The Sexual Impact of Infertility Among Women Seeking Fertility Care.

IntroductionInfertility affects approximately 6.7 million women in the United States. Couples with infertility have significantly more anxiety, depression, and stress. This is compounded by the fact that almost 40% of couples undergoing assisted reproduction technology still cannot conceive, which can have an ongoing effect on quality of life, marital adjustment, and sexual impact.AimTo assess the sexual impact of infertility in women undergoing fertility treatment.MethodsThis study is a cross-sectional analysis of women in infertile couples seeking treatment at academic or private infertility clinics. Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology. Multivariate regression analyses were used to identify factors independently associated with increased sexual impact.Main outcome measureSexual impact of perceived fertility diagnosis.ResultsIn total, 809 women met the inclusion criteria, of whom 437 (54%) agreed to participate and 382 completed the sexual impact items. Most of the infertility was female factor only (58.8%), whereas 30.4% of infertility was a combination of male and female factors, 7.3% was male factor only, and 3.5% was unexplained infertility. In bivariate and multivariate analyses, women who perceived they had female factor only infertility reported greater sexual impact compared with woman with male factor infertility (P = .01). Respondents who were younger than 40 years experienced a significantly higher sexual impact than respondents older than 40 years (P < .01). When stratified by primary and secondary infertility, respondents with primary infertility overall reported higher sexual impact scores.ConclusionIn women seeking fertility treatment, younger age and female factor infertility were associated with increased sexual impact and thus these women are potentially at higher risk of sexual dysfunction. Providers should consider the role young age and an infertility diagnosis plays in a women's sexual well-being

Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children

AbstractObjectives. To evaluate the usefulness of balloon angioplasty for relief of native aortic coarctation, we reviewed our experience with this procedure, with special emphasis on follow-up results.Background. Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation.Methods. During an 8.7-year period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty for native aortic coarctation. A retrospective review of this experience with emphasis on long-term follow-up forms the basis of this study.Results. Balloon angioplasty produced a reduction in the peak-to-peak coarctation gradient from 46 ± 17 (mean ± SD) to 11 ± 9 mm Hg (p < 0.001). No patient required immediate surgical intervention. At intermediate-term follow-up (14 ± 11 months), catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16 ± 15 mm Hg (p > 0.1). When individual results were scrutinized, 15 (25%) of 60 had recoarctation, defined as peak gradient >20 mm Hg. Recoarctation was higher (p < 0.01) in neonates (5 [83%] of 6) and infants (7 [39%] of 18) than in children (3 [8%] of 36), respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction in peak gradient from 52 ± 13 to 9 ± 8 mm Hg (p < 0.001). Reexamination 31 ± 18 months after repeat angioplasty revealed a residual gradient of 3 to 19 mm Hg (mean 11 ± 6). Three (5%) of 58 patients who underwent follow-up angiography developed an aneurysm. Detailed evaluation of the femoral artery performed in 51 (88%) of 58 patients at follow-up catheterization revealed patency of the femoral artery in 44 (86%) of 51 patients. Femoral artery occlusion, complete in three (6%) and partial in four (8%), was observed, but all had excellent collateral flow. Blood pressure, echocardiography-Doppler ultrasound and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms and minimal (2%) late recoarctation.Conclusions. On the basis of these data, it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation

Recognition and Positional Identity in an Elementary Professional Learning Community: A Case Study

Professional learning communities are typically conceived of as spaces for reducing teacher isolation, supporting informed and committed teachers, and fostering student academic gains. Focusing on a professional learning community that supported the teaching and learning of engineering in elementary schools, we also conceived of this learning environment as a space for negotiating a teacher-of- engineering identity. Calling attention to emergent issues of power and status through a lens of positional identity, this article examines a Black female educator’s sense of self as a teacher-of-engineering and how this perception was informed by participation in the professional learning community. Findings reveal that racialized and gendered positionings informed the teacher’s perception of having limited access to being recognized in this space as a teacher-of-engineering. Implications for this work include reimagining the design of professional learning spaces in engineering education that intentionally account for teachers’ identity development, as well as supporting the identity development for teachers from historically marginalized communities

Tight multi-messenger constraints on the neutron star equation of state from GW170817 and a forward model for kilonova light curve synthesis

We present a rapid analytic framework for predicting kilonova light curves following neutron star (NS) mergers, where the main input parameters are binary-based properties measurable by gravitational wave detectors (chirp mass and mass ratio, orbital inclination) and properties dependent on the nuclear equation of state (tidal deformability, maximum NS mass). This enables synthesis of a kilonova sample for any NS source population, or determination of the observing depth needed to detect a live kilonova given gravitational wave source parameters in low latency. We validate this code, implemented in the public MOSFiT package, by fitting it to GW170817. A Bayes factor analysis overwhelmingly ($B>10^{10}$) favours the inclusion of an additional luminosity source in addition to lanthanide-poor dynamical ejecta during the first day. This is well fit by a shock-heated cocoon model, though differences in the ejecta structure, opacity or nuclear heating rate cannot be ruled out as alternatives. The emission thereafter is dominated by a lanthanide-rich viscous wind. We find the mass ratio of the binary is $q=0.92\pm0.07$ (90% credible interval). We place tight constraints on the maximum stable NS mass, $M_{\rm TOV}=2.17^{+0.08}_{-0.11}$ M$_\odot$. For a uniform prior in tidal deformability, the radius of a 1.4 M$_\odot$ NS is $R_{1.4}\sim 10.7$ km. Re-weighting with a prior based on equations of state that support our credible range in $M_{\rm TOV}$, we derive a final measurement $R_{1.4}=11.06^{+1.01}_{-0.98}$ km. Applying our code to the second gravitationally-detected neutron star merger, GW190425, we estimate that an associated kilonova would have been fainter (by $\sim0.7$ mag at one day post-merger) and declined faster than GW170817, underlining the importance of tuning follow-up strategies individually for each GW-detected NS merger.Comment: Updated to match accepted version in MNRA

Two coastal upwelling domains in the northern California Current system

A pair of hydrographic sections, one north and one south of Cape Blanco at 42.9N, was sampled in five summers (1998–2000 and 2002–2003). The NH line at 44.6N lies about 130 km south of the Columbia River, and spans a relatively wide shelf off Newport, Oregon. The CR line at 41.9N off Crescent City, California, lies 300 km farther south and spans a narrower shelf. Summer winds are predominantly southward in both locations but the southward winds are stronger on the CR line. Sampling included CTD/rosette casts (to measure temperature, salinity, dissolved oxygen, nutrients, chlorophyll), zooplankton net tows and continuous operation of an Acoustic Doppler Current Profiler. We summarize and compare July-August observations from the two locations. We find significant summer-season differences in the coastal upwelling domains north and south of Cape Blanco. Compared to the domain off Newport, the domain off Crescent City has a more saline, cooler, denser and thicker surface mixed layer, a wider coastal zone inshore of the upwelling front and jet, higher nutrient concentrations in the photic zone and higher phytoplankton biomass. The southward coastal jet lies near the coast (about 20–30 km offshore, over the shelf) on the NH line, but far from shore (about 120 km) on the CR line; a weak secondary jet lies near the shelf-break (35 km from shore) off Crescent City. Phytoplankton tend to be light-limited on the CR line and nutrient-limited on the NH line. Copepod biomass is high (15 mg C m−3) inshore of the mid-shelf on both NH and CR lines, and is also high in the core of the coastal jet off Crescent City. The CR line shows evidence of deep chlorophyll pockets that have been subducted from the surface layer. We attribute these significant differences to stronger mean southward wind stress over the southern domain, to strong small-scale wind stress curl in the lee of Cape Blanco, and to the reduced influence of the Columbia River discharge in this region

Puzzling Low-Frequency Variations in the δ Scuti-type Kepler Star KIC 5988140 (HD 188774)

At first sight, the Kepler data of the A-type star KIC 5988140 mimics the light curve of an eclipsing binary system with a superposed short-period variability of type δ Scuti. It was attributed by the Kepler Asteroseismology Consortium (KASC) to the working group “Binary and Multiple Stars”, where we picked it up. We used the high-quality space photometry supplemented by recent high-resolution spectra to investigate the cause of the variability of this late A-type object. We considered three different possible scenarios: (1) binarity, (2) co-existence of γ Doradus and delta Scuti pulsations (the hybrid case) and (3) rotation of the stellar surface with an asymmetric intensity distribution (i.e. rotational modulation). We confirm the presence of various pressure modes of type delta Scuti. However, none of the previous scenarios is capable of reproducing all of the observed characteristics of the variations. Thus, the cause of the remaining light and radial velocity variations remains presently unexplained by any of the considered physical processes

Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort.

IntroductionSleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation.MethodsOur analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average.ResultsResults from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch.ConclusionThese results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management

Asymptotic Giant Branch Variables in the Galaxy and the Local Group

AGB variables, particularly the large amplitude Mira type, are a vital step on the distance scale ladder. They will prove particularly important in the era of space telescopes and extremely large ground-based telescopes with adaptive optics, which will be optimized for infrared observing. Our current understanding of the distances to these stars is reviewed with particular emphasis on improvements that came from Hipparcos as well as on recent work on Local Group galaxies. In addition to providing the essential calibration for extragalactic distances Gaia may also provide unprecedented insight into the poorly understood mass-loss process itself.Comment: Accepted for publication in Astrophysics and Space Science. From a presentation at the conference "The Fundamental Cosmic Distance Scale: State of the Art and Gaia Perspective, Naples May 2011. 8 Pages, 9 Figure

Duration of shedding of respiratory syncytial virus in a community study of Kenyan children

Background: Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Methods: In a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods. Results: From 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age. Conclusion: We provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community