Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

BACKGROUND: During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. METHODS: Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. RESULTS: Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and$654.55 +/- 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased. CONCLUSIONS: This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level

Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

BACKGROUND: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina. METHODS: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter. RESULTS: Centers for Medicare and Medicaid Services "Hospital Compare" data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01) and Union General Hospital (P = 0.01). This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02). When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (-3.44 versus -6.07, respectively, P = 0.54). CONCLUSION: The range of process of care scores submitted by acute care hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services "Hospital Compare" information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area

Array comparative genomic hybridization screening in IVF significantly reduces number of embryos available for cryopreservation

Objective During IVF, non-transferred embryos are usually selected for cryopreservation on the basis of morphological criteria. This investigation evaluated an application for array comparative genomic hybridization (aCGH) in assessment of surplus embryos prior to cryopreservation. Methods First-time IVF patients undergoing elective single embryo transfer and having at least one extra non-transferred embryo suitable for cryopreservation were offered enrollment in the study. Patients were randomized into two groups: Patients in group A (n=55) had embryos assessed first by morphology and then by aCGH, performed on cells obtained from trophectoderm biopsy on post-fertilization day 5. Only euploid embryos were designated for cryopreservation. Patients in group B (n=48) had embryos assessed by morphology alone, with only good morphology embryos considered suitable for cryopreservation. Results Among biopsied embryos in group A (n=425), euploidy was confirmed in 226 (53.1%). After fresh single embryo transfer, 64 (28.3%) surplus euploid embryos were cryopreserved for 51 patients (92.7%). In group B, 389 good morphology blastocysts were identified and a single top quality blastocyst was selected for fresh transfer. All group B patients (48/48) had at least one blastocyst remaining for cryopreservation. A total of 157 (40.4%) blastocysts were frozen in this group, a significantly larger proportion than was cryopreserved in group A (p=0.017, by chi-squared analysis). Conclusion While aCGH and subsequent frozen embryo transfer are currently used to screen embryos, this is the first investigation to quantify the impact of aCGH specifically on embryo cryopreservation. Incorporation of aCGH screening significantly reduced the total number of cryopreserved blastocysts compared to when suitability for freezing was determined by morphology only. IVF patients should be counseled that the benefits of aCGH screening will likely come at the cost of sharply limiting the number of surplus embryos available for cryopreservation

An Integrated Intelligent Approach to Enhance the Security Control of IT Systems. A Proactive Approach to Security Control Using Artificial Fuzzy Logic to Strengthen the Authentication Process and Reduce the Risk of Phishing

Hacking information systems is continuously on the increase. Social engineering attacks is performed by manipulating the weakest link in the security chain; people. Consequently, this type of attack has gained a higher rate of success than a technical attack. Based in Expert Systems, this study proposes a proactive and integrated Intelligent Social Engineering Security Model to mitigate the human risk and reduce the impact of social engineering attacks. Many computer users do not have enough security knowledge to be able to select a strong password for their authentication. The author has attempted to implement a novel quantitative approach to achieve strong passwords. A new fuzzy logic tool is being developed to evaluate password strength and measures the password strength based on dictionary attack, time crack and shoulder surfing attack (social engineering). A comparative study of existing tools used by major companies such as Microsoft, Google, CertainKey, Yahoo and Facebook are used to validate the proposed model and tool. A comprehensive literature survey and analytical study performed on phishing emails representing social engineering attacks that are directly related to financial fraud are presented and compared with other security threats. This research proposes a novel approach that successfully addresses social engineering attacks. Another intelligent tool is developed to discover phishing messages and provide educational feedback to the user focusing on the visible part of the incoming emails, considering the email’s source code and providing an in-line awareness security feedback

Forensic dissection of lip print as an investigative tool in a mixed Egyptian population

Background: Identification is a major problem facing forensic practitioners, DNA and finger prints are highly useful but sometimes aren’t easily collected from the crime scene. Lip print could be useful in this field being unique to each individual.Aim: The current study aimed at detecting the frequency and gender relation of lip print pattern in an Egyptian sample.Methodology: Samples were collected on white copy paper, divided into four quadrants then examined with magnifying lens for pattern distribution.Results: The study showed that pattern IV was the most frequently represented pattern in the study sample, pattern I &amp; II were more prevalent in males and females respectively. Prevalent pattern in Cairo and Lower Egypt was I while it was IV in Upper Egypt.Conclusion: The lip print pattern can differ due to gender and geographical origin in Egyptian subjects.Keywords: Lip print, Egypt, Gender, Geographical distribution, Identification, Anthropology. Gender differenc

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

Background Single embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET. Methods First-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups. Results For patients in Group A (n=55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n=48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology+aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p=0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p=0.009). There were no twin pregnancies. Conclusion Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET

Dry-sliding wear behavior of 3Y-TZP/Al2O3-NbC nanocomposites produced by conventional sintering and spark plasma sintering

[EN] This work presents the initial results of the dry-sliding wear behavior of 3 mol% yttria-stabilized zirconia reinforced with 5 vol% alumina-niobium carbide (3Y-TZP/5 vol% Al2O3-NbC) nanocomposites sintered by conventional sintering and spark plasma sintering methods in the temperature range of 1350-1450 degrees C. The reinforcement of 3Y-TZP matrix with hard nanoparticles aimed to improve wear strength of the composites. Wear tests were performed by the ball-on-disc method using alumina (Al2O3) and tungsten carbide with 6 wt% cobalt cermet (WC-6%Co) balls as counter-materials, a load of 15 N, a sliding distance of 2000 m, and a sliding speed of 0.1 m/s. Wear behavior was evaluated in terms of wear rate and FE-SEM micrograph analysis of the wear tracks. The nanocomposite sintered at 1450 degrees C by conventional sintering exhibited the least wear when tested with the WC-6%Co ball. Generally, the wear mechanism showed evidence of severe wear regime with both counter-materials.The authors acknowledge the Brazilian institutions CAPES-PVE (grant number 23038.009604/2013-12), FAPESP (grant number 2015/07319-8), Fundação Araucária (grant number 810/2014), European Union/Erasmus Mundus for doctorate mobility (grant number EB15DM1542), and the Spanish Ministry of Economy and Competitiveness (RYC-2016-20915).Salem, R.; Gutiérrez-González, C.; Borrell Tomás, MA.; Salvador Moya, MD.; Chinelatto, AL.; Chinelatto, AS.; Pallone, E. (2019). Dry-sliding wear behavior of 3Y-TZP/Al2O3-NbC nanocomposites produced by conventional sintering and spark plasma sintering. International Journal of Applied Ceramic Technology. 16(3):1265-1273. https://doi.org/10.1111/ijac.13151S12651273163Liu, H., Zhao, W., Ji, Y., Cui, J., Chu, Y., & Rao, P. (2017). Determination of fracture toughness of zirconia ceramics with different yttria concentrations by SEVNB method. 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Effect of Al2O3-NbC nanopowder incorporation on the mechanical properties of 3Y-TZP/Al2O3-NbC nanocomposites obtained by conventional and spark plasma sintering

[EN] The incorporation of Al2O3-NbC-nanopowder reinforcement in a 3Y-TZP matrix, and its influence on the mechanical properties of 3YTZP/Al2O3-NbC nanocomposites, obtained by conventional and spark plasma sintering (SPS), was investigated. Nanometric powders of Al2O3-NbC were prepared by reactive high-energy milling, deagglomeration, and leaching with acid, and added to the 3Y-TZP matrix, at a proportion of 5 vol%. The final powders were dried under airflow, compacted, and sintered in the temperature range of 1300-1500 degrees C. The effects of the sintering technique and final temperature, on the microstructure and mechanical properties, such as hardness, toughness, and Young's modulus, were analysed. Fracture toughness of the material reinforced with Al2O3-NbC nanopowders, which is one of its most important properties, differed significantly from that of the 3Y-TZP monolith (5.2 MPa m(1/2)). The nanocomposites, sintered conventionally at 1450 degrees C, showed higher fracture toughness (8.7 MPa m(1/2)). Microstructure observations indicated that NbC nanoparticles were dispersed homogeneously within the 3Y-TZP matrix, and limited its grain growth. However, partial oxidation of the NbC on the nanocomposite surface, at the conventional sintering temperature of 1500 degrees C, caused a reduction in the fracture toughness.The authors acknowledge the Brazilian institutions CAPES-PVE (grant number 23038.009604/2013-12), FAPESP (grant number 2015/07319-8), Fundação Araucária (grant number 810/2014), European Union/Erasmus Mundus for doctorate mobility (grant number EB15DM1542), and the Spanish Ministry of Economy and Competitiveness (grant number IJCI-2014-19839).Salem, R.; Monteiro, R.; Gutierrez, CF.; Borrell Tomás, MA.; Salvador Moya, MD.; Chinelatto, AS.; Chinelatto, A.... (2018). Effect of Al2O3-NbC nanopowder incorporation on the mechanical properties of 3Y-TZP/Al2O3-NbC nanocomposites obtained by conventional and spark plasma sintering. Ceramics International. 44(2):2504-2509. https://doi.org/10.1016/j.ceramint.2017.10.235S2504250944

Kinetic Turbulence

The weak collisionality typical of turbulence in many diffuse astrophysical plasmas invalidates an MHD description of the turbulent dynamics, motivating the development of a more comprehensive theory of kinetic turbulence. In particular, a kinetic approach is essential for the investigation of the physical mechanisms responsible for the dissipation of astrophysical turbulence and the resulting heating of the plasma. This chapter reviews the limitations of MHD turbulence theory and explains how kinetic considerations may be incorporated to obtain a kinetic theory for astrophysical plasma turbulence. Key questions about the nature of kinetic turbulence that drive current research efforts are identified. A comprehensive model of the kinetic turbulent cascade is presented, with a detailed discussion of each component of the model and a review of supporting and conflicting theoretical, numerical, and observational evidence.Comment: 31 pages, 3 figures, 99 references, Chapter 6 in A. Lazarian et al. (eds.), Magnetic Fields in Diffuse Media, Astrophysics and Space Science Library 407, Springer-Verlag Berlin Heidelberg (2015