Managing infertility in primary care

Couples may be reluctant to disclose they are experiencing infertility. Helen Allan and Ginny Mounce provide a discussion on the anxiety couples experience and how to care for these patient

CaII Infrared triplet line models in Classical T Tauri stars

We study the formation of the calcium II infrared triplet lines 8498\AA, 8542\AA and 8662\AA, in the accreting magnetospheric flows of Classical T Tauri stars (CTTS), and present a grid of models for a large range of magnetospheric conditions. We apply our models to the interpretation of multi epoch observations of the CTTS DI Cep. We find that these lines form in the magnetospheric infall and that the variability of the CaII triplet lines in DI Cep can be explained in the context of changes in the mass accretion rate/temperature of the accretion column gas

Padrões tecnológicos e econômicos do arroz de terras altas.

O presente trabalho teve como objetivo atualizar as informações sobre a cultura do arroz no Mato Grosso, visando fornecer subsídios às ações de pesquisa e transferência de tecnologia.bitstream/CNPAF/20437/1/comt_52.pd

Dissemination, implementation and impact of the ESHRE evidence-based guidelines

STUDY QUESTION What are the perceptions of ESHRE members about the dissemination, implementation and impact of the first four ESHRE evidence-based guidelines to be published? SUMMARY ANSWER Around 30% of ESHRE members know and use the ESHRE evidence-based guidelines in their routine practice and this is perceived to result in better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care, with on average three in each four members who make changes perceiving that their patients benefit from it. WHAT IS KNOWN ALREADY ESHRE has been developing and disseminating evidence-based guidelines, aiming to improve the quality of fertility care across Europe. However, evidence has shown that guidelines dissemination is not enough to change practice at clinics, with implementation strategies that address local barriers to implementation being recommended. STUDY DESIGN, SIZE, DURATION A cross-sectional study based on an online survey was sent by email to all ESHRE members (n = 7664) and advertised on ESHRE social media (20 February–3 April 2018). The survey was carried out to evaluate their perceptions about the dissemination, implementation and impact of the Management of Endometriosis (ENDO), Routine Psychosocial Care (RPC), Premature Ovarian Insufficiency (POI) and Recurrent Pregnancy Loss (RPL) ESHRE guidelines. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey was advertised via the ESHRE website, social media and email to all ESHRE members. It assessed the dissemination (knowledge the guidelines were published, downloaded), implementation (using guidelines in daily practice, changed practice) and impact (perceived patient benefit, referred patients to the guidelines) of the guidelines, as well as their perceived implementability. Open questions assessed perceived changes in practice, barriers to and desired support for implementation. MAIN RESULTS AND THE ROLE OF CHANCE The final sample consisted of 658 participants (not possible to calculate response rate), with the majority being embryologists, biologists or geneticists (n = 268, 40.7%), followed by clinicians (n = 260, 39.5%), scientists (n = 48, 7.3%), nurses or midwives (n = 30, 4.6%), psychologists, counsellors or social workers (n = 28, 4.3%) and others (e.g. medical student, lab manager, marketing, ethicist; n = 24, 3.6%). The majority knew that ESHRE published the guidelines (82.1% ENDO, 54.6% RPC, 56.6% POI, 59.4% RPL). From these, the majority downloaded it (65.9% ENDO, 52.4% RPC, 54.2% POI, 56.8% RPL), around one-third used it in their routine practice (41.7% ENDO, 29.5% RPC, 33.7% POI) and around one quarter made changes to their practice (30.7% ENDO, 18.9% RPC, 21.5% POI). Overall, <20% of members think that patients benefited from the guideline (19.4% ENDO, 16.3% RPC, 16.1% POI) and very few referred them to it (ENDO 8.9%, 12.8% RPC, 16.1% POI). However, on average every three in every four people who made changes to practice perceived that their patients benefited from it (ENDO 62%, RPC 80%, POI 75%). The main reported changes in practice were better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care. Main perceived barriers to implementation were lack of translation to other languages, guidelines being long and difficult to understand and lack of supporting evidence. Financial constraints and lack of staff expertise were also reported. Participants desired clear support for implementation in the form of step-by-step instructions, more training and support materials for staff and patients and translation to other languages. Results for the clinicians only showed that, despite less knowledge about the RPC guideline, they were more likely to download all the guidelines, to follow them, make changes in their daily practice and refer them to their patients. LIMITATIONS, REASONS FOR CAUTION Respondents were ESHRE members and these are not representative of all European reproductive health professionals. The response rate could not be calculated as ESHRE social media reaches more than just the members. The guidelines are mainly written for clinicians and in this sample the clinicians were under-represented. In addition, missing values increased as participants progressed through each guideline’s questions, with the open-ended questions being answered by only 74–97 participants. The survey assessed perceptions instead of actual practice. Overall, the results may convey a too optimistic picture of the impact of the guidelines. WIDER IMPLICATIONS OF THE FINDINGS ESHRE’s policy of investing in implementation and dissemination is important but insufficient to ensure the guidelines are implemented at clinics across Europe. ESHRE can address perceived barriers that are directly related to the guidelines, in particular lack of translation, as well as provide further support for implementation. This support should be clear and concise, focusing on how to implement the guidelines rather than on what to do. STUDY FUNDING/COMPETING INTEREST(S) None

ASILUM: A platform to evaluate advanced combinations of smart antennas and multi-user detection for UMTS FDD and TDD

The purpose of this paper is to present and explain some results of ASILUM, a project included into IST (Information Society Technologies), a research programme of European Community. This project aims to contribute to the technical innovation and policies of the European Community by validating new transceivers concepts to increase the capacity of UMTS (FDD and TDD modes) through new and efficient interference mitigation schemes. These schemes are jointly using smart antennas and multiuser detection. They have been validated through link and system level simulations

Intramural Vesical Leiomyoma in a Patient with a Pelvic Fibrous Tumour - Case Report

Introdução: O leiomioma vesical é um tumor benigno raro que representa,aproximadamente, 0,5% do total de neoplasias da bexiga. É frequentemente um achado imagiológico, sendo a sua localização e dimensões determinantes no desenvolvimento de sintomatologia e no tipo de procedimento a efectuar. Caso Clínico: Reporta-se o caso de um doente com queixas urinárias de disúria, polaquiúria e esforço miccional, inicialmente interpretadas como HBP. A investigação diagnóstica culminou com a enucleação de uma volumosa massa intramural da bexiga, com diagnóstico histológico de leiomioma, num doente com antecedentes de doença de Madelung e excisão prévia de um tumor fibroso paravesical. Discussão: O leiomioma vesical, embora apresentando características imagiológicas típicas, deve ser sempre biopsado para confirmação histológica da sua etiologia. O tumor fibroso pélvico apresenta sempre indicação cirúrgica pois, numa minoria de casos, pode apresentar comportamento agressivo com infiltração dos órgãos adjacentes

Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis

BACKGROUND: Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse consequences. We aimed to evaluate long-term adverse renal function and mortality after postoperative AKI in a cohort of patients undergoing major abdominal surgery. METHODS: We performed a retrospective analysis of adult patients who underwent major non-vascular abdominal surgery between January 2010 and February 2011 at the Department of Surgery II of Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Portugal. Exclusion criteria were as follows: chronic kidney disease on renal replacement therapy, undergoing renal replacement therapy the week before surgery, death before discharge and loss to follow-up through January 2014. Patients were categorized according to the development of postoperative AKI in the first 48 h after surgery using the Kidney Disease: Improving Global Outcomes classification. AKI was defined by an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to 6 h. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Cumulative mortality was analysed with the Kaplan-Meier method and log-rank test and outcome predictive factors with the Cox regression. Significance was set at P < 0.05. RESULTS: Of 390 selected patients, 72 (18.5%) developed postoperative AKI. The median follow-up was 38 months. Adverse renal outcomes and death after hospital discharge were more frequent among AKI patients (47.2 versus 22.0%, P < 0.0001; and 47.2 versus 20.5%, P < 0.0001, respectively). The 4 year cumulative probability of death was 44.4% for AKI patients, while it was 19.8% for patients with no AKI (log-rank test, P < 0.0001). In multivariate analysis, AKI was a risk factor for adverse renal outcomes (adjusted hazard ratio 1.6, P = 0.046) and mortality (adjusted hazard ratio 1.4, P = 0.043). CONCLUSIONS: AKI after major abdominal surgery was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge

Density streams in the disc winds of Classical T Tauri stars

Spectral and photometric variability of the Classical T Tauri stars RY Tau and SU Aur from 2013 to 2022 is analyzed. We find that in SU Aur the H-alpha line's flux at radial velocity RV = -50 +- 7 km/s varies with a period P = 255 +- 5 days. A similar effect previously discovered in RY Tau is confirmed with these new data: P = 21.6 days at RV = -95 +- 5 km/s. In both stars, the radial velocity of these variations, the period, and the mass of the star turn out to be related by Kepler's law, suggesting structural features on the disc plane orbiting at radii of 0.2 AU in RY Tau and 0.9 AU in SU Aur, respectively. Both stars have a large inclination of the accretion disc to the line of sight - so that the line of sight passes through the region of the disc wind. We propose there is an azimuthal asymmetry in the disc wind, presumably in the form of 'density streams', caused by substructures of the accretion disc surface. These streams cannot dissipate until they go beyond the Alfven surface in the disc's magnetic field. These findings open up the possibility to learn about the structure of the inner accretion disc of CTTS on scales less than 1 AU and to reveal the orbital distances related to the planet's formation.Comment: 9 pages, 10 figure

Search for associations containing young stars (SACY):II. Chemical abundances of stars in 11 young Associations in the Solar neighborhood

The recently discovered coeval, moving groups of young stellar objects in the solar neighborhood represent invaluable laboratories to study recent star formation and to search for high metallicity stars which can be included in future exo-planet surveys. In this study we derived through an uniform and homogeneous method stellar atmospheric parameters and abundances for iron, silicium and nickel in 63 Post T-Tauri Stars from 11 nearby young associations. We further compare the results with two different pre-main sequence (PMS) and main sequence (MS) star populations. The stellar atmospheric parameters and the abundances presented here were derived using the equivalent width of individual lines in the stellar spectra through the excitation/ionization equilibrium of iron. Moreover, we compared the observed Balmer lines with synthetic profiles calculated for model atmospheres with a different line formation code. We found that the synthetic profiles agree reasonably well with the observed profiles, although the Balmer lines of many stars are substantially filled-in, probably by chromospheric emission. Solar metallicity is found to be a common trend on all the nearby young associations studied. The low abundance dispersion within each association strengthens the idea that the origin of these nearby young associations is related to the nearby Star Forming regions (SFR). Abundances of elements other than iron are consistent with previous results on Main Sequence stars in the solar neighborhood. The chemical characterization of the members of the newly found nearby young associations, performed in this study and intended to proceed in subsequent works, is essential for understanding and testing the context of local star formation and the evolutionary history of the galaxy.Comment: 13 pages, 7 figures, 6 tables, accepted for publication in A&A on 26/03/200

Interpretation of the Veiling of the Photospheric Spectrum for T Tauri Stars in Terms of an Accretion Model

The problem on heating the atmospheres of T Tauri stars by radiation from an accretion shock has been solved. The structure and radiation spectrum of the emerging so-called hot spot have been calculated in the LTE approximation. The emission not only in continuum but also in lines has been taken into account for the first time when calculating the spot spectrum. Comparison with observations has shown that the strongest of these lines manifest themselves as narrow components of helium and metal emission lines, while the weaker ones decrease significantly the depth of photospheric absorption lines, although until now, this effect has been thought to be due to the emission continuum alone. The veiling by lines changes the depth of different photospheric lines to a very different degree even within a narrow spectral range. Therefore, the nonmonotonic wavelength dependence of the degree of veiling r found for some CTTS does not suggest a nontrivial spectral energy distribution of the veiling continuum. In general, it makes sense to specify the degree of veiling r only by providing the set of photospheric lines from which this quantity was determined. We show that taking into account the contribution of lines to the veiling of the photospheric spectrum can cause the existing estimates of the accretion rate onto T Tauri stars to decrease by several times, with this being also true for stars with a comparatively weakly veiled spectrum. Neglecting the contribution of lines to the veiling can also lead to appreciable errors in determining the effective temperature, interstellar extinction, radial velocity, and vsin(i)