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Background: Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown., Objectives: The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality., Search Strategy: We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms 'caesarean scar ectopic pregnancy and caesarean scar pregnancy'., Selection Criteria: We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English., Data Collection and Analysis: Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models., Main Results: A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3-4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503)., Conclusions: This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high-quality research that is both useful and relevant to patients., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Lymphatic vessels grow through active sprouting and mature into a vascular complex including lymphatic capillaries and collecting vessels that ensure fluid transport. However, the signaling cues that direct lymphatic sprouting and patterning remains unclear. In this study, we demonstrated the chemokine signaling, specifically through CXCL12/CXCR4 plays critical roles in regulating lymphatic development. We showed that LEC specific CXCR4 deficient embryos and CXCL12 mutant embryos exhibited server defects in lymphatic sprouting, migration, and lymphatic valve formation. We also discovered that CXCL12, originating from peripheral nerves, directs the migration of dermal lymphatic vessels to align with nerves in developing skin. Deletion CXCR4 or blockage of CXCL12/CXCR4 activity results in reduced VEGFR3 levels on the LEC surface. This, in turn, impairs VEGFC mediated VEGFR3 signaling and downstream PI3K/AKT activities. Taken together, these data identify previously unknown chemokine signaling originating from peripheral nerves that guides dermal lymphatic sprouting and patterning. Our work identifies for the first time a neuro-lymphatics communications during mouse development and reveals a novel mechanism by which CXCR4 modulates VEGFC/VEGFR3/AKT signaling., (© 2024. Published by The Company of Biologists Ltd.)

Background: Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic's impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported., Methods: In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women's access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic., Results: All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal., Conclusions: These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss., (© 2024. The Author(s).)

In response to the increase in Routine Outcome Monitoring and Clinical Feedback, the Patient-Perceived Helpfulness of Measures Scale (ppHMS) was developed to assess the helpfulness-as perceived by patients-of using measures in psychological treatment. Study 1: The construct of patient-perceived helpfulness of measures was explored using thematic analysis with 15 patients. Six helpful and three unhelpful themes were identified and informed item development. Study 2: 28 items were formulated and rated by experts. Ten items were taken forward for psychometric shortening in a sample of 76 patients. Confirmatory factor analysis (CFA) led to an adequately fitting six-item model with excellent internal consistency, and convergence with the Delighted-Terrible single item of product satisfaction and a single item of measure helpfulness. Study 3: In a stratified online sample of 514 U.K. psychotherapy patients, a five-item model constituted the best fit. The final ppHMS had excellent internal consistency (McDonald's ω = .90), convergent validity with psychotherapy satisfaction ( r = .5; p < .001), divergence from social desirability ( r = .1), and metric and scalar invariance across measures. Study 4: Analyses were replicated and confirmed in a stratified U.S. sample ( n = 602). The ppHMS is a reliable and valid scale that can be used to assess and compare patients' perceptions of the helpfulness of different measures as part of their psychological treatment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Problem: Early pregnancy losses [EPL] are common, varied, and require different courses of management and care., Background: In the UK, women who suspect or suffer a pregnancy loss are usually provided specialist care in early pregnancy assessment units [EPAUs]. Their configuration has recently been evaluated, but recommendations for change in-line with best practice for optimum outcomes were unable to be implemented due to the COVID-19 pandemic health system shock., Aim: To compare women's experiences of EPAUs during the pandemic to themes previously found in qualitative work undertaken with women who utilised EPAUs before the pandemic., Methods: We conducted semi-structured virtual interviews, with women (N = 32) who suffered an early pregnancy loss during the pandemic; analysing transcripts using Template Analysis, based on findings about women's (pre-pandemic) experiences of EPAU from The VESPA Study., Findings: We report on seven key themes: Barriers to Accessing Services; Communication & Information; Retention of Relational Care; Involvement in Care Decisions; Staffs' Attitude or Approach; Efficiency of Service Delivery; Sensitive Patient Management., Discussion: Sensitive patient management and woman-staff interactions in EPAU settings remain a fundamental issue. Women also reported their experiences of EPAUs were comparatively worse during the pandemic., Conclusions: Women valued the care provided by EPAUs and found services to be efficient, despite pandemic-related restrictions. However, psychological recognition surrounding EPL and appropriate, sensitive, relational care and support continue to be areas in need of improvement. Our recommendation is to implement the improvements suggested by VESPA as a priority to ameliorate present sub-optimal experiences and prevent further deterioration., Competing Interests: Declaration of Competing Interest None of the authors have any competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered., Methods: A consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy., Results: The synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, & Practice., Discussion: The evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision., Competing Interests: SAS (King's College London) is in receipt of a Personal Doctoral Fellowship from the NIHR ARC South London Capacity Building Theme [NIHR-INF-2170]. KDB (King's College London) is in receipt of an NIHR Doctoral Research Fellowship [NIHR302565]. CAW (King's College London) is supported by the NIHR as an Academic Clinical Lecturer. MN and JS (King's College London) are currently supported by the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] at King's College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CS (The International Stillbirth Alliance) is a Trustee for Mothers for Mothers, a perinatal mental health charity. VF (University of Liverpool) and KSS (University of the West of England Bristol) are currently serving committee members of the Society for Reproductive & Infant Psychology, with VF being a core officer (Treasurer) and KSS being the Communications Officer and one of the co-ordinators for the Research Development Workshop Grant scheme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Some of the authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Jackson, Greenfield, Payne, Burgess, Oza, Storey, Davies, De Backer, Kent-Nye, Pilav, Worrall, Bridle, Khazaezadeh, Rajasingam, Carson, De Pascalis, Fallon, Hartley, Montgomery, Newburn, Wilson, Harrold, Howard, Sandall, Magee, Sheen and Silverio.)

Objective: To address methodological deficiencies in published randomized controlled trials and systematic reviews, this study has developed a core outcome set to guide future research in ectopic pregnancy (EP)., Design: To identify potential outcomes, we performed a comprehensive literature review and interviews with individuals with lived experience in EP. Potential core outcomes were then entered into a 3-round Delphi survey. A total of 154 participants from 6 continents, comprising health care professionals, researchers, and individuals with lived experience in EP, completed all 3 rounds of the Delphi survey. Outcomes were prioritized at 3 consensus development meetings, and recommendations were developed on how to report these outcomes where possible., Setting: Not applicable., Patient(s): Health care professionals, researchers, and individuals with lived experience in EP., Intervention(s): Not applicable., Main Outcome Measure(s): Consensus for inclusion in core outcome set., Result(s): Six outcomes reached full consensus, including treatment success, resolution time, the number of additional interventions, adverse events, mortality and severe morbidity, and treatment satisfaction., Conclusion(s): The core outcome set with 6 outcomes for EP will help standardize reporting of clinical trials, facilitate implementation of findings into clinical practice, and enhance patient-centered care., (Copyright © 2023 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Increasing data infringement while transmission and storage have become an apprehension for the data owners. Even the digital images transmitted over the network or stored at servers are prone to unauthorized access. However, several image steganography techniques were proposed in the literature for hiding a secret image by embedding it into cover media. But the low embedding capacity and poor reconstruction quality of images are significant limitations of these techniques. To overcome these limitations, deep learning-based image steganography techniques are proposed in the literature. Convolutional neural network (CNN) based U-Net encoder has gained significant research attention in the literature. However, its performance efficacy as compared to other CNN based encoders like V-Net and U-Net++ is not implemented for image steganography. In this paper, V-Net and U-Net++ encoders are implemented for image steganography. A comparative performance assessment of U-Net, V-Net, and U-Net++ architectures are carried out. These architectures are employed to hide the secret image into the cover image. Further, a unique, robust, and standard decoder for all architectures is designed to extract the secret image from the cover image. Based on the experimental results, it is identified that U-Net architecture outperforms the other two architectures as it reports high embedding capacity and provides better quality stego and reconstructed secret images., (© 2022. The Author(s).)

Objectives: To examine how health care utilization and spending vary for low-income employees compared with high-income employees enrolled in an employer-sponsored high-deductible health plan (HDHP)., Study Design: We use commercial medical claims data and administrative human resource data from a large employer between 2014 and 2018. We link the administrative data, which include details on salary and other benefit choices, to each employee in each year with medical claims. Our variables of interest include medical spending and utilization outcomes grouped into different care settings., Methods: Using multivariate regressions, we estimate the association between salary buckets and health care utilization and spending, controlling for demographic characteristics, comorbidities of employees, human resource health plan benefits, and geography., Results: Employees earning less than $75,000 show lower rates of utilization and spending on preventive measures, such as outpatient visits and prescription drugs, while having higher rates of utilization of preventable and avoidable emergency department visits and inpatient stays, resulting in lower overall health care spending among lower-salary employees., Conclusions: Low-salary employees enrolled in HDHPs have higher rates of acute care utilization and spending but lower rates of primary care spending compared with high-salary employees. Results suggest that HDHPs discourage routine physician-patient care among low-salary employees.

Background: Randomised controlled trials (RCTs) evaluating ectopic pregnancy have reported many different outcomes, which are themselves often defined and measured in distinct ways. This level of variation results in an inability to compare results of individual RCTs. The development of a core outcome set to ensure outcomes important to key stakeholders are collected consistently will guide future research in ectopic pregnancy., Study Aim: To develop and implement a core outcome set to guide future research in ectopic pregnancy., Methods and Analysis: We have established an international steering group of key stakeholders, including healthcare professionals, researchers, and individuals with lived experience of ectopic pregnancy. We will identify potential outcomes from ectopic pregnancy from a comprehensive literature review of published randomised controlled trials. We will then utilise a modified Delphi method to prioritise outcomes. Subsequently, key stakeholders will be invited to score potential core outcomes on a nine-point Likert scale, ranging from 1 (not important) to 9 (critical). Repeated reflection and rescoring should promote whole and individual stakeholder group convergence towards consensus 'core' outcomes. We will also establish standardised definitions and recommend high-quality measurements for individual core outcomes., Trial Registration: COMET 1492 . Registered in November 2019., (© 2021. The Author(s).)

Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive compound in Cannabis, which is studied extensively for its medicinal value. A central gap in the science is the underlying mechanisms surrounding THC's therapeutic effects and the role of gut metabolite profiles. Using a mass-spectrometry based metabolomics, we show here that intraperitoneal injection of THC in C57BL/6 mice modulates metabolic profiles that have previously been identified as integral to health. Specifically, we investigated the effects of acute (single THC injection denoted here as '1X') and short -term (five THC injections on alternate days denoted as '5X') THC administration on fecal and intestinal tissue metabolite profiles. Results are consistent with the hypothesis that THC administration alters host metabolism by targeting two prominent lipid metabolism pathways: glycerophospholipid metabolism and fatty acid biosynthesis.

Objectives: To evaluate the impact of value-based insurance design (VBID), which removed patient cost sharing for primary care visits, on healthcare spending in a large, geographically diverse employer., Study Design: Quasi-experimental, difference-in-differences (DID) design, administrative claims-based study., Methods: Healthcare spending during the preintervention period (2008 and 2009) was compared with the postintervention period (2011 through 2014) to measure the impact of removing primary care cost sharing. The study population included Anthem commercially insured enrollees with continuous medical eligibility from 2008 to 2014 who were younger than 65 years. The VBID cohort included health plan enrollees from a national large employer that implemented the benefit change. The comparison cohort included other Anthem enrollees who did not have a similar benefit change and were propensity score-matched to the VBID cohort. Utilization of various types of healthcare services was also examined., Results: The VBID cohort experienced a $12.0 per member per month relative reduction in overall spending compared with the comparison cohort (P = .02). The trend was driven by reductions in expenditures for emergency department (ED) visits ($1.3 relative reduction; DID, -10.0%; P = .03) and other outpatient services ($7.6 relative reduction; DID, -5.8%; P = .02), which aligned with reduced utilization of ED visits (DID, -4.5%; P = .07) and other outpatient services (DID, -4.1%; P = .004). For physician office visits, the VBID cohort did not experience a significant relative increase compared with the comparison cohort (DID, 0.9%; P = .25)., Conclusions: The attempt to increase primary care access by reducing cost sharing did not produce a negative outcome in terms of total spending for healthcare.

Epilepsy is a common neurological disorder involving recurrent seizures and affecting about 1% of the population worldwide. Despite several antiepileptic drugs and effective therapies available for epilepsy, about 25% of the patients show therapeutic failure. Thus there exists an unmet need for newer antiepileptic drugs targeting newer targets with different mechanisms of action. Current research in epilepsy generally focuses on mechanisms that control neuronal excitability. Recently attention has been focussed on novel targets, their various interactions, and signalling cascades relating to epilepsy. This review summarizes several experimental and clinical findings from literature and explores potential targets which may play crucial role in epilepsy., (Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Alzheimer's disease (AD) is one of the most frequently encountered diseases in adults with progressive loss of memory and behavioral changes. Inspite of there being an intense research in the field of AD, only a few chemical entities exhibiting anti-AD activity make it through the clinical trials and it is thus need of an hour to develop new drugs or repurpose the existing ones for better management of Alzheimer's disease. Novel therapeutic targets can influence drug discovery in the field of AD. Cyclin Dependent Kinase 5 (Cdk5) which is a serine/threonine kinase can prove to be an upcoming beneficial target to be studied for treating AD. Cdk5 is important for development of CNS and neuron movements, however in AD pathological stimuli cause Cdk5 hyperactivation which eventually results in hyperphosphorylation of various substrates such as amyloid precursor protein, tau and many more. This review provides an insight on Cdk5 as a target for treatment of AD and discuss therapeutic candidates for targeting it., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Online drug information compendia (ODIC) are valuable tools that health care professionals (HCPs) and consumers use to educate themselves on pharmaceutical products. Research suggests that these resources, although informative and easily accessible, may contain misinformation, posing risk for product misuse and patient harm., Objective: Evaluate drug summaries within ODIC for accuracy and completeness and identify product-specific misinformation., Methods: Between August 2014 and January 2015, medical information (MI) specialists from 11 pharmaceutical/biotechnology companies systematically evaluated 270 drug summaries within 5 commonly used ODIC for misinformation. Using a standardized approach, errors were identified; classified as inaccurate, incomplete, or omitted; and categorized per sections of the Full Prescribing Information (FPI). On review of each drug summary, content-correction requests were proposed and supported by the respective product's FPI., Results: Across the 270 drug summaries reviewed within the 5 compendia, the median of the total number of errors identified was 782, with the greatest number of errors occurring in the categories of Dosage and Administration, Patient Education, and Warnings and Precautions. The majority of errors were classified as incomplete, followed by inaccurate and omitted., Conclusion: This analysis demonstrates that ODIC may contain misinformation. HCPs and consumers should be aware of the potential for misinformation and consider more than 1 drug information resource, including the FPI and Medication Guide as well as pharmaceutical/biotechnology companies' MI departments, to obtain unbiased, accurate, and complete product-specific drug information to help support the safe and effective use of prescription drug products., (© The Author(s) 2016.)