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ACOG Issues New Guidelines On Fetal Monitoring To Resolve Inconsistencies In Interpretation
The American College of Obstetrics and Gynecology recently published new guidelines on electronic fetal monitoring in an attempt to increase consistency in the way physicians interpret and act on the results, the New York Times reports. Electronic fetal monitoring, which was introduced in the 1970s, is used during labor for more than 85% of the four million infants born alive in the U.S. annually, the Times reports. According to the Times, use of fetal monitors became standard obstetrical practice before it was known if the benefits outweighed the risks. The new guidelines refine the meaning of various readings from fetal monitors and could help doctors make better decisions about whether to intervene during labor.According to experts, the widespread adoption of fetal monitoring has produced both negative and positive consequences, including significant increases in caesarean deliveries and the use of forceps during vaginal deliveries. Monitoring has not been found to reduce the risk of either cerebral palsy or fetal death resulting from inadequate oxygen to the fetal brain, as it was intended to do. Furthermore, lawyers commonly use monitoring results to support malpractice cases that might have little merit, which in turn has driven rising malpractice insurance costs and prompted some obstetricians to stop delivering infants.The new guidelines divide monitor readings into three categories to help doctors interpret readings more consistently. The old guidelines had two categories -- reassuring and non-reassuring -- and it was up to the obstetrician to determine whether a non-reassuring reading required intervention. Under the new guidelines, the first category applies when tracings of the fetal heart rate are normal and no specific action is required. The second category is for indeterminate tracings that require evaluation, continuous surveillance and re-evaluation. Obstetricians treating patients in this category should consider other clinical factors that could affect the fetus and whether the patient could be safely moved to category one, according to Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which produced recommendations on which the guidelines are based. The final category is for abnormal tracings that require immediate evaluation and efforts to reverse the abnormal heart rate. The Times reports that more refinements to the guidelines are expected to be released in 2010 (Brody, New York Times, 7/7).
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City Of Hope RNs Sound Alarm On Patient Care Practices As Contract Talks Heighten
City of Hope Medical Center registered nurses will be joined by a broad coalition of public officials, religious and labor leaders, and hospital employees at a June 17 rally at the Duarte facility, the California Nurses Association announced.
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Tension In Axons Is Essential For Synaptic Signaling, Researchers Report
Every time a neuron sends a signal - to move a muscle or form a memory, for example - tiny membrane-bound compartments, called vesicles, dump neurotransmitters into the synapse between the cells. Researchers report that this process, which is fundamental to the workings of the nervous system, relies on a simple mechanical reality: Tension in the axon of the presynaptic neuron is required.
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Baseline Dopamine Levels And Our Motivation To Eat Influenced By Fat Hormone

As we all know from experience, people eat not only because they are hungry, but also because the food just simply tastes too good to pass up. Now, a new study in the August 6th Cell Metabolism, a Cell Press publication, helps to explain how leptin, a hormone produced by fat tissue, influences that motivation to eat. The researchers describe for the first time a new bunch of leptin-responsive (LepRb) neurons in the brain"s lateral hypothalamic area (LHA). Those LHA neurons feed directly into the mesolimbic dopamine system seated in the ventral tegmental area (VTA) of the brain, which controls the rewarding properties we assign to things. "Dopaminergic neurons in the VTA and their downstream targets represent the site of action for drugs of abuse, and also control motivation for food, sex or a fancy car," explained Martin Myers, Jr., of the University of Michigan, Ann Arbor. Put simply, "they control our wanting of stuff." The study therefore adds to growing evidence that leptin doesn"t turn the appetite on and off just by controlling satiety - for instance, whether we feel hungry or full. "Most who have studied leptin in the brain have focused on an important circuit in the ARC," and the leptin-responsive neurons there, Myers said. ARC stands for arcuate nucleus and is an area in the brain"s hypothalamus that controls energy balance by controlling satiety. "It has been assumed that leptin action in the ARC - if not the be all and end all - was responsible for the vast majority of leptin"s effect on appetite." But in fact, neurons bearing leptin receptors exist in many other parts of the brain too. Earlier studies revealed the role of leptin action on the VTA and its influence on dopamine. The new findings show that leptin also has direct effects on the LHA, which in turn exerts greater influence on the dopamine system of the VTA. The new study shows that leptin injected in the LHAs of rats causes the animals to eat less and lose weight. Leptin action in the LHA also raises dopamine content in the brains of otherwise leptin-deficient animals. While in general higher dopamine release tends to be associated with wanting things - food or something else - Myers said he suspects the higher dopamine at baseline may in fact dampen the response to food temptations, making them easier to resist. "Some people may over-eat rewarding food because of a perceived "reward deficit,"" Myers suggested. "When leptin is turned up, it might fix that deficit and make us feel better about a lot of things." It"s not yet clear how the leptin-responsive neurons in the LHA and VTA work together to control dopamine and with it our motivations, according to the researchers. "The unique roles played by these subpopulations of LHA LepRb neurons, as well as those played by VTA LepRb neurons, remain unclear, but could include the requirement for leptin to differentially regulate specific populations of midbrain dopamine neurons and/or to distinctly modulate the incentive for feeding relative to other behaviors. Going forward, it will be important to determine how these various populations of mesolimbic dopamine system-interacting LepRb neurons differ in terms of their wiring and the control of different aspects of mesolimbic dopamine signaling." The new findings do highlight the LHA neurons as a major link between leptin"s anorectic action and the mesolimbic dopamine system, they conclude. "These findings reveal important mechanisms that underlie the regulation of the mesolimbic dopamine system by a crucial signal of energy stores. In the future, it will be crucial to address the potential dysregulation of these neurons in states of obesity." The researchers include Gina M. Leinninger, University of Michigan, Ann Arbor, MI; Young-Hwan Jo, Albert Einstein College of Medicine, Bronx, NY; Rebecca L. Leshan, University of Michigan, Ann Arbor, MI; Gwendolyn W. Louis, University of Michigan, Ann Arbor, MI; Hongyan Yang, University of Michigan, Ann Arbor, MI; Jason G. Barrera, University of Cincinnati, Cincinnati, OH; Hilary Wilson, University of Cincinnati, Cincinnati, OH; Darren M. Opland, University of Michigan, Ann Arbor, MI; Miro A. Faouzi, University of Michigan, Ann Arbor, MI; Yusong Gong, University of Michigan, Ann Arbor, MI; Justin C. Jones, University of Michigan, Ann Arbor, MI; Christopher J. Rhodes, University of Chicago, Chicago, IL; Streamson Chua, Jr., Albert Einstein College of Medicine, Bronx, NY; Sabrina Diano, Yale University, New Haven, CT; Tamas L. Horvath, Yale University, New Haven, CT; Randy J. Seeley, University of Michigan, Ann Arbor, MI; Jill B. Becker, University of Michigan, Ann Arbor, MI; Heike Munzberg, University of Michigan, Ann Arbor, MI; and Martin G. Myers Jr., University of Michigan, Ann Arbor, MI. Cathleen Genova Cell Press


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