Using ICD‐9 codes to establish prevalence of malformations in newborn infants

BACKGROUND The International Classification of Disease (ICD‐9) codes are used to identify, after discharge, diagnoses from a review of the medical record and provide the basis for reimbursement. These codes have been used to establish the prevalence of malformations and to assess potential teratogens. We have analyzed the accuracy of codes 740 to 759.9 to identify newborn infants with malformations. METHODS The diagnoses and ICD‐9 codes in the medical records of 1000 consecutive live‐born and stillborn infants were compared to the information provided in the medical records of those infants. RESULTS One hundred twenty‐seven of the 1000 infants had ICD‐9 codes between 740 and 759.9. 67 (52.8%) of the codes identified minor features, such as birth marks and minor anomalies. Twenty‐three (18.1%) of the codes designated a malformation and were correct. Two types of errors were identified in another 33 infants (26%) whose codes designated a malformation: either the pediatricians' notes described a less severe finding or the fact that there was no such abnormality. In addition, four malformed infants were missed in pregnancies that were either terminated electively or stillborn, as they did not have medical records. CONCLUSION The ICD‐9 codes 740 to 759.9 identified accurately some infants ( 18% ) with malformations, but identified incorrectly many others. The accuracy of the coding for identifying malformations would be improved if (1) the findings of the examining pediatricians were considered; (2) normal features of prematurity, such as patent foramen ovale and patent ductus arteriosus, were not considered malformations; (3) minor physical features were not assigned ICD‐9 codes within the 740 to 759.9 sequence. Birth Defects Research (Part A) 2012. © 2012 Wiley Periodicals, Inc.     

Unintended pregnancies and exposure to potential human teratogens

BACKGROUND: We aimed to investigate the risk factors associated with unintended pregnancies as well as the association between unintended pregnancies and potential teratogenic exposures. METHODS: A cross-sectional survey was performed among women attending the Maternity School of the Samsung Cheil Hospital and Women's Health Care Center in Seoul, Korea. Demographic data, obstetric history, socioeconomic status, intention to become pregnant, and exposure to potential teratogens were obtained. RESULTS: A total of 1354 women with median age of 29 years and median gestational age of 29 weeks were included. Of these, an educational level above high school was 74.2%, primigravida was 77.3% and unintended pregnancy was 48%. In the logistic regression analysis, women younger than 24 years of age had a relative risk (RR) of 2.5 (95% confidence interval [CI], 1.3-4.7) of having an unintended pregnancy and women with lower household monthly income level had a RR of 1.3 (95% CI, 1.0-1.6). Women with unintended pregnancies had an RR of 1.9 (95% CI, 1.5-2.5), 3.0 (95% CI, 2.0-4.5), 1.5 (95% CI, 1.0-2.3), 2.9 (95% CI, 1.1-7.2), and 2.0 (95% CI, 1.62.4) of being exposed to alcohol, medications, cigarette smoking, X-rays, or to any of these, respectively, during the first trimester of pregnancy. CONCLUSIONS: Unintended pregnancies are more likely to occur among young women with a lower household monthly income level. Prenatal counseling should be especially recommended for women with unintended pregnancies in order to evaluate whether they have been exposed to potential teratogenic agents.     

First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage

BACKGROUND: Conflicting findings with regard to the teratogenic risks of first trimester use of paroxetine have prompted the FDA, Health Canada, and the manufacturer of the drug to issue warnings against its use during pregnancy. Given that untreated depression during pregnancy can lead to deleterious effect on the mother and her unborn fetus, data on the relationship between the dose and the range of malformations is warranted. This study attempts to quantify the association between first trimester exposure to paroxetine and congenital cardiac malformations, adjusting for possible confounders, and to quantify the dose-response relationship between paroxetine use and cardiac defects. METHODS: The Medication and Pregnancy registry was used. This population-based registry was built by linking three administrative databases (RAMQ, Med-Echo, and ISQ), and includes all pregnancies in Quebec between 01/01/1997 and 06/30/2003. Date of entry in the registry is the date of the first day of the last menstrual period. To be eligible for this study, women had to: 1) be 15-45 years of age at entry; 2) be covered by the RAMQ drug plan >or=12 months before and during pregnancy; 3) be using only one type of antidepressant during the first trimester; and 4) have a live birth. Two nested case-control studies were carried out comparing the prevalence of paroxetine use in the first trimester of pregnancy to the prevalence of other antidepressant exposures during the same time period. Cases were defined as: 1) any major malformations; or 2) any cardiac malformations diagnosed in the first year of life; controls were defined as no major or minor malformations. Multivariate logistic regression techniques were used to analyze data. RESULTS: Among the 1,403 women meeting inclusion criteria, 101 infants with major congenital malformations were identified; 24 had cardiac malformations. Adjusting for possible confounders, the use of paroxetine (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 0.49-3.92), and the use of other SSRIs (OR = 0.89, 95% CI = 0.28-2.84) during the first trimester of pregnancy did not increase the risk of congenital cardiac malformations compared with the use of non-SSRI antidepressants. When considering the dose, however, a dose-response relationship was observed, thus women exposed to >25 mg/day of paroxetine during the first trimester of pregnancy were at increased risk of having an infant with major congenital malformations (adjusted [adj] OR = 2.23, 95% CI = 1.19, 4.17), or major cardiac malformations (adj OR = 3.07, 95% CI = 1.00, 9.42). CONCLUSIONS: Gestational exposure to paroxetine is associated with major congenital malformations and major cardiac malformations for only first trimester exposure above 25 mg/day.     

Sister-chromatid exchange (SCE) analysis in mothers exposed to DNA-damaging agents and their newborn infants

The incidence of SCE in the lymphocytes of mothers and their newborn infants was determined. A detailed antenatal history of parental habits such as smoking, alcohol consumption and possible exposure to DNA-damaging agents was documented. The results showed that the SCE rate in the newborn is significantly less than that of their mothers. Mothers who consumed alcohol, but not cigarette smokers, had a significantly increased SCE rate compared to control mothers. However, these maternal habits did not affect the SCE rate of their infants. Neonates with neural tube defects showed a significantly increased SCE rate compared to normal babies.     

Competitive exclusion and coexistence for pathogens in an epidemic model with variable population size

We study an SIR epidemic model with a variable host population size. We prove that if the model parameters satisfy certain inequalities then competition between n pathogens for a single host leads to exclusion of all pathogens except the one with the largest basic reproduction number. It is shown that a knowledge of the basic reproduction numbers is necessary but not sufficient for determining competitive exclusion. Numerical results illustrate that these inequalities are sufficient but not necessary for competitive exclusion to occur. In addition, an example is given which shows that if such inequalities are not satisfied then coexistence may occur.     

An evaluation of allowing for mismatches as a way to manage genotyping errors in parentage assignment by exclusion

In parentage assignment by exclusion, using multiple and very polymorphic loci, genotyping errors are a major cause of non‐assignment. Using stochastic simulations, we tested the possibility to allow for mismatches at one or more allele as a way to recover assignment power. This was very efficient provided the set of loci used had a high assignment power (> 99%) and the error rate was not too high (below 3–4%). In these cases, most of the theoretical assignment power could be recovered. We also showed the efficiency of the method in a practical experiment with rainbow trout.     

Clonazepam use in pregnancy and the risk of malformations

BACKGROUND: Clonazepam (Klonopin) is a benzodiazepine that has been used widely to treat seizures and conditions such as panic attacks and anxiety disorder. However, the current findings about its use in pregnancy are derived from limited studies of small sample size. Because it is commonly prescribed during pregnancy, more information about its safety is needed. METHODS: The medical records of 28,565 infants were surveyed as part of a hospital-based malformation surveillance program to identify those who had been exposed prenatally to an anticonvulsant, including clonazepam. RESULTS: During a 32-month period, 166 anticonvulsant-exposed infants were identified; 52 had been exposed to clonazepam, 43 as monotherapy. A total of 33 (76.7%) of the monotherapy infants were exposed during the first trimester. One (3.0%) infant had dysmorphic features, growth retardation, and a heart malformation (tetralogy of Fallot). CONCLUSIONS: This study did not observe an increase in major malformations in births exposed to clonazepam monotherapy. However, this study is not large enough to have adequate power to determine whether or not the rate of major malformations is increased in clonazepam-exposed pregnancies. No increase has been identified in three other case series. Although the number of patients in this series was larger than previous reports, continued monitoring of pregnancies is needed to determine whether or not clonazepam is teratogenic.     

Agnathia and associated malformations in a male rhesus monkey

BACKGROUND: Agnathia is a rare malformation characterized by the absence of the mandible. METHODS: A male rhesus monkey with malformations was found dead and studied by internal examination, radiographs and histopathology. RESULTS: A case of a rare first branchial arch anomaly with agenesis of the mandible and tongue is presented. The animal also had visceral deformities. However, ears were normal in shape and only slightly low in position. The craniofacial malformations may reflect incomplete separation of the first branchial arch into its maxillary and mandibular processes. CONCLUSIONS: The association between the craniofacial and other corporal anomalies is unclear.     

Advances in ultrasound imaging for congenital malformations during early gestation

BACKGROUND : With refinement in ultrasound technology, detection of fetal structural abnormalities has improved and there have been detailed reports of the natural history and expected outcomes for many anomalies. The ability to either reassure a high‐risk woman with normal intrauterine images or offer comprehensive counseling and offer options in cases of strongly suspected lethal or major malformations has shifted prenatal diagnoses to the earliest possible gestational age. METHODS : When indicated, scans in early gestation are valuable in accurate gestational dating. Stricter sonographic criteria for early nonviability guard against unnecessary intervention. Most birth defects are without known risk factors, and detection of certain malformations is possible in the late first trimester. RESULTS : The best time for a standard complete fetal and placental scan is 18 to 20 weeks. In addition, certain soft anatomic markers provide clues to chromosomal aneuploidy risk. Maternal obesity and multifetal pregnancies are now more common and further limit early gestation visibility. CONCLUSION : Other advanced imaging techniques during early gestation in select cases of suspected malformations include fetal echocardiography and magnetic resonance imaging. Birth Defects Research (Part A) 103:260–268, 2015. © 2015 Wiley Periodicals, Inc.     

Experimental trials to determine effective fence designs for feral Cat and Fox exclusion

Summary   Exclusion fencing is being increasingly used to protect areas of high conservation value or to create 'islands' of protected habitat for native fauna. The objective of this study was to test a range of fence designs to assess the optimum physical and/or electrical barrier required to exclude feral Cats ( Felis catus ) and Red Foxes ( Vulpes vulpes ). We tested against six fence designs by placing individual animals (18 Cats and 18 Foxes) in 20 × 20 m pens and recording their responses to various fence components. Fence design 1 was 1.8-m high with one electric wire at 1200 mm and another at 1500 mm offset by 80 mm and a curved overhang 600 mm in diameter. Fence design 2 and 3 had single electric wires placed at 400 mm and 1700 mm, respectively. Fence design 4 had a single electric wire at the end of the overhang. Fence design 5 had no electric wire and fence design 6 was 1.2-m high with an overhang and no electric wire. Neither feral Cats nor Foxes were able to scale the 1.8-m fence regardless of the position or absence of electric wires. One Fox and one feral Cat successfully breached the 1.2-m high fence by jumping onto the overhang and climbing over. Four Foxes excavated holes underneath the fence and one chewed through the mesh. Results from this work indicate that fences designed to exclude feral Cats and Foxes should be 1.8-m high, have an overhang that is at least 600 mm in circumference that is curved or shaped in such a way that prevents animals climbing over from underneath, and have an apron with a mesh hard enough to prevent Foxes chewing through. Exclusion fences do not require electric wires. The omission of electric wires will provide significant savings in building and maintenance costs for exclusion fencing.     

河口区营养物基准制定方法

河口区营养物基准是河口环境监测、评估和管理的基础。然而,如何从营养盐基准制定的角度分析相关的科学基础问题,提出有效操作方式和制定方法仍然缺乏系统研究,国内外营养物基准制定亦处于探索阶段。从基准状态的判断、基准关注的营养物质、河口生态系统对营养盐的响应特征3个方面分析了基准制定的科学基础问题,认为基准值的判断可以参照状态为基础,N、P、Si、Fe等对植物生长具有较明显限制作用,实践中均应纳入考虑,复杂的物理特征使河口营养物敏感性具有显著差异,地理区域和河口类型的划分有利于基准的制定。结合上述分析及国内外经验,提出了基准制定的6个步骤,认为河口分类与分区、参照状态确立是基准制定的核心步骤,其分析方法较多,需要针对河口特征选择并调整。结合我国营养物基准研究现状和管理需求,提出了建立我国河口基础数据库、制定河口营养物基准技术指南、建立基于生态系统健康的河口营养物基准及标准体系等建议。     

Solute exclusion from cellulose in packed columns: process modeling and analysis

In this investigation, process modeling and analysis were used to explore the behavior of solute exclusion from cellulose in packed columns. The study focused on modeling the effects of dispersion, mass transport, and pore diffusion. Three mathematical models were used to predict the behavior of the columns: an equilibrium model, a mass transfer model, and a combined mass transfer and pore diffusion model. Computer implementations of these models were tested against experimental conditions where cellulose particle size and solution velocity were used to either amplify or minimize dispersion or skewness in the elution curves. For small cellulose particles (200-300 mesh), all three models accurately predicted the shape of the elution curve and the particle porosity. For larger particles (45-60 mesh), the mass transfer model and the combined mass and pore diffusion model best represented the behavior of the column. At high solution velocities (0.63 cm(3) min(-1)) and large particles, only the combined mass transfer and pore diffusion model accurately represent the column behavior. Sensitivity analysis revealed that the mass transfer coefficient had little effect on the elution curves for the range of values (10(-6)-10(-3) cm s(-1)) calculated from the experimental data. The combined mass transfer and pore diffusion model presented in this article can be used to design solute exclusion measurement experiments for the larger cellulose particles found in a commercial cellulose-to-ethanol plant.