Preliminary experience of ovarian tissue cryopreservation procedure: alternatives, perspectives and feasibility

Chemotherapy and radiotherapy induce premature ovarian failure in many patients treated for oncological or benign diseases. The present paper reviews the risk of developing premature ovarian failure according to the type of treatment and the different options to preserve fertility, focusing on the cryopreservation of ovarian tissue. This technique constitutes a promising approach to preserve the fertility of young patients and offers the advantage of storing a large number of follicles that could be subsequently transplanted or cultured in vitro to obtain mature oocytes. Based on 34 requests, from which 19 were performed, the feasibility of the ovarian cryopreservation procedure is evaluated. The medical and ethical approaches of this protocol are also discussed. Cryopreservation of ovarian tissue constitutes new hope for many patients, but must still be kept for selected cases, with a significant risk of premature ovarian failure after treatments such as bone marrow transplantation.

Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

Call admission control algorithms in OFDM-based wireless multiservice networks

Orthogonal frequency division multiplexing(OFDM) is becoming a fundamental technology in future generation wireless communications. Call admission control is an effective mechanism to guarantee resilient, efficient, and quality-of-service (QoS) services in wireless mobile networks. In this paper, we present several call admission control algorithms for OFDM-based wireless multiservice networks. Call connection requests are differentiated into narrow-band calls and wide-band calls. For either class of calls, the traffic process is characterized as batch arrival since each call may request multiple subcarriers to satisfy its QoS requirement. The batch size is a random variable following a probability mass function (PMF) with realistically maximum value. In addition, the service times for wide-band and narrow-band calls are different. Following this, we perform a tele-traffic queueing analysis for OFDM-based wireless multiservice networks. The formulae for the significant performance metrics call blocking probability and bandwidth utilization are developed. Numerical investigations are presented to demonstrate the interaction between key parameters and performance metrics. The performance tradeoff among different call admission control algorithms is discussed. Moreover, the analytical model has been validated by simulation. The methodology as well as the result provides an efficient tool for planning next-generation OFDM-based broadband wireless access systems.

The CPR Survey (1948-1997): a gridded database browser of plankton abundance in the North Sea.

The Continuous Plankton Recorder (CPR) survey provides a unique multi- decadal dataset on the abundance of plankton in the North Sea and North Atlantic and is one of only a few monitoring programmes operating at a large spatio- temporal scale. The results of all samples analysed from the survey since 1946 are stored on an Access Database at the Sir Alister Hardy Foundation for Ocean Science (SAHFOS) in Plymouth. The database is large, containing more than two million records (~80 million data points, if zero results are added) for more than 450 taxonomic entities. An open data policy is operated by SAHFOS. However, the data are not on-line and so access by scientists and others wishing to use the results is not interactive. Requests for data are dealt with by the Database Manager. To facilitate access to the data from the North Sea, which is an area of high research interest, a selected set of data for key phytoplankton and zooplankton species has been processed in a form that makes them readily available on CD for research and other applications. A set of MATLAB tools has been developed to provide an interpolated spatio-temporal description of plankton sampled by the CPR in the North Sea, as well as easy and fast access to users in the form of a browser. Using geostatistical techniques, plankton abundance values have been interpolated on a regular grid covering the North Sea. The grid is established on centres of 1 degree longitude x 0.5 degree latitude (~32 x 30 nautical miles). Based on a monthly temporal resolution over a fifty-year period (1948-1997), 600 distribution maps have been produced for 54 zooplankton species, and 480 distribution maps for 57 phytoplankton species over the shorter period 1958-1997. The gridded database has been developed in a user-friendly form and incorporates, as a package on a CD, a set of options for visualisation and interpretation, including the facility to plot maps for selected species by month, year, groups of months or years, long-term means or as time series and contour plots. This study constitutes the first application of an easily accessed and interactive gridded database of plankton abundance in the North Sea. As a further development the MATLAB browser is being converted to a user- friendly Windows-compatible format (WinCPR) for release on CD and via the Web in 2003.

'Murder or Mercy?' an innovative module helping UK medical students to articulate their own ethical standpoints regarding end-of-life decisions

Objectives This student selected component (SSC) was designed to equip United Kingdom (UK) medical students to respond ethically and with sensitivity to requests they might receive as qualified doctors in regard to euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and to provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment. Method The module is delivered by specialists from a number of disciplines including law, theology, medicine and nursing, each providing students with a working knowledge allowing them to actively discuss cases, articulate their own views and practise ethical reasoning through group and individual study. Visits to local intensive care units, palliative care wards and hospices are integrated effectively with theory. Student assessment comprises a dissertation, student-led debate and reflective commentary. Module impact was evaluated by analysis of student coursework and a questionnaire. Results Students found the content stimulating and relevant to their future career and agreed that the module was well-structured and that learning outcomes were achieved. They greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to real cases and to debate ethical issues with peers. Students reported an increased discernment of the ethical and legal position and practical considerations and a greater awareness of the range of professional and lay viewpoints held. Student perceptions were confirmed on analysis of their submitted coursework. Many participants were less strongly in favour of euthanasia and assisted dying on module completion than at the outset but all felt better equipped to justify their own viewpoint and to respond appropriately to patient requests. Conclusions The multi-disciplinary nature of this course is helpful in preparing students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position.

Performance models of storage contention in cloud environments

We propose simple models to predict the performance degradation of disk requests due to storage device contention in consolidated virtualized environments. Model parameters can be deduced from measurements obtained inside Virtual Machines (VMs) from a system where a single VM accesses a remote storage server. The parameterized model can then be used to predict the effect of storage contention when multiple VMs are consolidated on the same server. We first propose a trace-driven approach that evaluates a queueing network with fair share scheduling using simulation. The model parameters consider Virtual Machine Monitor level disk access optimizations and rely on a calibration technique. We further present a measurement-based approach that allows a distinct characterization of read/write performance attributes. In particular, we define simple linear prediction models for I/O request mean response times, throughputs and read/write mixes, as well as a simulation model for predicting response time distributions. We found our models to be effective in predicting such quantities across a range of synthetic and emulated application workloads. 

Web-assisted first-year undergraduate teaching in engineering

A software system, recently developed by the authors for the efficient capturing, editing, and delivery of audio-visual web lectures, was used to create a series of lectures for a first-year undergraduate course in Dynamics. These web lectures were developed to serve as an extra study resource for students attending lectures and not as a replacement. A questionnaire was produced to obtain feedback from students. The overall response was very favorable and numerous requests were made for other lecturers to adopt this technology. Despite the students' approval of this added resource, there was no significant improvement in overall examination performance

From Lydia Pinkham to Queen Levitra:Direct-to-consumer advertising and medicalisation

The medicalisation of life problems has been occurring for well over a century and has increased over the past 30 years, with the engines of medicalisation shifting to biotechnology, managed care, and consumers. This paper examines one strand of medicalisation during the last century: direct-to-consumer advertising (DTCA) of pharmaceuticals. In particular, it examines the roles that physicians and the Food and Drug Administration (FDA) have played in regulating DTCA in the US. Two advertising exemplars, the late 19 century Lydia E. Pinkham's Vegetable Compound (for 'women's complaints') and contemporary Levitra (for erectile dysfunction) are used to examine the parallels between the patent medicine era and the DTCA era. DTCA re-establishes the direct and independent relationship between drug companies and consumers that existed in the late 19 century, encouraging self-diagnosis and requests for specific drugs. The extravagant claims of Lydia Pinkham's day are constrained by laws, but modern-day advertising is more subtle and sophisticated. DTCA has facilitated the impact of the pharmaceutical industry and consumers in becoming more important forces in medicalisation. © 2008 The Authors.

A Generic Reference Software Architecture for Load Balancing over Mirrored Web Servers: NaSr Case Study

With the rapid expansion of the internet and the increasing demand on Web servers, many techniques were developed to overcome the servers' hardware performance limitation. Mirrored Web Servers is one of the techniques used where a number of servers carrying the same "mirrored" set of services are deployed. Client access requests are then distributed over the set of mirrored servers to even up the load. In this paper we present a generic reference software architecture for load balancing over mirrored web servers. The architecture was designed adopting the latest NaSr architectural style [1] and described using the ADLARS [2] architecture description language. With minimal effort, different tailored product architectures can be generated from the reference architecture to serve different network protocols and server operating systems. An example product system is described and a sample Java implementation is presented.

Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines:a systematic review

Patients' desire for hastened death within the context of advanced disease and palliative care is a controversial topic, frequently discussed in the international literature. Much of the discussion has focused on opinion and debate about ethical matters related to hastened death. Not many research studies seem to have specifically targeted why palliative care patients may desire hastened death, and few have focused on clinical guidelines for responding to such requests.

The Relationship between Components of the Behavioural Phenotype in Prader-Willi Syndrome

Background

Repetitive questions and temper outbursts form part of the behavioural phenotype of Prader-Willi syndrome (PWS). We investigated the phenomenology of temper outbursts in PWS and their relationship with other PWS behavioural characteristics.

Method

Four individuals with PWS were observed (5-10 h), during a number of experimental and natural environment challenges, some of which were expected to trigger temper outbursts. Individual behaviours including crying, ignoring, arguing, questioning, stereotypy, frowning and posture changes were recorded and subjected to lag sequential analysis.

Results

All participants were significantly more likely to show repetitive questioning before more challenging behaviours such as crying, arguing or ignoring requests. Precursor behaviours such as frowning and stereotypical behaviour were identified in three participants.

Conclusions

Temper outbursts in PWS may be associated with other PWS behavioural phenotypic characteristics such as repetitive questions and 'stubbornness'. A progression of behaviours may lead up to the most challenging temper outburst behaviours. This may have important implications for effective coping strategies.

Construction Disputes in Small to Medium Enterprises in Ireland during Recession: Identification of Critical Factors

Purpose - To identify the critical factors causing construction disputes in Small to Medium Enterprises (SMEs) in Ireland during the recent recession period of 2007 to 2013.
Design/Methodology/Approach - A mixed method approach incorporating a literature review, case studies and questionnaire survey, with results analysed using exploratory (data reduction) factor analysis.
Findings - The results indicate seven core critical factors which result in construction disputes in SMEs in Ireland during a recession: Payment and extras; Physical work conditions; Poor financial/legal practise; Changes to the agreed scope of works; Time overrun; Defects; and Requests for increase in speed of project and long-term defects.
Research Limitations/Implications - With Ireland emerging from the current economic recession and the prevalence of SMEs to the construction sector, it is essential to document the core critical factors of construction disputes which emerge within this particular segment of the built environment.
Practical Implications - To address the adversarial nature of the construction sector and the prevalence of SMEs, it is essential to identify and document the critical factors of construction disputes within this remit. It is envisaged that the results of this research will be acknowledged, and the recommendations adopted, by construction SMEs, particularly within Ireland, as they emerge from the economic recession.
Originality/Value - This paper fulfils a gap in knowledge with the emergence of the economic recession and the identification of critical factors of construction dispute within SMEs in the Irish construction industry.

Young children's food brand knowledge. Early development and associations with television viewing and parent's diet

Brand knowledge is a prerequisite of children's requests and choices for branded foods. We explored the development of young children's brand knowledge of foods highly advertised on television - both healthy and less healthy. Participants were 172 children aged 3-5 years in diverse socio-economic settings, from two jurisdictions on the island of Ireland with different regulatory environments. Results indicated that food brand knowledge (i) did not differ across jurisdictions; (ii) increased significantly between 3 and 4 years; and (iii) children had significantly greater knowledge of unhealthy food brands, compared with similarly advertised healthy brands. In addition, (iv) children's healthy food brand knowledge was not related to their television viewing, their mother's education, or parent or child eating. However, (v) unhealthy brand knowledge was significantly related to all these factors, although only parent eating and children's age were independent predictors. Findings indicate that effects of food marketing for unhealthy foods take place through routes other than television advertising alone, and are present before pre-schoolers develop the concept of healthy eating. Implications are that marketing restrictions of unhealthy foods should extend beyond television advertising; and that family-focused obesity prevention programmes should begin before children are 3 years of age.

Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications

Objective: Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues-and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community.

Method: We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized.

Results: We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered.

Significance of Results: Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

UK publicly funded Clinical Trials Units supported a controlled access approach to share individual participant data but highlighted concerns

OBJECTIVES: Evaluate current data sharing activities of UK publicly funded Clinical Trial Units (CTUs) and identify good practices and barriers.

STUDY DESIGN AND SETTING: Web-based survey of Directors of 45 UK Clinical Research Collaboration (UKCRC)-registered CTUs.

RESULTS: Twenty-three (51%) CTUs responded: Five (22%) of these had an established data sharing policy and eight (35%) specifically requested consent to use patient data beyond the scope of the original trial. Fifteen (65%) CTUs had received requests for data, and seven (30%) had made external requests for data in the previous 12 months. CTUs supported the need for increased data sharing activities although concerns were raised about patient identification, misuse of data, and financial burden. Custodianship of clinical trial data and requirements for a CTU to align its policy to their parent institutes were also raised. No CTUs supported the use of an open access model for data sharing.

CONCLUSION: There is support within the publicly funded UKCRC-registered CTUs for data sharing, but many perceived barriers remain. CTUs are currently using a variety of approaches and procedures for sharing data. This survey has informed further work, including development of guidance for publicly funded CTUs, to promote good practice and facilitate data sharing.