Impact of letrozole co-treatment during ovarian stimulation on oocyte yield, embryo development, and live birth rate in women with normal ovarian reserve: secondary outcomes from the RIOT trial.

STUDY QUESTION: Does letrozole (LZ) co-treatment during ovarian stimulation with gonadotropins for in IVF impact follicle recruitment, oocyte number and quality, embryo quality, or live birth rate (LBR)? SUMMARY ANSWER: No impact of LZ was found in follicle recruitment, number of oocytes, quality of embryos, or LBR. WHAT IS KNOWN ALREADY: Multi-follicle stimulation for IVF produces supra-physiological oestradiol levels. LZ is an aromatase inhibitor that lowers serum oestradiol thus reducing negative feedback and increasing the endogenous gonadotropins in both the follicular and the luteal phases, effectively normalizing the endocrine milieu during IVF treatment. STUDY DESIGN, SIZE, DURATION: Secondary outcomes from a randomized, double-blind placebo-controlled trial (RCT) investigating once-daily 5 mg LZ or placebo during stimulation for IVF with FSH. The RCT was conducted at four fertility clinics at University Hospitals in Denmark from August 2016 to November 2018 and pregnancy outcomes of frozen-thawed embryo transfers (FET) registered until May 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS: One hundred fifty-nine women with expected normal ovarian reserve (anti-Müllerian hormone 8-32 nmol/l) were randomized to either co-treatment with LZ (n = 80) or placebo (n = 79). In total 1268 oocytes were aspirated developing into 386 embryos, and morphology and morphokinetics were assessed. One hundred twenty-nine embryos were transferred in the fresh cycle and 158 embryos in a subsequent FET cycle. The effect of LZ on cumulative clinical pregnancy rate (CPR), LBR, endometrial thickness in the fresh cycle, and total FSH consumption was reported. MAIN RESULTS AND THE ROLE OF CHANCE: The proportion of usable embryos of retrieved oocytes was similar in the LZ group and the placebo group with 0.31 vs 0.36 (mean difference (MD) -0.05, 95% CI (-0.12; 0.03), P = 0.65). The size and number of aspirated follicles at oocyte retrieval were similar with 11.8 vs 10.3 follicles per patient (MD 1.5, 95% CI (-0.5; 3.1), P = 0.50), as well as the number of retrieved oocytes with 8.0 vs 7.9 oocytes (MD 0.1, 95% CI (-1.4; 1.6), P = 0.39) in the LZ and placebo groups, respectively. The chance of retrieving an oocyte from the 13 to 16 mm follicles at trigger day was 66% higher (95% CI (24%; 108%), P = 0.002) in the placebo group than in the LZ group, whilst the chance of retrieving an oocyte from the ≥17 mm follicles at trigger day was 50% higher (95% CI (2%; 98%), P = 0.04) in the LZ group than in the placebo group. The proportion of fertilized oocytes with two-pronuclei per retrieved oocytes or per metaphase II oocytes (MII) (the 2PN rates) were similar regardless of fertilization with IVF or ICSI with 0.48 vs 0.57 (MD -0.09, 95% CI (-0.24; 0.04), P = 0.51), and 0.62 vs 0.64 (MD -0.02, 95% CI (-0.13; 0.07), P = 0.78) in the LZ and placebo groups, respectively. However, the MII rate in the ICSI group was significantly lower with 0.75 vs 0.88 in the LZ vs the placebo group (MD -0.14, 95% CI (-0.22; -0.06), P = 0.03). Blastocysts on Day 5 per patient were similar with 1.5 vs 2.0, P = 0.52, as well as vitrified blastocysts per patient Day 5 with 0.8 vs 1.2 in (MD -0.4, 95% CI (-1.0; 0.2), P = 0.52) and vitrified blastocysts per patient Day 6 with 0.6 vs 0.6 (MD 0, 95% CI (-0.3; 0.3), P = 1.00) in the LZ vs placebo group, respectively. Morphologic evaluation of all usable embryos showed a similar distribution in 'Good', 'Fair', and 'Poor', in the LZ vs placebo group, with an odds ratio (OR) of 0.8 95% CI (0.5; 1.3), P = 0.68 of developing a better class embryo. Two hundred and ninety-five of the 386 embryos were cultured in an embryoscope. Morphokinetic annotations showed that the odds of having a high KIDscore™ D3 Day 3 were 1.2 times higher (CI (0.8; 1.9), P = 0.68) in the LZ group vs the placebo group. The CPR per transfer was comparable with 31% vs 39% (risk-difference of 8%, 95% CI (-25%; 11%), P = 0.65) in the LZ and placebo group, respectively, as well as CPR per transfer adjusted for day of transfer, oestradiol and progesterone levels at trigger, progesterone levels mid-luteal, and number of oocytes retrieved (adjusted OR) of 0.8 (95% CI (0.4; 1.6), P = 0.72). Comparable LBR were found per transfer 28% vs 37% (MD -9%, 95% CI (-26%; 9%), P = 0.60) and per randomized women 24% vs 30% (MD of -6%, CI (-22%; 8%), P = 0.60) in the LZ group and placebo group, respectively. Furthermore, 4.8 years since the last oocyte aspiration, a total of 287 of 386 embryos have been transferred in the fresh or a subsequently FET cycle, disclosing the cumulative CPR, which is similar with 38% vs 34% (MD 95% CI (8%; 16%), P = 0.70) in the LZ vs placebo group. LIMITATIONS, REASONS FOR CAUTION: Both cleavage stage and blastocyst transfer and vitrification were permitted in the protocol, making it necessary to categorize their quality and pool the results. The study was powered to detect hormonal variation but not embryo or pregnancy outcomes. WIDER IMPLICATIONS OF THE FINDINGS: The similar utilization rate and quality of the embryos support the use of LZ co-treatment for IVF with specific indication as fertility preservation, patients with previous cancer, or poor responders. The effect of LZ on mature oocytes from different follicle sizes and LBRs should be evaluated in a meta-analysis or a larger RCT. STUDY FUNDING/COMPETING INTEREST(S): Funding was received from EU Interreg for ReproUnion, Sjaelland University Hospital, Denmark, Ferring Pharmaceuticals, and Gedeon Ricther. Roche Diagnostics contributed with assays. A.P. has received grants from Ferring, Merck Serono, and Gedeon Richter, consulting fees from Preglem, Novo Nordisk, Ferring, Gedeon Richter, Cryos, & Merck A/S, speakers fees from Gedeon Richter, Ferring, Merck A/S, Theramex, & Organon, and travel support from Gedeon Richter. The remaining authors declare that they have no competing interests in the research or publication. TRIAL REGISTRATION NUMBERS: NCT02939898 and NCT02946684.

Partisan bias in false memories for misinformation about the 2021 U.S. Capitol riot.

ABSTRACTMemory for events can be biased. For example, people tend to recall more events that support than oppose their current worldview. The present study examined partisan bias in memory for events related to the January 6, 2021, Capitol riot in the United States. Participants rated their memory for true and false events that were either favourable to their political party or the other major political party in the United States. For both true and false events, participants remembered more events that favoured their political party. Regression analyses showed that the number of false memories that participants reported was positively associated with their tendency to support conspiracy beliefs and with their self-reported engagement with the Capitol riot. These results suggest that Democrats and Republicans remember the Capitol Riot differently and that certain individual difference factors can predict the formation of false memories in this context. Misinformation played an influential role in the Capitol riot and understanding differences in memory for this event is beneficial to avoiding similar tragedies in the future.

A day that America will remember: flashbulb memory, collective memory, and future thinking for the capitol riots.

ABSTRACTThis study explores the topics of flashbulb memory, collective identity, future thinking, and shared representations for a public event. We assessed the memories of the Capitol Riots, which happened in Washington DC, on 6 January 2021. Seventy Belgian and seventy-nine American citizens participated in an online study, in which they freely recalled the unfolding of Capitol Riots and answered questions regarding their memory. Inter-subjects similarity of recalled details was analysed using a schematic narrative template (i.e., the event, the causes and the consequences). Results revealed that representations of the event, and its causes were more similar among Belgians compared to Americans, whereas Americans' representations of the consequences showed more similarity than Belgians'. Also, as expected, Americans reported more flashbulb memories (FBMs) than Belgians. The analysis underlined the importance of rehearsal through media and communication in FBM formation. This research revealed a novel relation between FBM and future representations. Regardless of national identity, participants who formed an FBM were more likely to think that the event would be remembered in the future, that the government should memorialise the event, and that a similar attack on the Capitol could happen in the future compared to participants who did not form FBM.

Clashes and crowds: protests, riots, and other mass gathering events in North America 2021-2022.

OBJECTIVE: This study aimed to provide an overview of the scope and challenges of historic events and help better prepare emergency healthcare services for future similar mass gathering events. STUDY DESIGN: This was a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022. INTRODUCTION: Recent protests, riots, and other conflict events in North America have highlighted the increasing challenges hospital-based and prehospital healthcare providers face. This study provides a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022, which may aid emergency healthcare services in understanding the scope and challenges of historic events and help better prepare for future similar mass gathering events. METHODS: Data collection was performed using a retrospective database search through the Armed Conflict Location & Event Data Project (ACLED) database. The ACLED database was searched using the internal database search functions for recorded events that occurred in North America from January 1, 2021 to December 31, 2022. Date, event type, event subtype, the country of incident, and fatality numbers were extracted. The results were exported into an Excel spreadsheet and analyzed independently by L.C., H.S., and R.H. RESULTS: There were a total of 52,529 recorded events of political conflict in North America, with 30,269 events in 2021 and 29,260 in 2022. Political conflict events included protests (40,934, 68.8%), violence against civilians (11,532, 19.4%), strategic developments (2,819, 4.7%), battles (2,293, 3.9%), riots (1,909, 3.2%), and remote violence (42, 0.1%). Violence against civilians caused the highest fatalities (13,466, 82.6%), followed by battles (2,662, 16.3%), riots (111, 0.7%), strategic developments, remote violence, and protests (57, 6, and 3 respectively). CONCLUSION: Mexico and the United States accounted for most of the political conflicts in North America across 2021 and 2022. In Mexico, protests and violence against civilians were the most common types of conflict, with the latter accounting for the comparatively high fatality compared with the other countries. Battles in Mexico between cartels were the most deadly political conflicts recorded in North America.

Investigating the effects of dermal exposure to in-vivo animal models on the riot-control properties of a powder formulation of Tragia involucrata leaf hair lining.

Purpose: Riot control agents (RCAs) such as CS, CN, CR, PAVA, and OC, etc., are already in use and has produced numerous health risks, including skin burns, dermatitis, gastrointestinal issues, impairment of respiratory variables, conjunctivitis, etc., and even prolonged and repeated exposure may cause death. Therefore, there is a demand and need for non-lethal, non-toxic RCAs that can effectively control riots without resulting in fatal outcomes. This study was carried out to evaluate the health risks related to a novel formulation made from isolated Tragia involucrata leaf hair lining, that can be used as the best suitable non-lethal RCAs.Methods: According to the OECD guidelines, studies on acute dermal toxicity, dermal irritation/corrosion, and skin sensitisation were carried out. Wistar rats were used in an acute dermal toxicity study, and the results indicated no mortality, morbidity, or abnormal food-and-water intake, biochemical parameters, or histopathological examination findings. A study on dermal irritation in Rabbits produced moderate erythema and the effect was instantaneous and resolved within 72 hrs of post-exposure. A skin sensitisation test was conducted on Guinea pig.Results: The results showed that the formulation had moderate skin-sensitizing properties after the application of the challenge dose. Patchy erythema was seen, and it went away 30 hrs after the gauze patch was removed.Conclusion: The preclinical results did not produce any indication of severe toxicity which supports it to be used as a natural RCAs in the future.

Toxicological evaluation of a nonlethal riot control combinational formulation upon dermal application using animal models.

Numerous adverse effects on human health have been reported in epidemiological studies of oleoresin capsicum (OC) and other riot control agents (RCAs). Importantly, the daunting risk of such RCAs can be neutralized by optimizing the desired concentration of such agents for mob dispersal. Hence, a nonlethal riot control combinational formulation (NCF) was prepared for dispersing rioters without imparting fatal outcomes. However, for desired utilization of NCF, it is essential to recognize its extent of potential toxicity. Therefore, the current investigation evaluated the dermal toxicity of NCF using experimental animals in compliance with the OECD guidelines. Additionally, few essential metal ions were analyzed and found non -significantly different in the test rats as compared to control rats. Moreover, abnormal dermal morphology and lesions ultrastructural tissue defects were not noticed as evinced by different studies like ultrasonography, histology, and scanning electron microscopy (SEM) respectively. Further, Doppler ultrasonography exhibited non-significantly different blood flow velocity in both groups, whereas miles test demonstrated a significantly increased Evans blue concentration in test rats compared to the control rats, which might be due to an initial increase in blood flow via an instant action of the NCF at the cutaneous sensory nerve endings. However, our results demonstrated NCF can produce initial skin irritating and sensitizing effects in guinea pigs and rabbits without the antecedence of acute toxicity (≤2000 mg/kg) in Wistar rats.

Simultaneous determination of trace level riot control agents in environmental water by solid-phase microextraction and gas chromatography coupled with a flame ionization detector.

In this paper, a direct immersion solid-phase microextraction procedure for the simultaneous analyses of four primary riot control agents: 2-chloroacetophenone, o-chlorobenzylidene malonitrile, dibenz(b,f)-1,4-oxazepine, and oleoresin capsicum at µg/L concentration from environmental water was developed. Several parameters that influence the extraction effectiveness were investigated, including fiber type, extraction temperature, extraction time, starring rate, and salinity. Under the recommended conditions, the optimized method had reasonable linearity and accuracy. The average recovery of this method ranged from 84 to 108.1%. The limit of detection for all the analytes ranged from 0.2 to 3 µg/L and the limit of quantification ranged from 1 to 10 µg/L, respectively. A relative standard deviation from 3.0 to 4.3% can be achieved depending on the compounds. The procedure was applied to analyze all the four riot control agents simultaneously in several environmental samples.

Mathematical modeling of the Chilean riots of 2019: An epidemiological non-local approach.

During the second half of October 2019, Chile, especially the capital city, Santiago, suffered from widespread violence and public and private infrastructure destruction. This work aims to expand an epidemiological non-local model that successfully described the French riots of 2005 to incorporate the topology of Santiago's subway network and explain the reported distribution of rioting activity in the city. Although the model reproduced the disorders' aggregated temporal evolution, it could not deliver results resembling the observed spatial distribution of activity on Santiago. The main reason for this failure can be attributed to the fact that the model lacks a population displacement mechanism, which seems vital to explain Santiago's unrest episodes.

Using laboratory intergroup conflict and riots as a "stress test".

We apply the author's computational approach to groups to our empirical work studying and modelling riots. We suggest that assigning roles in particular gives insight, and measuring the frequency of bystander behaviour provides a method to understand the dynamic nature of intergroup conflict, allowing social identity to be incorporated into models of riots.

Contesting a Medical Gaze: 'The 1888 Baby Riot' in Seoul - Social, Cultural, and Religious Collision.

This paper focuses on the encounter and collision of two different cultural systems in the influx of biomedicine and Protestant Christianity during the 1888 'baby riot' in Seoul, Korea. This research scrutinizes the relationship between religion and medicine in modern Korea to illustrate why Korean people contested against the nexus of Protestant Christianity and biomedicine that had been introduced from the West. For them, biomedicine was not simply a way of treating sickness or disease, but a way in which their bodies were examined and manipulated by placing a new gaze on the human body. These disputes developed due to the significant differences between biomedicine and the traditional perspective that was based on the values of Confucian teachings. The Korean people desired to protect the belief that the human body was a locus of virtue and should be preserved without modification, which was considered as a pivotal part of their social identity. Therefore, people who lacked social and political power tried to express their opposition to the medicine and religion from the West by spreading rumors of cannibalism. Through the spread of the rumors, the people interpreted and manifested that Western medicine was cruel, ignorant, immoral and dehumanizing. This paper states that Koreans were not merely passive recipients of biomedicine and Protestant Christianity, but also appropriated the new medical and religious discourses to maintain their dignity and cultural authority against the current of colonization.

We predict a riot: inequity, relative deprivation and collective destruction in the laboratory.

Riots are unpredictable and dangerous. Our understanding of the factors that cause riots is based on correlational observations of population data, or post hoc introspection of individuals. To complement these accounts, we developed innovative experimental techniques, investigated the psychological factors of rioting and explored their consequences with agent-based simulations. We created a game, 'Parklife', that physically co-present participants played using smartphones. In two teams, participants tapped on their screen to grow trees and flowerbeds on separate but adjacent virtual parks. Participants could also tap to vandalize the other team's park. In some conditions, we surreptitiously introduced inequity between the teams so that one (the disadvantaged team) had to tap more for each reward. The experience of inequity caused the disadvantaged team to engage in more destruction, and to report higher relative deprivation and frustration. Agent-based models suggested that acts of destruction were driven by the interaction between individual level of frustration and the team's behaviour. Our results provide insights into the psychological mechanisms underlying collective action.

Riot-related injuries managed at a hospital in Beirut, Lebanon.

BACKGROUND: Between October 2019 and February 2020, massive crowds protested in Lebanon against economic collapse. Various less than lethal weapons including riot control agents and rubber bullets were used by law enforcement, which led to several traumatic and chemical injuries among victims. This study describes the clinical presentation, management, outcome, and healthcare costs of injuries. METHODS: A retrospective review of the hospital records of all the casualties presenting to the Emergency Department of the American University of Beirut Medical Center between October 17th, 2019, and February 29th, 2020, was conducted. RESULTS: A total of 313 casualties were evaluated in the ED, with a mean age of 30.2 +/- 9.6 years and a predominance of males (91.1%). Most were protestors (71.9%) and arrived through EMS (43.5%) at an influx rate of one patient presenting every 2.7-8 min. Most patients (91.1%) presented with an Emergency Severity Index of 3. Most patients (77.6%) required imaging with 10% having major findings including fractures and hemorrhages. Stones, rocks, and tear gas canisters (30.7%) were the most common mechanism of injury. Musculoskeletal injuries were most common (62.6%), followed by lacerations (44.7%). The majority (93.3%) were treated and discharged home and 3.2% required hospital admission, with 2.6% requiring surgery. CONCLUSION: Less-than-lethal weapons can cause severe injuries and permanent morbidity. The use of riot control agents needs to be better controlled, and users need to be well trained in order to avoid misuse and to lessen the morbidity, mortality, and financial burden.

Mental health during and after protests, riots and revolutions: A systematic review.

OBJECTIVES: Protests, riots and revolutions have long been a part of human history and are increasing globally, yet their impact on mental health remains largely unknown. We therefore systematically reviewed studies on collective actions and mental health. METHOD: We searched PubMed, Web of Science, PsycINFO and CINAHL Plus for published studies from their inception until 1 January 2018. Study quality was rated using the Newcastle-Ottawa Scale. RESULTS: We identified 52 studies (n = 57,487 participants) from 20 countries/regions. The prevalence of post-traumatic stress disorder ranged from 4% to 41% in riot-affected areas. Following a major protest, the prevalence of probable major depression increased by 7%, regardless of personal involvement in the protests, suggestive of community spillover effects. Risk factors for poorer mental health included female sex, lower socioeconomic status, exposure to violence, interpersonal conflicts, frequent social media use and lower resilience and social support. Nevertheless, two studies suggested that collective actions may reduce depression and suicide, possibly due to a collective cathartic experience and greater social cohesion within subpopulations. CONCLUSION: We present the first systematic review of collective actions and mental health, showing compelling evidence that protests even when nonviolent can be associated with adverse mental health outcomes. Health care professionals therefore need to be vigilant to the mental and psychological sequelae of protests, riots and revolutions. Further research on this emerging sociopolitical determinant of mental health is warranted.

Cleveland Versus the Clinic: The 1960s Riots and Community Health Reform.

During the 1960s, cities across the United States erupted with rioting. Subsequent inquiries into its sources revealed long-simmering discontent with systemic deprivation and exploitation in the country's most racially segregated and resource-scarce neighborhoods. Urban medical centers were not exempt from this anger. They were standing symbols of maldistribution, cordoned off to those without sufficient economic means of access. In this article, I examine the travails of the world-famous and prestigious Cleveland Clinic after the 1966 riot in the Hough neighborhood on the East Side of Cleveland, Ohio. After years of unbridled expansion, fueled by federal urban renewal efforts, the riots caught the Clinic's leadership off guard, forcing it to rethink the long-standing insularity between itself and its neighbors. The riots were central to the Clinic's programmatic reorientation, but the concessions only went so far, especially as the political foment from the riots dissipated in the years afterward. The Cleveland experience is part of a larger-and still ongoing-debate on social obligations of medical centers, "town-gown" relations between research institutions and their neighbors, and the role of protest in catalyzing community health reform.

A riot on campus: The effects of social identity complexity on emotions and reparative attitudes after ingroup-perpetrated violence.

When a group commits a transgression, members who identify closely with the group often engage in defensive strategies in which they are less likely to experience guilt and shame in response to the transgression than are less identified group members. Subsequently, highly identified group members are often less willing to offer reparations to the injured parties. Because appropriate emotional responses and reparations are critical to community reconciliation, the present investigation examined whether social identity complexity-the degree to which individuals perceive their multiple social identities as interrelated-reduced these defensive responses. In the aftermath of a campus riot, emotional responses and reparative attitudes of undergraduate students were assessed. Results indicated that individuals who closely identified with the university were in fact capable of experiencing guilt and shame, but only if they also had complex social identities. A path model indicated that emotional responses, in turn, predicted willingness to provide reparations to the campus community. Accordingly, social identity complexity provides a new approach to understanding responses to ingroup-perpetrated violence.

[May 68 as seen by the elderly]. / Mai 68, vu par les aînés.

May 68 remains etched in everybody's mind. Fifty years on, many memories remain vivid and those who lived through this turbulent period. Yesterday's adults, today's senior citizens, share their testimonies.