The Future of IVF: The New Normal in Human Reproduction

Increased demand for in vitro fertilization (IVF) due to socio-demographic trends, and supply facilitated by new technologies, converged to transform the way a substantial proportion of humans reproduce. The purpose of this article is to describe the societal and demographic trends driving increased worldwide demand for IVF, as well as to provide an overview of emerging technologies that promise to greatly expand IVF utilization and lower its cost.

Surveillance Publishing

This essay develops the idea of surveillance publishing, with special attention to the example of Elsevier. A scholarly publisher can be defined as a surveillance publisher if it derives a substantial proportion of its revenue from prediction products, fueled by data extracted from researcher behavior. The essay begins by tracing the Google search engine’s roots in bibliometrics, alongside a history of the citation analysis company that became, in 2016, Clarivate. The essay develops the idea of surveillance publishing by engaging with the work of Shoshana Zuboff, Jathan Sadowski, Mariano-Florentino Cuéllar, and Aziz Huq. The recent history of Elsevier is traced to describe the company’s research-lifecycle data-harvesting strategy, with the aim to develop and sell prediction products to unviersity and other customers. The essay concludes by considering some of the potential costs of surveillance publishing, as other big commercial publishers increasingly enter the predictive-analytics business. It is likely, I argue, that windfall subscription-and-APC profits in Elsevier’s “legacy” publishing business have financed its decade-long acquisition binge in analytics. The products’ purpose, moreover, is to streamline the top-down assessment and evaluation practices that have taken hold in recent decades. A final concern is that scholars will internalize an analytics mindset, one already encouraged by citation counts and impact factors.  

ECMO use in Germany: An analysis of 29,929 ECMO runs

Background Extracorporeal Membrane Oxygenation (ECMO) use is increasing despite limited evidence. The aim of this study was to demonstrate heterogeneity of ECMO use and its association with hospital size and annual frequency in Germany. Methods This is a database analysis of all ECMO cases in Germany from 2010 to 2016 using the German Diagnosis Related Groups (DRG) coding system for ECMO. Results During the study period, 510 hospitals performed 29,929 ECMO runs (12,572 vvECMO, 11,504 vaECMO, 1993 pECLA) with an increase over time. Mortality ranged between 58% and 66% for vaECMO cases and 66% and 53% for vvECMO cases. 304 (61%) hospitals performed only one ECMO per year. 78%% of all ECMO runs were performed in centres with more than 20 cases per year and more than half of all ECMO runs were performed in hospitals with >1.000 beds. Mortality for vv and vaECMO was highest in very small hospitals (< 200 beds; 70%; 74%) and very large hospitals (>1000 beds; 60%; 62%). Conclusions Use of ECMO is still increasing and a substantial proportion of hospitals performs very few ECMO runs. Small hospitals had a significantly higher mortality, but dependence on hospital size and ECMO mortality was irregular.

The Perception Level of Thinking Models in General and Vocational Education

The revised Bloom’s taxonomy consists of six level which are remember (C1), understand (C2), apply (C3), analyze (C4), evaluate (C5) and create (C6). Every level of qualification sometimes applies different level of taxonomy, either complete model (C1 to C6) or incomplete model (C1 to C3, C2 to C4, C4 to C6). Thus, this research aimed to find the proportion of the complete and incomplete level of thinking models and their suitability in primary and secondary education. This research was a descriptive research using the ex-post facto approach. from six Educational Institutions for Educators in Java, Indonesia with 82 educational experts. The data was collected using survey questionnaire and was analyzed using descriptive and inferential statistics. The results showed that: (1) for the complete level of thinking model, elementary school covered the C1–C6 level of thinking with the most substantial proportion was C1; in junior high school was C2; and senior/vocational high school was C3; (2) for the incomplete level of thinking, elementary school covered the C1–C3 level of thinking with the most significant proportion was C1; junior high school covered the C1–C4 levels and the most substantial proportion was the C2; and senior/vocational high school included the C1–C5 levels with the most significant portion of the C3; (3) the suitable level of thinking was the complete model whereas the current practice referred to the incomplete model.

Maternal Mortality from Induced Abortion in Malawi: What Does the Latest Evidence Suggest?

It is commonly claimed that thousands of women die every year from unsafe abortion in Malawi. This commentary critically assesses those claims, demonstrating that these estimates are not supported by the evidence. On the contrary, the latest evidence—itself from 15 to 20 years ago—suggests that 6–7% of maternal deaths in Malawi are attributable to induced and spontaneous abortion combined, totalling approximately 70–150 deaths per year. I then offer some evidence suggesting that a substantial proportion of these are attributable to spontaneous abortion. To reduce maternal mortality by large margins, emergency obstetric care should be prioritised, which will also save women from complications of induced and spontaneous abortion.

TP5.2.1 Duplex ultrasound should be interpreted with caution in vascular access

Aims Dysfunctional vascular access in haemodialysis has varied clinical presentations, including prolonged bleeding, pain, loss of thrill, difficulties needling and ineffective dialysis. We aimed to establish whether specific presentations correlate with a higher frequency of adverse imaging findings and intervention. Methods Duplex ultrasound scans (DUS) of surgical AV fistulae and grafts performed in a teaching hospital trust between 01/07/2019 and 31/01/2020 were analysed. Referral reasons, diagnostic findings, onward imaging and interventions to salvage fistulae and grafts were cross-referenced from electronic patient databases. Results 359 scans of AV fistulae were performed in the period studied, of which, 220 were performed on men. Median age was 63 years (IQR 49-72). The most common referral reasons were loss of thrill and difficulty needling (n = 46, both). 185/359 (52%) scans lead to subtraction angiography and 46/359 (13%) to open surgical intervention. Median time from DUS to angiography was 21 days and 21% (39/185) of DUS did not match with angiographic results. When assessing outcomes based on presentation, 16/19 (85%, p &lt; 0.01) patients who had high venous pressures on dialysis and 23/31 (74%, p &lt; 0.01) of those with dialysis recirculation required endovascular intervention. Pain on dialysis correlated poorly with future intervention (6/30). Conclusions A substantial proportion of DUS of dysfunctional vascular access do not correlate with subtraction angiography. Referral for DUS prior to angiography may delay intervention. Patients with objective signs of dialysis dysfunction (recirculation and high venous pressure) are highly likely to need intervention. Such cases may benefit from proceeding directly to angiography and on-table intervention.

No Significant Difference in Viral Load Between Vaccinated and Unvaccinated, Asymptomatic and Symptomatic Groups When Infected with SARS-CoV-2 Delta Variant

We found no significant difference in cycle threshold values between vaccinated and unvaccinated, asymptomatic and symptomatic groups infected with SARS-CoV-2 Delta. Given the substantial proportion of asymptomatic vaccine breakthrough cases with high viral levels, interventions, including masking and testing, should be considered for all in settings with elevated COVID-19 transmission.

Abatacept as Adjunctive Therapy in Refractory Polymyalgia Rheumatica

Glucocorticoids (GCs) are the mainstay of treatment for patients with polymyalgia rheumatica (PMR).1 Despite their efficacy, GCs are associated with well-known adverse events and a substantial proportion of patients with PMR do not respond adequately, or are refractory, to initial GC treatment. GC-sparing agents in PMR are limited to methotrexate (MTX).1

Health Care Personnel (HCP) attitudes about COVID-19 vaccination after emergency use authorization

Background We previously reported on COVID-19 vaccination intent among HCP before emergency use authorization. We found widespread hesitancy and a substantial proportion of HCP did not intend to vaccinate. Methods We conducted a cross-sectional survey of HCP, including clinical and non-clinical staff, researchers, and trainees between February 21 and March 19, 2021. The survey evaluated vaccine attitudes, beliefs, intent and acceptance. Results Overall, 3,981 (87.7%) of respondents had already received a COVID-19 vaccine or planned to get vaccinated. There were significant differences in vaccine acceptance by gender, age, race, and hospital role. Males (93.7%) were more likely than females (89.8%) to report vaccine acceptance (p&lt;0.001). Mean age was higher among those reporting vaccine acceptance (p&lt;0.001). Physicians and scientists showed the highest acceptance rate (97.3%), while staff in ancillary services showed the lowest acceptance rate (79.9%). Unvaccinated respondents were more likely to be females, to have refused vaccines in the past due to reasons other than illness or allergy, to care for COVID-19 patients, or to rely on themselves when making vaccination decision. Vaccine acceptance was more than twice previous intent among Black respondents, an increase from 30.8% to 73.8%, and across all hospital roles with all &gt;80% vaccine acceptance. Conclusions The majority of HCP were vaccinated, much higher than reporting intent before vaccine was available. However, many HCP—particularly ancillary services—are still hesitant. Feasible and effective interventions to address the hesitant, including individually-tailored education strategies are needed, or vaccine can be mandated.

Virtual Equivalents of Real Objects (VEROs): A type of non-fungible token (NFT) that can help fund the 3D digitization of natural history collections

Describing a substantial proportion of the world’s species could be made much easier by the 3D digitization of collections, which would facilitate the dissemination of taxonomic information locked up in natural history museums. Three-dimensional imaging captures many characters and allows a lot of versatility in the way that morphological data is displayed and used (Wheeler et al. 2012; Faulwetter et al. 2013). Moreover, the loss and damage of valuable specimens, many of which are very fragile, can be reduced as a result of the use and sharing of 3D model substitutes among researchers. This can also lead to a reduction in the handling and transportation expenses of many specimens.