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RESEARCH QUESTION The cost of IVF treatment remains high, among other factors because of the medication needed for ovarian stimulation. This study investigated the effect of using low-dose human chorionic gonadotrophin (HCG) for the second phase of follicular maturation after corifollitropin alfa induction, to replace the more expensive, either recombinant or human menopausal gonadotrophin (HMG), on the cost of ovarian stimulation. DESIGN One hundred and five patients were randomly divided into two groups patients in the HCG group (n = 50) received low-dose HCG from Day 7 until the diameter of at least three follicles reached 17 mm or more, while patients in the FSH group (n = 55) received conventional ovarian stimulation with highly purified HMG injections. RESULTS The clinical pregnancy rate in the HCG group was 38% higher than in the FSH group (number needed to treat, NNT = 13). The cost per pregnancy needed for ovarian stimulation was reduced from €4902 in the FSH group to €2684 in the HCG group. Hence, the cost of ovarian stimulation medication to obtain 10 pregnancies using the conventional FSH protocol is sufficient to attain 18 pregnancies when applying the low-dose HCG protocol. CONCLUSION This study provides evidence that using HCG instead of HMG/FSH for ovarian stimulation results in a significant reduction in the cost of IVF with, at least, an equivalent pregnancy rate. A host of gastrointestinal (GI) peptides influence the regulation of vital functions, such as growth, appetite, stress, gut motility, energy expenditure, digestion and inflammation, as well as glucose and lipid homeostasis. Hence, impairments in the synthesis/secretion of glucagon-like peptide-1 (GLP-1), leptin, nesfatin-1, glucose-dependent insulinotropic peptide (GIP), ghrelin (acylated and unacylated forms), oxyntomodulin, vasoactive intestinal peptide, somatostatin, cholecystokinin, peptide tyrosine‒tyrosine, GLP-2 and pancreatic polypeptide were previously associated with the development of obesity-related disorders. It is currently emphasized that the beneficial metabolic outcomes associated with the normalization of the gut microbiota (GM) is influenced by increases in GLP-1 and peptide YY secretion as well as by decreases in acylated ghrelin production. These effects are associated with reductions in body weight and adiposity in combination with the normalization of glucose and lipid metabolism. However, important questions remain unanswered regarding how GLP-1, peptide tyrosine‒tyrosine, acylated ghrelin and other metabolically relevant GI peptides interact with the GM to modulate the host's metabolic functions. In addition, it is likely that the GM and other biologically active GI peptides influence metabolic functions, such as glucose control, although the mechanisms remain ill-defined. In this review, we investigate how GM and GI peptides influence glucose metabolism in experimental models, such as germ-free animals and dietary interventions. Emphasis is placed on pathways through which GM and GI peptides could modulate intestinal permeability, nutrient absorption, short-chain fatty acid production, metabolic endotoxemia, oxidative stress and low-grade inflammation. BACKGROUND It is uncertain if sleep deprivation impacts sleepy surgeons' technical skills. Lapses in surgical performance could increase morbidity and mortality. This review concludes if sleep deprivation impacts on technical skill performance in simulated environments. OBJECTIVE Primary 1. To identify if sleep deprivation has an impact on technical skill proficiency in surgeons. Secondary a. To identify if the level of surgical experience, quality of sleep, or quantity of sleep influences technical skill proficiency in sleep deprived surgeons. METHODS The review was conducted according to PRISMA guidelines utilising the databases Journals Ovid. Validation followed with two independent reviewers utilising an adapted version of BEME. RESULTS Thirty-three heterogeneous studies were included. Sleep deprivation likely negatively impacts technical performance between 11.9 and 32% decrement in performance. No strong evidence exists with regards to influence of experience, sleep type, or sleep length on technical proficiency. CONCLUSION Sleepy surgeons' technical skills are, on balance, between 11.9 and 32% negatively impacted in a standardised simulated environment. This is likely to have clinical implications for patient safety. In the recent years there has been increasing trend towards the practice of on-table extubation after pediatric cardiac surgery among practitioner in European and non-European countries. In this article we share our experience with on-table extubation among children after cardiac surgery in the developing world supported with the currently available literature. Communication highly influences what people think, feel, and decide about their health. This article discusses important barriers and success factors for effective communication in health contexts from the perspective of health communication, a subdiscipline of communication science. It focusses on aspects that are often not sufficiently addressed in our everyday communication the degree of target group orientation, the role of attention processes, the variety of possible negative effects, the process character of individuals' health behavior changes, and social influences. We conclude the article with a plea for a better evidence-basing of health-related communication processes. OBJECTIVE To determine the effectiveness and the incidence of severe adverse events in a cohort of Costa Rican patients with Rheumatoid Arthritis (RA) treated with intravenous (IV) tocilizumab (TCZ). PATIENTS AND METHODS A retrospective analysis was carried out in 45 patients that were unresponsive to disease-modifying antirheumatic drugs (DMARDs). The study included patients who received IV TCZ every 4 weeks (4mg/kg) along with methotrexate or leflunomide. Effectiveness was measured through the incidence of clinical remission according to a disease activity score - erythrocyte sedimentation rate (DAS28-ESR) less than 2.6. Safety was assessed by the incidence rate of serious adverse events. An univariate and multivariate logistic regression analysis was performed to assess the association of potential variables with the probability of achieving remission during the first 3 months of TCZ therapy. RESULTS During the 3rd month of TCZ therapy, a total of 22 patients (48.9%; 95% Confidence Interval (CI) 34.3-63.5%) achieved remission. The cumulative incidence of patients with remission at month 12 was 75.0% (n=34) (95% CI 62.3-87.6%). this website A total of 18 patients (40%; 95% CI 25.7-54.3%) were switched to a 8mg/kg dose due to the absence of remission. The incidence rate of serious adverse events was .98 per 100 patients/year, all of them due to infectious diseases with no fatal events reported. Only basal DAS28-ESR was associated with the probability of achieving remission at month 3. CONCLUSIONS IV TCZ (4mg/kg) is an effective and safe treatment for RA patients in a clinical setting in Costa Rica. OBJECTIVES This study aimed to provide a simplified, novel method for analysing technical skill involvements in an Australian Football context by reducing the dimensionality of commonly reported skill counts obtained from Australian Football League (AFL) games. This may facilitate their practical use and interpretability. DESIGN Retrospective longitudinal design where individual players' technical skill counts were collected over three seasons of official AFL games. METHODS Seventy-three skill count values provided publicly by ChampionData® were collected for each match over a three-year analysis period. A principal component analysis was used to reduce the dimensionality of a large number of correlated technical skill indicators into a smaller set of uncorrelated components whilst maintaining most of the variance from the original data set. RESULTS The principal component analysis derived four principal components pertaining to high-pressure success, low-pressure success, attacking ball movement ability and scoring ability. CONCLUSIONS This study is the first to provide a simplified, novel method for analysing technical skill counts in Australian Football. The derived metrics reveal useful information for coaches and practitioners. This may consequently ease the interpretation of skill count data available to coaches from games, guide opposition analysis, help in the design of representative practice and inform player performance ratings. Beta cells assume a fundamental role in maintaining blood glucose homeostasis through the secretion of insulin, which is contingent on both beta cell mass and function, in response to elevated blood glucose levels or secretagogues. For this reason, evaluating beta cell mass and function, as well as scrutinizing how they change over time in a diabetic state, are essential prerequisites in elucidating diabetes pathophysiology. Current clinical methods to measure human beta cell mass and/or function are largely lacking, indirect and sub-optimal, highlighting the continued need for noninvasive in vivo beta cell imaging technologies such as optical imaging techniques. While numerous probes have been developed and evaluated for their specificity to beta cells, most of them are more suited to visualize beta cell mass rather than function. In this review, we highlight the distinction between beta cell mass and function, and the importance of developing more probes to measure beta cell function. Additionally, we also explore various existing probes that can be employed to measure beta cell mass and function in vivo, as well as the caveats in probe development for in vivo beta cell imaging. PROBLEM There is a knowledge gap regarding women's experiences of coping with labour pain when not soliciting or not having access to pharmacological pain relief. BACKGROUND How women manage labour pain is complex, multifaceted and only the woman giving birth can assess the experienced pain. Women in the Nordic countries planning for a homebirth have little or no access to pharmacologic pain relief during labour. AIM The aim of this study was to explore how women experience and work with labour pain when giving birth in their own home. METHODS Quantitative and qualitative data was prospectively collected and altogether 1649 women with a planned homebirth answered closed and open-ended questions about labour pain and birth experience. RESULTS While labour pain was often experienced as positive or very positive, the intensity was experienced as severe or the worst imaginable pain. Two main themes arose from the womens´ descriptions of their birth experience regarding labour pain An encounter with extremes and Being in charge at home. DISCUSSION Women perceived labour pain as severe but manageable and were dedicated to completing the birth at home. Being at home enabled the women to exercise autonomy and work with labour pain on their own terms, together with the midwife and support persons. CONCLUSIONS This study provides knowledge about women's experiences of labour pain in a home birth setting who used varying strategies to work with labour pain. This is a subject that should be explored further since results could also apply to facility-based birth settings.