Decreased Success Rate Research Articles

Is it the egg or the endometrium? Elevated progesterone on day of trigger is not associated with embryo ploidy nor decreased success rates in subsequent embryo transfer cycles.

The purpose of our study was to determine if progesterone (P4) values on day of trigger affect certain cycle outcome parameters, ploidy status of embryos, as well as pregnancy outcomes in the subsequent first frozen embryo transfer cycle. Two hundred thirty-eight patients undergoing pre-gestational screening and freeze all protocol at our fertility center from 2013 to 2014 were included. Excluded patients were those whom had cancelled cycles prior to egg retrieval as well as cycles utilizing donor eggs. Once patients were identified as eligible for this study, frozen serum from the day of trigger was identified and analyzed using the Siemens Immulite 2000. Number of eggs retrieved, number of available embryos for biopsy, and number of euploid/aneuploid embryos were analyzed. The first frozen embryo transfer cycle was linked to the initial egg retrieval and outcomes including pregnancy rates, and live birth/ongoing pregnancy rates were calculated and analyzed. A discriminatory P4 value of 1.5ng/ml was set. Group A had P4 values of less than 1.5ng/ml and group B had P4 values greater than or equal to 1.5ng/ml. T tests and chi-squared tests were used for statistical analysis. Group A had an average trigger P4 value of 0.87 +/- 0.3 and group B had an average trigger P4 of 2.1 +/- 0.8. Table 1 shows the baseline characteristics of both group A and group B. The only significant difference between the two groups was total gonadotropin dosage (IU) with a p value of 0.02 and estradiol (pg/ml) at trigger, also with a p value of 0.02 (Table 1). Number of eggs retrieved, number of embryos biopsied, number euploid/aneuploid, and non-diagnosis embryos were all non-significant. Chi-square analysis was used to compare pregnancy rates between the two groups after the first frozen embryo transfer cycle. Group A had a pregnancy rate of 72% and Group B had a pregnancy rate of 66.7%, which was not significant. Ongoing pregnancy/live birth rates were 65.6% in group A and 66.67% in group B, also not significant (Table 2). P4 values on day of trigger do not affect number of eggs retrieved and number of chromosomally normal embryos available for transfer in a subsequent embryo transfer cycle. Elevated P4 values (≥1.5ng/ml) also do not affect pregnancy rates or live birth/ongoing pregnancy rates in the first subsequent frozen embryo transfer cycle.

Repositioning of Drugs in Cardiometabolic Disorders: Importance and Current Scenario.

Cardiometabolic disorder (CMD) is a cluster of diseases, including cardiovascular diseases (CVDs), metabolic syndrome (MS) and diabetes mellitus (DM). Cardiometabolic disorders (CMDs) remain the principal cause of death in both developed and developing countries, accounting for nearly 32% of all deaths worldwide per year. In addition, dyslipidemia, angina, arrhythmia, cardiac failure, myocardial infarction (MI), and diabetes mellitus represent the leading killer with an estimated 19 million people died from CMDs in 2012. By 2030 more than 23 million people will die annually from CVDs. Existing drugs are not efficient enough to reduce the disease burden as well as mortality. Therefore, there is an urgent demand for new drugs in this area to reduce the mortality and control the associated disability. Nonetheless, new drug discovery (NDD) in CMDs has become more challenging for last couple of decades due to increased expenses and decreased success rate. In such a scenario, drug repositioning in the CMDs appears promising for introducing existing drugs for new therapeutic indication. Repositioning is quite an old strategy dating back to 1960s and mainly followed by serendipitous observations during clinical use of drugs. A major advantage of repositioning is that the safety profile of the drug is well established thus reducing the chances of failure due to adverse toxic effects. In addition, repositioning requires less time and investment than NDD. Considering these facts, pharmaceutical companies are now becoming increasingly interested in drug repositioning. In this follow-up, we have talked about the concept of repositioning with important examples of repositioned drugs in cardiometabolic disorder.

The Detrimental Effect of Decentralization in Digital Replantation in the United States: 15 Years of Evidence From the National Inpatient Sample

Recent reports suggest a decrease in success rates in digital replantation in the United States. We hypothesize that this decrease may be associated with decentralization of replants away from high-volume hospitals. All amputation injuries and digital replants captured by the National Inpatient Sample during 1998 to 2012 were identified. Procedures were characterized as occurring athigh-volume hospitals (> 20 replants/y), and as being performed by high-volume surgeons (> 5 replants/y). A successful procedure was defined as one in which a replantation occurred without a subsequent revision amputation. Hospital and surgeon volume were tested for association with the year and the success of the procedure. The authors identified 101,693 amputation injuries resulting in 15,822 replants. The overall success of replants dropped from 74.5% during 2004 to 2006 to 65.7% during 2010 to 2012. The percentage of replants being performed at high-volume hospitals decreased from 15.5% during 2004 to 2006 to 8.9% during 2007 to 2009. Similarly, the percentage of replants being performed by high-volume surgeons decreased from 14.4% during 1998 to 2000 to 2.6% during 2007 to 2009. Replants performed by high-volume surgeons operating at high-volume hospitals had higher success rates than low-volume surgeons operating at low-volume hospitals (92.0% vs 72.1%). In addition, high-volume surgeons operating at high-volume hospitals attempted replantation at greater rates than low-volume surgeons operating at low-volume hospitals (21.5% vs 11.0%). Overall, an amputation injury presenting to a high-volume surgeon at a high-volume center had a 2.5 times greater likelihood of obtaining a successful replantation than an amputation injury presenting to a low-volume surgeon at a low-volume hospital. These data suggest that decreased success rates of digital replantation in the United States are correlated with the decentralization of digital replantation away from high-volume hospitals. The establishment of regional centers for replant referral may greatly increase the success of digital replantation in the United States.

The atypical antipsychotic blonanserin reverses (+)-PD-128907- and ketamine-induced deficit in executive function in common marmosets

Antagonism of the dopamine D3 receptor is considered a promising strategy for the treatment of cognitive impairment associated with schizophrenia. We have previously reported that the atypical antipsychotic blonanserin, a dopamine D2/D3 and serotonin 5-HT2A receptor antagonist, highly occupies dopamine D3 receptors at its antipsychotic dose range in rats. In the present study, we evaluated the effects of blonanserin on executive function in common marmosets using the object retrieval with detour (ORD) task. The dopamine D3 receptor-preferring agonist (+)-PD-128907 at 1mg/kg decreased success rate in the difficult trial, but not in the easy trial. Since the difference between the two trials is only cognitive demand, our findings indicate that excess activation of dopamine D3 receptors impairs executive function in common marmosets. Blonanserin at 0.1mg/kg reversed the decrease in success rate induced by (+)-PD-128907 in the difficult trial. This finding indicates that blonanserin has beneficial effect on executive function deficit induced by activation of the dopamine D3 receptor in common marmosets. Next, and based on the glutamatergic hypothesis of schizophrenia, the common marmosets were treated with the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine. Ketamine at sub-anesthetic doses decreased success rate in the difficult trial, but not in the easy trial. Blonanserin at 0.1mg/kg reversed the decrease in success rate induced by ketamine in the difficult trial. The findings of this study suggest that blonanserin might have beneficial effect on executive dysfunction in patients with schizophrenia.

Factors predicting Success of Vaginal Birth after Cesarean Section

ABSTRACT Aim The aim of this article is to study the various factors that can predict the success of vaginal birth after cesarean (VBAC) section. Materials and methods A retrospective cohort study of deliveries was conducted from 1 January 2014 to 31 December 2014 by the Department of Obstetrics and Gynecology in our hospital. Patients with previous low transverse cesarean section who had undergone a trial of labor were identified. Maternal inpatient and prenatal records were reviewed in all eligible subjects. During labor, uterine activity and fetal heart rate were monitored. When indicated, oxytocin or prostaglandin E2 was used for induction of labor according to Bishop score. Emergency cesarean delivery was considered in cases with the appearance of scar tenderness, fetal distress, nonprogress of labor, and deep transverse arrest. Results A total of 200 women were eligible for VBAC, but after written informed consent, 131 (65.5%) subjects were given trial of labor at term after one prior cesarean delivery among 3,604 deliveries while 69 (34.5%) subjects opted for elective repeat cesarean section. The overall VBAC success rate was 63.3% (76 of 120) in our study. History of spontaneous labor (p = 0.042) and history of previous vaginal delivery (p = 0.038) were found to be significantly associated with increased chance of success of VBAC, and lesser interdelivery interval was not found to be associated with decreased success rate (p = 0.096). Neither indication of previous cesarean nor birth weight of newborn (>3 kg) was found to be related to the success of VBAC. Conclusion Vaginal birth after cesarean section is a safe practice as long as it is offered with a proper selection of candidates with factors having a high success rate. Physicians need to be aware of factors having a good outcome before counseling mothers so that failure rates decrease and successful VBAC is increased. How to cite this article Verma ML, Nisha S, Singh U, Sankhwar PL, Qureshi S. Factors predicting Success of Vaginal Birth after Cesarean Section. J South Asian Feder Obst Gynae 2016;8(3):198-201.

Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data.

BackgroundAlthough the international guidelines emphasize early and systematic use of rescue intubation techniques, there is little evidence to support this notion. We aimed to test the hypothesis that preceding multiple failed intubation attempts are associated with a decreased success rate on the first rescue intubation in emergency departments (EDs).MethodsWe analysed data from two multicentre prospective registries designed to characterize current ED airway management in Japan between April 2010 and June 2013. All patients who underwent a rescue intubation after a failed attempt or a series of failed attempts were included for the analysis. Multiple failed intubation attempts were defined as ≥2 consecutive failed intubation attempts before a rescue intubation. Primary outcome measure was success rate on the first rescue intubation attempt.ResultsOf 6,273 consecutive patients, 1,151 underwent a rescue intubation. The success rate on the first rescue intubation attempt declined as the number of preceding failed intubation attempts increased (81% [95% CI, 79%-84%] after one failed attempt; 71% [95% CI, 66%-76%] after two failed attempts; 67% [95% CI, 55%-78%] after three or more failed attempts; Ptrend <0.001). In the multivariable analysis adjusting for age, sex, principal indication, change in methods, devices, and intubator specialty, and clustering of patients within EDs, success rate on the first rescue intubation after two failed attempts was significantly lower (OR, 0.56; 95% CI, 0.41-0.77) compared to that after one failed attempt. Similarly, success rate on the first rescue intubation attempt after three or more failed attempts was significantly lower (OR, 0.49; 95% CI, 0.25-0.94) compared to that after one failed attempt.ConclusionPreceding multiple failed intubation attempts was independently associated with a decreased success rate on the first rescue intubation in the ED.

Changing and challenging times for Canadian kidney health and disease research.

The issues In many ways, the Canadian renal researcher lives in privileged times. Never before has she or he enjoyed such remarkable access to the tools of the trade. Unprecedented advances in biotechnology, genomics, molecular biology, regenerative medicine, tissue banking, and computer databases along with the implementation of numerous infrastructure projects on a scale unparalleled in our history have together luxuriously equipped our scientific community. We stand poised for breakthroughs that will significantly impact the renal health of Canadians both tomorrow and well into the future. Thanks to initiatives such as the federally funded Canada Foundation for Innovation along with its provincial and local partners, it is not uncommon for both basic and clinician scientists specializing in nephrology to be employing state-of-the-art equipment, housed in dozens of newly minted laboratories and research buildings across our country. Moreover, training programs such as the Kidney Foundation of Canada (KFoC)/Canadian Institutes of Health Research (CIHR) supported Kidney Research Scientist Core Education and National Training Program (KRESCENT) initiative have fostered the development of the next generation of investigators, each eager to contribute to the advancement of knowledge. However, the times wherein the Canadian renal researcher lives are also defined by enormous challenges. Despite the wealth of research infrastructure and an abundance of well-trained investigators, as in the USA, our national research endeavor seems to have been designed however, inadvertently, in anticipation of unlimited growth. Over the past 15 years, universities, hospitals, and research institutes have continued to hire into new positions in order to fill expanding wet and dry lab space to capacity. Despite this increase in the hiring of principal investigators, our system continues to train far more graduate students and postdoctoral fellows than there are positions in academia, industry, and government. Competition for new investigator spots is fierce, forcing many individuals to remain in training positions during their most creative years until either obtaining their first independent position or leaving research for other career options. These issues have imposed stress upon the system and together with an unchanging pool of funds available to investigators, have driven down funding success for many individual research operations. Not long ago, CIHR funding levels hovered at the 20–27 % range; on some peer-review committees, this was as high as 40 %, allowing for most applications ranked in the excellent range (i.e., ≥4.0 on the CIHR scale) to be approved. Recent open operating grant competitions have seen application pressure steadily increase, placing greater burdens on both reviewers and their committees. This has created a vicious cycle where highly ranked proposals line up in the queue, often requiring several resubmissions before being funded, if at all. With the declining success rates for CIHR applications, more applicants have sought funding from other agencies, similarly driving up application pressures and decreasing success rates. The net effect has been that funding rates with most sources are now at historic lows. Correspondence: ckennedy@uottawa.ca Kidney Research Centre, Chronic Disease Program, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada Full list of author information is available at the end of the article

Repeated attempts at tracheal intubation by a single intubator associated with decreased success rates in emergency departments: an analysis of a multicentre prospective observational study

ObjectiveTo determine whether the success rate of repeated attempts at tracheal intubation by a single intubator was lower than those by alternate intubators in the emergency department (ED).MethodsAn analysis of...

CT-guided core biopsy and percutaneous fiducial seed placement in the lung: Can these procedures be combined without an increase in complication rate or decrease in technical success?

ObjectiveTo determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone. Materials and methodsAn IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N=63), with concomitant core biopsy (N=53) or only core biopsy (N=169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates. Statistical analysis was performed using univariate and multivariate pair-wise comparisons. ResultsA pathologic diagnosis of malignancy was confirmed in all cases undergoing seed placement alone and seed placement with concurrent biopsy, and in 144 of the biopsy alone lesions. On univariate analysis, major complication rates were similar for all three groups as were lesion size, depth, number of pleural passes, and technical success. Pair-wise comparisons of the remaining variables demonstrated a significant younger age and smaller needle size in the biopsy only group, and less minor complications in the fiducial only group. Overall there were 80/285 (28.1%) minor and 29/285 (10.2%) major complications. All major complications leading to admission consisted of either pneumothorax or hemothorax, while minor complications included asymptomatic stable or resolving pneumothoraces, transient hemoptysis or small hemothoraces. ConclusionsA combined procedure of percutaneous pulmonary core biopsy and stereotactic seed placement can be performed without additional risk of a major complication when compared to performing these separately.

Clinical Outcomes and Prognostic Factors of Empirical Antifungal Therapy with Itraconazole in the Patients with Hematological Malignancies: A Prospective Multicenter Observational Study in Korea

PurposeTo identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies.Materials and MethodsThree hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled.ResultsThe overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) ≥2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (≥4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity.ConclusionWe concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.

Diabetes mellitus: An endodontic perspective

AbstractDiabetes mellitus (DM) is a complex metabolic disease, characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. In patients with DM, several aspects of the immune system are compromised and wound healing is impaired. Studies indicate increased prevalence, severity of periapical lesions and a decreased success rate of endodontic treatment in diabetics, suggesting that diabetes may serve as a disease modifier of periapical lesions. A reciprocal relationship exists between glycaemic control and chronic periapical lesions. Treating infections of pulp and periodontium will improve glycaemic control and help in healing of lesions similar to non-diabetics. To provide competent care to patients with DM, dental clinicians must understand the disease, its treatment, and its impact on the patients′ ability to undergo and respond to endodontic treatment. This review article is a detailed assessment of the literature on DM and its implication on pulp and periapical diseases, and their treatment outcome.

Changing Trends of Speech Outcomes after Total Laryngectomy in the 21st Century

Objectives: Management of laryngeal cancer has changed significantly in the past decade. Total laryngectomy (TL) has been mainly reserved for patients with recurrence or failure after chemo-radiation or patients requiring major ablative and reconstructive surgeries. Tracheoesophageal puncture (TEP) continues to be the gold standard for speech rehabilitation, yet it is unknown what the overall speech outcomes are for individuals undergoing TL in the 21st century. Our study will describe the speech rehabilitation outcomes of patients after TL in the 21st century. Methods: This is a retrospective analysis of 391 patients who underwent TL from June 2000 to February 2012 with a minimum of one year follow-up. Demographic variables and medical/surgical factors related to laryngectomy will be reviewed. Patient speech rehabilitation outcomes will be assessed and categorized into the following groups: 1) use of esophageal speech; 2) use of electrolarynx; 3) use of TEP; 4) failure to achieve functional speech; and 5) non-compliant. To be in groups 1, 2, or 3, patients must use speech as the dominant mode of communication. Results: Patients who underwent TL in the 21st century may have overall decreased success rate in speech rehabilitation; there may be decreased success rate in the use of esophageal speech and TEP. Conclusions: The current gold standard for speech rehabilitation should be readdressed, as it may not adequately meet the need of the current patient populations. More up-to-date techniques and technologies are needed to improve the communication and speech rehabilitation of current laryngectomy patients.

Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome. A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome. The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher's exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively. The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.

Long-term analysis of tropospheric delay and ambiguity resolution rate of GPS data

Long-term GPS data analysis was performed in order to analyze the seasonal variation of tropospheric delay and the success rate of the ambiguity resolution. For this analysis, a total of 57 stations including 10 IGS stations in East Asia were processed together with double-differenced observables using Bernese GPS Software V5.0. The time span for this study ranges from 2002.0 to 2012.5 (10.5 years). The average baseline length is 339.0 km and the maximum reaches up to 2,000 km. The analysis is focused on two things: the annual variation of the tropospheric delay and the ambiguity resolution rate. The tropospheric delay is closely related to the weather condition, especially relative humidity, therefore it was estimated that the maximum would be in summer, while reaching its minimum in winter with the apparent seasonal variations. On the contrary, however, the success rate of the ambiguity resolution shows the opposite pattern: its maximum was in winter and minimum in summer. The fact seems to be induced by the surrounding conditions; that is, the trees thick with leaves near the GPS antenna interfere with GPS signals in summer. This seems to confirm partly that there is a distinct trend in the decreasing success rate since 2006 because the trees are growing every year. It is necessary to eliminate the factors that degrade the GPS quality and the tropospheric modeling for Korea needs to be studied further.

Increasing Need for Academic Leadership in Clinical Trials

During the past 2 decades, the pharmaceutical industry has produced some remarkable medicines to treat human disease by exploiting new discoveries that underpin the pathobiology of specific diseases. For example, insight into the biology of angiotensin II receptors [1] and antitumor necrosis factor [2] led to effective new medicines for the treatment of hypertension and rheumatoid arthritis, respectively. This achievement is remarkable given that of the tens of thousands of compounds screened each year for efficacy, only a fraction survive initial screening and preclinical pharmacology and safety tests, and ultimately survive to undergo clinical trials of efficacy and safety. The process typically requires a decade of development, and costs approach $500 million per drug approved for the U.S. market [3]. As a result of increasing development costs, decreasing success rates of innovative therapeutics, and pending patent expirations for major drug classes, the rate of development of new innovative products is in decline [4].

Role of Childhood Aerobic Fitness in Successful Street Crossing

Increased aerobic fitness is associated with improved cognition, brain health, and academic achievement during preadolescence. In this study, we extended these findings by examining the relationship between aerobic fitness and an everyday real-world task: street crossing. Because street crossing can be a dangerous multitask challenge and is a leading cause of injury in children, it is important to find ways to improve pedestrian safety. A street intersection was modeled in a virtual environment, and higher-fit (n = 13, 7 boys) and lower-fit (n = 13, 5 boys) 8- to 10-yr-old children, as determined by V˙O(2max) testing, navigated trafficked roads by walking on a treadmill that was integrated with an immersive virtual world. Child pedestrians crossed the street while undistracted, listening to music, or conversing on a hands-free cellular phone. Cell phones impaired street crossing success rates compared with the undistracted or music conditions for all participants (P = 0.004), a result that supports previous research. However, individual differences in aerobic fitness influenced these patterns (fitness × condition interaction, P = 0.003). Higher-fit children maintained street crossing success rates across all three conditions (paired t-tests, all P > 0.4), whereas lower-fit children showed decreased success rates when on the phone, relative to the undistracted (P = 0.018) and music (P = 0.019) conditions. The results suggest that higher levels of childhood aerobic fitness may attenuate the impairment typically associated with multitasking during street crossing. It is possible that superior cognitive abilities of higher-fit children play a role in the performance differences during complex real-world tasks.

Developmental potential of embryos from intracytoplasmic sperm injection cycles containing fragmented oocytes

To determine the incidence of fragmented oocytes in intracytoplasmic sperm injection (ICSI) cycles, describe the developmental potential of their sibling oocytes, and define clinical outcomes from affected cycles. Case-control study. Academic medical center. All ICSI cycles from January 2006 to December 2010 (n = 2,844) were reviewed for the presence of fragmented oocytes at cumulus stripping or fertilization check (n = 93). Sibling oocytes and corresponding embryos from index cycles were compared with matched control cycles without fragmented oocytes. None. Cycle characteristics, embryo quality, and pregnancy rates per retrieval. The incidence of ICSI cycles containing at least one fragmented oocyte was 3.3% (93/2,844). Twelve patients were represented more than once in these 93 index cycles. Only the first cycles (n = 81) were included, of which 28 contained fragmented oocytes at cumulus stripping, 48 at fertilization check, and five at both. Compared with matched controls, index cycles had fewer good-quality embryos available for transfer (18.8% vs. 32.1%) and significantly lower rates of implantation (20.3% vs. 32.7%), clinical pregnancy (33.3% vs. 58.0%), and ongoing delivery (29.6% vs. 49.4%). The cumulative ongoing delivered rate was also significantly lower for index cycles (32.1% vs. 55.6%), with no difference in the percentage of cycles with cryopreserved embryos remaining at study conclusion (13.5% vs. 23.5%). Cohorts containing fragmented oocytes have decreased developmental potential. The biologic mechanisms underlying this occurrence merit further investigation, and patient counseling should reflect the possible decreased success rates associated with this aberrant developmental pattern.

Sex Differences in Application, Success, and Funding Rates for NIH Extramural Programs

The authors provide an analysis of sex differences in National Institutes of Health (NIH) award programs to inform potential initiatives for promoting diversity in the research workforce. In 2010, the authors retrieved data for NIH extramural grants in the electronic Research Administration Information for Management, Planning, and Coordination II database and used statistical analysis to determine any sex differences in securing NIH funding, as well as subsequent success of researchers who had already received independent NIH support. Success and funding rates for men and women were not significantly different in most award programs. Furthermore, in programs where participation was lower for women than men, the disparity was primarily related to a lower percentage of women applicants compared with men, rather than decreased success rates or funding rates. However, for subsequent grants, both application and funding rates were generally higher for men than for women. Cross-sectional analysis showed that women and men were generally equally successful at all career stages, but longitudinal analysis showed that men with previous experience as NIH grantees had higher application and funding rates than women at similar career points. On average, although women received larger R01 awards than men, men had more R01 awards than women at all points in their careers. Therefore, while greater participation of women in NIH programs is under way, further action will be required to eradicate remaining sex differences.

Does estimating the mid-spinal canal depth improve lumbar puncture success rates? a single centre tertiary neonatal care audit

IntroductionLumbar puncture (LP) is part of the neonatal septic screen. A cerebro-spinal fluid (CSF) red blood cell (RBC) count of <500 is required to accurately interpret the CSF white cell...

The Effect of Cross-Training with Adjustable Airway Model Anatomies on Laryngoscopy Skill Transfer

A problem with learning endotracheal intubation on airway mannequins is poor transfer of direct laryngoscopy skills from model to patient. We developed an airway model with adjustable anatomic features and investigated whether practicing on a model with frequent adjustments improved laryngoscopy skills transfer. Fifty-one paramedic students and 18 medical students with minimal previous experience practiced laryngoscopy 25 times with either the novel model with static features, the novel model with variable features, or a Laerdal Adult Intubation mannequin. For the variable group, the configuration changed after every 5 attempts. After training, all subjects performed 10 laryngoscopies on 2 new mannequins to test their competence at skills transfer. A mixed linear model analyzed various predictors of success as a binary outcome, including training group and change in laryngoscopy model. The odds ratio for success after a recent change in mannequin was 0.69 (0.49, 0.96 [95% confidence interval]). Compared with the Laerdal group, subjects with the static trainer did worse (odds ratio 0.46 [0.23, 0.94]), and subjects in the variable group were no different (0.74 [0.36, 1.52]). Change in laryngoscopy model decreased success rate by approximately 30% for all training groups. The results verify that proficiency on one model does not guarantee success on another. However, subjects who trained with a laryngoscopy mannequin in multiple configurations did not show better skill transfer than subjects practicing on fixed configuration airway models.