Master of Science

thesisThe advancement in the knowledge of the chemical and physical laws controlling the behavior of solutions has been so rapid in recent years that they now cover a large field, and extend into nearly every department of science which it is possible for them to be concerned. Among the most important branches that have been influenced greatest in the direction of making the observed facts harmonize with the theory of solutions, is petrology. This subject is especially desirable as it presents phenomena outside of the physical and chemical laboratories. The facts as observed have not been produced by carefully arranged apparatus, but have been found ready made in nature

Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome

STUDY QUESTION What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? SUMMARY ANSWER International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. WHAT IS KNOWN ALREADY The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from six continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low to low quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, evidence quality was low and evidence-practice gaps persist. STUDY DESIGN, SIZE, DURATION The 2023 International Evidence-based Guideline update reengaged the 2018 network across professional societies and consumer organizations, with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation-II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength and diversity and inclusion were considered throughout. PARTICIPANTS/MATERIALS, SETTING, METHODS This summary should be read in conjunction with the full Guideline for detailed participants and methods. Governance included a six-continent international advisory and management committee, five guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health and other experts, alongside consumers, project management, evidence synthesis, statisticians and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and five face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across five guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council (NHMRC). MAIN RESULTS AND THE ROLE OF CHANCE The evidence in the assessment and management of PCOS has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpins 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include: i) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only; ii) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; iii) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care and shared decision making to improve patient experience, alongside greater research; iv) maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; and v) emphasizing evidence-based medical therapy and cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION Overall, recommendations are strengthened and evidence is improved, but remains generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. WIDER IMPLICATIONS OF THE FINDINGS The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the Guideline with an integrated evaluation program. STUDY FUNDING/COMPETING INTEREST(S) This effort was primarily funded by the Australian Government via the National Health Medical Research Council (NHMRC) (APP1171592), supported by a partnership with American Society for Reproductive Medicine, Endocrine Society, European Society for Human Reproduction and Embryology, and European Society for Endocrinology. The Commonwealth Government of Australia also supported Guideline translation through the Medical Research Future Fund (MRFCRI000266). HJT and AM are funded by NHMRC fellowships. JT is funded by a Royal Australasian College of Physicians (RACP) fellowship. Guideline development group members were volunteers. Travel expenses were covered by the partnering organizations. Disclosures of interest were strictly managed according to NHMRC policy and are available with the full guideline, technical evidence report, peer review and responses (www.monash.edu/medicine/mchri/pcos). Of named authors HJT, CTT, AD, LM, LR, JBoyle, AM have no conflicts of interest to declare. JL declares grant from Ferring and Merck; consulting fees from Ferring and Titus Health Care; speaker’s fees from Ferring; unpaid consultancy for Ferring, Roche Diagnostics and Ansh Labs; and sits on advisory boards for Ferring, Roche Diagnostics, Ansh Labs, and Gedeon Richter. TP declares a grant from Roche; consulting fees from Gedeon Richter and Organon; speaker’s fees from Gedeon Richter and Exeltis; travel support from Gedeon Richter and Exeltis; unpaid consultancy for Roche Diagnostics; and sits on advisory boards for Roche Diagnostics. MC declares travels support from Merck; and sits on an advisory board for Merck. JBoivin declares grants from Merck Serono Ltd.; consulting fees from Ferring B.V; speaker’s fees from Ferring Arzneimittell GmbH; travel support from Organon; and sits on an advisory board for the Office of Health Economics. RJN has received speaker’s fees from Merck and sits on an advisory board for Ferring. AJoham has received speaker’s fees from Novo Nordisk and Boehringer Ingelheim. The guideline was peer reviewed by special interest groups across our 39 partner and collaborating organizations, was independently methodologically assessed against AGREEII criteria and was approved by all members of the guideline development groups and by the NHMRC

Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Study question What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary answer International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. What is known already The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from 6 continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low- to low-quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus-based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, the evidence quality was low, and evidence-practice gaps persist. Study design, size, and duration The 2023 International Evidence-based Guideline update re-engaged the 2018 network across professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength, and diversity and inclusion were considered throughout. Participants/materials, setting, and methods This summary should be read in conjunction with the full guideline for detailed participants and methods. Governance included a 6-continent international advisory and management committee, 5 guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health, and other experts, alongside consumers, project management, evidence synthesis, statisticians, and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and 5 face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across 5 guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council. Main results and the role of chance The evidence in the assessment and management of PCOS has generally improved in the past 5 years but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include the following: (1) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm, and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only; (2) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnoea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; (3) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care, and shared decision-making to improve patient experience, alongside greater research; (4) maintained emphasis on healthy lifestyle, emotional well-being, and quality of life, with awareness and consideration of weight stigma; and (5) emphasizing evidence-based medical therapy and cheaper and safer fertility management. Limitations and reasons for caution Overall, recommendations are strengthened and evidence is improved but remains generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. Wider implications of the findings The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input, and consumer preferences. Research recommendations have been generated, and a comprehensive multifaceted dissemination and translation programme supports the guideline with an integrated evaluation programme

Influence of TAVI of the performance parameters of the right heart

Abstrakt Einleitung: Die Transkatheter-Aortenklappen-Implantation (TAVI) ist ein minimal invasives Verfahren zur Behandlung der Aortenklappenstenose, dem häufigsten Herzfehler in Europa und Nordamerika. Sie bietet eine Alternative für Patienten mit mittlerem und hohem Risiko für einen chirurgischen Klappenersatz und nimmt in letzter Zeit an Bedeutung zu. Bei der TAVI-Prozedur wird eine biologische Aortenklappenprothese meist über einen transfemoralen Zugang implantiert. Neben einer Verbesserung der Mortalität und Klinik konnte eine Verbesserung der linksventrikulären Hämodynamik mit der TAVI gezeigt werden. Aber nur wenig ist über Auswirkungen auf den rechten Ventrikel nach TAVI bekannt. Zu den echokardiographischen Leistungsparametern des rechten Ventrikels gehören neben TAPSE und RVSm auch andere wie FAC, RV dP/dt , RIMP und 3D RV-EF. Jedoch werden viele nicht in der Routine bestimmt oder haben keine gute Korrelation zu anderen Methoden. In der vorliegenden Arbeit wurden TAPSE und RVSm wegen der relativ einfachen und gut reproduzierbaren Messung und guten Korrelation zu MRT-Untersuchungen als Standardparameter der rechtsventrikulären Funktion gewählt. Methodik: In der vorliegenden retrospektiven Arbeit wurden Änderungen der Performanceparameter des rechten Ventrikels sowie andere echokardiographische Parameter nach der Durchführung eines transkatheter Aortenklappenersatzes überprüft. Insgesamt wurden 263 Patienten eingeschlossen. Die Daten wurden präoperativ, postoperativ und in der follow-up Kontrolle ermittelt. Es handelt sich um ein ausgeglichenes Patientenkollektiv mit ausgeprägter Komorbidität. Die Daten wurden statistisch und unter Bezug verschiedener Aspekte sowie innerhalb verschiedener Subgruppen analysiert. Es wurden auch zusätzliche Analysen bezüglich möglicher prognostischer Werte, klinischer und echokardiographischer Parameter durchgeführt. Ergebnisse: In der lineare Reggressionanalyse wurde ein Einfluss des initialen TAPSE / RVSm Wertes sowie anderen Variablen wie AV Pmax, LV-EF und Z. n. ACVB OP auf TAPSE bzw. RVSm Differenz nachgewiesen. Im gesamten Patientenkollektiv zeigt sich eine Besserung der TAPSE und des RVSm Wertes, sowie eine Besserung der linksventrikulären Funktion. Die Analyse der Subgruppen zeigt eine klinisch relevante Besserung der TAPSE und des RVSm Wertes in der Subgruppe mit einer initial eingeschränkten TAPSE unabhängig von der initialen LV-EF. Weiterhin wurde eine Besserung der LV-EF in der Subgruppe mit einer präoperativen LV-EF kleiner 54% unabhängig vom TAPSE-Wert beobachtet. Letztlich wurde eine initiale Abnahme und nachfolgend eine Zunahme der linksventrikulären Funktion in der Subgruppe mit normaler LV-EF unabhängig von dem TAPSE-Wert verzeichnet. Schlussfolgerung: Zusammenfassend wurde ein positiver Einfluss der TAVI auf die initial eingeschränkte LV-EF und RV-EF als Hinweis für eine rechtsventrikuläre Dysfunktion beobachtet. Die Unterschiede waren in der Subgruppe mit eingeschränkter TAPSE relevant. Somit zeigt sich positive Veränderung der Performance Parameter des rechten Herzens bei initial vorliegender rechtsventrikulärer Dysfunktion nach TAVI.Introduction : Transcatheter Aortic Valve Implantation is a minimal invasive method to treat aortic valve stenosis, the most common valvar failure in Europe and North America. It stands as an alternative for patients with elevated risk of complications by surgical valve replacement, these are about 30 % of all symptomatic patients with aortic stenosis. This method increases with time. With TAVI, a biological aortic valve prosthesis is implanted, usually via transfemoral approach. Though it is well known that TAVI in high risk patients carries a lower mortality risk compared to surgery, left ventricular hemodynamics and clinical status improves. Little is known about right ventricular hemodynamics. Echocardiographic performace parameters of the right ventricle are TAPSE and RVSm, and others as FAC, RV dP/dt, RIMP-RV and 3D RV-EF. However most of them are not measured routinely or prove pure correlation to other methods. Therefore TAPSE and RVSm were studied as parameters of right ventricular function, because they are relatively not complicated to measure and show good correlation to MRI-parameters. Methods: In this retrospective study were reviewed changes in the performance parameter of the right ventricle and other echocardiographic parameters after performing transcatheter aortic valve replacement in 263 patients. Data were determined preoperatively, postoperatively and during follow-up control. Patients are balanced in respect to severe comorbidity. Data were analyzed statistically and with reference to various aspects, as well as within different subgroups. Additional analysis regarding possible prognostic values of individual clinical or echocardiographic parameters were performed. Results: The linear Reggression shows influence of initial TAPSE/RVSm and other variable on TAPSE/RVSm variation. In the entire group of patients an improvement of TAPSE and the RVSM value, as well as an improvement of left ventricular function could be noticed. Analysis of subgroups shows improvement of TAPSE and RVSm in the subgroup with an initial limited TAPSE, regardless of the LV-EF. Furthermore, were observed an improvement of LV-EF in the subgroups with preoperative LV-EF below 54 % independent of TAPSE value. Ultimately the study shows an initial decline followed by an increase of left ventricular function in the subgroup with normal LV-EF regardless of the TAPSE value.Conclusion: In summary we observed a positive influence of TAVI to the initial impaired LV-EF and reduced RV-EF as an indication of left and right ventricular dysfunction. With that positive development of the performance parameters of the right heart in initial right ventricular dysfunction after TAVI is shown regardless of the TAPSE value

Mormon battalion monument; souvenir brochure, program and historical sketch. May 30, 1927.

"Issued by the state of Utah Mormon battalion monument commission."--Verso of t.-p.Mode of access: Internet