Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Aims The major aims of the study were to compare the safety of a continuous low-dose estradiol-releasing vaginal ring (ESTring) to that of a vaginal estradiol tablet (Vagifem®) on the endometrium and the relief of subjective symptoms and signs of urogenital estrogen deficiency. Quality of life and acceptability of treatment delivery were also assessed. Study design A prospective, randomized study in which women were assigned in a 2: 1 ratio to ESTring and Vagifem and followed for 12 months. The primary endpoint was endometrial safety, based on the results of ultrasound measurement of endometrial thickness and a progestogen challenge test at baseline and week 48. Efficacy was determined by subjective assessment of urogenital estrogen deficiency symptoms at baseline and weeks 3, 12, 24, 36 and 48 and assessment of signs of vaginal epithelial atrophy by the clinician at baseline, 12 and 48 weeks. In addition, pelvic floor strength, vaginal cytological evaluation and pH, bacteruria and patient acceptability were assessed. Quality of life was assessed using a menopause-specific quality-of-life questionnire and a 2-day bladder diary at baseline and 12 and 48 weeks. The comparability of the two groups was assessed using ANOVA, χ(2) or Fisher's exact tests. Results A total of 126 women were randomized to ESTring and 59 to Vagifem. There was no statistical difference between the groups in the alleviation of symptoms and signs of urogenital estrogen deficiency. Maturation indices increased in both groups, from generally atrophic at baseline to proliferative or highly proliferative at 48 weeks. After 48 weeks of treatment, there was no statistically significant difference in endometrial thickness between the two groups. A statistically smaller proportion of bleeding/spotting occurred in the ESTring group (n = 0) compared to the Vagifem users (n = 4). Estradiol and total estrone serum levels increased during treatment in both groups but remained within the normal postmenopausal range. General health status in both groups was unchanged but the urogenital component of health burden was significantly improved in both groups. Bladder diary variables showed no differences between treatment groups. Conclusion Equivalent endometrial safety and efficacy in the relief of the symptoms and signs of urogenital estrogen deficiency were demonstrated for the 12 months' use of a low-dose estradiol-releasing vaginal ring and a vaginal estradiol tablet.

Echinacea alkamide disposition and pharmacokinetics in humans after tablet ingestion

Echinacea is a widely used herbal remedy for the treatment of colds and other infections. However, almost nothing is known about the disposition and pharmacokinetics of any of its components, particularly the alkamides and caffeic acid conjugates which are thought to be the active phytochemicals. In this investigation, we have examined serial plasma samples from 9 healthy volunteers who ingested echinacea tablets manufactured from ethanolic liquid extracts of Echinacea angustifolia and Echinacea purpurea immediately after a standard high fat breakfast. Caffeic acid conjugates could not be identified in any plasma sample at any time after tablet ingestion. Alkamides were rapidly absorbed and were measurable in plasma 20 min after tablet ingestion and remained detectable for up to 12 h. Concentration-time curves for 2,4-diene and 2-ene alkamides were determined. The maximal concentrations for the sum of alkamides in human plasma were reached within 2.3 h post ingestion and averaged 336 +/- 131 ng eq/mL plasma. No obvious differences were observed in the pharmacokinetics of individual or total alkamides in 2 additional fasted subjects who took the same dose of the echinacea preparation. This single dose study provides evidence that alkamides are orally available and that their pharmacokinetics are in agreement with the one dose three times daily regimen already recommended for echinacea.

Tool support for executable documentation of Java class hierarchies

While object-oriented programming offers great solutions for today's software developers, this success has created difficult problems in class documentation and testing. In Java, two tools provide assistance: Javadoc allows class interface documentation to be embedded as code comments and JUnit supports unit testing by providing assert constructs and a test framework. This paper describes JUnitDoc, an integration of Javadoc and JUnit, which provides better support for class documentation and testing. With JUnitDoc, test cases are embedded in Javadoc comments and used as both examples for documentation and test cases for quality assurance. JUnitDoc extracts the test cases for use in HTML files serving as class documentation and in JUnit drivers for class testing. To address the difficult problem of testing inheritance hierarchies, JUnitDoc provides a novel solution in the form of a parallel test hierarchy. A small controlled experiment compares the readability of JUnitDoc documentation to formal documentation written in Object-Z. Copyright (c) 2005 John Wiley & Sons, Ltd.

Mutation-based exploration of a method for verifying concurrent Java components

Summary form only given. The Java programming language supports concurrency. Concurrent programs are harder to verify than their sequential counterparts due to their inherent nondeterminism and a number of specific concurrency problems such as interference and deadlock. In previous work, we proposed a method for verifying concurrent Java components based on a mix of code inspection, static analysis tools, and the ConAn testing tool. The method was derived from an analysis of concurrency failures in Java components, but was not applied in practice. In this paper, we explore the method by applying it to an implementation of the well-known readers-writers problem and a number of mutants of that implementation. We only apply it to a single, well-known example, and so we do not attempt to draw any general conclusions about the applicability or effectiveness of the method. However, the exploration does point out several strengths and weaknesses in the method, which enable us to fine-tune the method before we carry out a more formal evaluation on other, more realistic components.

Testing java interrupts and timed waits

Testing concurrent software is difficult due to problems with inherent nondeterminism. In previous work, we have presented a method and tool support for the testing of concurrent Java components. In this paper, we extend that work by presenting and discussing techniques for testing Java thread interrupts and timed waits. Testing thread interrupts is important because every Java component that calls wait must have code dealing with these interrupts. For a component that uses interrupts and timed waits to provide its basic functionality, the ability to test these features is clearly even more important. We discuss the application of the techniques and tool support to one such component, which is a nontrivial implementation of the readers-writers problem.

UML approach to the generation of test sequences for Java-based concurrent systems

Starting with a UML specification that captures the underlying functionality of some given Java-based concurrent system, we describe a systematic way to construct, from this specification, test sequences for validating an implementation of the system. The approach is to first extend the specification to create UML state machines that directly address those aspects of the system we wish to test. To be specific, the extended UML state machines can capture state information about the number of waiting threads or the number of threads blocked on a given object. Using the SAL model checker we can generate from the extended UML state machines sequences that cover all the various possibilities of events and states. These sequences can then be directly transformed into test sequences suitable for input into a testing tool such as ConAn. As an illustration, the methodology is applied to generate sequences for testing a Java implementation of the producer-consumer system. © 2005 IEEE

Dealing with non-determinism in testing concurrent java components

The testing of concurrent software components can be difficult due to the inherent non-determinism present in these components. For example, if the same test case is run multiple times, it may produce different results. This non-determinism may lead to problems with determining expected outputs. In this paper, we present and discuss several possible solutions to this problem in the context of testing concurrent Java components using the ConAn testing tool. We then present a recent extension to the tool that provides a general solution to this problem that is sufficient to deal with the level of non-determinism that we have encountered in testing over 20 components with ConAn. © 2005 IEEE

Maximising the information gained from an experimental analysis of code inspection and static analysis for concurrent Java components

The results of empirical studies are limited to particular contexts, difficult to generalise and the studies themselves are expensive to perform. Despite these problems, empirical studies in software engineering can be made effective and they are important to both researchers and practitioners. The key to their effectiveness lies in the maximisation of the information that can be gained by examining existing studies, conducting power analyses for an accurate minimum sample size and benefiting from previous studies through replication. This approach was applied in a controlled experiment examining the combination of automated static analysis tools and code inspection in the context of verification and validation (V&V) of concurrent Java components. The combination of these V&V technologies was shown to be cost-effective despite the size of the study, which thus contributes to research in V&V technology evaluation.

Modelling Java concurrency with Object-Z

In this paper, we present a formal model of Java concurrency using the Object-Z specification language. This model captures the Java thread synchronization concepts of locking, blocking, waiting and notification. In the model, we take a viewpoints approach, first capturing the role of the objects and threads, and then taking a system view where we capture the way the objects and threads cooperate and communicate. As a simple illustration of how the model can, in general be applied, we use Object-Z inheritance to integrate the model with the classical producer-consumer system to create a specification directly incorporating the Java concurrency constructs.

A classification of concurrency failures in java components

The Java programming language supports concurrency. Concurrent programs are hard to test due to their inherent non-determinism. This paper presents a classification of concurrency failures that is based on a model of Java concurrency. The model and failure classification is used to justify coverage of synchronization primitives of concurrent components. This is achieved by constructing concurrency flow graphs for each method call. A producer-consumer monitor is used to demonstrate how the approach can be used to measure coverage of concurrency primitives and thereby assist in determining test sequences for deterministic execution.