Change and stability in contraceptive use patterns among US women over a 12-month period: analysis using the 2013-2015 National Survey of Family Growth life history calendar.

OBJECTIVE: To improve understanding of contraceptive use over 1 year among women in the United States. STUDY DESIGN: We used the 2013-2015 National Survey of Family Growth to examine monthly contraceptive use patterns over a 12-month period. We focused on use of contraception during months in which non-sterilized women were sexually active and not pregnant; our outcomes were contraceptive use in every month, some months, and no months. We used simple and multivariate logistic regression to examine socio-demographic and method use characteristics associated with contraceptive use patterns. RESULTS: Some 72% of non-pregnant, non-surgically sterile women used contraception in every sexually active month. After controlling for other demographic and individual characteristics, adolescents had higher odds (aOR = 2.45) of using contraception in each sexually active month compared to women aged 25-29. Other groups more likely to use contraception monthly included those with some college (aOR = 1.58) compared to less than high school and non-cohabiting unmarried women (aOR = 1.49) compared to married women. Those with gaps in insurance coverage during the past year (aOR = 0.70), women who were not sexually active all 12 months (aOR = 0.42), and those with more than two male sexual partners (aOR = 0.49), were less likely to use contraception every sexually active month. Nearly half (46%) of contraceptive users in our sample used more than one type of contraceptive method over the 12-month period. CONCLUSIONS: The majority of women use contraception every month they are sexually active, although there is variation between socio-demographic groups. However, over a one-year period, many women used dynamic contraceptive strategies. IMPLICATIONS: Health care providers should recognize that contraceptive use patterns are dynamic and change over a relatively short time period for many women.

Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To examine associations between health insurance coverage, income level and contraceptive use - overall and most/moderately effective method use - among women ages 18-44 at risk of pregnancy, within and across 41 United States jurisdictions in 2017. STUDY DESIGN: Using data from the 2017 Behavioral Risk Factor Surveillance System, we calculated the proportions of women using any contraceptive method and using a most or moderately effective method for each state/territory and across all jurisdictions, categorized by health insurance coverage and income groups. For both contraceptive use outcomes, we ran simple and multivariable logistic regression models to test for significant differences in outcomes between insured and uninsured individuals. RESULTS: Across jurisdictions, compared to uninsured women, those who had health care coverage had higher levels of contraceptive use (65% versus 59%; p < .001) and most/moderately effective contraceptive use (43% compared to 35%; p < .001); low-income women with coverage also had higher levels of contraceptive use (64% versus 61%; p < .05) and most or moderately effective contraceptive use (42% versus 36%; p < .01) than their uninsured counterparts. Controlling for individual-level demographic characteristics, health insurance coverage was associated with increased odds of most or moderately effective contraceptive use across jurisdictions (adjusted odds ratio = 1.33, p < .01). In 11 states, insured women had significantly higher odds of at least one contraceptive use metric than their uninsured counterparts. CONCLUSIONS: Variation in contraceptive use across the states likely reflects broader demographic, social and structural differences across state and local populations. States' political will and support around contraceptive access likely play a role in individuals' ability to obtain and use contraception. IMPLICATIONS: Our key finding that insurance coverage is significantly associated with use of most/moderately effective contraceptive methods across the states but not any contraceptive use underscores the importance of health insurance in aiding access to methods that are more costly and often require a visit to a health care provider.

Polymeric Cups for Cavitation-mediated Delivery of Oncolytic Vaccinia Virus.

Oncolytic viruses (OV) could become the most powerful and selective cancer therapies. However, the limited transport of OV into and throughout tumors following intravenous injection means their clinical administration is often restricted to direct intratumoral dosing. Application of physical stimuli, such as focused ultrasound, offers a means of achieving enhanced mass transport. In particular, shockwaves and microstreaming resulting from the instigation of an ultrasound-induced event known as inertial cavitation can propel OV hundreds of microns. We have recently developed a polymeric cup formulation which, when delivered intravenously, provides the nuclei for instigation of sustained inertial cavitation events within tumors. Here we report that exposure of tumors to focused ultrasound after intravenous coinjection of cups and oncolytic vaccinia virus , leads to substantial and significant increases in activity. When cavitation was instigated within SKOV-3 or HepG2 xenografts, reporter gene expression from vaccinia virus was enhanced 1,000-fold (P < 0.0001) or 10,000-fold (P < 0.001), respectively. Similar increases in the number of vaccinia virus genomes recovered from tumors were also observed. In survival studies, the application of cup mediated cavitation to a vaccinia virus expressing a prodrug converting enzyme provided significant (P < 0.05) retardation of tumor growth. This technology could improve the clinical utility of all biological therapeutics including OV.

Echocardiographic speckle reduction comparison.

In this paper, a detailed description and comparison of speckle reduction of medical ultrasound, and in particular echocardiography, is presented. Fifteen speckle reduction filters are described in a detailed fashion to facilitate implementation for research and evaluation. The filtering techniques considered include anisotropic diffusion, wavelet denoising, and local statistics. Common nomenclature and notation are adopted, to expedite comparison between approaches. Comparison of the filters is based on their application to simulated images, clinical videos, and a computational requirement analysis. The ultrasound simulation method provides a realistic model of the image acquisition process, and permits the use of a noise-free reference image for comparison. Application of objective quality metrics quantifies the preservation of image edges, overall image distortion, and improvement in image contrast. The computational analysis quantifies the number of operations required for each speckle reduction method. A speed-accuracy analysis of discretization methods for anisotropic diffusion is included. It is concluded that the optimal method is the OSRAD diffusion filter. This method is capable of strong speckle suppression, increasing the average SNRA of the simulated images by a factor of two. This method also shows favorable edge preservation and contrast improvement, and may be efficiently implemented.

Objective and subjective evaluations of quality for speckle reduced echocardiography.

This paper presents the results of a study into the subjective effect of speckle reduction filtering in echocardiography, as assessed by clinical experts. Echocardiographic videos were filtered by a number of speckle reduction methods to produce a set of test videos with varying levels of speckle content. Six practicing cardiac technicians were asked to rate each video in three scoring categories, with the aim of quantifying their subjective evaluation of the diagnostic usefulness and the level of speckle in each video. The change in expert scores due to filtering is analyzed. Inter-expert difference in the evaluation is investigated, and intra-expert analysis of the association between each score category is also performed. In addition, a number of objective quality metrics are applied to the filtered videos, and the correlation between these metrics and the expert scores is determined. Results indicate that, while there are inter-expert differences, strong intra-expert relationships exist between the score categories. Furthermore each of the three subjective score categories is strongly associated with one of the objective quality metrics.