‘What are you going to do, confiscate their passports?’ Professional perspectives on cross-border reproductive travel

Objective: This article reports findings from a UK-based study which explored the phenomenon of overseas travel for fertility treatment. The first phase of this project aimed to explore how infertility clinicians and others professionally involved in fertility treatment understand the nature and consequences of cross-border reproductive travel. Background: There are indications that, for a variety of reasons, people from the UK are increasingly travelling across national borders to access assisted reproductive technologies. While research with patients is growing, little is known about how ‘fertility tourism’ is perceived by health professionals and others with a close association with infertility patients. Methods: Using an interpretivist approach, this exploratory research included focussed discussions with 20 people professionally knowledgeable about patients who had either been abroad or were considering having treatment outside the UK. Semi-structured interviews were recorded, transcribed verbatim and subjected to a thematic analysis. Results: Three conceptual categories are developed from the data: ‘the autonomous patient’; ‘cross-border travel as risk’, and ‘professional responsibilities in harm minimisation’. Professionals construct nuanced, complex and sometimes contradictory narratives of the ‘fertility traveller’, as vulnerable and knowledgeable; as engaged in risky behaviour and in its active minimisation. Conclusions: There is little support for the suggestion that states should seek to prevent cross-border treatment. Rather, an argument is made for less direct strategies to safeguard patient interests. Further research is required to assess the impact of professional views and actions on patient choices and patient experiences of treatment, before, during and after travelling abroad

An investigation of a criterion- referenced test using G-theory, and factor and cluster analyses

There has been relatively little research on analytical procedures for examin ing the dependability and validity of criterion-referenced tests especially when compared to similar investigations for norm-referenced ESL or EFL tests. This study used three analytical procedures, namely, G-theory, factor and cluster analyses, to investigate the dependability and validity of a criterion-referenced test developed at the University of California, Los Angeles in 1989. Dependability estimates showed that test scores are not equally depend able for all placement groups and are rather undependable for two out of the four placement groups. Factor analysis of test scores for the placement groups showed that though two-factor solutions were the best solutions for the different groups, there were differences in the way the subtests loaded in the different groups, with progressively fewer subtests loading on the second factor as ability increased. This finding led to the extension study with cluster analysis which showed that a number of students might have been differently placed if subtest scores were used to place them.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68766/2/10.1177_026553229200900104.pd

Localized surface states in HTSC: Alternative mechanism of zero-bias conductance peaks

It is shown that the quasiparticle states localized in the vicinity of surface imperfections of atomic size can be responsible for the zero-bias tunneling conductance peaks in high-Tc superconductors. The contribution from these states can be easily separated from other mechanisms using their qualitatively different response on an external magnetic field.Comment: REVTeX, 4 pages, 2 figs; to be published in PR

Evaluating Baculovirus as a Vector for Human Prostate Cancer Gene Therapy

Gene therapy represents an attractive strategy for the non-invasive treatment of prostate cancer, where current clinical interventions show limited efficacy. Here, we evaluate the use of the insect virus, baculovirus (BV), as a novel vector for human prostate cancer gene therapy. Since prostate tumours represent a heterogeneous environment, a therapeutic approach that achieves long-term regression must be capable of targeting multiple transformed cell populations. Furthermore, discrimination in the targeting of malignant compared to non-malignant cells would have value in minimising side effects. We employed a number of prostate cancer models to analyse the potential for BV to achieve these goals. In vitro, both traditional prostate cell lines as well as primary epithelial or stromal cells derived from patient prostate biopsies, in two- or three-dimensional cultures, were used. We also evaluated BV in vivo in murine prostate cancer xenograft models. BV was capable of preferentially transducing invasive malignant prostate cancer cell lines compared to early stage cancers and non-malignant samples, a restriction that was not a function of nuclear import. Of more clinical relevance, primary patient-derived prostate cancer cells were also efficiently transduced by BV, with robust rates observed in epithelial cells of basal phenotype, which expressed BV-encoded transgenes faster than epithelial cells of a more differentiated, luminal phenotype. Maximum transduction capacity was observed in stromal cells. BV was able to penetrate through three-dimensional structures, including in vitro spheroids and in vivo orthotopic xenografts. BV vectors containing a nitroreductase transgene in a gene-directed enzyme pro-drug therapy approach were capable of efficiently killing malignant prostate targets following administration of the pro-drug, CB1954. Thus, BV is capable of transducing a large proportion of prostate cell types within a heterogeneous 3-D prostate tumour, can facilitate cell death using a pro-drug approach, and shows promise as a vector for the treatment of prostate cancer

Influence of impurity scattering on tunneling conductance in normal metal- d -wave superconductor junctions

Tunneling conductance spectra between a normal metal / d-wave superconductor junction under the presence of bulk impurities in the superconductor are studied. The quasiclassical theory has been applied to calculate the spatial variation of the pair potential and the effect of impurity scattering has been introduced by t-matrix approximation. The magnitude of a subdominant s-wave component at the interface is shown to robust against the impurity scattering while that for a subdominant $d_{xy}$-wave component is largely suppressed with the increase of the impurity scattering rate. The zero-bias conductance peak due to the zero-energy Andreev bound states is significantly broadened for the case of Born limit impurity compared with that of unitary limit impurity.Comment: 14 pages, 5 figure

Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study

Background Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. Methods Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. ‘Embedders’ supported practices and self-management programme providers to embed programme referral into routine practice, and an online ‘toolkit’ contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months − 3–0), step one (months 1–9), step 2 (months 10–18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. Results No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices’ interactions with the toolkit. Conclusions Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted

Software for administering the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events: Usability study

Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). Conclusions: Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials

Achievements and Challenges in the Science of Space Weather

In June 2016 a group of 40 space weather scientists attended the workshop on Scientific Foundations of Space Weather at the International Space Science Institute in Bern. In this lead article to the volume based on the talks and discussions during the workshop we review some of main past achievements in the field and outline some of the challenges that the science of space weather is facing today and in the future.Peer reviewe

Répteis em fragmentos de Cerrado e Mata Atlântica no Campo das Vertentes, Estado de Minas Gerais, Sudeste do Brasil

Os dados sobre a fauna reptiliana em Minas Gerais são pontuais e revelam carência de informações sobre esse grupo, principalmente em regiões de transição entre a Mata Atlântica e o Cerrado. A área do estudo está situada no município de Ritápolis (21° 01' 37.07" S e 44° 19' 11.84" O), microrregião Campo das Vertentes, Estado de Minas Gerais, Sudeste do Brasil. Pretendeu-se com a presente pesquisa conhecer a composição da fauna de répteis local. As observações, capturas e coletas foram realizadas quinzenalmente, durante dois dias consecutivos, de agosto de 2005 a julho de 2006. As capturas foram realizadas por meio de armadilhas de interceptação e queda, distribuídas em oito sítios, sendo quatro em área de mata de galeria e quatro em área aberta, perfazendo um esforço amostral de 6.912 horas-balde. Foi também realizada procura ativa e encontros ocasionais com registros fotográficos dos espécimes, e, no caso de serpentes, alguns exemplares foram entregues por terceiros quando encontradas mortos. Registrou-se a presença de 31 espécies de répteis, sendo duas espécies de cágados, nove de lagartos, duas de anfisbenas e 18 de serpentes. Apenas os lagartos Cercosaura ocellata, Enyalius bilineatus e Tupinambis merianae e as serpentes Leptodeira annulata e Apostolepis assimilis foram capturados nas armadilhas de queda. Os lagartos mais comuns foram Ameiva ameiva e Mabuya frenata, e as serpentes mais abundantes foram Oxyrhophus guibei e Sibynomorphus mikanii. Os lagartos estão bem representados na área, com espécies típicas de mata, como Enyalius bilineatus, e de áreas aberta de cerrado, como Ameiva ameiva e Mabuya frenata. A fauna de serpentes possui representantes típicos de áreas abertas do Cerrado, como O. guibei e Micrurus frontalis, e de regiões florestadas, como Liophis poecilogyrus e Philodryas olfersii. A diversidade de espécies de répteis e o registro prévio de Amphisbaena dubia e Hydromedusa tectifera para o Estado de Minas Gerais indicam a grande potencialidade do Campo das Vertentes em revelar a ocorrência de espécies novas ou a ampliação na distribuição de outras

Geological discontinuity persistence: Implications and quantification

Persistence of geological discontinuities is of great importance for many rock-related applications in earth sciences, both in terms of mechanical and hydraulic properties of individual discontinuities and fractured rock masses. Although the importance of persistence has been identified by academics and practitioners over the past decades, quantification of areal persistence remains extremely difficult; in practice, trace length from finite outcrop is still often used as an approximation for persistence. This paper reviews the mechanical behaviour of individual discontinuities that are not fully persistent, and the implications of persistence on the strength and stability of rock masses. Current techniques to quantify discontinuity persistence are then examined. This review will facilitate application of the most applicable methods to measure or predict persistence in rock engineering projects, and recommended approaches for the quantification of discontinuity persistence. Furthermore, it demonstrates that further research should focus on the development of persistence quantification standards to promote our understanding of rock mass behaviours including strength, stability and permeability