Fair allocation of cryopreserved donor oocytes: towards an accountable process

2021 ◽  
Author(s):  
E M Kool ◽  
R van der Graaf ◽  
A M E Bos ◽  
B C J M Fauser ◽  
A L Bredenoord
Keyword(s):  
Previous Treatment ◽  
Oocyte Donation ◽  
Need For Treatment ◽  
Accountability For Reasonableness ◽  
Allocation Process ◽  
Allocation Criteria ◽  
Allocation Decisions ◽  
Donor Oocytes ◽  
Insight Into ◽  
Recipient Selection

ABSTRACT A growing number of people desire ART with cryopreserved donor oocytes. The allocation of these oocytes to couples and mothers to be is a 2-fold process. The first step is to select a pool of recipients. The second step is to decide who should be treated first. Prioritizing recipients is critical in settings where demand outstrips supply. So far, the issue of how to fairly allocate cryopreserved donor oocytes has been poorly addressed. Our ethical analysis aims to support clinics involved in allocation decisions by formulating criteria for recipient selection irrespective of supply (Part I) and recipient prioritization in case supply is limited (Part II). Relevant criteria for recipient selection are: a need for treatment to experience parenthood; a reasonable chance for successful treatment; the ability to safely undergo an oocyte donation pregnancy; and the ability to establish a stable and loving relationship with the child. Recipients eligible for priority include those who: have limited time left for treatment; have not yet experienced parenthood; did not undergo previous treatment with cryopreserved donor oocytes; and contributed to the supply of donor oocytes by bringing a donor to the bank. While selection criteria function as a threshold principle, we argue that the different prioritization criteria should be carefully balanced. Since specifying and balancing the allocation criteria undoubtedly raises a moral dispute, a fair and legitimate allocation process is warranted (Part III). We argue that allocation decisions should be made by a multidisciplinary committee, staffed by relevant experts with a variety of perspectives. Furthermore, the committees’ reasoning behind decisions should be transparent and accessible to those affected: clinicians, donors, recipients and children born from treatment. Insight into the reasons that underpin allocation decisions allows these stakeholders to understand, review and challenge decisions, which is also known as accountability for reasonableness.

scholarly journals A cross-sectional, non-interventional study of the correlation between insight and adherence in schizophrenia in Nepal

2019 ◽  
Author(s):  
Imogen Henrietta Stokes ◽  
Uddhav Lama ◽  
Jai Bahadar Khattri
Keyword(s):  
Correlation Coefficient ◽  
Living Arrangements ◽  
Cultural Beliefs ◽  
Self Report ◽  
P Value ◽  
Interventional Study ◽  
Cross Sectional ◽  
Need For Treatment ◽  
Patient Demographics ◽  
Insight Into

Abstract Background: There is a significant lack of research in the Nepalese study population on adherence in patients with schizophrenia. This cross-sectional, non-interventional study aims to re-examine the recognised correlation between insight and adherence in this population, whilst exploring the association between patient demographics and adherence to help bring understanding to how familial and environmental factors may impact adherence. Methods: Patients were recruited upon attendance to outpatient’s appointments and admission to the psychiatry department of Manipal Teaching Hospital. A self-report questionnaire was used to collect data on patient demographics, including age, ethnicity, religion, employment status, current living arrangements and education level; the Birchwood Insight Scale (BIS); and the Drug Attitude Inventory (DAI-10) score. Descriptive statistics on the demographics, BIS and DAI-10 were collated using SPSS. An analysis of variance of DAI-10 scores according to participant demographics was performed using a one-way ANOVA analysis. Correlation between the BIS and BIS subscales and the DAI-10 was tested using Pearson’s 2-tailed analysis at 0.01 significance level.Results: 19 participants consented to participate in this study with 100% data obtained. 57.9% unemployed, 63.2% living with parents and 47.4% had only a basic education. 36.8% of participants had poor insight; 84.2% of participants had poor insight into their symptoms; 78.9% of participants had poor insight into their illness and 36.8% had poor insight into their need for treatment. 52.7% of participants were poor adherers. No significant differences in DAI-10 scores were found between demographic groups. A positive correlation was found between the total BIS score and DAI-10 score (Pearson correlation coefficient of 0.585; P value = 0.009). Furthermore, the awareness of need for treatment subscale score and the DAI-10 score found a correlation coefficient of 0.609 (P value = 0.006). Conclusions: In conclusion, this study found prevalent non-adherence to medication and demonstrated that insight correlates with adherence. Although study findings did not suggest that patient demographics were associated with non-adherence, it is important to consider the possibility that these high rates of non-adherence have other contributing factors; overcoming rural health inequality, cultural beliefs regarding psychiatric illness and unaffordability remain the great challenges for the Nepalese population.

Treatment of anxiety disorders

2020 ◽  
pp. 961-966
Author(s):  
David S. Baldwin ◽  
Nathan T.M Huneke
Keyword(s):  
Anxiety Disorders ◽  
Previous Treatment ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Physical Symptoms ◽  
Need For Treatment ◽  
Cognitive Behavioural ◽  
Choice Of Treatment ◽  
Characteristic Features

The personal and societal burden associated with anxiety disorders is considerable, but many individuals who might benefit from treatment are not recognized. Recognition relies on awareness of psychological and physical symptoms common to all anxiety disorders, and accurate diagnosis on identifying specific features of particular disorders. The need for treatment is determined by the severity and persistence of symptoms, the impact of symptoms on everyday life, the presence of coexisting depressive symptoms, and other features such as response to previous treatment approaches. Patient characteristics and patient and doctor preferences influence the choice of treatment. There is much overlap between anxiety disorders in evidence-based and effective therapies (such as the prescription of a selective serotonin reuptake inhibitor or a course of individual cognitive behavioural therapy), but there are also important differences, so it helps to be familiar with the characteristic features and evidence base for each condition.

The Black-Litterman Model for Portfolio Optimization on Vietnam Stock Market

2020 ◽  
Vol 28 (Supp01) ◽  
pp. 99-111
Author(s):  
Bao Quoc Ta ◽  
Thao Vuong
Keyword(s):  
Stock Market ◽  
Portfolio Optimization ◽  
Portfolio Management ◽  
Asset Allocation ◽  
Market Equilibrium ◽  
Management Model ◽  
Optimal Portfolios ◽  
Allocation Model ◽  
Allocation Process ◽  
Allocation Decisions

The Black-Litterman asset allocation model is an extended portfolio management model to construct optimal portfolios by combining the market equilibrium with investor views into asset allocation decisions. In this paper we apply Black-Litterman model for portfolio optimization on Vietnames stock market. We chose ARIMA methodology utilized in financial econonometrics to predict the views of investor which are used as inputs of the Black-Litterman asset allocation process to find optimal portfolio and weights.

Creating land allocation zones for forest management: a simulated annealing approach

2004 ◽  
Vol 34 (8) ◽  
pp. 1669-1682 ◽  
Author(s):  
Mark Boyland ◽  
John Nelson ◽  
Fred L Bunnell
Keyword(s):  
Simulated Annealing ◽  
Forest Management ◽  
Simulated Annealing Algorithm ◽  
Allocation Model ◽  
Management Zones ◽  
Allocation Process ◽  
Growth Zones ◽  
Annealing Algorithm ◽  
Allocation Decisions ◽  
Coastal British Columbia

This paper describes the Zone Allocation Model (ZAM) that uses the simulated annealing algorithm to create forest management zones. ZAM partitions the landscape into the Timber, Habitat, and Old Growth zones by allocating small land tiles into contiguous areas. The zone allocation process is guided by landscape-level targets and size and shape objectives. An ecological representation objective proportionally distributes all ecosystem types into each of the three zones. Priority objectives control allocation of identified lands that are targeted for specific zones. All objectives are combined within an objective function, with a penalty-weighting system specifying relative importance of each objective. The ZAM model found 1.7%–4.4% of theoretical optimum scores from small to large problems, respectively. A demonstration on a 1.2 × 106–ha landscape from coastal British Columbia illustrates the iterative exploration of compromises between objectives that leads to informed zone allocation decisions.

scholarly journals Communication of bed allocation decisions in a critical care unit and accountability for reasonableness

2005 ◽  
Vol 5 (1) ◽  
Author(s):  
Andrew B Cooper ◽  
Amit S Joglekar ◽  
Jennifer Gibson ◽  
Alissa H Swota ◽  
Douglas K Martin
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Accountability For Reasonableness ◽  
Bed Allocation ◽  
Allocation Decisions

Cost effectiveness of utilizing cryo-bank oocytes versus fresh donor oocytes in an anonymous oocyte donation program

2014 ◽  
Vol 102 (3) ◽  
pp. e324
Author(s):  
J.T. Thorne ◽  
A.F. Bartolucci ◽  
B.-S. Maslow ◽  
C.A. Benadiva ◽  
J.C. Nulsen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Oocyte Donation ◽  
Donor Oocytes

scholarly journals Implementation and acceleration of optimal control for systems biology

2021 ◽  
Vol 18 (181) ◽  
pp. 20210241
Author(s):  
Jesse A. Sharp ◽  
Kevin Burrage ◽  
Matthew J. Simpson
Keyword(s):  
Optimal Control ◽  
Systems Biology ◽  
Iteration Process ◽  
System Size ◽  
Sweep Method ◽  
Acceleration Techniques ◽  
Fixed Point Iteration Process ◽  
Allocation Decisions ◽  
Insight Into ◽  
Forward Backward Sweep Method

Optimal control theory provides insight into complex resource allocation decisions. The forward–backward sweep method (FBSM) is an iterative technique commonly implemented to solve two-point boundary value problems arising from the application of Pontryagin’s maximum principle (PMP) in optimal control. The FBSM is popular in systems biology as it scales well with system size and is straightforward to implement. In this review, we discuss the PMP approach to optimal control and the implementation of the FBSM. By conceptualizing the FBSM as a fixed point iteration process, we leverage and adapt existing acceleration techniques to improve its rate of convergence. We show that convergence improvement is attainable without prohibitively costly tuning of the acceleration techniques. Furthermore, we demonstrate that these methods can induce convergence where the underlying FBSM fails to converge. All code used in this work to implement the FBSM and acceleration techniques is available on GitHub at https://github.com/Jesse-Sharp/Sharp2021 .

scholarly journals Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis

2018 ◽  
Vol 7 (3) ◽  
pp. e000190
Author(s):  
Kirit Singh ◽  
Fatima Ghazi ◽  
Rebecca White ◽  
Benedicta Sarfo-Adu ◽  
Peter Carter
Keyword(s):  
Early Intervention ◽  
Previous Treatment ◽  
Negative Effects ◽  
Eligibility Criteria ◽  
North East ◽  
The North ◽  
Allocation Process ◽  
Case Allocation ◽  
Early Intervention In Psychosis ◽  
The Impact

Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.

As the World Bank Turns: Determinants of IDA Lending in the Cold War and After

2011 ◽  
Vol 13 (2) ◽  
pp. 1-27 ◽  
Author(s):  
Kevin M. Morrison
Keyword(s):  
Cold War ◽  
Foreign Aid ◽  
International Development ◽  
Post Cold War ◽  
The World Bank ◽  
Internal Structures ◽  
The World ◽  
The Cold War ◽  
Allocation Decisions ◽  
Insight Into

How does the internal organization of a foreign aid donor affect its aid allocation decisions? Despite the voluminous literature on the political economy of foreign aid, little systematic scholarship exists on this topic. This paper analyzes the allocations of the International Development Association (IDA), the World Bank's lending arm for the poorest countries, to all eligible countries between 1977 and 2005. While factors such as a country's need and its policy environment have consistently impacted IDA's allocation decisions, other factors have changed in important ways. For example, IDA disbursements do not follow US aid disbursements in the post–Cold War period the way they did during the Cold War. And most strikingly, IDA's allocations have become tightly linked to debt owed to IDA's sister organization, the International Bank for Reconstruction and Development (IBRD). While IDA used to shy away from countries with higher debt to the IBRD, the last two decades have seen IDA engage in apparently defensive lending for the IBRD, lending more to countries with outstanding balances to that institution. The results suggest greater focus on the internal structures of donors would yield insight into their allocation decisions.

Turkish nurses’ decision making in the distribution of intensive care beds

2010 ◽  
Vol 17 (1) ◽  
pp. 87-98 ◽  
Author(s):  
Nermin Ersoy ◽  
Aslihan Akpinar
Keyword(s):  
Intensive Care ◽  
Important Criterion ◽  
Intensive Care Nurses ◽  
Patients Rights ◽  
Allocation Criteria ◽  
Nurses Role ◽  
Self Administered Questionnaire ◽  
Allocation Decisions

The aim of this study was to assess the opinions and role of intensive care unit (ICU) nurses regarding the distribution of ICU beds. We conducted this research among 30% of the attendees at two ICU congresses in Turkey. A self-administered questionnaire was used, which included 13 cases and allocation criteria. Of the total (136 nurses), 53.7% participated in admission/discharge decisions. The most important criterion was quality of life as viewed by the physician; the least important was the patient’s social status. According to the findings, the nurses thought that medical benefit and avoiding discrimination were important. On the other hand their ignorance of patients’ autonomous preferences arouses suspicions about these nurses’ role in advocating for patients’ rights. For this reason, nurses’ role in allocation decisions should be clearly described and should also be the basis on which intensive care nurses’ duties in allocation decisions should be determined.

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