Facilitating and inhibiting factors related to treatment adherence in women with polycystic ovary syndrome: a qualitative study

Background: Adherence issues in PCOS patients have not been examined thoroughly. Patients report prolonged periods of treatment and side effects of drug as the most common reason for withdrawal from treatment. To improve the effective management of PCOS patients, it is fundamental to understand facilitating and inhibiting factors to treatment adherence. Objective: to explore facilitating /inhibiting factors related to treatment adherence among PCOS patients. Material and Methods: This was a qualitative study with a purposive sample of women with confirmed diagnosis of PCOS. The data were collected via 20 in-depth semi-structured interviews with women aged between 21 to 34. A qualitative content analysis was used to analyze the data. Results: Five themes were identified which described different types of facilitating /inhibiting factors to treatment adherence. Inhibiting factors included financial issues, patient-related, disease-related, health care provider-related factors; social factors were found to be both facilitating and inhibiting. Conclusion: The findings suggest that successful adherence to PCOS treatment is highly dependent on patients recognizing and adapting to financial, social, and health care related inhibiting factors. It is also crucial for clinicians and policy makers to recognize these key inhibiting factors in order to improve treatment outcomes Keywords: polycystic ovarian syndrome, adherence, qualitative researc

Bulk and surface energetics of lithium hydride crystal: benchmarks from quantum Monte Carlo and quantum chemistry

We show how accurate benchmark values of the surface formation energy of crystalline lithium hydride can be computed by the complementary techniques of quantum Monte Carlo (QMC) and wavefunction-based molecular quantum chemistry. To demonstrate the high accuracy of the QMC techniques, we present a detailed study of the energetics of the bulk LiH crystal, using both pseudopotential and all-electron approaches. We show that the equilibrium lattice parameter agrees with experiment to within 0.03 %, which is around the experimental uncertainty, and the cohesive energy agrees to within around 10 meV per formula unit. QMC in periodic slab geometry is used to compute the formation energy of the LiH (001) surface, and we show that the value can be accurately converged with respect to slab thickness and other technical parameters. The quantum chemistry calculations build on the recently developed hierarchical scheme for computing the correlation energy of a crystal to high precision. We show that the hierarchical scheme allows the accurate calculation of the surface formation energy, and we present results that are well converged with respect to basis set and with respect to the level of correlation treatment. The QMC and hierarchical results for the surface formation energy agree to within about 1 %.Comment: 16 pages, 4 figure

Are advanced clinical practice roles in England’s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives

Objective: A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers’ and senior clinicians’ perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. Methods: We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Results: Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. Conclusions: While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in the context requires urgent attention

THE ACCUSED IS ENTERING THE COURTROOM: THE LIVE-TWEETING OF A MURDER TRIAL.

© 2017 Informa UK Limited, trading as Taylor & Francis GroupThe use of social media is now widely accepted within journalism as an outlet for news information. Live tweeting of unfolding events is standard practice. In March 2014, Oscar Pistorius went on trial in the Gauteng High Court for murder. Hundreds of journalists present began live-tweeting coverage, an unprecedented combination of international interest, permission to use technology and access which resulted in massive streams of consciousness reports of events as they unfolded. Based on a corpus of Twitter feeds of twenty-four journalists covering the trial, this study analyses the content and strategies of these feeds in order to present an understanding of how microblogging is used as a live reporting tool. This study shows the development of standardised language and strategies in reporting on Twitter, concluding that journalists adopt a narrow range of approaches, with no significant variation in terms of gender, location, or medium. This is in contrast to earlier studies in the field (Awad, 2006, Hedman, 2015; Kothari, 2010; Lariscy, Avery, Sweetser, & Howes, 2009 Lasorsa, 2012; Lasorsa, Lewis, & Holton, 2011; Sigal, 1999, Vis, 2013).Peer reviewe

Viscosity of High Energy Nuclear Fluids

Relativistic high energy heavy ion collision cross sections have been interpreted in terms of almost ideal liquid droplets of nuclear matter. The experimental low viscosity of these nuclear fluids have been of considerable recent quantum chromodynamic interest. The viscosity is here discussed in terms of the string fragmentation models wherein the temperature dependence of the nuclear fluid viscosity obeys the Vogel-Fulcher-Tammann law.Comment: 6 pages, ReVTeX 4 format, two figures, *.eps forma

The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis

The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.BackgroundWhile the survival ramifications of dialysis modality selection are still debated, it seems reasonable to postulate that outcome comparisons are not the same for all patients at all times. Trends in available data indicate the relative risk of death with hemodialysis (HD) compared to peritoneal dialysis (PD) varies by time on dialysis and the presence of various risk factors. This study was undertaken to identify key patient characteristics for which the risk of death differs by dialysis modality.MethodsAnalyses utilized incidence data from 398,940 United States Medicare patients initiating dialysis between 1995 and 2000. Proportional hazards regression identified the presence of diabetes, age, and the presence of comorbidity as factors that significantly interact with treatment modality. Stratifying by these factors, proportional and nonproportional hazards models were used to estimate relative risks of death [RR (HD:PD)].ResultsOf the 398,940 patients studied, 11.6% used PD as initial therapy, 45% had diabetes mellitus (DM), 51% were 65 years or older, and 55% had at least one comorbidity. Among the 178,693 (45%) patients with no baseline comorbidity, adjusted mortality rates in nondiabetic (non-DM) patients were significantly higher on HD than on PD [age 18–44: RR (95% CI) = 1.24 (1.07, 1.44); age 45–64: RR = 1.13 (1.02, 1.25); age 65+: RR = 1.13 (1.05, 1.21)]. Among diabetic (DM) patients with no comorbidity, HD was associated with a higher risk of death among younger patients [age 18–44: RR = 1.22(1.05, 1.42)] and a lower risk of death among older patients [age 45–64: RR = 0.92 (0.85, 1.00); age 65+: RR = 0.86 (0.79, 0.93)]. Within the group of 220,247 (55%) patients with baseline comorbidity, adjusted mortality rates were not different between HD and PD among non-DM patients [age 18–44: RR = 1.19 (0.94, 1.50); age 45–64: RR = 1.01 (0.92, 1.11); age 65+: RR = 0.96 (0.91, 1.01)] and younger DM patients [age 18–44: RR = 1.10 (0.92, 1.32)], but were lower with HD among older DM patients with baseline comorbidity [age 45–64: RR = 0.82 (0.77, 0.87); age 65+: RR = 0.80 (0.76, 0.85)].ConclusionValid mortality comparisons between HD and PD require patient stratification according to major risk factors known to interact with treatment modality. Survival differences between HD and PD are not constant, but vary substantially according to the underlying cause of ESRD, age, and level of baseline comorbidity. These results may help identify technical advances that will improve outcomes of patients on dialysis

Colloquium: Comparison of Astrophysical and Terrestrial Frequency Standards

We have re-analyzed the stability of pulse arrival times from pulsars and white dwarfs using several analysis tools for measuring the noise characteristics of sampled time and frequency data. We show that the best terrestrial artificial clocks substantially exceed the performance of astronomical sources as time-keepers in terms of accuracy (as defined by cesium primary frequency standards) and stability. This superiority in stability can be directly demonstrated over time periods up to two years, where there is high quality data for both. Beyond 2 years there is a deficiency of data for clock/clock comparisons and both terrestrial and astronomical clocks show equal performance being equally limited by the quality of the reference timescales used to make the comparisons. Nonetheless, we show that detailed accuracy evaluations of modern terrestrial clocks imply that these new clocks are likely to have a stability better than any astronomical source up to comparison times of at least hundreds of years. This article is intended to provide a correct appreciation of the relative merits of natural and artificial clocks. The use of natural clocks as tests of physics under the most extreme conditions is entirely appropriate; however, the contention that these natural clocks, particularly white dwarfs, can compete as timekeepers against devices constructed by mankind is shown to be doubtful.Comment: 9 pages, 2 figures; presented at the International Frequency Control Symposium, Newport Beach, Calif., June, 2010; presented at Pulsar Conference 2010, October 12th, Sardinia; accepted 13th September 2010 for publication in Reviews of Modern Physic

Influence of optical aberrations in an atomic gyroscope

In atom interferometry based on light-induced diffraction, the optical aberrations of the laser beam splitters are a dominant source of noise and systematic effect. In an atomic gyroscope, this effect is dramatically reduced by the use of two atomic sources. But it remains critical while coupled to fluctuations of atomic trajectories, and appears as a main source of noise to the long term stability. Therefore we measure these contributions in our setup, using cold Cesium atoms and stimulated Raman transitions

Pelvic floor dysfunction and polycystic ovary syndrome

Objectives: To compare the prevalence of pelvic floor muscle dysfunction (PFMD) in patients with and without polycystic ovary syndrome (PCOS); to test PFMD in women with different PCOS phenotypes. Methods: This was a case-control study of 202 women who were recruited in an infertility clinic in Hormozgan, Iran: PCOS (n=103) and control groups who were healthy women whose husbands were diagnosed with male infertility (n=99). According to the presence or absence of menstrual dysfunction (M), hyperandrogenism (HA) and polycystic ovaries on ultrasonoghraphy (PCO), patients with PCOS were divided into three phenotypes: HA+PCO, M+PCO and M+HA+PCO. PFMD was assessed by the Pelvic Floor Distress Inventory-20 (PFDI-20. Results: The reported PFMD symptoms were higher in PCOS (P=0.05) than the non-PCOS group. The mean PFDI score in the HA+M+PCO was higher compared to other phenotypes, although the difference did not reach significance level (P>0.05). The mean LH level was higher in HA+M+PCO than the two other phenotypes. There was a significant positive correlation between LH level and PFDI score (P<0.04). Conclusion: The findings suggest that a high level of LH may cause PFMD. Further studies are needed to determine the precise role of LH levels and potential treatment options in women with PCOS and PFMD. Keywords: polycystic ovary syndrome, pelvic floor distress inventory, pelvic floor muscle dysfunctio