Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports

BACKGROUND: This investigation was undertaken to describe patient perception and awareness of the polycystic ovary syndrome (PCOS), the most common cause of anovulation/oligoovulation among women of reproductive age. METHODS: Fifteen parameters were evaluated by a computer-based research instrument accessed by a large, unscreened population. Incomplete questionnaires were not entered, and responses were electronically tabulated to block duplicate submissions. RESULTS: From 657 participants, the majority (63%) were between 26–34 years old; mean BMI was 30.4 kg/m(2). 343 of 657 had at least one pregnancy and 61% of the study group had taken fertility medicine (any type) at least once. Physicians were the most common provider of PCOS information for all study participants, irrespective of age. Patient emotions associated with the diagnosis of PCOS included "frustration" (67%), "anxiety" (16%), "sadness" (10%), and "indifference" (2%). Self-reported patient aptitude regarding PCOS was scored as high or "very aware" in >60% of women. Respondents were also asked: "If your PCOS could be safely and effectively helped by something else besides fertility drugs or birth control pills, would that interest you?" Interest in alternative PCOS treatments was expressed by 99% of the sample (n = 648). CONCLUSIONS: In our study population, most women associated negative emotions with PCOS although the self-reported knowledge level for the disorder was high. While these women regarded their obstetrician-gynecologist as integral to their PCOS education, traditional PCOS therapies based on oral contraceptives or ovulation induction agents were regarded as unsatisfactory by most women

Is U.S. health care an appropriate system? A strategic perspective from systems science

<p>Abstract</p> <p>Context</p> <p>Systems science provides organizational principles supported by biologic findings that can be applied to any organization; any incongruence indicates an incomplete or an already failing system. U.S. health care is commonly referred to as a system that consumes an ever- increasing percentage of the gross domestic product and delivers seemingly diminishing value.</p> <p>Objective</p> <p>To perform a comparative study of U.S. health care with the principles of systems science and, if feasible, propose solutions.</p> <p>Design</p> <p>General systems theory provides the theoretical foundation for this observational research.</p> <p>Main Outcome Measures</p> <p>A degree of compliance of U.S. health care with systems principles and its space-time functional location within the dynamic systems model.</p> <p>Results of comparative analysis</p> <p>U.S. health care is an incomplete system further threatened by the fact that it functions in the zone of chaos within the dynamic systems model.</p> <p>Conclusion</p> <p>Complying with systems science principles and the congruence of pertinent cycles, U.S. health care would likely dramatically improve its value creation for all of society as well as its resiliency and long-term sustainability.</p> <p>Immediate corrective steps could be taken: Prioritize and incentivize <it>health </it>over <it>care</it>; restore fiscal soundness by combining health and life insurance for the benefit of the insured and the payer; rebalance horizontal/providers and vertical/government hierarchies.</p

Seismic imaging of the shallow crust beneath the Krafla central volcano, NE Iceland

We studied the seismic velocity structure beneath the Krafla central volcano, NE Iceland, by performing 3-D tomographic inversions of 1453 earthquakes recorded by a temporary local seismic network between 2009 and 2012. The seismicity is concentrated primarily around the Leirhnjúkur geothermal field near the center of the Krafla caldera. To obtain robust velocity models, we incorporated active seismic data from previous surveys. The Krafla central volcano has a relatively complex velocity structure with higher P wave velocities (V_p) underneath regions of higher topographic relief and two distinct low-V_p anomalies beneath the Leirhnjúkur geothermal field. The latter match well with two attenuating bodies inferred from S wave shadows during the Krafla rifting episode of 1974–1985. Within the Leirhnjúkur geothermalreservoir, we resolved a shallow (−0.5 to 0.5 km below sea level; bsl) region with low-V_p/V_s values and a deeper (0.5–1.5 km bsl) high-V_p/V_s zone. We interpret the difference in the velocity ratios of the two zones to be caused by higher rock porosities and crack densities in the shallow region and lower porosities and crack densities in the deeper region. A strong low-V_p/V_s anomaly underlies these zones, where a superheated steam zone within felsic rock overlies rhyolitic melt

Trauma and Stressor-Related Disorders: Systemic Processes

The first text to present DSM-5 diagnoses within a relational perspective, DSM-5 and Family Systems delivers timely content aimed at training marriage and family therapists, clinical mental health counselors, and other systems-oriented practitioners. It reflects how the DSM-5 examines, for the first time, its diagnostic categories from the perspective of cultural and environmental impact on the development of individual disorders and conditions. This comprehensive text provides students with an understanding of how to approach a diagnosis as it relates to assessments, treatment planning, and ethical implications from a family and relational systems perspective. With contributions from distinguished faculty at counseling and marriage and family therapy training programs, each chapter includes an overview of the DSM in family systems contexts, cultural aspects, family systems assessments and interventions, and ethical and legal implications. Abundant case vignettes aid students in conceptualizing diagnoses in each DSM-5 category. -- from publishers websit