Artificial Intelligence for Ovarian Stimulation

Ovarian stimulation, the basis of treatment strategies for infertility, from anovulation to in vitro fertilization, is a highly efficient therapeutic procedure. The stimulation should ensure a complete development of the follicle(s) along with maturation of the oocyte(s), all without risking hyperstimulation and multiple pregnancies. For these reasons, a stimulation protocol should be personalized, and its evolution must be continually scrutinized using measures of both blood hormone levels and ovarian responses by ultrasound. Essentially all of the stimulation algorithms proposed to date focus only on determination of the starting dose of gonadotropin. But ovarian stimulation should be continually monitored until the final decision is made to trigger or to abort the cycle. This decision can be achieved through use of an experience-based computer software system that monitors menstrual cycles through a beginning pregnancy. This software (StimXpert®) should work effectively with a classical stimulation as well as a controlled hyperstimulation for IVF. It may also be modified from experience-based to evidence-based programming through progressive learning

To what extent do water reuse treatments reduce antibiotic resistance indicators? A comparison of two full-scale systems

Water reuse is an essential strategy for reducing water demand from conventional sources, alleviating water stress, and promoting sustainability, but understanding the effectiveness of associated treatment processes as barriers to the spread of antibiotic resistance is an important consideration to protecting human health. We comprehensively evaluated the reduction of antibiotic resistance genes (ARGs) and antibiotic-resistant bacteria (ARB) in two field-operational water reuse systems with distinct treatment trains, one producing water for indirect potable reuse (ozone/biologically-active carbon/granular activated carbon) and the other for non-potable reuse (denitrification-filtration/chlorination) using metagenomic sequencing and culture. Relative abundances of total ARGs/clinically-relevant ARGs and cultured ARB were reduced by several logs during primary and secondary stages of wastewater treatment, but to a lesser extent during the tertiary water reuse treatments. In particular, ozonation tended to enrich multi-drug ARGs. The effect of chlorination was facility-dependent, increasing the relative abundance of ARGs when following biologically-active carbon filters, but generally providing a benefit in reduced bacterial numbers and ecological and human health resistome risk scores. Relative abundances of total ARGs and resistome risk scores were lowest in aquifer samples, although resistant Escherichia coli and Klebsiella pneumoniae were occasionally detected in the monitoring well 3-days downgradient from injection, but not 6-months downgradient. Resistant E. coli and Pseudomonas aeruginosa were occasionally detected in the nonpotable reuse distribution system, along with increased levels of multidrug, sulfonamide, phenicol, and aminoglycoside ARGs. This study illuminates specific vulnerabilities of water reuse systems to persistence, selection, and growth of ARGs and ARB and emphasizes the role of multiple treatment barriers, including aquifers and distribution systems

Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial

Background: Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy. Methods: In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493. Findings: Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12·1, 95% CI 3·7–39·9; p<0·0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14·0, 4·2–46·2; p<0·0001). These differences remained significant with sensitivity analyses. Interpretation: Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown

The Effect of Insecticide on Predator-prey Model to Control the Brown Planthopper

The interaction of brown planthopper with its natural enemies can be represented in a predator-prey model. In this research, predator prey model influenced by insecticide is discussed. It is assumed that insecticide is applied at only one time when the population of brown planthopper is rised. The simulation results indicate that the brown planthopper population could be reduced significantly, but only in a moment. For a long periods of time, the brown planthopper population and their natural enemies will be oscillated and lead to the specified value. This means, the brown planthopper populations for long periods of time only depends on the mortality rate of predator and the level of interaction of the brown planthopper and predators

Pemodelan Turbin Cross-flow Untuk Diaplikasikan Pada Sumber Air Dengan Tinggi Jatuh Dan Debit Kecil

Telah dilakukan suatu upaya memodifikasi dan rekayasa turbin jenis cross-flow. Rekayasa dilakukan dengan merubah jumlah sudut dan hubungannya dengan jumlah putaran, daya turbin, dan efisiensi turbin. Rekayasa juga dilakukan terhadap bentuk saluran yang digunakan yaitu saluran terbuka berbentuk persegi, setengah lingkaran dan trapesium. Penelitian ini dilakukan dengan mengambil beberapa input yang disesuaikan dengan kebanyakan yang ada di lapangan. Input yang diambil adalah kecepatan alir, tinggi jatuh, kemiringan saluran, lebar penampang saluran, jari-jari saluran, diameter luar turbin, dan lebar turbin. Sementara itu besaran yang dibuat variabel adalah jumlah sudu pada turbin cross-flow. Penampang sebagai saluran air dipakai persegi, setengah lingkaran, dan trapesium dan ketiganya dibuat terbuka. Hasil penelitian menunjukkan bahwa dengan asumsi lebar penampang 4 m, tinggi jatuh 2 m, jari-jari 2 m, kemiringan 1/√3, kecepatan aliran 2 m/s, diameter luar turbin 0,75 m, dan lebar turbin 4,3 m, maka turbin dengan jumlah sudu 12 memiliki jumlah putaran, daya turbin, dan efisiensi turbin yang paling besar. Bilamana jumlah sudu diperbanyak, maka jumlah putaran, daya turbin, dan efisiensi turbin semakin kecil. Sementara itu penelitian untuk menentukan jenis penampang saluran didapatkan bahwa jenis saluran dengan penampang trapesium dihasilkan jumlah putaran, daya turbin, dan efisiensi turbin yang paling besar disusul jenis persegi dan setengah lingkaran

Atrazine and Breast Cancer: A Framework Assessment of the Toxicological and Epidemiological Evidence

The causal relationship between atrazine exposure and the occurrence of breast cancer in women was evaluated using the framework developed by Adami et al. (2011) wherein biological plausibility and epidemiological evidence were combined to conclude that a causal relationship between atrazine exposure and breast cancer is “unlikely”. Carcinogenicity studies in female Sprague-Dawley (SD) but not Fischer-344 rats indicate that high doses of atrazine caused a decreased latency and an increased incidence of combined adenocarcinoma and fibroadenoma mammary tumors. There were no effects of atrazine on any other tumor type in male or female SD or Fischer-344 rats or in three strains of mice. Seven key events that precede tumor expression in female SD rats were identified. Atrazine induces mammary tumors in aging female SD rats by suppressing the luteinizing hormone surge, thereby supporting a state of persistent estrus and prolonged exposure to endogenous estrogen and prolactin. This endocrine mode of action has low biological plausibility for women because women who undergo reproductive senescence have low rather than elevated levels of estrogen and prolactin. Four alternative modes of action (genotoxicity, estrogenicity, upregulation of aromatase gene expression or delayed mammary gland development) were considered and none could account for the tumor response in SD rats. Epidemiological studies provide no support for a causal relationship between atrazine exposure and breast cancer. This conclusion is consistent with International Agency for Research on Cancer’s classification of atrazine as “unclassifiable as to carcinogenicity” and the United States Environmental Protection Agency's classification of atrazine as “not likely to be carcinogenic.

Ethical and policy issues in cluster randomized trials: rationale and design of a mixed methods research study

<p>Abstract</p> <p>Background</p> <p>Cluster randomized trials are an increasingly important methodological tool in health research. In cluster randomized trials, intact social units or groups of individuals, such as medical practices, schools, or entire communities – rather than individual themselves – are randomly allocated to intervention or control conditions, while outcomes are then observed on individual cluster members. The substantial methodological differences between cluster randomized trials and conventional randomized trials pose serious challenges to the current conceptual framework for research ethics. The ethical implications of randomizing groups rather than individuals are not addressed in current research ethics guidelines, nor have they even been thoroughly explored. The main objectives of this research are to: (1) identify ethical issues arising in cluster trials and learn how they are currently being addressed; (2) understand how ethics reviews of cluster trials are carried out in different countries (Canada, the USA and the UK); (3) elicit the views and experiences of trial participants and cluster representatives; (4) develop well-grounded guidelines for the ethical conduct and review of cluster trials by conducting an extensive ethical analysis and organizing a consensus process; (5) disseminate the guidelines to researchers, research ethics boards (REBs), journal editors, and research funders.</p> <p>Methods</p> <p>We will use a mixed-methods (qualitative and quantitative) approach incorporating both empirical and conceptual work. Empirical work will include a systematic review of a random sample of published trials, a survey and in-depth interviews with trialists, a survey of REBs, and in-depth interviews and focus group discussions with trial participants and gatekeepers. The empirical work will inform the concurrent ethical analysis which will lead to a guidance document laying out principles, policy options, and rationale for proposed guidelines. An Expert Panel of researchers, ethicists, health lawyers, consumer advocates, REB members, and representatives from low-middle income countries will be appointed. A consensus conference will be convened and draft guidelines will be generated by the Panel; an e-consultation phase will then be launched to invite comments from the broader community of researchers, policy-makers, and the public before a final set of guidelines is generated by the Panel and widely disseminated by the research team.</p

Dependence and Imperialism in India

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69044/2/10.1177_048661347300500111.pd