Market Diffusion of Extended Cycle Hormonal Contraceptives

Background: Extended cycle hormonal contraceptives (e.g. Seasonale, Seasonique) when introduced in 2003 were considered a very novel approach to contraception. The idea of manipulating the menstrual cycle so that women would experience just four menstruations a year was radical and was assumed to be responsible for the slow acceptance rate among the general public. Objective: This report analyzes two different aspects of the acceptance of this unique idea in the population. The first was the level of usage of extended cycle hormonal contraceptives in the general population, which was measured by a review of sales figures over time in the United States. The second was an examination of market diffusion as it relates to consumer perceptions regarding the characteristics of these products. Methods: To determine the degree of usage of extended cycle hormonal contraceptives the yearly sales, in terms of units sold, were compared with that of other leading methods of hormonal contraception. Along with the data, survey answers were obtained from 65 women who volunteered to participate in the study. Participants were selected randomly to represent the target population to assess the level of awareness about the benefits, risks, and any other concerns regarding the use of extended cycle hormonal contraceptives. Results: The yearly sales data of units sold showed a definitive increase in the sales of extended cycle hormonal contraceptives since their release on the market. The survey results showed an overwhelming awareness in the study population about the extended regimen. However, only about half of the women in the survey group were aware of its benefits. The main concern reported was the perceived significant side effect profile. Conclusion: Though awareness about the extended cycle hormonal contraception regimen was widespread, the survey population was not well informed about the advantages and the disadvantages regarding the degree of severity of side effects. To address these knowledge deficits, these aspects should be the focus when distributing information about extended cycle hormonal contraceptive regimens. This may boost the use of a potentially advantageous contraceptive regimen by a population who would derive benefit from its usage.   Type: Original Researc

Market Diffusion of Extended Cycle Hormonal Contraceptives

Background: Extended cycle hormonal contraceptives (e.g. Seasonale, Seasonique) when introduced in 2003 were considered a very novel approach to contraception. The idea of manipulating the menstrual cycle so that women would experience just four menstruations a year was radical and was assumed to be responsible for the slow acceptance rate among the general public. Objective: This report analyzes two different aspects of the acceptance of this unique idea in the population. The first was the level of usage of extended cycle hormonal contraceptives in the general population, which was measured by a review of sales figures over time in the United States. The second was an examination of market diffusion as it relates to consumer perceptions regarding the characteristics of these products. Methods: To determine the degree of usage of extended cycle hormonal contraceptives the yearly sales, in terms of units sold, were compared with that of other leading methods of hormonal contraception. Along with the data, survey answers were obtained from 65 women who volunteered to participate in the study. Participants were selected randomly to represent the target population to assess the level of awareness about the benefits, risks, and any other concerns regarding the use of extended cycle hormonal contraceptives. Results: The yearly sales data of units sold showed a definitive increase in the sales of extended cycle hormonal contraceptives since their release on the market. The survey results showed an overwhelming awareness in the study population about the extended regimen. However, only about half of the women in the survey group were aware of its benefits. The main concern reported was the perceived significant side effect profile. Conclusion: Though awareness about the extended cycle hormonal contraception regimen was widespread, the survey population was not well informed about the advantages and the disadvantages regarding the degree of severity of side effects. To address these knowledge deficits, these aspects should be the focus when distributing information about extended cycle hormonal contraceptive regimens. This may boost the use of a potentially advantageous contraceptive regimen by a population who would derive benefit from its usage.   Type: Original Researc

‘Sons of athelings given to the earth’: Infant Mortality within Anglo-Saxon Mortuary Geography

FOR 20 OR MORE YEARS early Anglo-Saxon archaeologists have believed children are underrepresented in the cemetery evidence. They conclude that excavation misses small bones, that previous attitudes to reporting overlook the very young, or that infants and children were buried elsewhere. This is all well and good, but we must be careful of oversimplifying compound social and cultural responses to childhood and infant mortality. Previous approaches have offered methodological quandaries in the face of this under-representation. However, proportionally more infants were placed in large cemeteries and sometimes in specific zones. This trend is statistically significant and is therefore unlikely to result entirely from preservation or excavation problems. Early medieval cemeteries were part of regional mortuary geographies and provided places to stage events that promoted social cohesion across kinship systems extending over tribal territories. This paper argues that patterns in early Anglo-Saxon infant burial were the result of female mobility. Many women probably travelled locally to marry in a union which reinforced existing social networks. For an expectant mother, however, the safest place to give birth was with experience women in her maternal home. Infant identities were affected by personal and legal association with their mother’s parental kindred, so when an infant died in childbirth or months and years later, it was their mother’s identity which dictated burial location. As a result, cemeteries central to tribal identities became places to bury the sons and daughters of a regional tribal aristocracy

Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections

Background and study aims: Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates. Patients and methods: All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included. Data including indications, technical success, clinical success, collection resolution, stent removal, early and late adverse events (AEs), mortality and recurrence at 6 months were collected. Results: 116 patients, median age 52.5 years (range 16 – 80) and 67 % male, were treated with a single LAMS in each case. The indication was walled off necrosis (WON) in 70 and pseudocyst in 46. Median size of the PFC was 11 cm (5 – 21 cm) and the estimated median necrotic volume in WON was 30 % (5 % – 90 %). Stent insertion was technically successful in 115 (99.1 %) and clinically successful in 109 (94 %). Early serious AEs (SAEs): n = 7 sepsis, n = 1 stent blockage with food, n = 1 stent migration requiring laparotomy, n = 1 stent dislodgement and n = 1 bleeding requiring emboliZation. Late AEs: n = 1 buried stent and n = 1 esophageal fistula. Non-procedure-related deaths: n = 3 (2.5 %). Conclusion: This multicenter case series demonstrates that use of the new LAMS is feasible, effective and relatively safe in draining PFC with a technical success rate of 99 % and cumulative SAE rate of 11.2 %

Rhizosphere-scale quantification of hydraulic and mechanical properties of soil impacted by root and seed exudates

Using rhizosphere-scale physical measurements we test the hypothesis that plant exudates gel together soil particles and on drying they enhance soil water repellency. Barley and maize root exudates were compared with chia seed exudate, a commonly used root exudate analogue. Sandy loam and clay loam soils were treated with root exudates at 0.46 and 4.6 mg exudate g-1 dry soil, and chia seed exudate at 0.046, 0.46, 0.92, 2.3 and 4.6 mg exudate g-1 dry soil. Soil hardness and modulus of elasticity were measured at -10 kPa matric potential using a 3 mm diameter spherical indenter. Water sorptivity and repellency index of air-dry soil were measured using a miniaturized infiltrometer device with a 1 mm tip radius. Soil hardness increased by 28% for barley root exudate, 62% for maize root exudate, and 86% for chia seed exudate at 4.6 mg g-1 concentration for sandy loam soil. For a clay loam soil, root exudates did not affect soil hardness, whereas chia seed exudate increased soil hardness by 48% at 4.6 mg g-1concentration. Soil water repellency increased by 48% for chia seed exudate and 23% for maize root exudate, but not for barley root exudate at 4.6 mg g-1 concentration for sandy loam soil. For clay loam soil, chia seed exudate increased water repellency by 45%, whereas root exudates did not affect water repellency at 4.6 mg g-1concentration. Water sorptivity and repellency were both correlated with hardness, presumably due to the combined influence of exudates on hydrological and mechanical properties of soils

A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: Recommendations for use in research and clinical practice

Background: Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient-reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations.  Methods: A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis.  Results: In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5).  Conclusion: Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted

RfaH Suppresses Small RNA MicA Inhibition of fimB Expression in Escherichia coli K-12

The phase variation (reversible on-off switching) of the type 1 fimbrial adhesin of Escherichia coli involves a DNA inversion catalyzed by FimB (switching in either direction) or FimE (on-to-off switching). Here, we demonstrate that RfaH activates expression of a FimB-LacZ protein fusion while having a modest inhibitory effect on a comparable fimB-lacZ operon construct and on a FimE-LacZ protein fusion, indicating that RfaH selectively controls fimB expression at the posttranscriptional level. Further work demonstrates that loss of RfaH enables small RNA (sRNA) MicA inhibition of fimB expression even in the absence of exogenous inducing stress. This effect is explained by induction of σE , and hence MicA, in the absence of RfaH. Additional work con- firms that the procaine-dependent induction of micA requires OmpR, as reported previously (A. Coornaert et al., Mol. Microbiol. 76:467–479, 2010, doi:10.1111/j.1365-2958.2010.07115.x), but also demonstrates that RfaH inhibition of fimB transcription is enhanced by procaine independently of OmpR. While the effect of procaine on fimB transcription is shown to be independent of RcsB, it was found to require SlyA, another known regulator of fimB transcription. These results demonstrate a complex role for RfaH as a regulator of fimB expression

Tumour expression of leptin is associated with chemotherapy resistance and therapy-independent prognosis in gastro-oesophageal adenocarcinomas

Background: Cytotoxic chemotherapy remains the main systemic therapy for gastro-oesophageal adenocarcinoma, but resistance to chemotherapy is common, resulting in ineffective and often toxic treatment for patients. Predictive biomarkers for chemotherapy response would increase the probability of successful therapy, but none are currently recommended for clinical use. We used global gene expression profiling of tumour biopsies to identify novel predictive biomarkers for cytotoxic chemotherapy. Methods: Tumour biopsies from patients (n=14) with TNM stage IB–IV gastro-oesophageal adenocarcinomas receiving platinum-based combination chemotherapy were used as a discovery cohort and profiled with Affymetrix ST1.0 Exon Genechips. An independent cohort of patients (n=154) treated with surgery with or without neoadjuvant platinum combination chemotherapy and gastric adenocarcinoma cell lines (n=22) were used for qualification of gene expression profiling results by immunohistochemistry. A cisplatin-resistant gastric cancer cell line, AGS Cis5, and the oesophageal adenocarcinoma cell line, OE33, were used for in vitro validation investigations. Results: We identified 520 genes with differential expression (Mann–Whitney U, P<0.020) between radiological responding and nonresponding patients. Gene enrichment analysis (DAVID v6.7) was used on this list of 520 genes to identify pathways associated with response and identified the adipocytokine signalling pathway, with higher leptin mRNA associated with lack of radiological response (P=0.011). Similarly, in the independent cohort (n=154), higher leptin protein expression by immunohistochemistry in the tumour cells was associated with lack of histopathological response (P=0.007). Higher leptin protein expression by immunohistochemistry was also associated with improved survival in the absence of neoadjuvant chemotherapy, and patients with low leptin protein-expressing tumours had improved survival when treated by neoadjuvant chemotherapy (P for interaction=0.038). In the gastric adenocarcinoma cell lines, higher leptin protein expression was associated with resistance to cisplatin (P=0.008), but not to oxaliplatin (P=0.988) or 5fluorouracil (P=0.636). The leptin receptor antagonist SHLA increased the sensitivity of AGS Cis5 and OE33 cell lines to cisplatin. Conclusions: In gastro-oesophageal adenocarcinomas, tumour leptin expression is associated with chemoresistance but a better therapy-independent prognosis. Tumour leptin expression determined by immunohistochemistry has potential utility as a predictive marker of resistance to cytotoxic chemotherapy, and a prognostic marker independent of therapy in gastro-oesophageal adenocarcinoma. Leptin antagonists have been developed for clinical use and leptin and its associated pathways may also provide much needed novel therapeutic targets for gastro-oesophageal adenocarcinoma

Apology and forgiveness evolve to resolve failures in cooperative agreements

Making agreements on how to behave has been shown to be an evolutionarily viable strategy in one-shot social dilemmas. However, in many situations agreements aim to establish long-term mutually beneficial interactions. Our analytical and numerical results reveal for the first time under which conditions revenge, apology and forgiveness can evolve and deal with mistakes within ongoing agreements in the context of the Iterated Prisoners Dilemma. We show that, when the agreement fails, participants prefer to take revenge by defecting in the subsisting encounters. Incorporating costly apology and forgiveness reveals that, even when mistakes are frequent, there exists a sincerity threshold for which mistakes will not lead to the destruction of the agreement, inducing even higher levels of cooperation. In short, even when to err is human, revenge, apology and forgiveness are evolutionarily viable strategies which play an important role in inducing cooperation in repeated dilemmas.SCOPUS: ar.jinfo:eu-repo/semantics/publishe