CT appearance and features of tubal pregnancy

International Nuclear Information System (INIS)

Wang Xiaohong; Shan Hong; Jiang Zaibo; Deng Xinghe; Meng Xiaochun; Ye Bingbing; Luo Mingyue; Lin Yunya

2004-01-01

Objective: To investigate the CT appearance and features of tubal pregnancy. Methods: Precontrast and postcontrast CT scans were employed in 38 patients who were clinically and ultrasonographically suspected of tubal pregnancy. 34 of them were verified as tubal pregnancy through operative pathology. Results: 1. The direct CT imaging feature was the whole pregnancies sac (4/34, 11.8%) or half-baked pregnancies sac (14/34, 41.2%); 2. The indirect CT imaging features were: (1) abnormal density image, which could be enhanced, in a cystic mass around adnexal area (8/34, 23.5%); (2) mix density mass around adnexal area, which was mainly solid and had mild to moderate inhomogeneous enhancement (19/34, 55.9%); (3) large area irregular shadow with high density were found beside the uterus, with no enhancement (3/34, 8.8%). (4) bloody density in uterus-rectum-fossa (23/34, 67.6%). 3. The CT imaging features of tubal pregnancy was classified as: (1) Pregnant sac type (4/34, 11.8%); (2) Cystic (8/34, 23.5%); (3) Massive type (17/34, 50%); (4) Chronic mass type (2/34, 5.9%); (5) Bleeding type (3/34, 8.8%). 4. The CT imaging appearance of tubal pregnancy related with the pregnancy location; 5. The CT imaging appearance of tubal pregnancy related with the clinical significant. Conclusion: The CT imaging appearance of tubal pregnancy has some features, which can help in the diagnosis or differential diagnosis of the pelvis masses. CT scan is an effective supplementary attempt to the clinically and ultrasonographically suspected tubal pregnancy patients

Cost-effectiveness of tubal patency tests.

Science.gov (United States)

Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

2013-04-01

Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

Science.gov (United States)

Moaddab, Amirhossein; McCullough, Laurence B; Chervenak, Frank A; Fox, Karin A; Aagaard, Kjersti Marie; Salmanian, Bahram; Raine, Susan P; Shamshirsaz, Alireza A

2015-06-01

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.

Ultrasonogram of tubal pregnancy: Unruptured or ruptured?

International Nuclear Information System (INIS)

Lee, Hee Jung; Kim, Jung Sik; Lee, Sung Moon; Kim, Hong; Woo, Seong Ku; Yeun, Seong Do; Lee, Doo Ryong

1993-01-01

To evaluate the usefulness of ultrasonography in the differentiation of the unruptured ones, we performed prospective ultrasonographic study in 56 patients with tubal pregnancy and subsequently correlated with the surgical (45 cases) and laparoscopic (11 cases) findings. The criterion for unruptured tubal pregnancy was the visualization of extra uterine gestational sac or a mass that was separated from the ipsilateral ovary. All cases were confirmed surgically or laparoscopically within 48 hours after sonographic examination. Forty five (80%)cases were proved as unruptured, tubal pregnancy, while 11 (20%) as ruptured one. Extra uterine gestational sac was seen in 31/45 (69%) in unruptured group and 2/11 (18%) in ruptured group. A mass separated from the ipsilateral ovary was seen in 7 unruptured tubal pregnancies and 2 ruptured pregnancies. A mass that was not separated from the ipsilateral ovary was seen in 13 cases. Seven of these were ruptured pregnancies, while 6 were unrupture dones. Using our criteria, the unruptured tubal pregnancy was diagnosed with a sensitivity of 84%, a specificity of 64%, an accuracy of 80%, a positive predictive value of 90% and a negative predictive value of 50%. We conclude that ultrasonography is useful in the differentiation of the unruptured tubal pregnancy from the ruptured one

High Titers of Chlamydia trachomatis Antibodies in Brazilian Women with Tubal Occlusion or Previous Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

A. C. S. Machado

2007-01-01

Full Text Available Objective. To evaluate serum chlamydia antibody titers (CATs in tubal occlusion or previous ectopic pregnancy and the associated risk factors. Methods. The study population consisted of 55 women wih tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. Results. The prevalence of chlamydial antibodies and antibody titers in women with tubal occlusion or previous ectopic pregnancy was significantly higher (P<.01 than in parous women. Stepwise logistic regression analysis showed that chlamydia IgG antibodies were associated with tubal damage and with a larger number of lifetime sexual partners. Conclusions. Chlamydia antibody titers were associated with tubal occlusion, prior ectopic pregnancy, and with sexual behavior, suggesting that a chlamydia infection was the major contributor to the tubal damage in these women.

Selective transcervical tubal recanalisation using DSA

International Nuclear Information System (INIS)

Kelekis, D.; Fezoulidis, I.; Petsas, T.; Tsapalira, A.; Kelekis, N.

1991-01-01

The results of selective transcervical tubal recanalisation by means of a catheter in 20 patients with tubal occlusions are reported and discussed. The advantages of tubal recanalisation under DSA are stressed. In 18 (90%) of the 20 patients treated, it was possible to recanalise at least one tube. Nine of these 18 women (50%) became pregnant during the period of observation, averaging 12 months. Selective transcervical recanalisation of obstructive tubes is a rapid, reliable, cheap and hardly invasive treatment of sterility, when compared with laparoscopy or laparotomy. In the majority of patients it makes surgery unnecessary. (orig.) [de

Fluoroscopically Guided Transcervical Fallopian Tube Recanalization of Post-Sterilization Reversal Mid-Tubal Obstructions

International Nuclear Information System (INIS)

Houston, J. Graeme; Anderson, David; Mills, John; Harrold, Anthony

2000-01-01

Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined.Results: Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23-37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12-28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies.Conclusions: FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion

LEF1 is preferentially expressed in the tubal-peritoneal junctions and is a reliable marker of tubal intraepithelial lesions.

Science.gov (United States)

Schmoeckel, Elisa; Odai-Afotey, Ashley A; Schleißheimer, Michael; Rottmann, Miriam; Flesken-Nikitin, Andrea; Ellenson, Lora H; Kirchner, Thomas; Mayr, Doris; Nikitin, Alexander Yu

2017-09-01

Recently it has been reported that serous tubal intraepithelial carcinoma (STIC), the likely precursor of ovarian/extra-uterine high-grade serous carcinoma, are frequently located in the vicinity of tubal-peritoneal junctions, consistent with the cancer-prone features of many epithelial transitional regions. To test if p53 (aka TP53)-signatures and secretory cell outgrowths (SCOUTs) also localize to tubal-peritoneal junctions, we examined these lesions in the fallopian tubes of patients undergoing salpingo-oophorectomy for sporadic high-grade serous carcinomas or as a prophylactic procedure for carriers of familial BRCA1 or 2 mutations. STICs were located closest to the tubal-peritoneal junctions with an average distance of 1.31 mm, while SCOUTs were not detected in the fimbriated end of the fallopian tube. As many epithelial transitional regions contain stem cells, we also determined the expression of stem cell markers in the normal fallopian tube, tubal intraepithelial lesions and high-grade serous carcinomas. Of those, LEF1 was consistently expressed in the tubal-peritoneal junctions and all lesions, independent of p53 status. All SCOUTs demonstrated strong nuclear expression of β-catenin consistent with the LEF1 participation in the canonical WNT pathway. However, β-catenin was preferentially located in the cytoplasm of cells comprising STICs and p53 signatures, suggesting WNT-independent function of LEF1 in those lesions. Both frequency of LEF1 expression and β-catenin nuclear expression correlated with the worst 5-year patient survival, supporting important role of both proteins in high-grade serous carcinoma. Taken together, our findings suggest the existence of stem cell niche within the tubal-peritoneal junctions. Furthermore, they support the notion that the pathogenesis of SCOUTs is distinct from that of STICs and p53 signatures. The location and discrete patterns of LEF1 and β-catenin expression may serve as highly sensitive and reliable ancillary

Interventional treatment of un-ruptured tubal pregnancy

International Nuclear Information System (INIS)

Shan Hong; Ma Zhuang; Jiang Zaibo; Yan Ying; Guan Shouhai; Zhu Kangshun; Huang Mingsheng; Chen Hanwei

2000-01-01

Objective: To discuss some concept about interventional treatment of tubal pregnancy. Methods: The procedure of trans-vaginal tubal intra-gestational SAC injection (IGSI) or percutaneous intra-utero-arterial infusion (IUAI) was selected for treatment of 40 patients with un-ruptured tubal pregnancy. Methotrexate (MTX), Rosch-Thurmoud fallopian tube catheterization set, and the general angiographic catheters of 4.1-5.0 F were used for the procedure. Ultrasound and urine beta-hCG were the main indexes monitoring the therapeutic effects. Results: 12 of 40 patients underwent a total of 15 IGSI. Of these, 3 patients required a second injection; 28 of 40 cases were treated with IUAI. The total successful rate of termination of ectopic pregnancy was 97.5%, the mean resolution time for reduction of beta-hCG concentration was 11.7 days (range 4-28), the range of menstruation recovery time was 7-45 days. Conclusion: The interventional therapy for tubal pregnancy will be more widely applied, on the basis of a better understanding about the pathology, characteristics of embryonic sac development and blood supply, the regular change of concentration of serum and urine hCG in tubal pregnancy

Ovarian and tubal cancer in Denmark

DEFF Research Database (Denmark)

Gottschau, Mathilde; Mellemkjaer, Lene; Hannibal, Charlotte G

2016-01-01

INTRODUCTION: The Nordic countries are areas with a high-incidence of ovarian cancer; however, differences between the countries exist. MATERIAL AND METHODS: We used the Danish Cancer Registry to identify 11 264 cases of ovarian cancer and 363 cases of tubal cancer during 1993-2013. We calculated...... age-standardized (world standard population) incidence rates for overall and subtype-specific ovarian cancer, and for tubal cancer. We compared age-standardized incidence rates, and 1- and 5-year age-standardized relative survival rates, respectively, for ovarian and tubal cancer combined in four...... Nordic countries using the NORDCAN database. RESULTS: The incidence rate of ovarian cancer overall in Denmark decreased statistically significantly by approximately 2.3% per year among women aged

Adnexal mass in tubal pregnancy

International Nuclear Information System (INIS)

Lee, Hee Jung; Kim, Jung Sik; Chu, Yang Ku

1993-01-01

Off the evaluation of clinical significance and pathologic correlation of echogenic adnexal mass in tubal pregnancy, which is separated from ipsilateral ovary, we performed a retrospective analysis of 15 proved tubal pregnancies. All showed hematosalpinx containing blood coagulum and chorionic villi with intact fallopian tube.The echogenicity of the adnexal mass was considered to represent the nonclotted or clotted blood within the fallopian tube. We conclude that the discrete, echogenic adnexal mass is the suggestive finding of unrupturedtubal pregnancy

Induced Abortion and the Risk of Tubal Infertility

Institute of Scientific and Technical Information of China (English)

无

2008-01-01

Objective To explore the association between induced abortion and tubal infertility in Chengdu, China.Methods A 1 :2 case-control study was designed. Infertile women with bilateral tubal occlusion in the case group compared with two control groups: infertile control group with bilateral tubal patency and pregnant control group with currently pregnancy. Data were collected using questionnaires through face-to-face interviews, covering the subjects' demographic details and histories of gynecology and obstetrics. Adjusted odds ratio was calculated as a measure of the association using stepwise multiple logistic regression analysis.Results Induced abortion was not found to be associated with tubal infertility in the analysis including either the infertile controls or the pregnant controls, but other risk factors were found, such as history of acute pelvic inflammatory disease (PID), lower abdominal surgeries, dysmenorrhea and pregnancy.Conclusion It is contended that facing an increasing trend of infertile cases with tubal occlusion in China, it is emphasized that special attention should paid to the long term impact of reproductive tract infection, especially, asymptomatic ones, rather than induced abortion.

Spontaneous Unruptured Bilateral Tubal Pregnancy: A Case Report

Directory of Open Access Journals (Sweden)

Nayereh Ghomian

2015-11-01

Full Text Available Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality.

Ectopic pregnancy after two times tubal ligation: a case report

Directory of Open Access Journals (Sweden)

Farideh Keypour

2013-06-01

Full Text Available Background: Tubal sterilization is the permanent and effective contraception method. This can be performed at any time, but at least half are performed in conjunction with cesarean or vaginal delivery and are termed puerperal. The most complication after tubal ligation is ectopic pregnancy. Ectopic pregnancy is the leading cause of maternal death in first trimester.Case presentation: We present a 33 years old woman gravida5, para4, all normal vaginal delivery, presented with complaints of delayed menstrual period, pelvic pain and spotting. She underwent tubal ligation for two times. For the first time she had puerperal Pomeroy tubal sterilization after third child delivery. Intra uterine pregnancy occurred three years later. One day after vaginal delivery of fourth child, she underwent post partum tubal ligation with the Parkland method. Tubal pregnancy occurred nine months later. Physical examination identified acute abdomen. Pelvic ultrasound showed no gestational sac in uterine cavity. The sac with fetal pole was in right adnexa. Beta-HCG was 2840mIU/ml. She underwent laparotomy. Surgical management included salpingectomy with cornual resection in both sides. The surgery identified Ectopic pregnancy.Conclusion: Any symptoms of pregnancy in a woman after tubal ligation must be investigated; an ectopic pregnancy should be excluded. Ectopic pregnancy must be considered, in any woman with lower abdominal pain, missed period and vaginal bleed-ing. Conception after tubal sterilization can be explained by fistula formation and re-canalization of fallopian tube.

Clinical observation of interventional treatment for tubal pregnancy

International Nuclear Information System (INIS)

Chen Zhilin; Zhang Qing; Ye Lijing; He Mei

2002-01-01

Objective: To investigate a new method to of conservative treatment of treat tubal pregnancy. Methods: 20 cases of tubal pregnancy were treated by two conservative methods. Among them, 10 cases received single dose 5-fluorouracil perfusion through the super selective catheterization for uterus artery. Others took RU486 orally and received intra-muscular injection of testosterone. Results: Hospitalization was shorter, less salpingectomy was recommended, and blood HCG decreased faster in interventional group, than in control group. Conclusion: The 5-fluorouracil interventional treatment had its advantages for tubal pregnancy

Interventional therapy for tubal pregnancy (report of 20 cases)

International Nuclear Information System (INIS)

Cao Xusheng; Gu Tongxiao; Liu Huisheng; Zhang Junfeng; Huang Jinyou; Hu Xiumin

2000-01-01

Objective: To search an approach to treat tubal pregnancy in a safe and economic way. Methods: 20 cases of tubal pregnancy were studied. Under fluoroscopic guidance, a 3F catheter was introduced to the site of tubal gestation through the uterine cavity, and methotrexate 30 mg in 10 ml saline was injected. Results: On the 5th day after operation, the level of serum hCG began to decline reaching the normal value on the 21 st-28 th day. The gestation sac was absorbed after 2-2.5 months. In 6 cases the fallopian tube was re-canalized after 3 months. Conclusion: Interventional therapy is a valuable and practical method for tubal pregnancy

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

Directory of Open Access Journals (Sweden)

Daniel Spadoto Dias

Full Text Available CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation.DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital.METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used.RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001, premenstrual symptoms (P < 0.001, dysmenorrhea (P = 0.019 and noncyclic pelvic pain (P = 0.001; and reductions in the number of sexual intercourse occurrences per week (P = 0.001 and in libido (P = 0.001. Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions.CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.

Tubal ligation and risk of ovarian cancer subtypes

DEFF Research Database (Denmark)

Sieh, Weiva; Salvador, Shannon; McGuire, Valerie

2013-01-01

Tubal ligation is a protective factor for ovarian cancer, but it is unknown whether this protection extends to all invasive histological subtypes or borderline tumors. We undertook an international collaborative study to examine the association between tubal ligation and ovarian cancer subtypes....

The diagnosis and treatment of tubal pregnancy with selective salpingography

International Nuclear Information System (INIS)

Li Qunying

2000-01-01

Objective: To study feasibility of diagnosing and treating tubal pregnancy with selective salpingography. methods: 13 women diagnosed clinically as ectopic pregnancy without abdominal bleeding were studied and confirmed as tubal pregnancy with selective salpingography, MTX was then injected through fallopian tube. Urine hCG, blood β-hCG and US were studied during follow-up. Results: 12 cases tubal pregnancy were confirmed as well as 1 case of intra-uterine pregnancy. X-ray showed a localized dilation of fallopian tube, half-loop, ring-like or irregular shaped filling defect. In one case, cluster of grapes appearance of contrast medium could be seen at the umbrella end of fallopian tube. Of the 12 cases of tubal pregnancy, 10 were successfully treated, the successful rate was 83%. Conclusion: Selective salpingography is a simple safe and effective method of diagnosing and treating tubal pregnancy

Risk factors for abnormal tubal hysterosalpingographic findings in ...

African Journals Online (AJOL)

Background: Acquired structural abnormalities of the female reproductive tract contributes to the aetiology of female infertility. So many presumed risk factors for female tubal infertility are seen among Nigerian women. However, reports on the relationship between these factors and tubal pathology as seen on ...

A case of bilateral tubal pregnancy

Directory of Open Access Journals (Sweden)

Ayano Funamizu

2017-11-01

Full Text Available Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG-human chorionic gonadotropin (hCG, and became pregnant. A gestational sac (GS was not detected in the uterus and transvaginal ultrasonography (USG revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Keywords: bilateral tubal pregnancy, ectopic pregnancy, human menopausal gonadotropin, laparoscopy

Association between history of abdominopelvic surgery and tubal ...

African Journals Online (AJOL)

EB

women. Reports on the relationship between these factors and tubal pathology seen on hysterosalpingography (HSG) from our .... (2) tubal dilatation with prolonged retention of ... irrespective of whether the patient has had single or .... women marry earlier in our culture. ... Münstedt K, Tinneberg HR, Hackethal A. Dtsch.

Microsurgical tubal recanalization: A hope for the hopeless

Directory of Open Access Journals (Sweden)

Jain M

2003-01-01

Full Text Available Objective: To analyse the various factors affecting pregnancy rate after microsurgical tubal recanalisation. Design: Prospective study, follow-up of 5 years in patients treated with tubal microsurgery. Setting: Referral Tertiary Care Hospital. Patients: Fifty women underwent microsurgical tubal recanalisation procedure. Principles of microsurgery were followed throughout the procedure meticulously. Interventions: Microsurgical tubal recanalisation. Main outcome measure: Pregnancy rate. Results: With microsurgery, an overall 60% pregnancy rate was achieved. In these patients, pregnancy outcome was in form of intrauterine pregnancy (96.66%, ectopic pregnancy (3.33%, term viable pregnancy (96.55% and spontaneous abortion (3.45%. Conclusions: The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation & the remaining length of the tube after recanalisation. The microsurgical technique should be available at specialized centres to improve the success of family planning services.

Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman

Directory of Open Access Journals (Sweden)

K. H. Odubamowo

2014-01-01

Full Text Available Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3+0 (3 alive woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days’ duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide. Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

Discordant relationship between Essure microinsert position and tubal occlusion.

Science.gov (United States)

Hou, Melody Y

2016-07-27

Hysteroscopic sterilisation with Essure requires confirmation of tubal occlusion by hysterosalpingogram or microinsert position by transvaginal sonography 3 months after placement before women can rely on the method for pregnancy prevention. A 39-year-old woman underwent hysteroscopic sterilisation via Essure, with successful bilateral tubal occlusion documented on hysterosalpingogram. She had a subsequent unintended pregnancy and termination, and presented with persistent pelvic pain and other non-specific symptoms. She underwent a laparoscopic-assisted vaginal hysterectomy with bilateral salpingectomy, with complete resolution of her symptoms. Pathological evaluation demonstrated a perforated Essure microinsert and ipsilateral tubal occlusion, and a correctly placed Essure microinsert with ipsilateral tubal patency. Clinicians should be cautious about the assumption that correctly placed microinserts based on ultrasonography, hysterosalpingogram or laparoscopic evaluation assures occlusion success. 2016 BMJ Publishing Group Ltd.

Chlamydial Infection, Plasma Peroxidation and Obesity in Tubal ...

African Journals Online (AJOL)

Objective: This study aimed to investigate the association of Chlamydial infection, obesity and oxidative response with tubal infertility in Nigerian women. Methods: It was a case-control study of 40 women with tubal infertility and 32 fertile women, respectively, recruited from the Infertility and Family Planning Clinics ...

Preliminary study of interventional treatment for tubal pregnancy

International Nuclear Information System (INIS)

Tang Yukuan; Chen Hanwei; Li Kaifang; Jiang Zaibo; Ma Zhuang; Liu Huanling

2000-01-01

Objective: To study the clinical value and methods of interventional treatment for tubal pregnancy. Methods: Two different methods were used in the interventional treatment of 18 patients with tubal pregnancy, which were transvaginal tubal intra-gestational methotrexate (MTX) injection and intra-utero-arterial MTX infusion. The former was selected for the treatment of 8 patients and the latter for 10 patients. Cook-fallopian tube catheterization set and the general angiographic catheters of 4.1 Fr Cobra were used. After the treatment, conditions of the patients, β-HCG level and ultrasound changes of the pregnant bladder were the main indexes for monitoring the therapeutic effect in this study. Results: The successful rate, cure rate, embryo killing rate reached 100%, 88.9%(16/18) and 94.4% (17/18) respectively. Two cases of intra-utero-arterial MTX infusion treatment failed, β-HCG was reduced to normal level with an average of 11.2 +- 11.6 d (3-28 d). In 10 cases, the ultrasound showed that the pregnancy bladder disappeared in 2-3 weeks, accounting for 76.9% (10/13). The longest time was 60 days. The range of menstruation recovery was 37 +- 9 d (21-50 d). Conclusions: Interventional treatment of tubal pregnancy is effective, reliable and easy for operation. It will be especially effective by arterial procedure. Interventional treatment will be a important method for terminating tubal pregnancy

Ectopic pregnancy with tubal rupture: an analysis of 80 cases

International Nuclear Information System (INIS)

Ashfaq, S.; Aziz, S.; Hasan, M.; Sultan, S.; Irfan, S.M.

2017-01-01

Ectopic pregnancy (EP) is a major problem in obstetrics as there is evidence of increasing incidence throughout the world. It is an important cause of maternal morbidity and mortality. In Pakistan, the care seeking behaviour among female is limited that makes female vulnerable to die due to complication of ectopic pregnancy. The aim of this study is to determine the frequency of tubal rupture in ectopic pregnancy in Pakistani patients. Method: In this cross-sectional study data pertaining to age, gestational age, parity and duration of presenting symptoms were collected and analysed. Result: 80 patients were diagnosed to have ectopic pregnancy. The frequency of tubal rupture was 91.25%. It is encountered significantly more often in women with age of 26 years. More tubal rupture is found in patient with low parity, in which the frequency of tubal rupture is up to 100% and decrease up to 78.6% with increasing parity up to four. Furthermore, it is noted that increase in gestational age from 8 weeks to 10 weeks caused an increase in frequency of tubal rupture from 80 to 100% respectively. It is also noted that earlier the patient presents the lesser is the frequency of tubal rupture, as compared to late presentation beyond 3-4 days which make frequency up to 95%. Conclusion: Tubal rupture is still common cause of maternal morbidity and mortality, and is still a major challenge in gynaecological practice. Creating awareness amongst midwives and GPs regarding early diagnosis can contribute to decrease the mortality, morbidity and fertility loss related to EP. (author)

Transuterinal artery interventional therapy for fallopian tubal pregnancy

International Nuclear Information System (INIS)

Jiang Zaibo; Shan Hong; Guan Shouhai; Ma Zhuang; Huang Mingsheng; Li Zhengran; Zhu Kangshun; Chen Hanwei; Xiao Jibo; Mu Yongsheng

2001-01-01

Objective: To study the methods and clinical effect of transuterinal artery interventional therapy of fallopian tubal pregnancy. Methods: The authors cured 34 cases of fallopian tubal pregnancy by interventional methods. In the procedure, 4.1 - 5.0 F catheters were used for performing super selective angiography in uterine artery and then infusing Methotrexate 50-100 mg. Finally gelfoam particles or stripes were used to embolise uterine artery. Before and after the procedure, patients showed changes of clinical symptom, physical signs. Value of urine β-hCG and size of pregnancy cyst were studied. Results: 31 cases were succeeded. The successful rate was 91%. 37 fallopian tubal arteries were displayed in 40 uterine arterial angiographies. The stain of ovary was shown done in 21 cases, the appearance rate was 68%. The stain of pregnant cyst was in six cases, the appearance rate was 18%. Conclusion: It is safe and efficient in performing transuterine artery chemo-embolization for therapy of fallopian tubal pregnancy. It could prevent and control fatal bleeding induced by pregnancy cyst rupture

Laparoscopic reconstructive tubal surgery in a tertiary referral centre ...

African Journals Online (AJOL)

Objectives. To establish the pregnancy rate (PR) following endoscopic reconstructive tubal surgery in patients with tubal disease presenting to the Reproductive Medicine Unit at Groote Schuur Hospital between January 1994 and December 1997. Design. A prospective descriptive study utilising the Hulka classification ...

Ruptured tubal molar pregnancy

African Journals Online (AJOL)

2011-05-19

May 19, 2011 ... In most instances, moles develop within the uterine cavity, but may occur at ... Patients with tubal molar pregnancy are very difficult to distinguish .... There was a left-sided adnexal mass, whose size could not be appreciated ...

An evaluation of sodium hyaluronate in preventing recurrence of tubal obstruction after interventional recanalization

International Nuclear Information System (INIS)

Chen Hanwei; Cao Xiaoying; Hu Peiling; Liu Haiying; Tang Yukuan; Xiao Chengjiang

2004-01-01

Objective: To evaluate the efficacy and application of sodium hyaluronate in preventing the recurrence of tubal obstruction after interventional recanalization. Methods: In total 103 cases of the study group were injected sodium hyaluronate to prevent tubal adhering obstruction after successful recanalization, while in the control group 206 cases were injected desamethasone, alphacutanee, metronidazole and gentamycin for the same purpose. Both groups were followed up in 2-3 months after the initial intervention. The assessments included water insufflation, intrauterine pregnancy rate, ectopic pregnancy rate and the normal labor. Results: In the study group, 190 tubes in 103 cases were obstructed, 27 tubes missing, and 188 tubes were recanalized out of 190 (99%). In the control group 390 tubes were obstructed, 27 tubes missing, 385 tubes were successfully recanalized (99%). In the 2-3 month follow up water insufflation showed satisfying patency in 99 cases in the study group, and in 178 cases in the control group. Significant difference of recurrence rate of tubal obstruction was found between the two groups. Conclusion: Sodium hyaluronate is effective to prevent the recurrence of tubal obstruction after interventional recanalization

The ESEP study: Salpingostomy versus salpingectomy for tubal ectopic pregnancy; The impact on future fertility: A randomised controlled trial

Directory of Open Access Journals (Sweden)

van Mello Norah M

2008-06-01

Full Text Available Abstract Background For most tubal ectopic pregnancies (EP surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy or radically (salpingectomy in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. Methods/Design International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation. The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision

Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis.

Science.gov (United States)

Hirshfeld-Cytron, Jennifer; Winter, Jordan

2013-07-01

Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or in vitro fertilization (IVF) for 3 separate age groups of women: 40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500. Copyright © 2013 Mosby, Inc. All rights reserved.

Spontaneous Bilateral Tubal Gestation: A Rare Case Report

Directory of Open Access Journals (Sweden)

Marwah Sheeba

2016-01-01

Full Text Available Here a case is presented where the woman after a positive pregnancy test underwent medical abortion for unwanted pregnancy without ultrasound confirmation of intrauterine pregnancy. On persistence of symptoms, a second opinion was procured, when examination and a transvaginal ultrasound scan revealed ruptured unilateral tubal ectopic pregnancy. However upon subsequent laparotomy (considering deteriorating hemodynamic status of the patient, intraoperatively it turned out to be a bilateral tubal ectopic gestation.

Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women.

Science.gov (United States)

Carta, Gaspare; Palermo, Patrizia; Pasquale, Chiara; Conte, Valeria; Pulcinella, Ruggero; Necozione, Stefano; Cofini, Vincenza; Patacchiola, Felice

2018-06-01

The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80-95.90), sensitivity was 85.7% (95% CI 57.20-98.20), positive and negative predictive values were 70.6% (95% CI: 44.00-89) and 94.7% (95% CI: 82.30-99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.

Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

Mara Clapp

2013-01-01

Full Text Available Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue. Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG confirmed tubal patency. The patient subsequently had an intrauterine pregnancy. Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

Does vitamin E prevent tubal damage caused by smoking? A light microscopy and animal study.

Science.gov (United States)

Duran, Muzeyyen; Ustunyurt, Emin; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun; Hızlı, Deniz; Sarac, Gulce Naz; Erdogan, Deniz

2014-04-01

To assess the histomorphological effects of smoking on the cilia of fallopian tubes in mice and the effect of vitamin E on the negative effects of smoke. Eighteen 12-14 week-old Swiss albino type female mice were randomly divided into three groups, each consisting of six mice: Group A: control group; Group B: mice exposed to cigarette smoke; Group C: mice exposed to cigarette smoke together with vitamin E. Groups B and C were exposed to cigarette smoke for 10 weeks. After 10 weeks, tubal excision was performed in all animals. Histopathologic examination of excised tubal tissue was conducted under light microscopy. The number of cilia was significantly lower in Group B. Although not statistically significant, the median number of cilia in Group C was measured to be higher than in Group B but lower than in Group A. Based on the results, it can be concluded that smoking decreases tubal cilia numbers. Supplementation by vitamin E may treat or at least help to slow down the decrease in number of cilia caused by smoking; therefore it could be used therapeutically in the treatment of smoking-related tubal damage. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

Hysteroscopic tubal sterilization: a health economic literature review.

Science.gov (United States)

2013-01-01

Hysteroscopic sterilization is a minimally invasive alternative to laparoscopic tubal ligation for women who want permanent contraception. In contrast to the laparoscopic technique, a hysteroscope is used to pass permanent microinserts through the cervix and place them in the fallopian tubes. This procedure does not require local or general anesthesia and can be performed in an office setting. The objective of this analysis was to determine, based on published literature, the cost-effectiveness of hysteroscopic tubal sterilization (HS) compared with laparoscopic tubal ligation (LS) for permanent female sterilization. A systematic literature search was conducted for studies published between January 1, 2008, and December 11, 2012. Potentially relevant studies were identified based on the title and abstract. Cost-utility analyses (studies that report outcomes in terms of costs and quality-adjusted life-years) were prioritized for inclusion. When not available, cost-effectiveness, cost-benefit, and cost-consequence analyses were considered. Costing studies were considered in the absence of all other analyses. A total of 33 abstracts were identified. Three cost analyses were included. A retrospective chart review from Canada found that HS was $111 less costly than LS; a prospective activity-based cost management study from Italy reported that it was €337 less costly than LS; and the results of an American decision model showed that HS was $1,178 less costly than LS. All studies had limited applicability to the Ontario health care system due to differences in setting, resource use, and costs. Three cost analyses found that, although the HS procedure was more expensive due to the cost of the microinserts, HS was less costly than LS overall due to the shorter recovery time required. Hysteroscopic sterilization is a minimally invasive alternative to conventional tubal ligation for women who want a permanent method of contraception. Both approaches involve closing off the

Expression of Stem Cell Markers in Preinvasive Tubal Lesions of Ovarian Carcinoma.

Science.gov (United States)

Chene, G; Ouellet, V; Rahimi, K; Barres, V; Meunier, L; De Ladurantaye, M; Provencher, D; Mes-Masson, A M

2015-01-01

In order to better understand the ovarian serous carcinogenic process with tubal origin, we investigated the expression of stem cell markers in premalignant tubal lesions (serous tubal intraepithelial carcinoma or STIC). We found an increased stem cell marker density in the normal fallopian tube followed by a high CD117 and a low ALDH and CD44 expression in STICs raising the question of the role of the stem cell markers in the serous carcinogenic process.

Expression of Stem Cell Markers in Preinvasive Tubal Lesions of Ovarian Carcinoma

Directory of Open Access Journals (Sweden)

G. Chene

2015-01-01

Full Text Available In order to better understand the ovarian serous carcinogenic process with tubal origin, we investigated the expression of stem cell markers in premalignant tubal lesions (serous tubal intraepithelial carcinoma or STIC. We found an increased stem cell marker density in the normal fallopian tube followed by a high CD117 and a low ALDH and CD44 expression in STICs raising the question of the role of the stem cell markers in the serous carcinogenic process.

Interventions for tubal ectopic pregnancy

NARCIS (Netherlands)

Hajenius, P. J.; Mol, F.; Mol, B. W. J.; Bossuyt, P. M. M.; Ankum, W. M.; van der Veen, F.

2007-01-01

BACKGROUND: Treatment options for tubal ectopic pregnancy are; (1) surgery, e.g. salpingectomy or salpingo(s)tomy, either performed laparoscopically or by open surgery; (2) medical treatment, with a variety of drugs, that can be administered systemically and/or locally by various routes and (3)

Surgical management of tubal pregnancy

NARCIS (Netherlands)

Mol, F.

2013-01-01

The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

Sonographic Diagnosis of Tubal Cancer with IOTA Simple Rules Plus Pattern Recognition

Science.gov (United States)

Tongsong, Theera; Wanapirak, Chanane; Tantipalakorn, Charuwan; Tinnangwattana, Dangcheewan

2017-11-26

Objective: To evaluate diagnostic performance of IOTA simple rules plus pattern recognition in predicting tubal cancer. Methods: Secondary analysis was performed on prospective database of our IOTA project. The patients recruited in the project were those who were scheduled for pelvic surgery due to adnexal masses. The patients underwent ultrasound examinations within 24 hours before surgery. On ultrasound examination, the masses were evaluated using the well-established IOTA simple rules plus pattern recognition (sausage-shaped appearance, incomplete septum, visible ipsilateral ovaries) to predict tubal cancer. The gold standard diagnosis was based on histological findings or operative findings. Results: A total of 482 patients, including 15 cases of tubal cancer, were evaluated by ultrasound preoperatively. The IOTA simple rules plus pattern recognition gave a sensitivity of 86.7% (13 in 15) and specificity of 97.4%. Sausage-shaped appearance was identified in nearly all cases (14 in 15). Incomplete septa and normal ovaries could be identified in 33.3% and 40%, respectively. Conclusion: IOTA simple rules plus pattern recognition is relatively effective in predicting tubal cancer. Thus, we propose the simple scheme in diagnosis of tubal cancer as follows. First of all, the adnexal masses are evaluated with IOTA simple rules. If the B-rules could be applied, tubal cancer is reliably excluded. If the M-rules could be applied or the result is inconclusive, careful delineation of the mass with pattern recognition should be performed. Creative Commons Attribution License

Identifying subfertile ovulatory women for timely tubal patency testing: A clinical decision rule based on medical history

NARCIS (Netherlands)

S.F.P.J. Coppus; H.R. Verhoeve (Harold); B.C. Opmeer (Brent); J.W. van der Steeg (Jan Willem); P. Steures (Pieternel); M.J.C. Eijkemans (René); P.G. Hompes (Peter); P.M.M. Bossuyt (Patrick); F. Veen (Fulco); B.W.J. Mol (Ben)

2007-01-01

textabstractBackground: The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred. Methods: Data on 3716

Role Of Hysteroscopy In The Evaluation Of Tubal Patency In Infertile Women

International Nuclear Information System (INIS)

Rashed, A.M.; Sweedan, Kh.H.; ElBishry, G.A.; Serag, I.F.; Ahmed, W.E.

2012-01-01

Purpose: To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. Methods: In this prospective study, 64 infertile women underwent hysteroscopy (HSC) and hysterosalpingography (HSG) on two consecutive days. Transvaginal ultrasonography (TVS) carried out before and after hysteroscopy in order to measure the fluid in the cul-de-sac.The difference between the two methods in diagnosis of tubal patency was compared using laparoscopy/chromotubationas a gold standard. Fluid volume measurements were used to determine a cut off value for tubal patency. Pain was recorded at the end of the processes. Results: According to the laparoscopy, the sensitivity and specificity of HSC and HSG in detecting tubal patency were (94.6% and 100% vs 92.8% and 50%, respectively). The best cut off point of the fluid volume in the cul-de-sac at which both tubes are patent is 6 ml. All of the patients reported significantly less pain during hysteroscopy in response to HSG. Conclusions: office HSC combined with TVS may be used as an alternative to HSG in the diagnosis of tubal patency in an easy, rapid, safe way with minimal pain.

Effect of menstrual cycle phase and hormonal treatments on evaluation of tubal patency in baboons.

Science.gov (United States)

Jensen, Jeffrey T; Hanna, Carol; Mishler, Emily; Lim, Jeong Y; Slayden, Ov D

2018-02-01

We evaluated whether menstrual cycle phase influences the assessment of tubal patency by hysterosalpingography (HSG) in baboons. Retrospective analysis of baseline tubal patency studies and serum estradiol (E 2 ) and progesterone (P4) values obtained from female baboons used as models for development of non-surgical permanent contraception in women. The main outcome measure was bilateral tubal patency (BTP) in relationship with estradiol level. Female baboons (n = 110) underwent a single (n = 81), two (n = 26), or three (n = 3) HSG examinations. In 33/142 (23%) HSG examinations, one or both tubes showed functional occlusion (FO). The median E 2 in studies with BTP (49 pg/mL) was significantly higher than in those studies with FO (32 pg/mL, P = .005). Among 18 animals with repeat examinations where serum E 2 changed from <60 to ≥ 60 pg/mL, 13 results changed from FO to BTP (P = .0001). No sets showed a change from BTP to FO with an increase in estradiol. In baboons, functional occlusion of the fallopian tube is associated with low estradiol levels, supporting a role for estrogen-mediated relaxation of the utero-tubal junction. © 2017 The Authors. Journal of Medical Primatology Published by John Wiley & Sons Ltd.

Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history

NARCIS (Netherlands)

Coppus, S. F. P. J.; Verhoeve, H. R.; Opmeer, B. C.; van der Steeg, J. W.; Steures, P.; Eijkemans, M. J. C.; Hompes, P. G. A.; Bossuyt, P. M. M.; van der Veen, F.; Mol, B. W. J.

2007-01-01

BACKGROUND: The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred. METHODS: Data on 3716 women who

Influence of mare uterine tubal fluids on the metabolism of stallion sperm.

Science.gov (United States)

Engle, C E; Foley, C W; Witherspoon, D M; Scarth, R D; Goetsch, D D

1975-08-01

Three experiments were conducted on the metabolism of stallion sperm. In experiment 1, whole and washed sperm were incubated under aerobic and anaerobic enviroments and analyzed before and after controlled incubation for motility, pH, lactic acid, glucose, fructose, and O2 comsumption. In experiment 2, whole and washed sperm were incubated aerobically and anaerobically with and without uterine tubal fluids. Experiment 3 was the same as experiment 2, except added substrates of glucose and lactic acid were studied. The same examinations were made in experiments 2 and 3 as for experiment 1. Motility decreased significantly during incubation for all treatments, with the greatest decrease occurring for whole semen where only trace amounts of substrate (fructose) were present. Exogenous glucose plus uterine tubal fluid maintained sperm motility better than did added lactate. However, sperm respiration rates were highest when exogenous lactate was the only substrate in the incubation medium. The mean pH values for gel-free stallion semen at the start of controlled aerobic and anaerobic incubation were 7.08 and 7.34. Lactic acid accummulation for 1 hour increased from 0.05 mg to 0.09 mg/10(9) sperm when uterine tubal fluid was added to the incubation medium. Washed spermatozoa incubated in 0.03 M glucose plus uterine tubal fluid utilized less glucose than did sperm incubated in the glucose medium. These results, along with the increased oxygen utilization (ZO2) values produced by adding uterine tubal fluid to the incubation mediums, might indicate utilization of a uterine tubal substrate. Added uterine tubal fluid resulted in increased ZO2 values (expressed in mul of O2 utilized by 10(8) sperm in 1 hour at 37 C) for whole semen from 10.45 to 12.63. Washed spermatozoa also respired at a significantly greater rate than whole sperm. Respiration rates were greater for sperm incubated with 0.01 M lactic acid than for any other substrate or experiment.

Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

Directory of Open Access Journals (Sweden)

Shahideh Jahanian Sadatmahalleh

2016-12-01

Full Text Available Background: Tubal ligation (TL is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders. Materials and Methods: A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group and on 140 women using condom as the main contraceptive method (Non-TL group. They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC was also used to measure the menstrual blood loss. Results: Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002. Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006, hypermenorrhea (12.1 vs. 2.1%, P=0.002, menorrhagia (62.9 vs. 22.1%, P<0.0001 and menometrorrhagia (15.7 vs. 3.6%, P=0.001 than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001. According to logistic regression, age odds ratio [(OR=1.08, confidence interval (CI:1.07-1.17, P=0.03], TL (OR=5.95, CI:3.45-10.26, P<0.0001 and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001 were significantly associated with menorrhagia. Conclusion: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

risk factors for abnormal tubal hysterosalpingographic findings

African Journals Online (AJOL)

Administrator

So many presumed risk factors for female tubal infertility are seen among. Nigerian women. ... strategies such as health awareness campaigns against unwanted pregnancy, promotion of responsible ..... of CT findings in acute pyogenic pelvic.

Factors Promoting Tubal Ligation in Females Presenting to Tertiary Care Centers

Directory of Open Access Journals (Sweden)

Hammad Ali Qazi

2009-09-01

Full Text Available Objective: Despite development of new contraceptive methods, sterilization remained the most widely used method. Our objective was to determine the factors contributing to decision making for tubal ligation in females.Materials and methods: A cross sectional study was conducted in Jinnah Post graduate Medical Centre (JPMC between March - November 2008. About 505 Females using contraceptive measures were consecutively included. Those having any severe debilitating disease and unfamiliar with “urdu” language were excluded. Three trained co researchers conducted structured interviews to determine the frequency and factors associated with tubal ligation.Results: The final multiple logistic regression showed illiteracy [AOR 2.91 95% CI 1.53-5.53], number of children < 3 [AOR 6.15 95% CI 2.61-14.50], age of women < 30 [AOR 0.12 95% CI 0.06-0.22] years and information gained through health worker [AOR 3.04 95% CI 1.60-5.80] to be statistically significant.Conclusion: This highlights tubal ligation was more common in uneducated women of age > 35 years having <3 children. The most common means of promoting tubal ligation was information gained through health workers.

Are all pelvic (nonuterine) serous carcinomas of tubal origin?

Science.gov (United States)

Przybycin, Christopher G; Kurman, Robert J; Ronnett, Brigitte M; Shih, Ie-Ming; Vang, Russell

2010-10-01

It has been proposed that the presence of tubal intraepithelial carcinoma (TIC), in association with one-third to nearly half of pelvic serous carcinomas, is evidence of fallopian tube origin for high-grade serous carcinomas that would have been otherwise classified as primary ovarian or peritoneal. To address this hypothesis, we evaluated a series of 114 consecutive pelvic (nonuterine) gynecologic carcinomas at our institution (2006 to 2008) to determine the frequency of TIC in 52 cases in which all the resected fallopian tube tissue was examined microscopically. These 52 cases were classified as ovarian (n=37), peritoneal (n=8), or fallopian tube (n=7) in origin as per conventional criteria based on disease distribution. The presence of TIC and its location and relationship to invasive carcinoma in the fallopian tubes and ovaries were assessed. Among the 45 cases of ovarian/peritoneal origin, carcinoma subtypes included 41 high-grade serous, 1 endometrioid, 1 mucinous, 1 high-grade, not otherwise specified, and 1 malignant mesodermal mixed tumor. TIC was identified in 24 cases (59%) of high-grade serous carcinoma but not among any of the other subtypes; therefore, the term serous TIC (STIC) is a more specific appellation. STICs were located in the fimbriated end of the tube in 22 cases (92%) and in the ampulla in 2 (8%); they were unilateral in 21 (88%) and bilateral in 3 (13%). STICs in the absence of an associated invasive carcinoma in the same tube were detected in 7 cases (30%) and with invasive carcinoma in the same tube in 17 (71%). Unilateral STICs were associated with bilateral ovarian involvement in 15 cases and unilateral (ipsilateral) ovarian involvement in 5 (the remaining case with a unilateral STIC had a primary peritoneal tumor with no ovarian involvement); the bilateral STICs were all associated with bilateral ovarian involvement. Six of the 7 primary tubal tumors were high-grade serous carcinomas, and 4 of these 6 (67%) had STICs. Based on

Serous tubal intraepithelial carcinoma, chronic fallopian tube injury, and serous carcinoma development.

Science.gov (United States)

Malmberg, Karin; Klynning, Charlotta; Flöter-Rådestad, Angelique; Carlson, Joseph W

2016-06-01

Ovarian carcinoma is the deadliest gynecological malignancy. Previous studies have suggested that the fallopian tube may be the primary site for high-grade serous carcinoma. In prophylactic salpingo-oophorectomies from women with hereditary high risk for ovarian cancer, precursors can be assessed prior to onset and studied as a model for serous cancer precursor lesions. Epidemiologic studies indicate that carcinogenesis may be a result of chronic fallopian tube injury. The aims of this study were to (1) to examine the incidence of serous tubal intraepithelial carcinoma (STIC) in relation to other clinical parameters and (2) to evaluate whether chronic fallopian tube injury was related to cancer development. This study enrolled 101 women, comprising the following three groups: hereditary (n = 60), sporadic serous cancer (n = 18; endometrial cancers were excluded), and control (n = 23). The cases were histologically examined and clinical risk factors were collected. The histological changes were compared between different patients and correlated to clinical risk factors. STICs were identified primarily on the fallopian tube fimbria. The incidence of STIC was 3 % in the hereditary patients. In sporadic serous cancer cases, 61 % were associated with STIC and tubal carcinoma (p STIC and invasive cancer were seen more often in the older patients than in the younger patients (p = 0.528). This small study, no correlation with chronic tubal injury or inflammation was identified.

Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population

Directory of Open Access Journals (Sweden)

Awoleke JO

2015-01-01

Full Text Available Jacob O Awoleke,1 Abiodun I Adanikin,1 Adeola O Awoleke2 1Department of Obstetrics and Gynaecology, Ekiti State University, 2School of Nursing, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Purpose: Morbidity and mortality from ruptured tubal pregnancies (RTPs have been linked with delays in seeking and receiving care. Evaluation of the reasons for these delays and their contributions to maternal deaths is rarely done for women with RTPs in resource-constrained settings.Patients and methods: This was a 3-year retrospective review of the case records of women with tubal pregnancies managed at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Clinical and sociodemographic parameters were obtained, including information on onset of symptoms and intervals between the symptoms and when help was sought and obtained at the hospital.Results: There were 92 cases of tubal pregnancies, giving an incidence of 18 per 1,000 births. Most of the patients were married (74.7%, parous (64.9%, and urban dwellers (76.9%, and 11% were severely anemic on arrival. The case-fatality rate was 1.1% and 74.7% had delay in seeking care, while 82.4% of the women spent more than 2 hours after admission before surgical intervention. Rural dwellers (adjusted odds ratio 2.96, 95% confidence interval 1.08–8.36 and those without formal education (adjusted odds ratio 6.39, 95% confidence interval 1.06–67.30 had delays in seeking help, while problems with funds (χ2=7.354, P=0.005 and initial misdiagnosis (χ2=5.824, P=0.018 predicted delay in obtaining help at the hospital.Conclusion: RTPs are common gynecological emergencies in our environment that are often associated with delayed decisions to seek help and obtain care. Efforts should be geared toward women’s education and financial independence, improved hospital accessibility, and better diagnostic skills. Keywords: delay, ruptured tubal pregnancies, predictors, health care, Nigeria

Retrospective cost analysis comparing Essure hysteroscopic sterilization and laparoscopic bilateral tubal coagulation.

Science.gov (United States)

Hopkins, Matthew R; Creedon, Douglas J; Wagie, Amy E; Williams, Arthur R; Famuyide, Abimbola O

2007-01-01

To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation. Retrospective cohort study (Canadian Task Force classification II-2). Midwestern academic medical center. Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied. Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy. Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was 180 dollars (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.

Do host genetic traits in the bacterial sensing system play a role in the development of Chlamydia trachomatis-associated tubal pathology in subfertile women?

Directory of Open Access Journals (Sweden)

Ito James I

2006-07-01

Full Text Available Abstract Background In women, Chlamydia (C. trachomatis upper genital tract infection can cause distal tubal damage and occlusion, increasing the risk of tubal factor subfertility and ectopic pregnancy. Variations, like single nucleotide polymorphisms (SNPs, in immunologically important host genes are assumed to play a role in the course and outcome of a C. trachomatis infection. We studied whether genetic traits (carrying multiple SNPs in different genes in the bacterial sensing system are associated with an aberrant immune response and subsequently with tubal pathology following a C. trachomatis infection. The genes studied all encode for pattern recognition receptors (PRRs involved in sensing bacterial components. Methods Of 227 subfertile women, serum was available for C. trachomatis IgG antibody testing and genotyping (common versus rare allele of the PRR genes TLR9, TLR4, CD14 and CARD15/NOD2. In all women, a laparoscopy was performed to assess the grade of tubal pathology. Tubal pathology was defined as extensive peri-adnexal adhesions and/or distal occlusion of at least one tube. Results Following a C. trachomatis infection (i.e. C. trachomatis IgG positive, subfertile women carrying two or more SNPs in C. trachomatis PRR genes were at increased risk of tubal pathology compared to women carrying less than two SNPs (73% vs 33% risk. The differences were not statistically significant (P = 0.15, but a trend was observed. Conclusion Carrying multiple SNPs in C. trachomatis PRR genes tends to result in an aberrant immune response and a higher risk of tubal pathology following a C. trachomatis infection. Larger studies are needed to confirm our preliminary findings.

Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications

Directory of Open Access Journals (Sweden)

Askin Dogan

2016-06-01

Full Text Available Our aim was to evaluate the relationship between the success of methotrexate treatment and β-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m2 was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6% responded to medical treatment, while the remaining 59 (15.36% underwent surgery due to treatment failure. β-hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116±3157 vs. 4178±3422, 2062±3551 vs. 4935±4103, and 1532±3007 vs. 3900±4783, respectively. The receiver operating characteristics curve for β-hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively. Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial β-hCG levels were >1418 mIU/mL.

Evaluation of time lapse for establishing distal tubal occlusion diagnosis during hysterosalpingography procedure performed by using water soluble contrast media

Directory of Open Access Journals (Sweden)

Serkan Kahyaoglu

2017-05-01

Conclusion: Although a trend exists towards shorter time period intervals between the first uterine visualization and distal tubal filling graphy among patients with tubal patency, rather than patients with distal tubal occlusion confirmed by diagnostic laparoscopy, clinically reliable objective time period intervals for finalizing the HSG procedure and proceeding with diagnostic laparoscopy due to distal tubal occlusion diagnosis on HSG could not be detected.

Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial)

NARCIS (Netherlands)

Broekmans, FJM; Mol, F.; Mello, N.M.; Strandell, Annika; Strandell, Karin; Jurkovic, Davor; Ross, Jackie; Barnhart, K.; Yalcinkaya, Tamer; Verhoeve, H.R.; Graziosi, G.C.M.; Koks, Carolien A M; Klinte, Ingmar; Hogstrom, Lars; Janssen, Ineke; Kragt, Harry; Hoek, Annemieke; Trimbos-Kemper, Trudy; Willemsen, Wim; Ankum, W.M.; Mol, Benwillem; Wely, M.; van der Veen, Fulco; Hajenius, Petra J

2015-01-01

STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better

Histology and scanning electron microscopy of the tubal tonsil of goats

Directory of Open Access Journals (Sweden)

V. R. Indu

2015-08-01

Full Text Available Aim: To observe the light and scanning electron microscopy (SEM of the caprine tubal tonsil. Materials and Methods: The study was conducted on six crossbred male goats of 6 months of age. From the median sections of the head, tissue pieces from the nasopharynx around the auditory tube were collected and fixed for histology and SEM. Results: Tonsillar lymphoid tissue was located in the nasopharynx ventral to the auditory tube opening in the lateral wall of the pharynx. The height of the surface epithelium of the tubal tonsil measured 80.17±1.08 μm and was a pseudostratified ciliated columnar type with basal, supporting, and goblet cells. Above the dome of lymphoid nodules, the epithelium was modified into a follicle associated epithelium (FAE, also called lympho-epithelium or reticular epithelium and was characterized by the absence of goblet cells and cilia, reduced number of cell layers, and a large number of lymphoid cells due to interrupted basement membrane. The height of FAE was smaller than that of the surface epithelium and measured 34.33±0.92 μm. The surface of tubal tonsil showed folds and invaginations, which formed crypts. The lamina propria-submucosa underneath the epithelium was formed by the meshwork of reticular and, thin and loose collagen fibers with dome-like accumulation of lymphoid nodules. In the secondary lymphoid nodules, a corona, parafollicular area, and interfnodular area were observed. The average number of lymphoid nodules counted per field under low power magnification of microscope was 1.17±0.17, and the internodular distance was 34.00±4.37 μm. The mean diameter of lymphoid nodules was 566.67±11.45 μm and the lymphocyte count per nodule was 14741.67±174.36. The number of plasma cells counted per field under low power was 44.38±2.90 below the surface epithelium. The tubal tonsil was not encapsulated. In SEM, the surface epithelium of the tubal tonsils presented ciliated cells, microvillus (MV cells, and

Histology and scanning electron microscopy of the tubal tonsil of goats

Science.gov (United States)

Indu, V. R.; Lucy, K. M.; Chungath, J. J.; Ashok, N.; Maya, S.

2015-01-01

Aim: To observe the light and scanning electron microscopy (SEM) of the caprine tubal tonsil. Materials and Methods: The study was conducted on six crossbred male goats of 6 months of age. From the median sections of the head, tissue pieces from the nasopharynx around the auditory tube were collected and fixed for histology and SEM. Results: Tonsillar lymphoid tissue was located in the nasopharynx ventral to the auditory tube opening in the lateral wall of the pharynx. The height of the surface epithelium of the tubal tonsil measured 80.17±1.08 µm and was a pseudostratified ciliated columnar type with basal, supporting, and goblet cells. Above the dome of lymphoid nodules, the epithelium was modified into a follicle associated epithelium (FAE), also called lympho-epithelium or reticular epithelium and was characterized by the absence of goblet cells and cilia, reduced number of cell layers, and a large number of lymphoid cells due to interrupted basement membrane. The height of FAE was smaller than that of the surface epithelium and measured 34.33±0.92 µm. The surface of tubal tonsil showed folds and invaginations, which formed crypts. The lamina propria-submucosa underneath the epithelium was formed by the meshwork of reticular and, thin and loose collagen fibers with dome-like accumulation of lymphoid nodules. In the secondary lymphoid nodules, a corona, parafollicular area, and interfnodular area were observed. The average number of lymphoid nodules counted per field under low power magnification of microscope was 1.17±0.17, and the internodular distance was 34.00±4.37 µm. The mean diameter of lymphoid nodules was 566.67±11.45 µm and the lymphocyte count per nodule was 14741.67±174.36. The number of plasma cells counted per field under low power was 44.38±2.90 below the surface epithelium. The tubal tonsil was not encapsulated. In SEM, the surface epithelium of the tubal tonsils presented ciliated cells, microvillus (MV) cells, and goblet cells. The

Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy

Directory of Open Access Journals (Sweden)

Erdem Fadıloğlu

2017-09-01

Full Text Available Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology

NARCIS (Netherlands)

Coppus, S. F. P. J.; Land, J. A.; Opmeer, B. C.; Steures, P.; Eijkemans, M. J. C.; Hompes, P. G. A.; Bossuyt, P. M. M.; van der Veen, F.; Mol, B. W. J.; van der Steeg, J. W.

2011-01-01

The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has

Tubal origin of ovarian cancer - the double-edged sword of haemoglobin.

Science.gov (United States)

Lin, Shiou-Fu; Gerry, Emily; Shih, Ie-Ming

2017-05-01

Ovarian high-grade serous carcinoma (HGSC) is the most malignant neoplasm of the gynaecological tract. While the origins of many human malignant neoplasms are clear, the origin of HGSC remains poorly understood. This lack of knowledge limits our understanding of its pathogenesis and compromises efforts devoted to developing better early detection tools and effective preventative interventions. The paradigm of the tubal origin of HGSC has been advanced since the initial report of dysplastic lesions (now known as serous tubal intraepithelial carcinomas or STICs) that morphologically resemble HGSC in the Fallopian tube. These were observed in a group of patients with a genetic predisposition to ovarian cancer who were undergoing risk-reducing salpingo-oophorectomy. Since then, a series of clinico-pathological and molecular studies have characterized STICs and their concurrent HGSCs, and the results support the new paradigm of a tubal origin of many 'ovarian' HGSCs. Reactive oxygen species-containing ovulatory follicular fluid has been thought to be the major culprit behind DNA damage in tubal epithelial cells, leading to either cell death or, if the cells survive, mutagenesis. A recent report from this journal demonstrates that ferryl haemoglobin (Hb) in peritoneal fluid could prevent cell death from DNA-damaged fimbrial epithelial cells, facilitating ovulation-induced carcinogenesis of tubal epithelium. This timely study provides new insight into the tumour initiation event in HGSC. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Bearing capacity and rigidity of short plastic-concrete-tubal vertical columns under transverse load

Science.gov (United States)

Dolzhenko, A. V.; Naumov, A. E.; Shevchenko, A. E.

2018-03-01

The results of mathematical modeling in determining strain-stress distribution parameters of a short plastic-concrete-tubal vertical column under horizontal load as those in vertical constructions are described. Quantitative parameters of strain-stress distribution during vertical and horizontal loads and horizontal stiffness were determined by finite element modeling. The internal stress in the concrete column core was analyzed according to equivalent stress in Mohr theory of failure. It was determined that the bearing capacity of a short plastic- concrete-tubal vertical column is 25% higher in resistibility and 15% higher in rigidness than those of the caseless concrete columns equal in size. Cracks formation in the core of a short plastic-concrete-tubal vertical column happens under significantly bigger horizontal loads with less amount of concrete spent than that in caseless concrete columns. The significant increase of bearing capacity and cracking resistance of a short plastic-concrete-tubal vertical column under vertical and horizontal loads allows recommending them as highly effective and highly reliable structural wall elements in civil engineering.

Pseudocarcinomatous hyperplasia of the fallopian tube mimicking tubal cancer: a radiological and pathological diagnostic challenge.

Science.gov (United States)

Lee, Nam Kyung; Choi, Kyung Un; Han, Ga Jin; Kwon, Byung Su; Song, Yong Jung; Suh, Dong Soo; Kim, Ki Hyung

2016-11-14

Pseudocarcinomatous hyperplasia of the fallopian tube is a rare, benign disease characterized by florid epithelial hyperplasia. The authors present the history and details of a 22-year-old woman with bilateral pelvic masses and a highly elevated serum CA-125 level (1,056 U/ml). Ultrasonography and magnetic resonance imaging (MRI) of the pelvis showed bilateral adnexal complex cystic masses with a fusiform or sausage-like shape. Contrast-enhanced fat-suppressed T1-weighted images showed enhancement of papillary projections of the right adnexal mass and enhancement of an irregular thick wall on the left adnexal mass, suggestive of tubal cancer. Based on MRI and laboratory findings, laparotomy was performed under a putative preoperative diagnosis of tubal cancer. The final pathologic diagnosis was pseudocarcinomatous hyperplasia of tubal epithelium associated with acute and chronic salpingitis in both tubes. The authors report a rare case of pseudocarcinomatous hyperplasia of the fallopian tubes mimicking tubal cancer.

Tubal Ectopic Gestation Associated with Genital Schistosomiasis: A ...

African Journals Online (AJOL)

AJRH Managing Editor

tract include: dyspareunia, bloody cervical discharge, dysmenorrhea, chronic pelvic pain and pelvic pseudotumour. Infertility may also result from tubal occlusion, secondary to the fibrosis2-6. Female reproductive tract infection/ parasitisation with Schistosoma species has been documented in countries where the parasite is.

Pre-hysterectomy assessment of immediate tubal occlusion with the third-generation ESSURE insert (ESS505).

Science.gov (United States)

Thiel, John; Rattray, Darrien; Cher, Daniel J

2014-01-01

To assess the ability of a new iteration of the ESSURE insert (ESS505) to achieve short-term fallopian tube occlusion. Prospective, single center, interventional cohort (Canadian Task Force classification II-1). Tertiary care hospital. Women scheduled to undergo hysterectomy. Patients underwent placement of the ESS505 in the right fallopian tube and ESS305 (the commercially approved previous version of the device) in the left fallopian tube at 30 (n = 10), 60 (n = 10), or 90 (n = 10) days before a planned hysterectomy. Tubal occlusion was assessed via hysterosalpingography (HSG) both at the time of placement and just before hysterectomy. Ultrasound was used to evaluate acute device placement. Thirty-five women (mean age, 39.7 years) were enrolled from July 2012 to January 2013, and 30 underwent both ESSURE placement and scheduled hysterectomy. Mean (SD) placement time for the ESS305 and ESS505 devices was 1.4 (0.65) minutes and 1.3 (0.42) minutes, respectively (p = .36). At 1 hour after ESS505 placement, 29 of 30 tubes (97%) exhibited complete occlusion at HSG, compared with only 4 of 30 tubes (13%) after ESS305 placement (p ESSURE placement. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

[Successive ectopic pregnancies associated with tubal shistosomiasis in a French traveler].

Science.gov (United States)

Laroche, Justine; Mottet, Nicolas; Malincenco, Marianna; Gay, Catherine; Royer, Pierre Yves; Riethmuller, Didier

2016-01-01

Schistosomiasis is the second endemic parasitic disease in the world and is a common cause of urogenital infections. Ectopic pregnancies due to tubal obstruction by schistosoma's eggs are usually reported in Africa. Schistosomiasis also affects travelers but infection of the female genital tract is less frequently described. We report an unusual clinical case of two successive ectopic pregnancies with tubal schistosomiasis in a French woman, seven years after a travel to Mali. The first event was discovered after histologic examination of salpingectomy and the second event required a controlateral salpingotomy with an injection of methotrexate, two months later.

Intra-gestational sac injection for tubal pregnancy: an interventional approach

International Nuclear Information System (INIS)

Wang Yitang; Sun Xiaobo; Xu Xiaojun; Zhang Feiyue; Wu Ke; Song Yingxin; Han Mingjun

2002-01-01

Objective: It's an investigation of the procedure, effects and clinical application of the interventional intra-gestational sac injection as a treatment of tubal pregnancy. Methods: Under DSA guidance a selective salpingography was performed and MTX was injected into the gestational sac or oviduct. The procedure was performed in 13 cases with oviductal pregnancy before the gestational sac ruptured. Results: Technical success was obtained in all cases. The serum HCG began to fall in 7 days after the procedure, and dropped to normal level in 2-4 weeks of the procedure. Conclusion: Interventional selective salpingography and intra-gestational sac injection is a simple, safe and effective treatment of the un-ruptured tubal pregnancy

Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

Directory of Open Access Journals (Sweden)

Sanam Moradan

2012-07-01

Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

The comparison of interventional tubal recanalization and drug irrigation recanalization in the management of oviduct obstruction

International Nuclear Information System (INIS)

Zhang Xiaomin; Li Yuzhi

2002-01-01

Objective: To explore and compare the efficacy of the interventional and drags irrigation tube recanalization for infertile women with fallopian tube obstruction. Methods: Eighteen patients with 36 tubal obstructions in the research group were treated with interventional tube recanalization and drugs infusion into tube through catheter. Other 10 cases with 20 tubal obstructions in the comparison group were treated only with drugs irrigation. All cases received followed up examination in 6 mouths. Results: The successful rates of recanalization were 61.1% (22/36) in the research group and 30.0% (6/20) in the comparison group, respectively. There was significant difference between the two groups (P < 0.05). The recurrence was 4 tube in the research group, 1 tube in the comparison group six months. Conclusion: The interventional tubal recanalization is a simple, sate and more effective treatment method of choice compared with the tubal recanalization with the traditional drag irrigation for fallopian tube obstruction

Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer.

Science.gov (United States)

Ludovisi, M; De Blasis, I; Virgilio, B; Fischerova, D; Franchi, D; Pascual, M A; Savelli, L; Epstein, E; Van Holsbeke, C; Guerriero, S; Czekierdowski, A; Zannoni, G; Scambia, G; Jurkovic, D; Rossi, A; Timmerman, D; Valentin, L; Testa, A C

2014-03-01

To describe clinical history and ultrasound findings in patients with tubal carcinoma. Patients with a histological diagnosis of tubal cancer who had undergone preoperative ultrasound examination were identified from the databases of 13 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed together all available digital ultrasound images and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings. We identified 79 women with a histological diagnosis of primary tubal cancer, 70 of whom (89%) had serous carcinomas and 46 (58%) of whom presented at FIGO stage III. Forty-nine (62%) women were asymptomatic (incidental finding), whilst the remaining 30 complained of abdominal bloating or pain. Fifty-three (67%) tumors were described as solid at ultrasound examination, 14 (18%) as multilocular solid, 10 (13%) as unilocular solid and two (3%) as unilocular. No tumor was described as a multilocular mass. Most tumors (70/79, 89%) were moderately or very well vascularized on color or power Doppler ultrasound. Normal ovarian tissue was identified adjacent to the tumor in 51% (39/77) of cases. Three types of ultrasound appearance were identified as being typical of tubal carcinoma using pattern recognition: a sausage-shaped cystic structure with solid tissue protruding into it like a papillary projection (11/62, 18%); a sausage-shaped cystic structure with a large solid component filling part of the cyst cavity (13/62, 21%); an ovoid or oblong completely solid mass (36/62, 58%). A well vascularized ovoid or sausage-shaped structure, either completely solid or with large solid component(s) in the pelvis, should raise the suspicion of tubal cancer, especially if normal

Hysteroscopic tubal sterilization: a systematic review of the Essure system

DEFF Research Database (Denmark)

Hurskainen, Ritva; Hovi, Sirpa-Liisa; Gissler, Mika

2010-01-01

OBJECTIVE: To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. DESIGN: The review...... in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly...... sterilization, but more information on the total cost is needed. CONCLUSION(S): The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization. Copyright (c) 2010 American Society for Reproductive Medicine. Published...

Papillary Cystadenoma: An Incidental Finding in Tubal Ligation

Directory of Open Access Journals (Sweden)

Tabitha Lynn Ward

2018-01-01

Full Text Available von Hippel-Lindau disease (vHLD is a rare autosomal dominant disorder with multiple benign and malignant tumors of different organs. We report a papillary cystadenoma of the mesosalpinx found in close association with an adenomatoid tumor discovered incidentally following tubal ligation in a patient with vHLD.

Treatment of tubal pregnancy by uterine artery perfusion and embolization

International Nuclear Information System (INIS)

Ni Caifang; Zou Jianwei; Zhao Hui; Jin Yonghai; Zhu Xiaoli; Liu Yizhi; He Qi; Shen Zhongji

2006-01-01

Objective: To study the feasibility, safety, and efficacy of the treatment for tubal pregnancy by interventional technique of transuterine arterial catheterization perfusion and embolization. Methods: Using modified Seldinger technique, 42 cases of tubal pregnancy received super-selective angiography of uterine artery, followed by perfusion of 50-100 mg methotrexate (MTX) through the catheter and embolization of uterine artery with gelatin sponge. Before and after the procedure, changes of clinical symptoms, physical signs, value of β-hCG and size of pregnancy cyst of patients were studied. Concentrations of MTX in peripheral blood were studied at 0.5, 6, 12, 24, 36, 48 hours after the procedure. Results: 38 out of 42 cases were cured with successful rate of 90.5%(38/42). The average time of β-hCG decreasing to normal was 8.26 ± 2.04 days. The concentration of MTX in peripheral blood with 50 mg or 75 mg dosage could not be detected at 36 hours after the procedure but could be detected as 0.01 μmol/L at 48 hours after the procedure with a dosage of 100 mg. Conclusions: It is simple, safe and efficient in performing trans-uterine artery chemo-embolization for therapy of fallopian tubal pregnancy, especially for those who complicated with manipules bleeding and also as the first choice for prevention of high risk massive hemorrhage. (authors)

Prediction of post-operative pain after a laparoscopic tubal ligation procedure

DEFF Research Database (Denmark)

Rudin, A.; Wolner-Hanssen, P.; Hellbom, M.

2008-01-01

ligation procedure. METHODS: Assessments of anxiety, mood, psychological vulnerability and pre-operative pain were made before surgery using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety Depression Scale (HADS), a psychological vulnerability test and the Short-Form McGill Pain......BACKGROUND: Pre-operative identification of reliable predictors of post-operative pain may lead to improved pain management strategies. We investigated the correlation between pre-operative pain, psychometric variables, response to heat stimuli and post-operative pain following a laparoscopic tubal...... Questionnaire (SF-MPQ), respectively. Pre-operative assessments of thermal thresholds and pain response to randomized series of heat stimuli (1 s, 44-48 degrees C) were made with quantitative sensory testing technique. Post-operative pain intensity was evaluated daily by a visual analogue scale during rest...

Serous Tubal Intraepithelial Carcinoma or Not? Metastases to Fallopian Tube Mucosa Can Masquerade as In Situ Lesions.

Science.gov (United States)

Singh, Reena; Cho, Kathleen R

2017-10-01

- Nonuterine high-grade serous carcinomas (HGSCs) are believed to arise most often from precursors in the fallopian tube referred to as serous tubal intraepithelial carcinomas (STICs). A designation of tubal origin has been suggested for all cases of nonuterine HGSC if a STIC is identified. - To highlight that many different types of nongynecologic and gynecologic carcinomas, including HGSC, can metastasize to the tubal mucosa and mimic de novo STIC. - A mini-review of several recently published studies that collectively examine STIC-like lesions of the fallopian tube. - The fallopian tube mucosa can be a site of metastasis from carcinomas arising elsewhere, and pathologists should exercise caution in diagnosing STIC without first considering the possibility of metastasis. Routinely used immunohistochemical stains can often be used to determine if a STIC-like lesion is tubal or nongynecologic in origin. In the context of uterine and nonuterine HGSC, STIC may represent a metastasis rather than the site of origin, particularly when widespread disease is present.

Serous tubal intraepithelial neoplasia : The concept and its application

NARCIS (Netherlands)

Meserve, Emily E. K.; Brouwer, Jan; Crum, Christopher P.

In recent years it has become clear that many extra-uterine (pelvic) high-grade serous carcinomas (serous carcinomas) are preceded by a precursor lesion in the distal fallopian tube. Precursors range from small self-limited 'p53 signatures' to expansile serous tubal intraepithelial neoplasms that

Changes in the Extracellular Matrix Are Associated With the Development of Serous Tubal Intraepithelial Carcinoma Into High-Grade Serous Carcinoma.

Science.gov (United States)

van der Steen, Sophieke C H A; Bulten, Johan; Van de Vijver, Koen K; van Kuppevelt, Toin H; Massuger, Leon F A G

2017-07-01

The identification of a marker for early progression of preinvasive lesions into invasive pelvic high-grade serous carcinoma (HGSC) may provide novel handles for innovative screening and prevention strategies. The interplay between cancer cells and the extracellular matrix (ECM) is one of the main principles in cancer development and growth, but has been largely neglected in preinvasive lesions. This is the first study addressing the involvement of the ECM in the "step-by-step" transition of normal fallopian tube epithelium into preinvasive lesions, and eventually the progression of preinvasive lesions into invasive HGSC. The expression of highly sulfated chondroitin sulfate (CS-E), a characteristic glycosaminoglycan of the cancer-associated ECM, was assessed by immunohistochemistry in a large cohort of precursor lesions of the full spectrum of HGSC development, including 97 serous tubal intraepithelial carcinomas (STICs), 27 serous tubal intraepithelial lesions, and 24 p53 signatures. In addition, the immunological reactivity in the microenvironment was evaluated. Increased stromal expression of highly sulfated CS-E was observed in 3.7%, 57.7%, and 90.6% of serous tubal intraepithelial lesions, STICs, and invasive HGSCs, respectively (P STIC, P STIC and paired HGSC was demonstrated. Intense stromal CS-E expression in STIC was significantly associated with an immune infiltrate (P < 0.001). Our study showed that increased stromal CS-E expression is related to the degree of the tubal epithelium abnormality. Specific alterations in the ECM (ie, CS-E expression) occur early in pelvic HGSC development and may represent a novel biomarker of early cancer progression, useful for the identification of novel clinical strategies.

Radiologic fallopian tube catheterization for diagnosis and treatment of proximal tubal obstruction

International Nuclear Information System (INIS)

Thurmond, A.S.; Rosch, J.

1988-01-01

Seventy-five infertile women in whom proximal fallopian tube obstruction had been demonstrated by conventional hysterosalpingography were managed by means of fluoroscopic transcervical fallopian tube catheterization techniques. The procedure helped avoid surgery for diagnosis and/or treatment of proximal tubal obstruction in 71 women (95%). In 32 patients who had patent tube(s) following the procedure, 15 pregnancies have occurred, 14 intrauterine and one tubal (follow-up, 6 months). Fifteen patients had follow-up studies after recanalization, and 19 of 23 tubes remained patent (83%). Fluoroscopic fallopian tube catheterization improves diagnosis of fallopian tube disease and is a low-cost, nonsurgical treatment for infertility caused by proximal fallopian tube obstruction

Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT

NARCIS (Netherlands)

Dreyer, K.; Lier, M. C. I.; Emanuel, M. H.; Twisk, J. W. R.; Mol, B. W. J.; Schats, R.; Hompes, P. G. A.; Mijatovic, V.

2016-01-01

STUDY QUESTION Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? SUMMARY ANSWER Hysteroscopic proximal tubal occlusion by intratubal

Next Generation Sequencing of Tubal Intraepithelial Carcinomas

Science.gov (United States)

McDaniel, Andrew S.; Stall, Jennifer N.; Hovelson, Daniel H.; Cani, Andi K.; Liu, Chia-Jen; Tomlins, Scott A.; Cho, Kathleen R.

2016-01-01

Importance High-grade serous carcinoma (HGSC) is the most prevalent and lethal form of ovarian cancer. HGSCs frequently arise in the distal fallopian tubes rather than the ovary, developing from small precursor lesions called serous tubal intraepithelial carcinomas (TICs or more specifically STICs). While STICs have been reported to harbor TP53 mutations, detailed molecular characterizations of these lesions are lacking. Observations We performed targeted next generation sequencing (NGS) on formalin-fixed, paraffin- embedded tissue from four women, two with HGSC and two with uterine endometrioid carcinoma (UEC) who were diagnosed with synchronous STICs. We detected concordant mutations in both HGSCs with synchronous STICs, including TP53 mutations as well as assumed germline BRCA1/2 alterations, confirming a clonal relationship between these lesions. NGS confirmed the presence of a STIC clonally unrelated to one case of UEC. NGS of the other tubal lesion diagnosed as a STIC unexpectedly supported the lesion as a micrometastasis from the associated UEC. Conclusions and Relevance We demonstrate that targeted NGS can identify genetic lesions in minute lesions such as TICs, and confirm TP53 mutations as early driving events for HGSC. NGS also demonstrated unexpected relationships between presumed STICs and synchronous carcinomas, suggesting potential diagnostic and translational research applications. PMID:26181193

Next-Generation Sequencing of Tubal Intraepithelial Carcinomas.

Science.gov (United States)

McDaniel, Andrew S; Stall, Jennifer N; Hovelson, Daniel H; Cani, Andi K; Liu, Chia-Jen; Tomlins, Scott A; Cho, Kathleen R

2015-11-01

High-grade serous carcinoma (HGSC) is the most prevalent and lethal form of ovarian cancer. HGSCs frequently arise in the distal fallopian tubes rather than the ovary, developing from small precursor lesions called serous tubal intraepithelial carcinomas (TICs, or more specifically, STICs). While STICs have been reported to harbor TP53 mutations, detailed molecular characterizations of these lesions are lacking. We performed targeted next-generation sequencing (NGS) on formalin-fixed, paraffin-embedded tissue from 4 women, 2 with HGSC and 2 with uterine endometrioid carcinoma (UEC) who were diagnosed as having synchronous STICs. We detected concordant mutations in both HGSCs with synchronous STICs, including TP53 mutations as well as assumed germline BRCA1/2 alterations, confirming a clonal association between these lesions. Next-generation sequencing confirmed the presence of a STIC clonally unrelated to 1 case of UEC, and NGS of the other tubal lesion diagnosed as a STIC unexpectedly supported the lesion as a micrometastasis from the associated UEC. We demonstrate that targeted NGS can identify genetic alterations in minute lesions, such as TICs, and confirm TP53 mutations as early driving events for HGSC. Next-generation sequencing also demonstrated unexpected associations between presumed STICs and synchronous carcinomas, providing evidence that some TICs are actually metastases rather than HGSC precursors.

Genital tuberculosis is common among females with tubal factor ...

African Journals Online (AJOL)

Methods: We conducted a prospective observational study in Al Thawra General Hospital (from March 2012 to February 2014). Of a total 151 women who had tubal factor infertility, 61 cases were investigated for genital tuberculosis. Women who were found to have the disease were treated by antitubercular therapy and the ...

Non-surgical female sterilization with quinacrine-induced tubal occlusion: a clinical trial

Directory of Open Access Journals (Sweden)

Seifi

2008-08-01

Full Text Available Background: Over the last 35 years, quinacrine has been used to sterilize more than 150,000 women in 40 countries, first in the form of slurry and now in the form of cylindrical pellets. Some studies confirmed the tubal occlusion by hysterosalpyngo-graphy, but this method increases the chance of failure. Only a few studies on tubal occlusion have used transvaginal sonography for confirmation, and there were some doubts about the effect of quinacrine on the endometrium. We performed this study to evaluate the tubal scar and endometrial pattern by ultrasound and to determine the feasibility, acceptance, and side effects of quinacrine sterilization (QS in Iranian women. Methods: This prospective clinical trial was done at the Vali-e-Asr Reproductive Health Research Center of the Tehran University of Medical Sciences between April 2005 and July 2006. One hundred sexually active women ranging from 30 to 47 years of age, who had at least two children above two years old, requesting sterilization, were sterilized by this method. By the end of menstrual bleeding, seven pellets, each containing 36mg quinacrine, were inserted in the uterine fundal area via the cervical canal. The procedure was repeated one month later. Three cycles after the first step, transvaginal sonography was performed to visualize the tubal scar and determine the endometrial pattern. Patients were followed at one and three years after initiation of the procedure. Results: All women were satisfied with the procedure. There were no side effects. No pregnancies had occurred, nor were there endometrial thickness abnormalities. Scar formation was visible in the tubes. "nConclusion: Quinacrine sterilization is a useful method for women and can be recommended to family planning services as an ambulatory procedure due to its efficacy, simplicity, acceptance and cost effectiveness.

Female sterilization by tubal ligation at caesarean section in Makurdi ...

African Journals Online (AJOL)

Background: Female sterilization is an important tool in reducing unplanned pregnancy and maternal mortality in our environment. The aim of this study was to determine the incidence, sociodemographic characteristics, technique, effectiveness and complications associated with female sterilization by bilateral tubal ligation ...

Hysteroscopic tubal sterilization: a systematic review of the Essure system.

Science.gov (United States)

Hurskainen, Ritva; Hovi, Sirpa-Liisa; Gissler, Mika; Grahn, Riitta; Kukkonen-Harjula, Katriina; Nord-Saari, Merja; Mäkelä, Marjukka

2010-06-01

To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008. The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare. Women over 30 years, who had been sterilized by the Essure method. Hysteroscopic tubal sterilization using Essure system. Efficacy/effectiveness, adverse events, costs. Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed. The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention.

Science.gov (United States)

Carlson, Joseph W; Miron, Alexander; Jarboe, Elke A; Parast, Mana M; Hirsch, Michelle S; Lee, Yonghee; Muto, Michael G; Kindelberger, David; Crum, Christopher P

2008-09-01

A diagnosis of primary peritoneal serous carcinoma (PPSC) requires exclusion of a source in other reproductive organs. Serous tubal intraepithelial carcinoma (STIC; stage 0) has been described in asymptomatic women with BRCA mutations and linked to a serous cancer precursor in the fimbria. This study examined the frequency of STIC in PPSC and its clinical outcome in BRCA-positive women. Presence or absence of STIC was recorded in consecutive cases meeting the 2001 WHO criteria for PPSC, including 26 patients with nonuniform sampling of the fallopian tubes (group 1) and 19 patients with complete tubal examination (group 2; sectioning and extensively examining the fimbriated end, or SEE-FIM protocol). In selected cases, STIC or its putative precursor and the peritoneal tumor were analyzed for p53 mutations (exons 1 to 11). Outcome of STIC was ascertained by literature review. Thirteen (50%) of 26 PPSCs in group 1 involved the endosalpinx, with nine STICs (35%). Fifteen (79%) of 19 cases in group 2 contained endosalpingeal involvement, with nine STICs (47%). STIC was typically fimbrial and unifocal, with variable invasion of the tubal wall. In five of five cases, the peritoneal and tubal lesion shared an identical p53 mutation. Of 10 reported STICs in BRCA-positive women, all patients were without disease on follow-up. The fimbria is the source of nearly one half of PPSCs, suggesting serous malignancy originates in the tubal mucosa but grows preferentially at a remote peritoneal site. The generally low risk of recurrence in stage 0 (STIC) disease further underscores STIC as a possible target for early serous cancer detection and prevention.

Serous tubal intraepithelial neoplasia: the concept and its application.

Science.gov (United States)

Meserve, Emily E K; Brouwer, Jan; Crum, Christopher P

2017-05-01

In recent years it has become clear that many extra-uterine (pelvic) high-grade serous carcinomas (serous carcinomas) are preceded by a precursor lesion in the distal fallopian tube. Precursors range from small self-limited 'p53 signatures' to expansile serous tubal intraepithelial neoplasms that include both serous tubal epithelial proliferations (or lesions) of uncertain significance and serous tubal intraepithelial carcinomas. These precursors can be considered from three perspectives. The first is biologic underpinnings, which are multifactorial, and include the intersection of DNA damage with Tp53 mutations and disturbances in transcriptional regulation that increase with age. The second perspective is the morphologic discovery and classification of intraepithelial neoplasms that are intercepted early in their natural history, either incidentally or in risk-reduction surgeries for germline mutations. For the practicing pathologist, as well as the investigators, a distinction between a primary intraepithelial neoplasm and an intramucosal carcinoma must be made to avoid misinterpreting (or underestimating) the significance of these proliferations. The third perspective is the application of this information to intervention, devising strategies that will actually lower the ovarian cancer death rate by opportunistic salpingectomy, widespread comprehensive genetic screening and early detection. Central to this issue are the questions of (1) whether some STICs are metastatic, (2) whether lower-grade epithelial proliferations can invade prior to evolving into intraepithelial carcinoma, or (3) metastasize and become malignant elsewhere ('precursor escape'). An important caveat is the persistent and unsettling reality that many high-grade serous carcinomas are not associated with an obvious point of initiation in the fallopian tube. The pathologist sits squarely in the midst of all of these issues, and has a pivotal role in managing expectations for stemming the death

Comparison of Levels of Antibodies against Chlamydia Trachomatis in Infertile Women Due to Tubal Factors and Fertile Women

Directory of Open Access Journals (Sweden)

F Ghalmbor

2009-01-01

Full Text Available Introduction: Chlamydia trachomatis infection is a common pathogen in sexual transmitted disease, but most of female patients with this infection are asymptomatic. Sequealae include pelvic inflammatory disease, infertility and ectopic pregnancy. The aim of the study was to determine the association between Chlamydia trachomatis and tubal factor infertility, if significant. Methods: This prospective, case -control study was done in April 2005-April2006. The study group consisted of 125 patients with tubal factor infertility and the control group included 125 fertile women. The level of antibodies to Chlamydia trachomatis was determined in both groups by ELIZA method. Results: Antibody to Chlamydia trachomatis was present in 29 women in the study group (23.2% and in15 women in the control group ( 12%, respectively, (P< 0.005. The mean level of antibody in both groups was 0.76 and 0.49, respectively (P<0.0005. Conclusion: The study showed that the level of antibody against Chlamydia is significantly more in tubal factor infertile women. We therefore suggest the screening of Chlamydia antibody testing is necessary for tubal factor infertility workup.

Bilateral tubal ectopic pregnancies: A report of two cases | Eze ...

African Journals Online (AJOL)

Bilateral tubal ectopic pregnancies are rare occurrences. Two recently managed cases are discussed. The first was a single, sexually active 23-year-old nullipara with family history of twinning who presented with eight weeks amenorrhea, positive pregnancy test, lower abdominal discomfort and other clinical and ultrasound ...

Serous tubal intraepithelial carcinoma localizes to the tubal-peritoneal junction: a pivotal clue to the site of origin of extrauterine high-grade serous carcinoma (ovarian cancer).

Science.gov (United States)

Seidman, Jeffrey D

2015-03-01

Recent data suggest that intraepithelial carcinoma of the fallopian tube [serous tubal intraepithelial carcinoma (STIC)] is the precursor of high-grade extrauterine serous carcinoma. A more specific location for the origin of this lesion is suggested by the recently described junction between the fallopian tubal epithelium and the peritoneum [tubal-peritoneal junction (TPJ)]. Fallopian tubes from 202 patients with advanced-stage high-grade extrauterine serous carcinoma or carcinosarcoma were evaluated histologically as were 124 prophylactic salpingo-oophorectomy specimens. These included 54 patients with BRCA or other high-risk mutation or a family history of BRCA mutation and 70 with a personal or family history of breast carcinoma. STIC was found in 81 of 202 patients with serous carcinoma (40.1%). STIC was present in 73 of 141 (52%) cases in which the fimbriae were present and in 62 of 100 (62%) cases in which the TPJ was present (P not significant). In comparison with these groups, when fimbriae and TPJ were absent, STIC was found in 8 of 61 (13%) cases (PSTIC. The mean size of STIC was 1.7 mm. In 32 cases (39.5%), the lesion was flat and in 49 (60.5%), papillary. The mean size of flat STICs was 0.8 mm as compared with 2.3 mm for papillary STICs (P=0.00005). STIC was identified in the same tissue fragment as the junction in 48 cases. The mean distance of STIC to the junction was 1.8 mm. In 11 cases, STIC was flanked by peritoneal mesothelium on one side and tubal epithelium on the opposite side. In 51 patients, the mean distance of invasive carcinoma from the TPJ was 1.8 mm. This distance was 1.9 mm when STIC was present (37 cases) in comparison with 1.5 mm when STIC was absent (14 cases) (P not significant). In 27 of 42 cases (64%), STIC was contiguous with invasive carcinoma. Lamina propria invasion was present in 71% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (PSTIC was present as compared with 26% of cases in

Diagnostic accuracy of hysterosalpingo-foam-sonography to confirm tubal occlusion after Essure® placement as treatment for hydrosalpinges.

Science.gov (United States)

Dreyer, Kim; Hompes, Peter G A; Mijatovic, Velja

2015-04-01

Consensus globally is that hydrosalpinges need to be treated before IVF owing to their negative influence on outcomes. The current standard treatment is laparoscopic salpingectomy. A potential less invasive treatment is proximal occlusion of a hydrosalpinx by hysteroscopic placement of an Essure® device. Tubal occlusion after Essure® placement needs to be verified by hysterosalpingography (HSG). However, this is a painful examination, that exposes patients to radiation. Hysterosalpingo-foam sonography (HyFoSy) is a less invasive alternative test to confirm proximal tubal occlusion. This prospective diagnostic accuracy study evaluated if HyFoSy is as accurate as HSG to confirm proximal tubal occlusion after placement of an Essure® device as treatment for a hydrosalpinx before IVF. Thirty-eight treated hydrosalpinges in 26 women were evaluated. Proximal occlusion was verified by HyFoSy (index test) and HSG (standard reference). The accuracy of HyFoSy was 97.4% (95% CI 92.3% to 100.0%). Sensitivity and specificity were 97.1% (95% CI.84.6% to 99.5%) and 100.0% (95% CI 40.2% to 100.0%), respectively. After an Essure® device is placed as treatment for a hydrosalpinx before IVF, HyFoSy is as able as HSG to confirm proximal tubal occlusion. If HyFoSy demonstrates tubal patency, a subsequent HSG needs to be carried out to validate this finding. Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.

Science.gov (United States)

Janse, Juliënne A; Pattij, Thyrza O S; Eijkemans, Marinus J C; Broekmans, Frank J; Veersema, Sebastiaan; Schreuder, Henk W R

2013-09-01

To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Prospective multicenter study (Canadian Task Force II-2). Ten community (teaching) hospitals in the Netherlands. A total of 631 women who underwent permanent sterilization by tubal microinserts. Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement. Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications. Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience. A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Multimodality imaging of the Essure tubal occlusion device

International Nuclear Information System (INIS)

Simpson, W.L.; Beitia, L.

2012-01-01

The Essure device is a permanent birth-control device, which is gaining popularity. The micro-inserts are composed of metallic elements that can be seen on radiography, computed tomography, ultrasound, and magnetic resonance imaging. Knowledge of the normal location and appearance of the Essure device will ensure appropriate patient care. The purpose of this review is to describe the Essure tubal occlusion device and illustrate its normal and abnormal appearance using various imaging methods.

Síndrome pós-laqueadura: repercussões clínicas e psíquicas da pós-laqueadura Post-tubal sterilization syndrome: evaluation of the psychological and clinical disturbances in tubal ligation syndrome

Directory of Open Access Journals (Sweden)

Rogério Dias

1998-05-01

Full Text Available O objetivo deste estudo foi investigar as alterações menstruais e os efeitos psíquicos decorrentes da laqueadura tubária - síndrome pós-laqueadura. Os autores acompanharam prospectivamente 300 mulheres do Setor de Endoscopia Ginecológica e Planejamento Familiar do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP, durante um, três e cinco anos após o procedimento cirúrgico de laqueadura. Diferentes parâmetros foram analisados após a laqueadura, tais como: intervalo do ciclo menstrual, duração e intensidade do fluxo menstrual, dismenorréia, dor pélvica, taxa de arrependimento e outros, comparando-se com os padrões prévios ao procedimento. Nossos achados sugerem que a maioria das mulheres estudadas não apresentaram alterações pós-laqueadura. Tais achados não negam ou diminuem a importância e os benefícios da esterilização tubária, mas servem como ponto de partida para futuras investigações.The purpose of the present study was to investigate the menstrual disturbances and the psychological effects of post-tubal sterilization - the so-called post-tubal sterilization syndrome. Does it exist? The authors followed-up prospectively 300 women from the Gynecological Endoscopy and Family Planning Section, Department of Obstetrics and Gynecology, Botucatu Medical School, Universidade Estadual Paulista (UNESP during one, three and five years after tubal sterilization surgery. Different parameters such as menstrual cycle length, duration of menstrual flow, dysmenorrhea, pelvic pain, regret rates etc, after tubal ligation, were analyzed. Each woman served as her own control. In conclusion, our findings suggest that most women reported no menstrual changes subsequent to sterilization. These findings do not deny or diminish the importance or benefits of tubal sterilization, but serve as a focus for further investigation.

A rare cause of acute abdominal pain in children: Isolated tubal torsion; a case series

Directory of Open Access Journals (Sweden)

Yasemin Dere Gunal

2017-06-01

Full Text Available Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US, color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2 and laparoscopy (n:1. One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility. Keywords: Fallopian tube, Torsion, Paratubal cyst, Adolescent, Acute abdomen

Laparoscopic evaluation of tubal pathology in cases of infertility

Directory of Open Access Journals (Sweden)

Maherunnessa

2013-07-01

Full Text Available Infertility is a public health problem in developed and developing countries. Diagnostic laparoscopy is a generally accepted procedure to detect pelvic organ pathologies affecting fertility. This study was undertaken to find out the tubal pathology contributing to primary and secondary infertility by laparoscopic examination. The study was carried out in the department of Gynaecology and Obstetrics, BIRDEM during the period of January 2001 to December 2001. The study group comprised of 100 cases of infertile patients of age between 20 to 40 years. Sixty seven percent patients had primary infertility and 33% patients had secondary infertility. Size and shape of the uterus was normal in 69% cases and bicornuate uterus was found in 2% cases. Out of total cases, 71% and 69% had normal right and left fallopian tubes respectively. Patency of right and left fallopian tube was normal in 90% and 89% cases respectively while 11% and 10% had peritubal adhesions. Laparoscopy examination is an important tool for evaluation of tubal pathology contributing to infertility and might play a major role in infertility management. Ibrahim Med. Coll. J. 2013; 7(2: 38-40

Diagnostic methods of tubal factor in infertility

International Nuclear Information System (INIS)

Korzon, T.; Mielnik, J.; Gosciniak, W.

1993-01-01

The diagnostic methods of tubal factor in infertility have been presented. In details have been discussed PJ, PK HSG and pelviscopy. These examinations themselves constitute the basic ones in infertility. We turned our attention into technical details and possible mistakes which may occur at the time of performing them, these misinterpretations may lead to absolutely wrong conclusion and diagnosis. Authors have wide experience in performing the discussed examinations and this allows them to share their opinion. Over the years several thousand of PK and HSG examinations have been carried out and also 1000 laparoscopies. (author)

[Rare complication following oesophagectomy: early peptic ulcer perforation of the tubal stomach].

Science.gov (United States)

Géczi, Tibor; Paszt, Attila; Simonka, Zsolt; Furák, József; Lázár, György

2011-10-01

We report the case of a 45-year-old male patient who developed an acute peptic ulcer perforation of the tubal stomach on the second postoperative day after oesophagectomy. The patient underwent emergency surgery (perforation was closed with a Graham patch) followed by treatment in intensive care, and was finally discharged on the 19th postoperative day. Gastric pull-up is a surgical technique that is widely used to re-establish the continuity of the gastrointestinal tract after oesophagectomy. Various early and late complications of reconstruction with the tubal stomach are well-known, such as gastric necrosis, gastritis, gastric ulcer, as well as benign and malignant tumors. The precise etiology of gastric tube ulceration is not known yet, however, it can develop not only in the late, but also in the early postoperative period, as well.

Shortened telomeres in serous tubal intraepithelial carcinoma: an early event in ovarian high-grade serous carcinogenesis.

Science.gov (United States)

Kuhn, Elisabetta; Meeker, Alan; Wang, Tian-Li; Sehdev, Ann Smith; Kurman, Robert J; Shih, Ie-Ming

2010-06-01

Short telomeres are one of the main genetic manifestations in human cancer, as they have been shown to play an important role in inducing chromosomal instability and in contributing to tumor progression. The purpose of this study was to determine if changes in telomere length occur in serous tubal intraepithelial carcinoma (STIC), the putative precursor of "ovarian" high-grade serous carcinoma (HGSC). Twenty-two STICs from 15 patients with concurrent but discrete HGSCs were analyzed for telomere length on formalin-fixed, paraffin-embedded sections by conducting p53 immunofluorescence to assist in identifying STICs and telomere-specific FISH. Telomere length (short, long, or no change) in STICs was compared with HGSCs using normal fallopian tube epithelium and stromal cells as controls. We found that STICs had the shortest telomeres, as 18 (82%) of 22 STICs had short telomeres, whereas only 2 (9%) showed no change and 2 (9%) had long telomeres compared with the normal-looking tubal epithelium. In contrast, among 12 paired HGSCs and STICs, 6 HGSCs showed an increase in telomere length, one showed a decrease in length and 5 did not show any change when compared with their matched STICs, although, such as STICs, the majority of HGSCs had shorter telomeres than the associated normal tubal epithelial cells. These differences in telomere length between normal tubal epithelial cells and STICs, and between STICs and HGSCs were statisticaly significant (PSTICs provides further support to the proposal that STICs are precursors of HGSC and opens new areas of research in elucidating the early events of ovarian high-grade serous carcinogenesis.

Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls.

NARCIS (Netherlands)

Mingels, M.J.J.M.; Roelofsen, T.; Laak, J.A.W.M. van der; Hullu, J.A. de; Ham, M.A.P.C. van; Massuger, L.F.A.G.; Bulten, J.; Bol, M.

2012-01-01

OBJECTIVE: A precursor lesion for ovarian carcinoma, tubal intraepithelial carcinoma (TIC), has been identified in BRCA-mutation carriers undergoing prophylactic bilateral salpingo-oophorectomy (pBSO). Other lesions were also identified in fallopian tubes, but different terminology, interpretation,

Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

Directory of Open Access Journals (Sweden)

Lutala Prosper M

2011-12-01

Full Text Available Abstract Background Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants. Methods This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description. Results Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains. Conclusions Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.

STUDIES ON HUMAN FALLOPIAN TUBAL EPITHELIUM IN DIFFERENT AGE GROUPS

Directory of Open Access Journals (Sweden)

Jayasri

2016-02-01

Full Text Available BACKGROUND AND AIMS The “fallopian tubes” (oviducts or uterine tubes are long paired flexuous reproductive organ which transports ova, spermatozoa, zygotes, the pre-implantation morulae and blastocyst. It has major role during reproductive period, but it remains as if vestigial organ before puberty and after menopause. Due to increasing rate of tubal block and infertility, oviducts and their structures gaining importance and have become a subject of research in present days particularly epithelium. The aim of the study is to ascertain any histological difference of tubal epithelium in different age groups and the research work could be utilized for investigation and management of infertility. MATERIALS AND METHODS Seven samples of each group i.e., prereproductive, reproductive & postmenopausal were collected from fresh unembalmed human cadavers received in the department of Anatomy, FAA Medical College, Barpeta, Assam. The slides were prepared using the standard laboratory procedure. Under low and high power objectives the type of cells were observed and epithelial height was measured in the different segments. Stress was given for any significant difference of epithelial height between the different age groups. RESULTS Study revealed that among the groups within the same segment, epithelial height was recorded highest (33.57µm in reproductive group as against the lowest (22.91µm in post-menopausal group. Epithelial structures of the prereproductive and reproductive groups were significantly differed (p<0.01 from the postmenopausal group. CONCLUSIONS From the findings of the present study it can be concluded that: 1. In all the groups fallopian tubal epithelium is of simple columnar type and contains three types of cells. Cells are ciliated, secretory & peg (intercalary cells. 2. In all the groups same type of increasing trend of epithelial height from intramural segment to ampullary segment was recorded. 3. In intergroup comparison of

Multimodality imaging of the Essure tubal occlusion device.

Science.gov (United States)

Simpson, W L; Beitia, L

2012-12-01

The Essure device is a permanent birth-control device, which is gaining popularity. The micro-inserts are composed of metallic elements that can be seen on radiography, computed tomography, ultrasound, and magnetic resonance imaging. Knowledge of the normal location and appearance of the Essure device will ensure appropriate patient care. The purpose of this review is to describe the Essure tubal occlusion device and illustrate its normal and abnormal appearance using various imaging methods. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

BCL2 and keratin 5 define the uterine-cervix-isthmus junction, a transition between endocervical and tubal-like epithelium.

Science.gov (United States)

Hoogduin, Klaas J; Hopman, Anton N H; Ramaekers, Frans C S; McCluggage, W Glenn; Smedts, Frank

2013-01-01

A clearcut definition of the transition from the cervix to the lower uterine segment is lacking. We therefore evaluated the location of the anatomic border between the cervix and the uterine corpus. Using both morphometry and immunohistochemisty, we examined the epithelial and stromal cell types in this transition zone. In 26 patients, longitudinal sections from the cervix uteri up to the fundus uteri were paraffin embedded and immunohistochemically stained for BCL2, keratin 5, Ki-67, CD10, and CD34. Examination of the slides resulted in the identification of a junctional zone in the cranial portion of the cervix, which is characterized by a usually abrupt morphologic and immunohistochemical transition from an endocervical-type mucinous epithelium to a ciliated tubal-like epithelium and a slow transition in stromal marker expression patterns. This epithelial transition was characterized by its intense keratin 5 and BCL2 staining with accompanying Ki-67 expression in the tubal-like epithelium, whereas the endocervical epithelium was largely negative for these markers. CD10 expression was usually quite intense directly around endocervical invaginations, but the remaining stroma was negative. Toward the endometrial cavity, expression increased and endometrial stroma displayed full thickness expression for CD10. CD34 showed a reverse pattern to CD10, with moderate expression in the endocervical stroma, which disappeared in the endometrial stoma. The immunohistochemical identification of this transition may allow a more objective determination of the extension of endometrial carcinoma into the cervix in cases that are morphologically problematic. Furthermore, as ciliated tubal-like epithelium is invariably found cranial to the uterine-cervix-isthmus junction, a diagnosis of tubal metaplasia should not be made in this region and tubal-like epithelium is not indicative of a metaplastic process.

Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer.

Science.gov (United States)

Winkler, H A; Anderson, P S; Fields, A L; Runowicz, C D; DeVictoria, C; Goldberg, G L

1999-01-01

To evaluate patient compliance with Papanicolaou (Pap) smear screening after tubal ligation compared with other methods of birth control in patients who develop cervical cancer, a retrospective review of 262 women with cervical cancer diagnosed at age Albert Einstein College of Medicine from January 1987 to December 1995. Demographic data, stage of the disease, histologic type, history of smoking, history of sexually transmitted disease (STD), and birth control use were recorded. The Pap screening history was obtained from all the patients. Women who had a bilateral tubal ligation (BTL) were compared with those who did not have this form of birth control. The date and result of their last Pap test prior to their diagnosis of cervical cancer was noted. Two hundred fourteen women with cervical cancer were evaluable. The clinical stage, mean age, history of smoking, and history of STD were similar for both groups. Gravidity among the BTL group was higher than in the non-BTL group (p < 0.01). Forty-eight (22.4%) women had a previous BTL. Twenty-seven of these 48 patients (56.3%) did not have a Pap smear within 3 years prior to the diagnosis of cervical cancer. Of the 166 patients, 61 (36.7%) did not have a Pap test within 3 years (p < 0.05). Fourteen women (29.2%) in the tubal ligation group never returned for a Pap test following the BTL. An average of 6.2+/-5.9 years elapsed since the last Pap test in the BTL group, with 4.0+/-5.1 years in the nontubal ligation group (p < 0.05). There was a correlation between the number of years since BTL (14.2+/-7.7) to the number of years since the last Pap test (6.2+/-5.9) (p < 0.05). Women who have had a BTL should be considered high risk because of poor screening compliance. A Pap test every 3 years is not adequate in this high-risk population group. We advocate improved counseling regarding the importance of continued annual Pap screening for women who are considering tubal ligation.

Intraoperative complications of outpatient interval tubal sterilization at a teaching hospital in Turkey

International Nuclear Information System (INIS)

Dilbaz, B.; Akdag, D.; Cengiz, H.; Akyunak, A.; Dilbaz, S.; Haberal, A.

2008-01-01

Objective was to evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. The data of 461 patients who underwent interval tubal ligation ITL at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or had a complication and/or an unplanned laparotomy were analyzed. The mean age of patients was 35.1 range: 21-51, gravidity was 4.6 range: 2-9, parity was 3.2 range: 2-7 and number of living children was 3.1 range 2-6. Out of 461 patients, only 20.4% had complications related with general anesthesia. Two cases 0.4% had bleeding from the port-site, 3 cases 0.6% had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding 0.2% from vagina wall. There was only one 0.2% intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1% and all the complications were encountered in patients who had laparoscopic surgery. Outpatient tubal ligation is a convenient and safe procedure and implementing endoscopic surgical techniques is necessary for correction of the complications. (author)

Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors

DEFF Research Database (Denmark)

Madsen, C; Baandrup, Louise; Dehlendorff, Christian

2015-01-01

OBJECTIVE: According to the recent theories on the ovarian cancer origin, any protective effect of tubal ligation may vary with histologic subtype of ovarian cancer. Furthermore, bilateral salpingectomy may represent an opportunity for surgical prevention of serous ovarian cancer. DESIGN: Nationw......OBJECTIVE: According to the recent theories on the ovarian cancer origin, any protective effect of tubal ligation may vary with histologic subtype of ovarian cancer. Furthermore, bilateral salpingectomy may represent an opportunity for surgical prevention of serous ovarian cancer. DESIGN...... sampling. We required that cases and controls have no previous cancer and that controls have no previous bilateral oophorectomy. METHODS: Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusting for potential confounders. MAIN OUTCOME MEASURES: Epithelial...

Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility

International Nuclear Information System (INIS)

Fenzl, Vanja

2012-01-01

Hysterosalpingo-contrast sonography (HyCoSy) is safe and easy to perform outpatient method in the evaluation of female infertility. During this procedure a certain level of discomfort and pain are experienced by patients. On the basis of reducing avoidable pain inductors the aim of this study was to compare pain sensation due to different warmth of applied contrasts (sterile saline and Echovist ® ). Prospective and randomized study was performed on patients requiring tubal and uterine assessment during standard infertility work up. One group of patients was examined using both contrasts at room temperature and the other group using preheated contrasts at body temperature. Pain experience of the procedure was rated by patients for each contrast by numerical scale (0–10) immediately after the procedure. There was significant statistical difference between pain scores during application of two contrasts in each group; Echovist induces significantly less pain in comparison to sterile saline at the same temperature (P = 0.002, 0.001). Between two groups there is also statistically significant difference in pain during introduction of the same contrast at different temperature (P < 0.001). The most tolerable for the patient is body temperature of the applied contrasts although their structure and concentrations can be another factor associated with tolerability of the procedure.

Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility

Energy Technology Data Exchange (ETDEWEB)

Fenzl, Vanja, E-mail: vanja.radic@inet.hr [Department of Gynecology and Obstetrics, University Hospital “Merkur”, Zajčeva 19 (Croatia); University of Applied Health Studies, Mlinarska Cesta 38, 10000 Zagreb (Croatia)

2012-12-15

Hysterosalpingo-contrast sonography (HyCoSy) is safe and easy to perform outpatient method in the evaluation of female infertility. During this procedure a certain level of discomfort and pain are experienced by patients. On the basis of reducing avoidable pain inductors the aim of this study was to compare pain sensation due to different warmth of applied contrasts (sterile saline and Echovist{sup ®}). Prospective and randomized study was performed on patients requiring tubal and uterine assessment during standard infertility work up. One group of patients was examined using both contrasts at room temperature and the other group using preheated contrasts at body temperature. Pain experience of the procedure was rated by patients for each contrast by numerical scale (0–10) immediately after the procedure. There was significant statistical difference between pain scores during application of two contrasts in each group; Echovist induces significantly less pain in comparison to sterile saline at the same temperature (P = 0.002, 0.001). Between two groups there is also statistically significant difference in pain during introduction of the same contrast at different temperature (P < 0.001). The most tolerable for the patient is body temperature of the applied contrasts although their structure and concentrations can be another factor associated with tolerability of the procedure.

Relationship between serum Chlamydia trachomatis antibody titer and tubal block in infertile Egyptian women

Directory of Open Access Journals (Sweden)

Ahmed Khairy Makled

2013-03-01

Conclusion: ELISA can be used as a simple, noninvasive screening test for C. trachomatis IgG antibodies, with a high predictive value for tubal occlusion in infertile Egyptian women, however larger studies are needed to confirm our results.

Papillary Tubal Hyperplasia. The Putative Precursor of Ovarian Atypical Proliferative (Borderline) Serous Tumors, Noninvasive Implants and Endosalpingiosis

Science.gov (United States)

Kurman, Robert J.; Vang, Russell; Junge, Jette; Hannibal, Charlotte Gerd; Kjaer, Susanne K.; Shih, Ie-Ming

2011-01-01

In contrast to the controversy regarding the terminology and behavior of ovarian noninvasive low-grade serous tumors (atypical proliferative serous tumor [APST] and serous borderline tumor [SBT]), little attention has been directed to their origin. Similarly, until recently, proliferative lesions in the fallopian tube have not been extensively studied. The recent proposal that ovarian high-grade serous carcinomas are derived from intraepithelial carcinoma in the fallopian tube prompted us to evaluate the possible role of the fallopian tube in the genesis of low-grade serous tumors. We have identified a lesion, designated “papillary tubal hyperplasia (PTH)”, characterized by small rounded clusters of tubal epithelial cells and small papillae, with or without associated psammoma bodies, that are present within the tubal lumen and which are frequently associated with APSTs. Twenty-two cases in this study were selected from a population-based study in Denmark of approximately 1000 patients with low-grade ovarian serous tumors in whom implants were identified on the fallopian tube. Seven additional cases were seen recently in consultation at The Johns Hopkins Hospital (JHH). These 7 cases were not associated with an ovarian tumor. Papillary tubal hyperplasia was found in 20 (91%) of the 22 cases in the Danish study. Based on this association of PTH with APSTs with implants and the close morphologic resemblance of PTH, not only to the primary ovarian APSTs but also to the noninvasive epithelial implants and endosalpingiosis, we speculate that the small papillae and clusters of cells from the fallopian tubes implant on ovarian and peritoneal surfaces to produce these lesions. The 7 JHH cases of PTH that were not associated with an ovarian tumor support the view that PTH is the likely precursor lesion. We propose a model for the development of ovarian and extraovarian low-grade serous proliferations (APST, noninvasive epithelial implants and endosalpingiosis) that

Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria ...

African Journals Online (AJOL)

Background and Objective: To document bilateral tubal ligation (BTL) rate and highlight the need to improve on the rates. Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. Results: There were a total of 103 BTLs, 58 were ...

The attitudes of Dutch fertility specialists towards the addition of genetic testing in screening of tubal factor infertility.

Science.gov (United States)

Malogajski, Jelena; Jansen, Marleen E; Ouburg, Sander; Ambrosino, Elena; Terwee, Caroline B; Morré, Servaas A

2017-06-01

This study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology. Experienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals. 60.4% (n=91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n=90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n=91) and cost-effectiveness (95.6%, n=91) were recognized by the respondents as important factors in gaining support for the new screening strategy. In summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making. Copyright © 2017 Elsevier B.V. All rights reserved.

Interventional ovarian tube catheterization in treating tubal ectopic pregnancy

International Nuclear Information System (INIS)

Hu Yi; Xiong Linhui; Du Pianqin; Chen Jiabin

2004-01-01

Objective: To explore the feasibility and curative effect of treating tubal pregnancy through the fallopian tube with interventional catheterization decrease the difficulty of the procedure and shorten the consuming time. Methods: Applying the method of interventional catheterization of fallopian tube and injecting 0.5 mg atropine at the cervix beforehand, then 70 mg MTX was administered into the fallopian tube. Results: 113 patients were successfully recovered with health except one without any adversary complication. Conclusions: The interventional fallopian tube catheterization for treating ectopic pregnancy is a simple, safe, minitraumatic, quick and effective method. (authors)

Simultaneous Bilateral Tubal Pregnancy After In Vitro Fertilization and Embryo Transfer

Directory of Open Access Journals (Sweden)

Sunduz Ozlem Altinkaya

2008-09-01

Conclusion: The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.

Silicone rubber band for laparoscopic tubal sterilization.

Science.gov (United States)

Ansari, A H; Sealey, R M; Gay, J W; Kang, I

1977-12-01

In 1974, Yoon and associates (Am J Obstet Gynecol 120:132, 1974) described a new approach in which laparoscopic tubal occlusion was accomplished by utilizing the silicone rubber band technique. Recognizing the great advantages of the new technique in eliminating potential thermal injury associated with electrocoagulation, the authors have utilized the Yoon silicone rubber band technique in these institutions over the past 20 months. Thus far the procedure has been performed in 304 patients without any major complications. In the hope of eliminating and/or reducing possible pregnancy-failure rates, in 110 cases. In addition to application of the silicone band, the tube within the band was transected with non-electrical Seigler biopsy forceps. This, we believe, should provide an interesting long-term comparative study.

Morphological and immunohistochemical pattern of tubo-ovarian dysplasia and serous tubal intraepithelial carcinoma.

Science.gov (United States)

Chene, Gautier; Cayre, Anne; Raoelfils, Ines; Lagarde, Nicole; Dauplat, Jacques; Penault-Llorca, Frederique

2014-12-01

Histopathological examination of material from prophylactic salpingo-oophorectomies performed in patients at genetic risk of ovarian cancer can reveal abnormalities interpreted as possible pre-cancerous "ovarian dysplasia" and tubal precursors lesions. We sought to study the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in prophylactically removed ovaries and fallopian tubes (pBSO) in comparison with a group of serous tubal intraepithelial carcinoma (STIC) and non-cancerous controls. Morphological features and immunohistochemical expression patterns of Ki-67 (for proliferation biomarker), p53 (key pathway of mullerian serous tumorogenesis), Bcl2 (anti-apoptotic), γH2AX (a double-strand breaks marker) and ALDH1 (a stem cell marker significantly associated with early-stage ovarian cancer) were blindly evaluated by two pathologists in 111 pBSO, 12 STICs and 116 non-cancerous salpingo-oophorectomies (control group) (nBSO). Morphological ovarian and tubal dysplasia scores were significantly higher in the pBSO than in controls (respectively, 8.8 vs 3.12, pSTICs compared with the controls whereas expression patterns of Ki67, p53 and bcl2 were low to moderate in the pBSO group. STICs overexpressed Ki67 and p53 while bcl2 expression was low; Interestingly, ALDH1 expression was low in non dysplastic epithelium, high in dysplasia and constantly low in STICs. The morphological and immunohistochemical profile of tubo-ovarian dysplasia and STICs might be consistent with progression toward neoplastic transformation in the Serous Carcinogenesis Sequence. These changes may be pre-malignant and could represent an important phase in early neoplasia. ALDH1 activation in pBSO samples and its extinction in STICs should be considered as a target for prevention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Serous tubal intraepithelial carcinoma: diagnostic reproducibility and its implications.

Science.gov (United States)

Carlson, Joseph W; Jarboe, Elke A; Kindelberger, David; Nucci, Marisa R; Hirsch, Michelle S; Crum, Christopher P

2010-07-01

Serous tubal intraepithelial carcinoma (STIC) is detected in between 5% and 7% of women undergoing risk-reduction salpingooophorectomy for mutations in the BRCA1 or 2 genes (BRCA+), and seems to play a role in the pathogenesis of many ovarian and "primary peritoneal" serous carcinomas. The recognition of STIC is germane to the management of BRCA+ women; however, the diagnostic reproducibility of STIC is unknown. Twenty-one cases were selected and classified as STIC or benign, using both hematoxylin and eosin and immunohistochemical stains for p53 and MIB-1. Digital images of 30 hematoxylin and eosin-stained STICs (n=14) or benign tubal epithelium (n=16) were photographed and randomized for blind digital review in a Powerpoint format by 6 experienced gynecologic pathologists and 6 pathology trainees. A generalized kappa statistic for multiple raters was calculated for all groups. For all reviewers, the kappa was 0.333, indicating poor reproducibility; kappa was 0.453 for the experienced gynecologic pathologists (fair-to-good reproducibility), and kappa=0.253 for the pathology residents (poor reproducibility). In the experienced group, 3 of 14 STICs were diagnosed by all 6 reviewers, and 9 of 14 by a majority of the reviewers. These results show that interobserver concordance in the recognition of STIC in high-quality digital images is at best fair-to-good for even experienced gynecologic pathologists, and a proportion cannot be consistently identified even among experienced observers. In view of these findings, a diagnosis of STIC should be corroborated by a second pathologist, if feasible.

Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).

Science.gov (United States)

Mol, F; van Mello, N M; Strandell, A; Jurkovic, D; Ross, J A; Yalcinkaya, T M; Barnhart, K T; Verhoeve, H R; Graziosi, G C; Koks, C A; Mol, B W; Ankum, W M; van der Veen, F; Hajenius, P J; van Wely, M

2015-09-01

Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher. Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy. We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively. We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle. Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by

Infertility caused by tubal blockage: An ayurvedic appraisal

Science.gov (United States)

Shukla (Upadhyaya), Kamayani; Karunagoda, Kaumadi; Dei, L. P.

2010-01-01

Tubal blockage is one of the most important factors for female infertility. This condition is not described in Ayurvedic classics, as the fallopian tube itself is not mentioned directly there. The present study is an effort to understand the disease according to Ayurvedic principles. Correlating fallopian tubes with the Artavavaha (Artava-bija-vaha) Srotas, its block is compared with the Sanga Srotodushti of this Srotas. Charak's opinion that the diseases are innumerable and newly discovered ones should be understood in terms of Prakriti, Adhishthana, Linga, and Aayatana, is followed, to describe this disease. An effort has been made to evaluate the role of all the three Doshas in producing blockage, with classification of the disease done as per the Dasha Roganika. PMID:22131704

Vocal local versus pharmacological treatments for pain management in tubal ligation procedures in rural Kenya: a non-inferiority trial.

Science.gov (United States)

Keogh, Sarah C; Fry, Kenzo; Mbugua, Edwin; Ayallo, Mark; Quinn, Heidi; Otieno, George; Ngo, Thoai D

2014-02-04

Vocal local (VL) is a non-pharmacological pain management technique for gynecological procedures. In Africa, it is usually used in combination with pharmacological analgesics. However, analgesics are associated with side-effects, and can be costly and subject to frequent stock-outs, particularly in remote rural settings. We compared the effectiveness of VL + local anesthesia + analgesics (the standard approach), versus VL + local anesthesia without analgesics, on pain and satisfaction levels for women undergoing tubal ligations in rural Kenya. We conducted a site-randomised non-inferiority trial of 884 women receiving TLs from 40 Marie Stopes mobile outreach sites in Kisii and Machakos Districts. Twenty sites provided VL + local anesthesia + analgesics (control), while 20 offered VL + local anesthesia without additional analgesics (intervention). Pain was measured using a validated 11-point Numeric Rating Scale; satisfaction was measured using 11-point scales. A total of 461 women underwent tubal ligations with VL + local anesthesia, while 423 received tubal ligations with VL + local anesthesia + analgesics. The majority were aged ≥30 years (78%), and had >3 children (99%). In a multivariate analysis, pain during the procedure was not significantly different between the two groups. The pain score after the procedure was significantly lower in the intervention group versus the control group (by 0.40 points; p = 0.041). Satisfaction scores were equally high in both groups; 96% would recommend the procedure to a friend. VL + local anesthesia is as effective as VL + local anesthesia + analgesics for pain management during tubal ligation in rural Kenya. Avoiding analgesics is associated with numerous benefits including cost savings and fewer issues related to the maintenance, procurement and monitoring of restricted opioid drugs, particularly in remote low-resource settings where these systems are weak. Pan-African Clinical Trials Registry PACTR201304000495942.

Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy

Directory of Open Access Journals (Sweden)

Mwaffaq Heis

2011-12-01

Full Text Available Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. Design: Descriptive retrospective study. Setting: A university hospital in the north of Jordan. Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD age was 31.5 (5.91 years. Mean (SD duration of infertility was 4 (3.44 years. Infertility was reported as primary and secondary by 119 (42.3 % and 162 (57.6 %, respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 % were referred for laparoscopy. Eight (17.3% of them were treated with unilateral salpingectomy and 28 (60.8% with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2% women, and 3 (6.7% women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7% conceived within 1 - 11 months after the hysterosalpingography. Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.

Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy.

Science.gov (United States)

Soliman, Amr A; Shaalan, Waleed; Abdel-Dayem, Tamer; Awad, Elsayed Elbadawy; Elkassar, Yasser; Lüdders, Dörte; Malik, Eduard; Sallam, Hassan N

2015-12-01

To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Secretory cell outgrowths, p53 signatures, and serous tubal intraepithelial carcinoma in the fallopian tubes of patients with sporadic pelvic serous carcinoma.

Science.gov (United States)

Mittal, Neha; Srinivasan, Radhika; Gupta, Nalini; Rajwanshi, Arvind; Nijhawan, Raje; Gautam, Upasana; Sood, Swati; Dhaliwal, Lakhbir

2016-01-01

High-grade serous carcinomas of ovarian, tubal, and peritoneal origin are together referred as pelvic serous carcinoma. The fallopian tubes, ovarian surface epithelium, and the tuboperitoneal junctional epithelium are all implicated in pelvic serous carcinogenesis. The aim of this study is to identify putative precursor lesions of serous carcinoma including secretory cell outgrowths (SCOUTs), serous tubal intraepithelial carcinoma (STIC), and p53 signatures and assign its probable site of origin. Prospective case-control study of consecutive specimen comprising 32 serous carcinomas and 31 controls (10 normal adnexa, 10 benign and 6 atypically proliferative surface epithelial tumors, and 5 other carcinomas). Sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol along with immunohistochemistry for Bcl-2, p53, and Ki-67 was employed for evaluating invasive carcinoma and precursor lesions in cases versus controls. SCOUT, p53 signatures, and STIC were most frequent in the serous carcinomas. p53 signatures and STIC were always seen in the fimbrial end. STICs were exclusively present in serous carcinomas, more common in ipsilateral tubes of cases with dominant ovarian mass. Multifocal p53 signatures with STIC were seen in 7 (21.9%) cases. STIC was present with or without an invasive carcinoma in 25% and in 6.25% of cases of pelvic serous carcinomas, respectively. The junctional epithelia did not show any lesion in any group. SEE-FIM protocol is recommended for evaluation of sporadicpelvic (ovarian/tubal/peritoneal) serous carcinoma. Based on the presence of STIC or invasive carcinoma, nearly 60% of all pelvic serous carcinomas are of fallopian tubal origin.

Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery

Directory of Open Access Journals (Sweden)

Masaki Tanito

2018-01-01

Full Text Available Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.

Laqueadura intraparto e de intervalo Intrapartum and interval tubal sterilization: characteristics correlated with the procedure and regret in a sample of women from a public hospital

Directory of Open Access Journals (Sweden)

Arlete Maria dos Santos Fernandes

2006-10-01

foi cesárea. Não se detectou diferença nas taxas de satisfação e arrependimento após o procedimento entre os grupos.BACKGROUND: Brazil is a country with a high prevalence of tubal ligation, which is frequently performed at the time of delivery. In recent years, an increase in tubal reversal has been noticed, primarily among young women. OBJECTIVES: To study characteristics correlated with the procedure, determine frequency of intrapartum tubal ligation, measure patient satisfaction rates and tubal sterilization regret, in a sample of post-tubal patients. METHODS: Three hundred and thirty-five women underwent tubal ligation. The variables studied were related to the procedure: age at tubal ligation, whether ligation was performed intrapartum (vaginal or cesarean section or after an interval (other than the intrapartum and puerperal period, health service performing the sterilization, medical expenses paid for the procedure, reason stated for choosing the method and causes related to satisfaction/regret: desire to become pregnant after sterilization, search for treatment and performance of tubal ligation reversal. The women were divided into two groups, a group undergoing ligation in the intrapartum period and a second group ligated after an interval, to evaluate the association between variables by using Fisher's exact test and chi-squared calculation with Yates' correction. The study was approved by the Ethics Committee of the institution. RESULTS: There was a predominance of Caucasian women over 35 years of age, married, and with a low level of education of which 43.5% had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2% of them had cesarean delivery and 44.6% vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0% and 80.8% reported satisfaction with the method. Although 14.6% expressed a desire to become pregnant at some time after

Secretory cell outgrowths, p53 signatures, and serous tubal intraepithelial carcinoma in the fallopian tubes of patients with sporadic pelvic serous carcinoma

Directory of Open Access Journals (Sweden)

Neha Mittal

2016-01-01

Full Text Available Context: High-grade serous carcinomas of ovarian, tubal, and peritoneal origin are together referred as pelvic serous carcinoma. The fallopian tubes, ovarian surface epithelium, and the tuboperitoneal junctional epithelium are all implicated in pelvic serous carcinogenesis. Aims: The aim of this study is to identify putative precursor lesions of serous carcinoma including secretory cell outgrowths (SCOUTs, serous tubal intraepithelial carcinoma (STIC, and p53 signatures and assign its probable site of origin. Settings and Design: Prospective case-control study of consecutive specimen comprising 32 serous carcinomas and 31 controls (10 normal adnexa, 10 benign and 6 atypically proliferative surface epithelial tumors, and 5 other carcinomas. Subjects and Methods: Sectioning and extensive examination of the fimbrial end (SEE-FIM protocol along with immunohistochemistry for Bcl-2, p53, and Ki-67 was employed for evaluating invasive carcinoma and precursor lesions in cases versus controls. Results: SCOUT, p53 signatures, and STIC were most frequent in the serous carcinomas. p53 signatures and STIC were always seen in the fimbrial end. STICs were exclusively present in serous carcinomas, more common in ipsilateral tubes of cases with dominant ovarian mass. Multifocal p53 signatures with STIC were seen in 7 (21.9% cases. STIC was present with or without an invasive carcinoma in 25% and in 6.25% of cases of pelvic serous carcinomas, respectively. The junctional epithelia did not show any lesion in any group. Conclusions: SEE-FIM protocol is recommended for evaluation of sporadicpelvic (ovarian/tubal/peritoneal serous carcinoma. Based on the presence of STIC or invasive carcinoma, nearly 60% of all pelvic serous carcinomas are of fallopian tubal origin.

Evidence-based management of non-tubal ectopic pregnancies.

Science.gov (United States)

Alalade, Aderemi Olaoluwa; Smith, Fredrick John Ennis; Kendall, Charlotte Emma; Odejinmi, Funlayo

2017-11-01

Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.

Embarazo ectópico tubárico roto posterior a esterilización quirúrgica (Ruptured tubal ectopic pregnancy after surgical sterilization

Directory of Open Access Journals (Sweden)

Ismael Suárez Torres

2014-07-01

Full Text Available Resumen (español La esterilización tubárica quirúrgica es un método comúnmente utilizado de anticoncepción. Aunque el embarazo después de la esterilización es poco común, este puede ocurrir y cuando esto ocurre existe un riesgo substancial de convertirse en un embarazo ectópico. Se presenta el caso un embarazo ectópico posterior a la esterilización quirúrgica tubárica en una paciente de 38 años, V gesta, III paras, I cesárea, con antecedentes de uso de dispositivos intrauterinos por varios años antes de la salpingectomía realizada 12 meses antes durante la cesárea, quien consultó por presentar marcada palidez cutáneo-mucosa, retraso menstrual y dolor abdominal de fuerte intensidad. Durante la laparotomía ambas trompas estaban separadas en dos porciones. La porción terminal de la trompa derecha se observó la presencia de una tumoración compatible con un embarazo ectópico tubárico roto. Abstract (english Surgical tubal sterilization is a commonly used method of contraception. Although pregnancy after sterilization is uncommon, when it occurs, there is a substantial risk that it will be an ectopic pregnancy. We report a case of ruptured tubal ectopic pregnancy following surgical tubal sterilization in a 38 years-old patient, gravida V, para III, cesarean I, with history of intrauterine device use for many years before salpingectomy performed 12 months before during cesarean section, who consulted for presenting menstrual delay and severe abdominal pain. During laparotomy both tubes were separated in two portions. There was observed in terminal portion of right tube the presence of a tumor compatible with ruptured tubal ectopic pregnancy.

Use of ICSI in IVF cycles in women with tubal ligation does not improve pregnancy or live birth rates.

Science.gov (United States)

Grimstad, F W; Nangia, Ajay K; Luke, B; Stern, J E; Mak, W

2016-12-01

Does ICSI improve outcomes in ART cycles without male factor, specifically in couples with a history of tubal ligation as their infertility diagnosis? The use of ICSI showed no significant improvement in fertilization rate and resulted in lower pregnancy and live birth (LB) rates for women with the diagnosis of tubal ligation and no male factor. Prior studies have suggested that ICSI use does not improve fertilization, pregnancy or LB rates in couples with non-male factor infertility. However, it is unknown whether couples with tubal ligation only diagnosis and therefore iatrogenic infertility could benefit from the use of ICSI during their ART cycles. Longitudinal cohort of nationally reported cycles in the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) of ART cycles performed in the USA between 2004 and 2012. There was a total of 8102 first autologous fresh ART cycles from women with the diagnosis of tubal ligation only and no reported male factor in the SART database. Of these, 957 were canceled cycles and were excluded from the final analysis. The remaining cycles were categorized by the use of conventional IVF (IVF, n = 3956 cycles) or ICSI (n = 3189 cycles). The odds of fertilization, clinical intrauterine gestation (CIG) and LB were calculated by logistic regression modeling, and the adjusted odds ratios (AORs) with 95% confidence intervals were calculated by adjusting for the confounders of year of treatment, maternal age, race and ethnicity, gravidity, number of oocytes retrieved, day of embryo transfer and number of embryos transferred. The main outcome measures of the study were odds of fertilization (2PN/total oocytes), clinical intrauterine gestation (CIG/cycle) and live birth (LB/cycle). The fertilization rate was higher in the ICSI versus IVF group (57.5% vs 49.1%); however, after adjustment this trend was no longer significant (AOR 1.14, 0.97-1.35). Interestingly, both odds of CIG (AOR 0.78, 0

Prevalence and Physical Distribution of SRY in the Gonads of a Woman with Turner Syndrome: Phenotypic Presentation, Tubal Formation, and Malignancy Risk.

Science.gov (United States)

Baer, Tamar G; Freeman, Christopher E; Cujar, Claudia; Mansukhani, Mahesh; Singh, Bahadur; Chen, Xiaowei; Abellar, Rosanna; Oberfield, Sharon E; Levy, Brynn

2017-01-01

Although monosomy X is the most common karyotype in patients with Turner syndrome, the presence of Y chromosome material has been observed in about 10% of patients. Y chromosome material in patients with Turner syndrome poses an increased risk of gonadoblastoma and malignant transformation. We report a woman with a diagnosis of Turner syndrome at 12 years of age, without signs of virilization, and karyotype reported as 46,X,del(X)(q13). At 26 years, cytogenetic studies indicated the patient to be mosaic for monosomy X and a cell line that contained a du-plicated Yq chromosome. Bilateral gonadectomy was performed and revealed streak gonads, without evidence of gonadoblastoma. Histological analysis showed ovarian stromal cells with few primordial tubal structures. FISH performed on streak gonadal tissue showed a heterogeneous distribution of SRY, with exclusive localization to the primordial tubal structures. DNA extraction from the gonadal tissue showed a 6.5% prevalence of SRY by microarray analysis, contrasting the 86% prevalence in the peripheral blood sample. This indicates that the overall gonadal sex appears to be determined by the majority gonosome complement in gonadal tissue in cases of sex chromosome mosaicism. This case also raises questions regarding malignancy risk associated with Y prevalence and tubal structures in gonadal tissue. © 2017 S. Karger AG, Basel.

Anti-Müllerian hormone levels in salpingectomized compared with nonsalpingectomized women with tubal factor infertility and women with unexplained infertility

DEFF Research Database (Denmark)

Grynnerup, Anna Garcia-Alix Haugen; Lindhard, Anette; Sørensen, Steen

2013-01-01

To investigate the consequence of salpingectomy on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before in vitro fertilization (IVF) treatment in salpingectomized women compared with nonsalpingectomized women with tubal factor infertility, women with unexplained infertility and...

Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation.

Science.gov (United States)

Balestrieri, P J; Hamza, M S; Ting, P H; Blank, R S; Grubb, C T

2005-10-01

After receiving a continuous spinal anesthetic for labor following an inadvertent dural puncture with a 17-gauge epidural needle, a morbidly obese parturient underwent post-partum tubal ligation 12 h after vaginal delivery. The patient received a total of 2 mL of 0.75% hyperbaric bupivacaine for the surgery. In response to moderate hypertension the patient received intravenous labetalol hydrochloride 20 mg. She subsequently was inadvertently administered approximately 15 mg of labetalol through the spinal catheter. The spinal catheter was removed immediately after the procedure. She suffered no apparent adverse neurologic effects.

Use of Hysterosalpingo-Foam Sonography for Assessment of the Efficacy of Essure Hysteroscopic Sterilization.

Science.gov (United States)

Rosič, Maja; Žegura, Branka; Vadnjal Đonlagić, Sabina

2018-01-18

Hysterosalpingo-foam sonography (HyFoSy) has been suggested to be a possible less invasive alternative to hysterosalpingography (HSG), which is the reference standard for confirmation of tubal occlusion after Essure (Bayer AG, Leverkusen, Germany) hysteroscopic sterilization. The purpose of our study was to evaluate the accuracy of HyFoSy compared to HSG for confirmation of tubal occlusion after Essure hysteroscopic sterilization. A prospective study included 90 patients who underwent Essure hysteroscopic sterilization. Twelve weeks after the sterilization, 2-dimensional transvaginal ultrasonography was performed to assess the microinsert position and was followed by HyFoSy and HSG for evaluation of tubal occlusion. Patients with patent fallopian tubes on HSG were scheduled for additional HSG procedures at 3-month intervals until tubal occlusion was documented. Of 90 enrolled patients, 86 patients with 170 fallopian tubes underwent the complete imaging protocol. Tubal occlusion was evaluated by HyFoSy as an index test and HSG as a reference standard. The accuracy of HyFoSy was 97.1% (95% confidence interval [CI], 93%-99%). The sensitivity and specificity were 100% (95% CI, 97%-100%) and 54.6% (95% CI, 23%-83%), whereas the positive and negative predictive values were 97.0% (95% CI, 93%-99%) and 100% (95% CI, 42%-100%), respectively. No long-term complications were reported for HyFoSy or HSG. Given that the concordance rate for tubal occlusion between HyFoSy and HSG was not 100%, an occluded fallopian tube on HyFoSy should be confirmed by HSG, which remains the reference standard for confirmation of tubal occlusion after Essure hysteroscopic sterilization. © 2018 by the American Institute of Ultrasound in Medicine.

Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Xiaolin Cheng

Full Text Available To compare the natural fertility outcomes of salpingotomy and salpingectomy among women treated for tubal pregnancy.An online database search including PubMed, Embase, CENTRAL and Web of Science was performed to identify studies comparing salpingotomy and salpingectomy to treat women with tubal pregnancy. The search included papers published after the databases were established until May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria and then extracted data and assessed the methodological quality of all of the included studies. The meta-analysis was conducted using RevMan 5.3 software. The registration number is CRD42015017545 in PROSPERO.Two randomized controlled trials (RCTs and eight cohort studies, including a total of 1,229 patients, were znalyzed. The meta-analysis of the RCT subgroup indicated that there was no statistically significant difference in IUP rates (RR = 1.04, 95% CI = 0.89-1.21, P = 0.61 nor the repeat ectopic pregnancy (REP rate (RR = 1.30, 95% CI = 0.72-2.38, P = 0.39 between the salpingotomy and salpingectomy group. In contrast, the cohort study subgroup analysis revealed that the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR = 1.24, 95% CI = 1.08-1.42, P = 0.002; Salpingotomy also increased the risk of REP rate (RR = 2.27, 95% CI = 1.12-4.58, P = 0.02. The persistent ectopic pregnancy (PEP occurred more frequently in the salpingotomy group than the salpingectomy group (RR = 11.61, 95% CI = 3.17-42.46, P = 0.0002. An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR = 1.16, 95% CI = 1.02-1.32, P = 0.03. The IUP rate (RR = 1.13, 95% CI = 1.01-1.26, P = 0.03, and the REP rate (RR = 1.62, 95% CI = 1.02-2.56, P = 0.04 was higher after salpingotomy than salpingectomy among patients from Europe compared with those from America.Based on the available evidence

Diphenhydramine and hyaluronic acid derivatives reduce adnexal adhesions and prevent tubal obstructions in rats.

Science.gov (United States)

Avsar, Ayse Filiz; Avsar, Fatih Mehmet; Sahin, Mustafa; Topaloglu, Serdar; Vatansev, Husamettin; Belviranli, Metin

2003-01-10

The purpose of this study is to investigate the effects of diphenhydramine-HCl and Na-hyaluronate derivatives on the development of postoperative peritoneal adhesion and tubal obstruction. Forty female rats of Sprague-Dawley type were used in the study. The rats were divided into four groups, each comprising 10 subjects. After all the rats were anaesthetized with 50mg/kg ketamine HCl, their abdomens were opened with a lower midline incision. Injury was induced on the right pelvic peritoneum and on the peritoneal surface of left uterine tube. No additional procedure was applied to the first group. 10 mg/kg diphenhydramine-HCl was given to the second group intravenously. In the third group, 0.25 mg/kg Orthovisc, a Na-hyaluronate derivative was diluted with 2 ml physiological saline and poured into the abdomen. For the fourth group, Seprafilm, a Na-hyaluronate derivative was covered in a layer of 0.7 cm x 3 cm over the left uterine tube. After 14 days, the rats were anaesthetized with ketamine HCl again, and 5 cm(3) blood sample was taken with cardiac puncture. The abdomen was opened with an incision transverse to the upper end of the midline incision, and the presence of adhesions was investigated. Detected adhesions were staged according to the Mazuji classification. Tubal patencies were inspected by injecting methylene blue from the uterine corpus into the lumen using an injector. A piece of abdominal wall of 4 cm x 4 cm was removed by extending the incision in the reverse U shape. The tensile strength and bursting pressure of the suture line were determined using the Peacock method. One gram of tissue was taken from the incision line, and hydroxyproline levels were determined by the Bergman-Loxley method. Aspartate aminotransferase (AST) levels were measured. All of the rats completed the study. AST levels, tissue hydroxyproline levels and tensile strength and bursting pressure test results were found to be similar in all groups. While adhesion rates in the groups

[Hysteroscopic tubal sterilization with Essure® devices: a retrospective descriptive study and evaluation of hypnosis].

Science.gov (United States)

Gauchotte, E; Masias, C; Bogusz, N; Koebele, A

2011-06-01

The Essure(®) system is a hysteroscopic sterilization method. The aim of our study is to retrospectively evaluate the sterilization procedure with Essure(®) devices, with and without anesthesia, and in particular with hypnosis. The descriptive study includes all tubal sterilization with Essure(®) performed during the year 2009 at the Maternité régionale de Nancy. Hypnosis efficiency is retrospectively evaluated with Verbal Numeric Rating Scale (VNRS) for peroperative pain, and analgesic medication use for postoperative pain. Ninety-four sterilizations are performed, 85% (85/94) of them without anesthesia. The mean VNRS is 3.0. The mean operative time is 8.7 minutes, positively correlated with the VNRS (P=0.0005). The rate of successful insertion is 94%. At 3 months, 91% of the implants have a correct location. Inadequate locations are more frequent when anesthesia have been performed (37% vs 4%, P=0.016). There is no significant difference between groups with and without hypnosis for the VNRS, the failure rate and the use of analgesic medication. Tubal sterilization with the Essure(®) system is a quick and efficient method. Our study does not demonstrate efficiency of hypnosis in pain control. This remains to be explored with a prospective study, including others parameters, such as anxiety. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Initial experience with hysteroscopic tubal occlusion (Essure®).

Science.gov (United States)

Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Lippi, Umberto Gazi; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

2016-01-01

To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied. Avaliar os resultados das primeiras oclusões tubárias realizadas pela via histeroscópica (Essure®). Estudo prospectivo com 38 pacientes, sendo 73,7% caucasianas, com média de idade de 34,5 anos, e com 3 gestações e 2,7 partos em média. Do total, 86,8% das pacientes fizeram preparo prévio do endométrio. Todos os procedimentos foram ambulatoriais e sem anestesia. A taxa de inserção do dispositivo foi de 100%, com tempo médio de 4 minutos e 50 segundos. Segundo a Escala Visual Analógica, a dor média obtida foi de três, e 55,3% das mulheres não referiram qualquer dor após o método. Ocorreu um caso de reflexo vagal e 89,5% das pacientes retornaram às atividades normais no mesmo dia. Após 3 meses, 89,5% das pacientes encontravam-se muito satisfeitas com o método. A radiografia simples da pelve evidenciou 92,1% de dispositivos tópicos, ocorrendo um caso de expulsão unilateral. Após 4 anos de seguimento, não houve

Tubal endometriosis diagnosed within one month after menarche: a case report.

Science.gov (United States)

Yamamoto, K; Mitsuhashi, Y; Takaike, T; Takase, K; Hoshiai, H; Noda, K

1997-03-01

A 13-year-old nulligravida girl, 158.5 cm in height and 76.0 kg in body weight, came to our department complaining of continuous right lower abdominal pain. One month earlier, an ovarian cyst in the right ovary, about 3 cm in diameter, was found when she underwent appendectomy at another hospital, but was left untreated. Menarche occurred at the age of 13 years and 1 month, which was after the appendectomy and 24 days before the present operation. Right hematosalpinx with peripheral obstruction and a para-ovarian serous cyst on the same side were diagnosed, and therefore right salpingectomy with para-ovarian cyst resection was performed. The bilateral ovaries and uterus were completely normal by inspection. The post operative histological examination confirmed hematosalpinx and revealed tubal endometriosis.

Essure hysteroscopic sterilization versus interval laparoscopic bilateral tubal ligation: a comparative effectiveness review.

Science.gov (United States)

Ouzounelli, Myrsini; Reaven, Nancy L

2015-01-01

A comparative effectiveness analysis was performed to examine the risks and benefits of laparoscopic bilateral tubal ligation compared with hysteroscopic sterilization using the Essure Permanent Birth Control System (Bayer HealthCare AG, Whippany, NJ). Existing evidence shows that both LBTL and Essure are safe and effective methods of female sterilization. Both have high rates of efficacy and low rates of complications although when complications do occur, those related to the Essure procedure are more likely to be minor in nature. The analysis was limited by the restricted number of studies involving head-to-head comparisons of the 2 approaches. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Improving Open Access through Prior Learning Assessment

Science.gov (United States)

Yin, Shuangxu; Kawachi, Paul

2013-01-01

This paper explores and presents new data on how to improve open access in distance education through using prior learning assessments. Broadly there are three types of prior learning assessment (PLAR): Type-1 for prospective students to be allowed to register for a course; Type-2 for current students to avoid duplicating work-load to gain…

Essure transcervical tubal sterilization: a 5-year x-ray follow up.

Science.gov (United States)

Franchini, Mario; Boeri, Cecilia; Calzolari, Stefano; Imperatore, Alberto; Cianferoni, Luciano; Litta, Pietro; Giarrè, Giovanna; Zerbetto, Irene; Moncini, Irene; Florio, Pasquale

2011-05-01

To evaluate the x-ray appearance of Essure microinserts 5 years after their insertion. Prospective controlled study. Tertiary referral centers for gynecologic care. Forty-five consecutive women with successful hysteroscopic bilateral placement of the Essure devices and postprocedure satisfactory hysterosalpingography confirmation test. Pelvic anteroposterior x-ray. Stability and and symmetric appearance of Essure microinsert positions; measurement of the intrauterine distance between the two devices. After 5 years from their placement, no detachment nor fracture of devices was observed. x-Ray recognition of the device after 5 years showed findings similar to those recorded at 3 months' follow-through hysterosalpingography. x-Ray evaluation of findings related to stability of position, symmetric appearance, and distance between the two Essure microinserts corroborates the irreversibility and the reliability of the fibrotic reaction that ensured tubal occlusion after devices placement. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Monitoring User-Based Accessibility Assessment in Urban Environments and in Public Buildings

Directory of Open Access Journals (Sweden)

Gintaras Stauskis

2018-04-01

Full Text Available The research features analysis of user-experience-based accessibility assessment and progress monitoring of buildings and public spaces; this analysis is used as a tool for facilitating the development of humane, socially sustainable and an inclusive urban environment. A group of users representing people with different kinds of disabilities, the elderly and families with children was created to assess the quality of access to various buildings with different functions and locations across Vilnius and in Singapore. A school, two hospitals, a rehab centre and two offices were selected for access monitoring in Vilnius City, while a hotel, a café and two metro stations with public squares were chosen for access assessment in Singapore. As the same method was principally applied to assess accessibility of selected buildings in Vilnius City in 2000 and 2017 and in Singapore in 2012, the article draws a comparative analysis of access levels in these two cities located in different global regions. The results show a definite improvement of access quality over time and also identify the critical aspects in this process. The segment of plot planning represents the lowest quality of access for all assessed building types as compared to the building segment and the external–internal element segments. The paper also draws conclusions that access improvement is a continuous process of implementing advanced urban policy instruments, and city planners can contribute to it by constantly analysing and presenting to public the monitoring data about the progress in access improvement. Comparing the assessment results between Vilnius City and Singapore – cities that are located in different global regions and in different socio-economic environments – provides a practical tool for benchmarking and setting the priorities for this process.

Serous tubal intraepithelial carcinoma upregulates markers associated with high-grade serous carcinomas including Rsf-1 (HBXAP), cyclin E and fatty acid synthase.

Science.gov (United States)

Sehdev, Ann Smith; Kurman, Robert J; Kuhn, Elisabetta; Shih, Ie-Ming

2010-06-01

Serous tubal intraepithelial carcinoma (STIC) has been proposed as a precursor for many pelvic high-grade serous carcinomas. Our previous analysis of the ovarian cancer genome identified several genes with oncogenic potential that are amplified and/or overexpressed in the majority of high-grade serous carcinomas. Determining whether these genes are upregulated in STICs is important in further elucidating the relationship of STICs to high-grade serous carcinomas and is fundamental in understanding the molecular pathogenesis of high-grade serous carcinomas. In this study, 37 morphologically defined STICs were obtained from 23 patients with stage IIIC/IV high-grade serous carcinomas. Both STICs and the high-grade serous carcinomas were analyzed for expression of Rsf-1 (HBXAP), cyclin E, fatty acid synthase (FASN) and mucin-4. In addition, they were examined for expression of established markers including p53, Ki-67 and p16. We found that diffuse nuclear p53 and p16 immunoreactivity was observed in 27 (75%) of 36 and 18 (55%) of 33 STICs, respectively, whereas an elevated Ki-67 labeling index (>or=10%) was detected in 29 (78%) of 37 STICs. Cyclin E nuclear staining was seen in 24 (77%) of 35 STICs, whereas normal tubal epithelial cells were all negative. Increased Rsf-1 and FASN immunoreactivity occurred in 63%, and 62% of STICs, respectively, compared with adjacent normal-appearing tubal epithelium. Interestingly, only one STIC showed increased mucin-4 immunoreactivity. Carcinomas, when compared with STICs, overexpressed p16, Rsf-1, cyclin E and FASN in a higher proportion of cases. In conclusion, STICs express several markers including Rsf-1, cyclin E and FASN in high-grade serous carcinomas. In contrast, mucin-4 immunoreactivity either did not change or was reduced in most STICs. These results suggest that overexpression of Rsf-1, cyclin E and FASN occurs early in tumor progression.

Clinical Application of Sperm Chromatin Structure Assessment in Andrology Patients

NARCIS (Netherlands)

M. Smit (Marij)

2011-01-01

textabstractInfertility, defined as the inability to conceive spontaneously within one year, is a common medical problem. Traditionally, fertility investigations initially focus on the evaluation of ovulation and tubal patency in females, and on assessment of sperm quantity and quality in males. In

An Assessment of Female Prisoners' Perception of the Accessibility ...

African Journals Online (AJOL)

Background: Accessibility of quality healthcare across the globe has generated a lot of attention among public health practitioners. Aim: This study explored the background characteristics of female prisoners and how it influences their assessment of the quality of accessible healthcare in the Kumasi Female Prison. Subjects ...

High grade serous ovarian carcinoma with serous tubal intraepithelial carcinoma in a case presented with atypical glandular cell favor neoplasm cervical cytology and dermatomyositis

Directory of Open Access Journals (Sweden)

Mun-Kun Hong

2015-04-01

Conclusion: The patient had serous carcinoma of the ovary with tubal STIC, which presented as dermatomyositis. The AGC-FN identified from a Pap smear hinted at a diagnosis of ovarian carcinoma. These presentations point to an occult malignancy in the genital tract and demand careful diagnostic workup.

Assessment of the accessibility legislation in Spain and its effective application

Directory of Open Access Journals (Sweden)

Jesús Hernández-Galán

2014-10-01

Full Text Available The existence of legislation on accessibility does not always imply it is enforced effectively. This article aims to answer the following question: Is the existence of accessibility legislation enough to make physical environments truly accessible?This study assesses the current Spanish legislation as well as any existing voluntary regulations in the country. This assessment is done chronologically, so as to show the historical evolution of the accessibility regulations in Spain.In order to determine whether accessibility legislation has been truly effectively enforced, the issue is studied as it affects Spanish municipalities with respect to urban planning, public buildings, public transportation and websites. The conclusion of this study is that the existence of accessibility legislation per se is not enough to ensure its practical application, and ultimately, to render physical environments, products and services accessible to the majority of the population regardless of their functional capabilities.

Assessing communication accessibility in the university classroom: towards a goal of universal hearing accessibility.

Science.gov (United States)

Cheesman, Margaret F; Jennings, Mary Beth; Klinger, Lisa

2013-01-01

Measures of accessibility typically focus on the physical environment and aspects relating to getting into and out of spaces. The transient sound environment is less well characterized in typical accessibility measures. Hearing accessibility measures can be based upon physical indices or functional assessment. The physical measures are indices that use signal-to-noise ratios to evaluate audibility while the functional assessment tool adopts universal design for hearing (UDH) principles derived from principles of universal design. The UDH principles include (1) Optimization of the hearing environment for all; (2) Optimization of interactions between persons and objects to promote better hearing in an environment; (3) Optimization of opportunities for people to have multiple choices of interactions with one another; (4) Optimization of opportunities for people to perform different activities in and across environments; (5) Optimization of opportunities for people to have safe, private, and secure use of the environment while minimizing distraction, interference, or cognitive loading; and (6) Optimization of opportunities for people to use the environment without extra steps for hearing access during preparatory, use and/or after use phases. This paper compares the two approaches using case examples from post-secondary classrooms in order to describe the potential advantages and limitations of each.

Transparency of Biobank Access in Canada: An Assessment of Industry Access and the Availability of Information on Access Policies and Resulting Research.

Science.gov (United States)

Gibson, Shannon G; Axler, Renata E; Lemmens, Trudo

2017-12-01

A key issue impacting public trust in biobanks is how these resources are utilized, including who is given access to biobank data and samples. To assess the conditions under which researchers are given access to Canadian biobanks, we reviewed websites and contacted Canadian biobanks to determine the availability of information on access policies and procedures; research resulting from access biobank data and samples; and conditions on private industry access to biobanks. We also conducted expert interviews with key Canadian stakeholders ( n = 11) to obtain their perspectives on biobank transparency and access policies. Among 21 Canadian biobanks, there was wide variation in the access information made publicly available, and the majority of these allowed access by industry applicants. Biobanks should be governed by the principles of transparency, accountability, and accessibility, and attention must be given to the conditions around the commercialization of biobank-based research.

Experimental protocol to assess the tourism vehicles accessibility based on heart rate and access time measurements

Energy Technology Data Exchange (ETDEWEB)

Alcala Fazio, E.; Alvarez Fernandez, N.

2016-07-01

The objective of the Project is to define an experimental protocol for the accessibility assessment of the transport vehicles, by analysing the evolution of the effort and time variables consumed by a target group –Persons of Reduced Mobility (PMRs). This protocol consisted in tests of accessibility on a sample of 6 passenger cars (class M1) by 8 elderly people carrying a heart rate monitor, and whose access manoeuvres were recorded by video cameras. Based on the Hilloskorpi et al. [1] model and by developing a method of truncation of the heart rate (HR) tests records - eliminating the component of the work biologically needed by the organism to keep its basal metabolic rate from the work each person performed – it was possible to evaluate how much energy each individual invested in each access manoeuver. Immediately after each test, and after the whole round of vehicles, each participant was surveyed for a subjective assessment of the difficulty of accessing to the cars. According to each of the above results, the HR objective measurements and the subjective opinion about the ease of access experienced by each individual, the vehicles were ranked by order of accessibility to the front and rear seats. The result of both rankings showed the orders of the similar vehicles, the potential of the method and a fair closeness between its results and the subjective, but real and unequivocal, judgments of the participants. (Author)

Assessment, authorization and access to medicaid managed mental health care.

Science.gov (United States)

Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T

2007-11-01

Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

Accessing and assessing young learner’s mathematical dispositions

Directory of Open Access Journals (Sweden)

mellony Graven

2012-07-01

Full Text Available It is argued in this paper that there is an absence of literature relating to research on learner mathematical dispositions, particularly with young learners. Drawing on Kilpatrick, Swafford and Findell’s (2001 five interrelated strands of mathematical proficiency, which include: conceptual understanding, procedural fluency, strategic competence, adaptive reasoning and productive disposition, it is argued that there has been little engagement with productive disposition in the field of mathematics education and how we might access and assess this strand. Despite competence in all strands being essential for mathematical proficiency, literature and assessments that seek to establish learner levels of mathematical proficiency have tended to focus on the first four and have neglected the last; productive disposition. Finding ways in which to access student mathematical learning dispositions can be challenging, especially with young learners who struggle to articulate their views. An instrument is shared that the author has designed with doctoral fellow, Debbie Stott, in order to access and assess the productive disposition of learners participating in maths clubs run within the South African Numeracy Chair. The findings that emerge in one Grade 3 club with six learners is shared. These findings are related to the data collected through instruments that assess the other four strands of mathematical proficiency. This enables a holistic picture of learner’s mathematical proficiency as intended in the conceptualisation of the interrelated five strands of proficiency.

Bipolar hysteroscopic procedures and placement of Essure microinserts for tubal sterilization: a case control study.

Science.gov (United States)

Panel, Pierre; Grosdemouge, Isabelle; Houllier, Marie; Renouvel, Frédérique; Friederich, Ludovic; Le Tohic, Arnaud

2011-06-01

To assess the effectiveness and complication rate with Essure microinsert placements for tubal sterilization and the concomitant bipolar intrauterine surgical procedure. Case control study. Department of gynecology and obstetrics of a general hospital in France. 382 women, including 41 undergoing one or several concomitant uterine procedures with Essure placement, and 341 undergoing Essure placement only (controls). Essure placement with or without bipolar hysteroscopic procedure for polyp, myoma, or endometrial ablation. Success rate for microinsert placement and complications at 3 months. Forty-one patients had Essure microinserts placed in combination with a bipolar hysteroscopic procedure: endometrial resection (n=32), fibroma resection (n=4), or polyp ablation (n=5). They were compared with 341 patients who underwent Essure placement only. The success rate for Essure placement was 97.6% in the combination group versus 97.6% in the control group. The complication rate was 4.9% (n=2) in the combination group versus 2.6% (n=9) in the control group. The difference in the success and complication rates was not statistically significant. Performing intrauterine bipolar resection during hysteroscopy for sterilization is possible without reducing the Essure placement success rate and without increasing morbidity. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chlamydia trachomatis and chlamydial heat shock protein 60-specific antibody and cell-mediated responses predict tubal factor infertility

DEFF Research Database (Denmark)

Tiitinen, A.; Surcel, H.-M.; Halttunen, M.

2006-01-01

60)-specific immunoglobulin G (IgG) antibodies were analysed using enzyme-linked immunosorbent assay (ELISA) kits. Proliferative reactivity of peripheral blood mononuclear cells was studied in vitro against Chlamydia elementary body (EB) and recombinant CHSP60 antigens. RESULTS: C. trachomatis......BACKGROUND: To evaluate the role of Chlamydia trachomatis-induced humoral and cell-mediated immune (CMI) responses in predicting tubal factor infertility (TFI). METHODS: Blood samples were taken from 88 women with TFI and 163 control women. C. trachomatis and chlamydial heat shock protein 60 (CHSP...

Assessment of Farmers (Women)' Access to Agricultural Extension ...

African Journals Online (AJOL)

Available online at http://www.ajol.info/index.php/njbas/index. Nigerian Journal of ... Key words: Assessment, Farmers, Access, Agricultural Extension, Credit Facility. INTRODUCTION ..... Unpublished Project Proposal, The. Department of Agric ...

Essure Microinsert Abdominal Migration after Hysteroscopic Tubal Sterilization of an Appropriately Placed Essure Device: Dual Case Reports and Review of the Literature.

Science.gov (United States)

Rezai, Shadi; LaBine, Meghan; Gomez Roberts, Hunter Azdel; Lora Alcantara, Isamarie; Henderson, Cassandra E; Elmadjian, Malvina; Nuritdinova, Dilfuza

2015-01-01

Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.

Essure Microinsert Abdominal Migration after Hysteroscopic Tubal Sterilization of an Appropriately Placed Essure Device: Dual Case Reports and Review of the Literature

Directory of Open Access Journals (Sweden)

Shadi Rezai

2015-01-01

Full Text Available Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.

[Expansion of secretory cells in the fallopian tubal epithelium in the early stages of the pathogenesis of ovarian serous carcinomas].

Science.gov (United States)

Asaturova, A V; Ezhova, L S; Faizullina, N M; Adamyan, L V; Khabas, G N; Sannikova, M V

to investigate the frequency of the types of fallopian tubal secretory cell expansion (SCE) in diseases of the reproductive organs and to determine the immunophenotype and biological role of the cells in the early stages of the pathogenesis of high-grade ovarian serous carcinomas (HGOSC). The investigation enrolled 287 patients with extraovarian diseases and ovarian serous tumors varying in grade, whose fallopian tubes were morphologically and immunohistochemically examined using p53, Ki-67, PAX2, Bcl-2, beta-catenin, and ALDH1 markers. The material was statistically processed applying the Mann-Whitney test and χ2 test. The rate of secretory cell proliferation (SCP) (more than 10 consecutive secretory cells) and that of secretory cell overgrowth (SCO) (more than 30 consecutive secretory cells) increase with age in all investigated reproductive system diseases. The rate of SCP in the corpus fimbriatum of the patients with HGOSC was 5.9 times higher than that in those with extraovarian disease (pepithelium (2.8), in SCP (1.3), in SCO (1.2), in serous tubal intraepithelial carcinoma (STIC) (1.0), and in HGOSC (0.9); Bcl-2 was in the intact epithelium (2.2), in SCP (2.1), STIC (0.9), and in HGOSC (0.6), β-catenin was in the intact epithelium (0.5), in SCP (2.85), in SCO (2.95), in STIC (0.6), and in HGOSC (0.5); ALDH1 was in the intact epithelium (0.5), in SCP (2.91), in SCO (2.92), in STIC (1.2), and in HGOSC (0.6). There were statistically significant differences with a 95% confidence interval (pepithelium and pathology (fallopian tube lesions and HGOSC); 2) Bcl-2 between the intact epithelium and SCE (SCP and SCO) and between SCE and HGOSC; 3) beta-catenin between the intact epithelium and SCE (SCP and SCO) and between SCE and HGOSC; 4) ALDH1 between the intact epithelium and SCE, between and SCE and STIC, and between STIC and HGOSC. SCE was shown to be an independent intraepithelial lesion. The incidence of this abnormality increased with age and significantly

Prediction of Tubal Ectopic Pregnancy Using Offline Analysis of 3-Dimensional Transvaginal Ultrasonographic Data Sets: An Interobserver and Diagnostic Accuracy Study.

Science.gov (United States)

Infante, Fernando; Espada Vaquero, Mercedes; Bignardi, Tommaso; Lu, Chuan; Testa, Antonia C; Fauchon, David; Epstein, Elisabeth; Leone, Francesco P G; Van den Bosch, Thierry; Martins, Wellington P; Condous, George

2017-12-08

To assess interobserver reproducibility in detecting tubal ectopic pregnancies by reading data sets from 3-dimensional (3D) transvaginal ultrasonography (TVUS) and comparing it with real-time 2-dimensional (2D) TVUS. Images were initially classified as showing pregnancies of unknown location or tubal ectopic pregnancies on real time 2D TVUS by an experienced sonologist, who acquired 5 3D volumes. Data sets were analyzed offline by 5 observers who had to classify each case as ectopic pregnancy or pregnancy of unknown location. The interobserver reproducibility was evaluated by the Fleiss κ statistic. The performance of each observer in predicting ectopic pregnancies was compared to that of the experienced sonologist. Women were followed until they were reclassified as follows: (1) failed pregnancy of unknown location; (2) intrauterine pregnancy; (3) ectopic pregnancy; or (4) persistent pregnancy of unknown location. Sixty-one women were included. The agreement between reading offline 3D data sets and the first real-time 2D TVUS was very good (80%-82%; κ = 0.89). The overall interobserver agreement among observers reading offline 3D data sets was moderate (κ = 0.52). The diagnostic performance of experienced observers reading offline 3D data sets had accuracy of 78.3% to 85.0%, sensitivity of 66.7% to 81.3%, specificity of 79.5% to 88.4%, positive predictive value of 57.1% to 72.2%, and negative predictive value of 87.5% to 91.3%, compared to the experienced sonologist's real-time 2D TVUS: accuracy of 94.5%, sensitivity of 94.4%, specificity of 94.5%, positive predictive value of 85.0%, and negative predictive value of 98.1%. The diagnostic accuracy of 3D TVUS by reading offline data sets for predicting ectopic pregnancies is dependent on experience. Reading only static 3D data sets without clinical information does not match the diagnostic performance of real time 2D TVUS combined with clinical information obtained during the scan. © 2017 by the American

Psychomotor skills and cognitive load training on a virtual reality laparoscopic simulator for tubal surgery is effective.

Science.gov (United States)

Bharathan, Rasiah; Vali, Saaliha; Setchell, Thomas; Miskry, Tariq; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

Validation of a virtual reality (VR) simulator for the training and assessment of laparoscopic tubal surgery and mapping of cognitive load. Prospective cohort study conducted at the Imperial College Virtual Reality Surgical Skills laboratory amongst 25 trainees and nine senior gynaecologists. Participants performed two sessions of salpingectomy and salpingotomy procedures on a VR simulator to assess construct validity. Nine novices performed ten such sessions to enable assessment of the learning curve. The relationship between cognitive load and the dexterity parameters was assessed. Simulator fidelity was reported by experienced and intermediate level gynaecologists. Statistical analyses utilised non-parametric tests, Kruskall-Wallis and Mann-Whitney U tests. Learning curves were assessed using the Friedman test and Wilcoxon Signed Ranks test. Relationship between dexterity metrics and cognitive load was performed using Spearman's rank order correlation. Salpingectomy demonstrated construct validity for time taken by experienced, intermediate and novice gynaecologists (median 170 vs. 191 vs. 313s (P=0.003) respectively) and movements (median 200 vs. 267 vs. 376s, P=0.045). Salpingotomy demonstrated construct validity for time taken (median 183 vs. 191 vs. 306s, P=<0.001) and movements (median 210 vs. 233 vs. 328s, P=0.005). Learning curve analysis for salpingectomy displayed a plateau for time taken after the eighth session, and the fourth session for movements. Salpingotomy displayed a plateau after the eighth session for both time taken and movements. Cognitive load correlated significantly with dexterity parameters. The fidelity scores were not significantly different between the two procedures (P=0.619). The LAP Mentor VR laparoscopic simulator is a valid and effective tool for training novice surgeons in ectopic pregnancy surgery. Reduction in cognitive load significantly correlates with the learning curves. Copyright © 2013 Elsevier Ireland Ltd. All rights

Assessment of Deafblind Access to Manual Language Systems (ADAMLS)

Science.gov (United States)

Blaha, Robbie; Carlson, Brad

2007-01-01

This document presents the Assessment of Deafblind Access to Manual Language Systems (ADAMLS), a resource for educational teams who are responsible for developing appropriate adaptations and strategies for children who are deafblind who are candidates for learning manual language systems. The assessment tool should be used for all children with a…

Coupling mode-destination accessibility with seismic risk assessment to identify at-risk communities

International Nuclear Information System (INIS)

Miller, Mahalia; Baker, Jack W.

2016-01-01

In this paper, we develop a framework for coupling mode-destination accessibility with quantitative seismic risk assessment to identify communities at high risk for travel disruptions after an earthquake. Mode-destination accessibility measures the ability of people to reach destinations they desire. We use a probabilistic seismic risk assessment procedure, including a stochastic set of earthquake events, ground-motion intensity maps, damage maps, and realizations of traffic and accessibility impacts. For a case study of the San Francisco Bay Area, we couple our seismic risk framework with a practical activity-based traffic model. As a result, we quantify accessibility risk probabilistically by community and household type. We find that accessibility varies more strongly as a function of travelers' geographic location than as a function of their income class, and we identify particularly at-risk communities. We also observe that communities more conducive to local trips by foot or bike are predicted to be less impacted by losses in accessibility. This work shows the potential to link quantitative risk assessment methodologies with high-resolution travel models used by transportation planners. Quantitative risk metrics of this type should have great utility for planners working to reduce risk to a region's infrastructure systems. - Highlights: • We couple mode-destination accessibility with probabilistic seismic risk assessment. • Results identify communities at high risk for post-earthquake travel disruptions. • Accessibility varies more as a function of home location than by income. • Our model predicts reduced accessibility risk for more walking-friendly communities.

Selective salpingography and recanalisation of blocked fallopian tubes.

LENUS (Irish Health Repository)

Allen, C

2010-09-01

Fallopian tubal disease is a common cause of subfertility. Reproductive surgery or assisted reproduction techniques such as in vitro fertilization (IVF) have been the main treatment options for patients with tubal disease in Ireland, although access to these treatments remains limited. We describe a case of pregnancy following selective salpingography and fallopian tube recanalisation.

Clinicopathologic study of serous tubal intraepithelial carcinoma with invasive carcinoma: is serous tubal intraepithelial carcinoma a reliable feature for determining the organ of origin?

Science.gov (United States)

Gao, Faye F; Bhargava, Rohit; Yang, Huaitao; Li, Zaibo; Zhao, Chengquan

2013-08-01

In the past several decades, the concept of serous ovarian carcinoma has been revised repeatedly. However, the exact pathogenesis remains controversial. The most popular current concept is origin from the epithelium of the fimbriated ends of the fallopian tubes. The objective of our study was to evaluate the characteristic clinical and morphologic features of serous tubal intraepithelial carcinoma (STIC) and associated invasive carcinomas. One hundred sixteen consecutive cases of STIC seen from 2007 to 2011 were included in this study. High-grade serous carcinoma (HGSC) with or without a mixed component was identified in 107 cases (92.2%), non-HGSC in 5 cases, and STICs without invasive carcinoma in 4 cases. Using conventional criteria, HGSCs were classified as fallopian tube in origin in 65 cases (60.7%), as ovarian in 30 (28.0%), as peritoneal in 9 (8.4%), and as endometrial in 3 (2.8%). Among the 107 cases with HGSCs, most STICs (86; 80%) were present unilaterally, whereas invasive tumors more commonly involved the ovaries bilaterally (79%; 84 cases). These findings support the hypothesis that STIC acts as a precursor lesion for most fallopian tube, ovarian, and peritoneal HGSCs, but not for endometrial HGSC. Copyright © 2013 Elsevier Inc. All rights reserved.

Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes

International Nuclear Information System (INIS)

Radic, Vanja; Canic, Tomislav; Valetic, Josip; Duic, Zeljko

2005-01-01

Background: Hysterosonosalpingography as a contrast ultrasound method is safer, cheaper and easier to perform than hysterosalpingography in the assessment of the uterine cavity and fallopian tubes. Is it feasible for all patients? Which is the main problem in the evaluation of target structures by ultrasound? Methods: In a prospective study, 68 patients in the initial stage of the infertility treatment were examined by hysterosonosalpingography using saline NaCl infundibile[reg] and Echovist[reg] as contrast media. Subsequently, further status of the tubes and uterine cavity was assessed by the 'gold standards', laparoscopy and hysteroscopy. Results: Sensitivity and specificity of hysterosonosalpingography using NaCl infundibile[reg] for evaluation of the uterine cavity was 100 and 88.8%, respectively. Negative predictive value was 100% and positive predictive value 97%. Sensitivity and specificity of the method for the assessment of the tubal status was 100 and 66%, respectively, negative predictive value was 100% and positive predictive value was 61%. For the assessment of tubal patency using positive contrast Echovist[reg] the method has shown 100% sensibility and negative predictive value again but it reached a specificity of 77% and a positive predictive value of 70%. There were no evident complications during or after the procedure. Conclusion: Hysterosonosalpingography is useful in making decisions regarding further procedures for the diagnosis and treatment of infertility. Uterine cavity evaluation using saline is the method of choice. Tubal patency can be assessed only under ideal sonographic conditions. The method is feasible for early assessment of the reproductive status of uterine cavity and fallopian tubes as a simple, safe and cheap outpatient method prior to any following invasive procedure or even histerosalpingography

Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes

Energy Technology Data Exchange (ETDEWEB)

Radic, Vanja; Canic, Tomislav; Valetic, Josip; Duic, Zeljko

2005-02-01

Background: Hysterosonosalpingography as a contrast ultrasound method is safer, cheaper and easier to perform than hysterosalpingography in the assessment of the uterine cavity and fallopian tubes. Is it feasible for all patients? Which is the main problem in the evaluation of target structures by ultrasound? Methods: In a prospective study, 68 patients in the initial stage of the infertility treatment were examined by hysterosonosalpingography using saline NaCl infundibile[reg] and Echovist[reg] as contrast media. Subsequently, further status of the tubes and uterine cavity was assessed by the 'gold standards', laparoscopy and hysteroscopy. Results: Sensitivity and specificity of hysterosonosalpingography using NaCl infundibile[reg] for evaluation of the uterine cavity was 100 and 88.8%, respectively. Negative predictive value was 100% and positive predictive value 97%. Sensitivity and specificity of the method for the assessment of the tubal status was 100 and 66%, respectively, negative predictive value was 100% and positive predictive value was 61%. For the assessment of tubal patency using positive contrast Echovist[reg] the method has shown 100% sensibility and negative predictive value again but it reached a specificity of 77% and a positive predictive value of 70%. There were no evident complications during or after the procedure. Conclusion: Hysterosonosalpingography is useful in making decisions regarding further procedures for the diagnosis and treatment of infertility. Uterine cavity evaluation using saline is the method of choice. Tubal patency can be assessed only under ideal sonographic conditions. The method is feasible for early assessment of the reproductive status of uterine cavity and fallopian tubes as a simple, safe and cheap outpatient method prior to any following invasive procedure or even histerosalpingography.

User's guide for remote access of the Performance Assessment Center

International Nuclear Information System (INIS)

Peterson, C.R.; Kostelnik, K.M.

1991-03-01

The Performance Assessment Center (PAC) was established by the Department of Energy's National Low-Level Waste Management Program to provide technical assistance to support the development of low-level radioactive waste disposal facilities. This user's manual provides guidance to remote users of the PAC. Information is presented on how remote users may most effectively access and use the systems available at the Performance Assessment Center in Idaho Falls, Idaho. Access requirements and operating procedures are presented to assist the first-time PAC user. This manual also provides brief descriptions of each code available on the system

Analytical resource assessment method for continuous (unconventional) oil and gas accumulations - The "ACCESS" Method

Science.gov (United States)

Crovelli, Robert A.; revised by Charpentier, Ronald R.

2012-01-01

The U.S. Geological Survey (USGS) periodically assesses petroleum resources of areas within the United States and the world. The purpose of this report is to explain the development of an analytic probabilistic method and spreadsheet software system called Analytic Cell-Based Continuous Energy Spreadsheet System (ACCESS). The ACCESS method is based upon mathematical equations derived from probability theory. The ACCESS spreadsheet can be used to calculate estimates of the undeveloped oil, gas, and NGL (natural gas liquids) resources in a continuous-type assessment unit. An assessment unit is a mappable volume of rock in a total petroleum system. In this report, the geologic assessment model is defined first, the analytic probabilistic method is described second, and the spreadsheet ACCESS is described third. In this revised version of Open-File Report 00-044 , the text has been updated to reflect modifications that were made to the ACCESS program. Two versions of the program are added as appendixes.

Infertility in Women: Hysterosalpingographic Assessment of the Fallopian Tubes in Lagos, Nigeria

Science.gov (United States)

Akinola, R. A.; Akinola, O. I.; Fabamwo, A. O.

2009-01-01

Tubal disease constitutes a major factor in infertility especially in developing countries. This study was undertaken to assess the hysterosalpingographic patterns seen in infertile patients in an urban centre in Lagos. Two hundred and twenty patients who reported from the gynaecology clinic to the radiology department of Lagos State University…

Dextromethorphan Reduces Postoperative Pain of Post Partum Tubal Ligation under General Anesthesia

Directory of Open Access Journals (Sweden)

N. Manochehrian

2009-04-01

Full Text Available Introduction & Objective: Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. Materials & Methods: In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral. The patients induced general anesthesia with thiopental (5mg/kg, fentanyl 1.5 g/kg and succinylcholin(1-1.5 mg/kg and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. Results: There was no significant difference in age, education, . . . Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine in dextromethophan was less than placebo group.Conclusion: Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time , 2 and 4 hours after the surgery.

Ambulatory laparoscopic tubal ligation: A comparison of general anaesthesia with local anaesthesia and sedation

Directory of Open Access Journals (Sweden)

Lokesh Gupta

2011-01-01

Full Text Available Background: To compare the anaesthetic techniques for laparoscopic tubal ligation using either general anaesthesia with LMA or a combination of local anaesthetic and intravenous sedation, this study was conducted on 60 ASA-1/2 patients in the age group of 20-40 years. Patients & Methods:60 ASA grade I & II female patients undergoing laparoscopic tubal ligation on a day care basis were randomly divided in two groups- group I (GA using LMA, n=30, group II (Local anaesthesia, n=30. Both groups received similar premedication. General anaesthesia in group I was induced with propofol 2-3 mg kg -1 and following LMA insertion, the anaesthesia was maintained with 0.5-1.5% halothane. In group II the incision site was infiltrated with 10 ml of 1.5% lidocaine with adrenaline and patients were sedated with intravenous midazolam 0.07mg kg -1 and ketamine 0.5 mg kg -1 . A rescue dose of 0.15 mg kg -1 of ketamine was given in group II if the patient complained of pain or discomfort during the procedure. Diclofenac sodium 1 mg kg -1 was used for postoperative analgesia in both the groups. All patients were observed in the PACU until they met the discharge criteria. Results:The demographic profile was similar in both the groups. The induction to skin incision time was significantly more in group I (5.13 ±0.93 min vs 3.01 ±1.86 min in group II. The decrease in pulse rate and blood pressure (systolic and diastolic was also significant in group I. The incidence of intraoperative bradycardia was 16.7% and 10% in group I & group II respectively. The changes in SpO 2 during the procedure, recovery time and time to meet discharge criteria were comparable in both the groups. The incidence of PONV was 20% & 3.3% in group I and 10% & 6.6% in group II respectively. All patients in both the groups required postoperative analgesics. Conclusions:Both the techniques were found to be comparable for laparoscopic sterilization, however a longer induction to skin incision time

Low grade serious carcinoma of the peritoneum in a BRCA1 carrier previously diagnosed with a "low-grade serous tubal intra-epithelial carcinoma" (STIC) on risk reducing surgery.

Science.gov (United States)

Chay, Wen Yee; Horlings, Hugo M; Tinker, Anna V; Gelmon, Karen A; Gilks, C Blake

2015-04-01

•Conventional definitions of STIC do not capture all lesions associated with serous neoplasia and the presence of abnormal p53 expression may be helpful diagnostically.•The management of STICs and tubal atypias remain uncertain.•The POINT Project is a registry set up to address this critical gap in knowledge.

Assessment of genetic diversity among maize accessions using inter ...

African Journals Online (AJOL)

Assessment of genetic diversity among maize accessions using inter simple sequence repeats (ISSR) markers. AT do Amaral Júnior, EC de Oliveira, LSA Gonçalves, CA Scapim, LS Candido, TR da Conceição Silva, C Vittorazzi, KS da Cunha ...

Evaluation of Influencing Factors on Tubal Sterilization Regret: A Cross-Sectional Study

Directory of Open Access Journals (Sweden)

Shahideh Jahanian Sadatmahalleh

2018-06-01

Full Text Available Background The aim of this study is to evaluate the menstrual pattern, sexual function, and anxiety, and depression in women with poststerilization regret, and potential influencing factors for regret following tubal ligation (TL in Iranian women. Materials and Methods In this cross-sectional study, 166 women with TL were subdivided into two groups including women with poststerilization regret (n=41 and women without poststerilization regret (n=125. They were selected from a health care center in Guilan province (Iran during 2015-2016. Menstrual blood loss was measured using the Pictorial Blood Loss Assessment Chart (PBLAC and through a self-administered questionnaire. In addition, sexual function was assessed by the Female Sexual Function Index (FSFI, and psychological distress was measured by employing the Hospital Anxiety and Depression Scale (HADS. Student’s t test and Chi-square test were used to reveal the statistical differences between the two groups. We used logistic regression to determine the influencing factors associated with regretting sterilization. Results Women with poststerilization regret had more menorrhagia (78 vs. 57.6%, P=0.03 than those who did not regret sterilization. A significant difference was found in sexual dysfunction in orgasm (P=0.02, satisfaction (P=0.004, pain (P=0.02, and total FSFI scores (P=0.007 between the two groups. Also, there was a significant difference between the two groups in anxiety, depression and total scores HADS (P=0.01. In the logistic regression model, age of sterilization [odds ratio (OR=2.67, confidence interval (CI: 1.03-7.81, P=0.04], pre-sterilization counseling (OR=19.92, CI: 6.61-59.99, P<0.001, score of PBLAC (OR=1.01, CI: 1.004-1.01, P=0.001, the number of days of bleeding (OR=1.37, CI: 1.01-1.99, P=0.04, and the length of menstrual cycles (OR=0.91, CI: 0.84-0.99, P=0.03 were significantly associated with regretting sterilization. Conclusion Complications due to sterilization are

Performance of the multitarget Mikrogen Chlamydia trachomatis IgG ELISA in the prediction of tubal factor infertility (TFI) in subfertile women : Comparison with the Medac MOMP IgG ELISA plus

NARCIS (Netherlands)

van Ess, Eleanne F.; Ouburg, Sander; Spaargaren, Joke; Land, Jolande A.; Morre, Servaas A.

2017-01-01

There is a need for more accurate Chlamydia trachomatis (CT) IgG antibody tests for tubal factor infertility (TFI) diagnostics. We evaluated the predictive value for TFI of Medac ELISA plus (MOMP) and multitarget Mikrogen ELISA (MOMP-CPAF-TARP). Based on Medac ELISA plus results, 183 subfertile

Factores asociados a la aceptación de salpingoclasia posparto entre mujeres infectadas por el VIH Factors associated with acceptance of postpartum tubal ligation among HIV infected women

Directory of Open Access Journals (Sweden)

Ricardo Figueroa-Damián

2001-04-01

artículo está disponible en: http://www.insp.mx/salud/index.htmlOBJECTIVE: To identify the factors associated with the acceptance of tubal ligation after childbirth among HIV-infected patients. MATERIAL AND METHODS: A case-control study was conducted from March 1988 to February 1999, at Mexico's National Institute of Perinatology (INPer, in 72 HIV-positive pregnant women. Cases were 49 women who accepted postpartum tubal ligation after childbirth, and controls were 23 women who refused this birth control method. Data collected for each patient were demographic characteristics, sexual and reproductive history, and HIV status. Statistical analysis consisted of descriptive measures, Chi² or Fisher's exact test for categorical variables, and Student's t test for continuous variables. Odds ratios (OR with 95% CI were used to compare groups and potential confounders were assessed by stratified analysis with the Mantel-Haenszel method. RESULTS: The patients' mean age was 25.5 ± 5.5 years. The median gestation period was 27 weeks (range 7 to 40 weeks; 16 women (22.2% had no prenatal care visits at INPer. The median time of HIV positivist awareness was 9 months (range 1 to 108. Variables associated with acceptance of tubal ligation were: having a prior childbirth (OR 11.1, 95% CI 3.4 to 36, pregnancy care from 1995 onward (OR 4.7, 95% CI 1.7 to 13.3, and having given birth to an HIV-infected child (OR 4.6, 95% CI 1.05 to 23.1. Stratified analysis showed no modification of the strength of association of these variables with acceptance of tubal ligation. CONCLUSIONS: A prior childbirth was the most important predictor of tubal ligation acceptance. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Ki-67 labeling index as an adjunct in the diagnosis of serous tubal intraepithelial carcinoma.

Science.gov (United States)

Kuhn, Elisabetta; Kurman, Robert J; Sehdev, Ann Smith; Shih, Ie-Ming

2012-09-01

There is mounting evidence that serous tubal intraepithelial carcinoma (STIC) may be the immediate precursor of ovarian high-grade serous carcinoma (HGSC) but the criteria for its diagnosis are not well established as highlighted in a recent study showing that interobserver reproducibility, even among expert gynecologic pathologists, was moderate at best. Given the clinical significance of a diagnosis of STIC in a patient who has no other evidence of ovarian carcinoma, this is a serious issue that we felt needed to be addressed. Although it is not clear, at this time, whether such a patient should or should not be treated, the importance of an accurate and reproducible diagnosis of precursors of ovarian carcinoma cannot be underestimated. We hypothesized that an elevated Ki-67 labeling index may aid the diagnosis of STIC. Accordingly, we compared the Ki-67 index of STIC and HGSC to normal fallopian tube epithelium (FTE) in the same patients and to a control group of patients without carcinoma, matched for age. A total of 41 STICs were analyzed, of which 35 were associated with a concurrent HGSC. In FTE, immunoreactivity for Ki-67 was restricted to a few scattered cells (mean 2.0%). No statistically significant difference was found between patients with and without HGSC (P>0.05). However, both STICs and HGSC had significantly higher Ki-67 indices than normal FTE (PSTICs uniformly had an elevated Ki-67 labeling index that ranged from 11.7% to 71.1% (average 35.6%). There was no correlation of the Ki-67 labeling index in the STICs and the associated HGSC, as the labeling index was lower in STIC in 18/35 (51.4%) whereas it was higher in 17/35 (48.6%) (P=0.86). In conclusion, the findings in this study indicate that compared with FTE, STICs have a significantly higher Ki-67 index similar to HGSC. Accordingly, the Ki-67 index can aid the diagnosis of intraepithelial tubal proliferations suspicious for STIC. Therefore, we propose that a Ki-67 index of 10% is a useful

Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT.

Science.gov (United States)

Dreyer, K; Lier, M C I; Emanuel, M H; Twisk, J W R; Mol, B W J; Schats, R; Hompes, P G A; Mijatovic, V

2016-09-01

Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates. It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy. A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers). We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment. The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P

Investigating Access to Educational Assessment for Students with Disabilities

Science.gov (United States)

Woods, Kevin; Parkinson, Gill; Lewis, Sarah

2010-01-01

Many countries have established systems for identifying, and providing for, the range of students with disabilities during their formal educational assessments. Most systems include the provision of variously termed "special access arrangements" (SAAs), such as the provision of extra time or practical assistance with some aspect of an…

Incidental Serous Tubal Intraepithelial Carcinoma and Non-Neoplastic Conditions of the Fallopian Tubes in Grossly Normal Adnexa: A Clinicopathologic Study of 388 Completely Embedded Cases.

Science.gov (United States)

Seidman, Jeffrey D; Krishnan, Jayashree; Yemelyanova, Anna; Vang, Russell

2016-09-01

Serous tubal intraepithelial carcinoma (STIC), the putative precursor of the majority of extrauterine high-grade serous carcinomas, has been reported in both high-risk women (those with a germline BRCA mutation, a personal history of breast carcinoma, and/or family history of breast or ovarian carcinoma) and average risk women from the general population. We reviewed grossly normal adnexal specimens from 388 consecutive, unselected women undergoing surgery, including those with germline BRCA mutation (37 patients), personal history of breast cancer or family history of breast/ovarian cancer (74 patients), endometrial cancer (175 patients), and a variety of other conditions (102 patients). Among 111 high-risk cases and 277 non-high-risk cases, 3 STICs were identified (0.8%), all in non-high-risk women (high risk vs. non-high risk: P=not significant). STIC was found in 2 women with nonserous endometrial carcinoma and 1 with complex atypical endometrial hyperplasia. Salpingoliths (mucosal calcifications), found in 9% of high-risk cases, and fimbrial adenofibromas in 9.9% of high-risk cases, were significantly more common in high-risk as compared with non-high-risk women (1.8% and 2.5%, respectively; PSTIC and endometrial hyperplasia and carcinoma, and clarify the frequency of non-neoplastic tubal findings in grossly normal fallopian tubes.

COMPARISON BETWEEN ACUPRESSURE AND PALONOSETRON IN PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING LAPAROSCOPIC TUBAL STERILISATION. A RANDOMISED CONTROL TRIAL

Directory of Open Access Journals (Sweden)

Raghavendra

2016-03-01

Full Text Available BACKGROUND AND OBJECTIVES To compare the effectiveness of acupressure at P6 point and palonosetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic tubal sterilisation. METHODS AND MATERIALS After obtaining institutional ethical clearance and patient consent, this study was conducted during the period of July 2015 to November 2015. Patients undergoing laparoscopic tubal sterilisation belonging to ASA 1 and 2 were included, and patients with hypertension, diabetes neurological diseases, peripheral vascular diseases, local skin diseases, patients on antiemetics and unwilling patients were excluded from the study. Randomisation done by sealed envelope method into two groups of sample size 25 each; group A (acupressure, at P6 point and group B (palonosetron 0.075 mg IV. Acupressure band and Inj palonosetron were given just before the induction of anaesthesia. Episodes of PONV were recorded at 0-2 hours, 2-6 hours, 6- 12 hours and evaluated separately as none, mild, moderate and severe. Rescue antiemetic was given to those who had episode of vomiting. Data analysed using Student ‘t’ test and P value <0.05 considered to be significant. RESULTS Between two group comparisons no significant differences in terms of severity of PONV was observed and Group B showed no incidence of PONV. CONCLUSION Acupressure being non-invasive, non-pharmacological, inexpensive and better patient acceptability can be effectively used as an alternative for the prophylaxis of PONV. However, palonosetron was more effective than acupressure in preventing PONV.

Trypan blue to assess Baerveldt tube patency after repair of its obstruction.

Science.gov (United States)

Grigg, John; Jang, John D W; Fung, Adrian T; Hunyor, Alex P; Wilson, Trevor

2011-12-01

Tubal obstruction is a recognized complication of glaucoma drainage implants. In correcting a blocked tube, the surgeon may be uncertain about shunt competence even after removing the suspected cause of obstruction. We report the use of trypan blue dye to show tubal patency directly after the repair of a blocked Baerveldt tube.

Assessment of genetic diversity among accessions of two traditional ...

African Journals Online (AJOL)

Assessment of genetic diversity among accessions of two traditional leafy vegetables (Acmella uliginosa (L.) and Justicia tenella (Nees) T.) consumed in Benin using amplified fragment length polymorphism (AFLP) markers. K Adéoti, A Rival, A Dansi, BS Ahohuendo, S Santoni, T Beule, A Nato, Y Henry, A Ahanchédé, ...

Second-Line Intraperitoneal Chemotherapy for Recurrent Epithelial Ovarian, Tubal and Peritoneal Cancer: A Propensity Score-Matching Study.

Science.gov (United States)

Lu, Chien-Hsing; Chang, Yen-Hou; Lee, Wai-Hou; Chang, Yi; Peng, Chia-Wen; Chuang, Chi-Mu

2016-01-01

The superiority of frontline intraperitoneal (IP) over intravenous (IV) chemotherapy is well established in the treatment of epithelial ovarian cancer. However, the role of IP chemotherapy in the second-line setting has rarely been investigated. Consecutive patients diagnosed with recurrent epithelial, tubal and peritoneal cancers between January 2000 and December 2012 were recruited using a propensity score-matching technique to adjust relevant risk factors. In total, 310 patients were included in the final analysis (94 for platinum-refractory/resistant disease and 216 for platinum-sensitive disease). IP chemotherapy demonstrated significantly longer median progression-free survival than IV chemotherapy (4.9 vs. 2.4 months, p chemotherapy confers longer progression-free survival than IV chemotherapy. Large-scale clinical trials should be conducted to validate the true efficacy. © 2016 S. Karger AG, Basel.

INSTITUTION FOR THE AGED: ASSESSING THE CONDITIONS OF ACCESSIBILITY AND FUNCTIONALITY OF THE ELDERLY.

Directory of Open Access Journals (Sweden)

Raphaella Lomanto Santos de Almeida

2015-04-01

Full Text Available The study aim was to assess the capacity to undertake the Basic Activities of Daily Living (BADL of elderly residents of an Institution for the Aged (IA and their level of accessibility. This is an observational, descriptive, cross-sectional study. The level of independence for BADL was assessed by the Barthel Index and the degree of accessibility of IA was verified through a check-list, based on the Brazilian Standard (NBR 9050/2004, the Brazilian Association of Technical Standards (ABNT. Of the 62 seniors who participated in the study, 64.5% had some degree of functional dependence. Noteworthy the level of functional dependency for activities undertaken in the bathroom among elderly on wheelchair. The assessed physical structure does not fully follow the technical standards established by NBR 9050, with differences mainly in the parameters of bedrooms, bathrooms and stairs. Although much of the institutionalized elderly presenting advanced and most functional vulnerability ages, level of IA architectural accessibility is still insufficient. Rooms and bathrooms are the places with the highest deficit of accessibility and also higher prevalence of falls among the elderly residents. A good level of accessibility in IA, can be an important factor in improving the level of independence for everyday activities and to prevent the risk of falls.

A Novel Trip Coverage Index for Transit Accessibility Assessment Using Mobile Phone Data

Directory of Open Access Journals (Sweden)

Zhengyi Cai

2017-01-01

Full Text Available Transit accessibility is an important measure on the service performance of transit systems. To assess whether the public transit service is well accessible for trips of specific origins, destinations, and origin-destination (OD pairs, a novel measure, the Trip Coverage Index (TCI, is proposed in this paper. TCI considers both the transit trip coverage and spatial distribution of individual travel demands. Massive trips between cellular base stations are estimated by using over four-million mobile phone users. An easy-to-implement method is also developed to extract the transit information and driving routes for millions of requests. Then the trip coverage of each OD pair is calculated. For demonstrative purposes, TCI is applied to the transit network of Hangzhou, China. The results show that TCI represents the better transit trip coverage and provides a more powerful assessment tool of transit quality of service. Since the calculation is based on trips of all modes, but not only the transit trips, TCI offers an overall accessibility for the transit system performance. It enables decision makers to assess transit accessibility in a finer-grained manner on the individual trip level and can be well transformed to measure transit services of other cities.

A multi-criteria approach of assessing public transport accessibility at a strategic level

OpenAIRE

Hawas, Yaser E.; Hassan, Mohammad Nurul; Abulibdeh, Ammar

2016-01-01

This paper presents an approach for accessibility categorization in areas where there is no extensive data available to run the conventional analysis. The presented method has the advantages of the lower data requirements and the utility of the results. Three benchmarks were selected to evaluate transit accessibility. The first one (transit coverage) investigates the spread of the service, and it is used to assess the percentage of people in a district that can access the service within a com...

25 CFR 30.125 - What happens if a State refuses to allow a school access to the State assessment?

Science.gov (United States)

2010-04-01

... if a State refuses to allow a school access to the State assessment? (a) The Department will work directly with State officials to assist schools in obtaining access to the State's assessment. This can... access to the State's assessment, the Bureau-funded school must submit a waiver for an alternative...

Regulatory assessment of proposed accessibility guidelines for pedestrians in the public right-of-way

Science.gov (United States)

2011-06-30

This report assesses the potential costs and benefits of proposed accessibility guidelines issued by the Access Board for pedestrian facilities in the public right-of-way. The report also analyzes the potential impacts of the proposed guidelines on s...

Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

DEFF Research Database (Denmark)

Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove

2009-01-01

. A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were......Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...... (n.s.). Conclusions. In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment...

Retained Intra-Abdominal Surgical Clamp Complicating Emergency Laparotomy: Incidental Finding on Hysterosalpingogram for Evaluation of Tubal Infertility

Directory of Open Access Journals (Sweden)

Adebiyi Gbadebo Adesiyun

2014-01-01

Full Text Available The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery.

Essure insert expulsion after 3-month hysterosalpingogram confirmation of bilateral tubal occlusion and bilateral correct placement: case report.

Science.gov (United States)

Garcia, Amy L; Lewis, Rae M; Sloan, Anita Lee

2013-01-01

Essure hysteroscopic sterilization is an effective permanent contraception option for women, with a 99.83% effectiveness rate. To date, more than 600,000 Essure procedures have been performed worldwide. This case report describes bilateral Essure insert placement, after which the left insert was subsequently expelled after hysterosalpingogram (HSG)-confirmed correct bilateral insert placement and bilateral tubal occlusion. Although insert expulsion has been reported before a 3-month post-procedure HSG, this is the first published report of expulsion after a confirmatory 3-month post-procedure HSG. Because there now exists documentation of Essure insert expulsion after a 3-month confirmatory HSG, physicians and patients should be informed of this rare occurrence. Further investigation into the causes of such an event is warranted. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Fallopian tube occlusion by selective transcatheter radiofrequency electrocautery

Energy Technology Data Exchange (ETDEWEB)

Oh, Joo Hyeong; Yoon, Yup; Ko, Young Tae; Nam, Duck Ho; Park, Yong Koo [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1998-04-01

The purpose of this study is to access the usefulness of transcatheter radiofrequency (RF) electrocautery as a method of nonsurgical tubal occlusion. Using the coaxial technique under fluoroscopic guidance, transvaginal fluoroscopic fallopian tube catheterization was performed in thirteen rabbits. In each rabbit, unilateral tubal ablation was performed using RF electrocautery. A 0.018 inch metallic wire protruding from the microcatheter tip was used as the source of the RF energy; the length of the noninsulated part of this wire was 10 mm and the duration of RF energy; the length of the noninsulated part of this wire 10 mm and the duration of RF supply was 20 seconds. The contralateral normal fallopian tube and uterus were used as a control. All 13 rabbits were randomly sacrificed on two days (group I) or 30 days (group II) after the procedure, and tubal patency and histologic change were evaluated. Transcatheter RF electrocautery is though to be a useful method for tubal occlusion. It is simple, safe, and less expensive and might have a role in future female tubal sterilization. (author). 25 refs., 1 tab., 4 figs.

Fallopian tube occlusion by selective transcatheter radiofrequency electrocautery

International Nuclear Information System (INIS)

Oh, Joo Hyeong; Yoon, Yup; Ko, Young Tae; Nam, Duck Ho; Park, Yong Koo

1998-01-01

The purpose of this study is to access the usefulness of transcatheter radiofrequency (RF) electrocautery as a method of nonsurgical tubal occlusion. Using the coaxial technique under fluoroscopic guidance, transvaginal fluoroscopic fallopian tube catheterization was performed in thirteen rabbits. In each rabbit, unilateral tubal ablation was performed using RF electrocautery. A 0.018 inch metallic wire protruding from the microcatheter tip was used as the source of the RF energy; the length of the noninsulated part of this wire was 10 mm and the duration of RF energy; the length of the noninsulated part of this wire 10 mm and the duration of RF supply was 20 seconds. The contralateral normal fallopian tube and uterus were used as a control. All 13 rabbits were randomly sacrificed on two days (group I) or 30 days (group II) after the procedure, and tubal patency and histologic change were evaluated. Transcatheter RF electrocautery is though to be a useful method for tubal occlusion. It is simple, safe, and less expensive and might have a role in future female tubal sterilization. (author). 25 refs., 1 tab., 4 figs

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya.

Science.gov (United States)

Oyugi, Boniface; Kioko, Urbanus; Kaboro, Stephen Mbugua; Gikonyo, Shadrack; Okumu, Clarice; Ogola-Munene, Sarah; Kalsi, Shaminder; Thiani, Simon; Korir, Julius; Odundo, Paul; Baltazaar, Billy; Ranji, Moses; Muraguri, Nicholas; Nzioka, Charles

2017-03-27

The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17. All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R 2 value, representing the percentage of

The prehospital intravenous access assessment: a prospective study on intravenous access failure and access delay in prehospital emergency medicine.

Science.gov (United States)

Prottengeier, Johannes; Albermann, Matthias; Heinrich, Sebastian; Birkholz, Torsten; Gall, Christine; Schmidt, Joachim

2016-12-01

Intravenous access in prehospital emergency care allows for early administration of medication and extended measures such as anaesthesia. Cannulation may, however, be difficult, and failure and resulting delay in treatment and transport may have negative effects on the patient. Therefore, our study aims to perform a concise assessment of the difficulties of prehospital venous cannulation. We analysed 23 candidate predictor variables on peripheral venous cannulations in terms of cannulation failure and exceedance of a 2 min time threshold. Multivariate logistic regression models were fitted for variables of predictive value (P0.6) of their respective receiver operating characteristic curve. A total of 762 intravenous cannulations were enroled. In all, 22% of punctures failed on the first attempt and 13% of punctures exceeded 2 min. Model selection yielded a three-factor model (vein visibility without tourniquet, vein palpability with tourniquet and insufficient ambient lighting) of fair accuracy for the prediction of puncture failure (AUC=0.76) and a structurally congruent model of four factors (failure model factors plus vein visibility with tourniquet) for the exceedance of the 2 min threshold (AUC=0.80). Our study offers a simple assessment to identify cases of difficult intravenous access in prehospital emergency care. Of the numerous factors subjectively perceived as possibly exerting influences on cannulation, only the universal - not exclusive to emergency care - factors of lighting, vein visibility and palpability proved to be valid predictors of cannulation failure and exceedance of a 2 min threshold.

ValeAS: an ICT tool to assess accessibility and safety of the built environment

Directory of Open Access Journals (Sweden)

Luigi Biocca

2014-05-01

Full Text Available ValeAS (Assessment of Accessibility and Safety is a software developed by the Construction Technologies Institute, Rome Unit, of the National Research Council (ITC-CNR, with the aim of giving an ICT tool for assessing the accessibility level of egress ways in the build environment for people with disabilities. The software takes into account the action sequence a person normally performs when involved in an emergency situation, from when he/she perceives the alarm until he/she reaches a safe place or meeting point, thus resulting into the dynamical insertion of the design elements along the path. Once completed the path elements composition, the program generates a result with the assessment of each parameter. The main purpose of ValeAS is to introduce a tool responding to the requirements of accessibility of the built environment, in order to allow relevant professionals and stakeholders to plan new design or adjustment interventions.

Is the fertile window extended in women with polycystic ovary syndrome? Utilizing the Society for Assisted Reproductive Technology registry to assess the impact of reproductive aging on live-birth rate.

Science.gov (United States)

Kalra, Suleena Kansal; Ratcliffe, Sarah J; Dokras, Anuja

2013-07-01

To assess whether women with polycystic ovary syndrome (PCOS) follow the same age-related decline in IVF outcomes as women with tubal factor infertility over the reproductive life span. PCOS is characterized by increased ovarian reserve as assessed by antral follicle counts and anti-Müllerian hormone levels. It is unclear whether these surrogate markers of ovarian reserve reflect a true lengthening of the reproductive window. Retrospective cohort. Not applicable. Women with PCOS and tubal factor infertility (42,286 cycles). IVF. Pregnancy and live-birth rates. The mean number of oocytes retrieved was higher in women with PCOS compared with in women with tubal factor (16.4 vs. 12.8; odds ratio [OR], 1.27; 95% confidence interval [CI], 1.25-1.29). The clinical pregnancy (42.5% vs. 35.8%; OR, 1.32; 95% CI, 1.27-1.38) and live-birth rates were also increased in women with PCOS (34.8% vs. 29.1%; OR, 1.30; 95% CI, 1.24-1.35). A similar rate of decline in clinical pregnancy and live-birth rates was noted in both groups (20-44 years). The implantation, clinical pregnancy, miscarriage, and live-birth rates were not significantly different for each year after age 40 in the two groups. Despite a higher oocyte yield in all age groups, women with PCOS over age 40 had similar clinical pregnancy and live-birth rates compared with women with tubal factor infertility. These findings suggest that the reproductive window may not be extended in PCOS and that patients with infertility should be treated in a timely manner despite indicators of high ovarian reserve. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Feasibility Assessment of a Fine-Grained Access Control Model on Resource Constrained Sensors.

Science.gov (United States)

Uriarte Itzazelaia, Mikel; Astorga, Jasone; Jacob, Eduardo; Huarte, Maider; Romaña, Pedro

2018-02-13

Upcoming smart scenarios enabled by the Internet of Things (IoT) envision smart objects that provide services that can adapt to user behavior or be managed to achieve greater productivity. In such environments, smart things are inexpensive and, therefore, constrained devices. However, they are also critical components because of the importance of the information that they provide. Given this, strong security is a requirement, but not all security mechanisms in general and access control models in particular are feasible. In this paper, we present the feasibility assessment of an access control model that utilizes a hybrid architecture and a policy language that provides dynamic fine-grained policy enforcement in the sensors, which requires an efficient message exchange protocol called Hidra. This experimental performance assessment includes a prototype implementation, a performance evaluation model, the measurements and related discussions, which demonstrate the feasibility and adequacy of the analyzed access control model.

Tubal Buccal Mucosa Graft without Anastomosis of the Proximal Urethra for Long Segment Posterior Urethral Defect Repair.

Science.gov (United States)

Min, Byung-Dal; Lee, Eui-Tai; Kim, Won-Tae; Kim, Yong-June; Yun, Seok Joong; Lee, Sang Cheol; Kim, Wun-Jae

2012-10-01

A 31-year-old man was referred for further management of a urethral stricture. He was a victim of a traffic accident and his urethral injury was associated with a pelvic bone fracture. He had previously undergone a suprapubic cystostomy only owing to his unstable general condition at another hospital. After 3 months of urethral injury, direct urethral anastomosis was attempted, but the surgery failed. An additional 4 failed internal urethrotomies were performed before the patient visited Chungbuk National University Hospital. Preoperative images revealed complete posterior urethral disruption, and the defect length was 4 cm. We performed a buccal mucosa tubal graft without anastomosis of the proximal urethra for a long segment posterior urethral defect. The Foley catheter was removed 3 weeks after the operation and the patient was able to void successfully. After 8 months, he had normal voiding function without urinary incontinence.

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

DEFF Research Database (Denmark)

Beran, David; Yudkin, John S; de Courten, Maximilian

2006-01-01

In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol...... for the gathering of other data through site visits, discussions, and document reviews....

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

Directory of Open Access Journals (Sweden)

de Courten Maximilian

2006-02-01

Full Text Available Abstract Background In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. Methods The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. Results In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. Conclusion The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to

Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Nam, Kyung Bum; Namkung, Sook; Hong, Myung Sun; Kim, Heung Cheol; Cho, Young; Choi, Young Hee [Chuncheon Sacred Heart Hospital, Chyncheon (Korea, Republic of)

2012-06-15

Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

International Nuclear Information System (INIS)

Nam, Kyung Bum; Namkung, Sook; Hong, Myung Sun; Kim, Heung Cheol; Cho, Young; Choi, Young Hee

2012-01-01

Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

TP53 mutations in serous tubal intraepithelial carcinoma and concurrent pelvic high-grade serous carcinoma—evidence supporting the clonal relationship of the two lesions

Science.gov (United States)

Kuhn, Elisabetta; Kurman, Robert J; Vang, Russell; Sehdev, Ann Smith; Han, Guangming; Soslow, Robert; Wang, Tian-Li; Shih, Ie-Ming

2016-01-01

Serous tubal intraepithelial carcinomas (STICs) have been proposed to be the most likely precursor of ovarian, tubal and ‘primary peritoneal’ (pelvic) high-grade serous carcinoma (HGSC). As somatic mutation of TP53 is the most common molecular genetic change of ovarian HGSC, occurring in more than 95% of cases, we undertook a mutational analysis of 29 pelvic HGSCs that had concurrent STICs to demonstrate the clonal relationship of STICs and HGSCs. In addition, we correlated the mutational data with p53 immunostaining to determine the role of p53 immunoreactivity as a surrogate for TP53 mutations in histological diagnosis. Somatic TP53 mutations were detected in all 29 HGSCs analysed and the identical mutations were detected in 27 of 29 pairs of STICs and concurrent HGSCs. Missense mutations were observed in 61% of STICs and frameshift/splicing junction/nonsense mutations in 39%. Interestingly, there were two HGSCs with two distinctly different TP53 mutations each, but only one of the mutations was detected in the concurrent STICs. Missense mutations were associated with intense and diffuse (≥ 60%) p53 nuclear immunoreactivity, while most of the null mutations were associated with complete loss of p53 staining (p STIC and pelvic HGSC and demonstrate the utility of p53 immunostaining as a surrogate for TP53 mutation in the histological diagnosis of STIC. In this regard, it is important to appreciate the significance of different staining patterns. Specifically, strong diffuse staining correlates with a missense mutation, whereas complete absence of staining correlates with null mutations. PMID:21990067

The Pattern of Hysterosalpingographic Findings in Women Being ...

African Journals Online (AJOL)

Background: Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. Objective: To review the pattern of hysterosalpingographic findings among women being ...

A database in ACCESS for assessing vaccine serious adverse events

Directory of Open Access Journals (Sweden)

Thomas RE

2015-04-01

Full Text Available Roger E Thomas,1 Dave Jackson2,3 1Department of Family Medicine, G012 Health Sciences Centre, University of Calgary Medical School, Calgary, AB, Canada; 2Independent Research Consultant, Calgary, AB, Canada; 3Database Consultant, University of Calgary, Calgary, AB, Canada Purpose: To provide a free flexible database for use by any researcher for assessing reports of adverse events after vaccination. Results: A database was developed in Microsoft ACCESS to assess reports of serious adverse events after yellow fever vaccination using Brighton Collaboration criteria. The database is partly automated (if data panels contain identical data fields the data are automatically also entered into those fields. The purpose is to provide the database free for developers to add additional panels to assess other vaccines. Keywords: serious adverse events after vaccination, database, process to assess vaccine-associated events 

Assessing the Library Homepages of COPLAC Institutions for Section 508 Accessibility Errors: Who's Accessible, Who's Not, and How the Online WebXACT Assessment Tool Can Help

Science.gov (United States)

Huprich, Julia; Green, Ravonne

2007-01-01

The Council on Public Liberal Arts Colleges (COPLAC) libraries websites were assessed for Section 508 errors using the online WebXACT tool. Only three of the twenty-one institutions (14%) had zero accessibility errors. Eighty-six percent of the COPLAC institutions had an average of 1.24 errors. Section 508 compliance is required for institutions…

Virtual reality for accessibility assessment of a built environment for a wheelchair user

OpenAIRE

MOUSSAOUI, Abdelhak; PRUSKI, Alain; MAAOUI, Choubeila

2012-01-01

The aging world population requires more attention to the autonomy of individuals. The impaired physical abilities need changes in the built environment for an optimal use. Due to physical limitations, aged persons frequently become users of a wheelchair which also leads to limitations in accessing their homes. This paper describes a tool for evaluating mobility and grasping, thus allowing housing professionals to assess the needed changes in terms of accessibility. This tool, which uses the ...

Antibodies to Chlamydia trachomatis heat shock proteins in women with tubal factor infertility are associated with prior infection by C. trachomatis but not by C. pneumoniae

DEFF Research Database (Denmark)

Persson, K; Osser, S; Birkelund, Svend

1999-01-01

The antibody response to heat shock proteins 60 and 10 were studied in 163 patients with tubal factor infertility and in 163 age-matched pregnant women. The associations of these antibodies with specific antibodies to Chlamydia trachomatis and to Chlamydia pneumoniae as well as with antibodies...... proteins and to C. trachomatis but no independent influence of antibodies to C. pneumoniae. No interaction between C. trachomatis and C. pneumoniae suggesting a synergistic effect was found although the heat shock proteins from these two organisms are immunologically similar. Antibodies to the chlamydial...

Assessment of Multifactor Gene-Environment Interactions and Ovarian Cancer Risk

DEFF Research Database (Denmark)

Usset, Joseph L; Raghavan, Rama; Tyrer, Jonathan P

2016-01-01

and non-obese women. METHODS: We considered interactions between 11,441 SNPs within 80 candidate genes related to hormone biosynthesis and metabolism and insulin-like growth factors with six hormone-related factors (oral contraceptive use, parity, endometriosis, tubal ligation, hormone replacement therapy...... Future work is needed to develop powerful statistical methods able to detect these complex interactions. IMPACT: Assessment of multifactor interaction is feasible, and, here, suggests that the relationship between genetic variants within candidate genes and hormone-related risk factors may vary EOC...

TP53 mutations in serous tubal intraepithelial carcinoma and concurrent pelvic high-grade serous carcinoma--evidence supporting the clonal relationship of the two lesions.

Science.gov (United States)

Kuhn, Elisabetta; Kurman, Robert J; Vang, Russell; Sehdev, Ann Smith; Han, Guangming; Soslow, Robert; Wang, Tian-Li; Shih, Ie-Ming

2012-02-01

Serous tubal intraepithelial carcinomas (STICs) have been proposed to be the most likely precursor of ovarian, tubal and 'primary peritoneal' (pelvic) high-grade serous carcinoma (HGSC). As somatic mutation of TP53 is the most common molecular genetic change of ovarian HGSC, occurring in more than 95% of cases, we undertook a mutational analysis of 29 pelvic HGSCs that had concurrent STICs to demonstrate the clonal relationship of STICs and HGSCs. In addition, we correlated the mutational data with p53 immunostaining to determine the role of p53 immunoreactivity as a surrogate for TP53 mutations in histological diagnosis. Somatic TP53 mutations were detected in all 29 HGSCs analysed and the identical mutations were detected in 27 of 29 pairs of STICs and concurrent HGSCs. Missense mutations were observed in 61% of STICs and frameshift/splicing junction/nonsense mutations in 39%. Interestingly, there were two HGSCs with two distinctly different TP53 mutations each, but only one of the mutations was detected in the concurrent STICs. Missense mutations were associated with intense and diffuse (≥ 60%) p53 nuclear immunoreactivity, while most of the null mutations were associated with complete loss of p53 staining (p STIC and pelvic HGSC and demonstrate the utility of p53 immunostaining as a surrogate for TP53 mutation in the histological diagnosis of STIC. In this regard, it is important to appreciate the significance of different staining patterns. Specifically, strong diffuse staining correlates with a missense mutation, whereas complete absence of staining correlates with null mutations. Copyright © 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Associação entre prevalência de laqueadura tubária e características sócio-demográficas de mulheres e seus companheiros no Estado de São Paulo, Brasil Association of prevalence of tubal ligation and sociodemographic characteristics of women and their partners in the State of São Paulo, Brazil

Directory of Open Access Journals (Sweden)

Anibal Faúndes

1998-01-01

Full Text Available O Brasil tem uma alta prevalência de laqueadura tubária. Alguns setores da sociedade acreditam que essa alta prevalência estaria indicando um controle da natalidade dissimulado, que visa diminuir a fecundidade nas camadas mais pobres da população. O objetivo deste trabalho é contribuir para a compreensão das possíveis diferenças sócio-econômicas quanto à prática da laqueadura. Para este fim, analisamos uma base de dados com 1.335 mulheres com idade de 15 a 49 anos, obtida entre mulheres de nível sócio-econômico médio-baixo ou baixo, em duas regiões do Estado de São Paulo, no ano de 1991. Os resultados mostraram uma aparentemente maior prevalência de laqueadura entre as mulheres com menor nível educacional e também entre as que moravam em habitação de boa qualidade. Entretanto, ao controlar por idade, essas associações desapareceram, sugerindo que se deviam apenas a menor escolaridade e maiores recursos das mulheres de maior idade, sendo este último o fator mais fortemente associado à prevalência de laqueadura. Discute-se a complexidade das relações entre nível sócio-econômico e ligadura tubária, incluindo a diferença sócio-econômica na prevalência de cesárea, intimamente ligada à esterilização feminina.Brazil has a high prevalence of tubal ligation. The hypothesis that it indicates undercover birth control efforts specifically addressed to the poorest sector of Brazilian society has been raised. The purpose of this paper is to evaluate whether there are differences in rates of tubal ligation depending on socioeconomic status. Data were gathered from interviews with 1335 women 15-49 years of age, of low or lower-middle socioeconomic status, carried out in 1991 in two regions of the State of São Paulo. The results showed an apparently higher prevalence of tubal ligation among women with less schooling,, but also among those living in better housing. However, after controlling for women's age, these

Dyscalculia and Access Arrangements for Exams and Assessments. NIACE Briefing Sheet 87

Science.gov (United States)

National Institute of Adult Continuing Education, 2009

2009-01-01

Dyscalculia is considered to be a learning difficulty or difference. It is increasingly being recognised and "diagnosed" within adult learning. However, practitioners are often unclear about whether learners who are considered to have dyscalculia are entitled to access arrangements for examinations and assessments, and which access…

Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility.

Science.gov (United States)

Cipolla, Valentina; Guerrieri, Daniele; Pietrangeli, Daniela; Santucci, Domiziana; Argirò, Renato; de Felice, Carlo

2016-09-01

Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up. © The Foundation Acta Radiologica 2015.

Multi-tool accessibility assessment of government department websites:a case-study with JKGAD.

Science.gov (United States)

Ismail, Abid; Kuppusamy, K S; Nengroo, Ab Shakoor

2017-08-02

Nature of being accessible to all categories of users is one of the primary factors for enabling the wider reach of the resources published through World Wide Web. The accessibility of websites has been analyzed through W3C guidelines with the help of various tools. This paper presents a multi-tool accessibility assessment of government department websites belonging to the Indian state of Jammu and Kashmir. A comparative analysis of six accessibility tools is also presented with 14 different parameters. The accessibility analysis tools used in this study for analysis are aChecker, Cynthia Says, Tenon, wave, Mauve, and Hera. These tools provide us the results of selected websites accessibility status on Web Content Accessibility Guidelines (WCAG) 1.0 and 2.0. It was found that there are variations in accessibility analysis results when using different accessibility metrics to measure the accessibility of websites. In addition to this, we have identified the guidelines which have frequently been violated. It was observed that there is a need for incorporating the accessibility component features among the selected websites. This paper presents a set of suggestions to improve the accessibility status of these sites so that the information and services provided by these sites shall reach a wider spectrum of audience without any barrier. Implications for rehabilitation The following points indicates that this case study of JKGAD websites comes under Rehabilitation focused on Visually Impaired users. Due to the universal nature of web, it should be accessible to all according to WCAG guidelines framed by World Wide Web Consortium. In this paper we have identified multiple accessibility barriers for persons with visual impairment while browsing the Jammu and Kashmir Government websites. Multi-tool analysis has been done to pin-point the potential barriers for persons with visually Impaired. Usability analysis has been performed to check whether these websites are suitable

Diagnostic value and timing of serum antichlamidial antibody level evaluation during infertility workup among infertile women in whom tubal factor was detected with diagnostic laparoscopy

Directory of Open Access Journals (Sweden)

Serkan Kahyaoğlu

2012-03-01

Full Text Available OBJECTIVES: With normal hysterosalpingography (HSG results, selecting suitable candidates for the laparoscopic treatment of probable pelvic adhesions following previous pelvic inflammatory disease, it would be wise to investigate serum antibody screening against chlamidia trachomatis. It is worth to evaluate whether it is useful to detect a negative antichlamidial antibody disease for cancelling laparoscopy for a while with abnormal HSG findings. These two subjects have been investigated in study. MATERIAL AND METHODS: For detecting diagnostic value of serum antichlamidial antibody, in our infertility clinic, postoperative blood samples of 80 patients who were hospitalized for diagnostic laparoscopy to investigate infertility ethiology between May 2004 and November 2005 have been tested with microelisa method for antichlamidial IgM and IgG antibodies. HSG films of the patients performed at least one year were evaluated. Venous blood was drawn from these patients during postoperative early period for studying serum IgM and IgG antibodies of chlamidia trachomatis and the results were compared with operative findings. RESULTS: According to the antichlamidial antibody levels 60 (75% patients have not been infected with chlamidia and 20 (25% patients have been infected previously. When the patients were divided to two groups; normal and abnormal; based on preoperative HSG films; 18 (30% of the 60 patients with abnormal HSG films and 2 (10% of the 20 patients with normal HSG films had positive antichlamidial antibody levels respectively. CONCLUSION: The relationship between chlamidia trachomatis infection and tubal infertility has been demonstrated among 85% of patients with positive antichlamidial antibody levels and 46.7% of patients with negative levels who had tubal passage defects detected during diagnostic laparoscopy.

DNA damage signaling and apoptosis in preinvasive tubal lesions of ovarian carcinoma.

Science.gov (United States)

Chene, Gautier; Ouellet, Veronique; Rahimi, Kurosh; Barres, Veronique; Caceres, Katia; Meunier, Liliane; Cyr, Louis; De Ladurantaye, Manon; Provencher, Diane; Mes Masson, Anne Marie

2015-06-01

High-grade serous ovarian cancer (HGSC) is the most life-threatening gynecological malignancy despite surgery and chemotherapy. A better understanding of the molecular basis of the preinvasive stages might be helpful in early detection and diagnosis. Genetic instability is 1 of the characteristics shared by most human cancers, and its level is variable through precancerous lesions to advanced cancer. Because DNA damage response (DDR) has been described as 1 of the first phases in genomic instability, we investigated the level of DDR activation and the apoptosis pathway in serous tubal intraepithelial carcinoma (STIC), the potential precursor of HGSC. A tissue microarray including 21 benign fallopian tubes, 21 STICs, 17 HGSCs from patients with STICs (associated ovarian cancer [AOC]) from the same individuals, and 30 HGSCs without STICs (non-AOC) was used in this study.Immunohistochemistry was performed to evaluate the level of DDR proteins (pATM, pChk2, γH2AX, 53BP1, and TRF2), apoptosis proteins (Bcl2, BAX, and BIM), and cyclin E. The expression of all DDR proteins increased from benign fallopian tubes to STICs. The level of expression of pATM, pChk2, γH2AX, and TRF2 was also increased in STICs in comparison with AOC. BAX, BIM, and cyclin E expressions were high in STICs, whereas Bcl2 expression was low. Immunohistochemical profiles of AOC and non-AOC were also different. These results suggest an activation of the DDR and apoptosis pathways in STICs, indicating that genomic instability may occur early in the precancerous lesions of HGSC.

Access and use of information resources in assessing health risks from chemical exposure: Proceedings

International Nuclear Information System (INIS)

1990-01-01

Health risk assessment is based on access to comprehensive information about potentially hazardous agents in question. Relevant information is scattered throughout the literature, and often is not readily accessible. To be useful in assessment efforts, emerging scientific findings, risk assess parameters, and associated data must be compiled and evaluated systemically. The US Environmental Protection Agency (EPA) and Oak Ridge National Laboratory (ORNL) are among the federal agencies heavily involved in this effort. This symposium was a direct response by EPA and ORNL to the expressed needs of individuals involved in assessing risks from chemical exposure. In an effort to examine the state of the risk assessment process, the availability of toxicological information, and the future development and transfer of this information, the symposium provided an excellent cadre of speakers and participants from state and federal agencies, academia and research laboratories to address these topics. This stimulating and productive gathering discussed concerns associated with (1) environmental contamination by chemicals; (2) laws regulating chemicals; (3) information needs and resources; (4) applications; (5) challenges and priorities; and (6)future issues. Individual reports are processed separately for the data bases

Access and use of information resources in assessing health risks from chemical exposure: Proceedings

Energy Technology Data Exchange (ETDEWEB)

1990-12-31

Health risk assessment is based on access to comprehensive information about potentially hazardous agents in question. Relevant information is scattered throughout the literature, and often is not readily accessible. To be useful in assessment efforts, emerging scientific findings, risk assess parameters, and associated data must be compiled and evaluated systemically. The US Environmental Protection Agency (EPA) and Oak Ridge National Laboratory (ORNL) are among the federal agencies heavily involved in this effort. This symposium was a direct response by EPA and ORNL to the expressed needs of individuals involved in assessing risks from chemical exposure. In an effort to examine the state of the risk assessment process, the availability of toxicological information, and the future development and transfer of this information, the symposium provided an excellent cadre of speakers and participants from state and federal agencies, academia and research laboratories to address these topics. This stimulating and productive gathering discussed concerns associated with (1) environmental contamination by chemicals; (2) laws regulating chemicals; (3) information needs and resources; (4) applications; (5) challenges and priorities; and (6)future issues. Individual reports are processed separately for the data bases.

Evaluating the impact of climate policies on regional food availability and accessibility using an Integrated Assessment Model

Science.gov (United States)

Gilmore, E.; Cui, Y. R.; Waldhoff, S.

2015-12-01

Beyond 2015, eradicating hunger will remain a critical part of the global development agenda through the Sustainable Development Goals (SDG). Efforts to limit climate change through both mitigation of greenhouse gas emissions and land use policies may interact with food availability and accessibility in complex and unanticipated ways. Here, we develop projections of regional food accessibility to 2050 under the alternative futures outlined by the Shared Socioeconomic Pathways (SSPs) and under different climate policy targets and structures. We use the Global Change Assessment Model (GCAM), an integrated assessment model (IAM), for our projections. We calculate food access as the weighted average of consumption of five staples and the portion of income spend on those commodities and extend the GCAM calculated universal global producer price to regional consumer prices drawing on historical relationships of these prices. Along the SSPs, food access depends largely on expectations of increases in population and economic status. Under a more optimistic scenario, the pressures on food access from increasing demand and rising prices can be counterbalanced by faster economic development. Stringent climate policies that increase commodity prices, however, may hinder vulnerable regions, namely Sub-Saharan Africa, from achieving greater food accessibility.

História reprodutiva de mulheres laqueadas Historia de la reproducción de mujeres con ligadura de trompas Reproductive history of women with tubal ligation

Directory of Open Access Journals (Sweden)

Ana Izabel Oliveira Nicolau

2010-10-01

-demographic variables and sex. METHODS: This is a quantitative and retrospective documentary study, developed in a Natural Birth Center in July 2008 in the city of Fortaleza-CE. The sample was composed by 277 medical records of patients who had tubal ligation. RESULTS: There were a high number of pregnancies associated with: low education, early onset of sexual life, lack of prior use of reversible contraceptive methods, and high frequency of cesarean delivery and abortions. CONCLUSIONS: The profile found reaffirms the need of: strengthen the guidance and exchange of information on family planning among health professionals and their patients; encouraging male participation; and, guarantee access to the various contraceptive methods.

Frequency of "incidental" serous tubal intraepithelial carcinoma (STIC) in women without a history of or genetic risk factor for high-grade serous carcinoma: A six-year study.

Science.gov (United States)

Meserve, Emily E K; Mirkovic, Jelena; Conner, James R; Yang, Eric; Muto, Michael G; Horowitz, Neil; Strickland, Kyle C; Howitt, Brooke E; Crum, Christopher P

2017-07-01

Objective The purpose of this study was to determine the prevalence of incidentally discovered serous tubal intraepithelial carcinoma in women without a genetic risk for or history of high grade serous carcinoma (HGSC) in the gynecologic tract. All pathology reports at our institution that included bilateral salpingectomies from January 2006-December 2011 were examined in women >50years old in which the entire tube or the distal one-third was examined histologically with the complete (proximal and distal fallopian tube) or modified (distal one third of the tube) SEE-FIM protocol. Cases were divided into: Group 1, a history of or known risk factors (BRCA1 or BRCA2 mutations) for HGSC and Group 2, those without these attributes for whom a STIC would be unexpected (incidental). Women undergoing unspecified "risk-reducing" procedures were included in Group 1. Of 4051 identified total, 2268 had complete examination of the distal fallopian tube and were age 50 or above. Of these, 1747 were in group 2. Two STICs were identified (0.1%), one associated with a grade 2 endometrial endometrioid adenocarcinoma and one with a low-grade ovarian serous carcinoma in the setting of a serous borderline tumor. Incidental STICs in women over age 50 are uncommon. However, the significance of lesser tubal atypias (0.3% in this study), risk of STIC in women with no epithelial pathology and the risk imposed by coexisting endometrioid neoplasia are unclear and require further study. Copyright © 2017 Elsevier Inc. All rights reserved.

Ambivalência em mulheres submetidas a laqueadura tubária Ambivalencia en mujeres sometidas a ligación de trompas Ambivalence in women submitted to tubal ligation

Directory of Open Access Journals (Sweden)

Gleice Adriana Araújo Gonçalves

2008-12-01

significativo de mujeres que tanto había motivo de satisfacción como de arrependimiento en relación a la ligadura de trompas (mujeres ambivalentes. Los resultados permitieron el entendimiento de que la ambivalencia con respecto a la ligadura de trompas es un fenómeno que, sujeto a múltiples determinaciones, implica una gran parte de la subjetividad de la mujer, lo que hace compleja su interpretación.Exploratory research, which used the database of a research involving women undergoing tubal ligation, to determine, more accurately, the frequency of ambivalent women and analyze the statistical distribution of these women according to the selected research and how they had originally classified themselves in regard to the procedure (totally or moderately satisfied, ambivalent, totally or moderately regretful. The assumption of the study was that, making up a more accurate assessment of the answers to several of the issues that were asked to them, the number of ambivalent women could be higher than previously disclosed. This assumption was confirmed, being noted a significant increase of women who both had reasons for satisfaction as to regret in relation to tubal ligation (ambivalent women. The results allowed the understanding that the ambivalence regarding tubal ligation is a phenomenon that, subject to multiple determinations, involves a very large portion of the subjectivity of women, making its interpretation a very complex one.

Accessibility assessment of MOOC platforms in Spanish: UNED COMA, COLMENIA and Miriada X

OpenAIRE

Iniesto, Francisco; Rodrigo, Covadonga

2014-01-01

This article develops a methodology for the assessment of MOOC courses, focusing on the degree of accessibility of three Spanish MOOC platforms: UNED COMA, COLMENIA and Miriada X. Four different criteria have been\\ud used in this context: automatic tools, disability simulators, testing tools and educational content

The treatment of tubal pregnancy by MTX drug perfusion and vascular embolization

International Nuclear Information System (INIS)

Dan Jian; Ke Yaojun; Tan Wei; Jiang Ling

2001-01-01

Objective: To study the feasibility of the treatment of tubule pregnancy by interventional technique. Methods: By using Seldinger's method, 40 cases of tubule pregnancy received super selective angiography of uterine artery, followed by perfusion of methotrexate (MTX) through the catheter and embolization of uterine artery with gelatin sponge. The concentration of serum β-HCG, the change of pelvic cavity, and the open condition of oviduct were regularly monitored postoperatively. Results: Angiographic findings of tubule pregnancy were classified into 3 types. type I, no abnormal vascular appearance were found in 3 cases (7.5%). Type II, patchy vascular staining of villi in parauterine area was observed in 4 cases (10.0%). Type III, a round vacuolar staining of villi surrounded by small blood vessels in parauterine area occurred in 33 cases (82.5%). The cure rate in total 40 cases achieved 97.5% (39/40). After treatment, the mean time that the serum β-HCG concentration returned to normal was (7.66 +- 2.01) d and the mean time that the menstruation returned to normal was (29.78 +- 7.14) d. In 21 cases who hoped their fertility remaining intact, the oviduct were verified open by hysterosalpingography (HSG) in 20 cases, the open rate was 95.24%. Conclusion: The treatment of tubule pregnancy by interventional technique was proved no harmful effect to reproductive organs and would expect to preserve fertility. This method could resolve the difficult problem of celiac hemorrhage which making conservative treatment impossible and internal hemorrhage happened in the course of traditional conservative therapy leading to treatment failure finally. This method might be a new conception and a choice to treat tubal pregnancy through artery

Incidental serous tubal intraepithelial carcinoma and early invasive serous carcinoma in the nonprophylactic setting: analysis of a case series.

Science.gov (United States)

Morrison, Jane C; Blanco, Luis Z; Vang, Russell; Ronnett, Brigitte M

2015-04-01

A precursor for invasive ovarian/pelvic high-grade serous carcinoma, termed serous tubal intraepithelial carcinoma (STIC), has been identified and characterized through careful analysis of the fallopian tubes in both prophylactic salpingo-oophorectomy specimens obtained from women with either a family history of breast and/or ovarian cancer or germline mutations of BRCA1 and BRCA2 and in cases of pelvic high-grade serous carcinoma. Data on incidental STICs and clinically occult microscopic invasive high-grade serous carcinomas are limited. We analyzed the clinicopathologic features of 22 cases, including 15 pure STICs and 7 STICs associated with microscopic invasive high-grade serous carcinomas, identified incidentally in fallopian tubes removed for nonprophylactic indications. Patient age ranged from 39 to 79 years (mean: 62.7; median: 61), with only 1 patient under the age of 50. No patients were known to carry BRCA1 or BRCA2 mutations. Of the 12 pure STICs for which the location in the fallopian tube could be established, 9 were in the fimbriated portion, 1 was at the junction of the fimbria and infundibulum, and 2 were in the nonfimbriated tube. Of the 7 STICs with associated invasive high-grade serous carcinoma, 3 were located in the fimbriated portion, 2 were at the junction of the fimbria and infundibulum, and 2 were in the nonfimbriated tube. The invasive components were in the fallopian tube in 6 cases, 4 in subepithelial stroma of tubal mucosa, and 2 as an intramucosal (exophytic) luminal lesion without invasion of underlying subepithelial stroma (size range: 1 to 4 mm). The remaining case had a microscopic focus of high-grade serous carcinoma within the ipsilateral ovary (1.3 mm cortical focus) identified only on deeper sections, without an associated invasive component in the fallopian tube. The preferential finding of atypical epithelium with the cytologic features of high-grade serous carcinoma, namely STIC, in the fallopian tubes rather than the

The World Stress Map - A Freely Accessible Tool For Geohazard Assessment

International Nuclear Information System (INIS)

Mueller, Birgit; Heidbach, Oliver; Tingay, Mark

2006-01-01

The World Stress Map (WSM) database contains over 16,000 indicators on contemporary crustal tectonic stress and provides an essential parameter for geohazard assessment. This paper focuses on the importance of database accessibility for geohazard assessment and presents the basic concepts and availability of the WSM. The WSM can be applied to several key aspects of geohazard assessment, in particular the mapping of stress patterns and places of stress concentration for improved delineation of zones of seismic hazard. Furthermore, contemporary tectonic stresses can be used in combination with numerical modeling to identify faults or sections of fault systems with high failure potential and can help to predict the likely type of fault reactivation. This approach is especially valuable for assessing the likelihood of strong and rare seismic events for which probabilistic hazard assessment will fail and physically based methodologies are required. Herein, we use the Caspian-Caucasian region as an example to apply WSM data for geohazard assessment. The Caspian-Caucasian area is characterized by the occurrence of a number of stress related geohazards on different spatial scales, in particular crustal earthquakes, seismically triggered landslides and mud volcanism

The diagnostic and biological implications of laminin expression in serous tubal intraepithelial carcinoma.

Science.gov (United States)

Kuhn, Elisabetta; Kurman, Robert J; Soslow, Robert A; Han, Guangming; Sehdev, Ann Smith; Morin, Patrick J; Wang, Tian-Li; Shih, Ie-Ming

2012-12-01

There is compelling evidence to suggest that serous tubal intraepithelial carcinoma (STIC) is the likely primary site for the development of many pelvic high-grade serous carcinomas (HGSCs). Identifying molecules that are upregulated in STIC is important not only to provide biomarkers to assist in the diagnosis of STIC but also to elucidate our understanding of the pathogenesis of HGSC. In this study, we performed RNA sequencing to compare transcriptomes between HGSC and normal fallopian tube epithelium (FTE), and we identified LAMC1 encoding laminin γ1 as one of the preferentially upregulated genes associated with HGSC. Reverse transcription polymerase chain reaction further validated LAMC1 upregulation in HGSC as compared with normal FTE. Immunohistochemical analysis was performed on 32 cases of concurrent HGSC and STIC. The latter was diagnosed on the basis of morphology, TP53 mutations, and p53 and Ki-67 immunohistochemical patterns. Laminin γ1 immunostaining intensity was found to be significantly higher in STIC and HGSC compared with adjacent FTE in all cases (PSTIC and HGSC cells, laminin γ1 staining was diffuse and intense throughout the cytoplasm. More importantly, strong laminin γ1 staining was detected in all 13 STICs, which lacked p53 immunoreactivity because of null mutations. These findings suggest that the overexpression of laminin γ1 immunoreactivity and alteration of its staining pattern in STICs can serve as a useful tissue biomarker, especially for those STICs that are negative for p53 and have a low Ki-67 labeling index.

Impact Assessment of the Brazilian Access to Information Act - An interdisciplinary methodological approach

Directory of Open Access Journals (Sweden)

Taiana Fortunato Araújo

2016-08-01

Full Text Available This article aims to discuss the potential efficacy and effectiveness of the Access to Information Law (LAI in Brazil, considering it not as an isolated legislation, but as part of public policy for transparency and accountability. For this, we use an interdisciplinary approach that combines elements of the discussion on the role of law in public policy and an analysis of the various possible meanings of the legal concept of efficacy (taken as element that combines the legal world with the real world. We have reviewed international assessment studies on access to information laws in other countries; with regards to Brazil, we analyze a few monitoring and assessment studies about LAI implementation made by the Controladoria-Geral da União (CGU/Comptroller General of the Union, and the (still rare academic literature on the subject. We conclude that the legal efficacy of LAI depends, in first instance, on the full adhesion of the State, which has to enact specific regulations without which the LAI does not function well. In a second instance, legal efficacy has a necessary, but not sufficient condition, a change of conduct by public managers, responsible for LAI`s implementation. This piece of legislation would have complete efficacy if it reached its primary goal of providing access to public information by increasing governmental transparency. Effectiveness, on the other hand, refers to the multiple uses of the information provided by citizens, both for individual objectives as well as governmental accountability.

Housing Accessibility Methodology Targeting Older People

DEFF Research Database (Denmark)

Helle, Tina

accessibility problems before the planning of housing intervention strategies. It is also critical that housing standards addressing accessibility intended to accommodate people with functional limitations are valid in the sense that their definitions truly support accessibility. However, there is a paucity...... of valid and reliable assessment instruments targeting housing accessibility, and in-depth analysis of factors potentially impacting on reliability in complex assessment situations is remarkably absent. Moreover, the knowledge base informing the housing standards appears to be vague. We may therefore...... reasonably question the validity of the housing standards addressing accessibility. This thesis addresses housing accessibility methodology in general and the reliability of assessment and the validity of standards targeting older people with functional limitations and a dependence on mobility devices...

Sri Lanka's national assessment on innovation and intellectual property for access to medical products.

Science.gov (United States)

Beneragama, Hemantha; Shridhar, Manisha; Ranasinghe, Thushara; Dissanayake, Vajira Hw

2016-09-01

In 2008, the Global strategy and plan of action on public health, innovation and intellectual property (GSPA-PHI) was launched by the World Health Organization, to stimulate fresh thinking on innovation in, and access to, medicines and to build sustainable research on diseases disproportionately affecting low- and middle-income countries. As part of the activities of the GSPA-PHI, Sri Lanka has been the first country to date to assess the national environment for medical technology and innovation. This year-long, multistakeholder, participative analysis facilitated identification of clear and implementable policy recommendations, for the government to increase its effectiveness in promoting innovation in health products through institutional development, investment and coordination among all areas relevant to public health. The assessment also highlighted areas for priority action, including closing the technology gap in development of health products, facilitating technology transfer, and building the health-research and allied workforces. The Sri Lankan experience will inform the ongoing independent external evaluation of the GSPA-PHI worldwide. The assessment process coincided with the passing of the National Medicines Regulatory Authority Act in 2015. In addition, there is growing recognition that regional cooperation will be critical to improving access to medical products in the future. Sri Lanka is therefore actively promoting cooperation to establish a regional regulatory affairs network. Lessons learnt from the Sri Lankan assessment may also benefit other countries embarking on a national GSPA-PHI assessment.

Assessing Pedestrian Accessibility to Green Space Using Gis

Directory of Open Access Journals (Sweden)

Tudor MORAR

2014-06-01

Full Text Available This paper aims at comparing the parameter of green space per capita currently requested by the Romanian legislation to accessible green space per capita. The comparison is undertaken through a Geographic Information System methodology that uses publicly available data to evaluate actual population numbers with pedestrian access to parks and green squares. Using the city of Timișoara as a case study, population is divided into three main groups according to neigh borhood type in order to investigate the urban planning implications of residential typologies in relation to green space. Two scenarios are compared, namely the existing situation which describes access to municipally-administered parks and squares and the possible situation where both existing and informal green spaces are considered. The main findings show that, at present, only a quarter of the city’s population benefits from proper access, yet by developing all residual green areas this proportion could be raised to over 40%. However, the current parameter of square meters per person requested by the Romanian legislation proves to be insufficient in indicating green space accessibility because of the uneven distribution of population and green areas across the city.

Early Patient Access to Medicines: Health Technology Assessment Bodies Need to Catch Up with New Marketing Authorization Methods.

Science.gov (United States)

Leyens, Lada; Brand, Angela

National and international medicines agencies have developed innovative methods to expedite promising new medicines to the market and facilitate early patient access. Some of these approval pathways are the conditional approval and the adaptive pathways by the European Medicines Agency (EMA); the Promising Innovative Medicine (PIM) designation and the Early Access to Medicines Scheme (EAMS) by the Medicines and Healthcare Products Regulatory Agency (MHRA), as well as the Fast Track, Breakthrough or Accelerated Approval methods by the Food and Drug Administration (FDA). However, at least in Europe, these methods cannot achieve the goal of improving timely access for patients to new medicines on their own; the reimbursement process also has to become adaptive and flexible. In the past 2 years, the effective access (national patient access) to newly approved oncology drugs ranged from 1 to 30 months, with an extremely high variability between European countries. The goal of early patient access in Europe can only be achieved if the national health technology assessment bodies, such as NICE (ENG), HAS (FR), G-BA (DE) or AIFA (IT), provide harmonized, transparent, flexible, conditional and adaptive methods that adopt the level of evidence accepted by the medicines agencies. The efforts from medicines agencies are welcome but will be in vain if health technology assessments do not follow with similar initiatives, and the European 'postcode' lottery will continue. © 2016 S. Karger AG, Basel.

Serous tubal intraepithelial carcinomas associated with high-grade serous ovarian carcinomas: a systematic review.

Science.gov (United States)

Chen, F; Gaitskell, K; Garcia, M J; Albukhari, A; Tsaltas, J; Ahmed, A A

2017-05-01

Serous tubal intraepithelial carcinomas (STICs) have been documented in high-grade serous ovarian carcinomas (HGSOCs). However, the rate of association between STICs and HGSOCs and, therefore, the fraction of HGSOCs that are likely to have originated from the fallopian tube (FT), has remained unclear. To appraise the literature describing the association between STICs and established HGSOCs. Ovid MEDLINE and EMBASE were searched. Studies were included if they evaluated the frequency of STICs in HGSOCs, and were published in an English peer-reviewed journal. Appropriate studies were evaluated for their compliance with the 'Strengthening and Reporting of Observational Studies in Epidemiology (STROBE)' criteria. Ten articles met the study selection criteria. The reported coexistence between STICs and HGSOCs ranged from 11% to 61% (mean: 31%, 95% CI: 17-46%). STICs were rarely found in other gynaecological cancers. Small sample size, lack of objective criteria to identify STICs and the retrospective nature of the studies contributed to the variability in reporting the rate of the association. STICs were identified commonly in the FTs of women with HGSOC. Finding the true rate of association between STICs and HGSOCs will require further investigations. While there is evidence that a fraction of HGSOCs arise from the FTs, an accurate estimate of that fraction remains to be determined. The lack of an accurate estimate of the association makes it difficult to evaluate the potential magnitude of reduction of HGSOCs following prophylactic salpingectomy. A systematic review of the incidence of STICs in HGSOCs identifies significant methodological inconsistencies. © 2017 Royal College of Obstetricians and Gynaecologists.

How accessible are coral reefs to people? A global assessment based on travel time.

Science.gov (United States)

Maire, Eva; Cinner, Joshua; Velez, Laure; Huchery, Cindy; Mora, Camilo; Dagata, Stephanie; Vigliola, Laurent; Wantiez, Laurent; Kulbicki, Michel; Mouillot, David

2016-04-01

The depletion of natural resources has become a major issue in many parts of the world, with the most accessible resources being most at risk. In the terrestrial realm, resource depletion has classically been related to accessibility through road networks. In contrast, in the marine realm, the impact on living resources is often framed into the Malthusian theory of human density around ecosystems. Here, we develop a new framework to estimate the accessibility of global coral reefs using potential travel time from the nearest human settlement or market. We show that 58% of coral reefs are located travel time from the market is a strong predictor of fish biomass on coral reefs. We also highlight a relative deficit of protection on coral reef areas near people, with disproportional protection on reefs far from people. This suggests that conservation efforts are targeting low-conflict reefs or places that may already be receiving de facto protection due to their isolation. Our global assessment of accessibility in the marine realm is a critical step to better understand the interplay between humans and resources. © 2016 John Wiley & Sons Ltd/CNRS.

Enabling Equal Access to Molecular Diagnostics: What Are the Implications for Policy and Health Technology Assessment?

Science.gov (United States)

Plun-Favreau, Juliette; Immonen-Charalambous, Kaisa; Steuten, Lotte; Strootker, Anja; Rouzier, Roman; Horgan, Denis; Lawler, Mark

2016-01-01

Molecular diagnostics can offer important benefits to patients and are a key enabler of the integration of personalised medicine into health care systems. However, despite their promise, few molecular diagnostics are embedded into clinical practice (especially in Europe) and access to these technologies remains unequal across countries and sometimes even within individual countries. If research translation and the regulatory environments have proven to be more challenging than expected, reimbursement and value assessment remain the main barriers to providing patients with equal access to molecular diagnostics. Unclear or non-existent reimbursement pathways, together with the lack of clear evidence requirements, have led to significant delays in the assessment of molecular diagnostics technologies in certain countries. Additionally, the lack of dedicated diagnostics budgets and the siloed nature of resource allocation within certain health care systems have significantly delayed diagnostics commissioning. This article will consider the perspectives of different stakeholders (patients, health care payers, health care professionals, and manufacturers) on the provision of a research-enabled, patient-focused molecular diagnostics platform that supports optimal patient care. Through the discussion of specific case studies, and building on the experience from countries that have successfully integrated molecular diagnostics into clinical practice, this article will discuss the necessary evolutions in policy and health technology assessment to ensure that patients can have equal access to appropriate molecular diagnostics. © 2016 S. Karger AG, Basel.

Does interval laparoscopic sterilisation influence the risk of lower ...

African Journals Online (AJOL)

Background. Tubal sterilisation is a safe, accessible and effective contraceptive method. There is a paucity of data regarding the risk of genital tract infections and menstrual abnormalities post sterilisation in Durban, South Africa. Objectives. To evaluate the risk of lower genital tract infections (LGTIs) and menstrual ...

Molecular analysis of high-grade serous ovarian carcinoma with and without associated serous tubal intra-epithelial carcinoma.

Science.gov (United States)

Ducie, Jennifer; Dao, Fanny; Considine, Michael; Olvera, Narciso; Shaw, Patricia A; Kurman, Robert J; Shih, Ie-Ming; Soslow, Robert A; Cope, Leslie; Levine, Douglas A

2017-10-17

Many high-grade serous carcinomas (HGSCs) of the pelvis are thought to originate in the distal portion of the fallopian tube. Serous tubal intra-epithelial carcinoma (STIC) lesions are the putative precursor to HGSC and identifiable in ~ 50% of advanced stage cases. To better understand the molecular etiology of HGSCs, we report a multi-center integrated genomic analysis of advanced stage tumors with and without STIC lesions and normal tissues. The most significant focal DNA SCNAs were shared between cases with and without STIC lesions. The RNA sequence and the miRNA data did not identify any clear separation between cases with and without STIC lesions. HGSCs had molecular profiles more similar to normal fallopian tube epithelium than ovarian surface epithelium or peritoneum. The data suggest that the molecular features of HGSCs with and without associated STIC lesions are mostly shared, indicating a common biologic origin, likely to be the distal fallopian tube among all cases.High-grade serous carcinomas (HGSCs) are associated with precursor lesions (STICs) in the fallopian epithelium in only half of the cases. Here the authors report the molecular analysis of HGSCs with and without associated STICs and show similar profiles supporting a common origin for all HGSCs.

Assessment of current practices in creating and using passwords as a control mechanism for information access

Directory of Open Access Journals (Sweden)

P. L. Wessels

2007-11-01

Full Text Available One of the critical issues in managing information within an organization is to ensure that proper controls exist and are applied in allowing people access to information. Passwords are used extensively as the main control mechanism to identify users wanting access to systems, applications, data files, network servers or personal information. In this article, the issues involved in selecting and using passwords are discussed and the current practices employed by users in creating and storing passwords to gain access to sensitive information are assessed. The results of this survey conclude that information managers cannot rely only on users to employ proper password control in order to protect sensitive information.

Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

Science.gov (United States)

Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

2012-03-01

The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

The pattern of hysterosalpingographic findings in women being investigated for infertility in Nnewi, Nigeria.

Science.gov (United States)

Okafor, C O; Okafor, C I; Okpala, O C; Umeh, E

2010-09-01

Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a period of five years (2001-2005). The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p < 0.05. Of the 320 studied, 230 were found suitable for analysis. Their ages ranged from 20 to 44 years (mean 32.8 +/- 5.8 years). The indications were primary infertility in 103 (44.8%), secondary infertility in 88(38.3%), while in 39 (16.9%) patients the type of infertility was not specified. The reports revealed that 67 (29.1%) had normal HSG Cervical abnormalities were found in 34 (14.8%), uterine cavity abnormalities in 108 (47.0%). Tubal pathologies were seen in 100 (43.5%) with bilateral tubal occlusion in 43 (18.7%) and bilateral hydrosalpinges in 6 (2.6%) patients. Tubal pathology remains a major contributor to female infertility in this part of the world.

Número ideal de filhos como fator de risco para laqueadura tubária Ideal number of children as a risk factor for tubal ligation

Directory of Open Access Journals (Sweden)

Luiz Eduardo Campos de Carvalho

2004-12-01

Full Text Available O objetivo deste artigo é avaliar a associação entre o número ideal de filhos (NIF e a realização da laqueadura. Foi feito um estudo de caso-controle aninhado, com base em uma análise secundária de dados obtidos em um estudo de coorte sobre a saúde reprodutiva de mulheres em Campinas, São Paulo, Brasil, que teve como sujeitos 3.878 mulheres, das quais 1.012 eram laqueadas (casos. A relação entre NIF e o número de nascidos vivos (NV foi dividida em duas categorias (NIF > NV e NIF ¾ NV. Foram calculados os riscos relativos estimados (odds ratio para a realização de laqueadura e seus respectivos intervalos de confiança (IC 95% para a relação NIF/NV, estratificando-se para outras dez variáveis. Todas as variáveis preditoras foram incluídas em um modelo de regressão logística para identificar os fatores independentemente associados à esterilização definitiva. Observou-se que o risco de laqueadura foi maior entre as mulheres com NIF The purpose of this paper was to evaluate the association between ideal number of children (INC and female sterilization. A nested case-control study was performed through a secondary analysis of data from a cohort study on the reproductive health of women in Campinas, São Paulo, Brazil. A total of 3,878 women were included, 1,012 being sterilized (cases. The relationship between INC and number of live births (LB was divided in two categories (INC > LB and INC ¾ LB. The relative risks of performing tubal ligation were calculated (odds ratio with their respective 95% confidence intervals for the relation INC/LB and all control variables. All predictor variables were included in a logistic regression model in order to identify the factors independently associated with female sterilization. The results showed that the risks of tubal ligation were higher among women with INC < LB, higher age, with partners, higher family income, more than two previous pregnancies, more deliveries, fewer abortions

Assessing the National Bioengineered Food Disclosure Standard of 2016: Can Americans Access Electronic Disclosure Information?

Directory of Open Access Journals (Sweden)

Craig F. Berning

2017-05-01

Full Text Available The debate as to whether to require mandatory labeling of genetically modified organism (GMO foods was partially settled on 29 July 2016, when President Obama signed the National Bioengineered Food Disclosure Standard into public law. In contrast to precipitating legislation passed by the State of Vermont that required disclosure of GMO ingredients on food shelves or food packages, the superseding National Standard allows firms to disclose bioengineered ingredients to consumers via symbols, electronic or digital links, or phone numbers, and further requires a study assessing the ability of consumers to access disclosure information by these means. This communication analyzes survey responses from 525 adults to investigate whether U.S. consumers are able to obtain information as per the disclosure methods allowed in the Federal legislation. The survey probes deeper to investigate consumer perceptions of genetically modified organisms and whether consumers would use the tools available to access disclosure about bioengineered ingredients. Findings from the survey show that 93.8% of respondents have the ability to access information via the disclosure methods permitted. Those in the lowest income group, and from the oldest age group are least likely to have such access. This provides the United State Department of Agriculture with information relevant to how they can implement the law and highlights particular demographic segments that may require additional attention to ensure the disclosed information is universally accessible.

The Effect of Education to Reduce Depression Rate in Women With a History of Tubal Ligation Surgery

Directory of Open Access Journals (Sweden)

Maryam Etefagh

2014-06-01

Full Text Available Introduction: Mental disorders such as depression are the most common complications after tubal ligation surgery. The aim of this study was to determine the effect of training to reduce depression rate in woman who had undergone tubectomy. Materials and Methods: This quasi-experimental study was performed on 80 women (40 in each of the control and intervention groups who had undergone tubectomy in Kaboudar-Ahang Health Centers. The participants completed a self-administered questionnaire containing demographic characteristics and General Health Questionnaire (GHQ-28.The educational plan set was performed during four educational sessions face-to-face and in-group for the individuals. The data was gathered before and two months after the training in the two groups. Data was analyzed by Pearson correlation test, independent T-test and ANCOVA using SPSS-18 software. Results: Educational Program had an impact to reduce depression rate in women in the intervention group, which was statically meaningful (p< 0.05. The mean score of depression was 29.85 before the training and 15.23 after it. Depression was associated with literacy and job status. More educated women had a lower rate of depression and depression in unemployed women was also higher. Conclusion: Result of the present study demonstrated the importance of education to improve mental health in women with a history of tubectomy.

Assessment of Business Information Access Problems in Uganda

Directory of Open Access Journals (Sweden)

Constant Okello-Obura

2007-09-01

Full Text Available Effective utilization of quality business information is crucial in attaining long-term and sustainable economic growth of the Small and Medium Enterprises (SMEs. It is established that SMEs in northern Uganda operate in a business environment that is characterized by fragmented and incomplete information. It is a situation where an awareness of markets, technology, policies, regulations and finance is limited because businesses fail to receive timely business information. This article reports a portion of the results of a larger study using a descriptive design with survey research and other techniques. The study examined the problems SMEs in northern Uganda face in accessing business information; identified problems information providers face in providing business information to the SMEs in the region and attempted to establish whether SMEs in northern Uganda use public libraries in accessing business information as should be expected. The study’s respondents included the SMEs, information providers and business policy makers with the response rate of 87.3%; 72% and 85% respectively. The article proposes strategic interventions for business information to be accessed by the SMEs. It concludes that there is a need for Uganda and, in particular, northern Uganda to develop a strategy for business information access by the SMEs

Statistical Approaches Used to Assess the Equity of Access to Food Outlets: A Systematic Review.

Science.gov (United States)

Lamb, Karen E; Thornton, Lukar E; Cerin, Ester; Ball, Kylie

2015-01-01

Inequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses. Searches were conducted for articles published from 2000-2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status. Fifty-four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the number of food outlets within a neighbourhood (or buffer). To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation. With advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.

Statistical Approaches Used to Assess the Equity of Access to Food Outlets: A Systematic Review

Directory of Open Access Journals (Sweden)

Karen E. Lamb

2015-07-01

Full Text Available BackgroundInequalities in eating behaviours are often linked to the types of food retailers accessible in neighbourhood environments. Numerous studies have aimed to identify if access to healthy and unhealthy food retailers is socioeconomically patterned across neighbourhoods, and thus a potential risk factor for dietary inequalities. Existing reviews have examined differences between methodologies, particularly focussing on neighbourhood and food outlet access measure definitions. However, no review has informatively discussed the suitability of the statistical methodologies employed; a key issue determining the validity of study findings. Our aim was to examine the suitability of statistical approaches adopted in these analyses.MethodsSearches were conducted for articles published from 2000-2014. Eligible studies included objective measures of the neighbourhood food environment and neighbourhood-level socio-economic status, with a statistical analysis of the association between food outlet access and socio-economic status.ResultsFifty-four papers were included. Outlet accessibility was typically defined as the distance to the nearest outlet from the neighbourhood centroid, or as the number of food outlets within a neighbourhood (or buffer. To assess if these measures were linked to neighbourhood disadvantage, common statistical methods included ANOVA, correlation, and Poisson or negative binomial regression. Although all studies involved spatial data, few considered spatial analysis techniques or spatial autocorrelation.ConclusionsWith advances in GIS software, sophisticated measures of neighbourhood outlet accessibility can be considered. However, approaches to statistical analysis often appear less sophisticated. Care should be taken to consider assumptions underlying the analysis and the possibility of spatially correlated residuals which could affect the results.

From the Margins to the Spotlight: Diverse Deaf and Hard of Hearing Student Populations and Standardized Assessment Accessibility

Science.gov (United States)

Cawthon, Stephanie

2015-01-01

Designing assessments and tests is one of the more challenging aspects of creating an accessible learning environment for students who are deaf or hard of hearing (DHH), particularly for deaf students with a disability (DWD). Standardized assessments are a key mechanism by which the educational system in the United States measures student…

Validation of an instrument to assess evidence-based practice knowledge, attitudes, access, and confidence in the dental environment.

Science.gov (United States)

Hendricson, William D; Rugh, John D; Hatch, John P; Stark, Debra L; Deahl, Thomas; Wallmann, Elizabeth R

2011-02-01

This article reports the validation of an assessment instrument designed to measure the outcomes of training in evidence-based practice (EBP) in the context of dentistry. Four EBP dimensions are measured by this instrument: 1) understanding of EBP concepts, 2) attitudes about EBP, 3) evidence-accessing methods, and 4) confidence in critical appraisal. The instrument-the Knowledge, Attitudes, Access, and Confidence Evaluation (KACE)-has four scales, with a total of thirty-five items: EBP knowledge (ten items), EBP attitudes (ten), accessing evidence (nine), and confidence (six). Four elements of validity were assessed: consistency of items within the KACE scales (extent to which items within a scale measure the same dimension), discrimination (capacity to detect differences between individuals with different training or experience), responsiveness (capacity to detect the effects of education on trainees), and test-retest reliability. Internal consistency of scales was assessed by analyzing responses of second-year dental students, dental residents, and dental faculty members using Cronbach coefficient alpha, a statistical measure of reliability. Discriminative validity was assessed by comparing KACE scores for the three groups. Responsiveness was assessed by comparing pre- and post-training responses for dental students and residents. To measure test-retest reliability, the full KACE was completed twice by a class of freshman dental students seventeen days apart, and the knowledge scale was completed twice by sixteen faculty members fourteen days apart. Item-to-scale consistency ranged from 0.21 to 0.78 for knowledge, 0.57 to 0.83 for attitude, 0.70 to 0.84 for accessing evidence, and 0.87 to 0.94 for confidence. For discrimination, ANOVA and post hoc testing by the Tukey-Kramer method revealed significant score differences among students, residents, and faculty members consistent with education and experience levels. For responsiveness to training, dental students

Assessing Pedestrian Accessibility to Green Space Using Gis

OpenAIRE

Tudor MORAR; Radu RADOSLAV; Luiza Cecilia SPIRIDON; Lidia PĂCURAR

2014-01-01

This paper aims at comparing the parameter of green space per capita currently requested by the Romanian legislation to accessible green space per capita. The comparison is undertaken through a Geographic Information System methodology that uses publicly available data to evaluate actual population numbers with pedestrian access to parks and green squares. Using the city of Timișoara as a case study, population is divided into three main groups according to neigh borhood type in order to inve...

An approach to assessing multicity implementation of healthful food access policy, systems, and environmental changes.

Science.gov (United States)

Silberfarb, Laura Oliven; Savre, Sonja; Geber, Gayle

2014-04-24

Local governments play an increasingly important role in improving residents' access to healthful food and beverages to reduce obesity and chronic disease. Cities can use multiple strategies to improve community health through, for example, land use and zoning policies, city contracting and procurement practices, sponsorship of farmers markets and community gardens, and vending and concession practices in parks and recreation facilities. With 41 cities in the Hennepin County Human Services and Public Health Department jurisdiction, the county undertook to measure the extent to which cities were engaged in making policy, systems, and environmental (PSE) changes to increase residents' access to healthful food. The results revealed that some cities, particularly those with higher resident demand for healthful food, are making nationally recommended PSE changes, such as sponsoring farmers markets and community gardens. Cities have moved more slowly to make changes in areas with perceived negative cost consequences or lesser public demand, such as parks and recreation vending and concessions. This article describes the assessment process, survey tools, findings, and implications for other health departments seeking to undertake a similar assessment.

Genetic variability assessment of accessions of Corchorus olitorius L ...

African Journals Online (AJOL)

SAM

2014-05-14

May 14, 2014 ... genetic variabilities among 14 accessions of the species using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Seven polypeptide bands were obtained ranging from. 9.73 to 88.79 KDa thus depicting variations in the banding patterns of the accessions. The unweighted.

IMPACT OF HEALTH TECHNOLOGY ASSESSMENT IN LITIGATION CONCERNING ACCESS TO HIGH-COST DRUGS.

Science.gov (United States)

Aleman, Alicia; Perez Galan, Ana

2017-01-01

The impact of health technology assessment (HTA) in the judicialization of the right of health has not been deeply studied in Latin American countries. The purpose of this study is to review the process of judicialization of the access to high cost drugs in Uruguay and assess the impact HTAs have had on this process. The methodology used for this study included a comprehensive literature search in electronic databases, local journals, internal documents developed in the Ministry of Health, as well as conducting interviews with key informants. Judicialization of the access of high cost drugs has been increasing since 2010. The strategy of the Ministry of Health of Uruguay to decrease this problem included the organization of roundtables with judges and other stakeholders on the basis of HTA, the training of defense lawyers in the use and interpretation of HTA, and the participation of a professional who develops HTA in the preparation of the defense arguments. A year after the implementation of this strategy, 25 percent of writs of protection were won by the Ministry of Health. Even though the strategy implemented was effective in reducing the loss of litigations, it was not effective in reducing the growing number of writs of protection. It is essential to address this problem in a broad debate and to promote understanding between the parties.

Laparoscopic findings of infertile women at Bangabandhu Sheikh Mujib Medical University

Directory of Open Access Journals (Sweden)

Shakeela Ishrat

2016-08-01

Full Text Available Background: Laparoscopy is an important component of infertility work up. It is the gold standard for evaluation of pelvic pathology and assessment of tubal patency. Objective: The objective of the study was to analyze the laparoscopic findings of infertile women presenting at Infertlity unit of Bangabandhu Sheikh Mujib Medical University. Method: We had a retrospective cross-sectional study on Japaroscopic findings of 110 women. Results: Out of all patients 22.7% women had endometriosis. Various degrees of adhesion of pouch of Douglus was present in 16.4 %. Regarding tubal pate:1cy , 26.4% had unilateral block and 28.2% had bilateral block. Conclusion: A significant number of infertile women at the Infertility unit of BSMMU has tuboperitoneal disease and bilateral tubal block and ultimately need in vitro fertilization.

Implementation of Extensive Cytoreduction Resulted in Improved Survival Outcomes for Patients with Newly Diagnosed Advanced-Stage Ovarian, Tubal, and Peritoneal Cancers.

Science.gov (United States)

Raspagliesi, Francesco; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Chiappa, Valentina; Borghi, Chiara; Scaffa, Cono; Morano, Federica; Maltese, Giuseppa; Lorusso, Domenica

2017-10-01

Residual disease (RD) after primary debulking surgery (PDS) is one of the main factors driving ovarian cancer prognosis. The primary end point of this study was assessment of the impact that surgery had on survival outcomes for patients with advanced ovarian cancer. Data on the effect of newly diagnosed advanced-stage ovarian, tubal, and peritoneal cancers were analyzed during two study periods (T1: 2001-2006 and T2: 2007-2012), in which the concepts of optimal and complete cytoreduction were introduced and implemented. In this study, 260 patients (36%) had surgery during T1 and 462 patients (64%) had surgery during T2. The rate of PDS increased, from 55.4% (144/260) during T1 to 85.5% (395/462) during T2 (p < 0.001). At the time of PDS, complete resection (RD0) was achieved for 45.1% of the patients during T1 and 76.7% of the patients during T2 (p < 0.001), whereas optimal resection (RD < 1 cm) was achieved for 60.4% of the patients during T1 and 85.3% of the patients during T2 (p < 0.001). Disease-free survival improved during the study periods (p = 0.006). Overall survival was similar in T1 and T2 (p = 0.18). The preoperative CA125 level, disease stage, and RD remained independently associated with disease-free survival (p ≤ 0.05). The performance of interval debulking surgery (IDS) instead of PDS correlated with worse survival outcomes (hazard ratio [HR] 1.47; 95% confidence interval [CI] 1.24-1.92; p = 0.02), whereas achievement of RD0 and RD < 1 cm independently improved overall survival (HR 0.45; 95% CI 0.22-0.91; p = 0.02 for RD0 and HR 0.47; 95% CI 0.23-0.96; p = 0.03 for RD0). The implementation of extensive cytoreduction allows improvement of patient outcomes. Further studies are needed to assess the risk-to-benefit ratio between PDS and IDS and to identify patients who benefit much more from one treatment method than from another.

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

Energy Technology Data Exchange (ETDEWEB)

Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime; Simons, Martin E.; Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.ca [University Health Network, University of Toronto, Division of Vascular and Interventional Radiology, Peter Munk Cardiac Center (Canada)

2016-10-15

PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

International Nuclear Information System (INIS)

Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime; Simons, Martin E.; Rajan, Dheeraj K.

2016-01-01

PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

Vascular access in pediatric patients in the emergency department: types of access, indications, and complications [digest].

Science.gov (United States)

Whitney, Rachel; Langhan, Melissa; Pade, Kathryn H

2017-06-22

Vascular access is a potentially life-saving procedure that is a mainstay of emergency medicine practice. There are a number of challenges associated with obtaining and maintaining vascular access, and the choice of the route of access and equipment used will depend on patient- and provider-specific factors. In this issue, the indications and complications of peripheral intravenous access, intraosseous access, and central venous access are reviewed. Timely and effective assessment and management of difficult-access patients, pain control techniques that can assist vascular access, and contraindications to each type of vascular access are also discussed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Assessment of availability, accessibility, and affordability of magnetic resonance imaging services in Ghana

International Nuclear Information System (INIS)

Piersson, A.D.; Gorleku, P.N.

2017-01-01

Introduction: The aim of this study was to assess the availability, accessibility, and affordability of MRI services to patients in Ghana. Methods: A descriptive quantitative research method which involve the use of a structured email 3-page survey questionnaire was employed, and addressed to the MRI radiographer-in-charge for completion. Results: A response rate of 92% was achieved. Sixty-seven percent (8) of the facilities were located in the Greater Accra region of Ghana with most (6[75%]) being private health facilities. The Western, Eastern, Brong Ahafo, Upper East, and Upper West lacked MRI scanners. MRI scanners per million population was 0.5. The mean cost per MRI examination, was lower in the public (i.e. GHȻ 563–GHȻ 686, p < 0.05 for non-contrast MRI examinations) compared to the private (i.e. GHȻ 618–GHȻ 775, p < 0.05 also for non-contrast MRI examinations). Most facilities (9[75%]) accept card bearers of some private health insurance to access MRI services, but none accepts that of the public-funded health insurance. Conclusion: There is wide disparity in the distribution of MRI scanners nationwide, with most of them located in the Greater Accra region. With only 5 regions having MRI scanners, it does imply that close to 40% of the general population do not readily have access to MRI services. Government can achieve an increase in availability, accessibility, and affordability of MRI by providing more public health facilities with MRI scanners and reimbursing MRI services via the NHIS (National Health Insurance Scheme). - Highlights: • In Ghana, 67% of MRI centres were located in the Greater Accra region. • MRI scanners per million population was 0.5. • About 40% of the population do not readily have access to MRI. • Mean cost per MRI examination was lower in the public compared to private centres. • Payment for MRI services was either by cash or some private health insurance.

Discussing Firearm Ownership and Access as Part of Suicide Risk Assessment and Prevention: "Means Safety" versus "Means Restriction".

Science.gov (United States)

Stanley, Ian H; Hom, Melanie A; Rogers, Megan L; Anestis, Michael D; Joiner, Thomas E

2017-01-01

The goal of this study was to describe the relative utility of the terms "means safety" versus "means restriction" in counseling individuals to limit their access to firearms in the context of a mock suicide risk assessment. Overall, 370 participants were randomized to read a vignette depicting a clinical scenario in which managing firearm ownership and access was discussed either using the term "means safety" or "means restriction." Participants rated the term "means safety" as significantly more acceptable and preferable than "means restriction." Participants randomized to the "means safety" condition reported greater intentions to adhere to clinicians' recommendations to limit access to a firearm for safety purposes (F[1,367] = 7.393, p = .007, [Formula: see text]). The term "means safety" may be more advantageous than "means restriction" when discussing firearm ownership and access in clinical settings and public health-oriented suicide prevention efforts.

Mevalonate Pathway Antagonist Suppresses Formation of Serous Tubal Intraepithelial Carcinoma and Ovarian Carcinoma in Mouse Models.

Science.gov (United States)

Kobayashi, Yusuke; Kashima, Hiroyasu; Wu, Ren-Chin; Jung, Jin-Gyoung; Kuan, Jen-Chun; Gu, Jinghua; Xuan, Jianhua; Sokoll, Lori; Visvanathan, Kala; Shih, Ie-Ming; Wang, Tian-Li

2015-10-15

Statins are among the most frequently prescribed drugs because of their efficacy and low toxicity in treating hypercholesterolemia. Recently, statins have been reported to inhibit the proliferative activity of cancer cells, especially those with TP53 mutations. Because TP53 mutations occur in almost all ovarian high-grade serous carcinoma (HGSC), we determined whether statins suppressed tumor growth in animal models of ovarian cancer. Two ovarian cancer mouse models were used. The first one was a genetically engineered model, mogp-TAg, in which the promoter of oviduct glycoprotein-1 was used to drive the expression of SV40 T-antigen in gynecologic tissues. These mice spontaneously developed serous tubal intraepithelial carcinomas (STICs), which are known as ovarian cancer precursor lesions. The second model was a xenograft tumor model in which human ovarian cancer cells were inoculated into immunocompromised mice. Mice in both models were treated with lovastatin, and effects on tumor growth were monitored. The molecular mechanisms underlying the antitumor effects of lovastatin were also investigated. Lovastatin significantly reduced the development of STICs in mogp-TAg mice and inhibited ovarian tumor growth in the mouse xenograft model. Knockdown of prenylation enzymes in the mevalonate pathway recapitulated the lovastatin-induced antiproliferative phenotype. Transcriptome analysis indicated that lovastatin affected the expression of genes associated with DNA replication, Rho/PLC signaling, glycolysis, and cholesterol biosynthesis pathways, suggesting that statins have pleiotropic effects on tumor cells. The above results suggest that repurposing statin drugs for ovarian cancer may provide a promising strategy to prevent and manage this devastating disease. ©2015 American Association for Cancer Research.

How to access data availability, accessibility and format for risk analysis?

NARCIS (Netherlands)

Humblet, M.F.; Vandeputte, S.; Mignot, C.; Bellet, C.; Koeijer, de A.A.; Swanenburg, M.; Afonso, A.; Sanaa, M.; Saegerman, C.

2016-01-01

Risk assessments are mostly carried out based on available data, which do not reflect all data theoretically required by experts to answer them. This study aimed at developing a methodology to assess data availability, accessibility and format, based on a scoring system and focusing on two diseases:

Bilio-entero-gastrostomy: prospective assessment of a modified biliary reconstruction with facilitated future endoscopic access

Directory of Open Access Journals (Sweden)

Hamad Mostafa A

2012-06-01

Full Text Available Abstract Background Hepaticojejunostomy (HJ is the classical reconstruction for benign biliary stricture. Endoscopic management of anastomotic complications after hepaticojejunostomy is extremely difficult. In this work we assess a modified biliary reconstruction in the form of bilio-entero-gastrostomy (BEG regarding the feasibility of endoscopic access to HJ and management of its stenosis if encountered. Methods From October 2008 till February 2011 all patients presented to the authors with benign biliary stricture who needed bilio-enteric shunt were considered. For each patient bilio-entero-gastrostomy (BEG of either type I, II or III was constructed. In the fourth week postoperatively, endoscopy was performed to explore the possibility to access the biliary anastomosis and perform cholangiography. Results BEG shunt was performed for seventeen patients, one of whom, with BEG type I, died due to myocardial infarction leaving sixteen patients with a diagnosis of postcholecystectomy biliary injury (9, inflammatory stricture with or without choledocholithiasis (5 and strictured biliary shunt (2. BEG shunts were either type I (3, type II (3 or type III (10. Endoscopic follow up revealed successful access to the anastomosis in 14 patients (87.5%, while the access failed in one type I and one type II BEG (12.5%. Mean time needed to access the anastomosis was 12.6 min (2-55 min. On a scale from 1–5, mean endoscopic difficulty score was 1.7. One patient (6.25%, with BEG type I, developed anastomotic stricture after 18 months that was successfully treated endoscopically by stenting. These preliminary results showed that, in relation to the other types, type III BEG demonstrated the tendency to be surgically simpler to perform, endoscopicall faster to access, easier and with no failure. Conclusions BEG, which is a modified biliary reconstruction, facilitates endoscopic access of the biliary anastomosis, offers management option for its

A Meta-analysis of randomized clinical trials assessing hemodialysis access thrombosis based on access flow monitoring: Where do we stand?

Science.gov (United States)

Muchayi, Timothy; Salman, Loay; Tamariz, Leonardo J; Asif, Arif; Rizvi, Abid; Lenz, Oliver; Vazquez-Padron, Roberto I.; Tabbara, Marwan; Contreras, Gabriel

2015-01-01

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95% confidence interval [CI], 0.67 to 1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95% CI, 0.41 to 1.01) and 1.06 (95% CI, 0.77 to 1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses. PMID:25644548

Features and selection of vascular access devices.

Science.gov (United States)

Sansivero, Gail Egan

2010-05-01

To review venous anatomy and physiology, discuss assessment parameters before vascular access device (VAD) placement, and review VAD options. Journal articles, personal experience. A number of VAD options are available in clinical practice. Access planning should include comprehensive assessment, with attention to patient participation in the planning and selection process. Careful consideration should be given to long-term access needs and preservation of access sites. Oncology nurses are uniquely suited to perform a key role in VAD planning and placement. With knowledge of infusion therapy, anatomy and physiology, device options, and community resources, nurses can be key leaders in preserving vascular access and improving the safety and comfort of infusion therapy. Copyright 2010 Elsevier Inc. All rights reserved.

Comparison of the diagnostic values of circulating steroid hormones, VEGF-A, PIGF, and ADAM12 in women with ectopic pregnancy

Directory of Open Access Journals (Sweden)

Zou Shien

2013-02-01

Full Text Available Abstract Background Several peripheral proteins that might be useful for detecting the presence of ectopic pregnancy (EP have been evaluated, but none have been proven entirely useful in the clinic. We investigated the presence and the possible changes in circulating molecules that distinguish between normal intrauterine pregnancy (IUP and tubal ectopic pregnancy. Methods Non-pregnant women during the menstrual cycle, women with IUP, and women with tubal EP after informed consent. Serum levels of 17β-estradiol (E2, progesterone (P4, testosterone (T, beta-human chorionic gonadotropin (β-hCG, vascular endothelial growth factor-A (VEGF-A, placental growth factor (PIGF, and a distintegrin and metalloprotease protein 12 (ADAM12 were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of EP and gestational age-matched IUP. Results E2, P4, PIGF, and ADAM12 levels increased and β-hCG decreased throughout IUP. E2 and VEGF-A levels were significantly different between women with tubal EP and IUP. However, using a serum β-hCG cut-off of less than 1000 mIU/mL, P4 was significantly lower in women with tubal EP compared to IUP. Although E2 was inversely correlated with VEGF-A in women in the early stages of IUP, E2 was not correlated with VEGF-A in women with EP prior to tubal surgery. There were no significant differences in either PIGF or ADAM12 alone between women with tubal EP or IUP. Although no significant correlations were seen between E2 and PIGF or P4 and ADAM12 in women in the early stages of IUP, E2 was positively correlated with PIGF and P4 was positively correlated with ADAM12 in women with EP prior to tubal surgery. Our studies defined associations but not causality. Conclusions Individual measurements of serum E2 or VEGF-A levels are strongly related to early pregnancy outcomes for women with IUP and EP, and pregnancy-associated E2 and VEGF-A levels provide diagnostic accuracy for the

Online medical books: their availability and an assessment of how health sciences libraries provide access on their public Websites.

Science.gov (United States)

MacCall, Steven L

2006-01-01

The objective of this study was to determine the number and topical range of available online medical books and to assess how health sciences libraries were providing access to these resources on their public Websites. The collection-based evaluative technique of list checking was used to assess the number and topical range of online medical books of the six largest publishers. Publisher inventory lists were downloaded over a two-day period (May 16-17, 2004). Titles were counted and compared with the 2003 Brandon/Hill list. A sample of health sciences libraries was subsequently derived by consulting the 2004 "Top Medical Schools-Research" in U.S. News & World Report. Bibliographic and bibliothecal access methods were evaluated based on an inspection of the publicly available Websites of the sample libraries. Of 318 currently published online medical books, 151 (47%) were Brandon/Hill titles covering 42 of 59 Brandon/Hill topics (71%). These 151 titles represented 22% (N = 672) of the Brandon/Hill list, which further broke down as 52 minimal core, 41 initial purchase, and 58 other recommended Brandon/Hill titles. These numbers represented 50%, 28%, and 12%, respectively, of all Brandon/Hill titles corresponding to those categories. In terms of bibliographic access, 20 of 21 of sampled libraries created catalog records for their online medical books, 1 of which also provided analytical access at the chapter level, and none provided access at the chapter section level. Of the 21 libraries, 19 had library Website search engines that provided title-level access and 4 provided access at the chapter level and none that at the chapter section level. For bibliothecal access, 19 of 21 libraries provided title-level access to medical books, 8 of which provided classified and alphabetic arrangements, 1 provided a classified arrangement only, and 10 provided an alphabetic arrangement only. No library provided a bibliothecal arrangement for medical book chapters or chapter

Quality assurance issues in the teacher-based assessment of students with literacy difficulties for examination access arrangements.

Science.gov (United States)

McMurray, Sharon; O'Callaghan, Paul; McVeigh, Claire

2018-02-01

This paper considers two major concerns centring on the Joint Council for Qualifications (JCQ) regulations for access arrangement and reasonable adjustments and qualifications for teachers who take on the role of Level 7 access arrangements assessor. Thus, the paper is divided into two parts. First, the JCQ 2017-2018 regulations are critically evaluated highlighting the areas of need for which greater clarity and more extensive detail is required in these regulations. The second part of the paper discusses the findings of research on teacher competence in test administration, scoring, and reporting. Drawing on evidence from the first stage of this research, McMurray, O'Callaghan, and McVeigh highlight the extensive formative process required to build a high-level skill set required for competent assessment involving the use of high level tests and also the specialist knowledge required to analyse and accurately report assessment findings to make recommendations for students with specific literacy difficulties. Recommendations are provided both at policy and practice levels regarding the content of courses and the assessment involving the use of high level tests and also the specialist knowledge required to analyse and accurately report assessment findings to make recommendations for students with specific literacy difficulties. The authors provide recommendations for test publishers, course providers, and assessors. Copyright © 2018 John Wiley & Sons, Ltd.

Mevalonate Pathway Antagonist Inhibits Proliferation of Serous Tubal Intraepithelial Carcinoma and Ovarian Carcinoma in Mouse Models

Science.gov (United States)

Kobayashi, Yusuke; Kashima, Hiroyasu; Wu, Ren-Chin; Jung, Jin- Gyoung; Kuan, Jen-Chun; Gu, Jinghua; Xuan, Jianhua; Sokoll, Lori; Visvanathan, Kala; Shih, Ie-Ming; Wang, Tian-Li

2015-01-01

Purpose Statins are among the most frequently prescribed drugs because of their efficacy and low toxicity in treating hypercholesterolemia. Recently, statins have been reported to inhibit the proliferative activity of cancer cells, especially those with TP53 mutations. Since TP53 mutations occur in almost all of the ovarian high-grade serous carcinoma, we determined if statins suppressed tumor growth in animal models of ovarian cancer. Experimental Design Two ovarian cancer mouse models were employed. The first one was a genetically engineered model, mogp-TAg, in which the promoter of oviduct glycoprotein-1 was used to drive the expression of SV40 T-antigen in gynecologic tissues. These mice spontaneously develop serous tubal intraepithelial carcinomas (STICs), which are known as ovarian cancer precursor lesions. The second model was a xenograft tumor model in which human ovarian cancer cells were inoculated into immunocompromised mice. Mice in both models were treated with lovastatin, and effects on tumor growth were monitored. The molecular mechanisms underlying the anti-tumor effects of lovastatin were also investigated. Results Lovastatin significantly reduced the development of STICs in mogp-TAg mice and inhibited ovarian tumor growth in the mouse xenograft model. Knockdown of prenylation enzymes in the mevalonate pathway recapitulated the lovastatin-induced anti-proliferative phenotype. Transcriptome analysis indicated that lovastatin affected the expression of genes associated with DNA replication, Rho/PLC signaling, glycolysis, and cholesterol biosynthesis pathways, suggesting that statins have pleiotropic effects on tumor cells. Conclusion The above results suggest that repurposing statin drugs for ovarian cancer may provide a promising strategy to prevent and manage this devastating disease. PMID:26109099

Evidence for a dualistic model of high-grade serous carcinoma: BRCA mutation status, histology, and tubal intraepithelial carcinoma.

Science.gov (United States)

Howitt, Brooke E; Hanamornroongruang, Suchanan; Lin, Douglas I; Conner, James E; Schulte, Stephanie; Horowitz, Neil; Crum, Christopher P; Meserve, Emily E

2015-03-01

Most early adnexal carcinomas detected in asymptomatic women with germline BRCA mutations (BRCA) present as serous tubal intraepithelial carcinomas (STIC). However, STICs are found in only ∼40% of symptomatic high-grade serous carcinomas (HGSCs) and less frequently in pseudoendometrioid variants of HGSC. Consecutive cases of untreated HGSC from BRCA and BRCA women with detailed fallopian tube examination (SEE-FIM protocol) were compared. STIC status (+/-) was determined, and tumors were classified morphologically as SET ("SET", >50% solid, pseudoendometrioid, or transitional) or classic predominate ("Classic"). SET tumors trended toward a higher frequency in BRCA versus BRCA women (50% vs. 28%, P=0.11), had a significantly younger mean age than those with classic HGSC in BRCA women (mean 56.2 vs. 64.8 y, P=0.04), and displayed a better clinical outcome in both groups combined (P=0.024). STIC was significantly more frequent in tumors from the BRCA cohort (66% vs. 31%, P=0.017) and specifically the BRCA tumors with classic morphology (83%) versus those with SET morphology (22%, P=0.003). Overall, several covariables-histology, BRCA status, age, coexisting STIC, and response to therapy-define 2 categories of HGSC with differences in precursor (STIC) frequency, morphology, and outcome. We introduce a dualistic HGSC model that could shed light on the differences in frequency of STIC between symptomatic and asymptomatic women with HGSC. This model emphasizes the need for further study of HGSC precursors to determine their relevance to the prevention of this lethal malignancy.

Housing accessibility problems for people with Parkinson's disease.

Science.gov (United States)

Slaug, B; Iwarsson, S; Ayala, J A; Nilsson, M H

2017-11-01

Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems. The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied. HE-scores differed significantly (Phousing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Suspect online sellers and contraceptive access.

Science.gov (United States)

Liang, Bryan A; Mackey, Tim K; Lovett, Kimberly M

2012-11-01

Issues surrounding contraception access have been a national focus. During this debate, adolescent and adult women may seek these products online. Due to safety concerns, including potential counterfeit forms, we wished to assess whether online "no prescription" contraceptives were available. We assessed online availability of reversible, prescription contraceptive methods resulting in online pharmacy marketing is shifting from direct search engine access to social media (Facebook, Twitter, Slidehare, flickr). Online contraceptive sales represent patient safety risks and a parallel system of high-risk product access absent professional guidance. Providers should educate patients, while policy makers employ legal strategies to address these systemic risks. Copyright © 2012 Elsevier Inc. All rights reserved.

Hysteroscopic sterilization of patient with intrauterine device Mirena®

Science.gov (United States)

Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Yatabe, Salete; Lopes, Reginaldo Guedes Coelho

2013-01-01

ABSTRACT Tubal sterilization is the definitive procedure most often used worldwide to control fecundity. Laparoscopic ligature is safe, but invasive and with possible surgical and anesthetic risks. The hysteroscopic approach enables tubal occlusion at outpatient's setting without the need of incisions or anesthesia. A microdevice (Essure®) is inserted directly into the tubes and its polyethelene fibers cause obstruction of tubes in about three months. During this period, it is recommended that patients continue the use of a temporary birth control method. Several women use the levonorgestrel-releasing intrauterine system, which is called in the market as Mirena®. This report evaluated the possibility of inserting Essure® without remove the intrauterine device; patient tolerance to the procedure was also assessed. The tubal device was successfully placed in the patient without the need to remove Mirena®. After three months the intrauterine device was removed with no intercurrent events. PMID:23579753

Assessing the Assessment: Access to Algebra in an Era of API

Science.gov (United States)

Lloyd, Jayson D.

2010-01-01

A high school education, which includes access to advanced math courses, has a positive effect on students. Math classes taken in high school show a relationship to higher salaries and college graduation rates. However, the high-stakes accountability system in California, redesigned in 2003 to meet the requirements of the No Child Left Behind Act…

Is open access sufficient? A review of the quality of open-access nursing journals.

Science.gov (United States)

Crowe, Marie; Carlyle, Dave

2015-02-01

The present study aims to review the quality of open-access nursing journals listed in the Directory of Open Access Journals that published papers in 2013 with a nursing focus, written in English, and were freely accessible. Each journal was reviewed in relation to their publisher, year of commencement, number of papers published in 2013, fee for publication, indexing, impact factor, and evidence of requirements for ethics and disclosure statements. The quality of the journals was assessed by impact factors and the requirements for indexing in PubMed. A total of 552 were published in 2013 in the 19 open-access nursing journals that met the inclusion criteria. No journals had impact factors listed in Web of Knowledge, but three had low Scopus impact factors. Only five journals were indexed with PubMed. The quality of the 19 journals included in the review was evaluated as inferior to most subscription-fee journals. Mental health nursing has some responsibility to the general public, and in particular, consumers of mental health services and their families, for the quality of papers published in open-access journals. The way forward might involve dual-platform publication or a process that enables assessment of how research has improved clinical outcomes. © 2014 Australian College of Mental Health Nurses Inc.

From the Margins to the Spotlight: Diverse Deaf and Hard of Hearing Student Populations and Standardized Assessment Accessibility.

Science.gov (United States)

Cawthon, Stephanie

2015-01-01

Designing assessments and tests is one of the more challenging aspects of creating an accessible learning environment for students who are deaf or hard of hearing (DHH), particularly for deaf students with a disability (DWD). Standardized assessments are a key mechanism by which the educational system in the United States measures student progress, teacher effectiveness, and the impact of school reform. The diversity of student characteristics within DHH and DWD populations is only now becoming visible in the research literature relating to standardized assessments and their use in large-scale accountability reforms. The purpose of this article is to explore the theoretical frameworks surrounding assessment policy and practice, current research related to standardized assessment and students who are DHH and DWD, and potential implications for practice within both the assessment and instruction contexts.

A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712

Directory of Open Access Journals (Sweden)

Piller Marsha D

2003-08-01

Full Text Available Abstract Background Gynecological laparoscopic surgery procedures are often complicated by postoperative pain resulting in an unpleasant experience for the patient, delayed discharge, and increased cost. Glucocorticosteroids have been suggested to reduce the severity and incidence of postoperative pain. Methods This study examines the efficacy of a sustained release betamethasone preparation to reduce postoperative pain and the requirement for pain relief drugs after either diagnostic laparoscopy or tubal ligation. Patients were recruited, as presenting, after obtaining informed consent. Prior to surgery, patients were randomly selected by a computer generated table to receive either pharmacy-coded betamethasone (12 mg IM Celestone™ or an optically identical placebo injection of Intralipid™ and isotonic saline mixture. The effect of non-controlled prophylactic intraoperative treatment with either fentanyl or ketorolac per surgeon's orders was also noted in this study. Blood samples taken at recovery and at discharge times were extracted and analyzed for circulating betamethasone. Visual analog scale data on pain was gathered at six post-recovery time points in a triple blind fashion and statistically compared. The postoperative requirement for pain relief drugs was also examined. Results Although the injection achieved a sustained therapeutic concentration, no beneficial effect of IM betamethasone on postoperative pain or reduction in pain relief drugs was observed during the postoperative period. Indeed, the mean combined pain scores during the 2 hour postoperative period, adjusted for postoperative opioids as the major confounding factor, were higher approaching statistical significance (P = 0.056 in the treatment group. Higher pain scores were also observed for the tubal ligation patients relative to diagnostic laparoscopy. Intraoperative fentanyl treatment did not significantly lower the average pain score during the 2 hour postoperative

Assessing the UN High-Level Panel on Access to Medicines Report in Light of the Right to Health

Directory of Open Access Journals (Sweden)

Lisa Forman

2016-11-01

Full Text Available Access to medicines is the lynchpin to realizing a range of human rights, public health and development imperatives. However, without strong policy action to increase access to affordable medicines, there is little hope of achieving the Sustainable Development Goals or of realizing the human right to health. Access to medicines is a fundamental element of the right to health, and the majority of states are bound by core obligations in this regard. Accordingly, states must ensure that this critical human rights, public health and development interest is appropriately prioritized against inadequate resource allocations and competing private or trade interests. This is an imperative which we have argued should have framed the deliberations of the UN High Level Panel on Access to Medicines, convened to propose solutions to the “policy incoherence” between international human rights, trade rules and public health that is impeding access to medicines and the right to health for millions. In this article we explore interpretations in international human rights law regarding state duties towards medicines that should have guided these deliberations, and which were presented by the first author in a submission to the panel. We argue that at least two clear right to health duties support the High Level Panel’s recommendations: (1 the duty to prevent unreasonably high costs for medicines from denying large segments of the population their rights to health; and (2 the core obligation to provide essential medicines. Consequently, we explore three areas of action implied by these duties: (1 consistent implementation of human rights impact assessment; (2 institutionalizing the Agreement on Trade-Related Intellectual Property Rights (TRIPS flexibilities in law and policy; (3 making permanent the waiver of TRIPS for least developed countries (LDC, and waiving the application of TRIPS to essential medicines in low and middle-income countries. Finally, we

An inventory to assess empathic concern for disability and accessibility: development and preliminary psychometric investigation

Directory of Open Access Journals (Sweden)

Motohide Miyahara

2017-11-01

Full Text Available Cultivating empathy and prosocial attitude towards disability is a first step for university students to become the leaders of society and professions to create accessible environments and inclusive society. Gauging levels of empathy and prosocial attitude towards disability among the students is important for evaluating the adequacy of disability training and education. We developed and conducted an initial psychometric validation of a novel inventory in Japanese and English languages to assess Empathic Concern for Disability and Accessibility (ECDA in Japan and New Zealand. Preliminary psychometric evaluation indicates strong internal consistency in the Japanese sample (α = .96 and the New Zealand sample (α = .93. Exploratory factor analysis demonstrated a four-factor solution for both samples. The present study has resulted in the development of the ECDA that demonstrated initial support for internal consistency and construct validity. The ECDA may be used for the cross-cultural comparisons of disability training and education.

The Use of Telemedicine Access to Schools to Facilitate Expert Assessment of Children with Asthma

Directory of Open Access Journals (Sweden)

David A. Bergman

2008-01-01

Full Text Available Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P<.05 in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist.

Economic assessment of strategies to deploy publicly accessible charging infrastructure

OpenAIRE

Madina, Carlos; Barlag, Heike; Coppola, Giovanni; Gómez-Arriola, Inés; Rodríguez-Sánchez, Raúl; Zabala, Eduardo

2015-01-01

From the end user perspective, the main barriers for widespread electric vehicle (EV) adoption are high purchase cost and range anxiety, both regarding battery capacity and availability of accessible EV charging infrastructure. Governments and public bodies in general are taking steps towards overcoming these barriers by, among others, setting up regulatory requirements regarding standardisation, customer information and recommending objectives of publicly accessible charging infrastructure. ...

Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

Directory of Open Access Journals (Sweden)

Iskrov G

2014-01-01

Full Text Available Georgi Iskrov, Rumen Stefanov Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria Abstract: This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisciplinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug

Stathmin 1 and p16(INK4A) are sensitive adjunct biomarkers for serous tubal intraepithelial carcinoma.

Science.gov (United States)

Novak, Marián; Lester, Jenny; Karst, Alison M; Parkash, Vinita; Hirsch, Michelle S; Crum, Christopher P; Karlan, Beth Y; Drapkin, Ronny

2015-10-01

To credential Stathmin 1 (STMN1) and p16(INK4A) (p16) as adjunct markers for the diagnosis of serous tubal intraepithelial carcinoma (STIC), and to compare STMN1 and p16 expression in p53-positive and p53-negative STIC and invasive high-grade serous carcinoma (HGSC). Immunohistochemistry (IHC) was used to examine STMN1 and p16 expression in fallopian tube specimens (n=31) containing p53-positive and p53-negative STICs, invasive HGSCs, and morphologically normal FTE (fallopian tube epithelium). STMN1 and p16 expression was scored semiquantitatively by four individuals. The semiquantitative scores were dichotomized, and reported as positive or negative. Pooled siRNA was used to knockdown p53 in a panel of cell lines derived from immortalized FTE and HGSC. STMN1 and p16 were expressed in the majority of p53-positive and p53-negative STICs and concomitant invasive HGSCs, but only scattered positive cells were present in morphologically normal FTE. Both proteins were expressed consistently across multiple STICs from the same patient and in concomitant invasive HGSC. Knockdown of p53 in immortalized FTE cells and in four HGSC-derived cell lines expressing different missense p53 mutations did not affect STMN1 protein levels. This study demonstrates that STMN1 and p16 are sensitive and specific adjunct biomarkers that, when used with p53 and Ki-67, improve the diagnostic accuracy of STIC. The addition of STMN1 and p16 helps to compensate for practical limitations of p53 and Ki-67 that complicate the diagnosis in up to one third of STICs. Copyright © 2015 Elsevier Inc. All rights reserved.

Stathmin 1 and p16INK4A are sensitive adjunct biomarkers for serous tubal intraepithelial carcinoma

Science.gov (United States)

Novak, Marián; Lester, Jenny; Karst, Alison M.; Parkash, Vinita; Hirsch, Michelle S.; Crum, Christopher P.; Karlan, Beth Y.

2015-01-01

Objective To credential Stathmin 1 (STMN1) and p16INK4A (p16) as adjunct markers for the diagnosis of serous tubal intraepithelial carcinoma (STIC), and to compare STMN1 and p16 expression in p53-positive and p53-negative STIC and invasive high-grade serous carcinoma (HGSC). Methods Immunohistochemistry (IHC) was used to examine STMN1 and p16 expression in fallopian tube specimens (n=31) containing p53-positive and p53-negative STICs, invasive HGSCs, and morphologically normal FTE (fallopian tube epithelium). STMN1 and p16 expression was scored semiquantitatively by four individuals. The semiquantitative scores were dichotomized, and reported as positive or negative. Pooled siRNA was used to knockdown p53 in a panel of cell lines derived from immortalized FTE and HGSC. Results STMN1 and p16 were expressed in the majority of p53-positive and p53-negative STICs and concomitant invasive HGSCs, but only scattered positive cells were positive in morphologically normal FTE. Both proteins were expressed consistently across multiple STICs from the same patient and in concomitant invasive HGSC. Knockdown of p53 in immortalized FTE cells and in four HGSC-derived cell lines expressing different missense p53 mutations did not affect STMN1 protein levels. Conclusions This study demonstrates that STMN1 and p16 are sensitive and specific adjunct biomarkers that, when used with p53 and Ki-67, improve the diagnostic accuracy of STIC. The addition of STMN1 and p16 helps to compensate for practical limitations of p53 and Ki-67 that complicate the diagnosis in up to one third of STICs. PMID:26206555

Assessing the model transferability for prediction of transcription factor binding sites based on chromatin accessibility.

Science.gov (United States)

Liu, Sheng; Zibetti, Cristina; Wan, Jun; Wang, Guohua; Blackshaw, Seth; Qian, Jiang

2017-07-27

Computational prediction of transcription factor (TF) binding sites in different cell types is challenging. Recent technology development allows us to determine the genome-wide chromatin accessibility in various cellular and developmental contexts. The chromatin accessibility profiles provide useful information in prediction of TF binding events in various physiological conditions. Furthermore, ChIP-Seq analysis was used to determine genome-wide binding sites for a range of different TFs in multiple cell types. Integration of these two types of genomic information can improve the prediction of TF binding events. We assessed to what extent a model built upon on other TFs and/or other cell types could be used to predict the binding sites of TFs of interest. A random forest model was built using a set of cell type-independent features such as specific sequences recognized by the TFs and evolutionary conservation, as well as cell type-specific features derived from chromatin accessibility data. Our analysis suggested that the models learned from other TFs and/or cell lines performed almost as well as the model learned from the target TF in the cell type of interest. Interestingly, models based on multiple TFs performed better than single-TF models. Finally, we proposed a universal model, BPAC, which was generated using ChIP-Seq data from multiple TFs in various cell types. Integrating chromatin accessibility information with sequence information improves prediction of TF binding.The prediction of TF binding is transferable across TFs and/or cell lines suggesting there are a set of universal "rules". A computational tool was developed to predict TF binding sites based on the universal "rules".

PERii electronic journals: Assessing access and use by ...

African Journals Online (AJOL)

Peter G. Underwood

institutional subscription to electronic journals through the Programme for Enhancement of .... These strategies include the promotion and marketing of these .... assist students and other library users to access PERii electronic journals resources. ..... Smith, H. Bukirwa, H. Mukasa, O. Snell, P. Adeh-Nsoh, S. Mbuyita, ...

Household energy consumption patterns and its environmental implications: Assessment of energy access and poverty in Nepal

International Nuclear Information System (INIS)

Malla, Sunil

2013-01-01

Approximately 87% of Nepal's total final energy is consumed by households. This paper analyzes the patterns of household energy use and associated air pollutant emissions in Nepal based on LEAP framework for thirteen analytical regions and three end-uses. Four scenarios involving different growth paths for socio economic and energy system development through the year 2040 are considered. The study finds that household energy use is heterogeneous across the regions and biomass for cooking dominates the country's energy-mix. Households' CO 2 emissions are less significant but their local indoor pollutant emissions will continue to rise in the future. To help strengthen government's commitment to the UN's sustainable energy for all initiative, this study devises an energy development index (EDI) to assess country's energy access and poverty across the regions. The results reveal that the current level of both energy access and energy poverty in the country is below the basic human needs and this situation will improve by little in next 30 years. The paper argues that to improve these situations require more coordinated and innovative plans and policies from the government. The paper suggests that greater emphasis will be needed in reducing dependence of biomass for cooking, promoting domestic alternative energy sources, scaling up biomass improved cookstoves programs and developing periodic regional level energy database. - Highlights: • Household energy use and air pollutant emissions in Nepal are analyzed based on LEAP framework. • Household energy use is heterogeneous across the regions and biomass for cooking dominates country's energy-mix. • Energy Development Index is devised to assess country's energy access and poverty across the regions. • Scaling up RETs and biomass ICS programs are suggested. • Coordination with inter-agencies and ODAs is vital in alleviating energy poverty in Nepal

Accessibility assessment of Houston's roadway network during Harvey through integration of observed flood impacts and hydrologic modeling

Science.gov (United States)

Gidaris, I.; Gori, A.; Panakkal, P.; Padgett, J.; Bedient, P. B.

2017-12-01

The record-breaking rainfall produced over the Houston region by Hurricane Harvey resulted in catastrophic and unprecedented impacts on the region's infrastructure. Notably, Houston's transportation network was crippled, with almost every major highway flooded during the five-day event. Entire neighborhoods and subdivisions were inundated, rendering them completely inaccessible to rescue crews and emergency services. Harvey has tragically highlighted the vulnerability of major thoroughfares, as well as neighborhood roads, to severe inundation during extreme precipitation events. Furthermore, it has emphasized the need for detailed accessibility characterization of road networks under extreme event scenarios in order to determine which areas of the city are most vulnerable. This analysis assesses and tracks the accessibility of Houston's major highways during Harvey's evolution by utilizing road flood/closure data from the Texas DOT. In the absence of flooded/closure data for local roads, a hybrid approach is adopted that utilizes a physics-based hydrologic model to produce high-resolution inundation estimates for selected urban watersheds in the Houston area. In particular, hydrologic output in the form of inundation depths is used to estimate the operability of local roads. Ultimately, integration of hydrologic-based estimation of road conditions with observed data from DOT supports a network accessibility analysis of selected urban neighborhoods. This accessibility analysis can identify operable routes for emergency response (rescue crews, medical services, etc.) during the storm event.

A Survey of Clients and Ethical Perspectives of Voluntary Tubal ...

African Journals Online (AJOL)

This is an open access article distributed under the terms of the Creative Commons ... maternal and child health services in a district, two were chosen at random using the ... of incentives, denial of rights because of client's refusal to accept a ...

The Oviduct and Serous Cancer Risk Assessment

Science.gov (United States)

2015-10-01

such as transitional-like metaplasia [Walthard cell nests (WCNs), n= 5]; (3) serous tubal intraepithelial neo- plasms (STINs) (n= 18); and (4...catenin staining in type 2 SCOUTs, with a shift in distribution from the membrane to the cyto- plasm and nucleus, is unclear but it is emblematic ofWnt...6 BRCA). Clinical outcome data including the time to last follow-up, and clinical status at last follow-up were extracted from the electronic

Validation of Housing Standards Addressing Accessibility

DEFF Research Database (Denmark)

Helle, Tina

2013-01-01

The aim was to explore the use of an activity-based approach to determine the validity of a set of housing standards addressing accessibility. This included examination of the frequency and the extent of accessibility problems among older people with physical functional limitations who used...... participant groups were examined. Performing well-known kitchen activities was associated with accessibility problems for all three participant groups, in particular those using a wheelchair. The overall validity of the housing standards examined was poor. Observing older people interacting with realistic...... environments while performing real everyday activities seems to be an appropriate method for assessing accessibility problems....

Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

International Nuclear Information System (INIS)

Winter, Leopold; Gluecker, Thomas; Steinbrich, Wolfgang; Pegios, Wassilios; Steimann, Sabine; De Geyter, Christian; Froehlich, Johannes M.

2010-01-01

Background: Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. Purpose: To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Material and Methods: Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. Results: dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be

Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

Energy Technology Data Exchange (ETDEWEB)

Winter, Leopold; Gluecker, Thomas; Steinbrich, Wolfgang; Pegios, Wassilios (Dept. of Radiology, Univ. Hospital Basel (Switzerland)), e-mail: winterl@uhbs.ch; Steimann, Sabine; De Geyter, Christian (Women' s Hospital, Univ. Hospital Basel (Switzerland)); Froehlich, Johannes M. (Guerbet AG, Zuerich (Switzerland))

2010-07-15

Background: Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. Purpose: To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Material and Methods: Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. Results: dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be

Assessing Effects of Climate Change on Access to Ecosystem Services in Rural Alaska: Enhancing the Science through Community Engagement

Science.gov (United States)

Brinkman, T. J.; Cold, H.; Brown, D. N.; Brown, C.; Hollingsworth, T. N.; Verbyla, D.

2017-12-01

In Arctic-Boreal regions, studies quantifying the characteristics and prevalence of environmental disruptions to access to ecosystem services are lacking. Empirical investigations are needed to assess the vulnerability of rural communities to climate change. We integrated community-based local observation (9 Interior Alaska Communities), field-based ground measurements, and remote sensing data to: 1) identify and prioritize the relative importance of different environmental changes affecting access, 2) characterize the biophysical causes and mechanisms related to access, and 3) evaluate long-term (30 year) trends in the environment that are challenging access. Dynamic winter ice and snow conditions (e.g., dangerous ice travel; n =147) were the most commonly reported cause of disturbance to access, followed by changes in summer hydrology (e.g., river navigability; n = 77) and seasonal shifts in freeze/thaw cycles (n = 31). Supporting local observations, our remote-sensing analysis indicated a trend toward environmental conditions that hinder or disrupt traditional uses of ecosystem services. For example, we found that the window of safe travel on ice has narrowed by approximately 2 weeks since the 1980s. Shifts in travel have implications on the effectiveness of subsistence activities, such as winter trapping and spring waterfowl hunting. From a methods perspective, we implemented a study design that generated novel science while also addressing locally relevant issues. Our approach and findings highlight opportunities for connecting biophysical science with societal concerns.

Assessing equitable access to urban green space: the role of engineered water infrastructure.

Science.gov (United States)

Wendel, Heather E Wright; Downs, Joni A; Mihelcic, James R

2011-08-15

Urban green space and water features provide numerous social, environmental, and economic benefits, yet disparities often exist in their distribution and accessibility. This study examines the link between issues of environmental justice and urban water management to evaluate potential improvements in green space and surface water access through the revitalization of existing engineered water infrastructures, namely stormwater ponds. First, relative access to green space and water features were compared for residents of Tampa, Florida, and an inner-city community of Tampa (East Tampa). Although disparities were not found in overall accessibility between Tampa and East Tampa, inequalities were apparent when quality, diversity, and size of green spaces were considered. East Tampa residents had significantly less access to larger, more desirable spaces and water features. Second, this research explored approaches for improving accessibility to green space and natural water using three integrated stormwater management development scenarios. These scenarios highlighted the ability of enhanced water infrastructures to increase access equality at a variety of spatial scales. Ultimately, the "greening" of gray urban water infrastructures is advocated as a way to address environmental justice issues while also reconnecting residents with issues of urban water management.

Identical TP53 mutations in pelvic carcinosarcomas and associated serous tubal intraepithelial carcinomas provide evidence of their clonal relationship.

Science.gov (United States)

Ardighieri, Laura; Mori, Luigi; Conzadori, Sara; Bugatti, Mattia; Falchetti, Marcella; Donzelli, Carla Maria; Ravaggi, Antonella; Odicino, Franco E; Facchetti, Fabio

2016-07-01

Pelvic carcinosarcomas (PCSs) are rare aggressive biphasic tumors that localize in the ovary, fallopian tube, or peritoneum and present frequently as bilateral disease. We undertook a morphological, p53 immunohistochemical and TP53 gene mutational analysis study in a single institution cohort of 16 PCSs in order to investigate the nature of bilateral tumors and to shed light on their origin and pathogenesis. Of the 16 patients, 10 presented with bilateral disease, 6 with a carcinosarcoma in both adnexa, and the remaining cases with a carcinosarcoma in one adnexum and a carcinoma in the opposite. The carcinoma component showed high-grade serous features in 13/16 of cases (81 %). In 10 patients (63 %), a serous tubal intraepithelial carcinoma (STIC) was found, in one case bilateral, making a total of 11 STICs. STIC was found only in cases with a carcinoma component with high-grade serous features. All 10 bilateral tumors and all 11 PCS-associated STICs showed a similar p53 immunostaining pattern. At mutation analysis of the TP53 gene, all five bilateral PCS contained an identical mutation in both localizations. Furthermore, a TP53 mutation was found in 8 of 10 STICs, with an identical mutation in the associated PCS. The finding of similar p53 immunostaining in all bilateral cases and identical TP53 mutations in most PCS-associated STIC provides evidence for a clonal relation between these neoplastic lesions, supporting a metastatic nature of bilateral PCS and suggesting that they have an extraovarian origin in a STIC.

Access and Equity Denied: Key Theories for School Psychologists to Consider When Assessing Black and Hispanic Students for Gifted Education

Science.gov (United States)

Ford, Donna Y.; Wright, Brian L.; Washington, Ahmad; Henfield, Malik S.

2016-01-01

Black and Hispanic students are consistently underrepresented in gifted education. Several factors contribute to their low identification and lack of access to such programs and services. While teacher underreferral is a significant contributing factor, problematic also is testing and assessment, which is often administered by school…

Libraries and Accessibility: Istanbul Public Libraries Case

Directory of Open Access Journals (Sweden)

Gül Yücel

2016-12-01

Full Text Available In the study; the assessment of accessibility has been conducted in Istanbul public libraries within the scope of public area. Public libraries commonly serve with its user of more than 20 million in total, spread to the general of Turkey, having more than one thousand branches in the centrums and having more than one million registered members. The building principles and standards covering the subjects such as the selection of place, historical and architectural specification of the region, distance to the centre of population and design in a way that the disabled people could benefit from the library services fully have been determined with regulations in the construction of new libraries. There are works for the existent libraries such as access for the disabled, fire safety precautions etc. within the scope of the related standards. Easy access by everyone is prioritized in the public libraries having a significant role in life-long learning. The purpose of the study is to develop solution suggestions for the accessibility problems in the public libraries. The study based on the eye inspection and assessments carried out within the scope of accessibility in the public libraries subsidiary to Istanbul Culture and Tourism Provincial Directorate Library and Publications Department within the provincial borders of Istanbul. The arrangements such as reading halls, study areas, book shelves etc. have been examined within the frame of accessible building standards. Building entrances, ramps and staircases, horizontal and vertical circulation of building etc. have been taken into consideration within the scope of accessible building standards. The subjects such as the reading and studying areas and book shelf arrangements for the library have been assessed within the scope of specific buildings. There are a total of 34 public libraries subsidiary to Istanbul Culture and Tourism Provincial Directorate on condition that 20 ea. of them are in the

Qualitative and quantitative analysis of women's perceptions of transvaginal surgery.

Science.gov (United States)

Bingener, Juliane; Sloan, Jeff A; Ghosh, Karthik; McConico, Andrea; Mariani, Andrea

2012-04-01

Prior surveys evaluating women's perceptions of transvaginal surgery both support and refute the acceptability of transvaginal access. Most surveys employed mainly quantitative analysis, limiting the insight into the women's perspective. In this mixed-methods study, we include qualitative and quantitative methodology to assess women's perceptions of transvaginal procedures. Women seen at the outpatient clinics of a tertiary-care center were asked to complete a survey. Demographics and preferences for appendectomy, cholecystectomy, and tubal ligation were elicited, along with open-ended questions about concerns or benefits of transvaginal access. Multivariate logistic regression models were constructed to examine the impact of age, education, parity, and prior transvaginal procedures on preferences. For the qualitative evaluation, content analysis by independent investigators identified themes, issues, and concerns raised in the comments. The completed survey tool was returned by 409 women (grouped mean age 53 years, mean number of 2 children, 82% ≥ some college education, and 56% with previous transvaginal procedure). The transvaginal approach was acceptable for tubal ligation to 59%, for appendectomy to 43%, and for cholecystectomy to 41% of the women. The most frequently mentioned factors that would make women prefer a vaginal approach were decreased invasiveness (14.4%), recovery time (13.9%), scarring (13.7%), pain (6%), and surgical entry location relative to organ removed (4.4%). The most frequently mentioned concerns about the vaginal approach were the possibility of complications/safety (14.7%), pain (9%), infection (5.6%), and recovery time (4.9%). A number of women voiced technical concerns about the vaginal approach. As in prior studies, scarring and pain were important issues to be considered, but recovery time and increased invasiveness were also in the "top five" list. The surveyed women appeared to actively participate in evaluating the technical

In vitro assessment of some sperm function following exposure to levonorgestrel in human fallopian tubes

Directory of Open Access Journals (Sweden)

Hermanny Alexia

2012-01-01

Full Text Available Abstract Background The mechanism of action of levonorgestrel (LNG as emergency contraception (EC remains a subject of debate and its effect on sperm function has been only partially explained. The aim of this study was to assess whether LNG at a similar dose to those found in serum following oral intake for EC could affect spermatozoa when exposed to human fallopian tubes in vitro. Methods Fifteen mini-laparotomies were performed, the side on which ovulation occurred was recorded, and both tubes were removed and perfused with a suspension containing 1 × 10(6 motile spermatozoa, with or without LNG. Following 4-hour incubation, the tubes were sectioned to separate the isthmus and the ampulla. Each segment was flushed and the material was evaluated to quantify the number of motile sperm, the number of spermatozoa adhering to the oviductal epithelium and the acrosome reaction (AR rate. Results The addition of LNG did not significantly alter the number of recovered motile spermatozoa either at the isthmus or at the ampulla, nor did it have any effect on the number of recovered spermatozoa adhered to the human tubal epithelium. Furthermore, LNG did not affect the AR rate. No significant differences were found even when the side on which ovulation occurred was taken into account. Conclusions In a similar dose to that observed in serum following oral intake for EC, LNG had no effect on the number of motile spermatozoa recovered from the human fallopian tubes in vitro, on their adhesion to the tubal epithelium, distribution or AR rate. The possible effect of LNG as EC on sperm function remains poorly understood.

Diversity in 113 cowpea [Vigna unguiculata (L) Walp] accessions assessed with 458 SNP markers.

Science.gov (United States)

Egbadzor, Kenneth F; Ofori, Kwadwo; Yeboah, Martin; Aboagye, Lawrence M; Opoku-Agyeman, Michael O; Danquah, Eric Y; Offei, Samuel K

2014-01-01

Single Nucleotide Polymorphism (SNP) markers were used in characterization of 113 cowpea accessions comprising of 108 from Ghana and 5 from abroad. Leaf tissues from plants cultivated at the University of Ghana were genotyped at KBioscience in the United Kingdom. Data was generated for 477 SNPs, out of which 458 revealed polymorphism. The results were used to analyze genetic dissimilarity among the accessions using Darwin 5 software. The markers discriminated among all of the cowpea accessions and the dissimilarity values which ranged from 0.006 to 0.63 were used for factorial plot. Unexpected high levels of heterozygosity were observed on some of the accessions. Accessions known to be closely related clustered together in a dendrogram drawn with WPGMA method. A maximum length sub-tree which comprised of 48 core accessions was constructed. The software package structure was used to separate accessions into three groups, and the programme correctly identified varieties that were known hybrids. The hybrids were those accessions with numerous heterozygous loci. The structure plot showed closely related accessions with similar genome patterns. The SNP markers were more efficient in discriminating among the cowpea germplasm than morphological, seed protein polymorphism and simple sequence repeat studies reported earlier on the same collection.

Global review of open access risk assessment software packages valid for global or continental scale analysis

Science.gov (United States)

Daniell, James; Simpson, Alanna; Gunasekara, Rashmin; Baca, Abigail; Schaefer, Andreas; Ishizawa, Oscar; Murnane, Rick; Tijssen, Annegien; Deparday, Vivien; Forni, Marc; Himmelfarb, Anne; Leder, Jan

2015-04-01

Over the past few decades, a plethora of open access software packages for the calculation of earthquake, volcanic, tsunami, storm surge, wind and flood have been produced globally. As part of the World Bank GFDRR Review released at the Understanding Risk 2014 Conference, over 80 such open access risk assessment software packages were examined. Commercial software was not considered in the evaluation. A preliminary analysis was used to determine whether the 80 models were currently supported and if they were open access. This process was used to select a subset of 31 models that include 8 earthquake models, 4 cyclone models, 11 flood models, and 8 storm surge/tsunami models for more detailed analysis. By using multi-criteria analysis (MCDA) and simple descriptions of the software uses, the review allows users to select a few relevant software packages for their own testing and development. The detailed analysis evaluated the models on the basis of over 100 criteria and provides a synopsis of available open access natural hazard risk modelling tools. In addition, volcano software packages have since been added making the compendium of risk software tools in excess of 100. There has been a huge increase in the quality and availability of open access/source software over the past few years. For example, private entities such as Deltares now have an open source policy regarding some flood models (NGHS). In addition, leaders in developing risk models in the public sector, such as Geoscience Australia (EQRM, TCRM, TsuDAT, AnuGA) or CAPRA (ERN-Flood, Hurricane, CRISIS2007 etc.), are launching and/or helping many other initiatives. As we achieve greater interoperability between modelling tools, we will also achieve a future wherein different open source and open access modelling tools will be increasingly connected and adapted towards unified multi-risk model platforms and highly customised solutions. It was seen that many software tools could be improved by enabling user

Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees.

Science.gov (United States)

Ndumele, Chima D; Cohen, Michael S; Cleary, Paul D

2017-10-01

Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Reported access to specialty care in the previous 6 months. Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities

Polyploidy creates higher diversity among Cynodon accessions as assessed by molecular markers.

Science.gov (United States)

Gulsen, Osman; Sever-Mutlu, Songul; Mutlu, Nedim; Tuna, Metin; Karaguzel, Osman; Shearman, Robert C; Riordan, Terrance P; Heng-Moss, Tiffany M

2009-05-01

Developing a better understanding of associations among ploidy level, geographic distribution, and genetic diversity of Cynodon accessions could be beneficial to bermudagrass breeding programs, and would enhance our understanding of the evolutionary biology of this warm season grass species. This study was initiated to: (1) determine ploidy analysis of Cynodon accessions collected from Turkey, (2) investigate associations between ploidy level and diversity, (3) determine whether geographic and ploidy distribution are related to nuclear genome variation, and (4) correlate among four nuclear molecular marker systems for Cynodon accessions' genetic analyses. One hundred and eighty-two Cynodon accessions collected in Turkey from an area south of the Taurus Mountains along the Mediterranean cost and ten known genotypes were genotyped using sequence related amplified polymorphism (SRAP), peroxidase gene polymorphism (POGP), inter-simple sequence repeat (ISSR), and random amplified polymorphic DNA (RAPD). The diploids, triploids, tetraploids, pentaploids, and hexaploids revealed by flow cytometry had a linear present band frequency of 0.36, 0.47, 0.49, 0.52, and 0.54, respectively. Regression analysis explained that quadratic relationship between ploidy level and band frequency was the most explanatory (r = 0.62, P Cynodon accessions' genetic structure can aid to enhance breeding programs and broaden genetic base of commercial cultivars.

Assessment of genetic diversity among accessions of two traditional ...

African Journals Online (AJOL)

user

2011-04-11

Apr 11, 2011 ... Adéoti K.1, Rival A.2, Dansi A.3*, Ahohuendo B.C4, Santoni S.5, Beule T.2, Nato ... Acmella accessions although three distinct clusters could be differentiated. ..... length polymorphism (AFLP): A review of the procedure and its.

Cluster analysis technique for assessing variability in cowpea (Vigna unguiculata L. Walp accessions from Nigeria

Directory of Open Access Journals (Sweden)

Ajayi Abiola Toyin

2013-01-01

Full Text Available The genetic variability among 10 accessions of cowpea, Vigna unguiculata (L. Walp was studied by the use of 13 qualitative and 13 quantitative traits. From the results on qualitative traits, dendrogram grouped the 10 accessions into two major clusters, 1 and 2.Cluster 1 had 3 accessions and cluster 2 had 2 sub-clusters (I and II, having 2 accessions in sub-cluster I and 5 accessions in sub-cluster II. The dendrogram revealed two major clusters, 1 and 2, for quantitative data, for the 10 accessions. At distance of 4 and 6, cluster 1 had two sub-clusters (I and II, with sub-cluster I having 5 accessions, sub-cluster II having 4 accessions while cluster 2 had only 1 accession. This study made the observation that identification of the right agro-morphological traits of high discriminating capacity is essential, before embarking on any genetic diversity; as it was revealed that some traits discriminated more efficiently among the accessions than others. A group of accessions, which are NGSA1, NGSA2, NGSA3, NGSA4, NGSA7, NGSA9 and NGSA10, was identified as being different from the others for number of seeds per pod, pod length, plant height, peduncle length, seed weight and number of pods per plant. These accessions may be good for cowpea improvement programs.

Postpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions.

Science.gov (United States)

McKenzie, Christine; Akdagli, Seden; Abir, Gillian; Carvalho, Brendan

2017-12-01

The primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL. An institutional-specific retrospective review of patients with ICD-9 procedure codes for PPTL over a 2-year period was conducted. Obstetric anesthesia fellowship directors were surveyed on anesthetic management of PPTL. Labor and delivery unit. Internet survey. 202 PPTL procedures were reviewed. 47 institutions were surveyed; 26 responses were received. Timing of PPTL, anesthetic management, postoperative pain and length of stay. There was an epidural catheter reactivation failure rate of 26% (18/69 epidural catheter reactivation attempts). Time from epidural catheter insertion to PPTL was a significant factor associated with failure: median [IQR; range] time for successful versus failed epidural catheter reactivation was 17h [10-25; 3-55] and 28h [14-33; 5-42], respectively (P=0.028). Epidural catheter reactivation failure led to significantly longer times to provide surgical anesthesia than successful epidural catheter reactivation or primary spinal technique: median [IQR] 41min [33-54] versus 15min [12-21] and 19min [15-24], respectively (P8h and >24h post-delivery, respectively. Epidural catheter reactivation failure increases with longer intervals between catheter placement and PPTL. Failed epidural catheter reactivation increases anesthetic and operating room times. Our results and the significant variability in practice from our survey suggest recommendations on the timing and anesthetic management are needed to reduce unfulfilled PPTL procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Access to scientific publications: the scientist's perspective.

Directory of Open Access Journals (Sweden)

Yegor Voronin

Full Text Available BACKGROUND: Scientific publishing is undergoing significant changes due to the growth of online publications, increases in the number of open access journals, and policies of funders and universities requiring authors to ensure that their publications become publicly accessible. Most studies of the impact of these changes have focused on the growth of articles available through open access or the number of open-access journals. Here, we investigated access to publications at a number of institutes and universities around the world, focusing on publications in HIV vaccine research--an area of biomedical research with special importance to the developing world. METHODS AND FINDINGS: We selected research papers in HIV vaccine research field, creating: 1 a first set of 50 most recently published papers with keywords "HIV vaccine" and 2 a second set of 200 articles randomly selected from those cited in the first set. Access to the majority (80% of the recently published articles required subscription, while cited literature was much more accessible (67% freely available online. Subscriptions at a number of institutions around the world were assessed for providing access to subscription-only articles from the two sets. The access levels varied widely, ranging among institutions from 20% to 90%. Through the WHO-supported HINARI program, institutes in low-income countries had access comparable to that of institutes in the North. Finally, we examined the response rates for reprint requests sent to corresponding authors, a method commonly used before internet access became widespread. Contacting corresponding authors with requests for electronic copies of articles by email resulted in a 55-60% success rate, although in some cases it took up to 1.5 months to get a response. CONCLUSIONS: While research articles are increasingly available on the internet in open access format, institutional subscriptions continue to play an important role. However

South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts.

Science.gov (United States)

Palep-Singh, M; Picton, H M; Vrotsou, K; Maruthini, D; Balen, A H

2007-10-01

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is required for PCOS cases that are refractory to standard ovulation induction or have co-existing infertility factors in women with PCOS and Tubal factor subfertility. Assess ethnic variations in response to IVF/ICSI treatment. Observational Comparative study in a University hospital fertility clinic in women with PCOS and Tubal factor subfertility. Women with PCOS (Asians: AP=104; Caucasians: CP=220) and those with tubal factor infertility seeking fertility treatment were assessed (Asians: AC=84; Caucasians: CC=200). Six hundred and eight fresh IVF or ICSI cycles using long protocol of GnRHa suppression and resulting in a fresh embryo transfer were compared. The primary endpoint was to assess the dose of gonadotropins used in the cycles. The secondary outcomes were: total number of oocytes retrieved, fertilization and ongoing clinical pregnancy rates. We found that the South Asian women presented at a younger age for the management of sub-fertility. An extended stimulation phase and Caucasian ethnicity showed an inverse correlation with the number of oocytes retrieved in the PCOS subgroup. Caucasian ethnicity was associated with a higher fertilization rate however increase in body mass index (BMI) and the laboratory technique of IVF appeared to have a negative impact on fertilization rates in the PCOS subgroup. Commencing down regulation on day 1 of the cycles was negatively associated with fertilization rates in the tubal group. In terms of clinical pregnancy rates, the Caucasian PCOS had a 2.5 times (95% CI: 1.25-5) higher chance of an ongoing clinical pregnancy as compared with their Asian counterpart. Also, a unit increase in the basal FSH concentration reduced the odds of pregnancy by 18.6% (95% CI: 1.8-32.6%) in the PCOS group. The Asian PCOS have a greater sensitivity to gonadotropin stimulation with lower fertilization and

Assessment of Low-Income Adults' Access to Technology: Implications for Nutrition Education

Science.gov (United States)

Neuenschwander, Lauren M.; Abbott, Angela; Mobley, Amy R.

2012-01-01

Objective: The main objective of this study was to investigate access and use of technologies such as the Internet among Indiana's low-income population. The secondary objective was to determine whether access and use of computers significantly differed by age, race, and/or education level. Methods: Data were collected from low-income adult…

Web accessibility of public universities in Andalusia

Directory of Open Access Journals (Sweden)

Luis Alejandro Casasola Balsells

2017-06-01

Full Text Available This paper describes an analysis conducted in 2015 to evaluate the accessibility of content on Andalusian public university websites. In order to determinate whether these websites are accessible, an assessment has been carried out to check conformance with the latest Web Content Accessibility Guidelines (WCAG 2.0 established by the World Wide Web Consortium (W3C. For this purpose, we have designed a methodology for analysis that combines the use of three automatic tools (eXaminator, MINHAP web accessibility tool, and TAW with a manual analysis to provide a greater reliability and validity of the results. Although the results are acceptable overall, a detailed analysis shows that more is still needed for achieving full accessibility for the entire university community. In this respect, we suggest several corrections to common accessibility errors for facilitating the design of university web portals.

Fitz‑Hugh‑Curtis syndrome: An incidental diagnostic finding in an ...

African Journals Online (AJOL)

Her husband's semen analysis was within normal range. She had a hysterosalpingogram that showed bilateral tubal blockage and clinical assessment showed right sided abdominal tenderness, cervical excitation tenderness, and adnexa tenderness. The endocervical swab test for Chlamydia trachomatis was a positive.

Accessible Earth: Enhancing diversity in the Geosciences through accessible course design

Science.gov (United States)

Bennett, R. A.; Lamb, D. A.

2017-12-01

The tradition of field-based instruction in the geoscience curriculum, which culminates in a capstone geological field camp, presents an insurmountable barrier to many disabled students who might otherwise choose to pursue geoscience careers. There is a widespread perception that success as a practicing geoscientist requires direct access to outcrops and vantage points available only to those able to traverse inaccessible terrain. Yet many modern geoscience activities are based on remotely sensed geophysical data, data analysis, and computation that take place entirely from within the laboratory. To challenge the perception of geoscience as a career option only for the non-disabled, we have created the capstone Accessible Earth Study Abroad Program, an alternative to geologic field camp for all students, with a focus on modern geophysical observation systems, computational thinking, data science, and professional development.In this presentation, we will review common pedagogical approaches in geosciences and current efforts to make the field more inclusive. We will review curricular access and inclusivity relative to a wide range of learners and provide examples of accessible course design based on our experiences in teaching a study abroad course in central Italy, and our plans for ongoing assessment, refinement, and dissemination of the effectiveness of our efforts.

Assessing Health Care Access and Use among Indigenous Peoples in Alberta: a Systematic Review.

Science.gov (United States)

Nader, Forouz; Kolahdooz, Fariba; Sharma, Sangita

2017-01-01

Alberta's Indigenous population is growing, yet health care access may be limited. This paper presents a comprehensive review on health care access among Indigenous populations in Alberta with a focus on the health care services use and barriers to health care access. Scientific databases (PubMed, EMBASE, CINAHL, and PsycINFO) and online search engines were systematically searched for studies and grey literature published in English between 2000 and 2013 examining health care services access, use and barriers to access among Indigenous populations in Alberta. Information on health care services use and barriers to use or access was synthesized based on the MOOSE guidelines. Overall, compared to non-Indigenous populations, health care use rates for hospital/emergency room services were higher and health care services use of outpatient specialists was lower among Indigenous peoples. Inadequate numbers of Indigenous health care professionals; a lack of cross-cultural training; fear of foreign environments; and distance from family and friends were barriers to health care use and access. Inequity in social determinants of health among Indigenous peoples and inadequate "health services with prevention approaches," may contribute to present health disparities between Indigenous and non-Indigenous populations in the province.

A national survey of UK health libraries investigating the cost of interlibrary loan services and assessing the accessibility to key orthopaedic journals.

Science.gov (United States)

Tahim, Arpan; Stokes, Oliver; Vedi, Vikas

2012-06-01

 NHS Library Services are utilised by NHS staff and junior trainees to locate scientific papers that provide them with the evidence base required for modern medical practice. The cost of accessing articles can be considerable particularly for junior trainees.  This survey looks at variations in cost of journal article loans and investigates access to particular orthopaedic journals across the country.  A national survey of UK Health Libraries was performed. Access to and costs of journals and interlibrary loan services were assessed. Availability of five wide-reaching orthopaedic journals was investigated.  Seven hundred and ten libraries were identified. One hundred and ten libraries completed the questionnaire (16.7%). Of these, 96.2% reported free access to scientific journals for users. 99.1% of libraries used interlibrary loan services with 38.2% passing costs on to the user at an average of £2.99 per article. 72.7% of libraries supported orthopaedic services. Journal of Bone and Joint Surgery (British) had greatest onsite availability.  The study demonstrates fluctuations in cost of access to interlibrary loan services and variation in access to important orthopaedic journals. It provides a reflection of current policy of charging for the acquisition of medical evidence by libraries in the UK. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

A discrete choice approach to modeling food store access

OpenAIRE

Amy Hillier; Tony Smith; Carolyn C Cannuscio; Allison Karpyn; Karen Glanz

2015-01-01

Assessments of access to healthful food frequently use GIS to measure the distance and concentration of food outlets relative to where residents live. These descriptive approaches do not account for food shopping behavior, which may vary based on the attributes of food shoppers and their activity space—places where they live, work, access resources, and socialize. Building on transportation research about accessibility, we reframe the issue of food access and equity from one about ‘what is ne...

Electronic information sources access and use for healthcare ...

African Journals Online (AJOL)

Background: Access to and use of electronic information sources for clinical decision is the key to the attainment of health related sustainable goals. Therefore, this study was to assess Electronic Information Sources (EIS) access and use for healthcare service among hospitals of Western Oromia, Ethiopia, 2013. Materials ...

An automated system for access to derived climate indices in support of ecological impacts assessments and resource management

Science.gov (United States)

Walker, J.; Morisette, J. T.; Talbert, C.; Blodgett, D. L.; Kunicki, T.

2012-12-01

A U.S. Geological Survey team is working with several providers to establish standard data services for the climate projection data they host. To meet the needs of climate adaptation science and landscape management communities, the team is establishing a set of climate index calculation algorithms that will consume data from various providers and provide directly useful data derivatives. Climate projections coming from various scenarios, modeling centers, and downscaling methods are increasing in number and size. Global change impact modeling and assessment, generally, requires inputs in the form of climate indices or values derived from raw climate projections. This requirement puts a large burden on a community not familiar with climate data formats, semantics, and processing techniques and requires storage capacity and computing resources out of the reach of most. In order to fully understand the implications of our best available climate projections, assessments must take into account an ensemble of climate projections and potentially a range of parameters for calculation of climate indices. These requirements around data access and processing are not unique from project to project, or even among projected climate data sets, pointing to the need for a reusable tool to generate climate indices. The U.S. Geological Survey has developed a pilot application and supporting web service framework that automates the generation of climate indices. The web service framework consists of standards-based data servers and a data integration broker. The resulting system allows data producers to publish and maintain ownership of their data and data consumers to access climate derivatives via a simple to use "data product ordering" workflow. Data access and processing is completed on enterprise "cloud" computing resources and only the relatively small, derived climate indices are delivered to the scientist or land manager. These services will assist the scientific and land

[Clinical Value of Prophylactic Salpingectomy in Hysterectomy due to Uterine Benign Lesions].

Science.gov (United States)

Zhao, Ling-Jun; Wang, Ping; Li, Xiu-Ying

2017-03-01

To explore the clinical value of resection of bilateral fallopian tubes in patients with benign uterine diseases who received (laparoscopic) hysterectomy or subhysterectomy through the postoperative pathologic analysis of resected fallopian tubes. A retrospective analysis was conducted to review the histopathological examination results in 1 272 women who underwent (laparoscopic) total hysterectomy or subtotal hysterectomy and the removal of bilateral fallopian tube simultaneously due to uterine leiomyoma, adenomyosis and other benign lesions from December 2010 to December 2015. Of the 1 272 patients, laparoscopic resection was underwent in 1 005 patients (79.01%) and laparotomy in 267 patients (20.99%). In the attachment area, 334 patients (26.26%) had tenderness signs, and 401 patients (31.53%) had signs of thickening. Total 2 498 fallopian tubes were removed. There were 1 654 tubal with no obvious abnormal appearance (66.21%), 636 tubal with lumen part of the uplift (25.46%), 128 fallopian tube with congestion and swelling (5.12%), 80 fallopian tube atrophy adhesions (3.20%). Pathological. showed 2 386 (95.52%) fallopian tubes with chronic fallopian tube inflammation, 988 (39.55%) of fallopian tube cyst, 80 (3.20%) of normal fallopian tube, 78 (3.12%) of tubal effusion, 48 (1.92% ) of tubal hyperplasia, 4 (0.26%) of tubal benign tumor, 8 (0.32%) of tubal mucosa atypical hyperplasia change and 2(0.08%) of tubal cancer. In the 10 cases of fallopian tube cancer and atypical hyperplasia, 8 had obvious changes of chronic inflammation in the contralateral fallopian tube, including 7 cases of atypical hyperplasia and 1 case of fallopian tube cancer. Prophylactic salpingectomy can prevent the occurrence of tubal inflammation and removal cancer incentives.

Cowpea fresh pods - a new legume for the market: assessment of their quality and dietary characteristics of 37 cowpea accessions grown in southern Europe.

Science.gov (United States)

Karapanos, Ioannis; Papandreou, Anastasia; Skouloudi, Marianna; Makrogianni, Despoina; Fernández, Juan A; Rosa, Eduardo; Ntatsi, Georgia; Bebeli, Penelope J; Savvas, Dimitrios

2017-10-01

Cowpea is traditionally cultivated in some regions of southern Europe for its dried seeds; however, there is a scarcity of information on the quality and dietary characteristics of fresh pods, which are occasionally used in folk diets. This paper aims at covering this gap in knowledge, thereby contributing to the dissemination of fresh cowpea pods as a novel product for the market. The quality and dietary characteristics of pods from 37 accessions (Vigna unguiculata ssp. unguiculata and ssp. sesquipedalis) grown in southern Europe were assessed in an attempt to provide information on pod quality and nutritional properties and to identify relationships between quality traits and accession origin. Pods from the sesquipedalis accessions were heavier and larger, and reached commercial maturity 2 days later, than those from the unguiculata accessions. There were also large differences in the quality and dietary characteristics of the accessions. The pods of most accessions were rich in proteins, chlorophylls, carotenoids and phenolics, and showed high antioxidant activity and low concentrations of nitrates and raffinose-family oligosaccharides. Cluster analysis based on quality, dietary or antinutritional traits did not reveal any apparent grouping among the accessions. All the quality characteristics were independent of accession origin and subspecies. Most of the accessions produced fresh pods of good quality and high dietary value, suitable for introduction in the market and/or for use as valuable genetic material for the development of new improved varieties. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Chlamydia trachomatis Antibody Testing in Vaginal Mucosal Material versus Blood Samples of Women Attending a Fertility Clinic and an STI Clinic

NARCIS (Netherlands)

van den Broek, I.V.F.; Land, J.A.; van Bergen, J.E.A.M.; Morré, S.A.; van der Sande, M.A.B.

2014-01-01

Background. Chlamydia infections often follow an asymptomatic course but may damage the reproductive tract. Chlamydia antibodies in serum are used as markers for past infections and can relate to tubal pathology and infertility. This "proof of principle" study aimed to assess whether Chlamydia

Secondary abdominal appendicular ectopic pregnancy.

Science.gov (United States)

Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac

2007-01-01

Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.

Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective

Directory of Open Access Journals (Sweden)

Maria Wiklund

2016-08-01

Full Text Available Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain. Objective: This study explores patient accounts and perceptions about important (social factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic. Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation. Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight. The character of diagnosis received (medical versus psychiatric or social was also noted. Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

A multisite audit to assess how women with complex social factors access and engage with maternity services.

Science.gov (United States)

Rayment-Jones, Hannah; Butler, Eleanor; Miller, Chelsie; Nay, Christine; O'Dowd, Jennifer

2017-09-01

to audit women with socially complex lives' documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes. women living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care. data was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences. non-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable. this data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Access road from State Route 240 to the 200 West Area, Hanford Site, Richland, Washington: Environmental assessment

Energy Technology Data Exchange (ETDEWEB)

1994-02-01

The US Department of Energy (DOE) proposes to construct an access road on the Hanford Site, from State Route (SR) 240 to Beloit Avenue in the 200 West Area. Traffic volume during shift changes creates an extremely serious congestion and safety problem on Route 4S from the Wye barricade to the 200 Areas. A Risk Evaluation (Trost 1992) indicated that there is a probability of 1.53 fatal accidents on Route 4S within 2 years. To help alleviate this danger, a new 3.5-kilometer (2.2-mile)-long access road would be constructed from Beloit Avenue in the 200 West Area to SR 240. In addition, administrative controls such as redirecting traffic onto alternate routes would be used to further reduce traffic volume. The proposed access road would provide an alternative travel-to-work route for many outer area personnel, particularly those with destinations in the 200 West Area. This proposal is the most reasonable alternative to reduce the problem. While traffic safety would be greatly improved, a small portion of the shrub-steppe habitat would be disturbed. The DOE would offset any habitat damage by re-vegetation or other appropriate habitat enhancement activities elsewhere on the Hanford Site. This Environmental Assessment (EA) provides information about the environmental impacts of the proposed action, so a decision can be made to either prepare an Environmental Impact Statement or issue a Finding of No Significant Impact.

Assessing the accessibility and degree of development in health care resources: evidence from the West of Iran

Directory of Open Access Journals (Sweden)

Satar Rezaei

2016-04-01

Full Text Available Introduction: Health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011. Method: This was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and Hamadan. For assessing these towns in terms of the degree of development in healthcare resources by the numerical taxonomy technique, 23 indicators of health resources were selected and obtained from the statistics yearbook. The data was analyzed by EXCEL software. Results:Our study showed that the highest and lowest access to health care based on numerical taxonomy belonged to cities of Kermanshah (0.61 and Salas Babajani (1.07. Also, most towns of Ilam, Lorestan and Kurdistan provinces are underdeveloped and developing, while the most towns of Kermanshah and Hamadan provinces were placed in the developed region. Conclusion: This study showed that there was a large gap between the cities of one province and also among the provinces in terms of the access to and degree of development in health care resources. Therefore, it is suggested that a higher priority in terms of health resource allocation should be placed on the developing and underdeveloped areas in order to reduce these disparities.

Hysterosalpingography and laparoscopy in infertile women

International Nuclear Information System (INIS)

Konarzewska, J.; Bianek-Bodzak, A.; Mielcarek, P.; Kobierski, J.

2009-01-01

Background: Despite dynamic development of diagnostic imaging methods and endoscopic procedures, X-ray hysterosalpingography remains the basic diagnostic procedure when anatomical cause of infertility is suspected. The aim of the study was to assess the correlation between HSG results and laparoscopy findings, especially in infertile women with normal results of hysterosalpingography. Material/Methods: The results of HSG and laparoscopies performed between 2002 and 2005 years in 53 infertile women were analyzed retrospectively. The indication for HSG was primary infertility in 44 cases and secondary infertility in 9 cases.Results: The result of HSG was normal in 51%. Pathological findings were observed in 49% of HSG and in 93% of laparoscopies. The most common pathological findings observed during laparoscopy were tubal occlusion (26% cases) and endometriosis (25% cases). Polycystic ovaries and myomas were observed in 20% of the performed laparoscopies. HSG and laparoscopy yield consistent results in evaluation of tubal patency (p < 0.001). Conclusions: HSG remains the method of first choice in the diagnostics of uterine malformations and tubal diseases as causes of infertility. When mechanical factors of female infertility are suspected, HSG allows the optimal choice of more invasive procedure. (authors)

Assessing the value and market attractiveness of the accessible tourism industry in Europe: a focus on major travel and leisure companies

Directory of Open Access Journals (Sweden)

James Bowtell

2015-10-01

Full Text Available Purpose – The purpose of this paper is to examine the accessible tourism market potential, alongside the implications of operating in the accessible tourism market and an assessment of major travel and leisure company involvement. The research focused on providing a market value forecast using historic data from 2005 and extrapolating this to 2025. An examination of the reasons for and against major travel and leisure company involvement in the accessible tourism market was accompanied by an analysis of managerial perceptions. Design/methodology/approach – The exploration of travel patterns of disabled tourists, in particular spend per head per holiday, was used to measure the value of the demand side of accessible tourism. Semi-structured interviews were carried out with employees of major travel and leisure companies in managerial positions. Findings – The study indicates that the accessible tourism market is a distinct sector, possessing the capacity for extensive future growth, and thus presents major travel providers with a potentially substantial and lucrative market, generating potential revenues of �88.6 billion by 2025. Research limitations/implications – Due to a lack of existing data an assumption had to be made on the evolution of travel spend per head per holiday. However, the formula used, using GDP/Capita growth, is a recognised way of forecasting this kind of data in the travel and leisure industry. Originality/value – This is the first paper to provide an examination of the reasons for and against major travel and leisure company involvement in the accessible tourism market, as well providing a forecast of the market value up to 2025.

[Utilization of Essure® micro-insert for hydrosalpynx occlusion in infertile women].

Science.gov (United States)

Thébault, N; Broux, P-L; Moy, L; Vialard, J

2012-04-01

To assess the feasibility and the results on fertility of tubal hysteroscopic proximal occlusion with Essure(®) micro-insert in women with hydrosalpinges. Thirteen infertile women with hydrosalpinges, who underwent hysteroscopic tubal exclusion by Essure(®) prior to IVF procedure. The placement of micro-insert was feasible and easy in every patient, with no intra-operative complication. Only one postoperative infectious complication (pyosalpinx) occurred. We report a 64 % rate of pregnancy, and a 18 % rate of normally ongoing pregnancies with no Essure(®)-related complication. Hydrosalpinges occlusion by Essure(®) device might be an easy and safe alternative to laparoscopic treatment, with successful results on fertility and without adverse effects on pregnancy outcomes. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

One-step transvaginal three-dimensional hysterosalpingo-foam sonography (3D-HyFoSy) confirmation test for Essure® follow-up: a multicenter study.

Science.gov (United States)

Zizolfi, B; Lazzeri, L; Franchini, M; Di Spiezio Sardo, A; Nappi, C; Piccione, E; Exacoustos, C

2018-01-01

To evaluate, in patients who underwent Fallopian-tube sterilization by hysteroscopic insertion of an Essure® device, the feasibility and accuracy of three-dimensional (3D) transvaginal sonography (TVS) to check the position of the device and 3D hysterosalpingo-foam sonography (3D-HyFoSy) using contrast-enhanced gel foam to assess consequent tubal occlusion. This was a prospective multicenter study conducted from June 2012 to July 2014 in four Italian centers, which included 50 women who underwent hysteroscopic Essure microinsert placement in a total of 95 Fallopian tubes. Placement of the microinserts was performed in an outpatient setting following standard procedure recommendations. All patients underwent transvaginal 3D-HyFoSy and hysterosalpingography (HSG) approximately 12-14 weeks after the procedure. The position of the devices was first checked on 3D-TVS and classified according to specific criteria (Positions A, B, C and D). Then, 3D-HyFoSy with ExEm® gel foam as the ultrasound contrast agent was performed to confirm tubal occlusion by the absence of contrast agent within the tubes and/or around the ovaries. To evaluate the feasibility of 3D-HyFoSy, consecutive volume acquisitions were performed while injecting the gel foam. After sonographic evaluation, women underwent HSG to assess the success of sterilization, as standard methodology. Side effects and pain evoked during and after 3D-HyFoSy and HSG were evaluated using a numeric pain rating scale. On 3D-TVS, 10 devices (10.5%) were in Position A, two (2.1%) in Position B, 59 (62.1%) in Position C and 24 (25.3%) in Position D. During 3D-HyFoSy, tubal occlusion was observed in 89 of 95 tubes (93.7%). In the six cases in which the passage of the contrast was observed, one device (16.7%) was in Position B, one device (16.7%) in Position D and four devices (66.7%) were found to lie in Position C. Tubal patency was confirmed at HSG with a concordance rate of 100%. The mean pain score associated with 3D

Accession Medical Standards Analysis and Research Activity (AMSARA), 2016 Annual Report

Science.gov (United States)

2016-11-01

NOTES The original document contains color photos. And four Supplemental Applicants and Accessions tables for: Army, Air Force, Marine, and Navy 14...accession characteristics and risk of attrition in the accessed population. T\\.VO manuscripts focus on the Assessment of Recruit Motivation and Strength...programs to improve military readiness by maximizing both the accession and retention of motivated and capable recruits. This report provides abstracts

Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments; Durchleuchtungsgesteuerte Eileiter-Rekanalisation mit vereinfachtem Instrumentarium

Energy Technology Data Exchange (ETDEWEB)

Schmitz-Rode, T.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Neulen, J. [Technische Hochschule Aachen (Germany). Frauenklinik fuer gynaekologische Endokrinologie und Reproduktionsmedizin

2004-10-01

Purpose: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. Materials and Methods: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. Results: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88%). The resulting fertility rate was 30% (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. (orig.)

Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments

International Nuclear Information System (INIS)

Schmitz-Rode, T.; Guenther, R.W.; Neulen, J.

2004-01-01

Purpose: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. Materials and Methods: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. Results: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88%). The resulting fertility rate was 30% (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. (orig.)

Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies.

Science.gov (United States)

Gonczi, Lorant; Kurti, Zsuzsanna; Golovics, Petra Anna; Lovasz, Barbara Dorottya; Menyhart, Orsolya; Seres, Anna; Sumegi, Liza Dalma; Gal, Alexander; Ilias, Akos; Janos, Papp; Gecse, Krisztina Barbara; Bessisow, Talat; Afif, Waqqas; Bitton, Alain; Vegh, Zsuzsanna; Lakatos, Peter Laszlo

2018-01-01

In the management of inflammatory bowel diseases, there is considerable variation in quality of care. The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center. In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years). Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients. Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Open access journals – what publishers offer, what researchers want

CERN Document Server

Dallmeier-Tiessen, Suenje; Goerner, Bettina; Hyppoelae, Jenni; Igo-Kemenes, Peter; Kahn, Deborah; Lamber, Simon; Lengenfelder, Anja; Leonard, Chris; Mele, Salvatore; Nowicka, Malgorzata; Polydoratou, Panayiota; Ross, David; Ruiz-Perez, Sergio; Schimmer, Ralf; Swaisland, Mark; van der Stelt, Wim

2011-01-01

The SOAP (Study of Open Access Publishing) project has analyzed the current supply and demand situation in the open access journal landscape. Starting from the Directory of Open Access Journals, several sources of data were considered, including journal websites and direct inquiries within the publishing industry to comprehensively map the present supply of online peer-reviewed OA journals. The demand for open access publishing is summarised, as assessed through a large-scale survey of researchers' opinions and attitudes. Some forty thousand answers were collected across disciplines and around the world, reflecting major support for the idea of open access, while highlighting drivers of and barriers to open access publishing.

What Are Women Told When Requesting Family Planning Services at Clinics Associated with Catholic Hospitals? A Mystery Caller Study.

Science.gov (United States)

Guiahi, Maryam; Teal, Stephanie B; Swartz, Maryke; Huynh, Sandy; Schiller, Georgia; Sheeder, Jeanelle

2017-12-01

Catholic Church directives restrict family planning service provision at Catholic health care institutions. It is unclear whether obstetrics and gynecology clinics that are owned by or have business affiliations with Catholic hospitals offer family planning appointments. Mystery callers phoned 144 clinics nationwide that were found on Catholic hospital websites between December 2014 and February 2016, and requested appointments for birth control generally, copper IUD services specifically, tubal ligation and abortion. Chi-square and Fisher's exact tests assessed potential correlates of appointment availability, and multivariable logistic regressions were computed if bivariate testing suggested multiple correlates. Although 95% of clinics would schedule birth control appointments, smaller proportions would schedule appointments for copper IUDs (68%) or tubal ligation (58%); only 2% would schedule an abortion. Smaller proportions of Catholic-owned than of Catholic-affiliated clinics would schedule appointments for birth control (84% vs. 100%), copper IUDs (4% vs. 97%) and tubal ligation (29% vs. 72%); for birth control and copper IUD services, no other clinic characteristics were related to appointment availability. Multivariable analysis confirmed that tubal ligation appointments were less likely to be offered at Catholic-owned than at Catholic-affiliated clinics (odds ratio. 0.1); location and association with one of the top 10 Catholic health care systems also were significant. Adherence to church directives is inconsistent at Catholic-associated clinics. Women visiting such clinics who want highly effective methods may need to rely on less effective methods or delay method uptake while seeking services elsewhere. Copyright © 2017 by the Guttmacher Institute.

Radioisotope study of Eustachian tube

International Nuclear Information System (INIS)

De Rossi, G.; Campioni, P.; Vaccaro, A.

1988-01-01

Radioisotope studies of Eustachian tube are suggested in the preoperative phase of tympanoplasty, in order to assess tubal drainage and secretion. The use of gamma camera fitted to a computer allowed the AA, to calculate some semi-quantitative parameters for an exact assessment of the radioactivity transit from the tympanic cass up to the pharyngeal cavity, throughout the Eustachian tube. (orig.) [de

Proposing a Master's Programme on Participatory Integrated Assessment of Energy Systems to Promote Energy Access and Energy Efficiency in Southern Africa

Science.gov (United States)

Kiravu, Cheddi; Diaz-Maurin, François; Giampietro, Mario; Brent, Alan C.; Bukkens, Sandra G.F.; Chiguvare, Zivayi; Gasennelwe-Jeffrey, Mandu A.; Gope, Gideon; Kovacic, Zora; Magole, Lapologang; Musango, Josephine Kaviti; Ruiz-Rivas Hernando, Ulpiano; Smit, Suzanne; Vázquez Barquero, Antonio; Yunta Mezquita, Felipe

2018-01-01

Purpose: This paper aims to present a new master's programme for promoting energy access and energy efficiency in Southern Africa. Design/methodology/approach: A transdisciplinary approach called "participatory integrated assessment of energy systems" (PARTICIPIA) was used for the development of the curriculum. This approach is based on…

Comparison of hysterosalpingograms with laparoscopy in the ...

African Journals Online (AJOL)

Introduction: The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. Methods: We conducted a comparative cross sectional study on 208 medical files of infertile women ...

Overcoming male factor infertility with intracytoplasmic sperm injection.

Science.gov (United States)

Borges, Edson; Zanetti, Bianca Ferrarini; Braga, Daniela Paes de Almeida Ferreira; Setti, Amanda Souza; Figueira, Rita de Cássia Sávio; Nardi, Aguinaldo César; Iaconelli, Assumpto

2017-08-01

To evaluate the effect of male factor infertility on intracytoplasmic sperm injection (ICSI) outcomes compared with a control group presenting isolated tubal factor. This retrospective study included 743 couples undergoing ICSI as a result of isolated male factor and a control group consisting of 179 couples undergoing ICSI as a result of isolated tubal factor, performed in a private university- -affiliated in vitro fertilization center, between January/2010 and December/2016. Patients were divided into two groups according to maternal age: women ≤35 years old and >35 years old. The effects of infertility causes on laboratorial and clinical ICSI outcomes were evaluated using Student's t-test and (2 test. No differences in controlled ovarian stimulation outcomes were observed between male factor cycles and tubal factor cycles in the two age groups. Implantation (male factor 35.5% vs. tubal factor 32.0%, p=0.340), pregnancy (male factor 46.9% vs. tubal factor 40.9%, p=0.184) and miscarriage (male factor 10.3% vs. tubal factor 10.6%, p=0.572) rates were similar between the infertility groups, irrespective of female age. Considering maternal age, the cancelation rate was higher in older women (>35 years old) undergoing ICSI as a result of male factor infertility (17.4% vs. 8.9%, p=0.013). Our results showed that there is no difference in the outcomes of pregnancy between couples with male or tubal factor infertility, which indicates that ICSI surpasses the worse specific outcomes associated with male factor.

Accessibility of health clubs for people with mobility disabilities and visual impairments.

Science.gov (United States)

Rimmer, James H; Riley, Barth; Wang, Edward; Rauworth, Amy

2005-11-01

We sought to examine the accessibility of health clubs to persons with mobility disabilities and visual impairments. We assessed 35 health clubs and fitness facilities as part of a national field trial of a new instrument, Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE), designed to assess accessibility of fitness facilities in the following domains: (1) built environment, (2) equipment, (3) swimming pools, (4) information, (5) facility policies, and (6) professional behavior. All facilities had a low to moderate level of accessibility. Some of the deficiencies concerned specific Americans with Disabilities Act guidelines pertaining to the built environment, whereas other deficiency areas were related to aspects of the facilities' equipment, information, policies, and professional staff. Persons with mobility disabilities and visual impairments have difficulty accessing various areas of fitness facilities and health clubs. AIMFREE is an important tool for increasing awareness of these accessibility barriers for people with disabilities.

Preferential Market Access, Foreign Aid and Economic Development

DEFF Research Database (Denmark)

Afesorgbor, Sylvanus Kwaku; Abreha, Kaleb Girma

contributed to the economic development of the beneficiary countries. Focusing on the ACP countries over the period 1970-2009, we show that only the EU preferential scheme is effective in promoting exports and that market access plays a significant and economically large role in the development of beneficiary......Several studies highlight that exporters in developing countries face substantial trade costs. To reduce these costs, a few developed countries mainly Canada, the EU, Japan and the USA granted preferential market access to these exporters. We assess whether these preferential accesses have...

Genetic relationships and diversity of Jatropha curcas accessions in ...

African Journals Online (AJOL)

This study has been undertaken to assess the extent of genetic diversity in a representative set of 16 accessions of Jatropha curcas. Inter-simple sequence repeat (ISSR) analysis was used to establish the genetic relationship among the accessions. From the eight ISSR primers used, the number of amplicons per primers ...

Teenagers’ access to contraception in Mexico City

Directory of Open Access Journals (Sweden)

Sofía Gómez-Inclán

2017-05-01

Full Text Available Objective. To study and understand the phenomenon of access to contraceptive methods in Mexican teenages, through the use of the Levesque model, which allows for the observation of both the system and the system and the user´s participation in the access process. Materials and methods. A qualitative study was conducted with focus groups technique in a middle and high school of Mexico City. Results. The perception of ability to access to health care is limited, teenagers do not know the mechanisms of care or supply of contraceptive methods. Prejudices of service providers provoke a negative reaction. The family is a source of information for adolescents to make decisions. Conclusions. The model allowed the assessment of access to contraceptive methods in teenagers. It were identified dif­ferent aspects that act as barriers to access and may inform health care providers about this population in their sexual and reproductive health.

Environmental assessment for the Area 5 radioactive waste management site access improvement at the Nevada Test Site

International Nuclear Information System (INIS)

1997-11-01

The United States Department of Energy has prepared an Environmental Assessment which analyzes the potential environmental effects of improving access to its AREA 5 RWMS at the NTS. The EA evaluates the potential impacts of constructing an extension of the Cane Springs Road between Mercury Highway and the 5-01 Road. Three alternative actions are also evaluated: (1) construction of a new road along the existing alignment of the Powerline Road between Mercury Highway and the 5-01 Road, (2) upgrading the existing 5-01 Road, and (3) taking no action. The purpose and need for improving access to the RWMS are addressed in Section 1.0 of the EA. A detailed description of the proposed action and alternatives is in Section 2.0. Section 3.0 describes the affected environment and Section 4.0 the environmental effects of the proposed action and alternatives. Health and transportation effects, accident scenarios, cumulative effects, and other relevant information are found in Sections 5.0 through 12.0 of the EA. DOE determined that the alternative action of upgrading the existing 5-01 Road would best meet the needs of the agency

Rural adolescents' access to adolescent friendly health services.

Science.gov (United States)

Secor-Turner, Molly A; Randall, Brandy A; Brennan, Alison L; Anderson, Melinda K; Gross, Dean A

2014-01-01

The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Factors associated with health care access and outcome.

Science.gov (United States)

Paek, Min-So; Lim, Jung-Won

2012-01-01

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

Access control within military C4ISR systems

Science.gov (United States)

Maschino, Mike

2003-07-01

Command, Control, Communications, Computers, Intelligence, Surveillance and Reconnaissance (C4ISR) tactical battlefield systems must provide the right information and resources to the right individuals at the right time. At the same time, the C4ISR system must enforce access controls to prevent the wrong individuals from obtaining sensitive information, or consuming scarce resources. Because lives, missions and property depend upon them, these access control mechanisms must be effective, reliable, efficient and flexible. The mechanisms employed must suit the nature of the items that are to be protected, as well as the varieties of access policies that must be enforced, and the types of access that will be made to these items. Some access control technologies are inherently centralized, while others are suitable for distributed implementation. The C4ISR architect must select from among the available technologies a combination of mechanisms that eases the burden of policy administration, but is inherently survivable, accurate, resource efficient, and which provides low latency. This paper explores various alternative access enforcement mechanisms, and assesses their effectiveness in managing policy-driven access control within the battlespace.

Let us make impact assessment more accessible

International Nuclear Information System (INIS)

Alton, Charles C.; Underwood, P. Benjamin

2003-01-01

Impact assessment professionals have traditionally written documents for themselves. Often, their work appears to be received with indifference by business professionals and decision makers who have different needs and interests. The two groups conflict when they should be thinking and planning together at the 'big picture' level (including the understanding of the social factors at work in environmental impact assessment) and developing related and workable 'site-specific' implementation that characterizes socially acceptable decision making. To achieve this goal, the IA professional needs to rethink the approach. IA professionals often focus on the traditional 'physical' environment, confining the assessment to facts and figures about hard aspects of the environment. Reams of detailed data are compiled to demonstrate impact assessment and to achieve a degree of certainty and precision. However, the sheer bulk of data assures that it will not be read by those who most need to use it. The IA professional must learn to prepare assessments that effectively consider less quantifiable, 'softer' aspects of the environment. We advocate preparation of an impact analysis that management decision makers and environmental stewards can use as a reference tool. The goal is to reduce or eliminate the hundreds of unread pages containing lengthy modeling runs and obscure details, and instead to prepare documents that are useful in both courtroom and boardroom. This convenient and quick-study 'consumer report' style combines with a tiered decision making process that assures broad long-term thinking and planning, and focused short-term detailed implementation, using a level of detail appropriate to the decision at hand. This methodology integrates social factors into decision making, so as to provide meaningful discussion and analysis. These principles, which have been proven in US boardrooms and courtrooms, will be illustrated with actual examples from broad policy-level impact

Ballistic representation for kinematic access

Science.gov (United States)

Alfano, Salvatore

2011-01-01

This work uses simple two-body orbital dynamics to initially determine the kinematic access for a ballistic vehicle. Primarily this analysis was developed to assess when a rocket body might conjunct with an orbiting satellite platform. A family of access opportunities can be represented as a volume for a specific rocket relative to its launch platform. Alternately, the opportunities can be represented as a geographical footprint relative to aircraft or satellite position that encompasses all possible launcher locations for a specific rocket. A thrusting rocket is treated as a ballistic vehicle that receives all its energy at launch and follows a coasting trajectory. To do so, the rocket's burnout energy is used to find its equivalent initial velocity for a given launcher's altitude. Three kinematic access solutions are then found that account for spherical Earth rotation. One solution finds the maximum range for an ascent-only trajectory while another solution accommodates a descending trajectory. In addition, the ascent engagement for the descending trajectory is used to depict a rapid access scenario. These preliminary solutions are formulated to address ground-, sea-, or air-launched vehicles.

Achieving open access to conservation science.

Science.gov (United States)

Fuller, Richard A; Lee, Jasmine R; Watson, James E M

2014-12-01

Conservation science is a crisis discipline in which the results of scientific enquiry must be made available quickly to those implementing management. We assessed the extent to which scientific research published since the year 2000 in 20 conservation science journals is publicly available. Of the 19,207 papers published, 1,667 (8.68%) are freely downloadable from an official repository. Moreover, only 938 papers (4.88%) meet the standard definition of open access in which material can be freely reused providing attribution to the authors is given. This compares poorly with a comparable set of 20 evolutionary biology journals, where 31.93% of papers are freely downloadable and 7.49% are open access. Seventeen of the 20 conservation journals offer an open access option, but fewer than 5% of the papers are available through open access. The cost of accessing the full body of conservation science runs into tens of thousands of dollars per year for institutional subscribers, and many conservation practitioners cannot access pay-per-view science through their workplace. However, important initiatives such as Research4Life are making science available to organizations in developing countries. We urge authors of conservation science to pay for open access on a per-article basis or to choose publication in open access journals, taking care to ensure the license allows reuse for any purpose providing attribution is given. Currently, it would cost $51 million to make all conservation science published since 2000 freely available by paying the open access fees currently levied to authors. Publishers of conservation journals might consider more cost effective models for open access and conservation-oriented organizations running journals could consider a broader range of options for open access to nonmembers such as sponsorship of open access via membership fees. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of the Society for

Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level.

Science.gov (United States)

O'Connell, Thomas S; Bedford, K Juliet A; Thiede, Michael; McIntyre, Di

2015-06-09

A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. To adequately understand access barriers as a

Open-access publishing for pharmacy-focused journals.

Science.gov (United States)

Clauson, Kevin A; Veronin, Michael A; Khanfar, Nile M; Lou, Jennie Q

2008-08-15

Pharmacy-focused journals that are available in open-access (OA), freely accessible, hybrid, or traditional formats were identified. Relevant journals were accessed from PubMed, International Pharmaceutical Abstracts, EMBASE, and the Pharmacology and Pharmacy category of Thomson Scientific Journal Citation Reports. Criteria were established to select journals that satisfied the definition of pharmacy focused. Journals were assessed based on accessibility, copyright transfer requirements, and restrictions. If tracked, the journal's impact factor (IF) was identified according to classification, and medians were calculated for each journal category. A total of 317 pharmacy-focused journals were identified. The majority of pharmacy-focused journals identified were traditional/non-OA (n = 240). A smaller number of journals were freely accessible/ non-OA (n = 37), freely accessible/non-OA with content restrictions (n = 20), or freely available/non-OA with date restrictions (n = 18). The fewest number of journals were completely OA (n = 2). The median IF for the 185 journals whose IF was tracked was 2.029. The median IF for freely accessible and hybrid journals (n = 42) was 2.550, whereas the median IF for traditional journals (n = 143) was 1.900. A very small number of pharmacy-focused journals adhere to the OA paradigm of access. However, journals that adopt some elements of the OA model, chiefly free accessibility, may be more likely to be cited than traditional journals. Pharmacy practitioners, educators, and researchers could benefit from the advantages that OA offers but should understand its financial disadvantages.

SSR-based genetic diversity and structure of garlic accessions from Brazil.

Science.gov (United States)

da Cunha, Camila Pinto; Resende, Francisco Vilela; Zucchi, Maria Imaculada; Pinheiro, José Baldin

2014-10-01

Garlic is a spice and a medicinal plant; hence, there is an increasing interest in 'developing' new varieties with different culinary properties or with high content of nutraceutical compounds. Phenotypic traits and dominant molecular markers are predominantly used to evaluate the genetic diversity of garlic clones. However, 24 SSR markers (codominant) specific for garlic are available in the literature, fostering germplasm researches. In this study, we genotyped 130 garlic accessions from Brazil and abroad using 17 polymorphic SSR markers to assess the genetic diversity and structure. This is the first attempt to evaluate a large set of accessions maintained by Brazilian institutions. A high level of redundancy was detected in the collection (50 % of the accessions represented eight haplotypes). However, non-redundant accessions presented high genetic diversity. We detected on average five alleles per locus, Shannon index of 1.2, HO of 0.5, and HE of 0.6. A core collection was set with 17 accessions, covering 100 % of the alleles with minimum redundancy. Overall FST and D values indicate a strong genetic structure within accessions. Two major groups identified by both model-based (Bayesian approach) and hierarchical clustering (UPGMA dendrogram) techniques were coherent with the classification of accessions according to maturity time (growth cycle): early-late and midseason accessions. Assessing genetic diversity and structure of garlic collections is the first step towards an efficient management and conservation of accessions in genebanks, as well as to advance future genetic studies and improvement of garlic worldwide.

Accessible Knowledge - Knowledge on Accessibility

DEFF Research Database (Denmark)

Kirkeby, Inge Mette

2015-01-01

Although serious efforts are made internationally and nationally, it is a slow process to make our physical environment accessible. In the actual design process, architects play a major role. But what kinds of knowledge, including research-based knowledge, do practicing architects make use of when...... designing accessible environments? The answer to the question is crucially important since it affects how knowledge is distributed and how accessibility can be ensured. In order to get first-hand knowledge about the design process and the sources from which they gain knowledge, 11 qualitative interviews...... were conducted with architects with experience of designing for accessibility. The analysis draws on two theoretical distinctions. The first is research-based knowledge versus knowledge used by architects. The second is context-independent knowledge versus context-dependent knowledge. The practitioners...

Assessing the Doha Round: Market Access, Transactions Costs and Aid for Trade Facilitation

OpenAIRE

Hoekman, Bernard; Nicita, Alessandro

2010-01-01

This paper compares the predicted trade impacts of a successful Doha Round with the trade effects of actions aimed at reducing domestic trade costs for traders in developing countries and the world as a whole. We show that a relatively small reduction in trade costs will generate trade impacts that are larger than what is likely to emerge even from a relatively ambitious Doha Round market access outcome. This illustrates the importance of complementing market access commitments with measures ...

Using routinely collected health data for surveillance, quality improvement and research: Framework and key questions to assess ethics, privacy and data access

Directory of Open Access Journals (Sweden)

Simon de Lusignan

2016-01-01

Full Text Available Background The use of health data for public health, surveillance, quality improvement and research is crucial to improve health systems and health care. However, bodies responsible for privacy and ethics often limit access to routinely collected health data. Ethical approvals, issues around protecting privacy and data access are often dealt with by different layers of regulations, making approval processes appear disjointed.Objective To create a comprehensive framework for defining the ethical and privacy status of a project and for providing guidance on data access.Method The framework comprises principles and related questions. The core of the framework will be built using standard terminology definitions such as ethics-related controlled vocabularies and regional directives. It is built in this way to reduce ambiguity between different definitions. The framework is extensible: principles can be retired or added to, as can their related questions. Responses to these questions should allow data processors to define ethical issues, privacy risk and other unintended consequences.Results The framework contains three steps: (1 identifying possible ethical and privacy principles relevant to the project; (2 providing ethics and privacy guidance questions that inform the type of approval needed; and (3 assessing case-specific ethics and privacy issues. The outputs from this process should inform whether the balance between public interests and privacy breach and any ethical considerations are tipped in favour of societal benefits. If they are then this should be the basis on which data access is permitted. Tightly linking ethical principles to governance and data access may help maintain public trust.

Using routinely collected health data for surveillance, quality improvement and research: Framework and key questions to assess ethics, privacy and data access.

Science.gov (United States)

De Lusignan, Simon; Liyanage, Harshana; Di Iorio, Concetta Tania; Chan, Tom; Liaw, Siaw-Teng

2016-01-19

The use of health data for public health, surveillance, quality improvement and research is crucial to improve health systems and health care. However, bodies responsible for privacy and ethics often limit access to routinely collected health data. Ethical approvals, issues around protecting privacy and data access are often dealt with by different layers of regulations, making approval processes appear disjointed. To create a comprehensive framework for defining the ethical and privacy status of a project and for providing guidance on data access. The framework comprises principles and related questions. The core of the framework will be built using standard terminology definitions such as ethics-related controlled vocabularies and regional directives. It is built in this way to reduce ambiguity between different definitions. The framework is extensible: principles can be retired or added to, as can their related questions. Responses to these questions should allow data processors to define ethical issues, privacy risk and other unintended consequences. The framework contains three steps: (1) identifying possible ethical and privacy principles relevant to the project; (2) providing ethics and privacy guidance questions that inform the type of approval needed; and (3) assessing case-specific ethics and privacy issues. The outputs from this process should inform whether the balance between public interests and privacy breach and any ethical considerations are tipped in favour of societal benefits. If they are then this should be the basis on which data access is permitted. Tightly linking ethical principles to governance and data access may help maintain public trust.

A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation

Directory of Open Access Journals (Sweden)

Ranju Singh

2013-01-01

Full Text Available Background: Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability. Settings and Design: Randomized, double blind. Methods: Patients were assigned to receive premixed injection of either fentanyl 1.5 μg/kg + propofol 2 mg/kg (Group PF, n0=50 or ketamine 0.5 mg/kg + propofol 2 mg/kg (Group PK, n=50. Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted. Statistical Analysis: Chi-square (χ2 test was used for categorical data. Student′s t-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired t-test was used. SPSS 14.0 was used for analysis. Results: Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK ( P<0.05. The time to reach Aldrete score ≥8 was significantly longer in group PK (11.14±3.29 min in group PF vs. 17.3±6.32 min in group PK, P<0.01. The time to discharge was significantly longer in group PK (105.8±13.07 min in group PF vs.138.18±13.20 min in group PK, P<0.01. Patient comfort and acceptability was better in group PF, P<0.01. Conclusion: As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability.

Decision Analysis of Dynamic Spectrum Access Rules

Energy Technology Data Exchange (ETDEWEB)

Juan D. Deaton; Luiz A. DaSilva; Christian Wernz

2011-12-01

A current trend in spectrum regulation is to incorporate spectrum sharing through the design of spectrum access rules that support Dynamic Spectrum Access (DSA). This paper develops a decision-theoretic framework for regulators to assess the impacts of different decision rules on both primary and secondary operators. We analyze access rules based on sensing and exclusion areas, which in practice can be enforced through geolocation databases. Our results show that receiver-only sensing provides insufficient protection for primary and co-existing secondary users and overall low social welfare. On the other hand, using sensing information between the transmitter and receiver of a communication link, provides dramatic increases in system performance. The performance of using these link end points is relatively close to that of using many cooperative sensing nodes associated to the same access point and large link exclusion areas. These results are useful to regulators and network developers in understanding in developing rules for future DSA regulation.

Hydrotubation in the management of female infertility: outcome in low resource settings.

Science.gov (United States)

Adesiyun, A G; Cole, B; Ogwuche, P

2009-01-01

To determine the outcome of therapeutic hydrotubation (tubal flushing) in patients with tubal infertility and unexplained infertility. Prospective non-randomised observational study. Alba hospital, a five bed multidisciplinary private hospital in Kaduna city, Nigeria. Infertile women with tubal and unexplained infertility. Two hundred and fifty seven patients that had therapeutic hydrotubation over 7.5 years were analysed. The age range was 21 to 44 years with mean of 34.5 years. Secondary infertility was found in 209 (81.3%) patients and primary infertility in 166 (64.6%) patients. Of the 257 patients, 134 (52.1%) had had induced abortion. Indications for hydrotubation were bilateral perifimbrial adhesion (incomplete tubal occlusion) 47.9%, bilateral fimbrial end occlusion 24.9%, bilateral cornual blockage 16% and unexplained infertility in 11.3% of cases. One hundred and nine conceptions were recorded in this study and the overall conception rate was 42.4%. Likewise, percentage ratio of conception in these 154 patients with evidence of post-hydrotubation tubal patency was 70.8%. Pregnancy outcome of the 109 conceptions are term pregnancy 84.4%, preterm pregnancy 9.2%, miscarriage 4.6% and ectopic pregnancy in 1.8% of the conceptions. Recorded complications were pelvic pain in 177 (68.9%) patients and vaginal bleeding in 63 (24.5%) patients. With good case selection, therapeutic hydrotubation may be beneficial in resource poor countries, especially in patients with incomplete tubal occlusion (bilateral perifimbrial adhesions) and as part of treatment for unexplained infertility.

The fallopian tube-peritoneal junction: a potential site of carcinogenesis.

Science.gov (United States)

Seidman, Jeffrey D; Yemelyanova, Anna; Zaino, Richard J; Kurman, Robert J

2011-01-01

Junctions between different types of epithelia are hot spots for carcinogenesis, but the junction of the peritoneal mesothelium with the fallopian tubal epithelium, the tubal-peritoneal junction, has not been characterized earlier. A total of 613 junctional foci in 228 fallopian tube specimens from 182 patients who underwent surgery for a variety of indications, including 27 risk-reducing salpingo-oophorectomy specimens, were studied. Edema, congestion, and dilated lymphatic channels were commonly present. Transitional metaplasia was found at the junction in 20% of patients and mesothelial hyperplasia in 17%. Inflammation at the junction was seen predominantly in patients with salpingitis, torsion, or tubal pregnancy. Ovarian-type stroma was found at the junction in 5% of patients, and was found elsewhere in the tubal lamina propria in an additional 27% of patients. Findings in risk-reducing salpingo-oophorectomy specimens in women with BRCA mutations, a personal history of breast cancer, and/or a family history of breast/ovarian cancer were similar to those in controls. Transitional metaplasia specifically localizes to this junction, and is the probable source of Walthard cell nests. The recently highlighted significance of fimbrial tubal epithelium in the origin of serous ovarian carcinomas and a study suggesting that mucinous and Brenner tumors may arise from transitional-type epithelium in this location suggest that the tubal-peritoneal junction may play a role in the development of these tumors. This is the first comprehensive description of a hitherto unrecognized transitional zone in the adnexa.

Hysterosalpingographic abnormalities in women with infertility in a ...

African Journals Online (AJOL)

Background: Structural tubal abnormalities are responsible for infertility in significant proportion of infertile couples. Hysterosalpingography (HSG) being a simple, less invasive, relatively inexpensive, and reproducible rapid diagnostic test provides valuable information about the uterine cavity and tubal architecture.

Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.

Science.gov (United States)

Costantino, Thomas G; Parikh, Aman K; Satz, Wayne A; Fojtik, John P

2005-11-01

We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction. Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach. Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of

Which journals do primary care physicians and specialists access from an online service?

Science.gov (United States)

McKibbon, K Ann; Haynes, R Brian; McKinlay, R James; Lokker, Cynthia

2007-07-01

The study sought to determine which online journals primary care physicians and specialists not affiliated with an academic medical center access and how the accesses correlate with measures of journal quality and importance. Observational study of full-text accesses made during an eighteen-month digital library trial was performed. Access counts were correlated with six methods composed of nine measures for assessing journal importance: ISI impact factors; number of high-quality articles identified during hand-searches of key clinical journals; production data for ACP Journal Club, InfoPOEMs, and Evidence-Based Medicine; and mean clinician-provided clinical relevance and newsworthiness scores for individual journal titles. Full-text journals were accessed 2,322 times by 87 of 105 physicians. Participants accessed 136 of 348 available journal titles. Physicians often selected journals with relatively higher numbers of articles abstracted in ACP Journal Club. Accesses also showed significant correlations with 6 other measures of quality. Specialists' access patterns correlated with 3 measures, with weaker correlations than for primary care physicians. Primary care physicians, more so than specialists, chose full-text articles from clinical journals deemed important by several measures of value. Most journals accessed by both groups were of high quality as measured by this study's methods for assessing journal importance.

Tubal Sterilization

Science.gov (United States)

... me? Are there other forms of permanent birth control? What if I want to reverse the procedure later ... time for me to have the procedure done? What are the risks involved with the ... Birth Control Methods U.S. Food and Drug Administration, Birth Control: ...

Transport Accessibility In Light Of The DEA Method

Directory of Open Access Journals (Sweden)

Górniak Joanna

2014-12-01

Full Text Available The development of transport infrastructure and increasing the efficiency of transport services are major factors of economic growth. The concept of transport accessibility can be analysed in various aspects. This article focuses on the accessibility of freight transport by road and rail, measured with infrastructure equipment. The primary objective of this study is to determine the efficiency of selected European countries in 2000, 2005 and 2010 in terms of transport accessibility for given expenditures and results. The efficiency will be measured with the Data Envelopment Analysis, which assesses the efficiency with which a given economy transforms expenditures into results. The hypothesis assumes the existence of differences between the efficiency in terms of transport accessibility in European countries and a possibility to increase this efficiency by using the experience of countries with a high efficiency level.

Access Request Trustworthiness in Weighted Access Control Framework

Institute of Scientific and Technical Information of China (English)

WANG Lun-wei; LIAO Xiang-ke; WANG Huai-min

2005-01-01

Weighted factor is given to access control policies to express the importance of policy and its effect on access control decision. According to this weighted access control framework, a trustworthiness model for access request is also given. In this model, we give the measure of trustworthiness factor to access request, by using some idea of uncertainty reasoning of expert system, present and prove the parallel propagation formula of request trustworthiness factor among multiple policies, and get the final trustworthiness factor to decide whether authorizing. In this model, authorization decision is given according to the calculation of request trustworthiness factor, which is more understandable, more suitable for real requirement and more powerful for security enhancement than traditional methods. Meanwhile the finer access control granularity is another advantage.

Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.

Science.gov (United States)

Squara, Fabien; Tomi, Julien; Scarlatti, Didier; Theodore, Guillaume; Moceri, Pamela; Ferrari, Emile

2017-12-01

Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture. Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator. Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Understanding the political economy and key drivers of energy access in addressing national energy access priorities and policies

International Nuclear Information System (INIS)

Rehman, I.H.; Kar, Abhishek; Banerjee, Manjushree; Kumar, Preeth; Shardul, Martand; Mohanty, Jeevan; Hossain, Ijaz

2012-01-01

Globally, 1.5 billion people lack access to electricity and nearly 3 billion lack access to modern cooking energy options. Of the world’s “energy poor”, 95% are in Asia and Sub-Saharan Africa. Within Asia, almost 80% of electricity-deprived and 86% of biomass-dependent populations are in the “Big 5” countries: Bangladesh, China, India, Indonesia, and Pakistan. In this paper, we discuss the broad contours of the political economy of energy access in these countries. The political economy is assessed through an examination of three sustainability objectives: accessibility of physical infrastructure; energy service delivery; and conformance to social goals. The key areas of concern include emphasis on supply-driven grid electricity; vested power dynamics favouring affluent and urban areas; unreliability of energy service provision; and misdirected and misappropriated subsidies. The above-mentioned issues are responsible for limiting accelerated achievement of universal energy access in the “Big 5” countries and need to be addressed through innovative approaches. The paper emphasizes the need for firm commitments, policy convergence, and the implementation of 'pro-poor' equitable energy policies through a broad-based energy framework of bench-marked, technology-neutral energy provisioning that ensures reliability and equity. It highlights the need for reorienting of the subsidy regime and incorporating energy service delivery indicators in monitoring and reporting mechanisms. - Highlights: ► Limited emphasis on improved cooking programmes relative to electrification schemes. ► Strong disparity between rural and urban electrification and LPG access. ► Grid extension and subsidy on cooking fuels has limited success. ► Electricity access does not indicate transition to better cooking options. ► Technology neutrality in choosing suitable alternatives may led to improved access. ► There is need to re-orient energy subsidies and incentives. �

Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

Energy Technology Data Exchange (ETDEWEB)

Fornazari, Vinicius Adami Vayego; Szejnfeld, Denis; Elito, Julio Júnior; Goldman, Suzan Menasce [Universidade Federal de São Paulo, São Paulo, SP (Brazil)

2015-07-01

The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

A Descriptive Assessment of Higher Education Access, Participation, Equity, and Disparity in Ghana

Directory of Open Access Journals (Sweden)

Francis Atuahene

2013-07-01

Full Text Available Since independence, Ghana has comparatively distinguished itself among many Sub-Saharan African (SSA countries in its educational developments. Tertiary education in Ghana over the past decade has witnessed tremendous growth in various frontages—increased access and participation, relative expansion of academic facilities, a growing private sector, and most importantly, a transformative policy environment. Despite these overwhelming developments, there remain inequalities in the higher education system in Ghana: access has not been broadened to include all social groups. Available data suggest unequal participation among women, minorities, individuals from low socioeconomic backgrounds, and spatial-based disparities. Using enrollment data from universities, policy document from the Ministry of Education, and the National Council for Tertiary Education in Ghana, and academic research reports, the authors provide descriptive and critical analyses of the structures of inequalities and disparities in higher education in Ghana. The authors argue that in spite of the massive developments over the years, there exist accessibility and participation gap with respect to students’ socioeconomic status, gender, regions of origin, and the type and location of secondary schools attended.

Characterizing Rural Food Access in Remote Areas.

Science.gov (United States)

Bardenhagen, Chris J; Pinard, Courtney A; Pirog, Rich; Yaroch, Amy Lazarus

2017-10-01

Residents of rural areas may have limited access to healthy foods, leading to higher incidence of diet related health issues. Smaller grocers in rural areas experience challenges in maintaining fresh produce and other healthy foods available for customers. This study assessed the rural food environment in northeast Lower Michigan in order to inform healthy food financing projects such as the Michigan Good Food Fund. The area's retail food businesses were categorized using secondary licensing, business, and nutrition program databases. Twenty of these stores were visited in person to verify the validity of the categories created, and to assess the availability of healthy foods in their aisles. In-depth interviews with key informants were carried out with store owners, economic development personnel, and other food system stakeholders having knowledge about food access, in order to learn more about the specific challenges that the area faces. Out-shopping, seasonality, and economic challenges were found to affect healthy food availability. Mid-sized independent stores were generally found to have a larger selection of healthy foods, but smaller rural groceries also have potential to provide fresh produce and increase food access. Potential healthy food financing projects are described and areas in need of further research are identified.

Birth Control: How to Use Your Diaphragm

Science.gov (United States)

... Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens ... MoreBMI Calculator Vasectomy: What to ExpectProgestin-Only Birth Control PillsDepo-Provera: An Injectable ContraceptiveTubal Sterilization (Tubal Ligation) ...

A review of promoting access to medicines in China - problems and recommendations.

Science.gov (United States)

Sun, Jing; Hu, Cecile Jia; Stuntz, Mark; Hogerzeil, Hans; Liu, Yuanli

2018-02-20

Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China. Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China. Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE) and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP). With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed. The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are facing. To further promote access to medicines, China should speed up

A review of promoting access to medicines in China - problems and recommendations

Directory of Open Access Journals (Sweden)

Jing Sun

2018-02-01

Full Text Available Abstract Background Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China. Methods Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China. Results Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP. With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed. Conclusions The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are

The Incremental Validity of the MMPI-2: When Does Therapist Access Not Enhance Treatment Outcome?

Science.gov (United States)

Lima, Elizabeth N.; Stanley, Sheila; Kaboski, Beth; Reitzel, Lorraine R.; Richey, Anthony; Castro, Yezzennya; Williams, Foluso M.; Tannenbaum, Kendra R.; Stellrecht, Nadia E.; Jakobsons, Lara J.; Wingate, LaRicka R.; Joiner, Thomas E.

2005-01-01

The present study examined whether therapist access to the Minnesota Multiphasic Personality Inventory (MMPI-2) predicted favorable treatment outcome, above and beyond other assessment measures. A manipulated assessment design was used, in which patients were randomly assigned either to a group in which therapists had access to their MMPI-2 data…

An assessment of accessibility and utilisation of toilet facilities in Wa

African Journals Online (AJOL)

2009-10-13

Oct 13, 2009 ... cultural conditions, the current system of public toilet operating in the ... beliefs and needs of potential users such as the flush system of public toilets. ... Access to and efficient use of safe sanitation facilities is an essential part of public health. ... managed and have become the site of local political conflict, ...

evaluating the performance of leucaena accessions for agroforestry

African Journals Online (AJOL)

Mgina

The performance of Leucaena accessions on acid soils in eastern coast Tanzania for ... Plant tree parameters assessed were fodder yield and plant stem ... adapted and potential in improving soil fertility and are recommended for agroforestry.

A global map of travel time to cities to assess inequalities in accessibility in 2015

Science.gov (United States)

Weiss, D. J.; Nelson, A.; Gibson, H. S.; Temperley, W.; Peedell, S.; Lieber, A.; Hancher, M.; Poyart, E.; Belchior, S.; Fullman, N.; Mappin, B.; Dalrymple, U.; Rozier, J.; Lucas, T. C. D.; Howes, R. E.; Tusting, L. S.; Kang, S. Y.; Cameron, E.; Bisanzio, D.; Battle, K. E.; Bhatt, S.; Gething, P. W.

2018-01-01

The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of ‘leaving no one behind’ established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

A global map of travel time to cities to assess inequalities in accessibility in 2015.

Science.gov (United States)

Weiss, D J; Nelson, A; Gibson, H S; Temperley, W; Peedell, S; Lieber, A; Hancher, M; Poyart, E; Belchior, S; Fullman, N; Mappin, B; Dalrymple, U; Rozier, J; Lucas, T C D; Howes, R E; Tusting, L S; Kang, S Y; Cameron, E; Bisanzio, D; Battle, K E; Bhatt, S; Gething, P W

2018-01-18

The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of 'leaving no one behind' established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

Accessible Transportation Technologies Research Initiative (ATTRI) : User Needs Assessment: Stakeholder Engagement Report.

Science.gov (United States)

2016-05-01

The Accessible Transportation Technologies Research Initiative (ATTRI) is a joint U.S. Department of Transportation (U.S. DOT) initiative that is co-led by the Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA). ATTRI ...

The Netherlands Chlamydia cohort study (NECCST) protocol to assess the risk of late complications following Chlamydia trachomatis infection in women.

Science.gov (United States)

Hoenderboom, B M; van Oeffelen, A A M; van Benthem, B H B; van Bergen, J E A M; Dukers-Muijrers, N H T M; Götz, H M; Hoebe, C J P A; Hogewoning, A A; van der Klis, F R M; van Baarle, D; Land, J A; van der Sande, M A B; van Veen, M G; de Vries, F; Morré, S A; van den Broek, I V F

2017-04-11

Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately. In the Netherlands Chlamydia Cohort Study (NECCST), a cohort of women of reproductive age with and without a history of CT-infection is followed over a minimum of ten years to investigate (CT-related) reproductive tract complications. This study is a follow-up of the Chlamydia Screening Implementation (CSI) study, executed between 2008 and 2011 in the Netherlands. For NECCST, female CSI participants who consented to be approached for follow-up studies (n = 14,685) are invited, and prospectively followed until 2022. Four data collection moments are foreseen every two consecutive years. Questionnaire data and blood samples for CT-Immunoglobulin G (IgG) measurement are obtained as well as host DNA to determine specific genetic biomarkers related to susceptibility and severity of infection. CT-history will be based on CSI test outcomes, self-reported infections and CT-IgG presence. Information on (time to) pregnancies and the potential long-term complications (i.e. PID, ectopic pregnancy and (tubal factor) subfertility), will be acquired by questionnaires. Reported subfertility will be verified in medical registers. Occurrence of these late complications and prolonged time to pregnancy, as a proxy for reduced fertility due to a previous CT-infection, or other risk factors, will be investigated using longitudinal statistical procedures. In the proposed study, the occurrence of late complications following

Assessment of genetic diversity among some accessions of sage (Salvia officinalis L. using electrophoresis of seed storage proteins

Directory of Open Access Journals (Sweden)

Seyed Abbas Mirjalili

2016-06-01

Full Text Available The genus Salvia (Lamiaceae comprises over 900 species in the world, with a relatively wide dispersion in the Iran’s flora. Until now, about 58 species of the genus have been reported and identified in Iran, in which 17 of them were endemic. In order to study, investigate and evaluate the intraspecific diversity, similarity and dissimilarity among Iranian Salvia officinalis accessions, an experiment was carried out using SDS-PAGE technique. In this study, the seeds from five accessions were collected from gene bank and were evaluated. The seed storage proteins were extracted by buffers and were measured. Phylogenetic relationships were analyzed according to presence and absence of bands on the gel. A dendrogram was prepared using calculation of the accession’s similarity index. Mean comparison were done by Tukey’s test. The seed protein contents showed significant differences (p≤0.01 among accessions. A total of 39 bands were indicated on the gel. The maximum diversity was detected in the accession No. 2 while, the lowest band’s number were recorded with the accessions No. 1 and 5. Based on dendrogram, the accessions were divided into two groups; one includes accession No. 1 and 4 other accessions were located in the second group further classified into two subgroup including accessions No. 2 and 3 in one clade and accessions No. 4 and 5 in the other ones.

Web accessibility standards and disability: developing critical perspectives on accessibility.

Science.gov (United States)

Lewthwaite, Sarah

2014-01-01

Currently, dominant web accessibility standards do not respect disability as a complex and culturally contingent interaction; recognizing that disability is a variable, contrary and political power relation, rather than a biological limit. Against this background there is clear scope to broaden the ways in which accessibility standards are understood, developed and applied. Commentary. The values that shape and are shaped by legislation promote universal, statistical and automated approaches to web accessibility. This results in web accessibility standards conveying powerful norms fixing the relationship between technology and disability, irrespective of geographical, social, technological or cultural diversity. Web accessibility standards are designed to enact universal principles; however, they express partial and biopolitical understandings of the relation between disability and technology. These values can be limiting, and potentially counter-productive, for example, for the majority of disabled people in the "Global South" where different contexts constitute different disabilities and different experiences of web access. To create more robust, accessible outcomes for disabled people, research and standards practice should diversify to embrace more interactional accounts of disability in different settings. Implications for Rehabilitation Creating accessible experiences is an essential aspect of rehabilitation. Web standards promote universal accessibility as a property of an online resource or service. This undervalues the importance of the user's intentions, expertize, their context, and the complex social and cultural nature of disability. Standardized, universal approaches to web accessibility may lead to counterproductive outcomes for disabled people whose impairments and circumstances do not meet Western disability and accessibility norms. Accessible experiences for rehabilitation can be enhanced through an additional focus on holistic approaches to

Violence Prevention, Access to Justice, and Economic ...

International Development Research Centre (IDRC) Digital Library (Canada)

Solutions to empower women, reduce violence Researchers will identify and analyze interventions in Colombia, Guatemala, Mexico, and Peru. They will assess the impact of efforts on: -preventing violence against women -reducing victimization -improving women's access to justice The results will guide governments, civil ...

47 CFR 32.5082 - Switched access revenue.

Science.gov (United States)

2010-10-01

... SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Instructions For Revenue Accounts § 32.5082 Switched access revenue. (a) This account shall consist of federally and state tariffed charges assessed to... and state tariffed charges. Such subsidiary record categories shall be reported as required by part 43...

Using Social Media to Increase Accessibility to Online Teaching Resources.

Science.gov (United States)

O'Kelly, B; McHugh, S; McHugh, T; Fady, N; Boyle, E; Hill, A D K

2015-09-01

The key learning points of Surgical Grand Rounds (SGR) are often not accessible at times of exam revision for students. We sought to use Twitter as an online teaching repository. A SGR Twitter profile was created. 23 SGR presentations were made accessible on Twitter over a 3 month period. 93 students were invited to complete a questionnaire assessing usage of the repository. 84 (90%) in total responded, of these, 25 (80.6%) felt that the online provision of SGR through twitter was "useful". The majority (71%) felt that the online content was easily accessible. The novel use of social media is a useful adjunctive educational tool in accessing an online repository of SGR presentations.

Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous Coronary Intervention.

Science.gov (United States)

Koshy, Linda M; Aberle, Laura H; Krucoff, Mitchell W; Hess, Connie N; Mazzaferri, Ernest; Jolly, Sanjit S; Jacobs, Alice; Gibson, C Michael; Mehran, Roxana; Gilchrist, Ian C; Rao, Sunil V

2018-01-01

This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI). Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown. We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference. Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound. This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.

Emotional Accessibility Is More Important Than Sexual Accessibility in Evaluating Romantic Relationships – Especially for Women: A Conjoint Analysis

Directory of Open Access Journals (Sweden)

T. J. Wade

2018-05-01

Full Text Available Prior research examining mate expulsion indicates that women are more likely to expel a mate due to deficits in emotional access while men are more likely to expel a mate due to deficits in sexual access. Prior research highlights the importance of accounting for measurement limitations (e.g., the use of incremental vs. forced-choice measures when assessing attitudes toward sexual and emotional infidelity, Sagarin et al., 2012, Wade and Brown, 2012. The present research uses conjoint analysis, a novel methodology for controlling several limitations of using continuous self-report measures in mate expulsion research. Participants (N = 181, 128 women recruited from Bucknell University and several psychology recruitment listservs in the United States rated nine profiles that varied in three potential levels of emotional and sexual accessibility. Men were more likely to want to break up with a partner due to sexual accessibility deficits, whereas women were more likely to want to break up due to emotional accessibility deficits. However, regardless of sex, emotional inaccessibility was more likely to produce mate expulsion. These findings are consistent with prior theory and highlight the need to disentangle emotional accessibility into its constituent in-pair benefits. This research also illustrates the utility of conjoint analysis as a statistical tool for studying how humans resolve trade-offs among competing outcomes during romantic decision-making.

Effect Through Broadcasting System Access Point For Video Transmission

Directory of Open Access Journals (Sweden)

Leni Marlina

2015-08-01

Full Text Available Most universities are already implementing wired and wireless network that is used to access integrated information systems and the Internet. At present it is important to do research on the influence of the broadcasting system through the access point for video transmitter learning in the university area. At every university computer network through the access point must also use the cable in its implementation. These networks require cables that will connect and transmit data from one computer to another computer. While wireless networks of computers connected through radio waves. This research will be a test or assessment of how the influence of the network using the WLAN access point for video broadcasting means learning from the server to the client. Instructional video broadcasting from the server to the client via the access point will be used for video broadcasting means of learning. This study aims to understand how to build a wireless network by using an access point. It also builds a computer server as instructional videos supporting software that can be used for video server that will be emitted by broadcasting via the access point and establish a system of transmitting video from the server to the client via the access point.

Planning Multitechnology Access Networks with Performance Constraints

Science.gov (United States)

Chamberland, Steven

Considering the number of access network technologies and the investment needed for the “last mile” of a solution, in today’s highly competitive markets, planning tools are crucial for the service providers to optimize the network costs and accelerate the planning process. In this paper, we propose to tackle the problem of planning access networks composed of four technologies/architectures: the digital subscriber line (xDSL) technologies deployed directly from the central office (CO), the fiber-to-the-node (FTTN), the fiber-to-the-micro-node (FTTn) and the fiber-to-the-premises (FTTP). A mathematical programming model is proposed for this planning problem that is solved using a commercial implementation of the branch-and-bound algorithm. Next, a detailed access network planning example is presented followed by a systematic set of experiments designed to assess the performance of the proposed approach.

Frequency of papillary tubal hyperplasia (PTH), salpingoliths and transition from adenoma to borderline ovarian tumors (BOT): A systematic analysis of 74 BOT with different histologic types.

Science.gov (United States)

Horn, Lars-Christian; Angermann, Karolin; Hentschel, Bettina; Einenkel, Jens; Höhn, Anne Kathrin

2017-04-01

Borderline ovarian tumors (BOT) arise from cystadenomas and represent a transition step within the development of low-grade ovarian carcinomas (Type I tumors). That pathway mirrors the adenoma-to-carcinoma sequence known for colorectal cancer. It has been suggested that papillary tubal hyperplasia (PTH) and salpingoliths may be associated with the development of BOT. To evaluate the frequency of the presence of benign cystadenoma and its transition to BOT in a given patient as well as the presence of PTH and salpingoliths we re-valuated in 74 consecutive cases of BOT with different histologic types. The majority of cases represented serous-BOT (60.8%), followed by mucinous BOT (25.7%), other histologic types were rare. 86.5% showed an adenoma-BOT sequence, which was seen in all mucinous BOT but was missed in 15.6% of serous BOT. Two cases had salpingoliths without associated PTH. PTH was seen in four out of the 74 (5.4%) BOT and occurred only in cases with serous histology. The vast majority of BOT represent a transition from benign cystadenoma to BOT in cases with mucinous and serous histology. Salpingoliths are rarely seen in association with BOT and occurred exclusively in BOT with serous histology. PTH may represent a distinct lesion but is rarely seen in association with BOT, especially in those with non-serous histology. Further studies are needed to evaluate the frequency and pathogenetic association of PTH with BOT. Copyright © 2017 Elsevier GmbH. All rights reserved.

Electrophysiological assessment of the time course of bilingual visual word recognition: Early access to language membership.

Science.gov (United States)

Yiu, Loretta K; Pitts, Michael A; Canseco-Gonzalez, Enriqueta

2015-08-01

Previous research examining the time course of lexical access during word recognition suggests that phonological processing precedes access to semantic information, which in turn precedes access to syntactic information. Bilingual word recognition likely requires an additional level: knowledge of which language a specific word belongs to. Using the recording of event-related potentials, we investigated the time course of access to language membership information relative to semantic (Experiment 1) and syntactic (Experiment 2) encoding during visual word recognition. In Experiment 1, Spanish-English bilinguals viewed a series of printed words while making dual-choice go/nogo and left/right hand decisions based on semantic (whether the word referred to an animal or an object) and language membership information (whether the word was in English or in Spanish). Experiment 2 used a similar paradigm but with syntactic information (whether the word was a noun or a verb) as one of the response contingencies. The onset and peak latency of the N200, a component related to response inhibition, indicated that language information is accessed earlier than semantic information. Similarly, language information was also accessed earlier than syntactic information (but only based on peak latency). We discuss these findings with respect to models of bilingual word recognition and language comprehension in general. Copyright © 2015 Elsevier Ltd. All rights reserved.

Converged wireline and wireless signal distribution in optical fiber access networks

DEFF Research Database (Denmark)

Prince, Kamau

This thesis presents results obtained during the course of my doctoral studies into the transport of fixed and wireless signaling over a converged otpical access infrastructure. In the formulation, development and assessment of a converged paradigma for multiple-services delivery via optical access...... networking infrastructure, I have demonstrated increased functionalities with existing optical technologies and commercially available optoelectronic devices. I have developed novel systems for extending the range of optical access systems, and have demonstrated the repurposing of standard digital devices...

Does Imaging Modality Used For Percutaneous Renal Access Make a Difference?

DEFF Research Database (Denmark)

Andonian, Sero; Scoffone, Cesare; Louie, Michael K

2013-01-01

OBJECTIVE To assess peri-operative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. METHODS A prospectively collected international CROES database containing 5806 patients treated with PCNL was used for the study. Patients were...... divided into two groups based on the methods of percutaneous access: ultrasound vs. fluoroscopy. Patient characteristics, operative data and post-operative outcomes were compared. RESULTS Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only...

46 CFR 520.9 - Access to tariffs.

Science.gov (United States)

2010-10-01

... this section. (3) Carriers and conferences may assess a reasonable fee for access to their tariff publication systems and such fees shall not be discriminatory. (4) Tariff publication systems shall provide... provided at the expense of the publishers. Any recurring connection fees, hardware rental fees, usage fees...

Broadband Access

Indian Academy of Sciences (India)

First page Back Continue Last page Overview Graphics. Broadband Access. Worldwide market for broadband access $30 Billion! Over 200 million broadband subscribers worldwide! Various Competing Broadband access. Digital Subscriber line; Wireless; Optical Fiber.

Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use.

Science.gov (United States)

Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C

2008-05-01

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

A study of access to sanitation profiles of rural upland and coastal ...

African Journals Online (AJOL)

In developing countries, e.g., Nigeria, several communities have limited access to sanitation and sanitation facilities, thus such communities dump their solid and liquid wastes indiscriminately. The aim of this study was to assess access to sanitation, and compare basic sanitation facilities between upland and coastal ...

Download

African Journals Online (AJOL)

abp

2015-11-19

Nov 19, 2015 ... peritoneal factors are responsible for about 30-40% of cases of female infertility and hence ... structural abnormalities of the uterus, endometriosis and fallopian tube patency were sought for. Tubal .... misinterpreted as tubal patency with peritoneal diffusion of contrast material. Another explanation is that, ...

Salpingoscopy: systematic use in diagnostic laparoscopy.

Science.gov (United States)

Marconi, G; Auge, L; Sojo, E; Young, E; Quintana, R

1992-04-01

To evaluate the importance of salpingoscopy together with laparoscopy in the diagnosis of tubal pathology. Salpingoscopy was performed as a complementary method in patients who were subjected to diagnostic laparoscopy. The relationship between the salpingoscopy and (1) the patient's previous history of tubal disease and (2) laparoscopic diagnoses was evaluated. Private patients referred to the Instituto de Fertilidad, Buenos Aires. Forty-two patients undergoing a diagnostic laparoscopy during the evaluation of their fertility or as a follow-up of previous therapy. Salpingoscopy was performed, using a colpomicrohysteroscope. We evaluated alterations in major and minor folds and their vascularization, the presence of microadhesions, and cellular nuclei dyed with methylene blue in the tubal lumen. Fifty percent of the patients who had no previous history of tubal disease presented with endosalpingeal alterations, and in 37% of the normal laparoscopies the salpinx had unilateral or bilateral salpingoscopic abnormalities. Salpingoscopy is a useful method to evaluate oviducts, before assuming their normality, and consideration of these women for assisted reproductive technology.

Assessing the Effects of ‘Stand-alone’ Structuration of Land Administration System on Urban Land Delivery and Accessibility in Nigeria

Directory of Open Access Journals (Sweden)

Akinbola Kazeem Bolayemi

2016-12-01

Full Text Available The efficiency and effectiveness of land administration system had been acknowledged to be premised on so many factors, arguably the chief of which, is the degree of mutuality, frictionlessness and bi-directionality in the interrelationship that exist amongst the various factors that are discharging arrays of tasks that these formal lands regulo-administrative machineries are saddled with. Undoubtedly, this simple conduct of affairs resultantly drives the formal lands delivery, hence it increases accessibility to urban lands by several categories of users in Nigeria, as thus the case globally. However, these interrelationships are absent among land administration and regulation systems in Nigeria. Hence, this study intends to assess the direct and possible indirect impacts that these interrelationships fallouts have on the formal delivery and accessibility of urban lands in Nigeria, Firstly, this was done by articulating the issues involved and calibrating them into constructs, then measuring them via the following score-cards, thus: myopism, non-ingenuity, disservice, eco-financial loss, distrust, trauma, anti-growth, death, market distortion and thriving informalisation focussing on the South Western Nigeria. Out of the total 586 individuals considered as the total population for the sample space, 120 individual qualified for the sample frame, upon which the structured questionnaires were distributed among land regulators, land administrators, independent land consultants and ultimate land users, essentially to have a fair and broad view of the issues inherent in this lands accessibility dilemma. 93 questionnaires were retrieved, out of which 87 questionnaires were valid, thus formed the basis upon which analyses were done, with emphasis on the 5 point Likert scale measurement usage, via both inferential and descriptive statistical tools. The results showed amongst other things, that unbridled relationship frictions had led to unwarranted role

Assessment of Genetic Diversity of Some Finger Millet (Eleusine coracana (L. Gaertn. Accessions Using Morphological Markers

Directory of Open Access Journals (Sweden)

D.V.S. Kaluthanthri

2017-03-01

Full Text Available AbstractGermplasm characterization is an important link between conservation and utilizationof plant genetic resources. The study was conducted to characterize randomly selected 20finger millet germplasm accessions obtained from Plant Genetic Resource Center,Gannoruwa, Sri Lanka using morphological markers. Morphological study was carried outusing Randomized Complete Block Design (RCBD and 15 morphological markers wererecorded. Analysis of variance (ANOVA results for quantitative morphological charactersrevealed that all quantitative morphological characters measured differed significantly(p˂0.05 among the accessions used for the study, indicating higher levels of morphologicaldiversity. According to the ANOVA results, days to flowering and days to maturity showhigh level of predictive capability while flag leaf length and number of productive tillersshow comparatively low level of predictive capability. Principal component analysisindicated that morphological characters such as days to flowering, finger number and yieldper plant were the important traits contributing for the overall variability implying thatbreeding effort on those traits can meet the targeted objective. The clustering pattern ofstudied finger millet accessions based on morphological markers comprised of two majorclusters. Both clusters comprised of Indian accessions those conserved at PGRC, Gannoruwaand as well as Sri Lankan accessions.Results of the study suggest a considerable morphological variability, which couldexist among the studied traits. Furthermore, this study revealed that the genetic diversityexisted irrespective to the geographical origin. This finding justifies the importance ofgermplasm characterization.Keywords: Finger Millet, Morphological Markers, Germplasm Accessions, GeneticDiversity, Crop Improvement

A review of accessibility of administrative healthcare databases in the Asia-Pacific region.

Science.gov (United States)

Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

2015-01-01

We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3-6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted

A review of accessibility of administrative healthcare databases in the Asia-Pacific region

Science.gov (United States)

Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

2015-01-01

Objective We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. Methods The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Results Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3–6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but

Outcomes of Incidental Fallopian Tube High-Grade Serous Carcinoma and Serous Tubal Intraepithelial Carcinoma in Women at Low Risk of Hereditary Breast and Ovarian Cancer.

Science.gov (United States)

Chay, Wen Yee; McCluggage, W Glenn; Lee, Cheng-Han; Köbel, Martin; Irving, Julie; Millar, Joanne; Gilks, C Blake; Tinker, Anna V

2016-03-01

The natural history and optimal management of serous tubal intraepithelial carcinoma (STIC), regardless of BRCA status, is unknown. We report the follow-up findings of a series of incidental fallopian tube high-grade serous carcinomas (HGSCs) and STICs identified in women at low risk for hereditary breast and ovarian cancer (HBOC), undergoing surgery for other indications. Cases of incidental STIC and HGSC were identified from 2008. Patients with known BRCA1 or BRCA2 mutations, or a family history of ovarian or breast cancer before the diagnosis of STIC or HGSC were excluded. A retrospective chart review was conducted to obtain clinical data. Eighteen cases were identified with a median follow-up of 25 months (range, 4-88 months). Twelve of 18 patients had a diagnosis of STIC with no associated invasive HGSC and 6 had STIC associated with other invasive malignancies. Completion staging surgery was performed on 7 of the 18 patients, including 5 of 12 in which there was STIC only identified on primary surgery; 3 cases were upstaged from STIC only to HGSC based on the staging surgery. Recurrence of HGSC occurred in 2 of the 18 patients. BRCA testing was performed on 3 patients, 1 of whom tested positive for a pathogenic BRCA1 mutation. Our study suggests that completion staging surgery for incidental STICs in non-BRCA patients may be considered. These patients should be offered hereditary testing. The Pelvic-Ovarian cancer INTerception (POINT) Project is an international registry set up to add to our understanding of STICs.

Barriers and facilitators to intraosseous access in adult resuscitations when peripheral intravenous access is not achievable.

Science.gov (United States)

James Cheung, Warren; Rosenberg, Hans; Vaillancourt, Christian

2014-03-01

Studies suggest that intraosseous (IO) access is underutilized in adult resuscitations, despite recommendations from advanced trauma and cardiac life support guidelines. The objective was to determine factors associated with IO access use by physicians during adult resuscitations when intravenous (IV) access is not immediately achievable. This study was an online survey among physicians purposefully recruited from various clinical care areas at three teaching hospitals. Questions were generated from the qualitative results of 20 iterative interviews, verified for internal validity, and piloted. The interview guide was based on the constructs of the Theory of Planned Behavior (TPB), which elicits salient attitudes, social influences, and control beliefs that potentially influence intention to use IO access. Recruitment took place in September 2012 until reaching more than 100% of the required sample size (n = 200). Internal consistency was measured using Cronbach's alpha, and the effect of TPB constructs and specific beliefs were assessed with regression analyses. For the 205 respondents, the mean age was 35 years (range = 20 to 66 years), and 53.3% were male. Participants' departmental affiliations were 50.3% emergency medicine (EM), 16.9% internal medicine, 14.9% anesthesia, 10.8% general surgery, and 7.2% critical care. Residents comprised 60.7% of the sample, and 39.3% were attending physicians. Median intention to use IO access when IV is not immediately achievable was 4.67 (interquartile range [IQR] = 4 to 5) out of 5 (5 highest) and predicted by the following TPB constructs: attitudes (AdjCoefficients = 0.504; 95% confidence interval [CI] = 0.334 to 0.673), social influences (AdjCoefficients = 0.285; 95% CI = 0.172 to 0.398), and control beliefs (AdjCoefficients 0.217; 95% CI = 0.113 to 0.320). Physicians were more likely to use IO access if they believed that it provided rapid vascular access for delivering large volumes of fluids, could prevent delays in

Assessing the Impact of Internet Access on Household Income and Financial Performance of Small Farms

OpenAIRE

Khanal, Aditya R.; Mishra, Ashok K.

2013-01-01

With increased focus on survival strategies for small farm businesses, we investigate the impact of Internet access on income and farm expenses of small farm business and households. Using a nation-wide farm-level data in the U.S. and non-parametric matching estimators, the study finds a significant positive impact of Internet access on total household and off-farm income.

Temporary authorization for use: does the French patient access programme for unlicensed medicines impact market access after formal licensing?

Science.gov (United States)

Degrassat-Théas, Albane; Paubel, Pascal; Parent de Curzon, Olivier; Le Pen, Claude; Sinègre, Martine

2013-04-01

To reach the French market, a new drug requires a marketing authorization (MA) and price and reimbursement agreements. These hurdles could delay access to new and promising drugs. Since 1992, French law authorizes the use of unlicensed drugs on an exceptional and temporary basis through a compassionate-use programme, known as Temporary Authorization for Use (ATU). This programme was implemented to improve early access to drugs under development or authorized abroad. However, it is suspected to be inflationary, bypassing public bodies in charge of health technology assessment (HTA) and of pricing. The aim of this study is to observe the market access after the formal licensing of drugs that went through this compassionate-use programme. We included all ATUs that received an MA between 1 January 2005 and 30 June 2010. We first examined market access delays from these drugs using the standard administrative path. We positioned this result in relation to launch delays observed in France (for all outpatient drugs) and in other major European markets. Second, we assessed the bargaining power of a hospital purchaser after those drugs had obtained an MA by calculating the price growth rate after the approval. During the study period, 77 ATUs were formally licensed. The study concluded that, from the patient's perspective, licensing and public bodies' review time was shortened by a combined total of 36 months. The projected 11-month review time of public bodies may be longer than delays usually observed for outpatient drugs. Nonetheless, the study revealed significant benefits for French patient access based on comparable processing to launch time with those of other European countries with tight price control policies. In return, a 12 % premium, on average, is paid to pharmaceutical companies while drugs are under this status (sub-analysis on 56 drugs). In many instances, the ATU programme responds to a public health need by accelerating the availability of new drugs

Two-port access versus four-port access laparoscopic ovarian cystectomy.

Science.gov (United States)

Choi, Won-Kyu; Kim, Jang-Kew; Yang, Jung-Bo; Ko, Young-Bok; Nam, Sang-Lyun; Lee, Ki-Hwan

2014-09-01

This study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy. Four hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more. There were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy. Two-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.

Accessibility on the agenda of social and educational inclusion

Directory of Open Access Journals (Sweden)

Tatiane Negrini

2010-10-01

Full Text Available The present paper aims at unveiling the route of the proposed legal accessibility, seeking to develop a reflection inside the devices that support the process of social inclusion and education. Thus, studies in the area were used, also making reference to policies oriented for accessibility. So the research does not aspire to the exhaustion of the subject, but rather, it provides clues to a discussion of both to include accessibility in the scope of Special Education. There is a rescue on the law of accessibility including the Law No. 7405 of November 12, 1985, Law No. 10,048 of November 8, 2000, Law No. 10,098 of December 19, 2000 and Decree No. 5296 of 2 December 2004. Moreover, the ideas are on discussion according the current proposal of inclusive education, which refers to the access of everyone into the educational environment. Note that there are consistent policies regarding accessibility, however, in regard to the school environment, the barriers are not restricted only to the architectural features, or communications infrastructure. It has to agree, too, curricular and attitudinal adaptations as well as an assessment about the training.

Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps.

Science.gov (United States)

Rusatira, Jean Christophe; Tomaszewski, Brian; Dusabejambo, Vincent; Ndayiragije, Vincent; Gonsalves, Snedden; Sawant, Aishwarya; Mumararungu, Angeline; Gasana, George; Amendezo, Etienne; Haake, Anne; Mutesa, Leon

2016-06-01

Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app

Genetic Diversity Analysis in 27 Tomato Accessions Using Morphological and Molecular Markers

Directory of Open Access Journals (Sweden)

Catur Herison

2018-02-01

Full Text Available Genetic diversity is the most important aspect in tomato breeding activities. Better assessment on the diversity of the collected accessions will come up with better result of the cultivar development. This study aimed at analyzing the genetic diversity of 27 tomato accessions by morphological and molecular markers. Twenty seven accessions collected from various regions of Indonesia were planted in the field and evaluated for their morphological traits, and RAPD analyzed for their molecular markers. The UPGMA clustering analyzes, elaborating the combination of morphological and molecular data, indicated that the tomato accessions could be grouped into 5 major groups with 70 % genetic similarity levels. Current study indicated that although many accessions came from different locations, they congregated into the same group. Cherry, Kudamati 1 and Lombok 3 were the farthest genetic distant accessions to the others. Those three genotypes will be the most valuable accessions, when they were crossed with other accessions, for designing a prospective breeding program in the future.

Iceland and European Union accession - the whaling issue

OpenAIRE

Davies, Peter G.G.

2011-01-01

This article seeks to assess one of the important questions regarding Iceland’s potential accession to the EU, namely, whether Iceland could legitimately continue its whaling operations under current EU environmental law if it becomes a member of the regional economic integration organization

Marine Biogeographic Assessment of the Main Hawaiian Islands: Synthesized physical and biological data offshore of the Main Hawaiian Islands from 1891-01-01 to 2015-03-01 (NCEI Accession 0155189)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — This accession contains analyses and data products used in a marine biogeographic assessment of the main Hawaiian Islands. The Bureau of Ocean Energy Management...

Noninflammatory fallopian tube pathology in children

International Nuclear Information System (INIS)

Merlini, Laura; Anooshiravani, Mehrak; Hanquinet, Sylviane; Vunda, Aaron; Borzani, Irene; Napolitano, Marcello

2008-01-01

Noninflammatory tubal abnormalities are rare in children and usually not well covered by traditional educational material. The presenting symptoms are nonspecific and are common to many other conditions, so its preoperative diagnosis is rarely made. The purpose of this study was to review the hospital charts and imaging findings in children and sexually inactive adolescents who showed fallopian tube pathology. Understanding of the pertinent findings of previous imaging examinations might assist radiologists in making the correct preoperative diagnosis and increase the likelihood of preserving the fallopian tubes. The clinical entities described in this article include isolated tubal torsion, paratubal cysts, hydrosalpinx, undescended/ectopic fallopian tube, and tubal inguinal hernia. (orig.)

Worktime control access, need and use in relation to work-home interference, fatigue, and job motivation.

Science.gov (United States)

Nijp, Hylco H; Beckers, Debby G J; Kompier, Michiel A J; van den Bossche, Seth N J; Geurts, Sabine A E

2015-07-01

Worktime control (WTC) has been suggested as a tool to reduce employees' work-home interference and fatigue and improve job motivation. The purpose of this study was twofold: (i) to examine the prevalence of employees' need for, access to, and use of WTC, as well as the incongruence between need for and access to WTC (ie, mismatch); and (ii) to examine the associations of this mismatch and the use of WTC with employees' work-home interference (WHI), fatigue and job motivation. Questionnaire data were collected among a large (N=2420) quasi-representative sample of Dutch employees. The prevalence of WTC need, access, use, and mismatch was assessed by means of descriptive statistics. Associations with employees' outcomes were assessed by analyses of covariance. The need for WTC was highly prevalent. For many employees, we observed a negative mismatch between access to and need for WTC (ie, accessmotivation. The use of WTC was also highly prevalent, but no meaningful associations were found with the outcome variables. It is relevant to examine WTC comprehensively, that is, to include measurements of employees' need for and access to WTC and assess employees' (mis)match between components of WTC. For practice, we recommend to introduce WTC on an organizational level and assess employees' need for WTC on an individual basis.

The Role of Social Factors in the Accessibility of Urban Areas for People with Motor Disabilities

Directory of Open Access Journals (Sweden)

Amin Gharebaghi

2018-03-01

Full Text Available The United Nations Convention on the Rights of People with Disabilities recognizes the right of people with disabilities to attain full social participation without discrimination on the basis of disability. Furthermore, mobility is one of the most important life habits for achieving such participation. Providing people with disabilities with information regarding accessible paths and accessible urban places therefore plays a vital role in achieving these goals. The accessibility of urban places and pedestrian networks depends, however, on the interaction between human capabilities and environmental factors, and may be subdivided into physical or social factors. An optimal analysis of accessibility requires both kinds of factors, social as well as physical. Although there has been considerable work concerning the physical aspects of the environment, social aspects have been largely neglected. In this paper, we highlight the importance of the social dimension of environments and consider a more integrated approach for accessibility assessment. We highlight the ways by which social factors such as policies can be incorporated into accessibility assessment of pedestrian networks for people with motor disabilities. Furthermore, we propose a framework to assess the accessibility of pedestrian network segments that incorporates the confidence level of people with motor disabilities. This framework is then used as a tool to investigate the influence of different policies on accessibility conditions of pedestrian networks. The methodology is implemented in the Saint-Roch neighborhood in Quebec City and the effectiveness of three policy actions is examined by way of illustration.

Availability and affordability of essential medicines for children in the Western part of Ethiopia: implication for access

OpenAIRE

Sado, Edao; Sufa, Alemu

2016-01-01

Background Essential medicines (EMs) are those medicines which satisfy the priority health care needs of the population. Although it is a fundamental human right, access to essential medicines has been a big challenge in developing countries particularly for children. WHO recommends assessing the current situations on availability and affordability of EMs as the first step towards enhancing access to them. Therefore, the aim of this study was to assess access to EMs for children based on avai...

Open access

NARCIS (Netherlands)

Valkenburg, P.M.

2015-01-01

Open access week Van 19 tot en met 25 oktober 2015 vond wereldwijd de Open Access Week plaats. Tijdens deze week werden er over de hele wereld evenementen georganiseerd waar open access een rol speelt. Ook in Nederland zijn er diverse symposia, workshops en debatten georganiseerd zoals het debat in

The assessment of exploitation process of power for access control system

Science.gov (United States)

Wiśnios, Michał; Paś, Jacek

2017-10-01

The safety of public utility facilities is a function not only of effectiveness of the electronic safety systems, used for protection of property and persons, but it also depends on the proper functioning of their power supply systems. The authors of the research paper analysed the power supply systems, which are used in buildings for the access control system that is integrated with the closed-circuit TV. The Access Control System is a set of electronic, electromechanical and electrical devices and the computer software controlling the operation of the above-mentioned elements, which is aimed at identification of people, vehicles allowed to cross the boundary of the reserved area, to prevent from crossing the reserved area and to generate the alarm signal informing about the attempt of crossing by an unauthorised entity. The industrial electricity with appropriate technical parameters is a basis of proper functioning of safety systems. Only the electricity supply to the systems is not equivalent to the operation continuity provision. In practice, redundant power supply systems are used. In the carried out reliability analysis of the power supply system, various power circuits of the system were taken into account. The reliability and operation requirements for this type of system were also included.

Assessing 15 proposals for promoting innovation and access to medicines globally.

Science.gov (United States)

Hoffman, Steven J; So, Karen

2014-01-01

There is widespread recognition that the existing global systems for innovation and access to medicines need reform. Billions of people do not have access to the medicines they need, and market failures prevent new drugs from being developed for diseases that primarily affect the global poor. The World Health Organization's Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) analyzed numerous proposals for reform. The aim of this article is to build on these previous inquiries. We conducted a structured analysis that grouped proposals into five broad opportunities for global policy reform to help researchers and decision makers to meaningfully evaluate each proposal in comparison with similar proposals. Proposals were also analyzed along three important dimensions-potential health impact, financial implications, and political feasibility-further facilitating the comparison and application of this information. Upon analysis, no one solution was deemed a panacea, as many (often competing) considerations need to be taken into account. However, some proposals, particularly product development partnership and prizes, appeared more promising and feasible at this time and deserve further attention. More research is needed into the effectiveness of these mechanisms and their transferability across jurisdictions. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Open Access @ DTU

DEFF Research Database (Denmark)

Ekstrøm, Jeannette

Open Access is high on the agenda in Denmark and internationally. Denmark has announced a national strategy for Open Access that aims to achieve Open Access to 80% in 2017 and 100% in 2022 to peer review research articles. All public Danish funders as well as H2020 requires that all peer review...... articles that is an outcome of their funding will be Open Access. Uploading your full texts (your final author manuscript after review ) to DTU Orbit is a fundamental part of providing Open Access to your research. We are here to answer all your questions with regards to Open Access and related topics...... such as copyright, DTU Orbit, Open Access journals, APCs, Vouchers etc....

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

Science.gov (United States)

Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

2018-01-11

The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

Differences in access and patient outcomes across antiretroviral ...

African Journals Online (AJOL)

Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across ...

Evaluation of Patients' Satisfaction with Services Accessed under ...

African Journals Online (AJOL)

Background: The evaluation of patient satisfaction provides an indicator of quality of care and contributes to strategies towards improvement of healthcare delivery. Objective: To assess patient satisfaction with services accessed under the National Health Insurance Scheme at a tertiary health facility in North central, Nigeria.

ORIGINAL ARTICLES

African Journals Online (AJOL)

commonest cause of female infertility in Africa. The therapeutic ... infertility.'5-l7. The aim of this study was to establish conception rates following endoscopic tubal surgery in patients with tubal disease presenting to the Reproductive Medicine Unit at Groote ... a severe male factor were a sperm count below 2 million/ml,.

Essure: a revolution in female definitive contraception

Directory of Open Access Journals (Sweden)

Daniella de Batista Depes

2009-09-01

Full Text Available Tubal sterilization is the most widely used procedure in the world for definitive contraception. It is safely performed by laparoscopy, but it is an invasive procedure with potential surgical and anesthetic risks. By hysteroscopy, the Essure micro-insert assures tubal obstruction with no need of hospitalization, incision or anesthesia.

Genetic divergence among accessions of Axonopus jesuiticus x A. scoparius based on morphological and agronomical traits

Directory of Open Access Journals (Sweden)

SIMONE M. SCHEFFER-BASSO

2014-03-01

Full Text Available This study had the objective of assessing the genetic divergence in giant missionary grass (Axonopus jesuiticus x A. scoparius germplasm based on morphological and agronomic traits. Five accessions were evaluated in the field: V14337, V14403, V14404, V14405 and V14406. Three contrasting groups were formed using the UPGMA clustering method: V14337 and V14404 formed one group, V14403 and V14405 formed another, and V14406 was isolated from the other accessions. The most striking traits for the identification of the accessions were the height of the plant and the change color of the leaf. Only V14406 accession had purplish green leaves. The other four accessions differed with regards to plant height and dry matter production, with superiority of V14337 and V14404 accessions. The high similarity, as assessed by the mean Euclidean distance, suggests that V14337 and V14404 share the same genotype. The genotypic variability among accessions indicates their potential use in breeding programs.

Spatial Distribution and Accessibility of Health Facilities in Akwa ...

African Journals Online (AJOL)

This paper therefore analyzed the spatial patterns of healthcare facilities in Akwa ... Data on six health indicator variables were obtained and analyzed to assess ... of healthcare facilities and thus hinders good access to high quality healthcare ...

Implementing the access and waiting time standard for early intervention in psychosis in the United Kingdom: An evaluation of referrals and post-assessment outcomes over the first year of operation.

Science.gov (United States)

Adamson, Vidyah; Barrass, Emma; McConville, Stephen; Irikok, Chantelle; Taylor, Kim; Pitt, Steve; Van Duyn, Rob; Bennett, Susan; Jackson, Lisa; Carroll, Jon; Andrews, Mark; Parker, Ann; Wright, Caroline; Greathead, Katie; Price, David

2018-03-26

Improving timely access to evidence-based treatment for people aged 14-65 years experiencing a first episode psychosis (FEP) or an at-risk mental state (ARMS) for psychosis is a national priority within the United Kingdom. An early intervention in psychosis (EIP) access and waiting time standard has been set which has extended the age range and acceptance criteria for services. This descriptive evaluation reports upon the referrals and access to treatment times within an EIP service over the first year of operating in line with the access and waiting time standard. Patient pathways and post-assessment status are also described. The service received 406 referrals, of which 88% (n = 357) were assessed. The mean length of time to treatment was 1.5 weeks, with 88% being seen within 2 weeks. Of those who engaged in an assessment, 34% (n = 138) were identified as ARMS cases and 30% (n = 123) were identified as FEP. Over 35 year olds accounted for 22% (n = 80) of the total accepted cases. The findings indicate clinical and operational issues, which will need careful consideration in the future planning of services. The high number of ARMS cases highlights the importance of clear treatment pathways and targeted interventions and may suggest a need to commission distinct ARMS services. The number of people who met the extended age and service acceptance criteria may suggest a need to adapt or redesign clinical services to meet the age-specific needs of over 35 year olds and those with an ARMS. It is unclear how changes to the remit of EIP services will impact upon future clinical outcomes. © 2018 John Wiley & Sons Australia, Ltd.

Probing Aircraft Flight Test Hazard Mitigation for the Alternative Fuel Effects on Contrails & Cruise Emissions (ACCESS) Research Team

Science.gov (United States)

Kelly, Michael J.

2013-01-01

The Alternative Fuel Effects on Contrails & Cruise Emissions (ACCESS) Project Integration Manager requested in July 2012 that the NASA Engineering and Safety Center (NESC) form a team to independently assess aircraft structural failure hazards associated with the ACCESS experiment and to identify potential flight test hazard mitigations to ensure flight safety. The ACCESS Project Integration Manager subsequently requested that the assessment scope be focused predominantly on structural failure risks to the aircraft empennage raft empennage.

Reconstrução cirúrgica tubária e condições de realização das laqueaduras Reconstrucción quirúrgica tubaria y condiciones de realización de las ligaduras Tubal reconstructive surgery and conditions for implementation of ligation

Directory of Open Access Journals (Sweden)

Escolástica Rejane Ferreira Moura

2010-09-01

masculina sobre las mujeres en el campo reproductivo.It was aimed to verify maternal age, parity, mode of delivery concurrent to tubal ligation and the contraceptive practice that preceded it; and to identify the reasons that motivated these women to ligation and tubal reconstructive surgery. This is a cross-sectional field study, carried out in a public laboratory for infertility in Fortaleza, Ceará, Brazil, with 13 women. Data were collected through interviews from January to April 2009. Ler foneticamenteTubal ligations were made on 25-year-old women or less, right after childbirth, mothers of two children or less, unaware of the contraceptive methods and/or how to obtain them. These women alleged male carelessness with fatherhood, the lack of desire for more children and pressure from families and employers as the reasons for the sterilizations. For 11 of these women, the change of male companion was decisive for looking for surgical reversion, the strong influence that partners have on women's decisions on the reproductive area.

Evaluating public space pedestrian accessibility: a GIS approach

NARCIS (Netherlands)

Morar, T.; Bertolini, L.; Radoslav, R.

2013-01-01

Public spaces are sources of quality of life in neighborhoods. Seeking to help professionals and municipalities assess how well a public space can be used by the community it serves, this paper presents a GIS-based methodology for evaluating its pedestrian accessibility. The Romanian city of

Access Denied! Contrasting Data Access in the United States and Ireland

Directory of Open Access Journals (Sweden)

Grogan Samuel

2016-07-01

Full Text Available The ability of an Internet user to access data collected about himself as a result of his online activity is a key privacy safeguard. Online, data access has been overshadowed by other protections such as notice and choice. This paper describes attitudes about data access. 873 US and Irish Internet users participated in a survey designed to examine views on data access to information held by online companies and data brokers. We observed low levels of awareness of access mechanisms along with a high desire for access in both participant groups. We tested three proposed access systems in keeping with industry programs and regulatory proposals. User response was positive. We conclude that access remains an important privacy protection that is inadequately manifested in practice. Our study provides insight for lawmakers and policymakers, as well as computer scientists who implement these systems.

Hepatitis B virus infection status and infertility causes in couples seeking fertility treatment-Indicator of impaired immune response?

Science.gov (United States)

Lao, Terence T; Mak, Jennifer S M; Li, Tin-Chiu

2017-04-01

The relationship between hepatitis B (HBV) infection in infertile couples seeking in vitro fertilization (IVF) treatment and infertility causes is unknown. A total of 831 infertile couples attending our unit seeking IVF during January to December 2015 were recruited. HBV infection was found in 6.3% and 7.3% of female and male partners, respectively, and infection in one or both partners was associated with less primary infertility (44.2% vs 55.1%, P=.038). Infected female partners had increased tubal (69.2% vs 43.2%, Pinfertility, while infected male partners were associated with increased tubal (62.3% vs 43.4%, P=.004) causes and reduced endometriosis (62.3% vs 73.9%, P=.050). Our results suggest HBV infection in either partner was associated with tubal infertility. HBV infection in either partner probably increases the risk of pelvic infection in female partner through impaired immune response to sexually transmitted infections, with consequent tubal damage and infertility. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hysterosalpingographic evaluation in infertility

International Nuclear Information System (INIS)

Kim, Jin Sik; Shin, Ma Rie; Jung, Eun Mi; Yoon, Chong Hyun; Lee, Chang Joon; Whang, In Soon; Kim, Han Suk

1984-01-01

H.S.G. has been proven to be an important diagnostic method in clinical gynecology for under 50 yrs. It is valuable in the investigation of the uterine and tubal factors of female infertility. Hysterosalpingograms of 81 patients with infertility were analyzed and following brief results were obtained. Ratio between primary and secondary infertility was 3 : 5, secondary infertility was more frequent. 2. Age distribution was more frequent under 30 years of age than over 30 years of age. 3. Abnormal uterine findings was only seen in 18 cases, abnormal tubal finding was only seen in 25 cases and combined uterine and tubal abnormalities were seen in 14 cases. 4. Abnormal uterine findings were malposition (12 cases), filling defect (5), spastic uterus (5), irregular contour (3), arcuate uterus (3), didelphia (1), in order of frequency. 5. Abnormal tubal findings were hydrosalpinx (21 cases), occlusion (19), intravasation (6), beaded appearance (3), and diverticula (2), in order of frequency. 6. Negative finding in both uterus tube was seen in 23 cases. 7. In 2 cases, pregnancy after the H.S.G. examination was confirmed.

Operators' Accessibility Studies using Virtual Reality

OpenAIRE

Louison , Céphise ,; Ferlay , Fabien ,; Keller , Delphine ,; Mestre , Daniel ,

2016-01-01

International audience; The development of fusion plants is more and more challenging. Compared to previous fusion experimental devices, integration constraints, maintenance and safety requirements are key parameters in the ITER project. Components are designed in parallel and we must consider integration, assembly and maintenance issues, which might have a huge impact on the overall design. That also implies to consider the operator's feedback to assess the feasibility of accessibility or ma...

Evaluating the performance of Leucaena accessions for agroforestry ...

African Journals Online (AJOL)

The performance of Leucaena accessions on acid soils in eastern coast Tanzania for agroforestry was evaluated for three years. Plant tree parameters assessed were fodder yield and plant stem height, stem girth, the number of total branches and poles production. Also, Leucaena psyllid, a common pest threatening the ...

Accessibility and sensory experiences

DEFF Research Database (Denmark)

Ryhl, Camilla

2010-01-01

and accessibility. Sensory accessibility accommodates aspects of a sensory disability and describes architectural design requirements needed to ensure access to architectural experiences. In the context of architecture accessibility has become a design concept of its own. It is generally described as ensuring...... physical access to the built environment by accommodating physical disabilities. While the existing concept of accessibility ensures the physical access of everyone to a given space, sensory accessibility ensures the choice of everyone to stay and be able to participate and experience....

Improving Urban Accessibility: A Methodology for Urban Dynamics Analysis in Smart, Sustainable and Inclusive Cities

OpenAIRE

Pérez-delHoyo, Raquel; Garcia-Mayor, Clara; Mora, Higinio; Gilart, Virgilio; Andújar-Montoya, María Dolores

2016-01-01

Despite the improvisations of current urban accessibility regulations and their application in urban systems, it is a fact that our cities are not accessible. Both, the assessment of the effectiveness of urban accessibility and its maintenance over time are issues that require a more consistent approach. In order to address these aspects, it is necessary to have an accurate awareness of the existing condition of urban accessibility. Therefore, the way this information is transformed into spec...

Assessing the accessibility of HIV care packages among tuberculosis patients in the Northwest Region, Cameroon

Directory of Open Access Journals (Sweden)

Miguel San

2010-03-01

Full Text Available Abstract Background Tuberculosis (TB and human immunodeficiency virus (HIV co-infection is a major source of morbidity and mortality globally. The World Health Organization (WHO has recommended that HIV counselling and testing be offered routinely to TB patients in order to increase access to HIV care packages. We assessed the uptake of provider-initiated testing and counselling (PITC, antiretroviral (ART and co-trimoxazole preventive therapies (CPT among TB patients in the Northwest Region, Cameroon. Methods A retrospective cohort study using TB registers in 4 TB/HIV treatment centres (1 public and 3 faith-based for patients diagnosed with TB between January 2006 and December 2007 to identify predictors of the outcomes; HIV testing/serostatus, ART and CPT enrolment and factors that influenced their enrolment between public and faith-based hospitals. Results A total of 2270 TB patients were registered and offered pre-HIV test counselling; 2150 (94.7% accepted the offer of a test. The rate of acceptance was significantly higher among patients in the public hospital compared to those in the faith-based hospitals (crude OR 1.97; 95% CI 1.33 - 2.92 and (adjusted OR 1.92; 95% CI 1.24 - 2.97. HIV prevalence was 68.5% (1473/2150. Independent predictors of HIV-seropositivity emerged as: females, age groups 15-29, 30-44 and 45-59 years, rural residence, previously treated TB and smear-negative pulmonary TB. ART uptake was 50.3% (614/1220 with 17.2% (253/1473 of missing records. Independent predictors of ART uptake were: previously treated TB and extra pulmonary TB. Finally, CPT uptake was 47.0% (524/1114 with 24% (590/1114 of missing records. Independent predictors of CPT uptake were: faith-based hospitals and female sex. Conclusion PITC services are apparently well integrated into the TB programme as demonstrated by the high testing rate. The main challenges include improving access to ART and CPT among TB patients and proper reporting and monitoring of

Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China.

Science.gov (United States)

Pan, Jay; Zhao, Hanqing; Wang, Xiuli; Shi, Xun

2016-12-01

identical. The E2SFCA method calculates population-adjusted density of hospitals, which measures deviation from the expected pattern, and therefore is more meaningful in assessing associations of the spatial access to hospitals with other factors (e.g., population density and investment). Copyright © 2016 Elsevier Ltd. All rights reserved.

Does Accessibility of Positive and Negative Schema Vary by Child Physical Abuse Risk?

Science.gov (United States)

Crouch, Julie L.; Risser, Heather J.; Skowronski, John J.; Milner, Joel S.; Farc, Magdalena M.; Irwin, Lauren M.

2010-01-01

Objective: To examine differences in accessibility of positive and negative schema in parents with high and low risk for child physical abuse (CPA). Methods: This study combined picture priming and lexical decision making methods to assess the accessibility of positive and negative words following presentation of child and adult faces. The child…

Accessible Earth: Enhancing diversity in the Geosciences through accessible course design and Experiential Learning Theory

Science.gov (United States)

Bennett, Rick; Lamb, Diedre

2017-04-01

The tradition of field-based instruction in the geoscience curriculum, which culminates in a capstone geological field camp, presents an insurmountable barrier to many disabled students who might otherwise choose to pursue geoscience careers. There is a widespread perception that success as a practicing geoscientist requires direct access to outcrops and vantage points available only to those able to traverse inaccessible terrain. Yet many modern geoscience activities are based on remotely sensed geophysical data, data analysis, and computation that take place entirely from within the laboratory. To challenge the perception of geoscience as a career option only for the able bodied, we have created the capstone Accessible Earth Study Abroad Program, an alternative to geologic field camp with a focus on modern geophysical observation systems, computational thinking, and data science. In this presentation, we will report on the theoretical bases for developing the course, our experiences in teaching the course to date, and our plan for ongoing assessment, refinement, and dissemination of the effectiveness of our efforts.

Presidential Management Fellows (PMF) Talent Acquisition System, PMF-TAS (ACCESS CONTROLLED)

Data.gov (United States)

Office of Personnel Management — Application and Assessment system for Presidential Management Fellows (PMF) and PMF Science, Technology, Engineering, and Math (STEM) programs. This sytem is access...

Lexical semantic access and letter access are involved in different aspects of reading

DEFF Research Database (Denmark)

Poulsen, Mads

). In this subset sample, both letter access and lexical access accounted for unique variance in reading fluency. The pattern of effects for lexical access did not change by controlling for serial rapid naming (RAN). Conclusions: The results suggest that letter access and lexical access are important for different......Purpose: This study investigated the effects of lexical access speed and letter access speed on reading fluency and reading comprehension. We hypothesized that 1) letter access speed would correlate with reading fluency but not comprehension, while 2) lexical access speed would influence reading...... comprehension. For readers who are struggling with recoding, most of the reading effort is probably tied up with recoding, leaving little to be explained by lexical access. Therefore we expected that 3) lexical access speed would primarily predict reading fluency for readers who were no longer struggling...

Systematic Assessment of Carbon Emissions from Renewable Energy Access to Improve Rural Livelihoods

Directory of Open Access Journals (Sweden)

Judith A. Cherni

2016-12-01

Full Text Available One way of increasing access to electricity for impoverished unconnected areas without adding significant amounts of CO2 to the atmosphere is by promoting renewable energy technologies. However, decision-makers rarely, if ever, take into account the level of in-built energy requirements and consequential CO2 emissions found in renewable energy, particularly photovoltaic cells and related equipment, which have been widely disseminated in developing countries. The deployment of solar panels worldwide has mostly relied on silicon crystalline cell modules, despite the fact that less polluting material—in particular, thin film and organic cells—offers comparatively distinct technical, environmental and cost advantages characteristics. A major scientific challenge has thus been the design of a single decision-making approach to assess local and global climate change-related impacts as well as the socio-economic effects of low-carbon technology. The article focuses on the functions of the multi-criteria-based tool SURE-DSS and environmental impact analysis focused on greenhouse gases (GHG emissions balance to inform the selection of technologies in terms of their impact on livelihoods and CO2eq. emissions. An application in a remote rural community in Cuba is discussed. The results of this study show that while PV silicon (c-Si, thin film (CdTe and organic solar cells may each equally meet the demands of the community and enhance people’s livelihoods, their effect on the global environment varies.

Access, attitudes and training in information technologies and ...

African Journals Online (AJOL)

Background: The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. Methods: The study ...

In vitro fertilization outcome in women with endometriosis & previous ovarian surgery

Directory of Open Access Journals (Sweden)

Sonja Pop-Trajkovic

2014-01-01

Full Text Available Background & objectives: Women with endometriosis often need in vitro fertilization (IVF to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. Methods: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH levels. Outcome measures included number of follicles, number of ocytes, peak oestradiol (E2 concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. Results: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. Interpretation & conclusions: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization.

Science.gov (United States)

Galen, Donald I; Khan, Naveed; Richter, Kevin S

2011-01-01

To estimate the safety and efficacy of Essure placement for proximal tubal occlusion in women with hydrosalpinx before in vitro fertilization (IVF). Prospective 2-center clinical study of women with hydrosalpinx who were recruited for off-label unilateral or bilateral placement of Essure before IVF (Canadian Task Force classification II-2). Tertiary office-based infertility and IVF practice settings. Twenty women with bilateral or unilateral hydrosalpinx desiring IVF. Office-based Essure placement and subsequent hysterosalpingography confirmation of proximal tubal occlusion. Placement success, and proximal tubal occlusion and birth rate after IVF. Eight women with unilateral hydrosalpinx received unilateral Essure placement, and 12 women with bilateral hydrosalpinx received bilateral placement. One unsuccessful placement occurred. Hysterosalpingography confirmed proximal tubal occlusion in 19 of 20 women (95%) and of 31 of 32 tubes (97%) with Essure placement. Subsequent IVF resulted in 12 live births, for a birth rate per transfer of 57% (12 of 21) and a birth rate per patient of 67% (12 of 20). Four obstetric complications were reported including placenta previa, hypertension, maternal diabetes with premature rupture of membranes, and preeclampsia. All infants are well. Placement of Essure microinserts is an effective method of nonincisional proximal tubal occlusion of hydrosalpinx. Success rates achieved through subsequent IVF are typical of outcomes of good-prognosis in similarly aged patients without hydrosalpinx in our same programs, based on 2008 Society for Assisted Reproductive Technologies data. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

Characterizing Journal Access at a Canadian University Using the Journal Citation Reports Database

Directory of Open Access Journals (Sweden)

Alan Gale

2011-07-01

Full Text Available This article outlines a simple approach to characterizing the level of access to the scholarly journal literature in the physical sciences and engineering offered by a research library, particularly within the Canadian university system. The method utilizes the “Journal Citation Reports” (JCR database to produce lists of journals, ranked based on total citations, in the subject areas of interest. Details of the approach are illustrated using data from the University of Guelph. The examples cover chemistry, physics, mathematics and statistics, as well as engineering. In assessing the level of access both the Library’s current journal subscriptions and backfiles are considered. To gain greater perspective, data from both 2003 and 2008 is analyzed. In addition, the number of document delivery requests, received from University of Guelph Library users in recent years, are also reviewed. The approach taken in characterizing access to the journal literature is found to be simple and easy to implement, but time consuming. The University of Guelph Library is shown to provide excellent access to the current journal literature in the subject areas examined. Access to the historical literature in those areas is also strong. In making these assessments, a broad and comprehensive array of journals is considered in each case. Document delivery traffic (i.e. Guelph requests is found to have decreased markedly in recent years. This is attributed, at least in part, to improving access to the scholarly literature. For the University of Guelph, collection assessment is an ongoing process that must balance the needs of a diverse group of users. The results of analyses of the kind discussed in this article can be of practical significance and value to that process.