak
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sara Neill
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Neill S, Hoe E, Fortin J, Goldberg AB, Janiak E. Management of early pregnancy loss among obstetrician-gynecologists in Massachusetts and barriers to mifepristone use. Contraception 2023; 126:110108. [PMID: 37394110 DOI: 10.1016/j.contraception.2023.110108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To measure the prevalence of early pregnancy loss management types among obstetrician-gynecologists in Massachusetts, and delineate barriers, facilitators, demographic and practice-related factors associated with mifepristone use for early pregnancy loss. STUDY DESIGN We surveyed a census of obstetrician-gynecologists in Massachusetts. Descriptive statistics measured the prevalence of offering expectant, misoprostol-alone, mifepristone and misoprostol, dilation and curettage in the office and operating room, and multivariate logistic regression analysis evaluated barriers and facilitators to mifepristone use. Data were weighted to account for nonresponders. RESULTS 198 obstetrician-gynecologists responded to the survey (response rate=29%). Participants most commonly offered expectant management (98%), dilation and curettage in the operating room (94%), and misoprostol-only medication management (80%). Fewer offered mifepristone-misoprostol (51%) or dilation and curettage in an office setting (45%). Those in private practice or other practice types had lower odds of offering mifepristone-misoprostol than those in academic practice (private practice: aOR 0.34, 95% confidence interval [CI] [0.19, 0.61]). Female physicians had higher odds of offering mifepristone-misoprostol (aOR 1.97, 95% CI [1.11, 3.49]). Obstetrician-gynecologists who included medication abortion in their practice had much higher odds of using mifepristone for early pregnancy loss (aOR 25.06, 95% CI [14.52, 43.24]). The Food and Drug Administration Risk and Evaluation Management Strategies Program was a primary barrier among those not using mifepristone (54%). CONCLUSIONS Many obstetrician-gynecologists do not offer mifepristone-based regimens for early pregnancy loss, which are more efficacious than misoprostol-only regimens. The Food and Drug Administration Risk Evaluation and Mitigation Strategies Program is a major barrier to mifepristone use. IMPLICATIONS Half of obstetrician-gynecologists in Massachusetts do not use mifepristone for early pregnancy loss management. Major barriers include lack of experience with mifepristone and the Food and Drug Administration Risk Evaluation and Mitigation Strategies Program regulations. Removing medically unnecessary regulations and increasing education on mifepristone via access to abortion care experts may increase uptake of this practice.
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Affiliation(s)
- Sara Neill
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Hoe
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer Fortin
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
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Keefe-Oates B, Fulcher I, Fortin J, Goldberg AB, Chen JT, Gottlieb B, Janiak E. Use of Abortion Services in Massachusetts After the Dobbs Decision Among In-State vs Out-of-State Residents. JAMA Netw Open 2023; 6:e2332400. [PMID: 37672274 PMCID: PMC10483311 DOI: 10.1001/jamanetworkopen.2023.32400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023] Open
Abstract
This cohort study compares observed vs expected abortion counts after Dobbs in Massachusetts among in-state vs out-of-state residents.
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Affiliation(s)
- Brianna Keefe-Oates
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Isabel Fulcher
- Department of Research, Planned Parenthood League of Massachusetts, Boston
| | - Jennifer Fortin
- Department of Research, Planned Parenthood League of Massachusetts, Boston
| | - Alisa B. Goldberg
- Department of Research, Planned Parenthood League of Massachusetts, Boston
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Barbara Gottlieb
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Janiak
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Neill S, Mokashi M, Goldberg A, Fortin J, Janiak E. Mifepristone use for early pregnancy loss: A qualitative study of barriers and facilitators among OB/GYNS in Massachusetts, USA. Perspect Sex Reprod Health 2023; 55:210-217. [PMID: 37394759 DOI: 10.1363/psrh.12237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
CONTEXT Early pregnancy loss (EPL) affects 1 million patients in the United States (US) annually, but integration of mifepristone into EPL care may be complicated by regulatory barriers, practice-related factors, and abortion stigma. METHODS We conducted qualitative, semi-structured interviews among obstetrician-gynecologists in independent practice in Massachusetts, US on mifepristone use for EPL. We recruited participants via professional networks and purposively sampled for mifepristone use, practice type, time in practice, and geographic location within Massachusetts until we reached thematic saturation. We analyzed interviews using inductive and deductive coding under a thematic analysis framework to identify facilitators of and barriers to mifepristone use. RESULTS We interviewed 19 obstetrician-gynecologists; 12 had used mifepristone for EPL and 7 had not. Participants were in private practice (n = 12), academic practice (n = 6), or worked at a federally qualified health center (n = 1). Seven had fellowship training, including four in complex family planning. The most common facilitators of mifepristone use for EPL were access to the expertise or protocols of local-regional experts, leadership from a "champion," prior experience with abortion care, and hospital capacity constraints during the COVID-19 pandemic. The most common barriers were related to the Mifepristone Risk Evaluation and Mitigation Strategy (REMS) Program imposed by the US Food and Drug Administration (FDA). Additionally, mifepristone's affiliation with abortion was a barrier to its use in EPL for some obstetrician-gynecologists. CONCLUSION The FDA Mifepristone REMS Program presents substantial barriers to obstetrician-gynecologists incorporating mifepristone into their EPL care.
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Affiliation(s)
- Sara Neill
- Department of Obstetrics, Gynecology, & Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Alisa Goldberg
- Department of Obstetrics, Gynecology, & Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Jennifer Fortin
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, & Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
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Ngo LL, Mokashi M, Janiak E, Bartz D, Fortin J, Maurer R, Goldberg AB. Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks. Contraception 2023; 117:61-66. [PMID: 36240901 DOI: 10.1016/j.contraception.2022.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E). STUDY DESIGN This retrospective, noninferiority, cohort study compared complication rates for same-day versus overnight cervical preparation with D&E between 14 and 16 weeks gestation. Cervical preparation was achieved with misoprostol, osmotic dilators, or both. Our primary outcome was the acute complication rate, defined as: hemorrhage (≥500 mL); hospitalization or hospital transfer; transfusion; or unplanned procedure occurring within 24 hours of the index procedure. Secondarily we evaluated nonmajor (re-aspiration, suture repair of cervical laceration, uterine tamponade, or emergency department only transfer) and major (transfusion, uterine artery embolization, abdominal surgery, or hospital admission) complications separately. Inverse probability of treatment weighting using the propensity score was used to perform an adjusted analysis, taking into account age, ethnicity, clinic location, insurance, gestational age, gravidity, and prior pregnancy outcomes. RESULTS We analyzed 1,319 subjects (n = 864 same-day, n = 455 overnight). Same-day cervical preparation patients were more likely to have Medicaid and a prior vaginal delivery. In both unadjusted and adjusted analyses, acute complication rates for same-day were noninferior to overnight preparation (unadjusted 0.93% vs 1.98%, difference of -1.05%, CI: -2.48% to 0.38%; adjusted difference -0.50%, CI: -1.45 to 0.44%). Only one major complication in the same-day group, a cervical laceration resulting in hemorrhage requiring transfusion, occurred in the entire sample. CONCLUSIONS In this retrospective review, same-day cervical preparation was noninferior to overnight preparation for D&E between 14 and 16 weeks gestation, both with low complication rates. IMPLICATIONS For early second trimester dilation and evacuation, same-day cervical preparation should be considered a safe alternative to overnight cervical preparation.
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Affiliation(s)
- Lynn L Ngo
- Southern California Permanente Medical Group, San Diego, CA, USA.
| | | | - Elizabeth Janiak
- Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA
| | | | - Rie Maurer
- Brigham and Women's Hospital, Center for Clinical Investigation, Boston, MA, USA
| | - Alisa B Goldberg
- Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA
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Fisette-Paulhus I, Morin M, Fortin J, Girard-Côté L, Gagnon C. Introducing a Guide in Physical Therapy Addressing Sexual Function in Adults with Neuromuscular Disorders. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Fulcher IR, Onwuzurike C, Goldberg AB, Cottrill AA, Fortin J, Janiak E. The impact of the COVID-19 pandemic on abortion care utilization and disparities by age. Am J Obstet Gynecol 2022; 226:819.e1-819.e15. [PMID: 35114184 PMCID: PMC8802456 DOI: 10.1016/j.ajog.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/08/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
Background A variety of state-level restrictions were placed on abortion care in response to the COVID-19 pandemic, leading to drops in utilization and delays in time to abortion. Other pandemic-related factors also may have impacted receipt of abortion care, potentially exacerbating existing barriers to care. Massachusetts is an ideal setting to study the impact of these other pandemic-related factors on abortion care utilization because there was no wide-scale abortion policy change in response to the pandemic. Objective This study aimed to evaluate the impact of the COVID-19 pandemic on abortion care utilization and disparities in utilization by patient age in Massachusetts. Study Design Using the electronic medical records from all abortions that occurred at the Planned Parenthood League of Massachusetts from May 1, 2017 through December 31, 2020 (N=35,411), we performed time series modeling to estimate monthly changes in the number of abortions from the expected counts during the COVID-19 pandemic. We also assessed if legal minors (<18 years) experienced delays in time to abortion, based on gestational age at procedure, and whether minors were differentially impacted by the pandemic. Results There were 1725 less abortions than expected, corresponding to a 20% drop, from March 2020 to December 2020 (95% prediction interval, −2025 to −1394) with 888 less (20% reduction) abortions among adults, 792 (20% reduction) less among young adults, and 45 (27% reduction) among minors. Adults and young adults experienced significant reductions in the number of abortions beginning in March 2020, whereas decreases among minors did not begin until July 2020. The rate of abortions occurring ≥12 weeks gestational age was unchanged during the COVID-19 pandemic among minors (adjusted rate ratio, 0.92; 95% confidence interval, 0.55–1.51) and among adults (adjusted rate ratio, 0.92; 95% confidence interval, 0.78–1.09). Young adults had a lower rate of second trimester abortion during the pandemic (adjusted rate ratio, 0.79; 95% confidence interval, 0.66–0.95). Conclusion Despite uninterrupted abortion service provision, abortion care utilization decreased markedly in Massachusetts during the pandemic. There was no evidence of an increase in second trimester abortions in any age group. Further research is needed to determine if a decline in the pregnancy rate or other factors, such as financial and travel barriers, fear of infection, or privacy concerns, may have contributed to this decline.
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Affiliation(s)
- Isabel R Fulcher
- Harvard Data Science Initiative, Cambridge, MA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA.
| | - Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Alisa B Goldberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
| | - Alischer A Cottrill
- Planned Parenthood League of Massachusetts, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
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Hailey K, Fortin J, Pratt P, Forbes PW, McCabe M. Feasibility and Effect of Reiki on the Physiology and Self-perceived Stress of Nurses in a Large US Hospital. Holist Nurs Pract 2022; 36:105-111. [PMID: 34293753 DOI: 10.1097/hnp.0000000000000475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurses experience stress in the workplace. We evaluated the feasibility and effect of Reiki to relieve stress of staff nurses during a work shift. All Reiki treatments were completed without interruption and lasted 30 minutes. Stress scores, respiratory rate, and heart rate were significantly decreased immediately following the Reiki treatment.
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Affiliation(s)
- Kellie Hailey
- Boston Children's Hospital, Boston, Massachusetts (Mss Hailey, Fortin, and Pratt and Mr Forbes); and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr McCabe)
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Fortin J, Grondin S, Blanchet S. Level of processing's effect on episodic retrieval following traumatic brain injury in the elderly: An event-related potential study. Brain Cogn 2021; 154:105805. [PMID: 34638050 DOI: 10.1016/j.bandc.2021.105805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
Individuals who have sustained a traumatic brain injury (TBI) can suffer from episodic memory impairments. Until now, the neural correlates underlying episodic retrieval in individuals with TBI remained scarce, particularly in older adults. We aimed to fill this gap by recording event-related potentials during an old/new episodic recognition task in 26 older adults, 13 healthy and 13 with TBI. The task manipulated the level of processing in encoding with the use of semantic organizational strategies (deep guided, deep self-guided, and shallow encoding). For all encoding conditions, behavioral data analyses on the discrimination rate indicated that older adults with TBI were globally impaired compared with healthy older adults. The electrophysiological results indicated that the left-parietal effect was larger in the deep guided condition than in the shallow condition. In addition, the results show that the mid-frontal and left-parietal positive old/new effects were absent in both groups. The main findings are the observation, in the control group only, of an early frontal old/new effect (P200; 150-300 ms) and of a late frontal old/new effect on the left hemisphere, only in the Spontaneous condition. Together, results suggest an impairment of the allocation of attentional resources and working memory necessary for retrieving and monitoring items in the elderly with TBI.
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Affiliation(s)
- J Fortin
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, CIRRIS, Quebec City (QC), Canada.
| | - S Grondin
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, CIRRIS, Quebec City (QC), Canada.
| | - S Blanchet
- École de psychologie, Université Laval, Quebec city, Quebec, Canada; Laboratoire Mémoire, Cerveau et Cognition (LMC(2)), Institut de Psychologie, Université de Paris, Paris, France.
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13
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Gagnon C, Fortin J, Lamontagne ME, Plourde A. The Rare Knowledge Mining Methodological Framework for the Development of Practice Guidelines and Knowledge Translation Tools for Rare Diseases. J Neuromuscul Dis 2021; 8:1017-1029. [PMID: 34250944 DOI: 10.3233/jnd-200536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rare diseases bring on a heavy health, social and economic burden that impacts patients' lives and puts pressure on the healthcare system. Furthermore, they are often associated with limited published studies to inform multidisciplinary clinical practice thus limiting evidence-based practice. Moreover, the development of knowledge translation products including clinical care guidelines are often very challenging based on the current available methodological frameworks relying mostly on critical appraisal of the published research evidence where randomized clinical trial design is considered as the gold standard. To overcome this barrier, we proposed the Rare Knowledge Mining Methological Framework (RKMMF). The RKMMF is one possible answer to improve the development of knowledge translation products for rare diseases. This framework includes other sources of evidence including registry information and qualitative studies and the involvement of expert patients. This article documents the RKMMF structure and its application is exemplified through knowledge translation products developed for a neuromuscular population.
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Affiliation(s)
- C Gagnon
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - J Fortin
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada
| | - M E Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de réadaptation en déficience physique de Québec, boul. Wilfrid-Hamel, Québec, QC, Canada.,Département de réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - A Plourde
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada
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14
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Vittecoq B, Fortin J, Maury J, Violette S. Earthquakes and extreme rainfall induce long term permeability enhancement of volcanic island hydrogeological systems. Sci Rep 2020; 10:20231. [PMID: 33214641 PMCID: PMC7677319 DOI: 10.1038/s41598-020-76954-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/04/2020] [Indexed: 11/09/2022] Open
Abstract
Earthquakes affect near-surface permeability, however temporal permeability evolution quantification is challenging due to the scarcity of observations data. Using thirteen years of groundwater level observations, we highlight clear permeability variations induced by earthquakes in an aquifer and overlaying aquitard. Dynamic stresses, above a threshold value PGV > 0.5 cm s−1, were mostly responsible for these variations. We develop a new model using earth tides responses of water levels between earthquakes. We demonstrate a clear permeability increase of the hydrogeological system, with the permeability of the aquifer increasing 20-fold and that of the aquitard 300-fold over 12 years, induced by fracture creation or fracture unclogging. In addition, we demonstrate unprecedented observations of increase in permeability due to the effect of extreme tropical deluges of rainfall and hurricanes. The water pressure increase induced by the exceptional rainfall events thus act as piston strokes strong enough to unclog congested fractures by colloids, particles or precipitates. Lastly, an analysis of regional permeabilities also highlights a permeability increase over geological timeframes (× 40 per million years), corroborating the trend observed over the last decade. This demonstrates that permeability of aquifers of andesitic volcanic islands, such as the Lesser Antilles, significantly evolve with time due to seismic activity and extreme rainfall.
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Affiliation(s)
- B Vittecoq
- BRGM, 97200, Fort-de-France, Martinique. .,CNRS, UMR.8538 - Laboratoire de Géologie, ENS-PSL Research University, 24 rue Lhomond, 75231, Paris, France.
| | - J Fortin
- CNRS, UMR.8538 - Laboratoire de Géologie, ENS-PSL Research University, 24 rue Lhomond, 75231, Paris, France
| | - J Maury
- BRGM, 45060, Orléans, France
| | - S Violette
- CNRS, UMR.8538 - Laboratoire de Géologie, ENS-PSL Research University, 24 rue Lhomond, 75231, Paris, France.,Sorbonne University, UFR.918, 75005, Paris, France
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Feldsine PT, Jucker MT, Kaur M, Lienau AH, Kerr DE, Adamson A, Beaupre L, Bishop J, Casasola E, Cote C, Desilets S, D’lima C, Elahimanesh P, Fitzgerald S, Forgey R, Fortin J, Gohil V, Griffin J, Hardin M, Kaur D, Ketrenos J, King A, Kupski B, Luce S, Lucia L, Maeda S, Markun D, Marquez-Gonzalez M, McClendon J, McKessock J, Nelson C, Nguyen T, O’Brien C, Ramos M, Reilly S, Roa N, Schiffelbein Z, Shaffer K, Shepherd D, Sowell S, Trujillo E, Wang S, Williams K. Evaluation of the Assurance GDS® for Salmonella Method in Foods and Environmental Surfaces: Multilaboratory Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/93.1.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A multilaboratory collaborative study was conducted to compare the detection of Salmonella by the Assurance GDS® for Salmonella method and the Reference culture methods. Six foods, representing a variety of low microbial and high microbial load foods were analyzed. Seventeen laboratories in the United States and Canada participated in this study. No statistical differences (P < 0.05) were observed between the Assurance GDS for Salmonella and the Reference culture methods for any inoculation level of any food type or naturally contaminated food, except for pasta, for which the Assurance GDS method had a higher number of confirmed test portions for Salmonella compared to the Reference method.
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Affiliation(s)
| | - Markus T Jucker
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Mandeep Kaur
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - Andrew H Lienau
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
| | - David E Kerr
- BioControl Systems, Inc., 12822 SE 32nd St, Bellevue, WA 98005
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Roe AH, Fortin J, Janiak E, Maurer R, Goldberg AB. Prevalence and predictors of initiation of intrauterine devices and subdermal implants immediately after surgical abortion. Contraception 2019; 100:89-95. [PMID: 31082394 DOI: 10.1016/j.contraception.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To estimate uptake of long-acting reversible contraception (LARC) methods immediately after surgical abortion in a system that makes these methods readily available, and to determine demographic, medical, social, and visit-specific predictors of immediate post-abortion intrauterine device (IUD) and implant initiation. STUDY DESIGN We performed a retrospective cohort study of LARC (levonorgestrel intrauterine system [IUS], copper IUD, and subdermal implant) initiation at the time of surgical abortion up to 21w0d gestation at Planned Parenthood League of Massachusetts from 2012 through 2017. We calculated proportions of IUD and implant initiation and used mixed effect logistic regression to estimate predictors of each outcome. RESULTS Among 26,858 surgical abortion patients, 25.4% received immediate post-abortion LARC: 14.2%, 4.2%, and 7.0% received a levonorgestrel IUS, copper IUD, and implant, respectively. Compared to White women, Black women had lower odds of initiating an IUD (aOR 0.81, 95% CI 0.74-0.89). Multiparous women had greater odds than nulliparous women of initiating an IUD (aOR 1.69, 95% CI 1.57-1.82) or implant (aOR 1.36, 95% 1.20-1.53). We found age was the strongest predictor of implant initiation (<18 versus≥35: aOR 3.26, 95% CI 2.26-4.71), but was not associated with IUD uptake. Gestational age was not associated with IUD or implant uptake. Implant uptake increased from 2.4% (2012) to 8.7% (2017) (aOR 3.65, 95% CI 2.36-5.65) while IUD uptake remained fairly constant. CONCLUSION About 25% of women chose to initiate intrauterine or implantable contraception immediately after surgical abortion when these methods are readily available. Implant uptake has increased significantly in recent years. Women who initiated IUDs and implants differed in their demographic and social profiles. IMPLICATIONS Women seeking surgical abortion should have same-day access to IUDs and implants. Clinicians and researchers should analyze IUD and implant initiation separately.
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Affiliation(s)
- Andrea Hsu Roe
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA.
| | | | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
| | - Rie Maurer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
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Janiak E, Fulcher IR, Cottrill AA, Tantoco N, Mason AH, Fortin J, Sabino J, Goldberg AB. Massachusetts' Parental Consent Law and Procedural Timing Among Adolescents Undergoing Abortion. Obstet Gynecol 2019; 133:978-986. [PMID: 30969206 PMCID: PMC6485490 DOI: 10.1097/aog.0000000000003190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe individual-level delay in obtaining abortion associated with use of the Massachusetts judicial bypass system, which legal minors (aged 17 years or younger) use to obtain abortion without consent of a parent or legal guardian in the setting of Massachusetts' parental consent law for abortion. METHODS We conducted a retrospective cohort study of 2,026 abortions among minors at a large, statewide network of abortion clinics between 2010 and 2016. Delay was defined as the number of calendar days between the minor's first call to the clinic to schedule an abortion, and the day the abortion was received. RESULTS In the study population, 1,559 (77%) abortions were obtained with parental consent and 467 (23%) using judicial bypass. Abortions after judicial bypass were more common among minors identifying as Hispanic, non-Hispanic black, or other race, those of low socioeconomic status (as indicated by having Medicaid insurance) and those with a prior birth or prior abortion (all P<.05). Minors with parental consent received their abortion a mean of 8.6 days after initial contact, compared with 14.8 days for minors with judicial bypass, for an unadjusted difference of 6.1 days. In multivariable linear regression modeling adjusting for demographic differences between groups, this difference persisted: minors who obtained abortions after judicial bypass had a significantly greater delay compared with those with parental consent (adjusted mean difference = 5.2 days; 95% CI 4.3 to 6.2). Using multivariable logistic regression modeling, minors with judicial bypass also had higher odds of becoming ineligible for medication abortion between the day of first call and the day of procedure (adjusted odds ratio 1.57; 95% CI 1.09 to 2.26). CONCLUSION Massachusetts' parental consent law for abortion is associated with delay among minors and thereby may constrain the clinical options available to them.
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Affiliation(s)
- Elizabeth Janiak
- Brigham and Women's Hospital, Harvard Medical School, Planned Parenthood League of Massachusetts, and Harvard T.H. Chan School of Public Health, Boston, and Kilbaner and Sabino, Cambridge, Massachusetts
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18
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Braaten K, Janiak E, Fulcher I, Cotrill A, Fortin J, Goldberg A. Surgical abortion in patients with opioid dependence: Disparities in demographic factors, procedural pain, and post-abortion contraception. Contraception 2019. [DOI: 10.1016/j.contraception.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roe AH, Fortin J, Gelfand D, Janiak E, Maurer R, Goldberg A. Advance notice of contraceptive availability at surgical abortion: a pilot randomised controlled trial. BMJ Sex Reprod Health 2018; 44:187-192. [PMID: 30012721 DOI: 10.1136/bmjsrh-2017-200023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND With advance notice about the availability and effectiveness of contraceptive methods, abortion patients have more time and information for decision-making. We assessed the impact of an informational telephone call prior to the surgical abortion visit on patient contraceptive knowledge. METHODS This was a pilot randomised controlled trial. Prior to their abortion visit, participants were randomised to the intervention message, a standardised notification about the availability, effectiveness and safety of long-acting (LARC) and short-acting reversible contraception (SARC) on the day of the abortion, or to the control message, a reiteration of appointment logistics without information about contraception. At the visit, participants completed a pre-procedure survey to assess contraceptive knowledge and usefulness of the intervention. The primary outcome was knowledge of LARC availability immediately after surgical abortion. A secondary outcome was contraceptive method uptake. RESULTS We enrolled 234 subjects. The pre-visit telephone notification improved knowledge that LARC is available immediately after surgical abortion (71.3% vs 50.9%, P<0.01). Participants in both study arms found the telephone notifications useful. Post-abortion contraceptive method choice did not differ between study arms. CONCLUSIONS Advance notice about contraception was acceptable to surgical abortion patients and improved their contraceptive knowledge. TRIAL REGISTRATION NUMBER NCT02836561.
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Affiliation(s)
- Andrea H Roe
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Danielle Gelfand
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alisa Goldberg
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
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Braaten KP, Urman RD, Maurer R, Fortin J, Goldberg AB. A randomized comparison of intravenous sedation using a dosing algorithm compared to standard care during first-trimester surgical abortion. Contraception 2018; 97:490-496. [DOI: 10.1016/j.contraception.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/21/2023]
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Horwitz G, Roncari D, Braaten KP, Maurer R, Fortin J, Goldberg AB. Moderate intravenous sedation for first trimester surgical abortion: a comparison of adverse outcomes between obese and normal-weight women. Contraception 2017; 97:48-53. [PMID: 28916485 DOI: 10.1016/j.contraception.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine if obese women experience increased rates of adverse outcomes with moderate intravenous sedation during first trimester surgical abortion compared to normal weight women. STUDY DESIGN We performed a retrospective cohort study of all first trimester surgical abortions with moderate intravenous sedation at an outpatient facility between September 2010 and June 2015. The primary outcome was supplemental oxygen administration. Secondary outcomes included reversal agent administration, anesthesia-related adverse events, and intraoperative lowest level of consciousness (LLOC). We compared three obesity groups [I (Body Mass Index, BMI=30-34.9), II (BMI=35-39.9), and III (BMI ≥40)] to normal weight women (BMI <25). We exported data from electronic medical records and reviewed adverse outcomes individually. RESULTS Of 20,381 first trimester surgical abortion procedures, 31 (0.15%) utilized supplemental oxygen, 24 (0.12%) utilized a reversal agent, 40 (0.20%) had a presumed anesthesia-related adverse event and 184 of 19,725 (0.93%) had a documented low intraoperative LLOC. One patient (0.005%) required hospital transfer or hospitalization. Supplemental oxygen administration (obesity versus normal weight: obese I, aOR 0.52, 95% CI 0.12-2.27; II/III, aOR 1.51, 95% CI 0.50-4.54), low intraoperative LLOC, and anesthesia-related adverse events were not associated with obesity. The rate of reversal agent administration was lower among obese I, II and III women combined compared to normal weight women (aOR 0.13, 95% CI 0.02-0.96). CONCLUSIONS Adverse outcomes were rare across all BMI categories with no detectable increased risk among obese women compared to normal weight women. IMPLICATIONS With appropriate clinical screening, obese women can safely receive moderate intravenous sedation for first trimester surgical abortion in an outpatient clinical setting. Restrictions on moderate intravenous sedation based on BMI alone may be unnecessary.
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Affiliation(s)
- Gillian Horwitz
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115
| | - Danielle Roncari
- Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA 02215; Tufts Medical Center, 800 Washington Street, Boston, MA, USA 02111
| | - Kari P Braaten
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115; Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA 02215; Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA 02115
| | - Rie Maurer
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA 02115
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA 02215
| | - Alisa B Goldberg
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115; Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA 02215; Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA 02115.
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Pocius K, Bartz D, Maurer R, Stenquist A, Fortin J, Goldberg A. Serum human chorionic gonadotropin (hCG) trend within the first few days after medication abortion: a prospective study. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Horwitz G, Roncari D, Braaten K, Maurer R, Fortin J, Goldberg A. BMI as predictor of adverse outcomes with moderate intravenous sedation during surgical abortion. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Ngo L, Braaten K, Eichen E, Fortin J, Maurer R, Goldberg A. Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Braaten KP, Fortin J, Maurer R, Goldberg AB. Use of an algorithm to determine intravenous sedation dosing during first-trimester surgical abortion. Contraception 2016. [DOI: 10.1016/j.contraception.2016.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Martin S, Parekh R, Guessasma M, Léchelle J, Fortin J, Saleh K. Study of the sintering kinetics of bimodal powders. A parametric DEM study. POWDER TECHNOL 2015. [DOI: 10.1016/j.powtec.2014.03.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hitomi M, Deleyrolle L, Sinyuk M, Otvos B, Brunet S, Jarrar A, Flavahan W, Goan W, Mulkearns-Hubert E, Zhang A, Rohaus M, Oli M, Vedam-Mai V, Fortin J, Futch H, Wu Q, Ahluwalia M, Rich J, Reynolds B, Lathia J. SC-11 * DIFFERENTIAL CONNEXIN FUNCTION ENHANCES SELF-RENEWAL IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou275.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Goldberg A, Fitzmaurice G, Fortin J, McKetta S, Dean G, Drey E, Lichtenberg E, Bednarek P, Chen B, Dutton C, Maurer R, Winikoff B. Cervical preparation before second-trimester dilation and evacuation: a multicenter randomized trial comparing osmotic dilators alone to dilators plus adjunctive misoprostol or mifepristone. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Villeneuve MP, Lebeuf Y, Gervais R, Tremblay G, Vuillemard J, Fortin J, Chouinard P. Milk volatile organic compounds and fatty acid profile in cows fed timothy as hay, pasture, or silage. J Dairy Sci 2013; 96:7181-7194. [DOI: 10.3168/jds.2013-6785] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/25/2013] [Indexed: 11/19/2022]
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Braaten KP, Hurwitz S, Fortin J, Goldberg AB. Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial. Contraception 2013; 89:116-21. [PMID: 24309219 DOI: 10.1016/j.contraception.2013.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/18/2013] [Accepted: 10/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester surgical abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion. STUDY DESIGN This was a randomized, double-blind, controlled trial. Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60-90 min preprocedure, or intramuscular ketorolac, 60 mg given 30-60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0-100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction. RESULTS Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ significantly by group. CONCLUSIONS Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion. IMPLICATIONS Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs.
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Affiliation(s)
- Kari P Braaten
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of Massachusetts, Boston, MA 02215, USA.
| | - Shelley Hurwitz
- Center for Clinical Investigation, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, Boston, MA 02215, USA
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA 02115, USA; Planned Parenthood League of Massachusetts, Boston, MA 02215, USA
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Fortin J, Wellisch A, Maier K. CNAP - Evolution of Continuous Non-Invasive Arterial Blood Pressure Monitoring. ACTA ACUST UNITED AC 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-G/bmt-2013-4179/bmt-2013-4179.xml. [PMID: 24042825 DOI: 10.1515/bmt-2013-4179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lesko J, Fortin J, Rooney V, Rie M, Goldberg A. The role of a semi-quantitative urine pregnancy test after uterine evacuation for very early, undesired pregnancy: a pilot randomized controlled trial. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ngapo T, Riendeau L, Laberge C, Leblanc D, Fortin J. “Chilled” pork—Part I: Sensory and physico-chemical quality. Meat Sci 2012; 92:330-7. [DOI: 10.1016/j.meatsci.2012.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/23/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Ngapo T, Riendeau L, Laberge C, Fortin J. “Chilled” pork — Part II. Consumer perception of sensory quality. Meat Sci 2012; 92:338-45. [DOI: 10.1016/j.meatsci.2012.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/23/2012] [Accepted: 04/25/2012] [Indexed: 11/26/2022]
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Lester F, Kakaire O, Byamugisha J, Fortin J, Averbach S, Maurer R, Goldberg A. O397 INTRACESAREAN INSERTION OF THE COPPER T 380A VS 6-WEEK POST-CESAREAN INSERTION: AN RCT. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60827-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lester F, Averbach S, Fortin J, Byamugisha J, Goldberg A, Kakaire O. M143 ACCEPTABILITY OF THE IUD AMONG WOMEN WHO OPTED OUT OF A RANDOMIZED CONTROLLED TRIAL OF INTRACESAREAN INSERTION OF THE COPPER-T 380A IN KAMPALA, UGANDA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Pocius K, Mauer R, Fortin J, Charm S, Bartz D. Medication abortion follow-up: the use of early post-procedural serum HCG. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Allen RH, Fortin J, Bartz D, Goldberg AB, Clark MA. Women's preferences for pain control during first-trimester surgical abortion: a qualitative study. Contraception 2012; 85:413-8. [DOI: 10.1016/j.contraception.2011.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 10/16/2022]
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Pouliot E, Gariépy C, Thériault M, Avezard C, Fortin J, Simmons NJ, Castonguay FW. Effects of low-voltage electrical stimulation and aging on lamb meat quality. Can J Anim Sci 2012. [DOI: 10.4141/cjas2011-076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pouliot, E., Gariépy, C., Thériault, M., Avezard, C., Fortin, J., Simmons, N. J. and Castonguay, F. W. 2012. Effects of low-voltage electrical stimulation and aging on lamb meat quality. Can. J. Anim. Sci. 92: 59–66. The aim of this study was to evaluate the effect of electrical stimulation (ES) and aging time on meat quality of heavy lamb as produced in Quebec. Seventy-six Suffolk-sired crossbred male lambs were slaughtered at a target weight of 50±2 kg. Half of them were electrically stimulated (ES vs. control) at 5–10 min postmortem (21 V; 0.25 A; 60 s). Postmortem pH decline and temperature were monitored. After carcass cutting, longissimus dorsi sections were assigned to aging periods of 1, 3 or 8 d. Temperature decline was the same for both treatments (P=0.749). However, ES carcasses always had a lower pH value than controls during the first 24 h (P<0.001) while the ultimate pH was equivalent (P=0.803). Tenderness, as assessed by either Warner-Bratzler shear force (39 carcasses) or sensory evaluation (35 carcasses) was enhanced by both ES (P<0.001) and aging (P<0.001). At each aging time, tenderness was greater for ES meat. In addition, only 3 d of aging were necessary for ES meat to achieve the tenderness level attained by the controls after 8 d. Sarcomeres were longer (P<0.001) in ES meat than in controls while myofibrillar fragmentation index was not affected by ES treatment (P=0.743). Electrical stimulation also had small effects on color parameters (a*, b* and L*; P<0.01) and flavor (P=0.04). These results provide the first evidence that tenderness of the meat from heavy lambs produced and processed in Quebec could be enhanced by ES, mostly through cold shortening reduction.
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Affiliation(s)
- E. Pouliot
- Département des sciences animales, 2425 rue de l'Agriculture, Université Laval, Québec, Québec, Canada G1V 0A6
| | - C. Gariépy
- Food Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd West, Saint-Hyacinthe, Quebec, Canada J2S 8E3
| | - M. Thériault
- Département des sciences animales, 2425 rue de l'Agriculture, Université Laval, Québec, Québec, Canada G1V 0A6
- Dairy and Swine Research and Development Centre, Agriculture and Agri-Food Canada, 2000 College Street, Sherbrooke, Quebec, Canada J1M 0C8
| | - C. Avezard
- Food Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd West, Saint-Hyacinthe, Quebec, Canada J2S 8E3
| | - J. Fortin
- Food Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Blvd West, Saint-Hyacinthe, Quebec, Canada J2S 8E3
| | - N. J. Simmons
- Carne Technologies Ltd, 4 Matos Segedin Drive, PO Box 740, Cambridge 3450, New Zealand
| | - F. W. Castonguay
- Département des sciences animales, 2425 rue de l'Agriculture, Université Laval, Québec, Québec, Canada G1V 0A6
- Dairy and Swine Research and Development Centre, Agriculture and Agri-Food Canada, 2000 College Street, Sherbrooke, Quebec, Canada J1M 0C8
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41
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Ougier-Simonin A, Guéguen Y, Fortin J, Schubnel A, Bouyer F. Permeability and elastic properties of cracked glass under pressure. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2010jb008077] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Taylor GP, Anderson J, Clayden P, Gazzard BG, Fortin J, Kennedy J, Lazarus L, Newell ML, Osoro B, Sellers S, Tookey PA, Tudor-Williams G, Williams A, de Ruiter A. British HIV Association and Children's HIV Association position statement on infant feeding in the UK 2011. HIV Med 2011; 12:389-93. [PMID: 21418503 DOI: 10.1111/j.1468-1293.2011.00918.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To prevent the transmission of HIV infection during the postpartum period, the British HIV Association and Children's HIV Association (BHIVA/CHIVA) continue to recommend the complete avoidance of breast feeding for infants born to HIV-infected mothers, regardless of maternal disease status, viral load or treatment.
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Affiliation(s)
- G P Taylor
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, London, UK.
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Pons A, David C, Fortin J, Stanchits S, Menéndez B, Mengus JM. X-ray imaging of water motion during capillary imbibition: A study on how compaction bands impact fluid flow in Bentheim sandstone. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2010jb007973] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ngapo T, Fortin J, Martin JF. Do pig farmers preferences bias consumer choice for pork? Response to critique of the pork preference studies. Meat Sci 2010; 85:788-91. [DOI: 10.1016/j.meatsci.2010.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 03/08/2010] [Accepted: 03/11/2010] [Indexed: 11/16/2022]
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Lacroix N, St-Gelais D, Champagne C, Fortin J, Vuillemard JC. Characterization of aromatic properties of old-style cheese starters. J Dairy Sci 2010; 93:3427-41. [DOI: 10.3168/jds.2009-2795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 04/01/2010] [Indexed: 11/19/2022]
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Pouliot É, Gariépy C, Thériault M, Avezard C, Fortin J, Castonguay FW. Growth performance, carcass traits and meat quality of heavy lambs reared in a warm or cold environment during winter. Can J Anim Sci 2009. [DOI: 10.4141/cjas08101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this study was to evaluate the impact of winter rearing environment on the growth performance and meat quality of heavy lambs. Half of sixty-four Dorset lambs (32 males and 32 females) were raised in each of two different environments: warm and cold with average temperature of 10.9 ± 0.7 °C and -2.0 ± 5.2 °C, respectively. The lambs were slaughtered at live weights of 41-45 kg for females and 46-50 kg for males. Cold environment had no adverse effect on either growth performance or carcass quality. The rate of longissimus dorsi muscle deposition (P = 0.049) and its depth at slaughter (P = 0.027) were rather greater in lambs reared in the cold environment and a higher proportion of oxido-glycolytic fibres (P = 0.047) was also observed in this muscle. Rearing environment had only a minor effect on the organoleptic qualities, with the cold environment promoting juiciness of the meat (P = 0.043). Therefore, cold environment rearing such as used in this study represents an economic advantage for lamb producers by reducing the costs associated with the construction of insulated barns, while maintaining growth performance, as well as carcass and meat quality. Key words: Lamb, rearing environment, temperature, growth, carcass, meat quality
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Faucitano L, Chouinard PY, Fortin J, Mandell IB, Lafrenière C, Girard CL, Berthiaume R. Comparison of alternative beef production systems based on forage finishing or grain-forage diets with or without growth promotants: 2. Meat quality, fatty acid composition, and overall palatability. J Anim Sci 2008; 86:1678-89. [PMID: 18375659 DOI: 10.2527/jas.2007-0756] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Faucitano
- Agriculture & Agri-Food Canada, Sherbrooke, Québec, J1M 1Z3, Canada.
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Fortin J, Marte W, Grüllenberger R, Hacker A, Habenbacher W, Heller A, Wagner C, Wach P, Skrabal F. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med 2006; 36:941-57. [PMID: 16483562 DOI: 10.1016/j.compbiomed.2005.04.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 04/11/2005] [Accepted: 04/18/2005] [Indexed: 11/18/2022]
Abstract
A new method and apparatus for non-disruptive blood pressure (BP) recording in the finger based on the vascular unloading technique is introduced. The instrument, in contrast to intermittent set point readjustments of the conventional vascular unloading technique, delivers BP without interruptions, thus refining the Penáz' principle. The method is based on concentrically interlocking control loops for correct long-term tracing of finger BP, including automatic set point adaptation, light control and separate inlet and outlet valves for electro-pneumatic control. Examples of long-term BP recordings at rest and during autonomic function tests illustrate the potential of the new instrument.
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Affiliation(s)
- J Fortin
- Institute of Medical Engineering, Graz, University of Technology, Krenngasse, Graz, Austria.
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50
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Fortin J, Habenbacher W, Heller A, Hacker A, Grüllenberger R, Innerhofer J, Passath H, Wagner C, Haitchi G, Flotzinger D, Pacher R, Wach P. Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. Comput Biol Med 2005; 36:1185-203. [PMID: 16131462 DOI: 10.1016/j.compbiomed.2005.06.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 06/17/2005] [Accepted: 06/17/2005] [Indexed: 10/25/2022]
Abstract
The report describes a method of impedance cardiography using an improved estimate of thoracic volume. The formulas and their implementation in hardware and software are explained and new shortband electrodes are described which generate a good homogeneous thoracic field. Examples of stroke volume and cardiac output curves underline the capabilities of the monitoring system "Task Force Monitor". In several experiments, results are compared to thermodilution as well as to BioZ measurements: the new method excels in comparison with thermodilution and is comparable to the BioZ device. Compared to traditional electrodes, the new shortband electrodes are shown to provide better reproducibility.
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Affiliation(s)
- J Fortin
- Institute of Medical Engineering, Graz University of Technology, Krenngasse 37, A-8010 Graz, Austria.
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