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1.
Nature ; 626(7998): 280-282, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38326592

RESUMO

Moons potentially harbouring a global ocean are tending to become relatively common objects in the Solar System1. The presence of these long-lived global oceans is generally betrayed by surface modification owing to internal dynamics2. Hence, Mimas would be the most unlikely place to look for the presence of a global ocean3. Here, from detailed analysis of Mimas's orbital motion based on Cassini data, with a particular focus on Mimas's periapsis drift, we show that its heavily cratered icy shell hides a global ocean, at a depth of 20-30 kilometres. Eccentricity damping implies that the ocean is likely to be less than 25 million years old and still evolving. Our simulations show that the ocean-ice interface reached a depth of less than 30 kilometres only recently (less than 2-3 million years ago), a time span too short for signs of activity at Mimas's surface to have appeared.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38787921

RESUMO

OBJECTIVES: The primary aim was the validation of benign descriptors (BDs), followed by Assessment of Different NEoplasia's of the adneXa (ADNEX) (when BDs cannot be applied), in a two-step strategy to classify adnexal masses in pregnancy. The secondary aim was to describe the natural history of adnexal masses in pregnancy. METHODS: Retrospective analysis of prospectively collected data of women with an adnexal mass on ultrasonography identified during pregnancy between 2017 and 2022. The study was conducted at Queen Charlotte's and Chelsea Hospital, UK. Relevant clinical and ultrasound data were extracted from the medical records and ultrasound software astraia. Adnexal masses were classified and managed according to expert subjective assessment (SA). Ultrasound features were recorded prospectively at the time of ultrasound examination. Borderline ovarian tumours (BOT) were classified as malignant. Benign Descriptors (BDs) were applied to classify adnexal masses, in cases where BDs were not applicable, the ADNEX model (using a risk of malignancy of >10%) was used, in a two-step strategy. The two-step strategy was applied retrospectively. The reference standard used was histology (where available) or expert SA at the postnatal ultrasound scan. RESULTS: 291 women with a median age of 33 (IQR 29-36) years presented with an adnexal mass in pregnancy, at a median gestation of 12 (IQR 8-17) weeks. 267 (267/291, 91.8%) women were followed up to the postnatal period, as 24 women (24/291, 8.2%) were lost to follow up. Based on the reference standard, 4.1% of adnexal masses (11/267) were classified as malignant (all BOTs) and 95.9% (256/267) as benign (41 on histology and 215 based on expert SA at postnatal ultrasound). BDs could be applied to 68.9% of adnexal masses (184/267); of these only one mass (BOT) was misclassified as benign (1/184, 0.5%). ADNEX was used to classify the residual masses (83/267) and misclassified three BOTs as benign (3/10, 30.0%) and 25 benign masses (based on reference standard) as malignant (25/73, 34.2%), 13 (13/25, 52.0%) of these were classified as decidualised endometriomas on expert SA, with confirmed resolution of decidualisation in the postnatal period. The two-step strategy had a specificity of 90.2%, sensitivity of 63.6%, negative predictive value of 98.3% and positive predictive value of 21.9%. 56 (56/267, 21.0%) women had surgical intervention, four as an emergency during pregnancy (4/267, 1.5%,) and four (4/267, 1.5%) electively during caesarean section. 48 (48/267, 18.0%) women had surgical intervention in the post-natal period, 11 (11/267, 4.1%) in the first 12 weeks postnatal and 37 >12 weeks (37/267, 13.9%) postnatal. 64 (64/267, 24.0%) adnexal masses resolved spontaneously during follow up. Cyst-related complications occurred in four women (4/267, 1.5%) during pregnancy (ovarian torsion n=2, cyst rupture n=2) and six (6/267, 2.2%) in the postnatal period (all ovarian torsion). 196 (196/267, 73.4%) had a persistent adnexal mass, including one of the women who had an ovarian torsion and underwent de-torsion and had a persistent adnexal mass at postnatal ultrasound. Presumed decidualisation occurred in 31.1% (19/61) of endometriomas and had resolved in 89.5% (17/19) by the first postnatal ultrasound scan. CONCLUSION: We found Benign Descriptors apply to most masses in pregnancy, however the small number of malignant tumours in the cohort (4.1%) restricted the evaluation of the ADNEX model, so expert subjective assessment should be used to classify adnexal masses in pregnancy, when BDs do not apply. A larger multicentre prospective study is required to evaluate the use of the ADNEX model to classify adnexal masses in pregnancy. Our data suggests that most adnexal masses can be managed expectantly during pregnancy given a large proportion of masses spontaneously resolved and the low risk of complications. This article is protected by copyright. All rights reserved.

3.
BMC Nephrol ; 24(1): 122, 2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-37131125

RESUMO

BACKGROUND: Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS: This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS: 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION: Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION: NCT04872933. Registered 5th May 2021.


Assuntos
Qualidade de Vida , Insuficiência Renal Crônica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exercício Físico , Estudos Prospectivos , Insuficiência Renal Crônica/terapia , Listas de Espera , Telemedicina
4.
Opt Express ; 30(14): 25753-25764, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-36237098

RESUMO

We demonstrate a miniaturised and highly robust system for performing Doppler-free spectroscopy on thermal atomic vapour for three frequencies as required for cold atom-based quantum technologies. The application of additive manufacturing techniques, together with efficient use of optical components, produce a compact, stable optical system, with a volume of 0.089 L and a weight of 120 g. The device occupies less than a tenth of the volume of, and is considerably lower cost than, conventional spectroscopic systems, but also offers excellent stability against environmental disturbances. We characterise the response of the system to changes in environmental temperature between 7 and 35 ∘C and exposure to vibrations between 0 - 2000 Hz, finding that the system can reliably perform spectroscopic measurements despite substantial vibrational noise and temperature changes. Our results show that 3D-printed optical systems are an excellent solution for portable quantum technologies.

5.
Phys Rev Lett ; 128(20): 207401, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35657862

RESUMO

Moiré excitons promise a new platform with which to generate and manipulate hybrid quantum phases of light and matter in unprecedented regimes of interaction strength. We explore the properties in this regime, through studies of a Bose-Hubbard model of excitons coupled to cavity photons. We show that the steady states exhibit a rich phase diagram with pronounced bistabilities governed by multiphoton resonances reflecting the strong interexciton interactions. In the presence of an incoherent pumping of excitons we find that the system can realize single- and multiphoton lasers.

6.
Ultrasound Obstet Gynecol ; 58(6): 909-915, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34605083

RESUMO

OBJECTIVE: To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early-pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non-coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. RESULTS: There were 22 683 consultations over the 2-year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first-line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. CONCLUSIONS: No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Gravidez Ectópica/diagnóstico , Cuidado Pré-Natal/normas , Adulto , COVID-19/epidemiologia , Feminino , Humanos , Londres , Pandemias , Gravidez , Resultado da Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Ultrassonografia Pré-Natal
7.
Phys Rev Lett ; 125(9): 092501, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32915599

RESUMO

The size of a ΔK=0 M1 excitation strength has been determined for the first time in a predominantly axially deformed even-even nucleus. It has been obtained from the observation of a rare K-mixing situation between two close-lying J^{π}=1^{+} states of the nucleus ^{164}Dy with components characterized by intrinsic projection quantum numbers K=0 and K=1. Nuclear resonance fluorescence induced by quasimonochromatic linearly polarized γ-ray beams provided evidence for K mixing of the 1^{+} states at 3159.1(3) and 3173.6(3) keV in excitation energy from their γ-decay branching ratios into the ground-state band. The ΔK=0 transition strength of B(M1;0_{1}^{+}→1_{K=0}^{+})=0.008(1)µ_{N}^{2} was inferred from a mixing analysis of their M1 transition rates into the ground-state band. It is in agreement with predictions from the quasiparticle phonon nuclear model. This determination represents first experimental information on the M1 excitation strength of a nuclear quantum state with a negative R-symmetry quantum number.

8.
Exp Appl Acarol ; 80(3): 399-407, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32072354

RESUMO

Apiculture in the Pacific island country of Papua New Guinea (PNG) is under significant pressure from emerging parasitic mites, Varroa jacobsoni and Tropilaelaps mercedesae. Although numerous mite control products exist, beekeepers in PNG have limited resources and access to these products and their effectiveness under local conditions is untested. Here we determined the effectiveness of two brood manipulation strategies-queen caging and queen removal-for managing V. jacobsoni and T. mercedesae in comparison to the chemical miticide Bayvarol®. Our results found Bayvarol was the most effective control strategy for V. jacobsoni, maintaining high efficacy (> 90%) over 4 months with significantly reduced levels of V. jacobsoni compared to untreated control hives. In contrast, T. mercedesae were significantly reduced by the brood manipulation strategies over 2 months, but not significantly by Bayvarol compared to the controls. These results highlight that a combination of strategies is likely needed to effectively manage both mite pests in PNG. We discuss how these findings are relevant to informing best practice for honey bee biosecurity and how these strategies can be implemented to improve the effectiveness of mite management for PNG beekeepers.


Assuntos
Criação de Abelhas/métodos , Abelhas/parasitologia , Ácaros , Controle de Ácaros e Carrapatos/métodos , Varroidae , Animais , Papua Nova Guiné
9.
Hum Brain Mapp ; 40(9): 2571-2580, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30773729

RESUMO

Persuasive messages can change people's thoughts, feelings, and actions, but these effects depend on how people think about and appraise the meaning of these messages. Drawing from research on the cognitive control of emotion, we used neuroimaging to investigate neural mechanisms underlying cognitive regulation of the affective and persuasive impact of advertisements communicating the risks of binge drinking, a significant public health problem. Using cognitive control to up-regulate (vs. down-regulate) responses to the ads increased: negative affect related to consequences of excessive drinking, perceived ad effectiveness, and ratings of ad self-relevance made after a one-hour delay. Neurally, these effects of cognitive control were mediated by goal-congruent modulation of ventromedial prefrontal cortex and distributed brain patterns associated with negative emotion and subjective valuation. These findings suggest that people can leverage cognitive control resources to deliberately shape responses to persuasive appeals, and identify mechanisms of emotional reactivity and integrative valuation that underlie this ability. Specifically, brain valuation pattern expression mediated the effect of cognitive goals on perceived message self-relevance, suggesting a role for the brain's valuation system in shaping responses to persuasive appeals in a manner that persists over time.


Assuntos
Emoções/fisiologia , Função Executiva/fisiologia , Comunicação Persuasiva , Córtex Pré-Frontal/fisiologia , Autocontrole , Adulto , Consumo Excessivo de Bebidas Alcoólicas , Feminino , Comunicação em Saúde , Humanos , Imageamento por Ressonância Magnética , Masculino , Córtex Pré-Frontal/diagnóstico por imagem , Adulto Jovem
10.
Phys Rev Lett ; 123(23): 233601, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31868492

RESUMO

We investigate a Bose-Einstein condensate strongly coupled to an optical cavity via a repulsive optical lattice. We detect a stable self-ordered phase in this regime, and show that the atoms order through an antisymmetric coupling to the P band of the lattice, limiting the extent of the phase and changing the geometry of the emergent density modulation. Furthermore, we find a nonequilibrium phase with repeated intense bursts of the intracavity photon number, indicating nontrivial driven-dissipative dynamics.

11.
Phys Rev Lett ; 117(17): 175302, 2016 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-27824448

RESUMO

We study fermions that are gauge coupled to a cavity mode via Raman-assisted hopping in a one-dimensional lattice. For an infinite lattice, we find a superradiant phase with an infinitesimal pumping threshold which induces a directed particle flow. We explore the fate of this flow in a finite lattice with boundaries, studying the nonequilibrium dynamics including fluctuation effects. The short-time dynamics is dominated by superradiance, while the long-time behavior is governed by cavity fluctuations. We show that the steady state in the finite lattice is not unique and can be understood in terms of coherent bosonic excitations above a Fermi surface in real space.

12.
BJOG ; 123(4): 625-31, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26011792

RESUMO

OBJECTIVES: To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia. DESIGN: Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results. SETTING: Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011. PARTICIPANTS: Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps. INTERVENTIONS: Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting. MAIN OUTCOME MEASURES: Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months. RESULTS: Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively. CONCLUSIONS: Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS. TWEETABLE ABSTRACT: HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy.


Assuntos
Assistência Ambulatorial/economia , Procedimentos Cirúrgicos em Ginecologia/economia , Custos de Cuidados de Saúde , Pacientes Internados , Pacientes Ambulatoriais , Pólipos/economia , Hemorragia Uterina/economia , Assistência Ambulatorial/estatística & dados numéricos , Pesquisa Comparativa da Efetividade , Custos e Análise de Custo , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Preferência do Paciente , Pólipos/complicações , Pólipos/cirurgia , Resultado do Tratamento , Reino Unido/epidemiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
13.
Inj Prev ; 22(5): 334-41, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26826177

RESUMO

BACKGROUND: Childhood falls, poisonings and scalds, occurring predominantly in the home, are an important public health problem, yet there is limited evidence on the costs of these injuries to individuals and society. OBJECTIVES: To estimate National Health Service (NHS) and child and family costs of falls, poisonings and scalds. METHODS: We undertook a multicentre longitudinal study of falls, poisonings and scalds in children under 5 years old, set in acute NHS Trusts across four UK study centres. Data from parental self-reported questionnaires on health service resource use, family costs and expenditure were combined with unit cost data from published sources to calculate average cost for participants and injury mechanism. RESULTS: 344 parents completed resource use questionnaires until their child recovered from their injury or until 12 months, whichever came soonest. Most injuries were minor, with >95% recovering within 2 weeks, and 99% within 1 month of the injury. 61% emergency department (ED) attendees were not admitted, 35% admitted for ≤1 day and 4% admitted for ≥2 days. The typical healthcare cost of an admission for ≥2 days was estimated at £2000-3000, for an admission for ≤1 day was £700-1000 and for an ED attendance without admission was £100-180. Family costs were considerable and varied across injury mechanisms. Of all injuries, scalds accrued highest healthcare and family costs. CONCLUSIONS: Falls, poisonings and scalds incur considerable short-term healthcare and family costs. These data can inform injury prevention policy and commissioning of preventive services.


Assuntos
Acidentes por Quedas/economia , Acidentes Domésticos/economia , Queimaduras/economia , Hospitalização/economia , Tempo de Internação/economia , Intoxicação/economia , Medicina Preventiva , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/prevenção & controle , Queimaduras/prevenção & controle , Queimaduras/reabilitação , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pais , Intoxicação/prevenção & controle , Intoxicação/reabilitação , Formulação de Políticas , Medicina Preventiva/economia , Medicina Preventiva/métodos , Inquéritos e Questionários
14.
Neuroimage ; 111: 379-84, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25721427

RESUMO

Individual differences in the temporal dynamics of the haemodynamic response can reflect cortical excitation and can reveal underlying cortical physiology. Here, we show differences in the shape of the haemodynamic response that are dependent on stimulus parameters. Two sets of visual stimuli were used varying in parameters that are known to manipulate the haemodynamic response in the visual cortex. We measured the oxyhaemoglobin response using near infrared spectroscopy. The first set of stimuli comprised chromatic square-wave gratings that varied with respect to the separation in the CIE UCS chromaticities of the alternating bars. The gratings with large separations in chromaticity evoked an oxyhaemoglobin response with greater amplitude, consistent with greater activation of the visual cortex. The second set of stimuli comprised horizontal achromatic gratings that (1) were static, (2) drifted at a constant velocity towards fixation, or (3) reversed direction every half spatial cycle to create a vertical vibrating motion. Although the three types of grating had a similar effect on the amplitude of the oxyhaemoglobin response, the moving gratings (2 and 3) evoked a steeper decrease in oxyhaemoglobin concentration after stimulus-offset. The steeper slope appears to reflect the post-stimulus undershoot and the slope may provide a correlate of cortical excitability when the amplitude of the haemodynamic response has saturated.


Assuntos
Hemodinâmica/fisiologia , Oxiemoglobinas , Reconhecimento Visual de Modelos/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Córtex Visual/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Phys Rev Lett ; 115(23): 236403, 2015 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-26684130

RESUMO

We explore the nonequilibrium response of Chern insulators. Focusing on the Haldane model, we study the dynamics induced by quantum quenches between topological and nontopological phases. A notable feature is that the Chern number, calculated for an infinite system, is unchanged under the dynamics following such a quench. However, in finite geometries, the initial and final Hamiltonians are distinguished by the presence or absence of edge modes. We study the edge excitations and describe their impact on the experimentally observable edge currents and magnetization. We show that, following a quantum quench, the edge currents relax towards new equilibrium values, and that there is light-cone spreading of the currents into the interior of the sample.

16.
Inj Prev ; 20(5): e11, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24842981

RESUMO

BACKGROUND: Scalds are one of the most common forms of thermal injury in young children worldwide. Childhood scald injuries, which mostly occur in the home, result in substantial health service use and considerable morbidity and mortality. There is little research on effective interventions to prevent scald injuries in young children. OBJECTIVES: To determine the relationship between a range of modifiable risk factors for medically attended scalds in children under the age of 5 years. DESIGN: A multicentre case-control study in UK hospitals and minor injury units with parallel home observation to validate parental reported exposures. Cases will be 0-4 years old with a medically attended scald injury which occurred in their home or garden, matched on gender and age with community controls. An additional control group will comprise unmatched hospital controls drawn from children aged 0-4 years attending the same hospitals and minor injury units for other types of injury. Conditional logistic regression will be used for the analysis of cases and matched controls, and unconditional logistic regression for the analysis of cases and unmatched controls to estimate ORs and 95% CI, adjusted and unadjusted for confounding variables. MAIN EXPOSURE MEASURES: Use of safety equipment and safety practices for scald prevention and scald hazards. DISCUSSION: This large case-control study will investigate modifiable risk factors for scalds injuries, adjust for potential confounders and validate measures of exposure. Its findings will enhance the evidence base for prevention of scalds injuries in young children.


Assuntos
Prevenção de Acidentes/métodos , Acidentes Domésticos/prevenção & controle , Queimaduras/prevenção & controle , Segurança , Queimaduras/etiologia , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco , Segurança/normas , Reino Unido
17.
Facts Views Vis Obgyn ; 16(2): 195-201, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38950533

RESUMO

Background: Laparoscopic myomectomy is increasingly considered the gold standard uterine preserving procedure and has well documented benefits over the open approach. Barriers that women have in accessing the most appropriate treatment need to be addressed to ensure optimal patient care and outcomes. Objectives: To analyse rates of open and laparoscopic myomectomy at a large NHS trust and identify how many cases could potentially have been performed laparoscopically, and any variation between sites. Materials and Methods: A retrospective review of preoperative imaging reports and a surgical database containing information for all myomectomies performed between 1st January 2015 and 31st December 2022. Main outcome measures: Number of procedures suitable for alternative surgical approach; length of hospital stay; estimated blood loss; cost differences. Results: 846 myomectomies were performed; 656 by laparotomy and 190 by laparoscopy. 194/591 (32.8%) open myomectomies could have been performed laparoscopically and 26/172 (15.1%) laparoscopic myomectomies may have been better performed via an open approach. Length of hospital stay, and estimated blood loss were significantly higher in the open group. Had cases been performed as indicated by pre-operative imaging, the cost differences ranged from -£115,752 to £251,832. Conclusions: There is disparity in access to the gold standard care of laparoscopic myomectomy. Due to multifactorial reasons, even at sites where the rate of laparoscopic myomectomy is high, there is still underutilisation of this approach. It is clear that there is scope for change and "levelling up" of this imbalance. What is new?: Robust pathways and guidelines must be developed, and more laparoscopic surgeons should be trained to optimise care for women with fibroids.

18.
HIV Med ; 14 Suppl 3: 19-24, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24033898

RESUMO

OBJECTIVES: Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis. METHODS: National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis. RESULTS: In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late (CD4 count < 350 cells/µL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15-24 years (31%). Sixty-four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men (MSM) (P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1-year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011. CONCLUSIONS: The National Health Service provides high-quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8-fold increased risk of 1-year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4/estatística & dados numéricos , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
19.
Phys Rev Lett ; 111(23): 232503, 2013 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-24476263

RESUMO

Classical novae are expected to contribute to the 1809-keV Galactic γ-ray emission by producing its precursor 26Al, but the yield depends on the thermonuclear rate of the unmeasured 25Al(p,γ)26Si reaction. Using the ß decay of 26P to populate the key J(π)=3(+) resonance in this reaction, we report the first evidence for the observation of its exit channel via a 1741.6±0.6(stat)±0.3(syst) keV primary γ ray, where the uncertainties are statistical and systematic, respectively. By combining the measured γ-ray energy and intensity with other experimental data on 26Si, we find the center-of-mass energy and strength of the resonance to be E(r)=414.9±0.6(stat)±0.3(syst)±0.6(lit.) keV and ωγ=23±6(stat)(-10)(+11)(lit.) meV, respectively, where the last uncertainties are from adopted literature data. We use hydrodynamic nova simulations to model 26Al production showing that these measurements effectively eliminate the dominant experimental nuclear-physics uncertainty and we estimate that novae may contribute up to 30% of the Galactic 26Al.

20.
Phys Rev Lett ; 109(21): 215302, 2012 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-23215598

RESUMO

Motivated by new capabilities to realize artificial gauge fields in ultracold atomic systems, and by their potential to access correlated topological phases in lattice systems, we present a new strategy for designing topologically nontrivial band structures. Our approach is simple and direct: it amounts to considering tight-binding models directly in reciprocal space. These models naturally cause atoms to experience highly uniform magnetic flux density and lead to topological bands with very narrow dispersion, without fine-tuning of parameters. Further, our construction immediately yields instances of optical Chern lattices, as well as band structures with Chern numbers of magnitude larger than one.

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