"I think maybe 10 years seems a bit long." Beliefs and attitudes of women who had never used intrauterine contraception

Aim To explore, in a general practice setting, the concerns, beliefs and attitudes about intrauterine contraception (IUC) reported by women, who had never used the methods. Methods We used a sequential mixed-method (QUAL/quant) approach. A pragmatic, self-selecting sample of 30 women, aged 18–46 years, who had never used IUC), was recruited through seven general practices in South East England. Themes arising from qualitative interviews were used to construct a quantitative survey, completed by a pragmatic sample of 1195 women, aged 18–49 years, attending 32 general practices in the same region, between February and August 2015. Results Qualitative themes were concerns about the long-acting nature of IUC, concerns about body boundaries, and informal knowledge of IUC, especially ‘friend of a friend’ stories. Women were not sure if the devices can be removed before their full 5- or 10-year duration of use, and felt that these timeframes did not fit with their reproductive intentions. Quantitative survey data showed that the most commonly endorsed concerns among never-users were painful fitting (55.8%), unpleasant removal of the device (60.1%), and concern about having a device ’inside me' (60.2%). Conclusions To facilitate fully informed contraceptive choice, information provided to women considering IUC should be tailored to more fully address the concerns expressed by never-users, particularly around the details of insertion and removal, and concerns about the adverse, long-term effects of the device. Women need to be reassured that IUC can be removed and fertility restored at any time following insertion

Design and Implementation of a Direct/Indirect Hybrid Trust Model for Secure Authentication in a Mobile Ad Hoc Network

We investigated the problem of cryptographic key authentication in a mobile ad hoc network (MANET). Using the theory of digital trust, we propose an authentication scheme for MANETs that includes a hybrid trust model between the direct and indirect approaches. Our hybrid trust model supplies trust data to a decentralized web of trust in order to authenticate nodes in a MANET. We ran some simulations of our authentication scheme to verify its security and investigate potential trust threshold values. Also, we designed and implemented a proof-of-concept iOS application that implements our authentication scheme. Some future work includes investing several implications of the mobility aspect of MANETs on trust management, such as the maximum levels of trust concatenation

Hearing loss and auditory processing ability in people with aphasia

BACKGROUND: Hearing loss can add to the linguistic deficits present in aphasia to make comprehension of speech difficult. Although some studies document a relatively high prevalence of hearing loss in adults with aphasia, many people with aphasia do not have their hearing tested. Self-reported disability measures offer a possible alternative to pure- tone audiometry when this service is not readily available. AIMS: This study aims to investigate the prevalence of hearing loss in a group of people with aphasia and to determine the usefulness of self-reported measures to screen for hearing impairment. METHODS AND PROCEDURES: Hearing ability was measured using pure-tone audiometry and five measures of auditory processing, which looked at speech perception in quiet and noise, for 21 individuals with aphasia recruited from a community clinic and 21 age- matched individuals without aphasia. The Speech, Spatial and Qualities of Hearing Scale (SSQ) and a brief questionnaire exploring whether they had experienced hearing difficulties were used to measure self-perception of hearing acuity. Differences in scores between the groups were analysed. Correlations and regressions were used to establish the relationship between self-perception of hearing and measures of hearing ability. OUTCOMES AND RESULTS: Despite minimal impairment and a non-significant difference between performance on pure-tone audiometry for participants with and without apha- sia, participants with aphasia performed significantly worse on measures of speech perception in noise than participants without aphasia. They also had a significantly greater degree of perceived hearing disability. Although SSQ scores were correlated with some behavioural measures for the participants with aphasia, the SSQ only predicted the hearing status and speech in noise performance of control participants. CONCLUSIONS: The results suggest that the prevalence of hearing loss for people with aphasia (at least for this group) is no greater than the general population. However, they are significantly more affected in their recognition of speech in noise and experience greater disability in listening situations than people without aphasia. The latter problems were not predicted by pure-tone audiograms or sound-in-noise performance. The brief questionnaire was not effective in identifying hearing impairment, indicating the need for a regular hearing screen to ensure provision of the most effective rehabilitation. Ideally, the screen should include disability and behavioural measures, as our results suggest they cannot replace each other. These findings should assist clinicians in setting realistic goals and delivering interventions in the most effective way for people with aphasia

Predictors of Non-use of Intrauterine Contraception among women aged 18-49 years in a General practice setting in the UK

Objectives: Our research examined the barriers to the uptake of Intrauterine Contraception (IUC) by women in a general practice setting in the UK. This paper reports predictors of non-use of IUC in this context. Design: We used a mixed method QUAL/Quant approach in which initial qualitative research provides a framework for subsequent larger quantitative surveys. Utilising findings derived from 30 qualitative interviews, a quantitative survey was developed and distributed to a pragmatic sample of 1195 women, aged 18-49 years, who were recruited through 32 participating GP practices in an area of England, UK. Outcome measures were percentage of attributes or responses in the sample and use or non-use of IUC. Results were analysed using descriptive statistical analysis and binary logistic regression, using Use/Non-Use as a binary response variable. Results: Attitudinal variables which were the strongest predictors of non-use of IUC were; an adverse opinion on long acting aspect of IUC (OR=8.34), disliking the thought of IUC inside the body (OR=3.138), concerns about IUC causing difficulties becoming pregnant in the future (OR=2.587), concerns about womb damage (OR=2.224), having heard adverse opinions about levonorgestrel - releasing IUS (Mirena®) (OR= 2.551), having an adverse opinion of having light, irregular periods (OR=2.382) and having an adverse opinion of having no periods (OR=2.018). Conclusions: Concerns about the long-acting nature of IUC and persisting concerns about the safety of IUC may act as barriers to its use. Information for women, tailored to specifically address these concerns, is needed

Provider-based barriers to provision of intrauterine contraception in general practice

Objectives: Intrauterine contraception (IUC) is highly effective, safe and long-lasting, but is not a popular method of contraception among British women. This study examined barriers to the uptake of IUC in general practice in England. Method: A sequential mixed-method approach to explore the views of practitioners regarding the provision of IUC. We e-surveyed 208 practitioners from 69 practices in a region of England and subsequently interviewed 14 practitioners from eight practices. Results: Just under half of general practitioners (GPs) (46.8%; 58/124), and only 8.2% (4/49) of nurses reported being trained to fit IUC. Lack of knowledge of IUC was a barrier to fitting, and also to recommending IUC, especially by practitioners who were not trained to fit. There was discordance between reported knowledge of eligibility for IUC and the likelihood of recommending IUC. Respondents were less likely to recommend IUC to young, nulliparous women, women who had experienced a previous ectopic pregnancy, a recent sexually transmitted infection (STI), or an abnormal cervical smear. The qualitative data indicate that risk aversion and limited training, together with practitioners’ assessments that women are uninterested, may lead to IUC being precluded as a suitable method. Conclusions: Increased practitioner education, for those not trained to fit IUC, may remove a barrier to the uptake of IUC in general practice. More research is required on the discordance between the practitioners’ views on the characteristics of women considered suitable for IUC, and the criteria set out in the UK Medical Eligibility Criteria (UKMEC) guidelines

A Lower Bound for Proving Hardness of Learning with Rounding with Polynomial Modulus

Regev\u27s Learning with Errors (LWE) problem (STOC 2005) is a fundamental hardness assumption for modern cryptography. The Learning with Rounding (LWR) Problem was put forth by Banarjee, Peikert and Rosen (Eurocrypt 2012) as an alternative to LWE, for use in cryptographic situations which require determinism. The only method we currently have for proving hardness of LWR is the so-called rounding reduction which is a specific reduction from an analogous LWE problem. This reduction works whenever the LWE error is small relative to the noise introduced by rounding, but it fails otherwise. For this reason, all prior work on establishing hardness of LWR forces the LWE error to be small, either by setting other parameters extremely large (which hurts performance), or by limiting the number of LWR samples seen by the adversary (which rules out certain applications). Hardness of LWR is poorly understood when the LWE modulus ($q$) is polynomial and when the number of LWE samples ($m$) seen by the adversary is an unbounded polynomial. This range of parameters is the most relevant for practical implementations, so the lack of a hardness proof in this situation is not ideal. In this work, we identify an obstacle for proving the hardness of LWR via a reduction from LWE in the above parameter regime. Specifically, we show that any point-wise reduction from LWE to LWR can be used to directly break the corresponding LWE problem. A reduction is point-wise if it maps LWE samples to LWR samples one at a time. Our argument goes roughly as follows: first we show that any point-wise reduction from LWE to LWR must have good agreement with some affine map; then we use a Goldreich-Levin-type theorem to extract the LWE secret given oracle access to a point-wise reduction with good affine agreement. Both components may be of independent interest

Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function

AbstractObjectivesWe sought to determine whether patients with congestive heart failure (CHF) avoid the left lateral decubitus (LLD) position during sleep and, if so, whether this avoidance would be more pronounced in those with greater degrees of cardiomegaly.BackgroundAnecdotal reports suggest that, in patients with CHF, the LLD position is associated with discomfort due to the enlarged apical heart beat and greater degree of dyspnea (trepopnea) than other positions. It has also been suggested that the LLD position is associated with increased sympathetic nervous activity.MethodsA total of 75 patients with CHF and 75 control subjects underwent nocturnal polysomnography with monitoring of body position. Echocardiography was performed in all patients with CHF to determine left ventricular end-diastolic diameter (LVEDD). A total of 40 patients underwent cardiac catheterization from which pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were obtained.ResultsPatients with CHF spent significantly less time in the LLD position than in the right lateral decubitus position. No such difference was observed among control subjects. Among patients with CHF, those with larger LVEDD, higher PCWP, and lower CO spent less time in the LLD position.ConclusionsPatients with CHF avoid the LLD position spontaneously during sleep. This may be a protective strategy to avoid discomfort from the enlarged apical heart beat or further hemodynamic or autonomic compromise

Experimental evidence of a natural parity state in 26^{26}Mg and its impact to the production of neutrons for the s process

We have studied natural parity states in $^{26}$Mg via the $^{22}$Ne($^{6}$Li,d)$^{26}$Mg reaction. Our method significantly improves the energy resolution of previous experiments and, as a result, we report the observation of a natural parity state in $^{26}$Mg. Possible spin-parity assignments are suggested on the basis of published $\gamma$-ray decay experiments. The stellar rate of the $^{22}$Ne($\alpha$,$\gamma$)$^{26}$Mg reaction is reduced and may give rise to an increase in the production of s-process neutrons via the $^{22}$Ne($\alpha$,n)$^{25}$Mg reaction.Comment: Published in PR