The smile that never came off

https://egrove.olemiss.edu/civ_clip/1011/thumbnail.jp

The impact of introducing patient co-payments in Germany on the use of IVF and ICSI:a price-elasticity of demand assessment

BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany. METHODS: Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from 'no fees' to (sic)1500-2000 by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology. RESULTS: The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of -0.41 and -0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be -0.36. The cross-price elasticity for clomifene was close to zero (-0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred. CONCLUSIONS: We report price elasticities for IVF and ICSI of -0.41 and -0.34 after introducing a (sic)1500-2000 co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change

A prospective, single-centre, single-arm, open label study of the long term use of a gonadotropin releasing hormone agonist (Triptorelin SR, 11.25 mg) in combination with Tibolone add-back therapy in the management of chronic cyclical pelvic pain.

BACKGROUND: Chronic cyclic pelvic pain (CCPP) affects women's quality of life and pituitary downregulation is often used for symptomatic relief. However, prolonged suppression of ovarian function is associated with menopausal side effects and can lead to osteoporosis. Currently, the use of gonadotropin releasing hormone agonists (GnRHa) for treatment of CCPP is usually restricted to 6-9 months, limiting their efficacy. There is limited information regarding safety and efficacy with longer-term use. The aim of this study is to examine the safety and efficacy of long-term (24 months) pituitary down-regulation with the GnRHa (Triptorelin SR) with add-back therapy (ABT) using Tibolone for symptom relief in women with CCPP. METHODS: A single-arm, prospective clinical trial at a Tertiary University Teaching Hospital of 27 patients receiving Triptorelin SR (11.25 mg) and Tibolone (2.5 mg). Outcomes measures were the safety of treatment assessed by clinical examination, haematological markers, liver and renal function tests and bone mineral density (BMD) at 12, 18 and 24 months as well as at 6 months post-treatment. Pain and health-related quality of life (HR-QoL) assessed using the endometriosis health profile (EHP-30) and chronic pain grade (CPG) questionnaires. RESULTS: There was no evidence for any significant harmful effects on any of the measured haematological, renal or liver function tests. Although results regarding the effect on BMD are not conclusive there is an increased risk of development of osteopaenia after 12 months of treatment. Pain and HRQoL assessments showed significant improvement during medication, but with deterioration after treatment cessation. CONCLUSION: Long- term Triptorelin plus Tibolone add-back therapy in women suffering from CCPP does not appear to be associated with significant serious adverse events apart from the possibility of deterioration in the BMD that needs to be monitored. This mode of therapy appears to be effective in pain relief and in improving quality of life over a 24-month period. TRIAL REGISTRATION: Clinical trials database NCT00735852

Drought rewires the cores of food webs

Droughts are intensifying across the globe, with potentially devastating implications for freshwater ecosystems. We used new network science approaches to investigate drought impacts on stream food webs and explored potential consequences for web robustness to future perturbations. The substructure of the webs was characterized by a core of richly connected species surrounded by poorly connected peripheral species. Although drought caused the partial collapse of the food webs, the loss of the most extinction-prone peripheral species triggered a substantial rewiring of interactions within the networks’ cores. These shifts in species interactions in the core conserved the underlying core/periphery substructure and stability of the drought-impacted webs. When we subsequently perturbed the webs by simulating species loss in silico, the rewired drought webs were as robust as the larger, undisturbed webs. Our research unearths previously unknown compensatory dynamics arising from within the core that could underpin food web stability in the face of environmental perturbations

Comparison of Bacterial Diversity within the Coral Reef Sponge, Axinella corrugata, and the Encrusting Coral Erythropodium caribaeorum

We compared the Caribbean reef sponge, Axinella corrugata, with the Caribbean reef coral, Erythropodium caribaeorum for differences in their resident microbial communities. This cursory survey of bacterial diversity applied 16S rRNA gene sequences. Over 100 culture-independent sequences were generated from five different Axinella 16S rRNA libraries, and compared with 69 cultured isolates. The cultureindependent 16S rDNA clones displayed a higher diversity of Proteobacteria, including “uncultured” or “unknown” representatives from the Deltaproteobacteria. Arcobacterium, and Cyanobacteria were also found. We have also confirmed that Axinella sponges appeared to host specific microbial symbionts, similar to the previously identified clones termed “OSO” environmental samples. In contrast, seawater samples near Axinella were dominated by Pseudoalteromonas. Adjacent sediment samples yielded clones of Planctomycetacea, Proteobacteria, sulfate-reducing Desulfovibrio spp, and other Deltaproteobacteria. Anaerobe-like 16S rRNA sequences were detected after the oxygen supply to one Axinella sample was deliberately curtailed to assess temporal changes in the microbial community. E. caribaeorum yielded more Betaproteobacteria relative to Axinella 16S libraries, and also included the Gammaproteobacteria genus Spongiobacter. However, Axinella-derived microbes appeared phylogenetically deeper with greater sequence divergences than the coral. Overall this study indicated that marine microbial community diversity can be linked to specific source hosts and habitats

The effects of climatic fluctuations and extreme events on running water ecosystems

Most research on the effects of environmental change in freshwaters has focused on incremental changes in average conditions, rather than fluctuations or extreme events such as heatwaves, cold snaps, droughts, floods or wildfires, which may have even more profound consequences. Such events are commonly predicted to increase in frequency, intensity and duration with global climate change, with many systems being exposed to conditions with no recent historical precedent. We propose a mechanistic framework for predicting potential impacts of environmental fluctuations on running water ecosystems by scaling up effects of fluctuations from individuals to entire ecosystems. This framework requires integration of four key components: effects of the environment on individual metabolism, metabolic and biomechanical constraints on fluctuating species interactions, assembly dynamics of local food webs and mapping the dynamics of the meta-community onto ecosystem function. We illustrate the framework by developing a mathematical model of environmental fluctuations on dynamically assembling food webs. We highlight (currently limited) empirical evidence for emerging insights and theoretical predictions. For example, widely supported predictions about the effects of environmental fluctuations are: high vulnerability of species with high per capita metabolic demands such as large-bodied ones at the top of food webs; simplification of food web network structure and impaired energetic transfer efficiency; reduced resilience and top-down relative to bottom-up regulation of food web and ecosystem processes. We conclude by identifying key questions and challenges that need to be addressed to develop more accurate and predictive bio-assessments of the effects of fluctuations, and implications of fluctuations for management practices in an increasingly uncertain world

Medical students’ experiences of health inequalities and inclusion health education

Background Inclusion health groups experience a significantly larger burden of morbidity and mortality than the general public. Despite this, undergraduate medical education is often limited in its approach to inclusion health curricula, leaving students disengaged and lacking understanding. Methods We conducted two research studies to explore medical students’ experiences of inclusion health education. All participants were studying medicine at the University of Leeds at the time of data collection. We gathered experiences of both compulsory and elective inclusion health education via semi-structured interviews. Interview responses were audio-recorded, transcribed and analysed thematically. Findings We identified several key findings across the two studies. Firstly, medical students felt unprepared to work with inclusion health groups. Further to this, medical students have a preference for interactive teaching and learning in inclusion health education. Finally, encountering inclusion health groups by chance (on placement) or choice (optional initiatives) present different opportunities. Discussion and Conclusion Our research suggests that simply being exposed to inclusion health groups through lectures and on placement is not considered sufficient by medical students, and in fact can lead to the perpetuation of misinformation and stigma. Participants perceived that optional initiatives or ‘choice encounters’ had profoundly positive impacts on attitudes and interest, particularly when there were opportunities to learn directly from individuals with lived experience of exclusion. We suggest that a flipped classroom approach to inclusion health education along with integrated experiential learning would provide medical students with comprehensive and patient-focused learning opportunities

Suppression Subtractive Hybridization PCR Isolation of cDNAs from a Caribbean Soft Coral

Transcriptomic studies of marine organisms are still in their infancy. A partial, subtracted expressed sequence tag (EST) library of the Caribbean octocoral Erythropodium caribaeorum and the sea fan Gorgonia ventalina has been analyzed in order to find novel genes or differences in gene expression related to potential secondary metabolite production or symbioses. This approach entails enrichment for potential non- housekeeping genes using the suppression subtractive hybridization (SSH) polymerase chain reaction (PCR) method. More than 500 expressed sequence tags (ESTs) were generated after cloning SSH products, which yielded at least 53 orthologous groups of proteins (COGs) and Pfam clusters, including transcription factors (Drosophila Big Brother), catalases, reverse transcriptases, ferritins and various hypothetical protein sequences. A total of 591 EST sequences were deposited into GenBank [dbEST: FL512138 - FL512331, and GH611838]. The results represent proof of concept for enrichment of unique transcripts over housekeeping genes, such as actin or ribosomal genes, which comprised approximately 17% of the total dataset. Due to the gene and sequence diversity of some ESTs, such sequences can find utility as molecular markers in current and future studies of this species and other soft coral biogeography, chemical ecology, phylogenetics, and evolution