Master of Medicine / The number of unwanted pregnancies has not decreased in recent years and this should be addressed. Emergency contraception may be effective when used correctly having the advantage that it can be used after an episode of unprotected sexual intercourse (when regular contraception has failed or was not used). In this research project I set out to explore some of the major reasons why there are still many unwanted pregnancies in Australia. I decided to focus on the use and non-use of emergency contraception, e.g. emergency contraception pill (ECP) “method failures” are not well understood because the actual mechanisms of action are still unclear. There is evidence ECP can effectively interfere with follicle growth and ovulation. It is much less clear is whether ECP is able to interfere with fertilization and implantation, in a way, which may make it acceptable to those who have strong religious beliefs in fertilization being the start of new life. Emergency contraception has the potential to prevent many unwanted pregnancies when unprotected intercourse has occurred. It has relatively high efficacy in many studies, but true method failures are not well understood. By contrast, many unwanted pregnancies occur for “social reasons” where emergency contraception has not been used. I set out to study changes in knowledge and usage of emergency contraception in these groups of Australian women seeking termination of pregnancy: 1. Before a dedicated emergency contraception pill (ECP) pack (Postinor) became available in Australia 2. One year after dedicated ECP became available on prescription 3. One year after the ECP pack became available “over the counter” without prescription. Ninety-nine women were recruited during their presentation with a request for ECP at the six Family Planning Clinics in Australia. All women took LNG 1.5mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, oestradiol and progesterone levels to calculate the day of the menstrual cycle. Based on these endocrine data we estimated the timing of ovulation to within a ±24-hour period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. Three women in this study became pregnant despite taking the ECP (pregnancy rate 3%). All three women who became pregnant had unprotected intercourse between day -1 and 0 and took the ECP on day +2, based on endocrine data. Day zero was taken as ovulation day. Among seventeen women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on day +1 to +2) we could have expected 3 or 4 pregnancies, based on Wilcox et al data. Three pregnancies were observed. Among 34 women who had intercourse on days –5 to –2 of the fertile period, and took ECP before or around ovulation, four pregnancies could have been expected, but none were observed. The major discrepancies between women’s self-report of stage of the cycle and the dating calculation based on endocrine data were observed in this study. These data are supportive of the concept that the LNG ECP has little or no effect on post-ovulation events, but is highly effective before ovulation. Our interpretation of the data in terms of timing of treatment relative to ovulation may explain why EC with LNG works sometimes and fails at other times. A larger study is needed to prove this hypothesis. To investigate other reasons for such a high rate of unwanted pregnancy, which probably has a larger impact we looked into womens knowledge of and attitude towards ECP. Seven hundred and eighteen women participated in this study by answering a questionnaire consisting of 15 questions on their demographic and reproductive characteristics as well as the knowledge about the ECP, e.g. 208 women were enrolled before the ECP was marketed in Australia in 2001, 308 after it was marketed and 202 after it became available over the counter (Group 1, 2, and 3, respectively). We found that the participants who have heard about ECP were significantly younger (p<0.005). The mean age of women who have never heard about of ECP was 29.8 years compared to 26.3 years in women who have heard about ECP. More women were aware about the ECP after it became available over the counter. Women in group 2 had higher educational level in comparison to women in group 2 and 3 (p<0.005). There was significant trend in increased use of ECP in women of higher educational level (p<0.005). The use of ECP did not increase significantly with improved availability and access to the ECP amongst women presenting for termination of pregnancy. Wider availability of he ECP pack in Australia and an easier access to it has increased women’s awareness about the ECP. However, the use of ECP has not increased. This study provides better understanding of mechanism of action of LNG ECP and an explanation to the method failure. It also reveals poor knowledge about ECP despite its wider availability and accessibility. Improving these is a worldwide challenge for family planners and all health professionals.

Master of Medicine / The number of unwanted pregnancies has not decreased in recent years and this should be addressed. Emergency contraception may be effective when used correctly having the advantage that it can be used after an episode of unprotected sexual intercourse (when regular contraception has failed or was not used). In this research project I set out to explore some of the major reasons why there are still many unwanted pregnancies in Australia. I decided to focus on the use and non-use of emergency contraception, e.g. emergency contraception pill (ECP) “method failures” are not well understood because the actual mechanisms of action are still unclear. There is evidence ECP can effectively interfere with follicle growth and ovulation. It is much less clear is whether ECP is able to interfere with fertilization and implantation, in a way, which may make it acceptable to those who have strong religious beliefs in fertilization being the start of new life. Emergency contraception has the potential to prevent many unwanted pregnancies when unprotected intercourse has occurred. It has relatively high efficacy in many studies, but true method failures are not well understood. By contrast, many unwanted pregnancies occur for “social reasons” where emergency contraception has not been used. I set out to study changes in knowledge and usage of emergency contraception in these groups of Australian women seeking termination of pregnancy: 1. Before a dedicated emergency contraception pill (ECP) pack (Postinor) became available in Australia 2. One year after dedicated ECP became available on prescription 3. One year after the ECP pack became available “over the counter” without prescription. Ninety-nine women were recruited during their presentation with a request for ECP at the six Family Planning Clinics in Australia. All women took LNG 1.5mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, oestradiol and progesterone levels to calculate the day of the menstrual cycle. Based on these endocrine data we estimated the timing of ovulation to within a ±24-hour period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. Three women in this study became pregnant despite taking the ECP (pregnancy rate 3%). All three women who became pregnant had unprotected intercourse between day -1 and 0 and took the ECP on day +2, based on endocrine data. Day zero was taken as ovulation day. Among seventeen women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on day +1 to +2) we could have expected 3 or 4 pregnancies, based on Wilcox et al data. Three pregnancies were observed. Among 34 women who had intercourse on days –5 to –2 of the fertile period, and took ECP before or around ovulation, four pregnancies could have been expected, but none were observed. The major discrepancies between women’s self-report of stage of the cycle and the dating calculation based on endocrine data were observed in this study. These data are supportive of the concept that the LNG ECP has little or no effect on post-ovulation events, but is highly effective before ovulation. Our interpretation of the data in terms of timing of treatment relative to ovulation may explain why EC with LNG works sometimes and fails at other times. A larger study is needed to prove this hypothesis. To investigate other reasons for such a high rate of unwanted pregnancy, which probably has a larger impact we looked into womens knowledge of and attitude towards ECP. Seven hundred and eighteen women participated in this study by answering a questionnaire consisting of 15 questions on their demographic and reproductive characteristics as well as the knowledge about the ECP, e.g. 208 women were enrolled before the ECP was marketed in Australia in 2001, 308 after it was marketed and 202 after it became available over the counter (Group 1, 2, and 3, respectively). We found that the participants who have heard about ECP were significantly younger (p<0.005). The mean age of women who have never heard about of ECP was 29.8 years compared to 26.3 years in women who have heard about ECP. More women were aware about the ECP after it became available over the counter. Women in group 2 had higher educational level in comparison to women in group 2 and 3 (p<0.005). There was significant trend in increased use of ECP in women of higher educational level (p<0.005). The use of ECP did not increase significantly with improved availability and access to the ECP amongst women presenting for termination of pregnancy. Wider availability of he ECP pack in Australia and an easier access to it has increased women’s awareness about the ECP. However, the use of ECP has not increased. This study provides better understanding of mechanism of action of LNG ECP and an explanation to the method failure. It also reveals poor knowledge about ECP despite its wider availability and accessibility. Improving these is a worldwide challenge for family planners and all health professionals.

The purpose of this study Has to determine attitudes toward the oral contraceptive as related to religious, regional, educational, age, sex, and marital status. The instrument utilized was a 30 item summated scale which was completed by 240 high school and college students from the Intermountain and Great Plains regions. The findings indicated a very large range or opinion regarding the pill. Attitudes were found to be related to religion, region, educational attainment, and marital status. Age and sex were not related to attitudes toward the pi11.

Nowadays, many firms are or have already been engaged in an acquisition process, either as target or acquirer. While these companies seem confident in the potential returns of such endeavors, the positive aspect of those acquisitions has yet to be proven. There is indeed a vivid discussion among scholars, which are divided into two categories. On the one hand, there are those considering acquisitions as a source of additional knowledge that will in turn increase the innovation within the company; and on the other hand, those denigrating acquisitions, assimilating them to a “poison pill” for innovation. The purpose of this research is therefore to investigate whether the acquisitions will influence positively or negatively the innovative performance of companies involved in such processes. Using a quantitative approach, this research analyzed the R&amp;D investments made by those companies and the issued patents gained in return. The research provides mixed results. While acquisitions seem to have a positive impact on the companies‟ innovative performance during the two years following the acquisition, this positive impact does not last and even becomes negative during the third year.

A sublingual electronic pill is a novel device designed to enhance delivery of drugs/biologics sublingually utilizing low-current electrical stimulation. Our primary aim was to explore safe limits of oral electrical stimulus in animals and conduct a randomized, sham-controlled animal study to quantify benefits of electrical stimulation on sublingual absorption of octreotide (a small peptide) as a first step in the development of this technology. A system to deliver low-current alternating and direct current stimuli to the oral mucosa of rabbits was constructed, and five groups were studied to determine the significance of sublingual octreotide diffusion in the presence of three different electrical stimulation scenarios: +DC (+4 mA), -DC (-4 mA), and AC (2 mA peak-to-peak, 20 Hz square wave). These were compared to an Oral Baseline Absorption Group (sublingual diffusion in the absence of stimulation) to determine statistical significance of electrical stimulus; and a Subcutaneous Control Group (bolus injection) to discern therapeutic significance. +DC stimulation (4mA) increased serum concentration 28x with high statistical significance (p-value=0.0008). -DC stimulation (-4mA) increased serum concentration by 19x with borderline significance (p=0.032). AC (20 Hz) stimulus (2mA peak-peak) increased serum concentration by 10x, but was not statistically significant. The absorption rate of octreotide was also calculated for each group and compared at t=10 minutes and t=30 minutes. The absorption rate of the +DC group was 28x greater than that of Baseline Group and was statistically significant (p=0.0008). The absorption rate of the -DC group was 19x greater than that of the Baseline Group and was statistically significant (p=0.032). The absorption rate of the AC group was 10x greater than the Baseline Group but was not statistically significant (p=0.135). While none of the sublingual groups reached therapeutically significant serum concentrations, therapeutic levels of sublingually-delivered octreotide could potentially be achieved by extending octreotide exposure and stimulation time, coupled with utilizing sublingual octreotide in higher concentrations. This research was a necessary first step in successful realization of the SEP device.

This triptych consists of three pointillist-style portraits of myself, a close friend and my mother, each assembled out of the specific pills we take. While we each appear “healthy” at first glance, a closer examination raises questions about society’s collective dependence on prescription drugs – a microcosm of the much larger tragedy of opioid abuse that is destroying many American families. In addition to the portraits is an animation, “Oxycodone Lungs,” comprised of individual Oxy pills, reflecting my personal experience with this wildly addictive opiate during an emergency room visit to relieve extreme chest pain from pericarditis. Creating each portrait required me to inventory the specific medicines taken by the subject, capture high-resolution images of each pill, then transfer the images to Adobe Illustrator to be used as individual design elements. In total, these three digital portraits required the use of over 10,000 elements. Beyond the rendering of each “pill face” I added critical context in the background, listing the pill name and a quote from each subject as to why she is taking it. I also added a subtle, almost transparent, layer of pill bottles to provide more texture to each portrait. For the “Oxycodone Lungs,” I created and duplicated two 2-D pills in Adobe Illustrator to form the trachea, lobes and bronchioles. To capture a realistic rendering, I added animation so that the lungs appear to be breathing. Three artists have provided valuable inspiration for my thesis project. Vik Muniz is a Brazilian multimedia artist who uses unusual everyday items to create art that is accessible and meaningful to all viewers. Yayoi Kusama’s work with polka dots creates a sense of movement and depth through scale and repetition. Lastly, I was inspired by Yung Jake’s innovative, accurate images that he creates solely out of emojis.

Magister Pharmaceuticae - MPharm / Background: The effectiveness of the combined oral contraceptive pill as a family planning method is dependent on its quality. The quality of medicines on the healthcare market is established through postmarket quality studies. Methods: The quality of the combined oral contraceptive pill was established through the collection of samples from 17 (62%) private retail pharmacies in the Nyeri town of Kenya. Their quality was then determined through the assay of content of levonorgestrel and ethinylestradiol and the levonorgestrel dissolution test at the National Quality Control Laboratory. Findings: 13 of the 17 pharmacies were licensed with the Pharmacy and Poisons Board while 4 were unlicensed. Femiplan® was available in all the 17 pharmacies while Microgynon® was available in only 4 pharmacies. 17 samples of Femiplan® and 4 samples of Microgynon® were collected. None of the samples was counterfeit or falsely labeled. All the samples passed the assay of content of levonorgestrel and ethinylestradiol and the levonorgestrel dissolution test. Conclusion: Notwithstanding the fact this study provides a snapshot in time, it is reasonable to conclude that the combined oral contraceptive pill (0.15mg levonorgestrel and 0.03mg ethinylestradiol) in the Nyeri town of Kenya private retail pharmacies is of the right quality with respect to the quality tests of assay of content of levonorgestrel and ethinylestradiol and the levonorgestrel dissolution test.

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