Business models and provider satisfaction in in vitro fertilization centers in the USA.

PURPOSE: The number of in vitro fertilization (IVF) cycles is increasing and the majority of patients undergoing IVF pay out of pocket. Reproductive endocrinology and infertility practitioners employ different business models to help create financial pathways for patients needing IVF but details regarding the different types of business models being used and physician satisfaction with those models have not been described previously. METHODS: A cross-sectional survey was sent to members of the Society of Reproductive Endocrinology and Infertility. The survey included 30 questions designed to assess demographics, practice patterns, and business models utilized. RESULTS: A total of 222/736 (30%) physicians responded to the survey. The majority of physicians offer a-la-carte (67%), bundled services (69%), grants (57%), and cost/risk-sharing (50%). The majority answered that the single ideal business model is bundled services (53%). There was no significant association between financial package offered and region of practice or state-mandated insurance. The largest barrier to care reported was cost with or without state-mandated coverage (94% and 99%, respectively). The majority of practices are satisfied with their business model (75%). Higher physician satisfaction was associated with private practice [69% vs 27%; OR (95%CI) = 3.8 (1.7, 8.6)], male gender [59% vs 30%; OR = 2.4 (1.1, 5.4)], and offering bundled services [83% vs 59%; OR = 2.8 (1.2, 6.7)]. CONCLUSIONS: Physicians utilize a variety of business models and most are satisfied with their current model. Cost is the major barrier to care in states with and without mandated coverage.

Spontaneous pneumothorax associated with ankylosing spondylitis.

OBJECTIVE: To review the incidence and clinical characteristics of spontaneous pneumothorax in patients with ankylosing spondylitis (AS). METHODS: This is a retrospective observational cohort study. Chest radiographs and medical records of patients with a diagnosis of AS from 1993 to 2003 in a tertiary referral centre were reviewed. RESULTS: A total of 1028 patients with a diagnosis of AS were identified from July 1993 to July 2003. Twenty-two patients had typical apical lung fibrotic changes in the chest radiographs (22/1028, 2.1%). Three of these patients (3/22, 13.6%) with lung disease had pneumothorax. Two patients had recurrences and received video-assisted thoracoscopic surgery (VATS) on the second attack. The third patient received talc pleurodesis on the first attack and did not have a recurrence. The incidence of spontaneous pneumothorax in patients with AS was 0.29% (3/1028) with an incidence density of 64.85/100,000 patient-yr (95% confidence interval: 66.17-63.57/100,000). CONCLUSION: Spontaneous pneumothorax appears to be exceedingly rare in AS unless there is an underlying fibrocystic lung disease, in which case its occurrence is not uncommon. Cigarette smoking may be an important co-factor. Once developed, recurrences are common even after treatment. Prophylactic procedures should thus be considered for the first attack of spontaneous pneumothorax.

Time-weighted average sampling of airborne n-valeraldehyde by a solid-phase microextration device.

A solid-phase microextraction (SPME) device was used as a time-weighted average sampler for n-valeraldehyde. The SPME device was first modified to improve the wearer's acceptance as a passive sampler. Then a poly(dimethylsiloxane)-divinylbenzene fiber was used and O-2,3,4,5,6-(pentafluorobenzyl)hydroxylamine hydrochloride (PFBHA) was loaded onto the fiber. Vapors of known concentrations around the threshold limit values time-weighted average of n-valeraldehyde and specific relative humidities (RHs) were generated by syringe pumps in a dynamic generation system. n-Valeraldehyde vapors in gas bags were also generated. An exposure chamber was designed to allow measurement of face velocities, temperatures, exposing vapor concentrations, and RHs. Gas chromatography with flame ionization detection was used for sample analysis. The appropriate adsorption time for SPME coating PFBHA was determined to be 2 min and the desorption time for oxime formed after sampling was optimized to be 2 min. The experimental sampling constant was found to be (3.86+/-0.13) x 10(-2) cm3/min and face velocity was not expect to have effect on the sampler.

Pancarditis in an extreme premature newborn following central venous catheterisation: report of one case.

We report a rare complication of pancarditis in an extreme premature neonate with a peripheral inserted central venous catheter which was positioned in the right atrium. She showed a picture of sepsis, pulmonary embolism, and heart failure. This case emphasizes the need for careful monitoring of the neonate with a central venous catheter to eliminate possible sequel. Echocardiography may help in making an early diagnosis of endocarditis in neonates.

Analysis of FHIT transcripts in cervical and endometrial cancers.

Carcinoma of the uterine cervix is a common malignancy, and many affected women, have been found to exhibit loss of heterozygosity (LOH) in the chromosome 3p region. Recent studies have localized the FHIT (fragile histidine triad) gene in this region and also demonstrated a high frequency of abnormalities of this gene in various cancers. To determine the role of the FHIT gene in cervical and uterine carcinomas, 16 cases of cervical carcinoma and 7 cases of endometrial carcinoma, as well as nearby non-cancerous tissues in these patients, were analyzed by reverse transcription of the FHIT mRNA followed by polymerase chain reaction amplification and sequencing of the products. In this study, 13 of 16 cervical cancers and 4 of 7 endometrial cancers displayed abnormal FHIT transcripts, including a lack of 2 or more exons of the FHIT gene, the insertion of several bases in the deletion junctions, and a 282 bp deletion from cDNA 171 to 452, resulting in a frameshift. Moreover, 5 of 16 matched non-cancerous tissues from the cervical cancer patients and 4 of 7 non-cancerous tissues from endometrial cancer patients also showed the presence of abnormal transcripts lacking 3 or more exons of the FHIT gene. Only 1 of 23 paired samples exhibited LOH. Our results suggest that the abnormal transcript of the FHIT gene is common in both normal and tumor tissues of the uterus and cervix. We also checked for HPV infection in these samples and found no definite relationship between the abnormal transcript and human papillomavirus infection.