BACKGROUND
In Brazil, access to infertility care, including assisted reproductive technology (ART) is restricted. This is a second report of a study which evaluated the availability and access of ...low-income couples to ART services. The objective was to assess the perspective of health professionals and patients with respect to access to ART procedures within the public health network
METHODS
Qualitative case studies were conducted in five centres offering ART in the public sector. Semi-structured interviews were conducted with 19 health professionals based at these centres and 48 patients (men and women). Data were analysed using thematic content analysis.
RESULTS
All services implemented ART procedures using resources already available. In all except one centre, patients had to pay for the drugs used for the procedures and, in some cases, a fee to cover operative costs and supplies. These charges were incompatible with the financial possibilities of the majority of the low-income Brazilian population. The waiting time for access to ART varied between 3 months and 6 years. In the perspective of both patients and health professionals, the government should help centres to offer ART procedures at no cost to low-income populations.
CONCLUSIONS
The low-income Brazilian population has limited access to ART procedures at the public services. The implementation of ART services cannot be based only on initiatives of the professionals involved but must be part of public health policies. One possible solution is to provide ART at lower cost, making it accessible for a large part of the population.
Objectives
The study aims to describe the characteristics of patients presenting to an ED with a fall and evaluate multidisciplinary Care Coordination Team (CCT) referrals on patient outcomes.
...Methods
A single‐centred retrospective analysis of electronic data at an adult tertiary hospital was performed using data from 2004 to 2009 of presentations for patients aged 65 years or over with a fall. The primary outcome measure was representation to hospital within 30 days, comparing patients referred to CCT and those not referred. Secondary outcomes were differences in demographic characteristics, mode of arrival, triage score and readmission.
Results
The proportion of ED patients presenting with a fall and their mean age is stable over time. From 2006 to 2009, 5162 fallers were referred to CCT in a decreasing trend, but with increased urgency. Statistically significant predictors for being referred to CCT were increasing age, being female, arriving by ambulance, being transferred from a nursing home and higher socioeconomic category. Arrival by ambulance and a history of previous falls were associated with representation and readmission. A decreasing trend from 2006 to 2009 was seen in rate ratios and odds ratios via regression modelling for both representation and readmission in patients referred to CCT.
Conclusion
Maturing of the CCT is associated with a decrease in representation and readmission rate. Over time, the CCT attended higher urgency patients associated with stable admission rates. These associations were not significant and the clinical effectiveness of ED CCTs requires further examination.
Methods for ex vivo expansion of natural killer (NK) cells have allowed obtaining enough numbers of human NK cells for clinical trials. However, the evaluation of these methods has been mostly ...limited to haematological malignancies. This study aimed at evaluating a method for selective expansion of NK cells when applied in peripheral blood mononuclear cells (PBMC) of patients with ovarian neoplasia. PBMC from 13 volunteer patients with ovarian neoplasia, seven benign and six malignant tumours, were cultured in CellGro medium supplemented with anti‐CD3 (9–10 initial days), IL‐2 and foetal bovine serum for 21 days. The resulting effector cells were evaluated for their phenotype, cytotoxicity and cytokine secretion. PBMC cultures resulted in multiple populations (NK, NKT and T) of effector cells, enriched with CD56+ lymphocytes. NK cells from patients with benign and malignant ovarian neoplasia were expanded 139.6 ± 63.4 and 82.7 ± 25.3‐fold, respectively, being the largest lymphocyte subtype among CD56+ population. Effector cells expanded from patients with malignant ovarian neoplasia had higher proportion of T lymphocytes and altered cytokine production patterns, characterized by lower INF‐γ, TNF‐α and higher IL‐4, compared with patients with benign ovarian neoplasia. Effector cells were cytotoxic against K562 and OVCAR3 cell lines. Cytotoxicity was significantly higher (P < 0.05) using magnetically separated CD56+ effector cell fractions compared with CD56‐deprived ones. The present study demonstrates the feasibility of the culture system employed to generate effector cells, enriched with CD56+ lymphocytes, from PBMC of patients with ovarian neoplasia. NK cells were the largest lymphocyte subtype among the CD56+ population and the main variable among the final effector cell preparation affecting target cell killing.
A new Large-Acceptance Forward Angle Spectrometer Super Bigbite Spectrometer (SBS), is under development for the upcoming experiments in Hall A at the Thomas Jefferson National Accelerator Facility ...(Virginia, USA), where a longitudinally polarized (up to
) electron beam up to 12 GeV energy is now available. The excellent beam intensity (up to 100
A), combined with innovative polarized targets, will provide luminosity up to
, opening interesting opportunities to investigate unexplored aspects of the inner structure of the nucleons. In one of the most demanding configuration, the new spectrometer will consist of a dipole magnet, one front charged particle tracker, two identical proton polarimeters with related back trackers and a segmented hadron calorimeter.
The front tracker, placed just after the dipole magnet, consists of up to six layers of large area GEM (Gas Electron Multiplier) chambers (
); each chamber is made by three adjacent GEM modules of
active rectangular area (18 modules as a total).
We have chosen the GEM technology in order to optimize spatial resolution (∼80 mm), high hit rate (
), cost/performance and high radiation hardness.
We present the main features of the SBS front tracker and its GEM detectors and, finally, we discuss the ongoing tracker commissioning at JLab and show some representative test results.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective
To establish the effectiveness of a brief intervention to prevent falls in older patients presenting to the ED post‐discharge.
Methods
The present study is a prospective single‐centre, ...quasi‐randomised controlled clinical trial of a brief targeted educational intervention to prevent falls. The intervention group received brief scripted education and were advised of their percentage probability of falling in the next 6 months. The key message was to reinforce the importance of falls prevention strategies and the seriousness of falls.
Results
A total of 412 over 65 years old were recruited; 63 (32.1%) patients in the intervention group and 67 (36.8%) in the control group reported falls in the 6 month follow up period (OR 0.81, 95% confidence interval CI 0.53–1.25, P = 0.34). No significant differences were noted for mortalities (P = 0.54), ED representations (P = 0.15) and medication changes (P = 0.17). Patients receiving intervention had less hospital admissions (P = 0.002) after adjustment for confounding variables. Intervention patients who presented with a fall had significant (P = 0.007) improvement in function at 6 months, whereas those not presenting with a fall experienced functional decline.
Conclusion
A brief intervention was associated with maintenance of function in fallers and reduced hospital admissions, without preventing falls post‐discharge.
To compare the Falls Risk for Older Persons-Community Setting Screening Tool (FROP Com Screen) with the Two-Item Screening Tool in older adults presenting to the ED.
A prospective cohort study, ...comparing the efficacy of the two falls risk assessment tools by applying them simultaneously in a sample of hospital ED presentations.
Two hundred and one patients over 65 years old were recruited. Thirty-six per cent reported falls in the 6-month follow-up period. The area under the receiver operating characteristic curve was 0.57 (95% CI 0.48 to 0.66) for the FROP Com Screen and 0.54 (95% CI 0.45 to 0.63) for the Two-Item Screening Tool. FROP Com Screen had a sensitivity of 39% (95% CI 0.27 to 0.51) and a specificity of 70% (95% CI 0.61 to 0.78), while the Two-Item Screening Tool had a sensitivity of 48% (95% CI 0.36 to 0.60) and a specificity of 57% (95% CI 0.47 to 0.66).
Both tools have limited predictive ability in the ED setting.
Traditional inspection methods are of limited use to detect the presence of fissile (U, Pu) samples inside containers. To overcome such limitations, prototypes of detection systems based on cosmic ...muon scattering from high-Z materials are being tested worldwide. This technique does not introduce additional radiation levels, and each event contributes to the tomographic image, since the scattering process is sensitive to the charge of the atomic nuclei being traversed. A new Project, started by the Muon Portal Collaboration, plans to build a large area muon detector able to reconstruct muon tracks with good spatial and angular resolution. Experimental tests of the individual detection modules are already in progress. The design and operational parameters of the muon portal under construction are here described, together with the preliminary simulation and test results. Due to the large acceptance of the detector for cosmic rays, coupled to the good angular reconstruction of the muon tracks, it is also planned to employ such detector for cosmic ray studies, complementing its detection capabilities with a set of trigger detectors located some distance apart, in order to measure multiple muon events associated to extensive air showers.
STUDY QUESTION
Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis?
SUMMARY ANSWER
It was possible to produce an international ...consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis.
WHAT IS KNOWN ALREADY
Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence.
STUDY DESIGN, SIZE, DURATION
A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement.
MAIN RESULTS AND THE ROLE OF CHANCE
A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman's life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis.
LIMITATIONS, REASONS FOR CAUTION
This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements.
WIDER IMPLICATIONS OF THE FINDINGS
This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.
STUDY FUNDING/COMPETING INTEREST(S)
The World Endometriosis Society commissioned and hosted the consensus meeting. Financial support for participants to attend the meeting was provided by the organizations that they represented. There was no other specific funding for this consensus process. Full disclosures of all participants are presented herein.
The Muon Portal Project aims at the construction of a large volume detector to inspect the content of travelling containers for the identification of high-Z hidden materials (U, Pu or other fissile ...samples), exploiting the secondary cosmic-ray muon radiation. An image of these materials is achieved reconstructing the deviations of the muons from their original trajectories inside the detector volume, by means of two particle trackers, placed one below and one above the container. The scan is performed without adding any external radiation, in a few minutes and with a high spatial and angular resolution. The detector consists of 4800 scintillating strips with two wavelength shifting (WLS) fibers inside each strip, coupled to Silicon photomultipliers (SiPMs). A smart strategy for the read out system allows a considerable reduction of the number of the read-out channels. Actually, an intense measurement campaign is in progress to carefully characterize any single component of the detector. A prototype of one of the 48 detection modules (1 x 3 m super(2)) is actually under construction. This paper presents the detector architecture and the preliminary results.
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