Review of outside pathology prior to treatment of cervical intraepithelial neoplasia: a cost analysis

Objectives: Academic institutions routinely require in-house review of pathology prior to treatment. However, it is unclear if pathology review is beneficial for the management of patients referred for cervical intraepithelial neoplasia (CIN). This study aims to determine if review of outside pathology for CIN at an academic medical center resulted in a change in the treatment plan and the associated cost for pathology review. Methods: A retrospective chart review of patients referred for treatment of CIN, including review of outside cytology and histology was performed from January 1 to December 31, 2007 after obtaining IRB approval. Data was analyzed to determine whether pathology diagnosis was changed from the outside facility interpretation; classified as minor if there was no change in clinical management and major if there was a change in treatment as a result of the internal review. Demographic and pathology information was collected from electronic medical records. Billing information was collected from the finance department. Data were analyzed using descriptive statistics. Results: Seventy-eight patients were identified of which 54 had outside pathology slides available for pathology review. Eleven had a minor change in the pathology diagnosis (20%). None of the changes in pathology diagnosis resulted in a change in treatment plan (major). The total pathology review charge was $14,679 for the 54 patients, with an average charge per patient of$272. Nine of the cases were charged twice to reflect the opinion of two separate pathologists (internal consultation). Of the 54 patients, 23 (43%) had state supported insurance, 24 (44%) had private insurance, and 7 (13%) were self-pay. A total of $12,969.29 was not covered/paid (88% of all charges) and thus absorbed by the institution. Conclusion: Mandatory review of outside pathology is a common practice. However, it may not be beneficial in all clinical situations. While this pathology review for CIN resulted in minor changes for 20% of patients referred to our academic/tertiary institution, it did not affect any treatment recommendations. Pathology review did increase the cost burden to the institution and the patient

Collisional and radiative processes in adiabatic deceleration, deflection, and off-axis trapping of a Rydberg atom beam

A supersonic beam of Rydberg hydrogen atoms has been adiabatically deflected by 90°, decelerated to zero velocity in less than 25μs, and loaded into an electric trap. The deflection has allowed the suppression of collisions with atoms in the trailing part of the gas pulse. The processes leading to trap losses, i.e., fluorescence to the ground state, and transitions and ionization induced by blackbody radiation have been monitored over several milliseconds and quantitatively analyzed. © 2011 American Physical Society

Measurements of AMPs in stratum corneum of atopic dermatitis and healthy skin-tape stripping technique

Abstract Decreased levels of antimicrobial peptides (AMPs) in atopic dermatitis (AD) have previously been reported and have been linked to the increased susceptibility to skin infections found in AD patients. This study intents to identify AMPs: hBD-2, hBD-3, RNase7, psoriasin and LL-37 in AD patients and healthy controls, and determine concentrations in consecutive depths of the outer most skin layers. Tape stripping was used on lesional and non-lesional skin. From each skin site, 35 consecutive tape strips were collected and pooled in groups of 5. Commercially available ELISA kits were used to determine AMP concentration in stratum corneum samples. hBD-2, hBD-3, RNase7 and psoriasin were identified in stratum corneum samples. hBD-3-level was markedly higher in AD non-lesional skin compared to healthy controls, and a similar trend was observed for RNase7. Most AMPs were distributed evenly through 35 tape strips, implying a homogeneous distribution of antimicrobial defense in the outer most skin layers. The findings indicate that AD patients may not suffer from a general baseline deficiency in AMPs, and that the innate immune defense is present throughout the stratum corneum, both insights of importance for understanding the role of AMPs in AD

Dissociation energy of the hydrogen molecule at 10−9^{-9} accuracy

The ionization energy of ortho-H$_2$ has been determined to be $E^\mathrm{o}_\mathrm{I}(\mathrm{H}_2)/(hc)=124\,357.238\,062(25)$ cm$^{-1}$ from measurements of the GK(1,1)--X(0,1) interval by Doppler-free two-photon spectroscopy using a narrow band 179-nm laser source and the ionization energy of the GK(1,1) state by continuous-wave near-infrared laser spectroscopy. $E^\mathrm{o}_\mathrm{I}$(H$_2$) was used to derive the dissociation energy of H$_2$, $D^{N=1}_{0}$(H$_2$), at $35\,999.582\,894(25)$ cm$^{-1}$ with a precision that is more than one order of magnitude better than all previous results. The new result challenges calculations of this quantity and represents a benchmark value for future relativistic and QED calculations of molecular energies.Comment: 6 pages, 5 figure

High molecular weight polystyrene particles by cationic miniemulsion polymerization catalyzed by an iron-containing imidazolium-based ionic liquid

Cationic styrene polymerizations in aqueous media were conducted using the miniemulsion polymerization technique with the ionic liquid 1-N-butyl-3-N-methylimidazolium heptachloro diferrate (BMI.Fe2Cl7) as catalyst, hexadecyltrimethylammonium bromide (CTAB) as surfactant and hexadecane as costabilizer. The ionic liquid was effective to initiate styrene miniemulsion polymerization at a BMI.Fe2Cl7:styrene molar ratios as low as 1:1000. Increasing the reaction temperature from 70 °C to 90 °C led to an increase in both, conversion and molecular weight. And polystyrene with much higher molecular weight (viscosity average molecular weights of up to 2231 kDa) than those usually obtained in cationic polymerizations was produced. Furthermore, while particle sizes remained almost constant around 150 nm during polymerizations, an almost linear increase of conversion with reaction time was observed. In addition, molecular weight increased steadily with conversion approaching the behavior of living cationic polymerization. Please click Additional Files below to see the full abstrac

Relatório sobre experiências na implantação de unidades de referencia tecnológica em sistemas agroflorestais, no Projeto Iguatú II.

O público alvo preferencial desta publicação são os agricultores familiares e técnicos de campo, principalmente aqueles motivados pelo cultivo de espécies arbóreas nativas e interessados na adoção de práticas agroecológicas. Com conteúdo simples e de fácil leitura, as informações e discussões foram descritas com a intenção de subsidiar a introdução do componente florestal nos sistemas de produção agropecuários, visando principalmente à sustentabilidade e à qualidade ambiental. A diversificação dos eventos ocorridos nas diferentes experiências traduz importantes recomendações que, embora de caráter aparentemente simples, nem sempre são de fácil solução.bitstream/item/40275/1/Doc181.pd

Práticas de marketing educacional nas escolas públicas

O presente trabalho tem como objetivo identificar práticas de Marketing Educacional nas escolas públicas. Tendo por base razões pessoais, profissionais, teóricas e legais que justificam estudos sobre as práticas de Marketing Educacional nas escolas públicas, revê-se a literatura sobre a evolução do marketing (geral) até à emergência do marketing societal e do Marketing Educacional. Partindo dos normativos legais e da literatura, exploram-se as fontes de informação, a autonomia das escolas, a accountability, o planeamento estratégico e evidências dessas práticas associadas ao Marketing Educacional. Para o efeito, optou-se, metodologicamente, por realizar uma pesquisa quantitativa através de um inquérito por questionário realizado junto dos(as) diretores(as) dos agrupamentos de escolas e escolas não agrupadas de Portugal Continental. No que respeita aos principais resultados obtidos, é possível concluir que, apesar de haver evidências de predominar a orientação da gestão para a “produção” do serviço educativo, há práticas de Marketing Educacional nas escolas públicas. Contudo, as escolas têm ainda uma consciência míope do que é o Marketing Educacional, pois há défice na identificação e na implementação dessas práticas. Verifica-se que as escolas fazem estudos de suporte a decisões sobre oferta formativa, de avaliação institucional e de satisfação junto dos alunos e restante comunidade educativa. Definem e implementam estratégias não só para cumprir os normativos legais, mas também adequar os serviços aos alunos, tornando-os parte ativa da coprodução do serviço educativo. Com base nas conclusões e nas opções de concordância do(a)s diretores(as), foi delineado um plano de ação de intervenção de Marketing Educacional.This project aims to identify educational marketing practices in state schools. Based on personal, professional, theoretical and legal reasons that justify studies on Educational Marketing practices in state schools, we'll be reviewing the literature on the evolution of marketing, and of general marketing until the emergence of Educational Marketing. Starting from legal requirements and literature, we will explore information sources, school autonomy, accountability, strategic and practical evidence associated with Educational Marketing. For this purpose, it was decided, as far as methodology is concerned, to carry out a quantitative research through a survey with the School Directors/headmasters of the school groupings and schools in mainland Portugal. Concerning the main results obtained, it is possible to conclude that, although there is evidence of a predominant management orientation towards the “production” of the educational service, it is undeniable that there are Educational Marketing practices in state schools. However, schools still have a short-sighted awareness of what Educational Marketing is, as there is a deficit in identifying and implementing these practices. In fact, schools carry out surveys that support decisions on training courses, institutional assessment and satisfaction among students and the rest of the educational community. They define and implement strategies not only to comply with legal regulations, but also to adapt services to students, making them an active part of the co-production of the educational service. Based on the headmasters' conclusions and agreement options, an Educational Marketing action plan was outlined. KEYWORDS: Educational Marketing

Chronic hand eczema in Europe:Patient experiences and perspectives (CHEPEP) in qualitative interviews

Background: Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life. Objectives: To explore perspectives of people with lived experience on CHE-related problems, wishes and goals. Methods: Following a qualitative approach, we conducted topic-guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE. Results: We interviewed 60 patients in seven outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands and Spain. Five main themes were identified: (1) knowledge about the disease and its course, (2) preventive behaviour, (3) hand eczema therapy, (4) impact on everyday life and (5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE. Conclusions: Due to its annoying symptoms, high visibility and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions.</p

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years : a Delphi consensus project mapping expert opinion in Northern Europe

Publisher Copyright: © 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.Background: Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. Objectives: This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD. Methods: Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements. Results: Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2–6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available. Conclusions: This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.Peer reviewe

Evidence-Based Management of Hand Eczema

Hand eczema is a common skin disease with a wide variation in morphology and a complex etiology based on endogenous and exogenous factors.The diagnosis of hand eczema is based on patient history, exposure assessment, physical examination, and the results of patch testing. Management of hand eczema starts with education of the patient on the etiology of the disease, and the needed changes in behavior regarding skin care and preventive measures, and avoidance of relevant exposure factors. In many cases, medical treatment is needed for successful management of the disease; use of medication can only be successful with proper education and avoidance of relevant exposure