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In this chapter, the evidence and use of in vitro fertilisation (IVF) add-ons in the UK is explored. In addition, the stance of professional and regulatory bodies is described. The term ‘add-on’ has been coined to describe the additional ‘extras’ to a routine or intracytoplasmic sperm injection cycle that are commonly offered to those undergoing treatment with the aim of improving livebirth rates. A summary of the highest quality available evidence for the following add-ons is presented: endometrial scratching; time-lapse imaging; assisted hatching; preimplantation genetic testing (PGT-A); endometrial receptivity array; GM-CSF containing culture media; Embryo Glue (hyaluronic acid); artificial egg activation with calcium ionophore; intracytoplasmic morphologically selected sperm injection (IMSI); physiological intracytoplasmic sperm injection (PICSI); sperm DNA test; and reproductive immunology procedures. There remains a paucity of evidence to support the routine use of add-ons based on the available randomised controlled trial and systematic review evidence. This is particularly important given that most patients pay additional fees to utilise add-ons. In order for patients to receive high- quality care in IVF clinics, clinicians must be prepared to discuss the relevant evidence regarding efficacy and safety of the specific add-on being considered.
Understanding differences in social-emotional behavior can help identify atypical development. This study examined the differences in social-emotional development in children at increased risk of an autism spectrum disorder (ASD) diagnosis (infant siblings of children diagnosed with the disorder). Parents completed the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) to determine its ability to flag children with later-diagnosed ASD in a high-risk (HR) sibling population. Parents of HR (n = 311) and low-risk (LR; no family history of ASD; n = 127) children completed the BITSEA when their children were 18 months old and all children underwent a diagnostic assessment for ASD at age 3 years. All six subscales of the BITSEA (Problems, Competence, ASD Problems, ASD Competence, Total ASD Score, and Red Flags) distinguished between those in the HR group who were diagnosed with ASD (n = 84) compared to non-ASD-diagnosed children (both HR-N and LR). One subscale (BITSEA Competence) differentiated between the HR children not diagnosed with ASD and the LR group. The results suggest that tracking early social-emotional development may have implications for all HR children, as they are at increased risk of ASD but also other developmental or mental health conditions.
Despite many notable successes, the failure rate of animal translocations remains high. Conservation practitioners and reintroduction specialists have emphasised the need for ongoing documentation of translocation attempts, whether successful or not, including detailed methodologies and monitoring approaches. This study reports on the first translocation of the North Island subspecies of New Zealand’s smallest bird, the endemic Rifleman Acanthisitta chloris granti. We describe an improved transfer methodology following recommendations arising from a previous translocation of South Island Rifleman Acanthisitta chloris chloris. Key modifications included a reduced capture window, shorter holding times, lack of extended aviary housing, and separation of territorial individuals during holding. Survival from capture to release increased from 52% to 97% using this new methodology. However, only 22% of 83 released birds were found in the reserve the next breeding season, resulting in an initial breeding population of only six males and five females. An integrated Bayesian analysis of three years of subsequent population data, including a population boost from a second translocation, projected a median decrease to 0–5 females over 10 years, but with 95% prediction intervals ranging from 0 to 33. These projections explicitly account for parameter uncertainty, as well as demographic stochasticity, and illustrate the need to do so when making inferences for small reintroduced populations.
This chapter explores the interface between co-produced research and community development, drawing on work undertaken in North East England as part of the Imagine project. Discussion of the process and outcomes of Imagine North East provides fruitful material for contributing to perennial debates about whether certain forms of co-produced research (especially participatory action research) are, in fact, indistinguishable from community development. In this chapter we offer a brief overview of the work of Imagine North East before outlining the debates about the relationship between co-production and community development. We then examine three elements of Imagine North East: (1) an academic-led study of community development from the 1970s to the present; (2) a series of community development projects undertaken by local community-based organisations; and (3) a joint process of reflection and co-inquiry. We consider the role of co-produced research in challenging stigma, celebrating place and developing skills and community networks, and also the challenges of a co-inquiry approach.
Exploring community development from the outside and inside: The work of Imagine North East
Imagine North East was a partnership between 12 community-based organisations in Tyneside (including a local museum) and Durham University, officially running during 2014 and 2015, with dissemination and reflection work continuing in 2016. Community development featured in several ways. Not only did community-based sub-projects use processes of community development (mobilising people to work together) and generate community development outcomes (for example, strengthened communities, improved facilities) in their work for Imagine North East, but our study also had community development as its main focus. We adopted three approaches to the study of community development, as outlined below:
1. Studying community development from the outside: The starting point of the research was the community development projects of the 1970s in Benwell (Newcastle-upon-Tyne) and North Shields. These were part of Britain's first anti-poverty programme, combining community development work and research with a view to diagnosing and alleviating poverty locally (Loney, 1983; Banks and Carpenter, 2017). We also looked at community development processes over time (from the 1970s to the present) as these areas were subject to numerous regeneration schemes in which local people were more or less engaged. This research was largely done by academic researchers and then shared in the wider group.
Prehospital blood transfusion has been adopted by many civilian helicopter emergency medical services agencies, and early outcomes are positive. The Shock Trauma Air Rescue Society operates six bases in Western Canada and started a blood on board process in 2013 in Regina that has expanded to all bases. Two units of O negative packed red blood cells are carried on every mission. We describe the processes and standard work ensuring safe storage, administration, and stewardship of this important resource.
The packed red blood cells are stored in an inexpensive, reusable temperature controlled cooler at 1°C–6°C. Close collaboration with local transfusion services and adherence to Canadian transfusion standards contributes to safety and sustainability.
From October 1, 2013 to October 10, 2017, the Shock Trauma Air Rescue Society administered blood to 431 patients. Of this total, 62.9% received blood carried on our aircraft. A total of 463 blood box units were administered, and the majority of patients (69.0%) received both units. Blood used in Calgary, Alberta was 100% traceable, and only 1.2% of total units dispensed was wasted. The vast majority of unused units were returned to circulation.
We describe the process to set up and monitor a prehospital blood transfusion program. Our standard work and stewardship processes minimize wastage of blood while keeping it readily available for our critically ill and injured patients.
The long-term outcome of intensive care unit (ICU)-acquired weakness has far-reaching consequences for the patient. Healthy postpartum women are at increased risk of postpartum depression. The treatment of postpartum depression has a biopsychosocial basis. It is important to recognize women at risk for the development of post-traumatic stress disorder (PTSD), and certain measures can be taken to reduce the risk of developing it. In order to help the obstetric patient to recover fully from ICU and enable her to have a good quality of life, measures must be taken to prevent cognitive impairment and delirium. Fertility and pregnancy after recovery from critical illness presents a challenge because of the limited data on which to base counseling. Counseling should address any risks to the pregnancy that might result from the inciting event or condition as well as any new risks resulting from sequelae.
There is increasing emphasis on the need for effective ways of sharing knowledge to enhance environmental management and sustainability. Knowledge exchange (KE) are processes that generate, share and/or use knowledge through various methods appropriate to the context, purpose, and participants involved. KE includes concepts such as sharing, generation, coproduction, comanagement, and brokerage of knowledge. This paper elicits the expert knowledge of academics involved in research and practice of KE from different disciplines and backgrounds to review research themes, identify gaps and questions, and develop a research agenda for furthering understanding about KE. Results include 80 research questions prefaced by a review of research themes. Key conclusions are: (1) there is a diverse range of questions relating to KE that require attention; (2) there is a particular need for research on understanding the process of KE and how KE can be evaluated; and (3) given the strong interdependency of research questions, an integrated approach to understanding KE is required. To improve understanding of KE, action research methodologies and embedding evaluation as a normal part of KE research and practice need to be encouraged. This will foster more adaptive approaches to learning about KE and enhance effectiveness of environmental management.
Adenosine, when given as an intravenous bolus, has been shown to produce atrioventricular nodal block in humans. To examine the effect of adenosine on conduction across both accessory pathways and the atrioventricular node in children, we reviewed our experience with adenosine administered during both atrial and ventricular pacing in 42 patients with atrioventricular resting tachycardia and in eight patients with atrioventricular nodal reentry tachycardia. Adenosine was administered as a mean bolus of 195 μg/kg/dose during both atrial and ventricular pacing, examining antegrade and retrograde conduction before and after radiofrequency ablation. In those patients with persistent or intermittent pre-excitation, anomalous ventricular activation was either unchanged (n=8) or increased (n=11). Retrograde conduction (either through the accessory pathway alone in three, or across both the accessory pathway and the atrioventricular node in 19) persisted in 92% of the 24 patients studied. Adenosine produced either first or third degree antegrade heart block in all patients studied without pre-excitation (those with either dual atrioventricular nodal pathways or concealed accessory pathways). Adenosine produced retrograde block in all of the eight patients with dual atrioventricular nodal pathways. In contrast, retrograde conduction persisted in 82% (14/17) of patients with concealed accessory pathways (p=0.001). When used to examine retrograde conduction, adenosine was a sensitive (82%) and highly specific (producing retrograde atrioventricular block in all patients with dual atrioventricular nodal pathways) predictor of tachycardia supported by a concealed accessory pathway. Adenosine yielded a sensitivity and specificity of 96% and a positive predictive value of 99.5% for the success of ablation of accessory pathways. These data indicate that the pattern of adenosine-induced changes in either antegrade or retrograde atrioventricular conduction, or conduction in both directions, in young patients with supraventricular tachycardia is related to the mechanism of the tachycardia. Adenosine, therefore, is a useful adjunct in the electrophysiologic evaluation of supraventricular tachycardia in children.
The jurisdiction of England and Wales is vastly experienced in application of the Hague Convention on the Civil Aspects of International Child Abduction1 (the Convention). The UK2 was the fifth3 Contracting State to the Convention, which now boasts 70 State Parties,4 and England and Wales consistently handles a significant proportion of annual Convention applications. In terms of applications, which were processed by Central Authorities, England and Wales was the second busiest Convention jurisdiction in 1999.5 The USA handled 466 applications, England and Wales 329, and Germany 210. Indeed the Central Authority for England and Wales handled more applications than any other, the USA having split incoming and outgoing applications between two separate bodies.6
The effects of folate sufficiency and deficiency in three pathways of folate metabolism were studied in 2- and 3-week-old broiler chicks. Erythrocyte phosphoribosylpyrophosphate concentrations and dihydro- folate reductase (EC 184.108.40.206) activity were significantly elevated in folate deficiency. Percentage incorporation of deoxyuridine into bone marrow DNA was reduced in folate deficiency. There was a trend towards reduced liver dihydrofolate reductase activity in deficient chicks. These studies identify further biochemical criteria that can be used to assess folate status of chicks.
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