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Gambling exposes people to risk for harm, but also has recreational benefits. The present study aimed to measure gambling harm and gambling benefits on similar scales using two novel methods adapted from the Burden of Disease approach (McCormack et al. in Psychol Med 18(4):1007-1019, 1988; Torrance et al. in Health Serv Res 7(2):118-133, 1972) to find whether gambling either adds or subtracts from quality of life. A Tasmanian population-representative survey of 5000 adults (2534 female) from random digit dialling (RDD) of landline telephones in Tasmania (50%), as well as pre-screened Tasmanian RDD mobiles (17%) and listed mobile numbers (33%), measured gambling benefits and harms amongst gamblers (59.2%) and a non-exclusive set of people who were "affected" by someone else's gambling (4.5%). The majority of gamblers indicated no change to their quality of life from gambling (82.5% or 72.6% based on direct elicitation or time trade off methods, respectively). Nevertheless, a weighted average of all the positive and negative influences on quality of life, inclusive of gamblers and affected others, revealed that the quality of life change from gambling is either a very modest + 0.05% or a more concerning - 1.9% per capita. Gambling generates only small or negative net consumer surpluses for Tasmanians.

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The field of taxonomy is critically important for the identification, conservation, and ecology of biological species. Modern taxonomists increasingly need to employ advanced imaging techniques to classify organisms according to their observed morphological features. Moreover, the generation of three-dimensional datasets is of growing interest; moving beyond qualitative analysis to true quantitative classification. Unfortunately, biological samples are highly vulnerable to degradation under the energetic probes often used to generate these datasets. Neutral atom beam microscopes avoid such damage due to the gentle nature of their low energy probe, but to date have not been capable of producing three-dimensional data. Here we demonstrate a means to recover the height information for samples imaged in the scanning helium microscope (SHeM) via the process of stereophotogrammetry. The extended capabilities, namely sparse three-dimensional reconstructions of features, were showcased via taxonomic studies of both flora (Arabidopsis thaliana) and fauna (Heterodontus portusjacksoni). In concert with the delicate nature of neutral helium atom beam microscopy, the stereophotogrammetry technique provides the means to derive comprehensive taxonomical data without the risk of sample degradation due to the imaging process.

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Nurses may see patients who have recently returned from tropical vacations complaining of a severe pruritic dermatitis known as seabather's eruption (SBE). Caused by exposure to jellyfish larvae, SBE is characterized by a pruritic rash, but some patients, particularly children, experience systemic signs and symptoms such as fever, chills, and nausea/vomiting. This article discusses SBE and reviews assessment tips, nursing care, and patient teaching.

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Promotions for online sports betting during televised sports broadcasts are regularly viewed by millions of Australians, raising concerns about their impacts on vulnerable groups including at-risk and problem gamblers. This study examined whether responses to these promotions varied with problem gambling severity amongst 455 Australian Internet sports bettors participating in an online survey. Results indicated that young male Internet sports bettors are especially vulnerable to gambling problems, particularly if they hold positive attitudes to gambling sponsors who embed promotions into sports broadcasts and to the promotional techniques they use and this heightens the risk that alluring messages contribute to excessive gambling. As problem gambling severity increased, so too did recognition that these promotions have impacted negatively on their sports betting behaviour. Because a plethora of sports betting brands and promotions are now heavily integrated into sports coverage, social marketing efforts are needed to offset their persuasive appeal and counter the positive attitudes towards them that appear linked to excessive gambling amongst Internet sports bettors.

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BACKGROUND: Previous studies of problem Internet gamblers have failed to distinguish whether their problem gambling relates to Internet or land-based gambling modes. Therefore, characteristics and help-seeking behaviors of people whose gambling problems relate specifically to Internet gambling are unknown, but could inform the optimal alignment of treatment and support services with the needs and preferences of problem gamblers. OBJECTIVE: This study aimed to compare (1) characteristics of problem Internet gamblers and problem land-based gamblers and (2) uptake of different types and modes of help between problem Internet gamblers and problem land-based gamblers. Hypothesis 1 was that problem Internet gamblers are less likely to seek help. Hypothesis 2 was that problem Internet gamblers are more likely to use online modes of help. METHODS: A sample of 620 respondents meeting criteria for problem gambling was drawn from an online survey of 4594 Australian gamblers. Respondents were recruited through advertisements on gambling and gambling help websites, Facebook, and Google. Measures consisted of gambling participation; proportion of gambling on the Internet; most problematic mode of gambling; help seeking from 11 different sources of formal help, informal help, and self-help for gambling problems; psychological distress (Kessler 6); problem gambling severity (Problem Gambling Severity Index, PGSI); and demographics. RESULTS: Problem Internet gamblers were significantly more likely than problem land-based gamblers to be male (χ(2) 1=28.3, P<.001, φ=0.21), younger (t616.33=4.62, P<.001, d=0.37), have lower psychological distress (χ(2) 1=5.4, P=.02, φ=0.09), and experience problems with sports and race wagering (χ(2) 4=228.5, P<.001, φ=0.61). Uptake of help was significantly lower among problem Internet compared to problem land-based gamblers (χ(2) 1=6.9, P<.001, φ=0.11), including from face-to-face services, gambling helplines, online groups, self-exclusion from land-based venues, family or friends, and self-help strategies. Both problem Internet and problem land-based gamblers had similarly low use of online help. However, problem land-based gamblers (37.6%, 126/335) were significantly more likely to have sought land-based formal help compared to problem Internet gamblers (23.5%, 67/285; χ(2) 1=14.3, P<.001, φ=0.15). CONCLUSIONS: The findings suggest that more targeted and innovative efforts may be needed to increase use of gambling help by problem Internet gamblers. Alternatively, their lower PGSI and K6 scores suggest Internet problem gamblers may have less need for gambling-related help. This is the first known study to classify problem Internet gamblers as those whose problem gambling specifically relates to Internet gambling. Further research is needed to better understand why help-seeking rates are lower among Internet problem gamblers.

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BACKGROUND: Pica is a commonly underappreciated disorder in pregnancy that can lead to several complications, including severe metabolic derangements and other adverse outcomes. We report a case of baking soda pica in pregnancy associated with both rhabdomyolysis and cardiomyopathy. CASE: A multigravid woman at 37 weeks of gestation presented with weakness and severe hypokalemia. She subsequently had development of rhabdomyolysis and presumed peripartum cardiomyopathy. After delivery, it was discovered that the patient had a long history of consumption of large quantities of baking soda. Her condition improved with cessation of the pica. CONCLUSION: Clinicians must have a high index of suspicion for pica in pregnancy because it can lead to complex diagnostic challenges and pregnancy complications. The diagnosis should be considered in a patient with unexplained metabolic abnormalities.

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OBJECTIVE: To review data regarding the efficacy of galactogogues available in the US to increase breast milk production in postpartum mothers. DATA SOURCES: Literature was sought using PubMed (1966-June 2012) and EMBASE (1973-June 2012). Search terms included breastfeeding, breast milk, lactation, galactogogue, metoclopramide, oxytocin, fenugreek, milk thistle, silymarin, growth hormone, thyroid releasing hormone, medroxyprogesterone, domperidone, goat's rue, beer, Asparagus racemosus, shatavari, Medicago sativa, alfalfa, Onicus benedictus, blessed thistle, Galega officinalis, brewer's yeast, and herbals. STUDY SELECTION AND DATA EXTRACTION: All studies including humans and published in English with data assessing the efficacy of galactogogues for increasing breast milk production were evaluated. DATA SYNTHESIS: Breast milk is considered the optimal food source for newborns through 1 year of age. Many factors influence overall maternal production, including maternal pain, illness, balance of time when returning to work, anxiety, or emotional stress. Although a variety of herbal and pharmaceutical options have anecdotal evidence of their ability to improve breast milk production, peer-reviewed studies proving their efficacy are lacking. Metoclopramide, oxytocin, fenugreek, and milk thistle have shown mixed results in improving milk production; however, the trials were small and had a variety of limitations. CONCLUSIONS: Nonpharmacologic recommendations should be exhausted before adding therapy. Although anecdotal evidence encourages the use of metoclopramide, fenugreek, asparagus, and milk thistle for their galactogogue properties, efficacy and safety data in the literature are lacking. Oxytocin and domperidone are potentially available for compounding purposes, but safety data are limited. More studies are needed to evaluate the effects of available galactogogues on breast milk production.

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OBJECTIVE: To determine whether survival is different in "early" (23(0/7)-23(3/7) weeks) vs "late" (23(4/7)-23(6/7) weeks) infants. STUDY DESIGN: Records of 126 consecutive liveborn infants delivered at 23(0/7) to 23(6/7) weeks' gestation from 2001-2010 were examined using the Vermont Oxford Network database. Infants born at 23 0/7 to 23 3/7 weeks were grouped into "early" and those at 23 4/7 to 23 6/7 weeks were "late." Clinical characteristics were compared between groups and multivariate analyses were used to predict survival. RESULTS: Seventy-two infants were early and 54 were late. Survival was 25% vs 56%, respectively (P < .001). The early group was less likely to receive steroids (43% vs 65%; P = .016) and had a lower mean birthweight (547 g vs 596 g; P < .001). No difference in other factors was seen between groups. No change in survival was observed during the study period in either group. CONCLUSION: Late 23-week infants have improved survival compared with early infants. Delaying delivery as little as 24-96 hours may improve survival for 23-week infants.

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BACKGROUND: Stiff person syndrome, also known as Moersche-Woltman syndrome, is a debilitating disorder that is rarely seen in the pregnant patient. It is characterized by muscle spasms triggered by startle, voluntary movement, or tactile or emotional stimuli, occurring predominantly in the axial musculature. CASE: A woman diagnosed with stiff person syndrome became pregnant 2 months after her diagnosis. Her medication regimen was adjusted because of pregnancy, and anesthesia was initiated early in labor to control her pain. She was able to have a full-term pregnancy with few complications. CONCLUSION: Stiff person syndrome may be successfully managed in pregnancy. Patients can deliver vaginally with adequate pain control to avoid muscle spasms.

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OBJECTIVE: To evaluate the safety of the human papillomavirus (HPV) bivalent and quadrivalent vaccines in pregnancy. DATA SOURCE: PubMed (1966-August 2010) was searched using the terms human papillomavirus, human papillomavirus vaccine, and pregnancy. References were reviewed for relevant information. STUDY SELECTION AND DATA EXTRACTION: All studies including humans that were published in English with data describing HPV vaccine administration in pregnancy were evaluated. DATA SYNTHESIS: Two combined analyses of 7 Phase 3 efficacy trials have retrospectively evaluated the safety of unintentional administration of either the bivalent (n = 1786) or quadrivalent (n = 2085) HPV vaccine during pregnancy. In addition, postmarketing pregnancy registry surveillance data (prospective, n = 787; retrospective, n = 76) for the quadrivalent HPV vaccine have been published. However, only 279 pregnancies from the studies and 90 pregnancies from the registry occurred within 30 days of receiving the vaccination. Overall, the vaccine does not appear to be associated with an increased risk of spontaneous abortion, fetal malformations, or adverse pregnancy outcomes beyond that found in the general population. Although the data are limited, neither HPV vaccine appears to be associated with an increased risk of adverse pregnancy outcomes. However, limitations of the data include small patient populations, minimal to no adjustments for factors known to influence pregnancy outcomes or malformations, and the majority of the available pregnancy data are from retrospective analysis of Phase 3 efficacy trials. CONCLUSIONS: Neither HPV vaccine should be routinely administered during pregnancy. If a pregnancy occurs midseries, the remaining vaccines should be given after pregnancy completion. Further studies are required to determine actual risk.

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OBJECTIVE: To examine the association between gestational weight gain and adverse maternal and infant outcomes among overweight women [body mass index (BMI) 26.0-29.0 kg/m(2)]. METHODS: A population-based cohort study using birth certificate data (1990-2004) from 34,143 singleton, full-term deliveries to nulliparous, Missouri residents ages 18-35. Gestational weight gain was divided into three categories: below Institute of Medicine (IOM) recommendations (<15 lbs), within IOM recommendations (15-25 lbs), and above IOM recommendations (>25 lbs). Categories of 10-lb increments were also evaluated. The primary outcomes were preeclampsia, cesarean section, macrosomia, low birth weight (LBW), and perinatal death. Adjusted relative risks and 95% confidence intervals (CI) were calculated using Mantel-Haenszel pooled estimator. RESULTS: Compared to women who gained 15-25 lbs, women who gained <15 lbs were 0.8 (95% CI 0.6-1.0), 0.9 (0.8-1.0), 0.6 (0.5-0.8), and 1.7 (1.4-2.2) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. Conversely, women who gained >25 lbs were 1.7 (1.5-1.9), 1.3 (1.2-1.4), 2.1 (1.9-2.3), and 0.6 (0.5-0.7) times as likely to have preeclampsia, cesarean section, macrosomia, and LBW, respectively. The lowest risk of adverse outcomes was for women who gained in the 6-14 and 15-24 lb categories. There was no association between gestational weight gain and perinatal death. CONCLUSIONS: Increasing gestational weight gain appears to decrease the risk of LBW but elevates the risks of preeclampsia, cesarean section, and macrosomia. Overweight women should gain within current IOM recommendations.

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OBJECTIVE: To describe a new placement technique for the transcervical Foley catheter that may succeed when other methods have failed. STUDY DESIGN: Sixteen patients were identified as candidates for placement of a transcervical Foley catheter for cervical ripening, but all had failed attempted placement using the classically described methods. Our new placement technique involved the use of a 5 French rigid catheter guide inserted into the Foley catheter to make the catheter rigid and to ease insertion. RESLLTS: Placement was 100% successful in all 16 patients using the new insertion technique. CONCLUSION: The use of a rigid stylet during insertion increases the chances of success. The ease of insertion using this technique makes the use of a Foley catheter for cervical ripening a valuable option.

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OBJECTIVE: To investigate the relationship between gestational weight gain and adverse pregnancy outcomes among women with normal prepregnancy body mass index. METHODS: We conducted a population-based cohort study of women with normal prepregnancy body mass index who delivered full-term singletons using Missouri birth certificate data for 1999-2001. The cohort was divided into three groups (less than recommended [less than 25 lb], n=16,852; recommended [25-35 lb], n=37,292; more than recommended [more than 35 lb], n=40,552) based on Institute of Medicine gestational weight gain guidelines. Logistic regression was used to adjust for known confounders. RESULTS: Compared with women gaining 25-35 lb, women gaining less than 25 lb during pregnancy had lower odds for preeclampsia (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.49-0.64), cephalopelvic disproportion (aOR 0.64, 95% CI 0.55-0.75), failed induction (aOR 0.68, 95% CI 0.59-0.78), cesarean delivery (aOR 0.82, 95% CI 0.78-0.87), and large for gestational age infants (aOR 0.40, 95% CI 0.37-0.44) and increased odds for small for gestational age infants (aOR 2.14, 95% CI 2.01-2.27). Likewise, women gaining more than 35 lb had lower odds for small for gestational age infants (aOR 0.48, 95% CI 0.45-0.50) and increased odds for preeclampsia (aOR 1.88, 95% CI 1.74-2.04), failed induction (aOR 1.51, 95% CI 1.39-1.64), cesarean delivery (aOR 1.35, 95% CI 1.29-1.40), and large for gestational age infants (aOR 2.43, 95% CI 2.30-2.56). CONCLUSION: Our study shows that adherence to the current Institute of Medicine guidelines results in lower risks for adverse pregnancy, labor, and delivery outcomes when comparing all outcomes collectively.

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BACKGROUND: Currently, the safety of pralidoxime administration via adult autoinjectors for pediatric patients has not been established. Up until 2000, the published literature did not recommend its usage for children less than 12 kg or under the age of 10 years old. Since 2000, limited published articles have emerged validating adult autoinjector usage for the pediatric victim, in extreme circumstances. OBJECTIVE: We sought to determine whether adverse drug reactions (ADR) from pralidoxime administration to children occur. METHOD: Recurrent PubMed Medline literature search of all years were performed from 2001 to 2004 inclusive. The main search criteria were articles pertaining to U.S. children 16 years or younger who received pralidoxime. In addition, a review of 3 years (1999-2001) of detailed retrospective TESS exposure annual poison center data was obtained from the AAPCC. RESULTS: Eighty-one children met inclusion criteria and received pralidoxime for suspected organophosphate poisoning. Two children (2.5%) expired. Three children (3.7%) were identified as having a potential adverse drug reaction; all were mild. CONCLUSION: The author's recognize this study possesses limitations that require its findings be interpreted with caution. Our data suggest that adverse drug reactions to pralidoxime treatment in children are rare. However, further investigation is needed to more firmly establish the safety of this antidote in children and for its use in the prehospital environment.

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PURPOSE: This study compares rural and small-city teenage and adult pregnancies, with respect to complication rates and pregnancy outcomes. METHODS: Chart review of Medicaid patients (513 teenage [under 20 years] and 174 adult controls [ages 25-34]) delivered (excluding multiple gestation) in Amarillo, Texas, from January 1999 to April 2001. Demographic data collected included maternal race, gravidity, parity, smoking status, drug usage, presence of antenatally diagnosed sexually transmitted disease(s), county type (rural vs small city) and number of prenatal visits. Outcomes included mode of delivery, primary cesarean section rates, preterm birth (<34 or <37 weeks), birth weight, birth weight <2500 g, preeclampsia, total maternal weight gain, hemoglobin changes after delivery, Apgar scores, and neonatal intensive care unit admissions. Statistical comparisons between groups were made for a number of factors and outcomes (P < .05). RESULTS: Teenagers did not have a significantly higher frequency of either illicit drug or tobacco usage, but teenagers <17 years had a greater incidence of sexually transmitted diseases (19.8% vs 10.4%, P < .008) and preeclampsia (7.1% vs 2.3%, P < .025, odds ratio 3.2 [1.1 to 9.9]) when compared with adults. The total weight gain was highest for teens < or =17 years (36.4 pounds vs adults: 28.2, P < .001). The primary cesarean section rate was higher in adults (all teens 18.5% vs adults 38.6%, P < 001). County rurality had no impact on any of the observed findings or variables tested. CONCLUSIONS: Young teenagers have a higher incidence of sexually transmitted diseases and preeclampsia and also gain significantly more weight with pregnancy than young adults. However, the pregnancy outcomes were no different for rural vs small city teens.

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OBJECTIVE: To determine if a student's subjective clinical evaluation score (CES) correlates with United States Medical Licensing Examination (USMLE) Step 1 or Step 2, obstetrics/gynecology clerkship final examination or Medical College Admission Test (MCAT) scores. STUDY DESIGN: The test scores for all students rotating at Texas Tech Health Sciences Center at Amarillo from 1994 to 2002 were obtained. Regression models were used to compare the CES and examination scores. The 10th percentile of the CES was statistically compared with each examination score as well as its 10th percentiles. RESULTS: The mean scores for the 285 students were USMLE Step 1, 204.4; USMLE Step 2, 205.0; MCAT, 29.1; obstetrics/gynecology final, 86.0; CES, 88.5. Linear correlations were found between the CES and USMLE Step 2 (r = 0.26, p < 0.001) and the obstetrics/gynecology final (r=0.25, p<0.001). Students with a poor CES (<10th percentile) had lower USMLE Step 2 scores, (188.2 vs. 206.3, p < 0.001) and more examination failures (odds ratio [OR] 8.9 [2.3-33.9]) as well as both lower obstetrics/gynecology final examination scores (81.1 vs. 86.3, p < 0.001) and more clerkship failures (OR 14.2 [1.9-107.4]). CONCLUSION: Students' subjective CESs correlate linearly with performance on both the USMLE Step 2 and obstetrics/gynecology final examinations. Poor CESs (< 10th percentile) predicted lower scores on the future standardized examinations studied.

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