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This study supports that MST, when combined with conventional treatment, is effective for the recovery of motor skills in post-stroke patients. Savannah River National Lab.
The low filter flux through the ARP has limited the rate at which radioactive liquid waste can be treated. Recent filter flux has averaged approximately 5 gallons per minute gpm. Salt Batch 6 has had a lower processing rate and required frequent filter cleaning.
In addition, at the time the testing started, SRR was assessing the impact of replacing the 0. This report describes testing of MST filterability to investigate the impact of filter pore size and MST particle size on filter flux and testing of filter enhancers to attempt to increase filter flux.
The authors constructed a laboratory-scale crossflow filter apparatus with two crossflow filters operating in parallel. One filter was a 0. The authors also constructed a dead-end filtration apparatus to conduct screening tests with potential filter aids and body feeds, referred to as filter enhancers.
The original baseline for ARP was 5. SRNL conducted tests varying the concentration of sodium and free hydroxide to determine whether those changes had a significant effect on filter flux.
It is possible that sample distortion bias could have affected the study The results did not provide information about missing values for study variables.
Although it is stated that the analysis was restricted to cases and controls which had valid values on all variables, the total number of cases and controls vary from table to table. In the descriptive analysis 2, controls were included and in the different tables showing the results of the adjusted analyses there were 2,, 2,, and 1, live births, respectively.
The authors did not mention having calculated sample sizes, and in the separate analysis of antepartum and intrapartum fetal deaths there is no information regarding the study's power to detect differences between groups. The crude results showed that No significance levels are provided, and in view of the marginal significance in the highest consumption category, one cannot conclude that caffeine consumption is a risk factor for fetal mortality.
It apparently makes more sense to study caffeine consumption in relation to prenatal fetal mortality, since the determinants of intrapartum deaths are much more closely related to access to quality of medical care during labor and delivery than to maternal factors Data on caffeine intake were also collected, and the association between caffeine intake before and during pregnancy and increased risk of fetal loss was investigated.
Cases were women hospitalized with a medically confirmed diagnosis of spontaneous abortion or fetal death from May to November at Hospital Sainte-Justine in Montreal, Quebec. Three controls were matched to each case in the following periods of gestation: Controls were women in the same period of pregnancy as cases and who had not experienced a fetal loss. They were recruited from pregnant women expected to deliver at the hospital when they presented for routine blood analysis.
Previous history of spontaneous abortion was an exclusion criterion for both cases and controls. A total of cases and controls were studied. The authors excluded patients admitted at night and discharged before the next morning, as well as those admitted on weekends or legal holidays, a methodological issue that generated criticism 9,21, On the other hand, the high percentage of refusals among cases In addition, controls were recruited among women attending prenatal care while cases were recruited upon their hospitalization and no information was provided as to whether cases had been receiving prenatal care.
Moreover, prenatal care was not included among the potential confounders presented by the authors. This imposed selection criterion only for controls may be another source of selection bias in this study 9, Another debatable methodological aspect of the study was that the authors mixed abortions and third-trimester fetal deaths An interview covered mother's age, race, education, obstetric history, smoking and alcohol use during pregnancy, occupational exposures, and medical conditions.
Regarding caffeine consumption, women were asked about the intake of beverages containing caffeine such as coffee, tea, and cola before pregnancy the month preceding conception and during pregnancy up to the time of study enrollment.
Although cases and controls reported their caffeine intake during a relatively comparable reference period, since the investigators obtained information on both current and past caffeine intake, differential recall bias may have affected the study if cases were more likely to remember the exposure than controls. In addition, since the control group was selected among women attending prenatal care, where counseling about avoiding caffeine consumption may have occurred, the control group may have had lower caffeine intake which could lead to an overestimated association between caffeine intake and fetal loss in the study 7, The authors did not describe how they measured caffeine from each source.
Apparently, they used a "cup of coffee", a "cup of tea", and a "can of cola" to quantify caffeine intake. Several factors affect the amount of caffeine in a given volume of coffee or tea, such as the size of the cup, the brand, and the method of preparation.
Neither a "cup" of coffee nor a "cup" of tea is a precise measure of coffee or tea intake and hence, the dose of caffeine may have been incorrectly calculated, leading to exposure misclassification. Even though this kind of error would be non-differential between cases and controls, differences in measurement methods hinder comparison across studies 7, Choice of controls is a persistently thorny methodological issue in case-control studies According to the investigator's sampling approach for controls, case-control designs can be "traditional", "concurrent", or "inclusive".
In "traditional" designs, controls are sampled from the population still at risk at the end of the study period. In "concurrent" designs, controls can be selected concurrently from those still at risk when a new case is diagnosed and a person originally selected as a control can therefore be classified as a case at a later date. Finally, in "inclusive" designs, controls are chosen from among all individuals in the population regardless of whether they have already had the condition under study.
The latter two choices of controls allow to obtain direct estimates of relative risk and relative rate, respectively, instead of OR, an indirect estimate When studying fetal death as outcome, many investigators select live births as controls. They compare their cases with "the best possible controls", those who survived the entire gestational period and were born alive. When the primary objective is to identify an association, then such case-control studies have the greatest power to find a statistically significant result.
In the study by Infante-Rivard et al. Controls were women at risk of experiencing a fetal loss because at the time of recruitment their fetuses were alive. As pregnancy advanced, if a woman previously selected as a control suffered a fetal loss, ideally she would have had the opportunity to be included as a case as well. In this type of design the control group represents the person-years-at-risk experience, and an analysis matched on time of selection will yield an unbiased estimate of the relative rate incidence density ratio instead of OR, which overestimates the real effect Since with such a design the authors found a statistical association between caffeine consumption during pregnancy and fetal death, it would be expected that using a traditional design the magnitude of the observed association would have been even greater.
From to all pregnant women admitted for delivery at the Aarthus University Hospital in Denmark were invited to participate in the study. Information about caffeine intake was obtained from a self-administered questionnaire at about 16 weeks of gestation, before the first prenatal visit. This was the first study in which the association between coffee intake and fetal death was studied in a cohort design, thus constituting its main strength.
The authors obtained information on current intake of caffeine at about 16 weeks of gestation. Due to the study design and the timing of data collection, this information was not biased by women's knowledge of pregnancy outcome.
However, several investigators demonstrated that women can change their pattern of caffeine intake during the course of pregnancy Even though caffeine consumption is more likely to change in the first trimester of gestation, particularly among women suffering morning sickness 29, since caffeine intake in this study was assessed at only one point in time, it may not precisely reflect the caffeine intake pattern throughout pregnancy.
It would have been more appropriate to perform a subsequent assessment of caffeine intake near the end of the pregnancy to decrease the risk that changes in caffeine consumption were not taken into account. The authors obtained information about various caffeine sources, but they only analyzed coffee intake because "only few women were exposed to high doses of caffeine from tea and hardly any from drinking chocolate or cola".
However, this reason for restricting the analysis to coffee intake is not sound, because to correctly classify the study population in terms of exposure it does not matter whether women reach high caffeine levels from different sources. An extensive accounting of all different sources of caffeine exposure would have allowed the authors to study "caffeine consumption", a more comprehensive exposure.
Concerning coffee quantification, the authors measured coffee intake by "cups" per day, and as we previously mentioned, a cup is not a precise measure of coffee intake.
The authors assumed that one cup of coffee contains approximately mg of caffeine, but they did not collect information on beverage cup size, type of coffee, or method of preparation, so the study was subject to exposure misclassification, as already mentioned in the comments on the Infante-Rivard et al.
However, the association in that category was not significant. Jacobs 31 commented that since the authors do not present the results of an overall test for the entire variable, it was impossible to determine whether, after adjustment, caffeine consumption was still significantly associated with stillbirth. Cohort studies have several major advantages over other types of observational studies to study the relationship between caffeine intake and fetal death, but very large cohorts are required to ensure adequate numbers of outcome events to yield statistically significant results In Wisborg et al.
Their results, although not definitive, suggest a trend of increasing risk of stillbirths as the number of cups of coffee consumed per day during pregnancy increases.
Conclusions The scoring system used to qualify the studies was useful to show that most of the investigations were not highly discrepant in terms of methodological quality. The analysis of the studies revealed that the main methodological flaw was the inaccurate exposure assessment, an issue already pointed out in other reviews focusing on caffeine consumption during human pregnancy. Despite the biological plausibility that caffeine may increase the risk of fetal death, there is still no clear answer to the question: The small number of publications addressing the subject, methodological limitations in the reviewed studies, and overall risks only moderately elevated and marginally significant in most cases disallow stating with certainty that this association actually exists.
In addition, due to the absence of studies showing negative results, the possibility of publication bias exists. This type of study would be difficult to plan and carry out, and also excessively expensive. The present review highlighted the scarcity of publications on the subject and the need for well-designed future research to define the role of caffeine in fetal mortality. A well-designed investigation to contribute with convincing evidence on the association between caffeine consumption during pregnancy and fetal death would require a more in-depth approach to caffeine assessment, attempting to be sufficiently creative to suitably measure caffeine exposure without overly complicating the investigation.
The FDA has been advising women since to avoid caffeine or consume it only moderately during pregnancy. Although the available information linking caffeine to fetal death is incomplete, many health professional organizations 32 advise pregnant women to reduce caffeine intake.
Although suspicion surpasses evidence at present, such caution appears to be prudent. Matijasevich performed the relevant article searches, systemized the results, and wrote the draft and final version of the article.
Santos oriented the methodological comments. Santos reviewed the draft and contributed to the review of the final version. International Agency for Research on Cancer. International Agency for Research on Cancer; Monographs on the Evaluation of Carcinogenic Risks to Humans, v. Pharmacological properties and neurophysiological effects of caffeine. Caffeine metabolism in the newborn. Clin Pharmacol Ther ; The disposition of caffeine during and after pregnancy. Semin Perinatol ; 5: Moderate to heavy caffeine consumption during pregnancy and relationship to spontaneous abortion and abnormal fetal growth: Reprod Toxicol ; Caffeine intake and pregnancy outcomes: Maternal caffeine consumption and spontaneous abortion: Effects of caffeine on human health.
Food Addit Contam ; Leviton A, Cowan L. A review of the literature relating caffeine consumption by women to their risk of reproductive hazards. Food Chem Toxicol ; Adverse pregnancy outcome in the monkey Macaca fascicularis after chronic caffeine exposure.
The essential oil of C. By considering the release factors of these areas and their proportion of the entire barn, total emission rates of CO2-eq.