Long-Acting Reversible Contraception

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. A 17-year-old high school student who has never been pregnant presents for advice regarding contraception. She has an unremarkable medical history and is planning to become sexually active with her boyfriend in the near future. Her primary concern is an unintended pregnancy, and she inquires about methods of contraception that are highly effective. How would you counsel her about options for contraception

China as a “National Strategic Buyer”: Towards a Multilateral Regime for Cross-Border M&A

Unlike the case of cross-border trade, there is no explicit international governance regime for cross-border M&A; rather, there is a shared understanding that publicly traded companies are generally for purchase by any bidder—domestic or foreign—willing to offer a sufficiently large premium over a target’s stock market price. The unspoken premise that undergirds the system is that the prospective buyer is motivated by private economic gain-seeking. The entry of China into the global M&A market threatens the fundamental assumptions of the current permissive international regime. China has become a significant player in the cross-border M&A market, particularly as an acquirer. The central claim of the article is that the cross-border M&A regime will require a new rules-of-the-game structure to take account of China’s ascension. This is because cross-border M&A with China introduces a new dimension: what we call the “national strategic buyer” (“NSB”), whose objective is to further the interests of a nation-state in the pursuit of industrial policy or out of national security concerns. Thus, China presents a problem of asymmetric motives in the global M&A market: sellers to Chinese firms have private motives for pursuing transactions, while at least some Chinese acquirers have non-economic motivations. Yet distinguishing commercial and financial motives from national strategic motives in Chinese firms is difficult. To date, the only mechanisms for addressing the NSB problem are national security review mechanisms such as the CFIUS process in the United States, as recently expanded through legislative amendment. The EU is moving forward on a screening regulation with a similar objective that contemplates activity both by the European Commission and the Member States. Whether suitably tailored or not, these approaches fail to take on the long-term concern of fully assimilating China as a normal actor in the global economic system. To address the NSB problem, we propose the adoption of a multilateral regime under which firms subject to potential government influence in their corporate decision-making must demonstrate their “eligibility” to engage in outbound M&A. For covered firms, the regime would require a commitment to exclusively commercial/financial motives in cross-border acquisitions, made credible through a corporate governance set-up featuring independent directors (selected by foreign investors) who publicly verify adherence and disclose the source of acquisition financing. Enforcement would consist of a secretariat that can evaluate eligibility and monitor post-acquisition conduct, and national legislation that would permit rejection of an acquisition of a local target by an acquirer that does not meet the eligibility criteria

Policy Brief No. 14 - The Underutilization of Immigrant Skills: Trends and Policy Issues

Since 1996, the problem of underutilization of immigrant skills in Canada has grown significantly. University-educated immigrants are more numerous, yet our census analysis shows that their access to skilled occupations in the professions and management declined between 1996 and 2006. In these years, the value of work lost to the Canadian economy from immigrant skill underutilization grew from about $4.80 billion to$11.37 billion, annually. Given the significance of immigration for economic development, the evaluation of current policies and consideration of future directions seem urgent

The receptor tyrosine kinase MerTK activates phospholipase C γ2 during recognition of apoptotic thymocytes by murine macrophages

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142076/1/jlb0705.pd

Impact of Infant Feeding Methods on the Development of Autism Spectrum Disorder

There is strong and convincing evidence that infant’s sensory stimulation, which is associated with breastfeeding, contributes significantly to the infant’s neurodevelopment. Our study compared the prevalence of autism spectrum disorder (ASD) in children who were breastfed, given breast milk through a bottle (breast-milk fed), or formula-fed. We reported significant association of ASD in children who were formula-fed from birth or weaned early from the breast. The statistical data revealed that increasing the duration of breastfeeding resulted in a decrease in prevalence of ASD. The odds ratio of a child not having autism was 0.27, 0.93, and 6.67 for breastfeeding for less than 6, 6–12, or longer than 12 months, respectively. There is significant evidence that this association is mediated by the ingredients of the breast milk and infant’s endogenous oxytocin. Oxytocin is a neurotransmitter and neuromodulator and we postulate that oxytocin may increase neuroplasticity, synaptic connections, and alter ASD genes’ expression. Animal experiments and imaging studies demonstrate the central role of oxytocin in maternal love and bonding. Currently, there are no specific treatments for patients diagnosed with autism; therefore, it is imperative to identify the risk factors that contribute to the development of ASD. In this communication, we demonstrate that lack of breastfeeding is highly associated with ASD development in children with genetic susceptibility

Risk of injury analysis in depth jump and squat jump

Introduction: The depth jump (DJ) and squat jump (SJ) are accepted ways to assess and train power producing ability but are not without risk of injury. Methods: Sixteen male participants (age = 21.7 ± 1.54 yrs., height = 177.7 ± 11.4 cm, mass = 77.7 ± 13.6 kg) were evaluated for power exertion capabilities while being assessed for risk of injury in the knee and low back through a range of resistances based on a percentage of participants’ heights in the DJ (0% through 50%) and bodyweights for the SJ (0% through 100%). Two variables were used to assess the risk of injury in the knee: valgus angle and internal abduction moment (IAM). Four variables were used in the low back: compression and shear force at the L5/S1 vertebrae, intra-abdominal pressure (IAP), and erector muscle tension. Results: With increasing DJ drop height, participants showed increased risk of injury in the knee through the valgus angle and IAM. In the low back, significant correlation occurred between increasing drop height and the shear force and IAP while compression force and erector muscle tension were more correlated with the power exertion of the participants than the drop height. With increasing SJ resistance, no significant increased risk of knee injury was detected. However, all low back variables except the IAP were significantly influenced by the increased resistance. Conclusion: Risk of injury in the knee and low back can be strongly dependent not only on the type of jump, but also the amount of resistance. The resulting power exerted by the athlete can also influence the risk of injury

Adaptation Kinetics in Bacterial Chemotaxis

Cells of Escherichia coli, tethered to glass by a single flagellum, were subjected to constant flow of a medium containing the attractant alpha-methyl-DL-aspartate. The concentration of this chemical was varied with a programmable mixing apparatus over a range spanning the dissociation constant of the chemoreceptor at rates comparable to those experienced by cells swimming in spatial gradients. When an exponentially increasing ramp was turned on (a ramp that increases the chemoreceptor occupancy linearly), the rotational bias of the cells (the fraction of time spent spinning counterclockwise) changed rapidly to a higher stable level, which persisted for the duration of the ramp. The change in bias increased with ramp rate, i.e., with the time rate of change of chemoreceptor occupancy. This behavior can be accounted for by a model for adaptation involving proportional control, in which the flagellar motors respond to an error signal proportional to the difference between the current occupancy and the occupancy averaged over the recent past. Distributions of clockwise and counterclockwise rotation intervals were found to be exponential. This result cannot be explained by a response regular model in which transitions between rotational states are generated by threshold crossings of a regular subject to statistical fluctuation; this mechanism generates distributions with far too many long events. However, the data can be fit by a model in which transitions between rotational states are governed by first-order rate constants. The error signal acts as a bias regulator, controlling the values of these constants.Molecular and Cellular Biolog

Patterns of Tumor Necrosis Factor Inhibitor (TNFi) Biosimilar Use Across United States Rheumatology Practices.

ObjectiveIt is unclear if biosimilars of biologics for inflammatory arthritis are realizing their promise to increase competition and improve accessibility. This study evaluates biosimilar tumor necrosis factor inhibitor (TNFi) utilization across rheumatology practices in the United States and compares whether patients initiating biosimilars remain on these treatments at least as long as new initiators of bio-originators.MethodsWe identified a cohort of patients initiating a TNFi biosimilar between January 2017 and September 2018 from an electronic health record registry containing data from 218 rheumatology practices and over 1 million rheumatology patients in the United States. We also identified a cohort of patients who initiated the bio-originator TNFi during the same period. We calculated the proportion of biosimilar prescriptions compared with other TNFi's and compared persistence on these therapies, adjusting for age, sex, diagnoses codes, and insurance type.ResultsWe identified 909 patients prescribed the biosimilar infliximab-dyyb, the only biosimilar prescribed, and 4413 patients with a new prescription for the bio-originator infliximab. Biosimilar patients tended to be older, have a diagnosis code for rheumatoid arthritis, and covered by Medicare insurance. Over the study period, biosimilar prescriptions reached a maximum of 3.5% of all TNFi prescriptions. Patients persisted on the biosimilar at least as long as the bio-originator infliximab (hazard ratio [HR] 0.83, P = 0.07).ConclusionThe uptake of biosimilars in the United States remains low despite persistence on infliximab-dyyb being similar to the infliximab bio-originator. These results add to clinical studies that should provide greater confidence to patients and physicians regarding biosimilar use