A qualitative study exploring the experience of viewing three‐dimensional medical images during an orthopaedic outpatient consultation from the perspective of patients, health care professionals, and lay representatives

Rationale, aims and objectives Three‐dimensional (3D) medical images are shown to patients during clinical consultations about certain health conditions. However, little is known about patients' experience of viewing them. The aim of this qualitative study was to explore the impact of sharing 3D medical images with patients during a clinical consultation about hip surgery, from the perspective of patients, health care professionals, and lay representatives. Method Interviews were conducted with 14 patients who were shown their own 3D medical images during their clinical consultation and four health care professionals conducting consultations within one orthopaedic outpatient clinic. In addition to interviews, 31 lay representatives participated in six focus groups. The focus groups aimed to gain a broader understanding of the advantages and concerns of showing patients their medical images and to compare 3D and two‐dimensional (2D) medical images. Interviews and focus groups were audio‐recorded, transcribed verbatim, and analysed using thematic analysis. Results Three themes were developed from the data: (a) the truthful image, (b) the empowering image, and (c) the unhelpful image. Focus group participants' preference for 3D or 2D images varied between conditions and groups, suggesting that the experience of viewing images may differ between individuals and conditions. Conclusions When shown to patients during an orthopaedic clinical consultation, 3D medical images may be an empowering resource. However, in this study, patients and focus group participants perceived medical images as factual and believed they could provide evidence of a diagnoses. This perception could result in overreliance in imaging tests or disregard for other forms of information

Durable rust resistance in wheat is effective against multiple pathogens

Tese de doutoramento em Ciências da Saúde, no ramo de Medicina Dentária, apresentada à Faculdade de Medicina da Universidade de CoimbraA osteonecrose maxilar associada aos bifosfonatos, que se apresenta como uma lesão pós-cirúrgica associada a incapacidade de cicatrização, é um dos efeitos secundários mais frequentemente observados nos doentes submetidos a terapêutica com bifosfonatos nitrogenados. Assim, esta patologia é diagnosticada maioritariamente em doentes com metastização óssea, sob terapêutica com bifosfonatos nitrogenados intra-venosos. A fisiopatologia da osteonecrose maxilar associada aos bifosfonatos tem sido relacionada com a supressão da remodelação óssea, com a infeção local e com a toxicidade dos bifosfonatos nos tecidos envolventes, que mantém e perpetua a exposição óssea. Os fatores de risco da osteonecrose maxilar associada aos bifosfonatos foram categorizados em fatores relacionados com a terapêutica, que incluem a administração intravenosa em doenças oncológicas e a utilização do bifosfonato mais potente, o zoledronato; e factores locais, que incluem as exodontias, a colocação de implantes, a cirurgia periapical e a cirurgia periodontal que envolva os tecidos ósseos. No entanto, no caso da cirurgia periapical, não foram encontrados estudos que relacionem este procedimento com a osteonecrose maxilar. No contexto da toxicidade do zoledronato, uma vez que os compostos de fosfato de cálcio têm a capacidade de o adsorver, nomeadamente quando utilizados como sistemas transportadores de bifosfonatos, e são passíveis de aplicação nas locas cirúrgicas, constituindo substitutos ósseos adequados, colocou-se a hipótese de estes compostos poderem, potencialmente, ter um efeito protetor nos tecidos que envolvem as locas cirúrgicas. Assim, constituíram objetivos deste trabalho a avaliação da cirurgia periapical como desencadeadora de osteonecrose maxilar na presença de zoledronato e, paralelamente, a avaliação do potencial protetor da aplicação de compostos de fosfato de cálcio na loca cirúrgica. Para cumprir os objetivos propostos neste trabalho, realizaram-se estudos de química, estudos in vitro e estudos in vivo. No que respeita aos estudos de química, avaliou-se a reação entre o zoledronato e os compostos de fosfato de cálcio. Através de espetroscopia do visível e de análise elementar, verificou-se que o zoledronato é adsorvido, em solução aquosa, pelos compostos bifásicos de fosfato de cálcio. A etiologia da osteonecrose maxilar descreve um efeito deletério dos bifosfonatos nos tecidos moles, especialmente nos fibroblastos, que apresentam uma função insubstituível na cicatrização das lesões cirúrgicas orais. No contexto dos estudos in vitro, estabeleceram-se culturas primárias de fibroblastos gengivais humanos, que constituíram um modelo para avaliar a citotoxicidade na presença de zoledronato e na presença da associação zoledronato/compostos bifásicos de fosfato de cálcio. Avaliou-se a atividade metabólica dos fibroblastos gengivais humanos através do ensaio de MTT (brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazol), a sua viabilidade através do ensaio de SRB (ensaio da sulforrodamina B), os tipos de morte e o ciclo celular dos fibroblastos gengivais humanos através de citometria de fluxo e a capacidade de migração através do scratch assay. Verificou-se que o zoledronato apresentou um efeito citotóxico significativo nos fibroblastos gengivais humanos, com diminuição da atividade metabólica e da viabilidade, com aumento das populações celulares em morte por apoptose e por necrose e pela diminuição da capacidade de migração. Com a associação zoledronato/compostos bifásicos de fosfato de cálcio, foi possível diminuir, ou mesmo anular, a toxicidade do zoledronato, que se manifestou pela ausência de diferenças em relação aos grupos controlo. Nos estudos in vivo, foi utilizado um modelo experimental reprodutível já estudado, que relaciona diretamente a administração crónica de bifosfonatos com o desenvolvimento de osteonecrose maxilar após exodontia. Este modelo animal serviu como base ao desenvolvimento de um modelo de cirurgia apical com administração crónica de bifosfonatos. Os grupos de animais tratados foram submetidos a administração intra-peritoneal de zoledronato nas quatro semanas antecedentes à intervenção cirúrgica e nas duas ou três semanas seguintes. As mandíbulas foram avaliadas macroscopicamente, através da medicina nuclear, radiologia e histologia. No contexto da medicina nuclear, foi utilizado o radiofármaco 99mTc-zoledronato, que foi obtido após o desenvolvimento e a optimização de um procedimento de marcação radioquímica do zoledronato, e respetivo controlo de qualidade. Verificou-se que, nos animais submetidos à terapêutica com zoledronato, em que se desenvolveu a exodontia, existiu maior captação de 99mTc-zoledronato, menor densidade radiográfica e alterações histológicas compatíveis com cicatrização diminuída. Com a aplicação dos compostos bifásicos de fosfato de cálcio, não se observaram diferenças em relação aos animais controlo. No caso dos animais submetidos à cirurgia apical, não se verificaram alterações significativas em relação aos animais controlo, nos animais submetidos à terapêutica com zoledronato, tanto na presença como na ausência da aplicação de compostos bifásicos de fosfato de cálcio. Este trabalho de investigação permitiu elucidar acerca dos desígnios que deram origem a esta tese. No modelo animal de cirurgia periapical desenvolvido, não foi observado um atraso significativo da cicatrização nem sinais da osteonecrose maxilar, nos tempos avaliados, concluindo-se que a terapêutica com zoledronato poderá não constituir um fator de risco nesta intervenção cirúrgica. Pelo contrário, no modelo animal de exodontia confirmou-se que, efetivamente, o zoledronato constitui um fator de risco, e que os compostos bifásicos de fosfato de cálcio, apresentam potencial efeito protetor da toxicidade inerente aos bifosfonatos. Esta conclusão foi sustentada pelos estudos de química, em que se verificou a adsorção do zoledronato, corroborada por supressão da toxicidade nos estudos in vitro e cicatrização favorecida no modelo animal de exodontia com administração crónica de zoledronato.Bisphosphonate-associated osteonecrosis of the jaw, a post-surgical non-healing wound condition, is one of the most often seen side effects in patients treated with nitrogencontaining bisphosphonates. Therefore, this pathology is primarily diagnosed in patients with metastatic bone disease, receiving intravenous administration of nitrogen-containing bisphosphonates. Bisphosphonate-associated osteonecrosis of the jaw physiopathology has been related with suppression of bone turnover, local infections or soft tissue toxicity. Recent studies associate the physiopathological mechanisms of the osteonecrosis of the jaw with toxic effects of bisphosphonates on different cell types, besides osteoclast, being the most important cause of soft tissues toxicity that contributes for the maintenance of bone exposure. Bisphosphonate-associated osteonecrosis of the jaw risk factors were categorized as drug-related factors, including intravenous administration in oncological diseases and the use of the most potent bisphosphonate, zoledronate; and local factors including, dental extractions, dental implant placement, periapical surgery and periodontal surgery involving osseous injury. However, there are no studies that relate periapical surgery with osteonecrosis of the jaw. Considering zoledronate toxicity, since calcium phosphate compounds are able to adsorb it, namely when used as drug delivery vehicle, and are also used in surgical wounds, as a bone substitute, it was hypothesised this compounds had a potential protective effect to the soft tissues surrounding surgical osseous wounds. Thus, the aim of this study was to assess periapical surgery as a trigger of osteonecrosis of the jaw in the presence of zoledronate and also the potential protective effect of calcium phosphate compounds when applied in the surgical wound. To fulfil the proposed objectives of this work were carried out studies of chemistry, in vitro and in vivo studies. Regarding chemical studies, it was evaluated the chemical reaction between zoledronate and calcium phosphate compounds. Through ultraviolet-visible spectroscopy and elemental analysis it has been found that zoledronate, in aqueous solution, was adsorbed by biphasic calcium phosphate compounds. Bisphosphonate-associated osteonecrosis of the jaw aetiology describes a deleterious effect of bisphosphonates on soft tissues, especially on fibroblasts, which play an important role in oral wound healing. Considering in vitro studies it was established a primary culture of human gingival fibroblasts that constituted a model to evaluate the cytotoxicity in the presence of zoledronate and of zoledronate/biphasic calcium phosphate compounds association. It was investigated the metabolic activity of human gingival fibroblasts through MTT (3-(4,5- dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, cell viability through SRB (sulforhodamine B) assay, types of cell death and cell cycle through flow cytometry and migration ability of human gingival fibroblasts through scratch assay. It was verified that zoledronate had a strong cytotoxic effect in the human gingival fibroblasts, by the reduction of metabolic activity, cell viability, increase of cells in apoptosis and reduction of migration. With the association zoledronate/biphasic calcium phosphate compounds it was possible to reduce or abolish zoledronate toxicity, as it was demonstrated by the absence of differences related to control. In the in vivo study it was used a reproducible experimental model that directly relates chronic bisphosphonate administration with the development of osteonecrosis of the jaw with tooth extraction. This animal model also served as basis to the development of a osteotomy in periapical surgery model with chronic bisphosphonate administration. The animals were treated with zoledronate intraperitoneally, during the four weeks that preceded the surgeries and in the following two and three weeks. The mandibles were macroscopic evaluated, examined by nuclear medicine, radiology and histologically analysed. Concerning nuclear medicine it was used the radiopharmaceutical 99mTc-zoledronate, which was obtained after the development and optimization of a procedure for zoledronate radiochemical labelling, and respective quality control. It has been found that the animals with zoledronate, submitted to tooth extraction, had a higher 99mTc-zoledronate uptake, lower radiological density and histologic images compatible with a decreased healing. With biphasic calcium phosphate compounds application, there were no differences related to controls. In the animals submitted to osteotomy in periapical surgery there were no significant differences related to the controls, in both animals with zoledronate, with and without biphasic calcium phosphate compounds application. This research work allowed the clarification of the goals that led to this thesis. In the created animal model of osteotomy in periapical surgery, it was not observed a significant delay in the wound healing, neither osteonecrosis of the jaw, in the evaluated periods, therefore it was conclude that zoledronate therapeutic may not constitute a risk factor in this surgical approach. Contrarily, in the tooth extraction animal model, it was confirmed that zoledronate therapeutic constitute a risk factor, and it was found that biphasic calcium phosphate compounds presents a potential protector effect from bisphosphonates toxicity. This conclusion was supported by the chemical studies, in which it was observed adsorption of zoledronate, corroborated by the lower toxicity in the in vitro studies and by the improved cicatrisation in the tooth extraction animal model with chronic bisphosphonates administration

Do medical images aid understanding and recall of medical information? An experimental study comparing the experience of viewing no image, a 2D medical image and a 3D medical image alongside a diagnosis

Objective: This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis. Methods: We conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors. Results: Participants preferred to view 3D images alongside a diagnosis (p < .001) and reported greater understanding (p < .001), perceived accuracy (p < .001) and increased trust (p < .001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not. Conclusion: When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information. Practical Considerations: Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations

Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries. A retrospective analysis of nationally representative surveys

Background A quarter of a century ago, two global events—the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing—placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey data and national-level indicators of social determinants from 74 countries to examine change in satisfaction of contraceptive need from a contextual perspective. Methods We searched for individual-level data from repeated nationally representative surveys that included information on sexual and reproductive health, and created a single dataset by harmonising data from each survey to a standard data specification. We described the relative timings of sexual initiation, first union (cohabitation or marriage), and first birth and used logistic regression to show the change in prevalence of sexual activity, demand for contraception, and modern contraceptive use. We used linear regression to examine country-level associations between the gender development index and the expected length of time in education for women and the three outcomes: sexual activity, demand for contraception, and modern contraceptive use. We used principal component analysis to describe countries using a combination of social-structural and behavioural indicators and assessed how well the components explained countrylevel variation in the proportion of women using contraception with fractional logistic regression. Findings In 34 of the 74 countries examined, proportions of all women who were sexually active, not wanting to conceive, and not using a modern contraceptive method decreased over time. Proportions of women who had been sexually active in the past year changed over time in 43 countries, with increases in 30 countries; demand for contraception increased in 42 countries, and use of a modern method of contraception increased in 37 countries. Increases over time in met need for contraception were correlated with increases in gender equality and with women’s time in education. Regression analysis on the principal components showed that country-level variation in met contraceptive need was largely explained by a single component that combined behavioural and social-contextual variables. Interpretation Progress towards satisfying demand for contraception should take account of the changing context in which it is practised. To remove the remaining barriers, policy responses—and therefore research priorities—could require a stronger focus on social-structural determinants and broader aspects of sexual health. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction

A Component Framework for Java-based Real-time Embedded Systems

Rank (CORE): A.International audienceThe Real-Time Specification for Java (RTSJ) is becoming a popular choice in the world of real-time and embedded programming. However, RTSJ introduces many non-intuitive rules and restrictions which prevent its wide adoption. Moreover, current state-of-the-art frameworks usually fail to alleviate the development process into higher layers of the software development life-cycle. In this paper we extend our philosophy that RTSJ concepts need to be considered at early stages of software development, postulated in our prior work, in a framework that provides continuum between the design and implementation process. A component model designed specially for RTSJ serves here as a cornerstone. As the first contribution of this work, we propose a development process where RTSJ concepts are manipulated independently from functional aspects. Second, we mitigate complexities of RTSJ-development by automatically generating execution infrastructure where real-time concerns are transparently managed. We thus allow developers to create systems for variously constrained real-time and embedded environments. Performed benchmarks show that the overhead of the framework is minimal in comparison to manually written object-oriented approach, while providing more extensive functionality. Finally, the framework is designed with the stress on dynamic adaptability of target systems, a property we envisage as a fundamental in an upcoming era of massively developed real-time systems

Sexual identity, attraction and behaviour in Britain: The implications of using different dimensions of sexual orientation to estimate the size of sexual minority populations and inform public health interventions.

BACKGROUND: Sexual orientation encompasses three dimensions: sexual identity, attraction and behaviour. There is increasing demand for data on sexual orientation to meet equality legislation, monitor potential inequalities and address public health needs. We present estimates of all three dimensions and their overlap in British men and women, and consider the implications for health services, research and the development and evaluation of public health interventions. METHODS: Analyses of data from Britain's third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey (15,162 people aged 16-74 years) undertaken in 2010-2012. FINDINGS: A lesbian, gay or bisexual (LGB) identity was reported by 2·5% of men and 2·4% of women, whilst 6·5% of men and 11·5% of women reported any same-sex attraction and 5·5% of men and 6·1% of women reported ever experience of same-sex sex. This equates to approximately 547,000 men and 546,000 women aged 16-74 in Britain self-identifying as LGB and 1,204,000 men and 1,389,000 women ever having experience of same-sex sex. Of those reporting same-sex sex in the past 5 years, 28% of men and 45% of women identified as heterosexual. INTERPRETATION: There is large variation in the size of sexual minority populations depending on the dimension applied, with implications for the design of epidemiological studies, targeting and monitoring of public health interventions and estimating population-based denominators. There is also substantial diversity on an individual level between identity, behaviour and attraction, adding to the complexity of delivering appropriate services and interventions

The long-term impact of the MEMA kwa Vijana adolescent sexual and reproductive health intervention: effect of dose and time since intervention exposure.

BACKGROUND: Despite recent decreases in HIV incidence in many sub-Saharan African countries, there is little evidence that specific behavioural interventions have led to a reduction in HIV among young people. Further and wider-scale decreases in HIV require better understanding of when behaviour change occurs and why. The MEMA kwa Vijana adolescent sexual and reproductive health intervention has been implemented in rural Mwanza, Tanzania since 1999. A long-term evaluation in 2007/8 found that the intervention improved knowledge, attitudes to sex and some reported risk behaviours, but not HIV or HSV2 prevalence. The aim of this paper was to assess the differential impact of the intervention according to gender, age, marital status, number of years of exposure and time since last exposure to the intervention. METHODS: In 2007, a cross-sectional survey was conducted in the 20 trial communities among 13,814 young people (15-30 yrs) who had attended intervention or comparison schools between 1999 and 2002. Outcomes for which the intervention had an impact in 2001 or 2007 were included in this subgroup analysis. Data were analysed using cluster-level methods for stratified cluster-randomised trials, using interaction tests to determine if intervention impact differed by subgroup. RESULTS: Taking into account multiplicity of testing, concurrence with a priori hypotheses and consistency within the results no strong effect-modifiers emerged. Impact on pregnancy knowledge and reported attitudes to sex increased with years of exposure to high-quality intervention. CONCLUSIONS: The desirable long-term impact of the MEMA kwa Vijana intervention did not vary greatly according to the subgroups examined. This suggests that the intervention can have an impact on a broad cross-section of young people in rural Mwanza. TRIAL REGISTRATION: ClinicalTrials.gov NCT00248469

Asking about Sex in General Health Surveys: Comparing the Methods and Findings of the 2010 Health Survey for England with Those of the Third National Survey of Sexual Attitudes and Lifestyles

Including questions about sexual health in the annual Health Survey for England (HSE) provides opportunities for regular measurement of key public health indicators, augmenting Britain's decennial National Survey of Sexual Attitudes and Lifestyles (Natsal). However, contextual and methodological differences may limit comparability of the findings. We examine the extent of these differences between HSE 2010 and Natsal-3 and investigate their impact on parameter estimates

The economic and innovation contribution of universities: a regional perspective

Universities and other higher education institutions (HEIs) have come to be regarded as key sources of knowledge utilisable in the pursuit of economic growth. Although there have been numerous studies assessing the economic and innovation impact of HEIs, there has been little systematic analysis of differences in the relative contribution of HEIs across regions. This paper provides an exploration of some of these differences in the context of the UK’s regions. Significant differences are found in the wealth generated by universities according to regional location and type of institution. Universities in more competitive regions are generally more productive than those located in less competitive regions. Also, traditional universities are generally more productive than their newer counterparts, with university productivity positively related to knowledge commercialisation capabilities. Weaker regions tend to be more dependent on their universities for income and innovation, but often these universities under-perform in comparison to counterpart institutions in more competitive regions. It is argued that uncompetitive regions lack the additional knowledge infrastructure, besides universities, that are more commonly a feature of more competitive regions