Group A Streptococcus in the Gynecologic Patient

Background: Over the past few decades, physicians have been reminded of the potential for serious complications arising from group A streptococcal (GAS) infections. These infections continue to pose a serious threat, primarily because the pathophysiology of these infections is complex. This article reviews some of the features of GAS infections and presents two case reports of GAS pelvic infections in women

The impact of introducing patient co-payments in Germany on the use of IVF and ICSI:a price-elasticity of demand assessment

BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany. METHODS: Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from 'no fees' to (sic)1500-2000 by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology. RESULTS: The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of -0.41 and -0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be -0.36. The cross-price elasticity for clomifene was close to zero (-0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred. CONCLUSIONS: We report price elasticities for IVF and ICSI of -0.41 and -0.34 after introducing a (sic)1500-2000 co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change

What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

Background: Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all made important contributions to our understanding of the FP decision-making process, none of them examine solely and specifically these processes for women of reproductive age with a diagnosis of any cancer, leaving a gap in the knowledge base. Given the expectation that care is patient-centred, our review aims to address this gap which may be of help to those managing patients struggling to make difficult decisions in the often brief period before potentially sterilising cancer treatment is started. Objective and rationale: Underpinning this narrative review was the question “What factors hinder the decision-making process for women with any cancer and contemplating FP treatment?” Our objectives were to i) assess and summarise this existing literature, ii) identify the factors that hinder this decision-making process, iii) explore to what extent these factors may differ for women choosing different methods of FP, and iv) make recommendations for service delivery and future research. Search methods: A systematic search of the medical and social science literature from the 1st January 2005 up to the end of January 2016 was carried out using three electronic databases (Web of Science (PubMed), Ovid SP Medline and CINAHL via Ebsco). Included in the review were quantitative, qualitative and mixed-method studies. Reference lists of relevant papers were also hand searched. From the 983 papers identified, 46 papers were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and thematic analysis was used to analyse the data. Outcomes: From the analysis, six key themes with 15 sub-themes emerged: 1) fertility information provision (lack of information, timing of the information, patient-provider communication); 2) fear concerning the perceived risks associated with pursuing FP (delaying cancer treatment, aggravating a hormone positive cancer, consequences of a future pregnancy); 3) non-referral from oncology (personal situation, having a hormone positive cancer, not a priority, transition between service issues); 4) the dilemma (in survival mode, whether to prioritise one treatment over another); 5) personal situation (parity, relationship status); and 6) costs (financial concerns). Wider implications: This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women’s fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these ‘risks’ were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Health care professionals in both oncology and fertility services may also benefit from the implementation of training programs and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poor prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research

The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: A longitudinal, mixed methods study

© 2015 The Authors.Objective: To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy. Methods: Prospective, longitudinal, mixed-methods study. Twenty-three women aged >18 years with a new diagnosis of vulval cancer were recruited. The EORTC QLQ C30, SF-36 and an electronic pelvic floor assessment questionnaire (ePAQ-PF) were administered at baseline (pre-treatment) and 3, 6, 9 and 12 months post-treatment. Mixed effects repeated measures models (all adjusted for age and BMI) were used to investigate changes over time and differences between cancer stage. Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach. Results: Mean age was 59.9 years (SD=15.3; range=23.8-86.6 yrs). Mean BMI was 30.0 (SD=4.5; range=24.4-38.2). Sixteen women had early (Stage 1 to 2B), and seven women had advanced stage disease (Stage 3 to 4B). Questionnaire scores revealed that physical and social functioning, fatigue, pain and general sex life were significantly worse at 12 months than pre-treatment (p=< 0.05). Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring. Women with advanced vulval cancer had significantly worse SF-36 mental health scores at 12 months compared to women with early stage disease (p=0.037). Conclusions: Surgery for vulval cancer has long-term implications which can be persistent 12 months post-treatment. High rates of morbidity relating to lymphoedema and sexual function re-enforce the need for specialist clinics to support women who suffer these complications

Characterisation of multiple conducting permeable objects in metal detection by polarizability tensors

Realistic applications in metal detection involve multiple inhomogeneous‐conducting permeable objects, and the aim of this paper is to characterise such objects by polarizability tensors. We show that, for the eddy current model, the leading order terms for the perturbation in the magnetic field, due to the presence of N small conducting permeable homogeneous inclusions, comprises of a sum of N terms with each containing a complex symmetric rank 2 polarizability tensor. Each tensor contains information about the shape and material properties of one of the objects and is independent of its position. The asymptotic expansion we obtain extends a previously known result for a single isolated object and applies in situations where the object sizes are small and the objects are sufficiently well separated. We also obtain a second expansion that describes the perturbed magnetic field for inhomogeneous and closely spaced objects, which again characterises the objects by a complex symmetric rank 2 tensor. The tensor's coefficients can be computed by solving a vector valued transmission problem, and we include numerical examples to illustrate the agreement between the asymptotic formula describing the perturbed fields and the numerical prediction. We also include algorithms for the localisation and identification of multiple inhomogeneous objects

Prehistory of Transit Searches

Nowadays the more powerful method to detect extrasolar planets is the transit method. We review the planet transits which were anticipated, searched, and the first ones which were observed all through history. Indeed transits of planets in front of their star were first investigated and studied in the solar system. The first observations of sunspots were sometimes mistaken for transits of unknown planets. The first scientific observation and study of a transit in the solar system was the observation of Mercury transit by Pierre Gassendi in 1631. Because observations of Venus transits could give a way to determine the distance Sun-Earth, transits of Venus were overwhelmingly observed. Some objects which actually do not exist were searched by their hypothetical transits on the Sun, as some examples a Venus satellite and an infra-mercurial planet. We evoke the possibly first use of the hypothesis of an exoplanet transit to explain some periodic variations of the luminosity of a star, namely the star Algol, during the eighteen century. Then we review the predictions of detection of exoplanets by their transits, those predictions being sometimes ancient, and made by astronomers as well as popular science writers. However, these very interesting predictions were never published in peer-reviewed journals specialized in astronomical discoveries and results. A possible transit of the planet beta Pic b was observed in 1981. Shall we see another transit expected for the same planet during 2018? Today, some studies of transits which are connected to hypothetical extraterrestrial civilisations are published in astronomical refereed journals. Some studies which would be classified not long ago as science fiction are now considered as scientific ones.Comment: Submiited to Handbook of Exoplanets (Springer

Accelerating magnetic induction tomography‐based imaging through heterogeneous parallel computing

Magnetic Induction Tomography (MIT) is a non‐invasive imaging technique, which has applications in both industrial and clinical settings. In essence, it is capable of reconstructing the electromagnetic parameters of an object from measurements made on its surface. With the exploitation of parallelism, it is possible to achieve high quality inexpensive MIT images for biomedical applications on clinically relevant time scales. In this paper we investigate the performance of different parallel implementations of the forward eddy current problem, which is the main computational component of the inverse problem through which measured voltages are converted into images. We show that a heterogeneous parallel method that exploits multiple CPUs and GPUs can provide a high level of parallel scaling, leading to considerably improved runtimes. We also show how multiple GPUs can be used in conjunction with deal.II, a widely‐used open source finite element library

Extreme low flow effects on riverine fauna: a perspective on methodological assessments

River flow regimes face increasing pressure from human activities including water resource management operations and climate change. Consequently, extreme hydrological events are becoming more severe and commonplace, and there is a pressing need to understand and manage their ecological effects. Extreme low-flows (ELFs) – those displaying significantly greater magnitudes and durations than typical low-flow conditions – are being increasingly experienced globally. Fish and macroinvertebrate responses to ELFs have been more widely researched relative to other organism groups in riverine environments, although such studies have employed variable methodological techniques. In this perspective piece, we identify field-based assessments and controlled experiments as two key research paradigms used to examine riverine faunal responses to ELFs. Field-based assessments are often explorative and can benefit from utilising large-scale and long-term datasets. Alternatively, controlled experiments typically employ more hypothesis-driven approaches and can establish strong cause and effect linkages through high replication and control over potentially confounding parameters. Each paradigm clearly possesses their respective strengths, which we highlight and discuss how these could be better harnessed to optimise scientific advancements. To date, studies examining faunal responses to ELFs in these two research paradigms have largely been undertaken in parallel. Here, we argue that future research should seek to develop closer synergies to optimise the quality and quantity of evidence to better understand riverine faunal responses to ELFs. Such scientific advances are of paramount importance given the vulnerability of riverine fauna, and the ecosystems they comprise, as they face a new era of ELFs in many global regions