Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient's perspective.

OBJECTIVE: For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative. The primary objective of this study was to evaluate women's perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy. STUDY DESIGN: A single centre service evaluation study performed at Birmingham Women's & Children's Foundation Hospital Trust. An anonymised semi-structured survey link was posted to all women (n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018). Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey. MAIN OUTCOME MEASURES: Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications. Climacteric symptoms were assessed using the Greene Climacteric Scale. RESULTS: Data was obtained for 119 women. The written survey yielded higher response rates (n = 73, 61.3%). Most respondents were 51-60 years old (n = 51 42.9%) and 87.4% (n = 104) were 'White British'. 70 women used estradiol only implants. 30.1%% (n = 34) of patients reported a low Greene Climacteric Scale score (0-5). Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages. There was a lower prevalence of psychological symptoms amongst ≥51 year olds. High satisfaction rates were reported. CONCLUSIONS: Data from a large cohort is presented. Good symptom control, satisfaction and long-term efficacy was demonstrated. This study supports the value of HRT implants for refractory menopause symptoms. A national database of implant users would be a useful tool to record satisfaction scores and adverse events.

Ion chamber gas-to-wall conversion factors for fast neutron dosimetry.

Modern ionising photon dosimetry is essentially entirely based upon gas-filled cavity determinations. For photons, ion chamber response is largely independent of photon energy almost perfectly transforming absorbed dose in the gas to the surrounding media. Absolute uncertainties are <1-2%. For fast neutron dosimetry, this is certainly not the case. Interpretation of the response of the cavity filling material, usually a gas, to the charged particle spectrum induced in the walls and interacting with the cavity gas is fraught with uncertainties. Despite these challenges, gas filled cavities surrounded by various mixtures, compounds and elements, have proved to be essential for integral determinations of the indirectly ionising neutrons, generating dosimetric quantities, such as kerma and absorbed dose. The transformation from gas response to wall dose is material dependent and varies with neutron energy. This study discusses recent advances in cavity response interpretation using the results from complex nuclear modelling of microscopic cross sections as well as estimates of secondary particle production enabling much improved cavity gas-to-wall media conversion factors.

ENDF nuclear data in the physical, biological, and medical sciences.

PURPOSE: This paper gives an overview of recent advances in the ENDF (Evaluated Nuclear Data File) database of neutron, proton, and photonuclear cross sections. ENDF nuclear data aim to provide accurate and comprehensive representations of all reaction processes that need to be simulated in radiation transport applications. The paper reviews some of the most importance capabilities embodied in the ENDF/B-VII.0 database released a few years ago, and describes new capabilities being developed for the forthcoming ENDF/B-VII.1 release planned for later in 2011. CONCLUSION: Illustrative examples are given for nuclear reactions of particular importance to Monte Carlo N-Particle (MCNP) simulations of biological and medical applications. The examples show the utility of these evaluated ENDF data for simulating energy deposition and transport, for therapy and for radiation protection applications.