How often are clinicians performing genital exams in children with disorders of sex development?

Background: We sought to determine the frequency with which genital exams (GEs) are performed in children with disorders of sex development (DSD) and ambiguous genitalia (AG) during routine visits to the pediatric endocrine clinic. Methods: Medical records of children with DSD and AG seen at one large academic center since 2007 were reviewed. Data analyzed included diagnosis, sex of rearing, age, initial or follow up visit, number of individuals present and sex of the pediatric endocrinologist. Repeated measures analysis was performed to evaluate associations between GEs and patient/physician factors. Results: Eighty-two children with DSD and AG who had a total of 632 visits were identified. Sex of rearing was female in 78% and the most common diagnosis was congenital adrenal hyperplasia (CAH) (68%). GEs were performed in 35.6% of visits. GEs were more likely in patients with male sex of rearing (odds ratio [OR] 17.81, p=0.006), during initial vs. follow-up visits (OR 5.99, p=0.012), and when the examining endocrinologist was female (OR 3.71, p=0.014). As patients aged, GEs were less likely (OR 0.76, p<0.0001). Conclusions: GEs were performed in approximately one-third of clinic visits in children with DSD and AG. Male sex of rearing, initial visits and female pediatric endocrinologist were associated with more frequent GEs

Research in and application of state variable feedback design of guidance control systems for aerospace vehicles Progress report

Weighted least squares parameter estimation, Kalman filter, and random search problems for aerospace guidance control system desig

Analisis Retail Service Quality Terhadap Customer Loyalty Dengan Customer Satisfaction Sebagai Variabel Intervening Pada Supermarket Super Indo Merr Surabaya

Penelitian membahas pengaruh retail service quality terhadap customer loyatly dengan customer satisfaction sebagai variabel intervening di Supermarket Super Indo MERR Surabaya. Sampel penelitian ini berjumlah 100 responden pelanggan Super Indo MERR yang telah berbelanja sebanyak 3x dalam 3 bulan terakhir (Januari-Maret) dengan total transaksi lebih dari Rp. 100.000. Pengukuran dilakukan dari variabel Retail Service Quality (X1) dengan indikator Physical Aspects, Reliability, Personal Interaction, Problem Solving, Policy, variabel Customer Satisfaction (Y1) dengan indikator Fulfillment, Pleasure, Ambivalance, sedangkan Customer Loyalty (Z1) memiliki indikator Say Positive Thing, Recommend Friends, Continue Purchasing, hasil penelitian menunjukkan: (1) Retail Service Quality berpengaruh signifikan terhadap Customer Satisfaction dengan hasil T-statistics 8.146; (2) Retail Service Quality berpengaruh signifikan terhadap Customer Loyalty dengan hasil T-statistics 4.054; (3) Customer Satisfation berpengaruh signifikan terhadap Customer Loyalty dengan hasil T-statistics 4.665

Pengaruh Pemberian Ekstrak Etanol Daun Dadap Ayam (Erythrina Variegata L.) Terhadap Kualitas Spermatozoa Tikus Putih Jantan Galur Wistar (Rattus Norvegicus)

PENGARUH PEMBERIAN EKSTRAK ETANOL DAUN DADAP AYAM (Erythrina variegata L.) TERHADAP KUALITAS SPERMATOZOA TIKUS PUTIH JANTAN GALUR WISTAR (Rattus norvegicus)Stefani Tjiphanata1), Edwin De Queljoe1), Sri Sudewi1)1)Program Studi Farmasi FMIPA UNSRAT Manado, 95115 ABSTRACT Spermatozoa are a sperm cell that has flagella and produced in spermatogenesis. To fertilize the ovum, the spermatozoa have to have a good quality. The Quality of spermatozoa is one of the most important elements to evaluate the male fertility. This study was being held to determine the effect of applying ethanol extract of Dadap leaf against the quality of white male Wistar rats (Rattus norvegicus)'s spermatozoa. This study is using a complete random design (CRD) approached, using 24 white male Wistar rats (Rattus norvegicus) divided into several groups where the group 1 as a non-treatment control group, while the group 2, 3 and 4 as the treatment groups with dosage of 200 mg, 400 mg and 800 mg, respectively. Treatment is given by oral with 1 cc once a day for 50 days follows the cycle of spermatogenesis. The observed variable included the quantity, motility and morphology of spermatozoa. The results of this study showed that the ethanol extract of Dadap leaf could reduce the quality of spermatozoa in terms of quantity, motility and morphology while based on statistic, the ethanol extract of Dadap leaf can only reduce the quality of spermatozoa in mophology aspect significantly. Keywords: Dadap leaf (Erythrina variegata L.), spermatozoa, white male wistar rats (Rattus norvegicus) ABSTRAKSpermatozoa adalah sel kelamin jantan yang memiliki bulu cambuk dan dihasilkan dalam spermatogenesis. Untuk dapat membuahi sel telur, syarat yang harus dipenuhi spermatozoa adalah bahwa kualitas spermatozoa harus baik. Kualitas spermatozoa merupakan salah satu unsur penting untuk evaluasi kesuburan pria. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian ekstrak etanol daun dadap ayam terhadap kualitas spermatozoa tikus putih jantan galur wistar (Rattus norvegicus). Penelitian ini menggunakan rancangan acak lengkap (RAL) dengan menggunakan 24 ekor tikus putih jantan galur wistar (Rattus norvegicus) yang dibagi atas beberapa kelompok dimana kelompok 1 sebagai kelompok kontrol tanpa perlakuan, kelompok 2, 3 dan 4 sebagai kelompok perlakuan denagn dosis secara berturut-turut 200 mg, 400 mg dan 800 mg. Perlakuan diberikan secara oral sekali sehari sebanyak 1 cc selama 50 hari sesuai siklus spermatogenesis. Variabel yang diamati meliputi jumlah, motilitas dan morfologi spermatozoa. Hasil penelitian ini menunjukkan bahwa ekstrak etanol daun dadap ayam dapat menurunkan kualitas spermatozoa dari segi kuantitas, motilitas serta morfologi spermatozoa sedangkan berdasarkan statistik ekstrak daun dadap ayam hanya dapat menurunkan kualitas spermatozoa dalam aspek morfologi spermatozoa secara signifikan

Relativistic models of magnetars: Nonperturbative analytical approach

In the present paper we focus on building simple nonperturbative analytical relativistic models of magnetars. With this purpose in mind we first develop a method for generating exact interior solutions to the static and axisymmetric Einstein-Maxwell-hydrodynamic equations with anisotropic perfect fluid and with pure poloidal magnetic field. Then using an explicit exact solution we present a simple magnetar model and calculate some physically interesting quantities as the surface elipticity and the total energy of the magnetized star.Comment: 10 pages, LaTe

Reversals in nature and the nature of reversals

The asymmetric shape of reversals of the Earth's magnetic field indicates a possible connection with relaxation oscillations as they were early discussed by van der Pol. A simple mean-field dynamo model with a spherically symmetric $\alpha$ coefficient is analysed with view on this similarity, and a comparison of the time series and the phase space trajectories with those of paleomagnetic measurements is carried out. For highly supercritical dynamos a very good agreement with the data is achieved. Deviations of numerical reversal sequences from Poisson statistics are analysed and compared with paleomagnetic data. The role of the inner core is discussed in a spectral theoretical context and arguments and numerical evidence is compiled that the growth of the inner core might be important for the long term changes of the reversal rate and the occurrence of superchrons.Comment: 24 pages, 12 figure