The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a safe, effective and acceptable form of contraception used by over 150 million women worldwide. It also has a variety of noncontraceptive benefits including treatment for menorrhagia, endometriosis, and endometrial hyperplasia. The LNG-IUS has also been used in combination with estrogen for hormone replacement therapy and as an alternative to hysterectomy. Overall, the system is very well tolerated and patient satisfaction is quite high when proper education regarding possible side effects is provided. However, despite all of the obvious benefits of the LNG-IUS, utilization rates remain quite low in the developed countries, especially in the United States. This is thought to be largely secondary to the persistent negative impressions from the Dalkon Shield intrauterine experience in the 1970s. This history continues to negatively influence the opinions of both patients and health care providers with regards to intrauterine devices. Providers should resolve to educate themselves and their patients on the current indications and uses for this device, as it, and intrauterine contraception in general, remains a largely underutilized approach to a variety of women’s health issues

Effects of sex chromosome dosage on corpus callosum morphology in supernumerary sex chromosome aneuploidies.

BackgroundSupernumerary sex chromosome aneuploidies (sSCA) are characterized by the presence of one or more additional sex chromosomes in an individual's karyotype; they affect around 1 in 400 individuals. Although there is high variability, each sSCA subtype has a characteristic set of cognitive and physical phenotypes. Here, we investigated the differences in the morphometry of the human corpus callosum (CC) between sex-matched controls 46,XY (N =99), 46,XX (N =93), and six unique sSCA karyotypes: 47,XYY (N =29), 47,XXY (N =58), 48,XXYY (N =20), 47,XXX (N =30), 48,XXXY (N =5), and 49,XXXXY (N =6).MethodsWe investigated CC morphometry using local and global area, local curvature of the CC boundary, and between-landmark distance analysis (BLDA). We hypothesized that CC morphometry would vary differentially along a proposed spectrum of Y:X chromosome ratio with supernumerary Y karyotypes having the largest CC areas and supernumerary X karyotypes having significantly smaller CC areas. To investigate this, we defined an sSCA spectrum based on a descending Y:X karyotype ratio: 47,XYY, 46,XY, 48,XXYY, 47,XXY, 48,XXXY, 49,XXXXY, 46,XX, 47,XXX. We similarly explored the effects of both X and Y chromosome numbers within sex. Results of shape-based metrics were analyzed using permutation tests consisting of 5,000 iterations.ResultsSeveral subregional areas, local curvature, and BLDs differed between groups. Moderate associations were found between area and curvature in relation to the spectrum and X and Y chromosome counts. BLD was strongly associated with X chromosome count in both male and female groups.ConclusionsOur results suggest that X- and Y-linked genes have differential effects on CC morphometry. To our knowledge, this is the first study to compare CC morphometry across these extremely rare groups

Galaxy interactions in IllustrisTNG-100, I: The power and limitations of visual identification

We present a sample of 446 galaxy pairs constructed using the cosmological simulation IllustrisTNG-100 at z = 0, with M_(FoF,dm)=10¹¹−10^(13.5) M⊙. We produce ideal mock SDSS g-band images of all pairs to test the reliability of visual classification schema employed to produce samples of interacting galaxies. We visually classify each image as interacting or not based on the presence of a close neighbour, the presence of stellar debris fields, disturbed discs, and/or tidal features. By inspecting the trajectories of the pairs, we determine that these indicators correctly identify interacting galaxies ∼45 per cent of the time. We subsequently split the sample into the visually identified interacting pairs (VIP; 38 pairs) and those which are interacting but are not visually identified (nonVIP; 47 pairs). We find that VIP have undergone a close passage nearly twice as recently as the non-VIP, and typically have higher stellar masses. Further, the VIP sit in dark matter haloes that are approximately 2.5 times as massive, in environments nearly 2 times as dense, and are almost a factor of 10 more affected by the tidal forces of their surroundings than the nonVIP. These factors conspire to increase the observability of tidal features and disturbed morphologies, making the VIP more likely to be identified. Thus, merger rate calculations which rely on stellar morphologies are likely to be significantly biased toward massive galaxy pairs which have recently undergone a close passage

Photonic integrated beam delivery in a rubidium 3D magneto-optical trap

Cold atoms are important for precision atomic applications including timekeeping and sensing. The 3D magneto-optical trap (3D-MOT), used to produce cold atoms, will benefit from photonic integration to improve reliability and reduce size, weight, and cost. These traps require the delivery of multiple, large area, collimated laser beams to an atomic vacuum cell. Yet, to date, beam delivery using an integrated waveguide approach has remained elusive. We report the demonstration of a 87Rb 3D-MOT using a fiber-coupled photonic integrated circuit to deliver all beams to cool and trap > 1 x 10^6 atoms to near 200 {\mu}K. The silicon nitride photonic circuit transforms fiber-coupled 780 nm cooling and repump light via waveguides to three mm-width non-diverging free-space cooling and repump beams directly to the rubidium cell. This planar, CMOS foundry-compatible integrated beam delivery is compatible with other components, such as lasers and modulators, promising system-on-chip solutions for cold atom applications

Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

Introduction Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. Methods and analysis The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. Ethics and dissemination The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12617000821392.</p

Galaxy interactions in IllustrisTNG-100, I: The power and limitations of visual identification

We present a sample of 446 galaxy pairs constructed using the cosmological simulation IllustrisTNG-100 at z = 0, with M$_{FoF, dm}$ = 10$^{11}$-10$^{13.5}$ M$_{\odot}$. We produce ideal mock SDSS g-band images of all pairs to test the reliability of visual classification schema employed to produce samples of interacting galaxies. We visually classify each image as interacting or not based on the presence of a close neighbour, the presence of stellar debris fields, disturbed discs, and/or tidal features. By inspecting the trajectories of the pairs, we determine that these indicators correctly identify interacting galaxies $\sim45\%$ of the time. We subsequently split the sample into the visually identified interacting pairs (VIP; 38 pairs) and those which are interacting but are not visually identified (nonVIP; 47 pairs). We find that VIP have undergone a close passage nearly twice as recently as the nonVIP, and typically have higher stellar masses. Further, the VIP sit in dark matter haloes that are approximately 2.5 times as massive, in environments nearly 2 times as dense, and are almost a factor of 10 more affected by the tidal forces of their surroundings than the nonVIP. These factors conspire to increase the observability of tidal features and disturbed morphologies, making the VIP more likely to be identified. Thus, merger rate calculations which rely on stellar morphologies are likely to be significantly biased toward massive galaxy pairs which have recently undergone a close passage.Comment: 20 pages, 11 figures, thumbnail catalog of interacting pairs sampl

Galaxy interactions in IllustrisTNG-100, I: The power and limitations of visual identification

We present a sample of 446 galaxy pairs constructed using the cosmological simulation IllustrisTNG-100 at z = 0, with M_(FoF,dm)=10¹¹−10^(13.5) M⊙. We produce ideal mock SDSS g-band images of all pairs to test the reliability of visual classification schema employed to produce samples of interacting galaxies. We visually classify each image as interacting or not based on the presence of a close neighbour, the presence of stellar debris fields, disturbed discs, and/or tidal features. By inspecting the trajectories of the pairs, we determine that these indicators correctly identify interacting galaxies ∼45 per cent of the time. We subsequently split the sample into the visually identified interacting pairs (VIP; 38 pairs) and those which are interacting but are not visually identified (nonVIP; 47 pairs). We find that VIP have undergone a close passage nearly twice as recently as the non-VIP, and typically have higher stellar masses. Further, the VIP sit in dark matter haloes that are approximately 2.5 times as massive, in environments nearly 2 times as dense, and are almost a factor of 10 more affected by the tidal forces of their surroundings than the nonVIP. These factors conspire to increase the observability of tidal features and disturbed morphologies, making the VIP more likely to be identified. Thus, merger rate calculations which rely on stellar morphologies are likely to be significantly biased toward massive galaxy pairs which have recently undergone a close passage

C-Reactive Protein Level and the Incidence of Eligibility for Statin Therapy: The Multi-Ethnic Study of Atherosclerosis

Background: Given the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, statin initiation may be considered for individuals with elevated high-sensitivity C-reactive protein (hsCRP). However, if followed prospectively, many individuals with elevated CRP may become statin eligible, limiting the impact of elevated CRP as a treatment indication. This analysis estimates the proportion of people with elevated CRP that become statin eligible over time. Hypothesis: Most people with elevated CRP become statin eligible over a short period of time. Methods: We followed 2153 Multi-Ethnic Study of Atherosclerosis (MESA) participants free of cardiovascular disease and diabetes with low-density lipoprotein cholesterol <130 mg/dL at baseline to determine the proportion who become eligible for statins over 4.5 years. The proportion eligible for statin therapy, defined by the National Cholesterol Education Program (NCEP) 2004 updated guidelines, was calculated at baseline and during follow-up stratified by baseline CRP level (≥2 mg/L). Results: At baseline, 47% of the 2153 participants had elevated CRP. Among participants with elevated CRP, 29% met NCEP criteria for statins, compared with 28% without elevated CRP at baseline. By 1.5 years later, 26% and 22% (P = 0.09) of those with and without elevated CRP at baseline reached NCEP low-density lipoprotein cholesterol criteria and/or had started statins, respectively. These increased to 42% and 39% (P = 0.24) at 3 years and 59% and 52% (P = 0.01) at 4.5 years following baseline. Conclusions: A substantial proportion of those with elevated CRP did not achieve NCEP-based statin eligibility over 4.5 years of follow-up. These findings suggest that many patients with elevated CRP may not receive the benefits of statins if CRP is not incorporated into the NCEP screening strategy

Randomized trial assessing home use of two pregnancy tests for determining early medical abortion outcomes at 3, 7 and 14days after mifepristone

AbstractObjectiveTo evaluate the accuracy, feasibility and acceptability of two urine pregnancy tests in assessing abortion outcomes at three time points after mifepristone administration.Study designThis randomized trial enrolled women seeking early medical abortion at two hospitals in Vietnam. Investigators randomly allocated participants to at-home administration of a multilevel urine pregnancy test (MLPT) or a high sensitivity urine pregnancy test (HSPT) to assess their abortion outcomes. A baseline test was administered on the same day as mifepristone. Participants performed and interpreted results of pregnancy tests taken 3, 7 and 14days after mifepristone. Ultrasound exam determined continuing pregnancy.ResultsSix hundred women enrolled, and 300 received each test. A percentage of 97.4 (584) had follow-up, of whom 13 women had continuing pregnancies. The specificity of MLPT at detecting absence of continuing pregnancy was 63.9%, 90.4% and 97.1% at study day 3, 7 and 14. The specificity of HSPT was 6.0%, 19.8% and 62.2%, respectively. The positive predictive value (PPV) of MLPT at detecting continuing pregnancy was 6.4% at day 3 and rose to 46.7% at day 14. In contrast, the PPV for HSPT was 2.2% at day 3 and rose to 6.5% at day 14. At all three time points, the sensitivity and negative predictive values for both tests were 100.0%. Most women found their assigned tests easy to use and would prefer future home follow-up with a pregnancy test.ConclusionsThe MLPT enables women to assess their abortion outcomes more reliably than with HSPT. With MLPT, women can know their outcomes as early as 3 days after mifepristone.ImplicationsMedical abortion service delivery with an MLPT to obtain a baseline (preabortion) human chorionic gonadotropin (hCG) estimate and a second follow-up MLPT 1 to 2 weeks later can establish whether there has been a drop in hCG, signifying absence of a continuing pregnancy. Used this way, MLPTs can enable women to assess their abortion status outside of a clinic setting and without serum hCG testing and/or ultrasound