Although prevalence estimates and cross-sectional correlates of erectile dysfunction have recently been established, incidence estimates were lacking. Incidence is necessary to assess risk, and plan treatment and prevention strategies. The risk of erectile dysfunction was about 26 cases per 1,000 men annually, and increased with age, lower education, diabetes, heart disease and hypertension.

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Background The profound changes wrought by COVID-19 on routine hospital operations may have influenced performance on hospital measures, including healthcare-associated infections (HAIs). We aimed to evaluate the association between COVID-19 surges and HAI and cluster rates. Methods In 148 HCA Healthcare-affiliated hospitals, 3/1/2020-9/30/2020, and a subset of hospitals with microbiology and cluster data through 12/31/2020, we evaluated the association between COVID-19 surges and HAIs, hospital-onset pathogens, and cluster rates using negative binomial mixed models. To account for local variation in COVID-19 pandemic surge timing, we included the number of discharges with a laboratory-confirmed COVID-19 diagnosis per staffed bed per month. Results Central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as COVID-19 burden increased. There were 60% (95% CI, 23-108%) more CLABSI, 43% (95% CI, 8-90%) more CAUTI, and 44% (95% CI, 10-88%) more cases of MRSA bacteremia than expected over 7 months based on predicted HAIs had there not been COVID-19 cases. Clostridioides difficile infection was not significantly associated with COVID-19 burden. Microbiology data from 81 of the hospitals corroborated the findings. Notably, rates of hospital-onset bloodstream infections and multidrug resistant organisms, including MRSA, vancomycin-resistant enterococcus and Gram-negative organisms were each significantly associated with COVID-19 surges. Finally, clusters of hospital-onset pathogens increased as the COVID-19 burden increased. Conclusion COVID-19 surges adversely impact HAI rates and clusters of infections within hospitals, emphasizing the need for balancing COVID-related demands with routine hospital infection prevention.

Altered coagulation during pregnancy increases the risk of thromboembolic disorders. At present, thromboembolism is the commonest direct cause of maternal death in the United Kingdom. Use of an inferior vena cava (IVC) filter is warranted to prevent life-threatening complications including pulmonary embolism when thromboembolism recurs despite adequate anticoagulation, or when anticoagulant therapy is contraindicated.The investigators retrospectively reviewed pregnancy outcomes in 6 women who, during 12 pregnancies at the same center over the past 11 years, had an IVC filter in place. In 8 instances the filter was in place before pregnancy and was retained throughout gestation. In 4 others a filter was placed during pregnancy. The filters were inserted under fluoroscopic guidance through the internal jugular vein in 4 women and through the femoral vein in 2 women treated before pregnancy. Three women received permanent and 3 received retrievable filters. Four infants in this series were delivered vaginally. Four others had elective cesarean section, and 4 underwent emergency section because of fetal distress in labor. No antenatal complications were ascribed to placement of an IVC filter and, when a filter was in place before conception, there were no recurrences of thromboembolism. Birth weights averaged 2982 gm. All infants were in good condition at birth with normal Apgar scores.These results tentatively support the use of an IVC filter when indicated to prevent complications of thromboembolism during pregnancy. ABSTRACTPrevious research suggests that normal term birth depends on programmed development of the uterus in early pregnancy. A short cervix in mid-pregnancy is associated with an increased risk of spontaneous preterm birth. The present study tested the hypothesis that a long cervix in mid-pregnancy is associated with a higher risk of cesarean delivery during term labor. The study population included 27,472 primiparous women whose cervical length was 16 mm or more at a median gestational age of 23 weeks, and who delivered a live infant in labor at term. Cervical length was estimated by transvaginal ultrasonography.The rate of cesarean delivery at term was lowest (16%) in women whose mid-pregnancy cervical length was in the lowest quartile (16-30 mm). The rate was progressively greater in the second quartile (18%, 31-35 mm), third quartile (22%, 36-39 mm), and fourth quartile (26%, 40-67 mm). Compared with women in the first quartile, the odds ratio (OR) for cesarean delivery in women in the fourth quartile was 1.8 (95% confidence interval [CI], 1.66-1.97). The OR was 1.68 (95% CI, 1.53-1.84) after adjusting for numerous variables including maternal age, body mass index, smoking status, race or ethnic group, gestational age at birth, spontaneous or induced labor, and birth weight percentile. The 550Obstetrical and Gynecological Survey ABSTRACTIt may be difficult to manage nulliparous women who have labor induced because these women are likelier to have an "unfavorable" cervix, and consequently a lower r...

SummaryActin depolymerizing factor (ADF)/cofilin is important for regulating actin dynamics, and in plants is thought to be required for tip growth. However, the degree to which ADF is necessary has been elusive because of the presence of multiple ADF isoforms in many plant species. In the moss Physcomitrella patens, ADF is encoded by a single, intronless gene. We used RNA interference to demonstrate that ADF is essential for plant viability. Loss of ADF dramatically alters the organization of the F-actin cytoskeleton, and leads to an inhibition of tip growth. We show that ADF is subject to phosphorylation in vivo, and using complementation studies we show that mutations of the predicted phosphorylation site partially rescue plant viability, but with differential affects on tip growth. Specifically, the unphosphorylatable ADF S6A mutant generates small polarized plants with normal F-actin organization, whereas the phosphomimetic S6D mutant generates small, unpolarized plants with a disorganized F-actin cyotskeleton. These data indicate that phosphoregulation at serine 6 is required for full ADF function in vivo, and, in particular, that the interaction between ADF and actin is important for tip growth.

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OBJECTIVE-A well-publicized January 2001 federal advisory recommended that pregnant women limit consumption of certain fish because of concerns about mercury contamination. We endeavored to estimate the extent to which pregnant women changed fish consumption habits after dissemination of this national advisory METHODS-We performed interrupted time series analysis of data from a cohort of pregnant women (2235 who completed at least one dietary questionnaire) visiting obstetric offices in a multispecialty group practice in eastern Massachusetts, surveyed before the advisory from April 1999 through December 2000 and after the advisory from April 2001 through February 2002. Main outcome measures were consumption of total fish and of four fish types: canned tuna, dark meat fish, shellfish, and white meat fish. Subjects reported fish consumption on semiquantitative food frequency questionnaires administered at each trimester of pregnancy. RESULTS-We observed diminished consumption of dark meat fish, canned tuna, and white meat fish after the national mercury advisory. These decreases resulted in a reduction in total fish consumption of approximately 1.4 servings per month (95% confidence interval 0.7, 2.0) from December 2000 to April 2001, with ongoing declines through the end of the study period. There was no change in shellfish intake. CONCLUSION-After dissemination of federal recommendations, pregnant women in this cohort reported reduced consumption of fish, including tuna, dark meat fish, and white meat fish. Because these fish may confer nutritional benefits to mother and infant, public health implications of these changes remain unclear. Oh mercy mercy me Oh things ain't what they used to be. Oil wasted on the oceans and upon our seas Fish full of mercury.

It is believed that the mechanism underlying vascular endothelial cell damage in preeclampsia is associated with the formation of lipid peroxides and other reactive free radical oxygen species generated from persistent placental underperfusion. Support for the role of oxidative stress (free radical-mediated lipid peroxidation) in the pathophysiology of preeclampsia is provided by biochemical evidence that the plasma serum of patients with the disorder has a high concentration of lipid peroxidation products and is deficient in endogenous antioxidants. One clinical trial showed that oral administration of lycopene, a strong antioxidant and free radical scavenger, significantly reduced the risk of preeclampsia and intrauterine growth retardation in low-risk primigravidas. Because of this and other evidence, it was expected that lycopene would prevent preeclampsia in a similar low-risk population.This randomized double blind placebo-controlled trial evaluated the effectiveness of antioxidant supplementation with lycopene for the prevention of preeclampsia in 159 healthy singleton primigravidas between 12 and 20 weeks of gestation. The study subjects were randomized to receive oral daily doses of lycopene 2 mg (n ϭ 77) or a placebo (n ϭ 82) and were followed until delivery for the development of preeclampsia.There was no difference between the 2 groups in the percentage of patients who developed preeclampsia (18% in both groups). However, women who received lycopene had a significantly higher incidence of preterm labor than the placebo (10.4% vs. 1.2%, P ϭ 0.02), and more low birth weight (Ͻ2.5 kg) babies (22.1% vs. 9.8%, P ϭ 0.05).These findings indicate that the antioxidant lycopene is not effective for prevention of preeclampsia in healthy primigravidas and may be associated with an increased incidence of adverse effects such as preterm labor and low birth weight babies. ABSTRACTIt is unclear whether idiopathic oligohydramniosis is associated with hot weather. One small study in a large European city reported a substantially higher incidence of oligohydramnios during a heat wave. The higher incidence appeared to be related to dehydration. The frequency of oligohydramniosis may also vary among different ethnic groups. The Bedouin population has much greater exposure to the hot and arid climate of the desert in small remote settlements. In contrast, the Jewish population-representative of any Western society-tends to live in urban areas with benefits such as air-conditioning and other comforts. 774Obstetrical and Gynecological Survey Physiology and Pathophysiology of Pregnancy, Labor, and Puerperium 775 ABSTRACTAlthough induction of labor in pregnant women at term with gestational hypertension or mild preeclampsia is already recommended and practiced in the United States and other developed countries, no randomized clinical trials have been carried out comparing induction of labor versus expectant monitoring.This multicenter, parallel, randomized, unblinded controlled trial compared the effect of labor induction or e...