373 research outputs found
Re: Hilton P, Bryant A, Howel D, McColl E, Buckley BS, Lucas MG, et al. Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: A survey within a mixed methods feasibility study. Neurourol Urodyn. 2012;31(8):1223-30.
No full textRe: Hilton P, Bryant A, Howel D, McColl E, Buckley BS, Lucas MG, et al. Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: A survey within a mixed methods feasibility study. Neurourol Urodyn. 2012;31(8):1223-30
Randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks' gestation
No full textObjectives: To determine the acceptability, efficacy and costs of medical termination of pregnancy (MTOP) compared with surgical termination of pregnancy (STOP) at less than 14 weeks’ gestation, and to understand women’s decision-making processes and experiences when accessing the termination service. Design: A partially randomised preference trial and economic evaluation with follow-up at 2 weeks and 3 months. Setting: The Royal Victoria Infirmary, Newcastle upon Tyne, UK. Participants: Women accepted for termination of pregnancy (TOP) under the relevant Acts of Parliament with pregnancies < 14 weeks’ gestation on the day of abortion. A further group of women attending contraception and sexual health clinics participated in a discrete choice experiment (DCE). Interventions: STOP: all women ≥ 6 weeks’ and < 14 weeks’ gestation were primed with misoprostol 400 μg 2 hours before the procedure. STOP was performed under general anaesthesia using vacuum aspiration. MTOP: all women < 14 weeks’ gestation were given mifepristone 200 mg orally, returning 36–48 hours later for misoprostol. Outcome measures: Main outcome measure was acceptability of TOP method. Secondary outcome measures included strength of preference by willingness to pay (WTP); distress, using the Impact of Event Scale (IES); anxiety and depression; satisfaction with care; experience of care; frequency and extent of symptoms including self-assessment of pain; clinical effectiveness; and complications. A DCE was used to identify attributes that shape women’s preferences for abortion services. Results: The trial recruited 1877 women, 349 in the randomised arms and 1528 in the preference arms. Of those in the preference arms, 54% chose MTOP. At 2 weeks after the procedure more women having STOP would choose the same method again in the future. Acceptability of MTOP declined with increasing gestational age. The difference in acceptability between STOP and MTOP persisted at 3 months. At 2 weeks after TOP, women in the preference arms were prepared to pay more to have their preferred option. There was no difference in anxiety or depression scores in women having MTOP or STOP. However, women randomised to MTOP had higher scores on subscales of the IES at both 2 weeks and 3 months. There was no difference in IES scores between MTOP and STOP in the preference arm. Women were more likely to be satisfied overall and with technical and interpersonal aspects of care if they had STOP rather than MTOP. Experience of care scores were lower after MTOP in both randomised and preference arms. During admission women undergoing MTOP had more symptoms and reported higher mean pain scores, and after discharge reported more nausea and diarrhoea. There were no differences in time taken to return to work between groups; around 90% had returned to work and normal activity by 2 weeks. Rates of unplanned or emergency admissions were higher after MTOP than after STOP. Overall complication rates were also higher after MTOP, although this only achieved statistical significance in the preference arm. Overall, STOP cost more than MTOP due to higher inpatient standard costs. Even though complication rates were higher with MTOP, it was still more cost-effective. DCE identified three attributes with an almost equal impact on women’s preferences: provision of counselling, number of days delay to the procedure, and possibility of an overnight stay. Conclusions: MTOP was associated with more negative experiences of care and lower acceptability. Acceptability of MTOP declined with increasing gestational age. MTOP was less costly but also less effective than STOP. The majority of women choosing MTOP were satisfied with their care and found the procedure acceptable. Recommendations for further research: An audit of provision of MTOP and STOP in England and Wales is urgently required. Further studies exploring the barriers to offering women the choice of method of TOP are needed, together with research on the acceptability and effectiveness of (1) MTOP and manual VA in pregnancies below 9 weeks’ gestation and (2) MTOP and dilatation and evacuation after 14 weeks’ gestation. Trial registration: Current Controlled Trials ISRCTN07823656
0029: D. Farrier Letter, 1857
No full textHolograph request for collection of money in order to pay a debt to List and Howel
Smith Bridge Company, Toledo, Ohio [approximately 1870]
No full textThis photo, which was taken in early 1870's, shows some of the employees in front of the Smith Bridge Company in East Toledo. R. W. Smith, president and inventor, is the second man from the left. Some of the other employees in the company are J. J. Swigart, vice-president, J. D. Cook, secretary, A. Boyd, treasurer, Daniel Howel, chief engineer, F. E. Tracy, Andrew Strehlin, Ferdinand Zwilling, Tom Hamilton, Robert Barber, William S. Daly, Lewis Motter, Jacob Confer, Mr. Berry, and Mr. Huston. Terms associated with the photograph are: workers | lumber | buildings | factory | Smith Bridge Company (Toledo, Ohio) | East Toledo (Toledo, Ohio) | Smith, Robert W. | Swigart, J. J. | Cook, J. D. | Boyd, A. | Howel, Daniel | Tracy, F. E. | Strehlin, Andrew | Zwilling, Ferdinand | Hamilton, Tom | Barber, Robert | Daly, William S. | Motter, Lewis | Confer, Jacob | employees | Thompson, Perry | Berry, Mr. | Huston, Mr
The Li6(a,2a)d Reaction at 50 to 80 MeV
No full textThe Li6(a,2a)d reaction was studied at 50.4, 59.0, 60.5, 70.3 and 79.6
MeV bombarding energy. For each bombarding energy, several coincident energy
spectra of the two emitted a-particles were measured. Special emphasis was
placed on measuring spectra at pairs of angles where zero momentum (in the laboratory
frame of reference) was possible for the residual deuteron. Using the
constraints on three body kinematics, events corresponding to an a+ a+ d final
state were selected from the coincident energy spectra. The cross section for
these events was projected onto the E1 energy axis of the coincident spectra.
The projected energy spectra were analyzed with the Plane Wave Impulse
Approximation. From those points in the projected spectra which corresponded
to zero deuteron recoil momentum, off-mass-shell a-a scattering cross sections
were extracted. These were found to be in excellent agreement with free a-a
scattering cross sections, if free cross sections for the final state center of
mass energy of the two a's in the Li6 (a,2a)d reaction were chosen for the comparison.
Off- mass-shell a-a cross sections were also extracted for data where
the residual deuteron had a momentum of 30 MeV/c. These cross sections were
also found to agree with free a-a scattering, but it was necessary to introduce
an ad hoc shift in the a-a scattering angle to produce this agreement. Predictions
of off-mass-shell a-a cross sections were made using a potential model. These
indicate that the off-mass-shell cross section should indeed be very similar to
the on-mass-shell cross section at the final state energy. Using the Plane Wave Impulse Approximation a momentum distribution for
a's in Li6 was extracted from the experimental data. A cluster model for Li6
was devised to fit the binding energy and r.m.s. charge radius of Li6, as well
as the 3s1 a-d scattering phase shift. For comparison with the experimental
data, the momentum wave function of the a-particle in Li6 was calculated by
taking the Fourier transform of the a-d relative motion. The theoretical and
experimental momentum distributions were found to be in serious disagreement,
both in magnitude and width at half maximum. By introducing a cut-off radius into the theoretical wave function, the discrepancies between theory and experiment
were accounted for. It was also found, that if the cut-off radius is used
as an adjustable parameter, then this Li6 wave function and reaction model explains
the magnitudes and widths of the a-d relative momentum distributions
determined from a wide variety of other reactions
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