A thematic analysis of the perceptions of reversible inhibition of sperm under guidance as a potential family planning method in the United Kingdom.

BACKGROUND: This exploratory study aimed to look into public perceptions of Reversible Inhibition of Sperm Under Guidance (RISUG) as a family planning method in the United Kingdom (UK). It also aimed to discover if there were any sex differences in perceptions between males and females. DESIGN: Twelve semi-structured interviews were conducted, six with males and six with females, all residents of the UK. METHODS: The audio data from the interviews then was transcribed for analysis. An inductive and a semantic thematic analysis was conducted on the data set. RESULTS: Three main themes were constructed, including: (i) RISUG Hesitancy, (ii) Females perceived benefits of RISUG and (iii) Males perceived concerns regarding RISUG. Hesitancy was related to vaccination hesitancy, females wanted males to have more reproductive autonomy and males placed their concerns through the lens of 'other' males that their may be unintended side effects. Together these three themes represent both perceived risk and overall benefits of the method. However, while randomized control trails have been completed to standard for RISUG, males perceived concerns, suggesting a disconnect between the public's perceptions and professionals understanding of trails. CONCLUSION: RISUG was perceived as a viable option for family planning in the future, however trust of the new contraceptive method will need to be fostered among the public in order to effectively transfer knowledge on the potential side effects and the standard of pre-market testing for these. Effective public health messages can result in better education of people concerning the new contraceptive method, including the risks and benefits. By using perceptions to inform health messages around RISUG, researchers and practitioners can learn from potential users how to best address misinformation or concerns, while at the same time building an evidence base for when new male methods reach the contraceptive market.

LGYSB:Nd─High-Performance Lasing in the Near-Infrared Region.

Three incongruent melting LawNdxGdyYzSc4-w-x-y-z(BO3)4 (LGYSB:Nd) crystals with different Y concentrations (z = 0.15, 0.05, and 0.025) have been grown by the Czochralski method for the first time. The LGYSB:Nd-type crystals exhibit an acentric structure similar to that of the natural mineral huntite CaMg3(CO3)4, with space group R32. The composition of the LGYSB:Nd_3 (z = 0.025) crystal grown from the starting melt composition La0.628Gd0.547Y0.025Nd0.05Sc2.75(BO3)4 was measured by inductively coupled plasma mass spectrometry method, and it was found to be La0.6794Gd0.4105Y0.0178Nd0.0381Sc2.8542(BO3)4. The transversal spatial distribution of the refractive index in the LGYSB:Nd_3 crystal was investigated. Third-order nonlinear optical susceptibility χ(3) of the LGYSB:Nd_3 crystal was determined from third-harmonic generation experiments with ultrashort (fs) laser pulses. The optical transmission spectrum was measured in the range of 200-2000 nm. The absorption cross-section at 808 nm in σ-polarization was determined to be 1.18 × 10-19 cm2 for the LGYSB:Nd_3 crystal. The 10K absorption spectra revealed that the Nd3+ ions occupy only La3+ cationic sites in the LGYSB host matrix. The emission cross-section at 1064 nm in σ-polarization was determined to be σem(σ) = 1.74 × 10-19 cm2 for the LGYSB:Nd_3 crystal. The fluorescence lifetime was found to be τ = 115 µs for all of the LGYSB:Nd crystals. The LGYSB:Nd_3 laser was operated at an emission wavelength of 1062 nm with very high slope efficiencies of ηsa = 0.74 and ηsa = 0.64 in quasi-cw and cw regimes, respectively.

RE3+-Doped Ca3(Nb,Ga)5O12 and Ca3(Li,Nb,Ga)5O12 Crystals (RE = Sm, Dy, and Pr): A Review of Current Achievements.

Spectroscopic characteristics of RE3+ ions (RE = Sm, Dy, and Pr) doped in partially disordered Ca3Nb1.6875Ga3.1875O12-CNGG and Ca3Li0.275Nb1.775Ga2.95O12-CLNGG crystals are reviewed in detail to assess their prospects as laser crystals with emission in the visible spectral domain. All investigated crystals were grown using the Czochralski crystal growth technique. High-resolution absorption and emission measurements at different temperatures, as well as emission dynamics measurements, were performed on the grown crystals. The spectroscopic and laser emission characteristics of the obtained crystals were determined based on the Judd-Ofelt parameters. The obtained results indicate that CNGG:RE3+ and CLNGG:RE3+ (RE = Sm, Dy, and Pr) crystals can be promising materials for lasers in the visible range.

Efficient 1 µm Laser Emission of Czochralski-Grown Nd:LGSB Single Crystal.

A 5.0-at.% Nd-doped La0.64Gd0.41Sc2.95(BO3)4 (Nd:LGSB) borate laser crystal was successfully grown by the Czochralski method, for the first time to our knowledge. The spectroscopic properties of the grown crystal are discussed and 1 µm laser emission, under end-pumping with a fiber-coupled diode laser at 807 nm, is reported. A c-cut Nd:LGSB medium yielded 1.35 W continuous-wave output power at 0.63 overall optical-to-optical efficiency, with respect to the absorbed pump power, together with the high 0.68 slope efficiency. With an a-cut Nd:LGSB sample, 0.81 W output power at 0.52 optical-to-optical efficiency was obtained. The laser emission performances under quasi-continuous wave pumping are presented as well, for both c-cut and a-cut crystals. Passive Q-switching was investigated with a semiconductor saturable absorber mirror (SESAM). Laser pulses with 2.2 µJ energy and 32.8 ns durations were recorded from a-cut Nd:LGSB. The average output power reached 0.36 W at 1.55 W absorbed pump power. Passive mode-locking with SESAM was achieved in a long Z-type resonator. Ultrashort pulses with 0.19 W average power, 1.63 nJ energy, and 1.43 ps pulse duration, at 118 MHz repetition rate, are demonstrated for the a-cut Nd:LGSB medium.

Elders' environs and their end-of-life preferences.

HYPOTHESIS: Elders' predilections regarding end-of-life interventions vary with their living environs. METHODS: Patients in 3 settings--assisted living/outpatient, skilled nursing facility (SNF), and acute hospitalization--were asked to complete a brief questionnaire. RESULTS: A total of 269 patients who averaged 80.0 ± (SD) 8.1 years, 44% male, 70% white were studied. Eighty-five patients were outpatient elderly, 101 were hospitalized for acute illnesses, and 83 were interviewed in SNFs. Outpatients (44/85; 52%) and acutely ill inpatients (40/101; 40%) were more likely than patients residing in SNFs (19/81; 23%) to choose comfort care only (P = .047) for acute pneumonia requiring endotracheal intubation (ETI). Overall, 32% changed their choice for ETI, opting for comfort care only if acute pneumonia was followed by disposition to an SNF. However, ambulatory and acutely ill elderly patients were 3 times as likely as SNF patients to change from aggressive to comfort care if the most likely outcome was disposition to an SNF (P < .001). In multivariate regression models, age (>80), gender, number of lost ADLs (>2), and self-described quality of life were not associated with choosing comfort care instead of ETI, whereas place of residence (SNF versus home) was independently associated with choosing ETI (odds ratio = 3.5; 95%CI = 1.9-6.4). Similarly, those already living in an SNF were more likely to opt for remaining there for advancing dementia (odds ratio = 7.7; 95%CI = 3.8-15.8). However, choices for ETI did not coincide with choosing an SNF for advancing dementia. CONCLUSIONS: Elders residing in nursing homes were more likely than ambulatory patients to request invasive end-of-life care, a difference that was more pronounced when outcome required disposition to an SNF. These preferences were not dependent on patients' self-described disability or quality of life. This study suggests that qualitative outcomes matter to patients and their choices are associated with their place of residence.

Accuracy of bedside physical examination in distinguishing categories of shock: a pilot study.

HYPOTHESIS: Selected elements of a simple physical examination algorithm accurately predict categories of shock. SETTING: A 350-bed community teaching hospital. METHODS: Resident trainees who manage all critically ill and medically unstable patients were instructed to document capillary refill, (palpated) pulse volume, skin temperature, jugular venous pressure (JVP) and lung examination in all patients with prolonged (>30 minutes hypotension <90 mmHg). Treatment was determined by house officers guided by attending physicians of record. All cases were retrospectively reviewed by a senior clinician who applied consensus criteria/definitions to categorize shock as septic, cardiogenic or hypovolemic. Operating characteristics of examination findings for predicting categories of shock were computed. RESULTS: A total of 68 patients, averaging 71 ± 16 years, were studied. A total of 37 patients were diagnosed with septic shock, 18 with cardiogenic shock of and 13 with hypovolemic shock. Capillary refill and skin temperature predicted septic shock with sensitivity of 89%, specificity of 68%, positive predictive value (PPV) of 77%, negative predictive value (NPV) of 84%, and overall accuracy of 79%. Presence of JVP >7 cmH(2)O was more accurate than bilateral pulmonary crackles (>1/3 from bases) in predicting cardiogenic shock for low-output patients with sensitivity of 82%, specificity of 79%, PPV of 75%, NPV of 85%, and overall accuracy of 80%. Using just skin temperature and JVP, the bedside approach correctly diagnosed 52/68 cases (overall accuracy = 76%). CONCLUSIONS: Simple bedside clinical examination findings correctly predict categories of shock in a majority of cases.

Gurgling breath sounds may predict hospital-acquired pneumonia.

OBJECTIVES: To determine whether gurgling sounds heard during speech or quiet breathing, with or without a stethoscope over the glottis, predict hospital-acquired pneumonia (HAP). METHODS: All patients admitted to the respiratory or general medicine ward of a 350-bed community teaching hospital were eligible. Patients were examined each day, and those who had upper airway gurgling, heard with or without the stethoscope, during breathing or speech at any point during admission were noted. Assuming an overall incidence of HAP (>48 h after admission) of 5% to 10% and estimated incidence of 30% to 50% in patients with gurgle, 20 patients with gurgle and 60 patients without gurgle, matched on the same day and ward of admission, were included in the study. Demographic, physiologic, and outcome variables were compared using univariate and multivariate techniques to ascertain whether gurgling is independently associated with HAP, rate of transfer to ICU, and inhospital mortality. RESULTS: Twenty patients with gurgle were compared with 60 patients without gurgle. Patients with gurgle were older (78.5 vs 65.2 y; P < .001), more likely to reside in nursing homes (75% vs 6%; P < .001), and were more likely to have dementia (70% vs 13%; P < .001). In multivariate analysis, dementia (odds ratio [OR] = 23.4; 95% CI, 4.2-131.9) and recent (within 24 h) treatment with opiates (OR = 14.7; 95% CI, 2.2-97.5) emerged as the only statistically significant independent predictors of gurgling. HAP occurred in 55% of patients with gurgle compared with 1.7% of patients without gurgle (P < .001), and 50% of patients with vs 3.3% of patients without gurgle required transfer to ICU (P < .001). After adjustment for age, Charlson score, dementia, opiate administration, and stroke, gurgling emerged as the sole independent predictor of HAP (OR = 140.1; 95% CI, 5.6-3,529.4) and ICU transfer (OR = 35.1; 95% CI, 4.1-303.7). Gurgling did not predict mortality; the Charlson comorbidity index was the only significant predictor of inhospital death. CONCLUSIONS: Gurgling sounds heard during quiet breathing or speech are independently associated with HAP.

Efficient sensitization of Yb3+ emission by Nd3+ in Y2O3 transparent ceramics and the prospect for high-energy Yb lasers.

Very efficient energy transfer from Nd3+ to Yb3+ in transparent Y2O3 ceramics in the temperature range 10-300 K is demonstrated. It is inferred that this shows potential for the construction of high-energy Yb3+ lasers under diode or flash-lamp excitation of Nd3+.

Enhanced end-of-life care associated with deploying a rapid response team: a pilot study.

HYPOTHESIS: Institution of a rapid response team (RRT) improves patients' quality of death (QOD). SETTING: A 425-bed community teaching hospital. PATIENTS: : All medical-surgical patients whose end-of-life care was initiated on the hospital wards during the 8 months before (pre-RRT) and after (post-RRT) actuation. STUDY DESIGN: Retrospective cohort study. METHODS: Medical records of all patients were reviewed using a uniform data abstraction tool. Demographic information, diagnoses, physiologic and laboratory data, and outcomes were recorded. RESULTS: A total of 197 patients died in both the pre-RRT and post-RRT periods. There were no differences in age, sex, advance directives, ethnicity, or religion between groups. Restorative outcomes, including in-hospital mortality (27 vs. 30/1000 admissions), unexpected transfers to intensive care (17 vs. 19/1000 admissions) and cardiac arrests (3 vs. 2.5/1000 admissions) were similar during the 2 periods. Outcomes, including formal comfort care only orders (68 vs. 46%), administration of opioids (68 vs. 43%), pain scores (3.0 +/- 3.5 vs. 3.7 +/- 3.2), patient distress (26 vs. 62%), and chaplain visits (72 vs. 60%), were significantly better in the post-RRT period compared to the pre-RRT period (all P < 0.05). During the post-RRT period, 61 patients died with RRT care and 136 died without RRT care. End-of-life care outcomes were similar for these groups except more RRT patients had chaplain visits proximate to their deaths (80% vs. 68%; P = 0.0001). CONCLUSIONS: Institution of an RRT in our hospital had negligible impact on outcomes of patients whose goal was restorative care. Deployment of the RRT was associated with generally improved end-of-life pain management and psychosocial care.

Age, duration of mechanical ventilation, and outcomes of patients who are critically ill.

BACKGROUND: Age and duration of mechanical ventilation (MV) are strongly associated with mortality and hospital discharge disposition. METHODS: Electronic administrative records from a 425-bed community teaching hospital were obtained for 9,912 patients who were admitted to hospital ICUs between 2003 and 2008. Risk estimates of age and duration of MV for in-hospital mortality and discharge to home vs extended-care facilities (ECFs) also were obtained. RESULTS: Of 9,912 patients, 37 were discharged to hospice care, and 668 were < 18 years of age. Of the remaining 9,207 patients, 4,238 received invasive MV. Mortality or hospital discharge to ECFs increased consistently for each decade of age > 65 years and as the duration of MV increased. Although only 11.7% of patients < 65 years age who received MV for 1 or 2 days died during hospitalization, the mortality rate increased to 72.1% for patients > 85 years of age who had received MV for > 7 days. For patients requiring MV for >or= 7 days, < 10% of the >or= 65 years of age and < 5% of patients >or= 85 years of age survived to be discharged home from the hospital. Multivariate logistic regression analyses showed that age > 65 years and duration of MV remained significantly associated with outcomes, even after adjustment for hospital discharge diagnoses (Charlson scores). CONCLUSIONS: This study suggests that age and duration of MV are strongly associated with mortality and posthospital disposition. If confirmed, the simple combination of age and duration of MV provides prognostic information that could be used with trajectory of illness and in the context of patients' values to inform end-of-life discussions with patients or their surrogates during a trial of critical care.

The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study).

UNLABELLED: The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. THE AIM: of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. METHODS: The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease. RESULTS: Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 +/-17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome - 15.93%, anemia - 24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III- 64.81 %, Marsh II-35.19%. CONCLUSIONS: The prevalence of the coeliac disease in Romania is 2.22%: its sex distribution is fairly equal, the age distribution includes two peaks, at 30-40 and 50-60 years respectively, and patients from urban areas predominate. The most frequent (over 50% of the cases) histological type was M III. The most common clinical symptoms were diarrhoea, asthenia, anemia, aphthae, while the most frequent associated diseases were diabetes mellitus and Duhring-Brocq dermatiti