Age Limit Research Articles

Limits of Viability: Perspectives of Portuguese Neonatologists and Obstetricians.

Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants. An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023. We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively). Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.

Opioid analgesic dose and route conversion ratio studies: a scoping review to inform an eDelphi guideline.

Clinicians regularly prescribe opioids to manage acute and chronic cancer pain, frequently to address acute postoperative pain, and occasionally to manage chronic non-cancer pain. Clinical efficacy may be suboptimal in some patients due to side effects and/or poor response, and opioid rotation/switching (conversions) is frequently necessary. Despite the widespread practice, opioid conversion ratios are inconsistent between clinicians, practices, and countries. Therefore, we performed a scoping systematic review of opioid conversion studies to inform an international eDelphi guideline. To ensure a comprehensive review, we conducted a systematic search across multiple databases (OVID Medline, PsycINFO, Embase, EBM-Cochrane Database of Systematic Reviews and Registered Trials, LILACS, IMEMR, AIM, WPRIM) using studies published up to June 2022. Additionally, we performed hand and Google Scholar searches to verify the completeness of our findings. Our inclusion criteria encompassed randomized and non-randomized studies with no age limit, with only a few pediatric studies identified. We included studies on cancer, non-cancer, acute, and chronic pain. The level and grade of evidence were determined based on the Multinational Supportive Care in Cancer (MASCC) criteria. Our search yielded 21,118 abstracts, including 140 randomized (RCT) and 68 non-randomized (NRCT) clinical trials. We compared these results with recently published conversion ratios. Modest correlations were noted between published reviews and the present scoping systematic review. The present scoping systematic review found low-quality evidence to support an opioid conversion guideline. We will use these data, including conversion ratios and type and route of administration, to inform an eDelphi guideline.

Abuse of Authority Against Judicial Power in Constitutional Court Decision No.90/PUU-XXI/2023

Each law enforcer has its own authority according to what has been regulated in Indonesian laws and regulations. These provisions are stated in the Judicial Power Law No. 48 of 2009 which states that power judiciary according to The 1945 Constitution of the Republic of Indonesia is independent power . However, what has happened in Indonesia recently seems to be diminishing justice and putting aside codes of ethics in the world of law. The facts that occurred in the Constitutional Court decision No. 90 of 2023 regarding the age limit for presidential and vice presidential candidates were considered a decision that violated the code of ethics because there was a conflict of interest. In fact, the decision was built based on less than rational legal reasoning, resulting in a decision that was considered problematic. Based on the background description above, problems arise in the form of how a judge's authority should be in deciding cases in accordance with what is contained in the legislation. Then what are the legal remedies given in the form of sanctions to judges who are proven to be abusing their authority? This research uses a normative juridical approach, namely by looking at the rules and principles applied in the judiciary in Indonesia. The administration of government must be based on the principles of legality, protection, human rights and AUPB, especially in terms of the principle of not abusing power. Article 10 paragraph (1) letter e and the explanation of Law Number 30 of 2014 stipulate the principle of not abusing one's own authority. This basis requires every government agency and official not to exceed, abuse or confuse their authority for personal or other interests.

Legal Politics of Changes to Marriage Laws in Indonesia

The research aims to analyze changes to articles in Law Number 16 of 2019 concerning Marriage which are the result of revisions to previous provisions, namely Law Number 1 of 1974 concerning Marriage. This research is a juridical research by analyzing legal politics regarding changes in marriage law using a statutory approach, case approach, conceptual approach, and legal comparative approach. The results of this research are: First, the revision carried out by the government still leaves legal problems, this is based on the decision of the Constitutional Court in several judicial reviews of Law no. 1 of 1974 concerning Marriage. Second, the age limit regulated in Law no. 16 of 2019 concerning Marriage is not yet ideal and synergistic with other statutory provisions. Third, the purpose of the amendment to Law no. 1 of 1974 concerning Marriage is to reduce legal problems in society. On the other hand, the same problems still occurred when the previous provisions were implemented, such as the death rate for girls who married at a young age, the increasing number of requests for marriage dispensations, and the failure to achieve the marriages desired by law. However, changes to the marriage age limit provisions at least attempt to minimize cases of early child marriage in Indonesia.

Politik Hukum Batas Minimum Usia Perkawinan Pasca Putusan Mahkamah Konstitusi Nomor 22/PUU-XV/2017

Abstract Regulations regarding the minimum age for marriage in Indonesia have basically gone through a long history and dynamics starting from the pre-Dutch Colonial government until the New Order era when Law Number 1 of 1974 concerning Marriage was born and was most recently revised into Law Number 16 of 2019 concerning Amendments. Based on Law Number 1 of 1974 concerning Marriage. This research discusses two problem formulations, First, how is the minimum age limit for marriage regulated before the Constitutional Court Decision Number 22/PUU-XV/2017?, Second, what are the legal politics of the minimum age limit for marriage after the Constitutional Court Decision Number 22/PUU-XV/2017 ? To be able to discuss this problem, a normative juridical research method with a historical and statutory approach is used, where the data source used is a secondary data source. From the research and discussions that have been carried out, the following results were obtained: First, the history of setting the minimum age limit for marriage in Indonesia has started since pre-Dutch Colonial times where at that time the applicable marriage law was the respective religious law which was then enforced during the Dutch occupation. Classification is based on ethnicity and each group has its own rules. In the old order era, Law Number 22 of 1946 concerning Marriage Registration, Divorce and Reconciliation (hereinafter referred to as NTR) was born, in the new order era Law Number 1 of 1974 concerning Marriage was born, which was followed by its first revision in the reform era to become Law. Number 16 of 2019 concerning Amendments to Law Number 1 of 1974 concerning Marriage. Second, the will (political will) of the state authorities is a determining factor in where the law will be directed, including in the issue of determining the minimum age limit for marriage. This can be seen from the development of marriage law in Indonesia starting from the Dutch colonial period, the post-independence period, and the New Order period where marriage law experienced a very strong influence from the interests of the authorities.

Analysing the Dynamics of Marriages Across Different Ages and Legal Frameworks

This research paper aims into the various aspects of marriages through different age groups and exploring the related legal frameworks governing such leagues. The study aims to provide a comprehensive analysis of the psychological, social and legal implications associated with marriages at varying stages of life A major part of the research is staunch/dedicated to analysing the legal frameworks and policies surrounding marriage age limits in different jurisdictions. It explores the co-relation between marriage ages, socio-economic indicators, such as health education and gender equality

A Cross-Sectional Study of Cardiovascular Autonomic Reactivity in Ehlers-Danlos Syndrome.

Ehlers-Danlos syndrome (EDS) may be linked to dysfunction in the autonomic nervous system, affecting collagen production and processing. These collagen abnormalities lead to a condition called dysautonomia. Findings underscore the need for further investigation into autonomic nervous system function in EDS which involves larger studies to strengthen the evidence of non-invasive screening tools like cardiovascular reflex tests. These tests might offer a valuable way to assess an individual's risk for future complications. This study aimed to assess autonomic reactivity in EDS patients using cardiovascular reflex tests. This study was conducted at the Department of Physiology, Naraina Medical College and Research Centre, Kanpur (Uttar Pradesh). The cardiovascular reflex test was used to identify 60 individuals, 30 of whom were EDS patients and 30 were healthy controls, with a common age limit of 18-25 years. Cardiovascular reflex tests, such as the delta heart rate, lying-to-standing test (LST), deep breathing test (DBT), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data. The expiration-to-inspiration (E:I) ratio and delta heart rate of the EDS patients both significantly decreased as compared to the healthy control group (1.10±0.02 versus 1.22±0.77 and 14.03±0.31 versus 15.52±0.32). The Valsalva ratio of the EDS patients decreased (1.28±0.01) as compared to the healthy control group (1.46±0.01), which was statistically significant. The 30:15 ratio in the EDS patients was significantly decreasedcompared to the healthy control group (1.08±0.01 versus 1.15±0.01). The handgrip test and cold pressor test results were statistically insignificant. The study suggests a connection between EDS and autonomic nervous system dysfunction, causing symptoms like tachycardia and hypotension. It recommends exploring non-invasive cardiovascular reflex tests as a tool to identify autonomic dysfunction in EDS patients and predict long-term cardiovascular complications. These tests offer valuable insights into autonomic function.

Occurrence of Body Posture Abnormalities in Overweight and Obese Children Aged 5-6 Years-Pilot Study.

The study aimed to assess the occurrence of body posture disorders and their changes under the influence of a physioprophylactic program in children depending on body weight. In the examined children, the general and segmental body composition and body posture were determined using a physiotherapeutic assessment based on the Kasperczyk method. Mass, overall, and segmental body composition were determined using the bioelectrical impedance method using a TANITA body composition analyzer. The study group of 76 children was divided due to body weight disorders into Group I (n = 51), in which BMI and fat mass values were within the normative limits for age and gender, and Group II (n = 19), comprising children whose body weight exceeded the norm and/or fat mass exceeded normative values. The examined children underwent a physioprophylactic. The program was conducted by qualified physiotherapists for 12 weeks, once a week for 30 min. The therapeutic program was focused on physioprevention of being overweight and the correction of body posture. A distal distribution of fat mass was observed in the examined group. Asymmetry in the sagittal plane was found in 35% of children. No statistically significant differences were found in the presence of asymmetry in the sagittal plane between the groups. No statistically significant differences were found in the occurrence of posture irregularities between the groups. There were no changes in the weight and body posture of the examined children under the influence of the physiotherapy program. The lack of correlation in the examined group between body weight and posture irregularities in 5-6-year-olds may suggest the acquisition of posture defects as a consequence of the persistence of overweight or obesity.

Effects of Government Jobs on the Labour Market in Bangladesh

This paper empirically studies the implications of attractive government jobs for labour market. Exploiting an age ceiling policy that sets the age limit for eligibility for public employment at age 30, the study finds that the likelihood of private sector employment is about five percentage points higher for ineligible than eligible at the cutoff age of 30, mainly driven by females, particularly after doubling the public service salaries. The increase in employment after expiring the eligibility for government jobs is explained by increasing labour force participation rather than declining unemployment. During the eligibility period, candidates repeatedly try for government jobs and delay the pursuit of other opportunities, incurring substantial monetary expenses, time costs, and opportunity costs of time. At the same time, there is some evidence that public sector exam preparation gives rise to brain gain. While several papers studied this phenomenon theoretically, this study contributes by providing empirical evidence. The data for this study was drawn from population censuses and labour force surveys for the period 1991–2017 and a primary survey conducted online for this study in Bangladesh, and labour force surveys of India for 2011–2012, 2017–2018, and 2019–2020.

Quartzites of the Khobeinskaya suite of the Subpolar Urals: Material composition, age limitations and possible sources of terrigenous material

Research subject. Quartzites that make up the ridge part of the ridge Rosomaha in the northern part of the Lyapinsky meganticlinorium in the Subpolar Urals. Material and methods. Detrital zircons were isolated from quartzites and their optical and isotope-geochronological U-Pb (LA-SF-ICP-MS) studies were performed. On the basis of chemical analyzes of rocks using indicator ratios and coefficients, the conditions for the formation of deposits were established. Results. The stratigraphic position of the quartzite ridge Rosomaha was determined. The time and conditions for the formation of the Khobeinskaya formation were specified. The role of polymetamorphic complexes of the Subpolar Urals as possible sources of terrigenous material removal during the formation of the Upper Precambrian section of the Subpolar Urals was estimated. Conclusions. It was established that the quartzites belong to the ridge Rosomaha to the Khobeinskaya formation, whose age is limited to the interval of 850–800 Ma (Inzersky level). It is shown that the crystalline complexes of Fennoscandia and the Central Russian orogen, as well as polymetamorphic complexes of the crystalline basement of the Timan-Severoural margin of the East European Platform, could be sources of terrigenous material.

Penyuluhan Tentang Pendewasaan Usia Perkawinan di SMP N 1 Sungai Tebelian Tahun 2024

Increasing the age of marriage is an effort to increase the age at first marriage, namely the minimum age of 21 years for women and 25 years for men. The aim is to find out the healthy age limit for marriage and the impact of early marriage and unwanted pregnancy. The activity method is counseling on preparation for menarche including surveys, determining implementation schedules and data collection, pre-tests, socializing activities with outreach media, namely videos and leaflets. The activity was held on June 12 2024 at SMPN 1 Sungai Tebelian which was attended by 59 students aged 12-15 years. Post test and evaluation of questionnaire data processing using the Paired Sample Test. The results of data analysis show changes in the increase in knowledge of young women in pre-test and post-test Sig values. (2-tailed) of 0.000 &lt; 0.05. The conclusion is that there is a difference in the increase in knowledge before and after counseling on maturation during marriage at SMPN 1 Sungai Tebelian. This outreach activity increases students' knowledge about healthy marriage age limits and the impact of early marriage and unwanted pregnancies.

Headache/migraine-related stigma, quality of life, disability, and most bothersome symptom in adults with current versus previous high-frequency headache/migraine and medication overuse: results of the Migraine Report Card survey

BackgroundHigh-frequency headache/migraine (HFM) and overuse of acute medication (medication overuse [MO]) are associated with increased disability and impact. Experiencing both HFM and MO can potentially compound impacts, including stigma; however, evidence of this is limited. The objective of this report was to evaluate self-reported stigma, health-related quality of life (HRQoL), disability, and migraine symptomology in US adults with HFM + MO from the Harris Poll Migraine Report Card survey.MethodsUS adults (≥ 18 yrs., no upper age limit) who screened positive for migraine per the ID Migraine™ screener completed an online survey. Participants were classified into “current HFM + MO” (≥ 8 days/month with headache/migraine and ≥ 10 days/month of acute medication use over last few months) or “previous HFM + MO” (previously experienced HFM + MO, headaches now occur ≤ 7 days/month with ≤ 9 days/month of acute medication use). Stigma, HRQoL, disability, and most bothersome symptom (MBS) were captured. The validated 8-item Stigma Scale for Chronic Illnesses (SSCI-8) assessed internal and external stigma (scores ≥ 60 are clinically significant). Raw data were weighted to the US adult population. Statistically significant differences were determined by a standard t-test of column proportions and means at the 90% (p < 0.1) and 95% (p < 0.05) confidence levels.ResultsParticipants (N = 550) were categorized as having current (n = 440; mean age 41.1 years; 54% female; 57% White, not Hispanic; 24% Hispanic; 11% Black, not Hispanic) or previous (n = 110; mean age 47.2 years; 49% female; 75% White, not Hispanic; 13% Hispanic; 4% Black, not Hispanic) HFM + MO. Compared to those with previous HFM + MO (21%), adults with current HFM + MO were more likely to experience clinically significant levels of stigma (47%). Men with current HFM + MO (52% compared to men with previous HFM + MO [25%] and women with current [41%] or previous [18%] HFM + MO), non-Hispanic Black (51% compared to White, not Hispanic [45%] and Hispanic [48%] current HFM + MO groups and White, not Hispanic previous HFM + MO [12%]), current HFM + MO aged 18–49 years (50% compared to those with current HFM + MO aged ≥ 50 years [33%] and those with previous HFM + MO aged 18–49 [34%] and ≥ 50 years [4%]), and employed respondents (53% current and 29% previous compared to those not employed [32% current and 12% previous]) reported higher rates of clinically significant stigma. Those with current HFM + MO were more likely to have worse HRQoL and disability due to headache/migraine. Respondents aged ≥ 50 years with current HFM + MO were more likely than respondents aged 18–49 years with current HFM + MO to indicate that their overall quality of life (66% vs. 52%) and their ability to participate in hobbies/activities they enjoy were negatively impacted by headache/migraine (61% vs. 49%). Pain-related symptoms were identified as the MBS.ConclusionsTogether these data suggest that current and previous HFM + MO can be associated with undesirable outcomes, including stigma and reduced HRQoL, which were greatest among people with current HFM + MO, but still considerable for people with previous HFM + MO.Graphical abstract

P-728 Age limits in medically assisted reproduction: Assessing clinical and pregnancy outcomes in women over 50 years of age undergoing donor oocyte in vitro fertilization

Abstract Study question Is pregnancy in women over 50 years of age undergoing donor oocyte IVF associated with adverse clinical and pregnancy outcomes? Summary answer In vitro fertilization treatment in women over 50 years of age using donor oocytes is not associated with adverse clinical and pregnancy outcomes. What is known already In vitro fertilization with donor oocytes (d-IVF) has become a common strategy for managing cases of very advanced maternal age. However, there is ongoing scientific debate entailing legal and societal implications regarding the age limit beyond which d-IVF should no longer be considered safe. Different age limits and guidelines have been proposed, with no globally accepted consensus. The most commonly reported age limit is 50 years, representing the median age of menopause. However, there is a lack of robust data to support that d-IVF beyond the age of 50 is associated with adverse clinical and pregnancy outcomes. Study design, size, duration A retrospective single-centre study was conducted to evaluate medical records of d-IVF cycles between July 2021-January 2023. A total of 575 medical records of women undergoing d-IVF were analyzed. The study population was divided into two groups based on maternal age: women aged 45-49 years (group A, n = 318) and women aged 50-54 years (group B, n = 257). The outcome measures were positive-hCG, clinical pregnancy, viable pregnancy at 12 weeks of gestation, pregnancy loss and live birth. Participants/materials, setting, methods For oocyte recipients advanced maternal age was the sole infertility etiology and endometrial preparation was performed employing conventional protocols. Oocyte donors were up to 35 years of age and oocyte donation cycles were performed according to national guidelines. Single or double embryo transfers (ETs) were performed at the cleavage or blastocyst stage. Embryo quality assessment was performed according to Veeck and Gardner grading systems. Statistical analysis was performed employing R Programming Language for Statistical Purposes. Main results and the role of chance The mean age of group A was 47.02 ± 1.35 while the mean age of group B was 51.84 ± 1.59. No statistically significant difference was observed regarding the age of oocyte donors (25.17 ± 4.18 vs 26.09 ± 4.13; p-value=0.26). Considering embryo transfer, 90 cleavage stage and 228 blastocyst stage transfers were performed in group A, and 75 cleavage stage and 182 blastocyst stage transfers were performed in group B (p-value=0.23). No statistically significant difference was observed between the two groups with regards to the number of transferred embryos (1.89 ± 0.35 vs 1.90 ± 0.36; p-value=0.69) and embryo quality (Group A: Good 157, Fair 143, Poor: 18; Group B: Good 121, Fair 117; Poor 19; p-value=0.66). Considering clinical and pregnancy outcomes no statistically significant difference was observed between the two groups regarding positive hCG rate (147/318 vs 109/257, respectively; RR: 0.91; 95%CI: 0.76-1.10; p-value=0.36), clinical pregnancy rate (129/318 vs 98/257, respectively; RR: 0.94; 95%CI: 0.77-1.15; p-value=0.55), viable pregnancy rate at 12 weeks of gestation (96/318 vs 70/257, respectively; RR: 0.90; 95%CI: 0.70-1.17; p-value=0.44), pregnancy loss rate (39/129 vs 33/98, respectively; RR: 1.13; 95%CI: 0.76-1.63; p-value=0.58) and live-birth rate (90/318 vs 65/257, respectively; RR: 0.91; 95%CI: 0.68-1.17; p-value=0.42). Limitations, reasons for caution The retrospective and the single-centre nature of the study are important reasons for caution. In addition, the relatively small sample size may serve as another limitation. The lack of neonatal outcomes may also be considered an additional limitation when interpreting data on the safety of d-IVF in the over-50s. Wider implications of the findings Women over 50 who undergo d-IVF are not at increased risk of complications. This highlights the need to reconsider age limits and provide robust evidence ascertaining both safety and reproductive autonomy. Studies are needed to assess neonatal outcomes and maternal age impact on long-term infant health from an epigenetic standpoint. Trial registration number Not applicable

P-206 Unveiling the elasticity of zona pellucida: shifting focus to a neglected embryonic feature

Abstract Study question Is it feasible to quantitatively assess the elasticity of the zona pellucida, and how does this measurement correlate with blastocyst features? Summary answer The elasticity of the zona pellucida can be quantitatively evaluated, demonstrating a correlation with distinct developmental stages and morphological features of blastocysts. What is known already Embryologists have primarily focused on assessing morphokinetic and morphological features of embryos to enhance success rates in assisted reproduction technology cycles. However, the zona pellucida (ZP) has often been overlooked as a potential marker of embryonic quality. Previous studies have established a correlation between the thickness of the ZP and implantation rates in cleavage-stage embryos. Yet, the comprehensive attributes of the ZP in blastocysts remain under-explored, with critical aspects such as its elasticity receiving scant attention. Study design, size, duration A retrospective analysis was conducted on 254 blastocysts from 103 patients. For each blastocyst, two images were captured: one prior to and another following lased-induced artificial shrinkage. This study focused on assessing ZP elasticity by comparing its thickness during blastocele pressure-induced distension and subsequent to blastocyst collapse. Variations in thickness were interpreted as reflections of pressure release. To ensure the reliability and accuracy of data, measurements were performed by two independent operators. Participants/materials, setting, methods Measurements were performed using ImageJ software. Operators executed twelve radial assessments of ZP thickness at 30-degree intervals and three additional measurements of the area within the ZP. These measurements were averaged for analysis. The ZP re-expansion percentage post-laser collapse was determined by comparing the change in thickness relative to the initial thickness. Linear regression and Spearman’s correlation were employed to examine the relationships among ZP re-expansion, thickness, enclosed area, patient age, and blastocyst features. Main results and the role of chance The average ZP thickness prior to freezing (Pre-ZPT) was 5.1 ± 2.0 micrometers, increasing to 8.6 ± 2.0 micrometers following collapse. The mean blastocyst diameter at the time of freezing was 192 ± 17 micrometers, with ZP re-expansion averaging 82.1%. A strong correlation was observed between Pre-ZPT and post-collapse thickness, with a coefficient of 0.75 (P = 4.8 × 10−47). Pre-ZPT showed a significant inverse and non-linear relationship with pre-collapse blastocyst diameter (Pre-BD), as assessed by Spearman’s correlation (P value: 2.9 × 10−³¹). Additionally, a linear correlation was observed between Pre-BD and the percentage of ZP re-expansion post-collapse (P value: 3.8 × 10−²¹). Given the strong interdependence of these parameters, reflecting expected behavior from a semi-elastic sheath undergoing stretching, linear correlation between Pre-BD and re-expansion percentage was used to define ZP elasticity. Deviations from average behavior were normalized into percentiles and analyzed against patient age and blastocyst characteristics. Multivariate regression, adjusted for variables including Pre-ZPT, revealed a strong inverse association between blastocyst elasticity and freezing day, with a decrease of 16.8 percentiles on average (P value: 4.9 × 10−6). Conversely, a positive association was identified with poor-quality blastocysts, which showed an average increase of 12.4 percentiles in elasticity (P value: 1.5 × 10−³). No significant correlation emerged between ZP elasticity and patient age Limitations, reasons for caution This preliminary study was limited to the evaluation of the morphological and developmental characteristics of blastocysts, without delving into clinical outcomes. It is critical to note that blastocyst quality assessment is influenced by operator interpretation, which introduces a degree of variability into the morphological evaluation process. Wider implications of the findings Evaluating the elasticity of the ZP, a relatively unexplored aspect, might provide insights into its predictive value of blastocyst competence and subsequent successful clinical outcomes following embryo transfer. Such an analysis could significantly enrich our understanding of embryonic reproductive competence. Trial registration number not applicable

The Mount Distin assemblage: Neoproterozoic metasedimentary rocks in the Nome Complex of Seward Peninsula, Alaska, USA

Proterozoic to Paleozoic rocks involved in Jurassic and earliest Cretaceous (Brookian) orogenesis and subsequently extended, metamorphosed at high temperature and intruded by Cretaceous plutons, are widespread on the Seward Peninsula, Alaska, USA. These blueschist and greenschist facies metasedimentary and metaigneous rocks make up the highly deformed Nome Complex. We describe and bracket the age of a distinct Precambrian succession in the Nome Complex, the Mount Distin assemblage (informal). The Mount Distin assemblage consists of marble, impure marble, calc-schist, quartz mica schist, and lesser quartzite that was originally a shelfal succession. Metamafic bodies, originally dikes and/or sills, are minor but common components. Three new U-Pb detrital zircon (DZ) samples are characterized by numerous peaks between 1.5 Ga and 1.0 Ga, with minor ages of 1000−900 Ma and 2000−1500 Ma and only 1−2 grains 3.0−2.5 Ga, indicating maximum depositional ages of 1000−900 Ma. A new U-Pb zircon age for an orthogneiss lens in marble is 661 ± 3 Ma like others previously dated in the Nome Complex. Orthogneiss ages provide an upper age limit for the Mount Distin assemblage of ca. 687 Ma, the oldest reported date. Zircons in three other orthogneiss bodies are interpreted as inherited as they have a range of U-Pb ages like those in their country rocks. The Mount Distin assemblage DZ ages are like those from schist-bearing carbonate sequences in the Central and Schist belts of the Brooks Range and inherited zircon populations in Neoproterozoic plutons on Wrangel Island, Russia. The discovery and documentation of the Mount Distin assemblage explains the previously reported enigmatic lack of country rocks to Neoproterozoic orthogneiss bodies, establishes the continuity of older rocks across the entire extent of the Arctic Alaska−Chukotka microplate, and further confirms this microplate’s Baltica affinities.

“A study of knowledge, attitude and practice patterns regarding eye donation, eye banking and corneal transplantation in tertiary care hospital”

Aim The aim of the study is to assess the knowledge, attitude and practice patterns regarding eye donation, eye banking and corneal transplantation in patients attending the outpatient department of a tertiary care hospital. Methodology This cross-sectional study/survey was carried out at the Department of Ophthalmology of a tertiary care medical college hospital. The study included 380 participants who were at least 18 years old and willing to take part. Results A total of 39.5% of the study participants believed there is an age limit for eye donation while around 70% of the participants responded that a history of cataract/glaucoma is a contraindication for donating eyes while 17.1% of them responded that eye donation was against their religious belief. Still, 292(76.8%) people pledged to donate their eyes. Conclusion Our survey found that 86.3% of participants were aware of eye donation. The fact that doctors were the main source of information on eye donation shows how important their job is. Amongst society average knowledge was present regarding eye donation. Moreover, two-thirds of the patients expressed their willingness and commitment to donate their eyes. Although the awareness level regarding eye donation and the pledge rate is high, still there is a significant information gap about the donation as well as the eye bank.

Pediatric atlas anatomy and its implications for fracture treatment: an anatomical and radiological study

Introduction and objectivesThe objective of the study was: (1) to describe changes in the shape of the atlas during growth, including gender and side differences; (2) to assess the dimension essential for identification of the optimal entry point; (3) to determine the age limit for a safe insertion of 3.5-mm screws into the lateral masses according to our own limiting parameters. Materials and methodsDimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0–18 years and on 34 anatomical specimens of the first cervical vertebra (aged 2.5–18 years). Both series were divided according to the gender and age. The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides. ResultsThe atlas reaches its maximum growth rate between 0 and 2 years of age, then the growth decelerates and continues until the age of 18 years. The proportion of dimensions of C1 vertebral foramens changes with age. The youngest children show a relatively greater distance from the left to the right medial pedicle; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater. The transverse foramen has a slightly oval shape throughout the period of growth. Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age. ConclusionThe study has proved adequate size of lateral masses for insertion of 3.5-mm screws in all patients from the age of 5 years. In younger children, the patient´s anatomy should be respected and the surgical technique tailored accordingly.

Tonsillectomy and the Risk of Post-Tonsillectomy Hemorrhage: A Retrospective Cross-Sectional Study

Introduction. Aim of article was to Retrospectively reviewed occurrence of post-tonsillectomy hemorrhage (PTH) in a population with a wide age range and assessing the association between patients’ age, time of PTH, and the need for surgery to control bleeding. Methods. A retrospective cross-sectional study of 240 patients who underwent a tonsillectomy, tonsilloadenotomy or adenectomy in our Department. Demographic parameters, indication, complication, performed operation and PHD were analyzed in patients. Results. A total of 240 patients with a mean age of 12.29 years, a median age of 8 years and an interquartile range of 5 to 15 years. In relation to the age limit of 16 years, 181 (75.4%) patients were 16 or younger, and 59 (24.6%) were over 16. 9 (5%) children had PTH, primary in 2.2%, and secondary in 2.8%. 8 adults (13.6%) had secondary PTH. Patients older than 16 had a 2.73 times higher risk of bleeding than patients younger than 16 (RR=2.73; p=0.030). In terms of gender, 9 male patients (8%) and 8 female patients (6.3%) experienced bleeding. There was no significant statistical difference (p=0.529). Conclusion. The risk of PTH has increased with age. In terms of gender, there was no difference.

Exploring the limit of Cu-based small-pore zeolite framework collapse during hydrothermal aging in NOx abatement from diesel vehicle exhaust

Cu-SSZ-13 small-pore zeolites have been commercialized for NOx abatement in diesel engines, while they still suffer from hydrothermal deactivation. To identify the changes occurring in catalysts during the whole hydrothermal aging (HTA) process, the selective catalytic reduction by ammonia (NH3-SCR) performance of hydrothermally aged catalysts was investigated until total deactivation occurred. Through precisely identifying the alterations in the zeolite framework and active Cu sites during HTA, three stages were distinguished under progressively more severe HTA conditions, which were dealumination/transformation of active Cu species, CuOx accumulation, and structural collapse. These three stages were found to cause a slight decrease, serious attenuation, and total deactivation of the deNOx efficiency, which stemmed from the loss of Bronsted acid sites, reduction in the number of active Cu ion sites and structural collapse, respectively. This work also depicted simulated deactivation curves of Cu-SSZ-13 with various compositions during the HTA process, which helps in understanding the hydrothermal aging limits of catalysts with various Si/Al ratios and Cu loadings.

Management of Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear through Ayurvedic management: A case report

Individuals like dancers can suffer from knee difficulties and there is no upper age limit for such knee joint-related disorders. During standing, walking, jogging, etc., the complex structure of the knee joint absorbs a lot of stress. Acute injuries to the joint may cause discomfort, swelling, and difficulty moving, which could be signs of a ruptured or broken ligament. The severity of the condition depends on the source of injury and the involved structures. Despite being less severe, some of them will still be uncomfortable and functionally restrictive. The symptoms of Janu sandhigata vata as described in Ayurveda may be correlated with signs and symptoms related to damage to the knee joint. A case where the patient was diagnosed as Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear was managed by Ayurveda approaches that are presented here. The Ayurveda treatment protocol comprises Tikta ksheera basti (~therapeutic enema), Janu seka (~therapeutic streaming over the knee), Dashanga lepa (~anointment), and Sandhaniya upanaha (~poultice application). The treatment has resulted in significant improvement in the functioning of the affected knee joint. This case has demonstrated the role of Ayurveda treatment protocols and management strategies in such ligament and meniscal injuries, without any surgical intervention.