Bleeding changes after levonorgestrel 52-mg intrauterine system insertion for contraception in women with self-reported heavy menstrual bleeding.

BackgroundThe levonorgestrel 52-mg intrauterine system has proven efficacy for heavy menstrual bleeding treatment in clinical trials, but few data exist to demonstrate how rapidly the effects occur and the effects in women with self-reported heavy bleeding, as seen commonly in clinical practice.ObjectiveEvaluate changes in bleeding patterns in women with self-reported heavy menstrual bleeding before levonorgestrel 52-mg intrauterine system insertion.Study designA total of 1714 women aged 16-45 years old received a levonorgestrel 52-mg intrauterine system in a multicenter trial evaluating contraceptive efficacy and safety for up to 10 years. At screening, participants described their baseline menstrual bleeding patterns for the previous 3 months. Participants completed daily diaries with subjective evaluation of bleeding information for the first 2 years. For this analysis, we included women with at least 1 complete 28-day cycle of intrauterine system use and excluded women using a hormonal or copper intrauterine contraception in the month prior to study enrollment. We evaluated changes in menstrual bleeding and discontinuation for bleeding complaints per 28-day cycle over 26 cycles (2 years) in women who self-reported their baseline pattern as heavy. We also compared rates of amenorrhea, defined as no bleeding or spotting, within the entire study population in women with subjective heavy menstrual bleeding at baseline compared with those who did not complain of heavy menstrual bleeding.ResultsOf the 1513 women in this analysis, 150 (9.9%) reported baseline heavy menstrual bleeding. The majority of women reported no longer experiencing heavy menstrual bleeding by the end of cycle 1 (112/150, 74.7%) with even greater rates by cycle 2 (124/148, 83.8%). At the end of cycles 6, 13, and 26, 129 of 140 (92.1%; 95% confidence interval, 87.7%-96.6%), 114 of 123 (92.7%; 95% confidence interval, 88.1%-97.3%), and 100 of 103 (97.1%; 95% confidence interval, 93.8%-100%) women reported no heavy menstrual bleeding, respectively. After cycles 13 and 26, 63 of 123 (51.2%; 95% confidence interval, 42.4%-60.1%) and 66 of 103 (64.1%; 95% confidence interval, 54.8%-73.3%), respectively, reported their bleeding as amenorrhea or spotting only. A lower proportion of women with baseline self-reported heavy menstrual bleeding reported amenorrhea as compared with women in the overall study cohort without heavy menstrual bleeding at the end of 6 cycles (319 [25.5%] vs 21 [15.0%], P=.005) and 13 cycles (382 [34.4%] vs 26 [21.1%], P=.003); differences were not significant after 19 cycles (367 [37.2%] vs 36 [31.0%], P=.022) and 26 cycles (383 [43.5%] vs 38 [36.9%], P=.21). Only 4 (2.7%) women with baseline heavy menstrual bleeding discontinued for bleeding complaints (2 for heavy menstrual bleeding and 2 for irregular bleeding), all within the first year.ConclusionMost women who self-report heavy menstrual bleeding experience significant improvement quickly after levonorgestrel 52-mg intrauterine system insertion. Discontinuation for bleeding complaints among women with baseline heavy menstrual bleeding is very low

Understanding How EdD Students View Educational Research: A Qualitative Study Using Domain, Taxonomic, Componential and Text Mining Analysis

The purpose of this qualitative study is to explore how EdD students initially view educational research and themselves as researchers before taking their first required research course. This study used four types of qualitative data analysis methods: domain, taxonomic, componential, and text mining. The findings suggest that the EdD students are able to identity several attributes of research, but there is a dissonance on the attributes aligned with upper academic research. The students understand the importance of research to educational practices, but do not have sufficient understanding about research methods and methodologies. Their views of what research is are formal but their views on who does research is informal. Recommendations for EdD research course designs are offered

ECSTM Studies of the Electrocatalyst Stability for the AAEM Fuel Cell

poster abstractAlkaline fuel cells (AFC) have come to the forefront of fuel cell research due to the friendlier environment they provide to the cell’s components in comparison to acid-based Proton Exchange Membrane (PEM) fuel cells. The AFC shows real world application of 60% efficiency, but suffers from long term degradation due to the formation of carbonate precipitates formed from carbon dioxide. A solid-state form of the AFC, the alkaline anion exchange membrane (AAEM) fuel cell, is under development to overcome the degradation, due to the usage of liquid potassium hydroxide (KOH) or sodium hydroxide (NaOH) electrolytes in the AFC. Also, the AFC are known to have a higher rate of contamination and therefore need higher purity fuel than their acidic counterparts. This problem is eliminated by the AAEM fuel cell. The cathode, which consists of the catalyst, ionomer and current supports in the AAEM fuel cell or the AFC, is the key component that determines the cell’s performance and stability. The material found to work best for the AAEM fuel cell is platinum (Pt). The issue with Pt as a catalyst material for these fuel cells is that is it very cost prohibitive for mass production. Therefore, other metals are being investigated to find a material with less cost, but perform as well as the Pt in AAEM fuel cells. Several theories have been proposed as to the cause of cathode degradation. It was found that an increase in current density, temperature and ligand (OH-) concentration accelerated corrosion of catalysts and carbon supports. Studies have been done on the catalyst material of Pt, as well as the highly oriented pytolytic graphite (HOPG). HOPG is a carbon-based material that Pt is deposited upon. So far, most of these studies were done in acid media. The objective of this work is to develop an in situ electrochemical scanning tunneling microcopy (ECSTM) method for characterizing stability of nano-Pt and HOPG substrate under operation conditions of an AFC. Future research will characterize the stability of other metal nanostructure in an attempt to find cheaper and effective alternatives to Platinum

Policy Poisoning in Batch Learning for Linear Quadratic Control Systems via State Manipulation

In this work, we study policy poisoning through state manipulation, also known as sensor spoofing, and focus specifically on the case of an agent forming a control policy through batch learning in a linear-quadratic (LQ) system. In this scenario, an attacker aims to trick the learner into implementing a targeted malicious policy by manipulating the batch data before the agent begins its learning process. An attack model is crafted to carry out the poisoning strategically, with the goal of modifying the batch data as little as possible to avoid detection by the learner. We establish an optimization framework to guide the design of such policy poisoning attacks. The presence of bi-linear constraints in the optimization problem requires the design of a computationally efficient algorithm to obtain a solution. Therefore, we develop an iterative scheme based on the Alternating Direction Method of Multipliers (ADMM) which is able to return solutions that are approximately optimal. Several case studies are used to demonstrate the effectiveness of the algorithm in carrying out the sensor-based attack on the batch-learning agent in LQ control systems.Comment: First appeared at CISS 202

Genomic profiling of malignant peritoneal mesothelioma reveals recurrent alterations in epigenetic regulatory genes BAP1, SETD2, and DDX3X.

Malignant mesothelioma is a rare cancer that arises from the mesothelial cells that line the pleural cavity and less commonly from the peritoneal lining of the abdomen and pelvis. Most pleural mesotheliomas arise in patients with a history of asbestos exposure, whereas the association of peritoneal mesotheliomas with exposure to asbestos and other potential carcinogens is less clear, suggesting that the genetic alterations that drive malignant peritoneal mesothelioma may be unique from those in pleural mesothelioma. Treatment options for all malignant mesotheliomas are currently limited, with no known targeted therapies available. To better understand the molecular pathogenesis of malignant peritoneal mesothelioma, we sequenced 510 cancer-related genes in 13 patients with malignant mesothelioma arising in the peritoneal cavity. The most frequent genetic alteration was biallelic inactivation of the BAP1 gene, which occurred in 9/13 cases, with an additional two cases demonstrating monoallelic loss of BAP1. All 11 of these cases demonstrated loss of BAP1 nuclear staining by immunohistochemistry, whereas two tumors without BAP1 alteration and all 42 cases of histologic mimics in peritoneum (8 multilocular peritoneal inclusion cyst, 6 well-differentiated papillary mesothelioma of the peritoneum, 16 adenomatoid tumor, and 12 low-grade serous carcinoma of the ovary) demonstrated intact BAP1 nuclear staining. Additional recurrently mutated genes in this cohort of malignant peritoneal mesotheliomas included NF2 (3/13), SETD2 (2/13), and DDX3X (2/13). While these genes are known to be recurrently mutated in pleural mesotheliomas, the frequencies are distinct in peritoneal mesotheliomas, with nearly 85% of peritoneal tumors harboring BAP1 alterations versus only 20-30% of pleural tumors. Together, these findings demonstrate the importance of epigenetic modifiers including BAP1, SETD2, and DDX3X in mesothelial tumorigenesis and suggest opportunities for targeted therapies

Depositing catalyst layers in polymer electrolyte membrane fuel cells : a review

Fuel cell technology continues to advance and offers to be a potentially promising solution to many energy needs. Of particular interest are manufacturing techniques to improve performance and decrease overall cost. For catalyst deposition on the membrane electrode assembly (MEA), there are a number of techniques that have been used in the past decades. This paper aims to review many of these main techniques that have been published to show the wide variety of catalyst deposition methods