Interest Groups Research Articles

A Qualitative Study of National Perspectives on Advancing Social Prescribing Using Co-Design in Canada.

Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well-being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co-design methodology. The institute received input from a participant advisory council, co-design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co-design approach and the barriers and facilitators to implementing social prescribing in Canada. We used a qualitative descriptive study design, document analysis, participant observation and semi-structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co-design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Participants' reflections on the co-design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co-design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro- and micro-level settings in which social prescribing is practiced. The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing.

Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework

BackgroundThe American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011–2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network.MethodsA mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles.ResultsUS and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite limited perceived benefit to their academic portfolios. Based on AMIGO’s success, a counterpart program for adult rheumatology, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018.ConclusionsDespite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties.

Wheat seed quality assessment after thiamethoxam treatment: integrating optical techniques with standard methods

Insecticide treatment of seeds protects against early field pests. Therefore, studies on the physiological and biochemical responses of crops exposed to insecticides are required. Standard (non-optical) tests are used to evaluate the physiological quality of seeds. However, some tests may need to be more sensitive to observe possible differences between the control group and the groups of interest. Optical techniques such as ultra- weak photon emission and Fourier transform infrared spectroscopy have been discovered to aid standard tests. The effects of different doses of Thiamethoxam were evaluated on wheat seeds from the cultivar FPS Certero. Samples were divided into five groups: control and treated with 75, 150, 225, and 300 mL of Thiamethoxam for each 100 kg of seeds. The ultra-weak photon emission results showed that it was possible to classify the treatment doses through the intensity of photon emissions. The Fourier transform infrared spectroscopy analyses can be used for biological analysis but are unrelated to Thiamethoxam seed treatment. Considering the findings, optical techniques can be used as an additional tool for assessing the physiological quality of seeds.

The myth of federal reserve de facto independence

AbstractIn the literature on central banks independence these institutions are considered as being apolitical. In reality, central banks are political actors and their de facto independence changes over time even if their de jure independence remains unvaried. An example of this is the Federal Reserve Bank (Fed), whose de facto independence in the past decades has fluctuated significantly because of the pressures of Congress and the President. To counter these pressures, the Fed seeks support from certain interest groups. The success of this behavior is more likely when the President and Congress represent different political parties.

Comparison of internal and external reference populations for occupational cancer surveillance in a cohort drawn from a diverse workforce.

Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program. A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost-time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario. SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal. Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest.

Effects of anesthesia with sevoflurane on outcome parameters in murine experimental studies.

Multiple murine studies modelling the immuno-pathophysiological consequences of trauma, shock, burn or sepsis were performed during the last decades. Almost every animal model requires anesthesia for practical and ethical reasons. Furthermore, often, corresponding control groups involve untreated animals without or with a limited exposure to anesthetics. However, the influences of anesthetic drugs on immuno-pathophysiological reactions remain insufficiently investigated. Therefore, we aimed to closer characterize the anesthetic impact exemplified by sevoflurane on the organ performance in mice and thereby investigate the influence of anesthesia itself on major outcome parameters in animal studies. C57/BL6 mice were subjected either to 270min of sevoflurane narcosis or directly euthanized. Plasma, BAL-fluids, lungs, kidneys, liver and intestine were collected and examined for immunological, functional and morphological changes. Systemic levels of the cytokine keratinocyte chemoattractant (KC) were raised in the narcosis group, while concentrations of high mobility group box protein 1 (HMGB-1) as a major inflammatory marker were reduced. In the lungs, levels of HMGB-1 and interleukin 6 (IL-6) were reduced. In contrast, systemic concentrations of intestinal fatty acid binding-protein (i-FABP) as an intestinal damage marker were elevated. Furthermore, liver-type fatty acid binding-protein (L-FABP) levels were lower in the narcosis animals, and inflammatory markers were reduced in liver tissues. Anesthesia also ameliorated the inflammatory reaction in renal tissues, while plasma levels of urea and creatinine were elevated, reflecting either dehydration and/or impaired renal function. As anesthesia with sevoflurane exhibited distinct effects in different organs, it is difficult to predict its specific impact on targets of interest in in vivo studies. Therefore, further studies are required to clarify the effects of different anesthetic drugs. Overall, the inclusion of a control group subjected to the same anesthesia protocol as the experimental groups of interest seems helpful to precisely define the inherent impact of the anesthetic when investigating immuno-pathophysiologic conditions in vivo.

Leveraging a Podcast Series for Nutrition Education in Medical Curriculum

Background: Malnutrition is a worldwide problem. Despite the paradoxical global prevalence of both an obese and underfed population, physicians have historically fallen short in their efforts to combat this epidemic. Unfortunately, medical education has only recently prioritized nutrition curriculum, and its incorporation has been slow. The Culinary Medicine Interest Group (CMIG) at New York Medical College (NYMC) aims to expand access to nutrition education in medical school. Methods: The CMIG podcast was conceived as an adjunct to the preclinical curriculum. Podcasts were distributed via the NYMC learning-management system in parallel with pre-clinical curriculum and made widely available via Spotify, YouTube, and Google Podcasts. A pre-podcast survey was conducted to establish a baseline of nutrition knowledge in the NYMC student population, and a post-podcast survey was also distributed. Results: During 2022-2023, twelve episodes covering various nutrition-related subspecialty topics were released. We received 76 pre-podcast survey responses which made the need for nutrition curriculum clear: 37% reported no experience with nutrition, less than half took coursework that covered nutrition, 59% were uncomfortable discussing eating disorders, and only 21.5% reported feeling comfortable discussing diet in relation to menopause. Post-podcast survey responses could not be analyzed due to low participation. Conclusion: Limited survey responses hinder conclusions about the podcast's potential impact; we believe this is related to the lack of value conferred upon content beyond the scope of mandated material. Nevertheless, baseline data support the need for more nutrition curriculum; we present a novel approach to expanding access to nutrition curriculum in medical education.

Assessing the Factors Affecting Recruitment to Child and Adolescent Psychiatry Fellowship Programs.

The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship. A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students. A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it. The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

Everyday Ethics or Deference to Expertise: Experiences of Pediatric Palliative Care Teams with Ethics Consultancy.

Background: Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Objective: Describe the extent to which PPC team members serve in pediatric health care ethics (PHCE) consultancy roles and to describe their experiences interacting with pediatric ethic consultant services. Design: Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Results: Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training. Further research is warranted to delineate scope of ethics consultancy relevant to PPC and role clarity.

A recommendation for the use of electrical biosensing technology in neonatology.

Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice. IMPACT STATEMENT: TEBT is not recommended as an accurate determinant of cardiac output (CO) (or stroke volume (SV)). TEBT may be useful for monitoring longitudinal changes from baseline of hemodynamic parameters on an individual patient basis. TEBT-derived thoracic fluid content (TFC) longitudinal changes from baseline may be useful in monitoring progress in respiratory disorders and circulatory conditions affecting intrathoracic fluid volume. Currently there is insufficient evidence to make any recommendations regarding the use of WBEBT for CO monitoring in neonates. Further research is required in all areas prior to the implementation of these monitors into routine clinical practice.

Spectral changes in electroencephalography linked to neuroactive medications: A computational pipeline for data mining and analysis

Background and objectivesThe increasing amount of open-access medical data provides new opportunities to gain clinically relevant information without recruiting new patients. We developed an open-source computational pipeline, that utilizes the publicly available electroencephalographic (EEG) data of the Temple University Hospital to identify EEG profiles associated with the usage of neuroactive medications. It facilitates access to the data and ensures consistency in data processing and analysis, thus reducing the risk of errors and creating comparable and reproducible results. Using this pipeline, we analyze the influence of common neuroactive medications on brain activity. MethodsThe pipeline is constructed using easily controlled modules. The user defines the medications of interest and comparison groups. The data is downloaded and preprocessed, spectral features are extracted, and statistical group comparison with visualization through a topographic EEG map is performed. The pipeline is adjustable to answer a variety of research questions. Here, the effects of carbamazepine and risperidone were statistically compared with control data and with other medications from the same classes (anticonvulsants and antipsychotics). ResultsThe comparison between carbamazepine and the control group showed an increase in absolute and relative power for delta and theta, and a decrease in relative power for alpha, beta, and gamma. Compared to antiseizure medications, carbamazepine showed an increase in alpha and theta for absolute powers, and for relative powers an increase in alpha and theta, and a decrease in gamma and delta. Risperidone compared with the control group showed a decrease in absolute and relative power for alpha and beta and an increase in theta for relative power. Compared to antipsychotic medications, risperidone showed a decrease in delta for absolute powers. These results show good agreement with state-of-the-art research. The database allows to create large groups for many different medications. Additionally, it provides a collection of records labeled as “normal” after expert assessment, which is convenient for the creation of control groups. ConclusionsThe pipeline allows fast testing of different hypotheses regarding links between medications and EEG spectrum through ecological usage of readily available data. It can be utilized to make informed decisions about the design of new clinical studies.

Resolving the term “offshore aquaculture” by decoupling “exposed” and “distance from the coast”

The terms “offshore” and “open ocean” have been used to describe aquaculture sites that are further from the coast or in higher energy environments. Neither term has been clearly defined in the scientific literature nor in a legal context, and the terms are often used interchangeably. These and other related terms (for example “exposed”, “high-energy”) variously refer to aspects of a site such as the geographic distance from shore or infrastructure, the level of exposure to large waves and strong currents, the geographic fetch, the water depth, or some combination of these parameters. The ICES Working Group (ICES, 2024) on Open Ocean Aquaculture (WGOOA) therefore identified a need to define the terminology to reduce ambiguity for these types of aquaculture sites or more precisely, to: (1) promote a common understanding and avoid misuse for different classifications; (2) enable regulators to identify the characteristics of a marine site; (3) allow farmers to be able to assess or quantitatively compare sites for development; (4) equip developers and producers to identify operational parameters in which the equipment and vessels will need to operate; (5) provide insurers and investors with the terminology to consistently assess risk and premiums; and (6) circumvent the emergence of narratives that root in different cognitive interpretations of the terminology in public discourse. This paper describes the evolution of the use of the term “offshore aquaculture” and define the most relevant parameters to shift to a more definitive and robust term “exposed aquaculture” that can inherently relay clearer information. Adoption of this more definitive definition of “exposed” will allow the user to define a site with more than just distance from shore. Key differences and the importance of these terms are discussed that affect various interest groups. Follow-up articles in this compilation from scientific members of the WGOOA as well as other scientists outside ICES are incorporated that develop a set of definitions and a rigorous exposure index.

Sex and gender differences in cognitive resilience to aging and Alzheimer's disease.

Sex and gender-biological and social constructs-significantly impact the prevalence of protective and risk factors, influencing the burden of Alzheimer's disease (AD; amyloid beta and tau) and other pathologies (e.g., cerebrovascular disease) which ultimately shape cognitive trajectories. Understanding the interplay of these factors is central to understanding resilienceand resistance mechanismsexplaining maintained cognitive function andreduced pathology accumulation in aging and AD.In this narrative review, the ADDRESS! Special Interest Group (Alzheimer's Association) adopted a multidisciplinary approach to provide the foundations and recommendations for future research into sex- and gender-specific drivers of resilience, including a sex/gender-oriented review of risk factors, genetics, AD and non-AD pathologies, brain structure and function, and animal research.We urge the field to adopt a sex/gender-aware approach to resilience to advance our understanding of the intricate interplay of biological and social determinants and consider sex/gender-specific resilience throughout disease stages. HIGHLIGHTS: Sex differences in resilience to cognitive decline vary by age and cognitive status. Initial evidence supports sex-specific distinctions in brain pathology. Findings suggest sex differences in the impact of pathology on cognition. There is a sex-specific change in resilience in the transition to clinical stages. Gender and sex factors warrant study: modifiable, immune, inflammatory, and vascular.

Perceived barriers to help-seeking for people who use crystal methamphetamine: Perspectives of people with lived experience, family members and health workers.

Barriers to help-seeking for illicit drug use cross psychosocial (e.g., knowledge of where to seek help, attitudinal beliefs like being afraid of what people will think) and structural (e.g., service availability) domains. Along with people who use illicit drugs, it is important to consider the perspectives of other key groups who are often involved in the help-seeking and recovery process. This study aimed to examine the perceived barriers to help-seeking for people who use crystal methamphetamine ('ice') among key groups (people who use crystal methamphetamine, families and friends, health workers) as well as the general community. A cross-sectional online survey open to all Australian residents (aged ≥18 years) was conducted November 2018-March 2019. Four key groups of interest were recruited to examine and compare perceived barriers to help-seeking for crystal methamphetamine use. Participants (n = 2108) included: people who use/have used crystal methamphetamine (n = 564, 39%), health workers (n = 288, 26.8%), affected family/friends (n = 434, 13.7%) and general community (n = 822, 20.6%). People who used crystal methamphetamine demonstrated increased odds of reporting attitudinal (OR 1.35; 1.02-1.80) or structural (OR 1.89; 1.09-3.27) barriers, or a previous negative help-seeking experience (OR 2.27; 1.41-3.66) compared to knowledge barriers. Health workers demonstrated decreased odds of reporting attitudinal compared to knowledge barriers (OR 0.69; 0.50-0.95). Perceived barriers to seeking help for crystal methamphetamine use differed among key groups involved in treatment and recovery. Acknowledging and addressing the mismatches between key groups, through targeted interventions may better support people to seek help for crystal methamphetamine use.

To Study The Impact Of Performance Management On Organizational Performance In Merino Industries Ltd.

Purpose: This study primarily deals with the impact of performance management on organizational performance of Merino Industries Ltd. Managing the performance of the employees working in the organization is one of the hardest challenges the organizations are going through now a days, Performance Management entirely rest on the employee’s commitment, competence and clarity. Design/methodology/approach: During the study, the descriptive research design was conducted to analysis the effect of performance management on organizational performance. Questionnaire was constructed to extract the primary data from the employees working at Merino Industries Ltd. 67 employees were included as the sample for the study. The exploratory factor analysis was done using SPSSv16 with the 26 independent variables resulting in six major factors and four items did not load on any of the six factors, and hence they are removed from further analysis. Findings: Findings of the study suggests that if a well- planned reward exercise and feedback mechanism is followed, the performance management system aids as an important tool for employee motivation and development which in turn leads to better organizational performance. Value: The major groups of interest (i.e. management students, academicians, researchers, practicing managers etc.) will be able to understand the impact of Performance Management on Organizational Performance in Merino Industries in a better way.

Implications of Hamka’s thoughts in tafsir al-Azhar on the standpoint of Islamic social organizations in preventing authoritarianism in Indonesia

Indonesian Islamic social organizations not only function as religious organizations but they serve as interest groups as well. Islamic social organizations are often faced with a dilemma of engaging in practical political matters or otherwise. This study analyzes thoughts and practices relating to the relationship between Islamic social organizations and the state. Study data were mined from Hamka’s thoughts in his seminal work Tafsir al-Azhar and historical documents of Muhammadiyah and the Indonesian Ulema Council (Majelis Ulama Indonesia – MUI) during the early period of the New Order, i.e., 1970-1980. The research questions posed in this study refer to how did Hamka interpret Qur’anic verses containing messages regarding the relationship between society and state and what are their implications on the practices of Indonesian Islamic social organizations in their relational dynamics with the state. Study results indicate that Hamka’s thoughts in Tafsir al-Azhar consider syura (deliberation) as a determinant in the relationship between society and state, and distinction between state and religious authority. The implications that Hamka’s thoughts had on the standpoint of Muhammadiyah as an Islamic social organization was its ability to separate itself from its political party affiliation. Muhammadiyah until 1960s was a special member of the Masyumi party. Following its separation with the Masyumi party, Muhammadiyah became an independent non-government civil institution that is critical of the state. As a civil institution, Muhammadiyah succeeded in playing its role as a civil society organization (CSO) and keeping the political regime to develop into an authoritarian and repressive state.

The politics of public space at São Paulo’s Parque Minhocão

São Paulo’s Minhocão (Big Worm) is a 3.5 km elevated expressway that cuts across a dense part of the central city. Opened in 1971, it was controversial from the start, and widely held responsible for the decline of the city’s historic centre in the 1970s and 1980s. However, it has been gradually tamed over the years, first closed to traffic at night, and then at weekends and on holidays, becoming an impromptu park, the Parque Minhocão, which has had official status since 2014. Those informal closures have been accompanied by numerous architectural schemes over the years to make the Minhocão a permanent park on the lines of New York’s High Line. The Parque Minhocão in its present condition represents a stand-off between various interest groups, all of whom have claims on it as public space. The paper explores the history of the Parque Minhocão since 1969 through different forms of visualisation, arguing that its present condition, however imperfect, keeps multiple and contradictory interests in balance.

Real-world approaches to outpatient treatment of status migrainosus: A survey study.

Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients. SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72-h duration is required before the attack can be treated as SM. The Refractory Headache Special Interest Group from AHS developed a four-question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed. Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72-h period had elapsed. Most (76.0%, 149/196) chose "treat remotely using outpatient medications at home" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti-inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196). Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management.

O-240 Embryo assessment: the Istanbul consensus revised

Abstract Study question What are the current recommended criteria for morphological assessment of oocytes, zygotes and embryos? Summary answer The present ESHRE/Alpha Scientists in Reproductive Medicine consensus document provides several novel recommendations to assess oocyte and embryo morphology and rank embryos for transfer. What is known already A previous Alpha Scientists in Reproductive Medicine / ESHRE consensus on oocyte and embryo morphological assessment was published in 2011. After more than a decade, a thorough review and update was needed. Study design, size, duration A working group consisting of Alpha Scientists in Reproductive Medicine executive board members and ESHRE Special interest group of Embryology members formulated recommendations on oocyte and embryo morphological assessment. Participants/materials, setting, methods The working group included 17 internationally recognized experts with extensive experience in clinical embryology. Seven members represented Alpha Scientists in Reproductive Medicine and 8 members represented ESHRE, in addition to two methodological experts from the ESHRE central office. Based on a systematic literature search and discussion of existing evidence, the recommendations of the Istanbul Consensus (2011) were reassessed and, where appropriate, updated based on consensus within the working group. After stakeholder review, the final version will be approved by the working group, the Alpha executive board and the ESHRE Executive Committee. Main results and the role of chance This updated consensus paper provides 20 recommendations focused on the timeline of preimplantation developmental events and morphological criteria for oocyte, zygote, and embryo assessment. Based on duration of embryo culture, recommendations are given on the frequency and timing of assessments to ensure safety and effectiveness. Limitations, reasons for caution Several criteria relevant to oocyte and embryo morphology have not been well studied, leading to either a recommendation against their use for grading or for use in ranking rather than grading. Future updates may require further revision of these recommendations. Wider implications of the findings This document provides embryologists with clear advice on best practices when assessing oocyte and embryo quality based on the most recent evidence.

Even More Loyalist than Most: The Round Table Movement in New Zealand, 1910–1923

This article illustrates the extent of the Round Table movement’s influence in New Zealand from 1910 until its decline in the early 1920s. There have been several in-depth analyses of this political movement in Australia, Britain, Canada, and South Africa. In contrast, the Round Table movement in New Zealand has received startlingly little attention. The article highlights that the New Zealand movement became a noteworthy lobby group and recruited some prominent members. However, it also highlights that the movement’s social elitism and internal tensions marred the effectiveness of its outreach.