Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs

Background: The UK health service, nursing homes and public spend around £94 million per year on incontinence pads (absorbent products) to contain urine and/or faeces, but the research base for making informed choices between different product designs is very weak.Objectives: The aim of this trial was to compare the performance and cost-effectiveness of the key absorbent product designs to provide a more solid basis for guiding selection and purchase.A further aim was to carry out the first stage in the development of a quality of life instrument for measuring the impact of absorbent product use on users' lives.Design: The work involved three clinical trials focusing on the three biggest market sectors. Each trial had a similar crossover design in which each participant tested all products within their group in random order.Settings, participants and methods: In Trial 1, 85 women with light urinary incontinence living in the community tested three products from each of the four design categories available (total of 12 test products): disposable inserts (pads); menstrual pads; washable pants with integral pad; and washable inserts. In Trial 2a, 85 moderate/heavily incontinent adults (urinary or urinary/faecal) living in the community (49 men and 36 women) tested three (or two) products from each of the five design categories available (total of 14 test products): disposable inserts (with mesh pants); disposable diapers (nappies); disposable pull-ups (similar to toddlers' trainer pants); disposable T-shaped diapers (nappies with waist-band); and washable diapers. All products were provided in a daytime and a (mostly more absorbent) night-time variant. In these first two trials, the test products were selected on the basis of data from pilot studies. In Trial 2b, 100 moderate/heavily incontinent adults (urinary or urinary/faecal) living in 10 nursing homes (27 men and 73 women) evaluated one product from each of the four disposable design categories from Trial 2a. Products were selected on the basis of product performance in Trial 2a and, again, daytime and night-time variants were provided. The first phase of work to develop a quality of life tool for measuring the impact of using different pad designs was carried out by interviewing participants from Trials 1 and 2a.Outcome measures: Product performance was characterised using validated questionnaires, which asked the participants (in Trials 1 and 2a) or carers (all participants in Trial 2b, except for the few who could report for themselves) to evaluate various aspects of pad performance (leakage, ease of putting on, discreetness, etc.) using a five-point scale (very good–very poor) at the end of the week (or 2 weeks for Trial 2b) of product testing. In addition, participants/carers were asked to save individual used pads in bags for weighing and to indicate the severity of any leakage from them on a three-point scale (none, a little, a lot). These data were used to determine differences in leakage performance. Numbers of laundry items and pads used were recorded to estimate costs, and skin health changes were recorded by the participant or by the researchers (Trial 2b). At the end of testing, participants were interviewed and ranked their preferences (with and without costs), stated the acceptability of each design (highly acceptable–totally unacceptable) and recorded their overall opinion on a visual analogue scale (VAS) of 0–100 points (worst design–best design). This VAS score was used with product costs to estimate cost-effectiveness. In addition, a timed pad changing exercise was conducted with 10 women from Trial 2b to determine any differences between product designs.Results: Results presented are for statistically and clinically significant findings.<br/

Water footprints of cities indicators for sustainable consumption and production

Water footprints have been proposed as sustainabilityindicators, relating the consumption of goods likefood to the amount of water necessary for their productionand the impacts of that water use in the source regions. Wefurther developed the existing water footprint methodology,by globally resolving virtual water flows from production toconsumption regions for major food crops at 5 arcmin spatialresolution. We distinguished domestic and internationalflows, and assessed local impacts of export production. Applyingthis method to three exemplary cities, Berlin, Delhiand Lagos, we find major differences in amounts, composition,and origin of green and blue virtual water imports,due to differences in diets, trade integration and crop waterproductivities in the source regions. While almost all ofDelhi’s and Lagos’ virtual water imports are of domestic origin,Berlin on average imports from more than 4000 km distance,in particular soy (livestock feed), coffee and cocoa.While 42% of Delhi’s virtual water imports are blue waterbased, the fractions for Berlin and Lagos are 2 and 0.5 %, respectively,roughly equal to the water volumes abstracted inthese two cities for domestic water use. Some of the externalsource regions of Berlin’s virtual water imports appear tobe critically water scarce and/or food insecure. However, forderiving recommendations on sustainable consumption andtrade, further analysis of context-specific costs and benefitsassociated with export production will be required

Exploring the equivalence of two common mixture models for duration data

The beta-geometric (BG) distribution and the Pareto distribution of the second kind (P(II)) are two basic models for duration-time data that share some underlying characteristics (i.e., continuous mixtures of memoryless distributions), but differ in two important respects: first, the BG is the natural model to use when the event of interest occurs in discrete time, while the P(II) is the right choice for a continuous-time setting. Second, the underlying mixing distributions (the beta and gamma for the BG and P(II), respectively, are very different—and often believed to be non-comparable with each other. Despite these and other key differences, the two models are strikingly similar in terms of their fit and predictive performance as well as their parameter estimates. We explore this equivalence, both empirically and analytically, and discuss the implications from both a substantive and methodological standpoint

"How to project customer retention" revisited: the role of duration dependence

Cohort-level retention rates typically increase over time, and the beta-geometric (BG) distribution has proven to be a robust model for capturing and projecting these patterns into the future. According to this model, the phenomenon of increasing cohort-level retention rates is purely due to cross-sectional heterogeneity; an individual customer’s propensity to churn does not change over time. In this paper we present the beta-discrete-Weibull (BdW) distribution as an extension to the BG model, one that allows individual-level churn probabilities to increase or decrease over time. In addition to capturing the phenomenon of increasing cohort-level retention rates, this new model can also accommodate situations in which there is an initial dip in retention rates before they increase (i.e., a U-shaped cohort-level retention curve). A key finding is that even when aggregate retention rates are monotonically increasing, the individual-level churn probabilities are unlikely to be declining over time, as conventional wisdom would suggest. We carefully explore these connections between heterogeneity, duration dependence, and the shape of the retention curve, and draw some managerially relevant conclusions, e.g., that accounting for cross-sectional heterogeneity is more important than accounting for any individual-level dynamics in churn propensities

Document Filtering for Long-tail Entities

Filtering relevant documents with respect to entities is an essential task in the context of knowledge base construction and maintenance. It entails processing a time-ordered stream of documents that might be relevant to an entity in order to select only those that contain vital information. State-of-the-art approaches to document filtering for popular entities are entity-dependent: they rely on and are also trained on the specifics of differentiating features for each specific entity. Moreover, these approaches tend to use so-called extrinsic information such as Wikipedia page views and related entities which is typically only available only for popular head entities. Entity-dependent approaches based on such signals are therefore ill-suited as filtering methods for long-tail entities. In this paper we propose a document filtering method for long-tail entities that is entity-independent and thus also generalizes to unseen or rarely seen entities. It is based on intrinsic features, i.e., features that are derived from the documents in which the entities are mentioned. We propose a set of features that capture informativeness, entity-saliency, and timeliness. In particular, we introduce features based on entity aspect similarities, relation patterns, and temporal expressions and combine these with standard features for document filtering. Experiments following the TREC KBA 2014 setup on a publicly available dataset show that our model is able to improve the filtering performance for long-tail entities over several baselines. Results of applying the model to unseen entities are promising, indicating that the model is able to learn the general characteristics of a vital document. The overall performance across all entities---i.e., not just long-tail entities---improves upon the state-of-the-art without depending on any entity-specific training data.Comment: CIKM2016, Proceedings of the 25th ACM International Conference on Information and Knowledge Management. 201

Valuing Subscription-Based Businesses Using Publicly Disclosed Customer Data

The growth of subscription-based commerce has seen a change in the types of data firms report to external shareholders. More than ever before, companies are discussing and disclosing data on the number of customers acquired and lost, customer lifetime value, and more. This has fueled an increasing interest in linking the value of a firm’s customers to the overall value of the firm, with the term customer-based corporate valuation being using to describe such efforts. While a number of researchers in the fields of marketing and accounting have explored this idea, their underlying models of customer acquisition and retention do not adequately reflect the empirical realities associated with these behaviors, and the associated valuation models do not live up to the standards of finance professionals. We develop a framework for valuing subscription-based firms that addresses both issues, and apply it to data from Dish Network and Sirius XM Holdings

Collagenolytic and gelatinolytic matrix metalloproteinases and their inhibitors in basal cell carcinoma of skin: comparison with normal skin

Tissue from 54 histologically-identified basal cell carcinomas of the skin was obtained at surgery and assayed using a combination of functional and immunochemical procedures for matrix metalloproteinases (MMPs) with collagenolytic activity and for MMPs with gelatinolytic activity. Collagenolytic enzymes included MMP-1 (interstitial collagenase), MMP-8 (neutrophil collagenase) and MMP-13 (collagenase-3). Gelatinolytic enzymes included MMP-2 (72-kDa gelatinase A/type IV collagenase) and MMP-9 (92-kDa gelatinase B/type IV collagenase). Inhibitors of MMP activity including tissue inhibitor of metalloproteinases-1 and -2 (TIMP-1 and TIMP-2) were also assessed. All three collagenases and both gelatinases were detected immunochemically. MMP-1 appeared to be responsible for most of the functional collagenolytic activity while gelatinolytic activity reflected both MMP-2 and MMP-9. MMP inhibitor activity was also present, and appeared, based on immunochemical procedures, to reflect the presence of TIMP-1 but not TIMP-2. As a group, tumours identified as having aggressive-growth histologic patterns were not distinguishable from basal cell carcinomas with less aggressive-growth histologic patterns. In normal skin, the same MMPs were detected by immunochemical means. However, only low to undetectable levels of collagenolytic and gelatinolytic activities were present. In contrast, MMP inhibitor activity was comparable to that seen in tumour tissue. In previous studies we have shown that exposure of normal skin to epidermal growth factor in organ culture induces MMP up-regulation and activation. This treatment concomitantly induces stromal invasion by the epithelium (Varani et al (1995) Am J Pathol146: 210–217; Zeigler et al (1996 b) Invasion Metastasis16: 11–18). Taken together with these previous data, the present findings allow us to conclude that the same profile of MMP/MMP inhibitors that is associated with stromal invasion in the organ culture model is expressed endogenously in basal cell carcinomas of skin. © 2000 Cancer Research Campaig

Dynamics of two laterally coupled semiconductor lasers: strong- and weak-coupling theory.

Copyright © 2008 The American Physical SocietyThe stability and nonlinear dynamics of two semiconductor lasers coupled side to side via evanescent waves are investigated by using three different models. In the composite-cavity model, the coupling between the lasers is accurately taken into account by calculating electric field profiles (composite-cavity modes) of the whole coupled-laser system. A bifurcation analysis of the composite-cavity model uncovers how different types of dynamics, including stationary phase-locking, periodic, quasiperiodic, and chaotic intensity oscillations, are organized. In the individual-laser model, the coupling between individual lasers is introduced phenomenologically with ad hoc coupling terms. Comparison with the composite-cavity model reveals drastic differences in the dynamics. To identify the causes of these differences, we derive a coupled-laser model with coupling terms which are consistent with the solution of the wave equation and the relevant boundary conditions. This coupled-laser model reproduces the dynamics of the composite-cavity model under weak-coupling conditions

Improving diaper design to address incontinence associated dermatitis

<p>Abstract</p> <p>Background</p> <p>Incontinence associated dermatitis (IAD) is an inflammatory skin disease mainly triggered by prolonged skin contact with urine, feces but also liberal detergent use when cleansing the skin. To minimize the epidermal barrier challenge we optimized the design of adult incontinence briefs. In the fluid absorption area we interposed a special type of acidic, curled-type of cellulose between the top sheet in contact with the skin and the absorption core beneath containing the polyacrylate superabsorber. The intention was to minimize disturbance of the already weak acid mantle of aged skin. We also employed air-permeable side panels to minimize skin occlusion and swelling of the stratum corneum.</p> <p>Methods</p> <p>The surface pH of diapers was measured after repeated wetting with a urine substitute fluid at the level of the top sheet. Occlusive effects and hydration of the stratum corneum were measured after a 4 hour application of different side panel materials by corneometry on human volunteers. Finally, we evaluated skin symptoms in 12 patients with preexisting IAD for 21 days following the institutional switch to the optimized diaper design. Local skin care protocols remained in place unchanged.</p> <p>Results</p> <p>The improved design created a surface pH of 4.6 which was stable even after repeated wetting throughout a 5 hour period. The "standard design" briefs had values of 7.1, which is alkaline compared to the acidic surface of normal skin. Side panels made from non-woven material with an air-permeability of more than 1200 l/m²/s avoided excessive hydration of the stratum corneum when compared to the commonly employed air-impermeable plastic films. Resolution of pre-existing IAD skin lesions was noted in 8 out of 12 patients after the switch to the optimized brief design.</p> <p>Conclusions</p> <p>An improved design of adult-type briefs can create an acidic pH on the surface and breathable side panels avoid over-hydration of the stratum corneum and occlusion. This may support the epidermal barrier function and may help to reduce the occurrence of IAD.</p