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The aim of this study was to identify prescribing patterns at a specialist menopause service in a central London teaching hospital for women following treatment for a malignancy.
This was a prospective cohort study with data collected over a seven-month period from December 2019 to June 2020. All women reviewed at the specialist menopause services following treatment of a malignancy, BRCA carriers and Lynch syndrome were included in the study, with management options divided into three categories hormonal, non-hormonal and no treatment.
The primary outcome of this study was to identify prescribing patterns for all women reviewed following a diagnosis of a malignancy, as well as those with genetic mutations necessitating risk-reducing prophylactic bilateral salpingo-oopherectomy (BSO).
Altogether 71 women were included in this study, with the majority of women post management of a non-gynaecological malignancy (51/71, 72%), of which breast cancer was the most common (37/71, 52%). Solutol HS-15 mw While non-hormonal treatment was the most popular among those treated for breast cancer, for all other malignancies, hormonal treatment was more widespread. Fourteen women also had genetic mutations, with all of these women commencing hormonal treatment post risk reducing surgery.
With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital.
With the exception of those with a history of hormone-sensitive breast cancer, the use of hormonal treatment for menopausal symptoms remained widespread. While this was a relatively small study, the need for long-term follow-up across specialist menopause services, to assess the risk of recurrence is vital.Stress in higher education students is an issue of growing concern, as stress impacts quality of life and has been linked to drop-out from higher education. The aim was to investigate how stress was related to how far along students were in their degree program, using the Spanish Perceived Stress Scale (PSS10). We expected 1) first-year education students to experience more perceived lack of control than second-year students, 2) second-year students to experience more perceived stress than first-year students. Participants were students in three university education-degree programs (N = 399). The psychometric properties of the Perceived Stress (PS) and Perceived Lack of Control (PLC) subscales were investigated using Rasch models. One item was eliminated from each subscale. The estimated interval-level Rasch scores were utilized for testing hypotheses with general linear models. Results showed a somewhat more complex pattern than predicted as interaction effects between degree year and gender and between degree year and basis for admission were found.Paroxysmal sympathetic hyperactivity (PSH) occurs in ∼10% of patients following acute severe brain injury. While PSH is associated with worse outcomes, there are no clinical practice guidelines to inform treatment. We aimed to systematically review the literature on the pharmacological management of PSH. MEDLINE, Embase, and Cochrane library databases were searched from inception to August 2020. Eligible studies met the following criteria 1) randomized controlled trials, non-randomized controlled trials (case control or controlled cohort), observational studies, case series, and case reports; 2) study population of adult and pediatric patients; 3) exposure to an acute neurological insult complicated by PSH (or historic synonym); 4) description of pharmacological treatment of PSH. Our search retrieved 2729 citations with 83 articles assessed for inclusion. After full text extraction, 56 manuscripts inclusive of 459 patients met eligibility criteria. We identified 31 case reports, 15 case series (152 patients), seven retrospective case control or cohort studies (212 patients), and three prospective observational studies (52 patients). Traumatic brain injury was the most common precipitating insult (407 patients), followed by hypoxic encephalopathy (72 patients) and intracranial hemorrhage (10 patients). There were 48 drugs from 22 classes prescribed for the management of PSH. The most frequently prescribed agents were benzodiazepines, β-blockers, opioids, α-2 agonists, and baclofen. However, route and dose of drug and subsequent outcome were inconsistently reported, such that no summary was possible. While a wide variety of drugs have been reported to treat PSH, there is a lack of even moderate-quality evidence to inform clinical decision making.The last three decades have witnessed a revolution in the therapeutic scenario of metastatic renal cell carcinoma (mRCC), due to the advent of novel agents including tyrosine kinase inhibitors, immune checkpoint inhibitors and the combination of both treatments. These strategies have reported unprecedented response rates, thus improving the clinical outcomes of mRCC patients, and current international guidelines support the use of immune-based combinations as first-line treatment in patients with metastatic disease. However, more data are awaited to help clinicians in the decision-making process. Herein, we provide an overview of recently published results regarding immune-based combinations as first-line treatment in mRCC patients, critically discussing available data that could help in suggesting determinants of treatment in this setting.Many ecological systems are now exposed to multiple stressors, and ecosystem management increasingly requires consideration of the joint effects of multiple stressors on focal populations, communities and ecosystems. In the absence of empirical data, ecosystem managers could use null models based on the combination of independently acting stressors to estimate the joint effects of multiple stressors. Here, we used a simulation study and a meta-analysis to explore the consequences of null model selection for the prediction of mortality resulting from exposure to two stressors. Comparing five existing null models, we show that some null models systematically predict lower mortality rates than others, with predicted mortality rates up to 67.5% higher or 50% lower than the commonly used Simple Addition model. However, the null model predicting the highest mortality rate differed across parameter sets, and therefore there is no general 'precautionary null model' for multiple stressors. Using a multi-model framework, we re-analysed data from two earlier meta-analyses and found that 54% of the observed joint effects fell within the range of predictions from the suite of null models. Furthermore, we found that most null models systematically underestimated the observed joint effects, with only the Stressor Addition model showing a bias for overestimation. Finally, we found that the intensity of individual stressors was the strongest predictor of the magnitude of the joint effect across all null models. As a result, studies characterizing the effects of individuals stressors are still required for accurate prediction of mortality resulting from multiple stressors.Age at first reproduction constitutes a key life-history trait in animals and is evolutionarily shaped by fitness benefits and costs of delayed versus early reproduction. The understanding of how intrinsic and extrinsic changes affects age at first reproduction is crucial for conservation and management of threatened species because of its demographic effects on population growth and generation time. For a period of 40 years in the Scandinavian wolf (Canis lupus) population, including the recolonization phase, we estimated age at first successful reproduction (pup survival to at least three weeks of age) and examined how the variation among individuals was explained by sex, population size (from 1 to 74 packs), primiparous or multiparous origin, reproductive experience of the partner and inbreeding. Median age at first reproduction was 3 years for females (n = 60) and 2 years for males (n = 74), and ranged between 1 and 8-10 years of age (n = 297). Female age at first reproduction decreased with increasing population size, and increased with higher levels of inbreeding. The probability for males to reproduce later first decreased, reaching its minimum when the number of territories approached 40-60, and then increased with increasing population size. Inbreeding for males and reproductive experience of parents and partners for both sexes had overall weak effects on age at first reproduction. These results allow for more accurate parameter estimates when modelling population dynamics for management and conservation of small and vulnerable wolf populations, and show how humans through legal harvest and illegal hunting influence an important life-history trait like age at first reproduction.Words are the building blocks of communicating science. As our understanding of the world progresses, scientific disciplines naturally enrich their specialized vocabulary (jargon). However, in the era of interdisciplinarity, the use of jargon may hinder effective communication among scientists that do not share a common scientific background. The question of how jargon limits the transmission of scientific knowledge has long been debated but rarely addressed quantitatively. We explored the relationship between the use of jargon and citations, using 21 486 articles focusing on cave research, a multidisciplinary field particularly prone to terminological specialization, and where linguistic disagreement among peers is frequent. We demonstrate a significant negative relationship between the proportion of jargon words in the title and abstract and the number of citations a paper receives. Given that these elements are the hook to readers, we urge scientists to restrict jargon to sections of the paper where its use is unavoidable.Ecological divergence is a fundamental source of phenotypic diversity between closely related species, yet the genetic architecture of most ecologically relevant traits is poorly understood. Differences in elevation can impose substantial divergent selection on both complex, correlated suites of traits (such as life-history), as well as novel adaptations. We use the Mimulus guttatus species complex to assess if the divergence in elevation is accompanied by trait divergence in a group of closely related perennials and determine the genetic architecture of this divergence. link2 We find that divergence in elevation is associated with differences in life-history, as well as a unique trait, the production of rhizomes. link3 The divergence between two perennials is largely explained by few mid-to-large effect quantitative trait loci (QTLs). However, the presence of QTLs with correlated, but opposing effects on multiple traits leads to some hybrids with transgressive trait combinations. Lastly, we find that the genetic architecture of the ability to produce rhizomes changes through development, wherein most hybrids produce rhizomes, but only later in development. Our results suggest that elevational differences may shape life-history divergence between perennials, but aspects of the genetic architecture of divergence may have implications for hybrid fitness in nature.