Cell-free fetal DNA-based noninvasive prenatal testing (NIPT) could significantly change the paradigm of prenatal testing and screening. Intellectual property (IP) and commercialization promise to be important components of the emerging debate about clinical implementation of these technologies. We have assembled information about types of testing, prices, turnaround times and reimbursement of recently launched commercial tests in the United States from the trade press, news articles, and scientific, legal, and business publications. We also describe the patenting and licensing landscape of technologies underlying these tests and ongoing patent litigation in the United States. Finally, we discuss how IP issues may affect clinical translation of NIPT and their potential implications for stakeholders. Fetal medicine professionals (clinicians and researchers), genetic counselors, insurers, regulators, test developers and patients may be able to use this information to make informed decisions about clinical implementation of current and emerging noninvasive prenatal tests.
IMPORTANCE Sunscreen use is a modifiable behavior that can help reduce the risk for skin cancer, prevent sunburns, mitigate photoaging, and treat photosensitive dermatoses. A better understanding of consumer sunscreen preferences would inform dermatologists in their own recommendations. OBJECTIVE To determine the characteristics and the most commonly cited positive and negative features of highly rated sunscreens described by consumers. DESIGN, SETTING, AND PARTICIPANTS The top 1 percentile of sunscreen products on Amazon.com as of December 2015 was selected according to average consumer review (Ն4 stars) and the highest number of consumer reviews. Descriptive data for each product were collected from the product page and manufacturer claims. The top 5 "most helpful" reviews (positive and critical) were analyzed and coded by a consensus qualitative coding scheme, which included positive and negative descriptors in 6 major categories according to consumer comments: affordability, cosmetic elegance, separate ratings, product ingredients, product performance, and skin compatibility. MAIN OUTCOMES AND MEASURES The Kruskal-Wallis test was performed to determine whether characteristics of each product (eg, American Academy of Dermatology [AAD] criteria, sun protection factor [SPF], or vehicle) could be used to predict price per ounce. The number (percentage) of comments categorized by major themes and subthemes was determined. Illustrative consumer comments were also collected. RESULTS There were 6500 products categorized as sunscreens in the Amazon.com, online catalog. Of the 65 products evaluated, the median price per ounce was $3.32 (range, $0.68-$23.47). Of products, 40% (26 of 65) did not adhere to AAD guidelines (broad spectrum, SPF Ն30, and water resistant) for sunscreens. Vehicles, fulfillment of AAD criteria, and sunscreen type predicted a higher price per ounce. Cosmetic elegance was the most cited positive feature (198 of 325 [61%] comments) followed by product performance (146 of 325 [45%] comments) and skin type compatibility (78 of 325 [24%] comments). CONCLUSIONS AND RELEVANCE In this cohort of highly rated sunscreen products, a significant proportion did not adhere to AAD guidelines, mostly attributable to a lack of water resistance. The most striking variation in this cohort was price, which varied by more than 3000%. Dermatologists should balance the importance of cosmetic elegance, cost, and AAD guidelines for sun protection in making their recommendations to consumers.
Müllerian duct anomalies occur in 0.1% to 3% of women, and they are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Having a twin pregnancy in a patient with a bicornuate uterus (uterus bicornis unicollis) is very rare, especially if it is a spontaneous conception. This is a case of a primigravida aged 21 yrs, conceived naturally, she came for a routine early pregnency scan, no pain giddiness, bleeding etc. Equipment GE E10 transvaginal scan was done after obtaining consent. There was evidence of a bicornuate uterus with a single sac in each cavity and corresponding to 5 weeks 2 days gestational age. A 3D rendering was done which clearly showed the bicornuate uterus with a single sac in each horn, sac outlines were regular. The incidence of spontaneous twin pregnancy in a bicornuate uterus has been estimated to be as low as 1 in 10,00,000, hence this is an extremely rare case. the patient was unfortunately lost for follow up after this scan.
Virtual poster abstractsrarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcomes of fetuses with ICH. Methods: Medline, Embase, Clinicaltrials.gov and Cochrane Library databases were searched. We included studies reporting the outcomes of fetuses with ICH. The primary outcome was perinatal death (PND), i.e. the sum of intra-uterine (IUD) and neonatal death (NND). The secondary outcomes were IUD, NND, TOP, need for surgery/shunting at birth, cerebral palsy, neurodevelopmental delay, and intact survival. Outcomes were explored in the whole population and for intra and extra-axial ICH. Meta-analyses of proportions were used to combine data, we reported pooled proportion and their 95% confidence intervals (CI). Results: 16 studies (193 fetuses) were included. PND occurred in 14.6% (95%CI 7.3-24.0), of fetuses with ICH. Of those liveborn, 27.6% (95%CI 12.5-45.9) required a shunt after birth and 32.0% (95%CI 22.2-42.6) had cerebral palsy. 16.7% of children had mild and 31.1% experienced severe neurodevelopmental delay. A normal outcome was reported in 53.6% fetuses. Looking at location, PND occurred in 13.3% (95%CI 5.7-23.4) of fetuses with intra-axial and in 26.7% ) with extra-axial bleeding. In cases with intra-axial hemorrhage, 24.7% required a shunt after birth and 27.1% had cerebral palsy. Mild and severe neurodevelopmental delay were observed in 15% (95%CI 6.9-25.6) and 32.3% 3) of cases, respectively, while 51.9% experienced a normal outcome. Robust evidence for fetuses with extra-axial hemorrhage could not be extrapolated due to the small number of cases. Conclusions: Fetuses with ICH are at high risk of perinatal morality and impaired neurodevelopmental outcome. Postnatal shunt placement was performed in 28% and cerebral palsy was diagnosed in approximately one third of these infants.
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