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Insulin edema is a poorly understood complication of insulin therapy. It has been reported in patients with both type 1 and 2 diabetes mellitus and typically occurs in patients with newly diagnosed or poorly controlled diabetes mellitus either after initiation or intensification of insulin therapy. A 20-year-old man presented with anorexia, polydipsia, and weight loss. Serum glucose on admission was 824 mg/dL (45.8 mmol/L) and hemoglobin A1c was >14.0. Additional workup was notable for positive anti-IA2 antibodies and low C-peptide of 0.5 ng/mL (1.1-4.4 ng/mL). He was diagnosed with type 1 diabetes mellitus and was started on insulin therapy with glargine and lispro. Within 4 days after insulin initiation, he developed bilateral leg swelling and reported a 25-pound (11.3-kg) weight gain over the next 10 days. After excluding other systemic causes of edema such as heart failure, renal failure, and liver failure, a diagnosis of insulin edema was made. Insulin glargine was switched to insulin degludec. Complete resolution of edema occurred within 3 days of switching the insulins. Insulin edema is a diagnosis of exclusion. Insulin's role in renal sodium handling, vasodilation, and increased vascular permeability have been postulated as possible mechanisms. Clinicians should be aware of this rare complication. [ABSTRACT FROM AUTHOR]

Cognitive control is the ability to flexibly adapt behavior in a goal-directed manner when habit will not suffice. Control can be separated into distinct forms based on the timescale (present–future) and/or medium (external–internal) over which it operates. Both the frontoparietal network (FPN) and cingulo-opercular network (CON) are engaged during control, but their respective functions and interactions remain unclear. Here, we examined activations in the FPN and CON with fMRI in humans (male and female) during a task that manipulated control across timescales/mediums. The findings show that the CON can be distinguished into the following two separable subnetworks mirroring the FPN: a rostral/ventral subnetwork sensitive to future-oriented control involving internal representations, and a caudal/dorsal subnetwork sensitive to presentoriented control involving external representations. Relative to the FPN, activation in the CON was particularly pronounced during transitions into and out of particular control demands. Moreover, the relationship of each CON subnetwork to behavior was mediated by a respective FPN subnetwork. Such data are consistent with the idea that the CON motivates the FPN, which, in turn, drives behavior. Within the CON, the dorsomedial prefrontal cortex (dmPFC) mediated the relationship between the anterior insula and FPN, suggesting that the dmPFC acts as the crux that links the CON to the FPN. Collectively, these data indicate that parallel CON–FPN subnetworks mediate controlled behaviors at distinct timescales/ mediums. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sensory processing dysfunction in children has been linked to attention-deficit/hyperactivity disorder, autism, feeding disorders, and functional abdominal pain. However, little is known about sensory processing in the broader pediatric gastroenterology population. OBJECTIVE: To characterize frequency and type of sensory processing dysfunction seen in pediatric gastroenterology compared to a general pediatric population. METHODS: The Short Sensory Profile 2 was administered to the parents of children ranging 3-14 years, being seen in a pediatric gastrointestinal (Gl) subspecialty clinic or general pediatric clinic. Short Sensory Profile 2 scores from age- and gender-matched groups were compared with nonparametric statistics. RESULTS: Sensory processing dysfunction was increased in children seen in the Gl clinic compared to children in the general pediatric clinic. Short Sensory Profile 2 quadrant analysis revealed greatest differences in avoiding, primarily in young females of the Gl population. CONCLUSION: Children presenting to a pediatric Gl clinic demonstrate greater sensory processing dysfunction compared to children in a general pediatric practice. [ABSTRACT FROM AUTHOR]

We examined the perceived impact of the COVID-19 pandemic on sexual health, sexual behaviour, well-being, and access to sexual health services among university students in Canada. Between December 2020 and January 2021, 1504 university students across Canada completed an online survey focused on overall sexual health, well-being, solitary sexual behaviours, partnered sexual interactions, and access to sexual health services. The survey was designed by the Sex Information & Education Council of Canada and administered by the Leger polling company. Reported levels of overall sexual health were high. Cisgender women reported significantly greater scores of COVID-19—related stress compared to cisgender men; LGBQ+ students had higher levels of stress compared to heterosexual participants. Overall, solitary sexual behaviours (i.e., masturbation, porn use, vibrator use) remained unchanged or were perceived to increase compared to the time before the pandemic. Cisgender men reported higher scores (i.e., greater perceived increases) on masturbation and porn use than cisgender women. Frequency of sex with casual partners was perceived as similar or lower than what was usual before the pandemic, and most participants did not engage in sex where the close personal contact put them or their partner at risk for COVID-19. Declines in access were reported for all sexual health care services surveyed, with cisgender women and students of colour more likely to report decreased access to services. Results highlight the need for targeted public health messaging regarding sexual behaviour, investment in sexual health services, and supports tailored to the needs of women, LGBTQ+ individuals, and people of colour. [ABSTRACT FROM AUTHOR]

Fixed-income corporate bond markets were the last bastion of non-electronic trading activity. For most of the twentieth century these markets were also dominated by the largest Wall Street dealer-banks. These banks had long argued that corporate bonds were too complex and illiquid to be electronified. In reality though, opaque Over-The-Counter trading in these bonds allowed Wall Street to monopolise highly uncompetitive markets; this market environment had changed very little over the decades, despite the financial services revolutions that had gripped other markets. By the 2010s however, Wall Street banks had finally begun to lose their stranglehold. This paper tracks the two explanatory factors, the emergence of new financial technology and the decisive intervention of state managers and post-crisis regulation – in the form of the Volcker Rule and Basel III. Recent accounts have become increasingly sceptical of the disruptive, pro-competitive impact of fintech. We argue that – at least in markets for US corporate bonds – there is evidence of a more competitive, democratic market environment emerging as a direct result of new financial technologies. [ABSTRACT FROM AUTHOR]

Background: Participants want to receive the results of trials that they have participated in. Dissemination practices are disparate, and there is limited guidance available on what information to provide to participants and how to deliver it. Objectives: This study aimed to establish what trial participants believe should be included in a results summary and how this information should be delivered. Methods: A mixed‐methods design was used with focus groups and interviews involving women convenience‐sampled from two host randomized‐controlled trials. Participants ranked information items in order of their importance for inclusion in a trial results summary and potential modes of delivery by preference. All participants provided written informed consent. Results: Sixteen women (mean age [SD] = 71.6 [9.7] years) participated. Participants ranked 'individual results from the study' and 'summary of overall trial results' as most important. Themes such as reassurance and setting results in context were identified as contributing to participants' decisions around ranking. 'A thank you for your contribution to the study' was ranked the least important. Delivery by post was the preferred mode of receiving results, with receiving a hard copy of results cited as helpful to refer back to. Conclusion: Our findings provide insight into what information trial participants deem as important when receiving trial results and how they would like results delivered. Involving patients during development of trial results to be communicated to participants could help to ensure that the right information is delivered in the right way. Patient or Public Contribution: Public partners were involved in focussed aspects of study conduct. [ABSTRACT FROM AUTHOR]

Working memory (WM) is the ability to maintain and manipulate internal representations. WM recruits varying brain regions based on task demands. Although the hippocampus has historically been associated with long-term memory (LTM), several studies provide evidence for its involvement during WM tasks. Slotnick (this issue) posits that this involvement is due to LTM processes. This argument rests on the assumption that processes are not shared among WM and LTM, and that WM processes are necessarily sustained. We argue that there are processes utilized by both WM and LTM, and that such processes need not be sustained to support WM. [ABSTRACT FROM AUTHOR]

This review aims to develop an evidence-based pathway for isolated adult orbital blowout fractures. Evaluation of assessment methods, outcome measures, imaging modalities, and crucially, the optimal timing of surgical intervention was critically examined to develop a clinically applicable care pathway. A literature search was carried out using Scopus, PubMed and Web of Knowledge. The literature favors the use of HAR% ratio, Field of Binocular Single Vision (FOBSV) and Exophthalmometer as the core tests that should form part of the standardized assessment for blow-out fractures (BOFs). CT imaging remains gold standard, particularly to identify 'red-flags' warranting early intervention. There was some disagreement in relation to timing of intervention in adult fractures who continue to be symptomatic without initial extraocular muscle (EOM) entrapment and enophthalmos >3 mm, where early intervention within two weeks is not indicated. The limited literature available agreed that successful functional and radiological outcomes can be achieved with conservative or late surgical management following an extended observational period of four weeks, opposed to the conventional two weeks. An evidence-based care pathway has been created, confidently including the initial assessment methods, imaging modality, and the criteria for observation. A four-week observational period has been advocated due to evidence suggesting that there is no significant difference in outcomes from two-week observation, plus with careful functional evaluation, surgery may be avoided in some cases. [ABSTRACT FROM AUTHOR]

Sexual, romantic, and intimate relationships provide opportunities for individual and interpersonal fulfillment and the enhancement of well-being. Though research has identified that consensual non-monogamy (CNM) offers unique relational benefits, little work has examined why individuals pursue CNM relationships. Both self-determination theory and self-expansion theory provide frameworks for understanding the range of intra- and interpersonal motives for choosing or negotiating a multipartnered relationship. We explored the reasons for which people engage in CNM and discuss how motivations for CNM might be linked to well-being and need fulfillment. Our study used a qualitative approach to examine the motivations individuals report for engaging in CNM relationships. As part of a larger online survey, participants completed open-ended questions examining motivations for, and experiences of, CNM relationships. Data from participants who indicated that they were currently in a CNM partnership was selected for the analyses (n = 540). Data were analyzed using thematic analysis, within a critical realist framework. Motivations were organized into six interconnected themes: reasons related to autonomy, beliefs and value systems, relationality, sexuality, growth and expansion, and pragmatism. Individuals reported diverse reasons for engaging in CNM relationships; reasons addressed both individual and relational needs and well-being. Findings contrast with stereotypic views of CNM relationships as unstable/unfulfilling or that individuals engage in CNM because of relationship problems. The findings may facilitate therapeutic interventions for counselors working with individuals who are in the process of negotiating or re-negotiating relationship boundaries. [ABSTRACT FROM AUTHOR]

School-based sexual health education plays a key role in providing young people with the information, motivation, and skills needed to enhance their sexual health. However, the extent and quality of sexual health education curricula varies across Canada. Though parents' support is often considered when making curricular decisions, there is limited data examining parental attitudes towards sexual health education across Canada. In the current study, we examined parental attitudes towards school-based sexual health education in a national sample of Canadian parents. Using an online survey, we examined overall support for the inclusion of sexual health education in schools, perceived quality of the sexual health education children received, assessed support for 33 sexual health education topics, and determined if parental support varied across geographic regions. Participants were 2,000 parents with children attending elementary and/or secondary school in Canada. The majority of parents (85%) agreed that sexual health education should be taught in the schools. Support was high across all regions in Canada, ranging from 82% in Ontario to 91% in the Atlantic provinces. However, significantly fewer parents in Ontario and Quebec supported school-based sexual health education compared to other regions. Overall, parents want a wide variety of topics included in school-based sexual health education and support the teaching of foundational topics in the early and middle school grades. The current study is the first to use a national sample to examine parents' attitudes towards sexual health education in schools. Results can inform provincial/territorial health education policies and national sexual health promotion strategies. [ABSTRACT FROM AUTHOR]

Intimate and sexual relationships provide opportunity for emotional and sexual fulfillment. In consensually non-monogamous (CNM) relationships, needs are dispersed among multiple partners. Using Self-Determination Theory (SDT) and dyadic data from 56 CNM partnerships (112 individuals), we tested how sexual motives and need fulfillment were linked to relational outcomes. We drew from models of need fulfillment to explore how sexual motives with a second partner were associated with satisfaction in the primary relationship. In a cross-sectional and daily experience study we demonstrated that self-determined reasons for sex were positively associated with sexual satisfaction and indirectly linked through sexual need fulfillment. Self-determined reasons for sex predicted need fulfillment for both partners at a three-month follow up. The association between sexual motives and need fulfillment was stronger on days when participants engaged in sex with an additional partner, though this was not related to satisfaction in the primary relationship. Implications for need fulfillment are discussed. [ABSTRACT FROM AUTHOR]

Objective: The Montreal Cognitive Assessment (MoCA) is a popular and simple-to-administer screening instrument to detect cognitive impairment. The MoCA generates a total score and six domain-specific index scores: (1) Memory, (2) Executive Functioning, (3) Attention, (4) Language, (5) Visuospatial, and (6) Orientation. It is unclear whether these MoCA scores can differentiate between distinct clinical dementia syndromes. This study compared MoCA Index scores between amnestic dementia of the Alzheimer's type (DAT) and primary progressive aphasia (PPA), a language-based dementia. Method: Baseline MoCA data were analyzed from 33 DAT, 37 PPA, and 83 cognitively normal individuals enrolled in the Clinical Core of the Northwestern Alzheimer's Disease Center. A one-way analysis of covariance adjusted for age was used to compare MoCA scores among groups. A logistic regression model was implemented to observe individual likelihood of group affiliation based on MoCA Index scores. Results: The mean MoCA total score was significantly higher in controls compared to both patient groups (p <.001) but did not differ between DAT and PPA groups. However, in accordance with salient clinical features commonly observed in DAT versus PPA, Memory and Orientation Index scores were lowest in the DAT group (p <.001), whereas Language and Attention Index scores were lowest in the PPA group (p <.001). Multivariate logistic regression analysis showed that the individual effects of Memory (p =.001), Language (p =.002), and Orientation (p =.025) Indices were significant. Conclusions: MoCA Index scores can help differentiate among distinct cognitive syndromes, suggesting it may be a useful brief screening tool to detect domain-specific cognitive impairment. [ABSTRACT FROM AUTHOR]

The phycosome – the algal microbiome – can impact microalgal cultivation productivity and stability through metabolic interaction networks. Polycultures can be designed based upon complementary traits and metabolic potential to maximize yields. Stable and resilient consortia are a sustainable approach to contamination challenges compared to the traditional use of pesticides and extensive sterilizing methods. High-pH/high-alkalinity microalgal cultivation can better control inputs and outputs via direct air CO 2 capture. Less is known about the ecology of extreme and productive systems, with implications for long-term, repeated cultivations. Lessons learned from natural and industrial systems with varying pH, alkalinity, temperature, and salinity can inform input and output control of algal growth systems. Algal–bacterial interactions are ubiquitous in both natural and industrial systems, and the characterization of these interactions has been reinvigorated by potential applications in biosystem productivity. Different growth conditions can be used for operational functions, such as the use of low-quality water or high pH/alkalinity, and the altered operating conditions likely constrain microbial community structure and function in unique ways. However, research is necessary to better understand whether consortia can be designed to improve the productivity, processing, and sustainability of industrial-scale cultivations through different controls that can constrain microbial interactions for maximal light-driven outputs. The review highlights current knowledge and gaps for relevant operating conditions, as well as suggestions for near-term and longer-term improvements for large-scale cultivation and polyculture engineering. [ABSTRACT FROM AUTHOR]

Approximately 4% of individuals in North America participate in consensually nonmonogamous (CNM) relationships, wherein all partners have agreed to additional sexual and/or emotional partnerships. The CNM relationships are stigmatized and viewed as less stable and satisfying than monogamous relationships, a perception that persists despite research evidence. In our study, we assess the legitimacy of this negative perception by using a self-determination theory (SDT) framework to explore how sexual motivation impacts relational and sexual satisfaction among CNM and monogamous participants in romantic relationships. A total of 348 CNM (n = 142) and monogamous participants (n = 206) were recruited from Amazon’s Mechanical Turk (MTurk. (2016). www.mturk.com) to complete a cross-sectional survey. Participants reported on their sexual motivations during their most recent sexual event, their level of sexual need fulfillment, and measures of sexual and relational satisfaction with their current (primary) partner. The CNM and monogamous participants reported similar reasons for engaging in sex, though CNM participants were significantly more likely to have sex for personal intrinsic motives. No differences in mean levels of relationship and sexual satisfaction were found between CNM and monogamous individuals. Participants who engaged in sex for more self-determined reasons reported increased relational and sexual satisfaction. This relationship was mediated by sexual need fulfillment; participants who reported more self-determined motives reported higher levels of need fulfillment and, in turn, greater relationship and sexual satisfaction. This study indicates that CNM and monogamous individuals report similar levels of satisfaction within their relationship(s) and that the mechanisms that affect relational and sexual satisfaction are similar for both CNM and monogamous individuals. Our research extends theoretical understandings of motivation within romantic relationships and suggests that SDT is a useful framework for considering the impact of sexual motivation on relational outcomes. [ABSTRACT FROM AUTHOR]

Researchers' interest in the use of sex toys has increased in the past 10 years as products become more accepted in mainstream media, and incorporated into individuals' sexual scripts. Though researchers and health educators have emphasized the importance of sex toy use hygiene behaviours, few studies have addressed the extent to which individuals are sharing, cleaning and covering their sex toys. The current research examined 1) the prevalence, frequency, predictors, and types of sex toys use/used, 2) the prevalence/frequency of sex toy use hygiene behaviours (e.g., cleaning, sharing, covering) and 3) whether sex toy use hygiene behaviours were related to vulvovaginal health outcomes among a sample of Canadian participants. As part of a larger survey examining genital health and hygiene practices, 1435 participants across Canada completed an anonymous online survey. Prevalence of sex toy use was 52.3%. Sex toys users were more likely to report a bisexual, lesbian, queer or questioning identity and were more likely to report engaging in additional partnered sexual activities such as oral and anal sex. Participants used a wide variety of sex toys including vibrators, butt plugs, BDSM toys, and household items. Most participants indicated that they cleaned their sex toys regularly using soap and water and 21.7% reported sharing their sex toy(s) with a partner. Sex toy use is common among Canadian women and individuals report using a variety of sexual enhancement products. Implications for educators and medical practitioners working with sexually active clients are also discussed. [ABSTRACT FROM AUTHOR]

The current study aimed to extend existing research concerning HPV vaccination rates, sexual behaviour practices, and risk of HPV-related morbidity and mortality among Canadian university students. A survey research firm recruited an online sample of Canadian university students between 18 and 24 years of age and from across Canada for a study of student sexual health. The current report represents a secondary analysis of responses to this sexual health survey that is focused on HPV morbidity risk. An analysis sample of 1,412 university students responded to an assessment of demographic characteristics, HPV vaccination status (vaccinated or unvaccinated), and recent and lifetime sexual behaviours and condom use. Conservative estimates indicated that approximately one-quarter of university student women, at least two-thirds of university student men, and at least one-third of trans/non-binary university students had not been vaccinated against HPV. Recent and lifetime sexual behaviours of HPV vaccinated and HPV unvaccinated university students were strikingly similar. HPV unvaccinated status, HPV-risk sexual behaviour, and HPV-related morbidity and mortality risk were very common in this national sample of Canadian university students. Cost-free catch-up HPV vaccination programs for unvaccinated university students are urgently needed to mitigate substantial HPV-related health risks in this population. [ABSTRACT FROM AUTHOR]

Oral sex has become a standard component of the heterosexual sexual script, though little is known about the level of pleasure men and women experience from giving and receiving oral sex and the extent to which relationship context is associated with levels of pleasure. The purpose of this study was to investigate gender differences in giving and receiving oral sex, and associations with pleasure experienced and partner type. Participants were 899 heterosexual university students who reported on their sexual activities in their most recent sexual encounter in an online survey. Over two-thirds of participants reported that their last sexual encounter included giving and/or receiving oral sex. More women (59%) than men (52%) reported giving oral sex to their partner. More men (63%) than women (44%) reported receiving oral sex. Most men (73%) and women (69%) reported that receiving oral sex was ''very pleasurable.'' Though most participants rated giving oral sex as at least ''somewhat pleasurable,'' men were significantly more likely than women to report that giving oral sex was very pleasurable (52% vs. 28%). Overall, ratings of pleasure for giving oral sex were higher for men, but no gender differences were found for overall pleasure ratings of receiving oral sex. Regardless of gender, higher pleasure ratings were reported when giving and receiving oral sex with more committed partners compared to more casual ones. Findings highlight the utility of discussing gendered norms for sexual behaviour with young people, and including pleasure-enhancing information in sexual health education programs. [ABSTRACT FROM AUTHOR]

While traditional economic models assume that agents are self-interested, humans and most non-human primates are social species. Therefore, many of decisions they make require the integration of information about other social agents. This study asks to what extent information about social status and the social context in which decisions are taken impact on reward-guided decisions in rhesus macaques. We tested 12 monkeys of varying dominance status in several experimental versions of a two-choice task in which reward could be delivered to self only, only another monkey, both the self and another monkey, or neither. Results showed dominant animals were more prone to make prosocial choices than subordinates, but only when the decision was between a reward for self only and a reward for both self and other. If the choice was between a reward for self only and a reward for other only, no animal expressed altruistic behaviour. Finally, prosocial choices were true social decisions as they were strikingly reduced when the social partner was replaced by a non-social object. These results showed that as in humans, rhesus macaques' social decisions are adaptive and modulated by social status and the cost associated with being prosocial. [ABSTRACT FROM AUTHOR]

Parental/guardian support can be a key input for policy decision-making for sexual health education curriculum development and it is, therefore, critical to examine parental/guardian attitudes towards the principles underlying comprehensive sexual health education. The Canadian Guidelines for Sexual Health Education (SIECCAN, 2019) specify nine Core Principles of Comprehensive Sexual Health Education that should inform the planning and delivery of sexual health education programs. This study examines parental/guardian attitudes towards the Core Principles and determines whether attitudes vary based on demographic and regional variables. Two thousand parents/guardians from across Canada completed an online questionnaire assessing demographic characteristics and overall agreement with each of the Core Principles. There was strong consensus among parents/guardians; 73% to 85% support the inclusion of the nine Core Principles in the planning and development of sexual health education programs. We tested agreement with Core Principles in two ways: first using averaged scores across all Core Principle items, then across individual Core Principles. We found some statistically significant effects based on parent/guardian gender, educational attainment, region of residence, and importance of religion, however all effect sizes were small (between 1%–4% variance accounted for) suggesting these were not particularly meaningful. Therefore, findings demonstrate parental/guardian support across Canada for the Core Principles of Comprehensive Sexual Health Education. Understanding parents'/guardians' attitudes towards the philosophical underpinnings of sexual health education provides policymakers with a firmer understanding of parental perspectives which may be particularly salient as new issues emerge in public discourse about the content of sexual health education in schools. [ABSTRACT FROM AUTHOR]

Background: Healthcare technologies are becoming more commonplace, however clinical and patient perspectives regarding the use of technology in the management of childhood asthma have yet to be investigated. Within a clinical trial of asthma management in children, we conducted a qualitative process evaluation that provided insights into the experiences and perspectives of healthcare staff and families on (i) the use of smart inhalers to monitor medication adherence and (ii) the use of algorithm generated treatment recommendations. Methods: We interviewed trial staff (n = 15) and families (n = 6) who were involved in the trial to gauge perspectives around the use of smart inhalers to monitor adherence and the algorithm to guide clinical decision making. Findings: Staff and families indicated that there were technical issues associated with the smart inhalers. While staff suggested that the smart inhalers were good for monitoring adherence and enabling communication regarding medication use, parents and children indicated that smart inhaler use increased motivation to adhere to medication and provided the patient (child) with a sense of responsibility for the management of their asthma. Staff were open-minded about the use of the algorithm to guide treatment recommendations, but some were not familiar with its' use in clinical care. There were some concerns expressed regarding treatment step-down decisions generated by the algorithm, and some staff highlighted the importance of using clinical judgement. Families perceived the algorithm to be a useful technology, but indicated that they felt comforted by the clinicians' own judgements. Conclusion: The use of technology and individual data within appointments was considered useful to both staff and families: closer monitoring and the educational impacts were especially highlighted. Utilising an algorithm was broadly acceptable, with caveats around clinicians using the recommendations as a guide only and wariness around extreme step-ups/downs considering contextual factors not taken into account. [ABSTRACT FROM AUTHOR]

Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women who are not experiencing sexual problems. The current study investigated whether reasons for sex differed by women reporting high versus low overall sexual functioning, as assessed by the Female Sexual Function Index (FSFI) (Rosen et al., 2000). As low desire and inability to achieve orgasm are the two most commonly reported sexual problems for women, the study also investigated whether women with and without problems specifically related to sexual desire or orgasm cited different reasons for sex. The sample consisted of 446 heterosexual women between the ages of 18 and 61 who completed an online questionnaire assessing reasons for sex and sexual functioning. Women with low sexual functioning overall were more likely to endorse insecurity reasons for sex, while women with high sexual functioning overall were more likely to endorse physical reasons for sex. Women experiencing low desire specifically were less likely to endorse emotional and physical reasons for sex than women without desire difficulties. Women experiencing orgasm difficulties specifically were more likely to endorse insecurity reasons for sex than women without orgasm difficulties. The variance accounted for was low in all cases. This research offers insights into the important but limited role sexual functioning may play in the broader context of women's sexual motivations. [ABSTRACT FROM AUTHOR]

Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women who are not experiencing sexual problems. The current study investigated whether reasons for sex differed by women reporting high versus low overall sexual functioning, as assessed by the Female Sexual Function Index (FSFI) (Rosen et al., 2000). As low desire and inability to achieve orgasm are the two most commonly reported sexual problems for women, the study also investigated whether women with and without problems specifically related to sexual desire or orgasm cited different reasons for sex. The sample consisted of 446 heterosexual women between the ages of 18 and 61 who completed an online questionnaire assessing reasons for sex and sexual functioning. Women with low sexual functioning overall were more likely to endorse insecurity reasons for sex, while women with high sexual functioning overall were more likely to endorse physical reasons for sex. Women experiencing low desire specifically were less likely to endorse emotional and physical reasons for sex than women without desire difficulties. Women experiencing orgasm difficulties specifically were more likely to endorse insecurity reasons for sex than women without orgasm difficulties. The variance accounted for was low in all cases. This research offers insights into the important but limited role sexual functioning may play in the broader context of women's sexual motivations. [ABSTRACT FROM AUTHOR]

Background: Two commonly performed surgical interventions are available for severe (grade II-IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery.Methods: The eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II-IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723.Findings: Between Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference -0·073 (95% CI -0·140 to -0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group. 24 (7%) of 338 participants who received stapled haemorrhoidopexy and 33 (9%) of 352 participants who received traditional excisional surgery had serious adverse events.Interpretation: As part of a tailored management plan for haemorrhoids, traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice.Funding: National Institute for Health Research Health Technology Assessment programme. [ABSTRACT FROM AUTHOR]

Comparative research involving consensually non-monogamous (CNM) relationships and outcomes related to well-being continues to grow as an area of interest within sexual science. However, claims of sameness and/or difference between groups rely on two critical, yet widely under-appreciated assumptions: that the concepts being compared between groups are the same (i.e., measurement invariance), and that logically and statistically coherent procedures are used for evaluating sameness (i.e., equivalence testing). We evaluated the state of measurement invariance and equivalence across three studies, involving different types of CNM comparisons (i.e., relationship types, partner types) and designs (analysis of primary individual data, primary dyadic data, and secondary data). Our invariance tests of CNM compared to monogamous individuals (Study 1) and "primary" compared to "secondary" partners in dyadic appraisal of CNM individuals (Study 2) revealed that many measures of well-being failed to replicate their measurement models and were not generalizable across relationship types or partner types. Our reanalyses of existing comparative CNM effects using individual and meta-analyzed equivalence tests (Study 3), meanwhile, indicated that this literature requires more consistent reporting practices and larger samples, as most studies produced uninformative tests of equivalence. Our results illustrate the importance of auxiliary hypothesis evaluation and statistical procedure selection for generating informative comparative tests. Our findings also highlight potential divergences in social construction of well-being. We offer suggestions for researchers, reviewers, and editors in terms of needed methodological reforms for future comparative CNM research. [ABSTRACT FROM AUTHOR]

Background: Heavy menstrual bleeding (HMB) is a common problem affecting approximately 1.5 million women in England and Wales with a major impact on their physical, emotional, social and material quality of life. It is the fourth most common reason why women attend gynaecology outpatient clinics and accounts for one-fifth of all gynaecology outpatient referrals. Initial treatment in primary care is medical - either by means of oral or injected medication or the levonorgestrel-intrauterine system (Mirena®). If medical treatment fails then surgical treatment can be offered, either endometrial ablation (EA), which destroys the lining of the cavity of the uterus (endometrium), or hysterectomy, i.e. surgical removal of the uterus. While effective, conventional hysterectomy is invasive and carries a risk of complications due to injury to other pelvic structures. The procedure can be simplified and complications minimised by undertaking a 'supracervical' hysterectomy where the cervix is left in situ and only the body of the uterus removed. Recent advances in endoscopic technologies have facilitated increased use of laparoscopic supracervical hysterectomy (LASH) which can be performed as a day-case procedure and is relatively easy for the surgeon to learn. HEALTH (Hysterectomy or Endometrial AbLation Trial for Heavy menstrual bleeding) aims to address the question 'Is LASH superior to second generation EA for the treatment of HMB in terms of clinical and cost effectiveness?'Methods/design: Women aged < 50 years, with HMB, in whom medical treatment has failed and who are eligible for EA will be considered for trial entry. We aim to recruit women from approximately 30 active secondary care centres in the UK NHS who carry out both surgical procedures. All women who consent will complete a diary of pain symptoms from day 1 to day 14 after surgery, postal questionnaires at six weeks and six months after surgery and 15 months post randomisation. Healthcare utilisation questions will also be completed at the six-week, six-month and 15-month time-points.Discussion: Measuring the comparative effectiveness of LASH vs EA will provide the robust evidence required to determine whether the new technique should be adopted widely in the NHS.Trial Registration: International Standard Randomised Controlled Trials, ISRCTN49013893 . Registered on 28 January 2014. [ABSTRACT FROM AUTHOR]

Research suggests the relationship between pleasure and condom use during penile–vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI asVery pleasurablewhen condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences. [ABSTRACT FROM AUTHOR]