Women\u27s Experience of Infertility: A Multi-systemic Perspective

This article describes a study that used a multi-system perspective to document the self-reported experience of women struggling with infertility and its treatment. A sub-sample of 56 participants from a parent study that examined posttraumatic growth in the context of infertility was used based on their answers to a single open-ended question about their infertility experience, which was included in the original questionnaire. Inclusion criteria were self-identified failure to achieve a pregnancy or carry it to term after at least one year of trying in the six years prior to the study and absence of a recent crisis unrelated to the infertility. Responses were content analyzed independently by a team of three researchers. The analysis yielded agreed upon 85 codes clustered in six themes: Challenges, perception of the experience, reactions, support, coping strategies and posttraumatic growth. The main overall finding points to the sense of being “trapped” in a web of multi-faceted, environmental and internal relationships between diverse systems involved in the infertility treatment. Implications for practice are identified and directions for future research suggested

Anesthetic considerations for robot-assisted gynecologic and urology surgery

Robotic surgery was first conceived by the United States military in the 1980s. It rapidly developed in both complexity and utility and, in the early 21st century, modern robotic surgery for gynecologic and urologic surgery gained approval in the United States. Today, an ever-increasing number and variety of surgical procedures enlist robotic-assistance. Numerous anesthetic considerations for robotic surgery exist. A few of the most important aspects of conducting a safe anesthetic include: investigating the patient’s co-morbid conditions, realizing the risks associated with the robotic equipment, and positioning the patient with care. This manuscript reviews the current literature on robotic-assisted surgery for gynecologic and urologic procedures with emphasis on history, marketplace, type, variety, and expansion of surgery in these fields. The review focuses on practical considerations for the anesthesiologist caring for patients undergoing robotic surgery. Preoperative, intraoperative and postoperative issues are explored in detail. The rapid expansion of robotic surgery worldwide requires thoughtful consideration of the technique’s weaknesses and associated risks. This review provides a roadmap to adequately prepare anesthesiologists for care of gynecologic and urologic patients undergoing robot-assisted surgery

Identifying Future Brand Ambassadors in The National Basketball Association (NBA) for Predicting Future NBA Superstars for Superior Marketing

This paper seeks to determine which factors/variables are useful to predict the salary of a National Basketball Association (NBA) player. Our goal is motivated by the presumed connection between a player’s salary and how well he is known nationally and perhaps internationally, and the connection between how well a player is known and his value as a brand ambassador/spokesperson for selected brands. We use stepwise regression as the key statistical tool for our analyses

Ultrasound imaging of the sciatic nerve division in the popliteal fossa: A volunteer study

Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx® with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites

Incommensurate magnetic ordering in Cu2Te2O5X2 (X=Cl, Br) studied by single crystal neutron diffraction

Polarized and unpolarized neutron diffraction studies have been carried out on single crystals of the coupled spin tetrahedra systems Cu2Te2O5X2 (X=Cl, Br). A model of the magnetic structure associated with the propagation vectors k'Cl ~ -0.150,0.422,1/2 and k'Br ~ -0.172,0.356,1/2 and stable below TN=18 K for X=Cl and TN=11 K for X=Br is proposed. A feature of the model, common to both the bromide and chloride, is a canted coplanar motif for the 4 Cu2+ spins on each tetrahedron which rotates on a helix from cell to cell following the propagation vector. The Cu2+magnetic moment determined for X=Br, 0.395(5)muB, is significantly less than for X=Cl, 0.88(1)muB at 2K. The magnetic structure of the chloride associated with the wave-vector k' differs from that determined previously for the wave vector k~0.150,0.422,1/2 [O. Zaharko et.al. Phys. Rev. Lett. 93, 217206 (2004)]

The crucial role of bilateral infraclavicular nerve blocks in the anesthetic management of a trauma patient

Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques

Cardiovascular outcomes among elderly patients with heart failure and coronary artery disease and without atrial fibrillation: a retrospective cohort study

Background Coronary artery disease accelerates heart failure progression, leading to poor prognosis and a substantial increase in morbidity and mortality. This study was aimed to assess the impact of coronary artery disease on all-cause mortality, myocardial infarction (MI), and ischemic stroke (IS) among hospitalized newly-diagnosed heart failure (HF) patients with left ventricular systolic dysfunction (LVSD). Methods This retrospective cohort study included Medicare patients (aged ≥65 years) with ≥1 inpatient heart failure claim (index date = discharge date) during 01JAN2007-31DEC2013. Patients were required to have continuous enrollment for ≥1-year pre-index date (baseline: 1-year pre-index period) without a prior heart failure claim (in the 1 year pre-index prior to the index hospital admission); follow-up ran from the index date to death, disenrollment from the health plan, or the end of the study period, whichever occurred first. HF with LVSD patients, identified with diagnosis codes of systolic dysfunction (excluding baseline atrial fibrillation), were stratified based on prevalent coronary artery disease at baseline into coronary artery disease and non-coronary artery disease cohorts. Main outcomes were occurrence of major adverse cardiovascular events including all-cause mortality, myocardial infarction, and ischemic stroke. Propensity score matching (PSM) was used to balance patient characteristics. Kaplan-Meier curves of ACM and cumulative incidence distribution of MI/IS were presented. Results Of 22,230 HF with LVSD patients, 15,827 (71.2%) had coronary artery disease and were overall more likely to be younger (79.8 vs 80.9 years), male (49.6% vs. 35.6%), white (86.2% vs 81.4%), with more prevalent comorbidities including hypertension (80.7% vs 74.3%), hyperlipidemia (67.7% vs 46.7%), and diabetes (46.3% vs 35.8%) (all p < 0.0001). After propensity score matching, cohorts included 5792 patients each. The coronary artery disease cohort had significantly higher cumulative incidence of myocardial infarction and ischemic stroke at the end of 7-year follow-up vs non-coronary artery disease (myocardial infarction = 50.0% vs 18.0%; ischemic stroke = 23.3% vs 18.7%; all p < 0.0001). Follow-up all-cause mortality rates were similar between the two cohorts. Conclusions HF with LVSD patients with coronary artery disease had significantly higher incidence of ischemic stroke and myocardial infarction, but similar all-cause mortality compared to those without coronary artery disease

Shrinking the Quadratic Estimator

We study a regression characterization for the quadratic estimator of weak lensing, developed by Hu and Okamoto (2001,2002), for cosmic microwave background observations. This characterization motivates a modification of the quadratic estimator by an adaptive Wiener filter which uses the robust Bayesian techniques described in Strawderman (1971) and Berger (1980). This technique requires the user to propose a fiducial model for the spectral density of the unknown lensing potential but the resulting estimator is developed to be robust to misspecification of this model. The role of the fiducial spectral density is to give the estimator superior statistical performance in a "neighborhood of the fiducial model" while controlling the statistical errors when the fiducial spectral density is drastically wrong. Our estimate also highlights some advantages provided by a Bayesian analysis of the quadratic estimator