Irish National Research Articles

Transparency trade-offs in the operation of national Public Private Partnership units: The case of Ireland’s National Development Finance Agency

Since 2002, the Irish National Development Finance Agency [NDFA] has played a leading role in the procurement of Public Private Partnership [PPP] projects in Ireland (UNECE, 2008). It has procured 9 PPP projects bundles, which are currently listed on its website, between 2002 and 2022 11ndfa.ie/projects in addition to Primary Care, Justice, OPW and Education bundles not currently listed on its website. Ireland follows a global pattern where national or provincial PPP units, frequently organised as arm’s-length bodies, play a central role in managing the partnership-based procurement of infrastructure projects (Burger, 2009). This paper examines how the NDFA, acting as Ireland’s PPP unit, has affected the transparency and accountability of Irish PPP procurement. Our analysis indicates that the expanding role played by the NDFA has been depoliticisation and agencification. Our analysis deviates from some previous critical studies of PPP agency governance (Sześciło, 2020) in that we argue that agencification can adversely affect some aspects of PPP transparency while strengthening others, such as selection process transparency. Nonetheless, we suggest the approach to PPP procurement could harm the long-term sustainability of Irish PPP. Using the example of Ireland, our paper contributes to an understanding of the impact of such institutional arrangements on transparency and accountability of PPP procurement.

Role of religious minorities’ deputies in the Iranian National Consultative Assembly towards the most prominent economic and social issues 1906-1915

The study of the roles of minority deputies in the Iranian National Consultative Assembly is an important study, especially since the previous scientific studies related to this topic were not mentioned by Iraqi academic researchers except in a limited way. Therefore, we resorted to choosing this topic to rely on the lectures of the Iranian National Consultative Assembly and its laws during the period (1906-1915), and the reason for choosing the study period since 1906, which is the year that witnessed the writing of the first constitution for Iran after the constitutional revolution; It was followed by the enactment of the Iranian National Consultative Assembly elections law and as a result of which the first legislative session of the council was held in 1906. The determination of 1915 came as a result of the suspension of the council's work in its third legislative session following the events of World War I and the entry of Allied forces into Iranian territory; Which led to the disruption of the council.

CORR Insights®: The Irish National Orthopaedic Register Under Cyberattack: What Happened, and What Were the Consequences?

1Norman M. Rich Professor and Chair, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD, USA B. K. Potter, Uniformed Services University of Health Sciences, 4310 Jones Bridge Road, A3011-SUR, Bethesda, MD 20814, USA, Email: [email protected] This CORR Insights® is a commentary on the article “The Irish National Orthopaedic Register Under Cyberattack: What Happened, and What Were the Consequences?” by Russell and colleagues available at: DOI: 10.1097/CORR.0000000000002643. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense. This work was prepared by a military or civilian employee of the US Government as part of the individual's official duties and therefore is in the public domain and does not possess copyright protection (public domain information may be freely distributed and copied; however, as a courtesy it is requested that the Uniformed Services University and the author be given an appropriate acknowledgement). The author received no financial support for this commentary.

#MeToo and the Northern Ireland Troubles: Anna Burns' Milkman

This article examines the relationship between Anna Burns’ Milkman (2018) and the gender politics of the #MeToo movement. It argues that reading Milkman in light of #MeToo helps us understand the book’s depiction of sexual violence and illuminates an important, hidden history of the Northern Irish conflict. Drawing on a range of feminist scholars, it situates Milkman within a series of broader debates about the ‘cultural scaffolding’ of sexual violence and the historically masculinist logic of Irish nationalism. The article concludes by situating Milkman within a predominant thematic strain in recent Irish fiction; namely, the ‘retrospective mood’ whereby authors have sought to revisit the past and re-examine its legacies for the precarious peace of the present.

Geospatial Analysis and Molecular Epidemiologic Study of Emerging Pulmonary Lophomoniasis in Iran: A National Registry-Based Study.

Bronchopulmonary lophomoniasis (BPL) is a protozoan pulmonary disease that has been reported sporadically, but its incidence has been increasing. However, the epidemiology and risk factors of the disease have not been clearly identified. The current study aims to identify BPL cases molecularly and assess the demographic and some environmental factors for the first time on the prevalence of BPL as a national registry-based study in Iran. Methodology. The study tested 960 patients with lower respiratory tract symptoms whose bronchoalveolar lavage samples were submitted from seven provinces of Iran to the Iranian National Registry Center for Lophomoniasis. They were tested for BPL by a newly developed polymerase chain reaction test. The study assessed the association of Normalized difference vegetation index (NDVI), digital elevation model (DEM), and geographic latitude as environmental factors and sex and age as demographic factors on the prevalence of BPL. Geospatial information systems methods and chi-squared and Pearson's correlation tests were used for the assessment of geographical and environmental factor effects and statistical analysis, respectively. Of the 960 patients, 218 (22.7%) tested positive for BPL; the highest and lowest prevalence rates were reported from the south and northeast of Iran, respectively. The study found a correlation between geographic latitude and age with BPL prevalence, but no association was found for gender, NDVI, or DEM. Most patients were over 40 years old, and the rate of disease was higher in southern latitudes. Age and geographical latitude were found to be risk factors for BPL. More exposure to dust and/or chronic pulmonary problems may explain the higher prevalence of the disease in older adults. Higher rates of BPL in lower latitudes may be due to warmer weather and longer days, which can confine individual activities indoors and result in more contact with domestic insects and infected dust.

Temporal Pattern and Age-Period-Cohort Analysis of Breast Cancer Incidence in Iranian Women (2009-2017).

Breast cancer accounted for 28.1% of all female cancers in 2020 in Iran. This study was conducted to evaluate the time trend of breast cancer incidence and to identify the changes of breast cancer incidence in age, period, and birth cohorts in Iran, in the 2009-2017 timeframe. Annual cancer statistics for female breast cancer were obtained from the Iranian National Population-based Cancer Registry (INPCR) database from 2009 to 2017. The age-period-cohort (APC) analysis was used to evaluate the time trend of breast cancer incidence in age, period and birth cohorts between 2009 and 2017. R package (Epi) was used to analyze data. Results were considered statistically significant at P<0.05. The age effect showed an increased incidence of breast cancer until the age of 45, and after this age the speed of increase was slower until 65 years. There was an increased diagnosis in 2015-2017 (period effect) for many age groups, especially in the 70- and over 80-year-old group. Our findings indicated that breast cancer incidence peaks in the age of 45 in Iranian women, which is a decade earlier compared to the Western world. The period effect in 2015-2017 can be explained by the fact that in 2014, the former Iranian pathology-based cancer registry was upgraded to a population-based cancer registry, which resulted in improved coverage of cancer registry and case finding.

From Constructive Ambiguities to Structural Contradictions: The Twilight of the Good Friday Agreement?

The Good Friday Agreement contained a series of constructive ambiguities which were critical to ensuring that it received broad cross-political support. These ambiguities were reflective of the balance of political power of the time. Once institutionalized, they contained an immanent potential to morph in to structural contradictions as the re-balancing of demographic and political power in Ireland moved from latent to manifest status. As the Agreement reaches its 25th anniversary, three outstanding structural contradictions are manifesting, prompted by Brexit and the re-introduction of the ‘Irish question’ in to Irish-British relations. The constitutional status of the North of Ireland, the raison d’etre of statelet, and the inability of the governing institutions to function representationally or effectively have co-joined with a new balance of political power favoring Irish nationalism over Ulster unionism. Consequently, whether or not we are witnessing the twilight of the Good Friday Agreement will be contingent upon the short-medium term political decisions of key political actors, most notably, Ulster unionism. Three probable future developments will be further stasis, institutional reform, or (r)evolutionary constitutional change.

An electronic operation note proforma improves the quality of operation notes in burns surgery.

An Operation Note should provide a comprehensive account of the details of a surgical procedure performed and document clinically relevant events which occur throughout the procedure. The Royal College of Surgeons of England, in 2014, updated guidelines on specific criteria to be included in operation notes. Standardisation using procedure-specific operation notes has been shown to significantly improve adherence to these guidelines. The aim of this study was to evaluate the quality of operation notes in the Irish National Burns Unit before and after the design and implementation of an electronic patient record and the subsequent introduction of an operation template and a burns surgery specific checklist, within the electronic system. A 30-point checklist was designed based on existing sources. Operation notes prior to and following the adoption of a electronic-based operation note were analysed, and then reanalysed following the introduction of a procedure-specific operation note. Ninety-three operation notes were included for analysis. An electronic operation record significantly improved the quality of documentation within our unit. The subsequent procedure specific operation note had a significant improvement across all areas and achieved 100% compliance in many categories. The use of an electronic patient record to document a patient's procedure has been shown to significantly improve the quality of documentation. One could expect this to result in an improved patient hand-over and subsequent episode of care. We highlight a number of initial pit-falls that others may avoid in their implementation of a digital record.

Evaluation of Selenium Status among Iranian Pregnant Women: A Systematic Review and Met-Analysis

Background: Selenium (Se) plays an important role in numerous immunological functions of human health. It has been shown that maternal Se deficiency contributes to many pregnancy complications such as pre-eclampsia, gestational diabetes mellitus (GDM), miscarriage, and even fetal growth restriction. Due to the evidence of importance of Se in pregnancy outcomes and the inconsistency of current shreds of evidence on Se adequacy in Iranian pregnant women, this study aimed to provide a comprehensive evaluation of published studies. This systematic review explored studies reporting dietary Se intake, serum or plasma Se, and Umbilical cord Se in Iranian pregnant women.&#x0D; Methods: PubMed, Scopus, Web of Science, Embase, Google scholar (in English and Persian), and Persian databases, including Scientific Information Database, IranDoc, Iranian National Library, Magiran, and Regional Information Center for Science and Technology, were reviewed.&#x0D; &#x0D; Results: A total of 30 studies were included in the meta-analysis. Pooled effect sizes show an overall value of 90.09 µg/l (95% CI: 81.89, 98.29) and 75.08 µg/d (95% CI: 63.01, 87.16) for serum and dietary Se. Geographically, the lowest serum Se was in Fars and East-Azerbaijan with values of 61.97 µg/l (51.38, 72.55) and 55.12 µg/l (48.5, 61.74), respectively. Dietary intake pooled estimate showed that the lowest Se intake was in West-Azerbaijan with a value of 42.80 µg/d (95% CI: 38.95, 46.65).&#x0D; Conclusion: The current study shows that the overall serum and dietary intake of Se in Iranian pregnant women is acceptable. Some parts of the country need monitoring to prevent Se inadequacy and related-adverse complications in pregnant women.

The Introduction to Mohammad-Taqi Bahār’s Sabkshenāsi: A Translation

Abstract Mohammad-Taqi Bahār’s 1942 textbook Sabkshenāsi (“Stylistics”) was a landmark text in modern Persian literary studies. It coined terms (like sabk-e Hendi or the “Indian style” of Persian poetry) and laid out a tripartite, geographical-temporal model for the history of Persian poetry which largely remain dominant today. Bahār’s articulation of a national canon of Iranian literature (comprising writings in various stages of the Persian language as well as Arabic) made Sabkshenāsi an important text not only for the nascent department of Persian literature at the University of Tehran for which it was written, but for twentieth-century Iranian nationalism in general. By combining traditional forms of knowledge with the methodologies pioneered by European Orientalists, it played an important role in modernizing Persian literary studies. The influential introduction to Sabkshenāsi is translated here into English in full for the first time, along with a preface explaining the work’s importance for Persian literary studies.

The association between weather warnings and hip fractures in the Republic of Ireland

SummaryThis study examined the relationship between hip fractures and weather warnings with the hypothesis higher rates of fractures occur during warnings. National hip fracture database and weather warning records were utilised. Higher rates of hip fractures were found with severe warnings. This has implications for planning in future severe warnings.BackgroundHip fractures represent a significant burden on the Irish Health system with 3666 in 2020. The Irish National Meteorological Service operates a colour coded warning system. Yellow being least severe, while orange represents weather with capacity to impact individuals in affected areas and red represents advice to protect themselves and property. Previous studies investigated the seasonality of hip fractures, which remains but none have investigated the relationship between weather warnings and rates of hip fractures. The hypothesis was that increasing weather warnings would be associated with increased hip fractures. The aim was to investigate the relationship between weather warnings and hip fractures in the Republic of Ireland.MethodsComparison of national weather warning archives from 2013 to 2019 to Fracture Database records. Reviews assessed whether fractures occurred on days a weather warning was in place in the individual’s local county. A statistical analysis of warning features and their relationship to hip fractures was then performed. Fractures and weather warnings were stratified by county with both a panel and case crossover analysis performed.ResultsThere was a tendency towards increased incidence of hip fractures with weather warnings in adjusted analysis (IRR 1.02; 95%CI 0.99–1.06; p-value 0.123). Orange warnings were associated with a statistically higher incidence of fractures (IRR 1.06; 1.01–1.12; p-value 0.026). In both panel and case crossover analysis, both orange and yellow warnings were associated with fractures. Red warnings were associated with a lower incidence of fracture on day of warning (adjusted incidence rate ratio 0.92; 0.70–1.22; p-value 0.569) but a higher incidence on the following day (adjusted incidence rate ratio 1.14; 0.88–1.46; p-value 0.313).ConclusionAn increased incidence of hip fractures appears to occur during weather warnings. Consideration should be given when preparing for periods of extreme weather, ensuring sufficiently resources.

Epidemiology and survival of cervical cancer in Iran based on national cancer registry data (2008-2014).

Cervical cancer (CC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide, associated with the incidence of human papillomavirus (HPV) infection. The CC incidence is low in Iran, ranking 11th among cancers. This study aimed to estimate the survival rate of CC and the reasons for its low survival rate based on the data retrieved from the Iranian National Cancer Registry System. In this retrospective cohort study, data for patients diagnosed with CC from 2008 to 2014 were collected and analyzed. The Kaplan-Meier method was used for survival analysis based on epidemiological and clinical factors. A total of 5,304 women were diagnosed from March 10, 2008 to March 9, 2014 and 2,423 patients were followed. The mean age of the cases was 51.91 years, and 65.91% were alive. The 5- and 10-year survival rates were 58% and 50%, respectively, with no difference between younger cases with SCC or AC but better survival rates for older patients with SCC. As a preventable disease, CC is related to biological factors and geographical and sociodemographic indices. Geographical, cultural, and religious behaviors affect the CC incidence and survival. In Iran, the 5-year survival rate ranges from 34% to 70% among different geographic regions. Hence, effective screening based on cultural and sociodemographic issues is recommended.

Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey

IntroductionThis study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. MethodsQuantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. Results39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51–80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. ConclusionThere were differences in experiences of SDM by aspects of care and patient group. Practice implicationsEfforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.

The Irish National Orthopaedic Register Under Cyberattack: What Happened, and What Were the Consequences?

On May 14, 2021, a criminal cyberattack was launched against the Irish public healthcare system, the Health Service Executive, resulting in a complete shutdown of all national healthcare computer systems, including the Irish National Orthopaedic Register (INOR). Cyberattacks of this kind occur sporadically, and postevent analyses can inform future preparedness efforts, but few such analyses have been published. What was the impact of the cyberattack in terms of (1) registry downtime, (2) harms to patients, and (3) costs to the INOR for data contingency and reconciliation? All nine hospitals using the INOR were included for data collection. Since establishment in 2014, the INOR has been rolled out to all eight public elective hospitals, capturing all hip and knee arthroplasty procedures. One private hospital was also captured, with plans to expand the private sector coverage. Individual institutional records and central INOR records were queried with respect to downtime, potential harms to patients (including intraoperative complications because of a lack of data on existing implanted components and complications directly attributed to delayed or canceled procedures), and costs related to additional person-hours addressing data reconciliation. Objective data directly related to the uncontrolled INOR downtime were collected, including duration of downtime, contingency methods employed, quality of contingency data collected, adverse patient events, methods of data salvage and reconciliation, and the cost of data contingency and reconciliation measures. Costs were estimated by the additional person-hours of work completed, multiplied by the hourly rate of that employee. Employees at each of the nine hospitals were asked to provide their additional person-hours of work performed because of the attack. These hours were corroborated by observing the time taken at each unit to reconcile data for single cases multiplied by the number of cases at that unit. Employees included nurses, clinical nurse specialists, and doctors of various grades. Person-hour rates were calculated using the Health Service Executive's published salary scales. The INOR suffered a median downtime of 134 days (range 119 to 272 days) across nine sites. No serious adverse patient events were identified. The immediate implementation of a paperwork fallback method for the INOR successfully resulted in 100% case capture during the downtime. However, 2850 additional person-hours were required for data reconciliation at an estimated cost of USD 181,000 to USD 216,000. More subjectively, as reported by interviews with INOR leads at each hospital, the cyberattack negatively impacted operating room efficiency with delays between procedures because of additional paperwork data collection, disrupted patient flow for paperwork data collection on the ward level and in the outpatient clinics, and disrupted resource allocations and staff capabilities because of additional paperwork requirements during the contingency period. Disruptions to data collection and data accessibility after this cyberattack were successfully countered by a contingency plan; however, substantial financial costs and additional resources were required for data conservation and reconciliation. In addition to robust preventative security measures, national registers and other healthcare systems should have secondary data backup facilities and reliable fallback procedures prepared for such events.

“Ruritania” and “Megalomania” as "ideal models" in Ernest Gellner’s concept of nationalism and the prospects for its application to analysis of Iranian history

The purpose of this study is to analyze the implentation possibilities of classical theories of nationalism to analysis of the Iranian nationalism history. The author analyzes the ideal models of Ruritania and Magalomania as imagining nationalizing and modernizing societies proposed by Ernest Gellner. The novelty of the study lies in the analysis of the features and contradictions of the development of the historical forms of Iranian nationalism in contexts of the ideal models proposed in modernist historiography. It is assumed that the nationalist modernization of the Qajars and Pahlavi in Iranian historiography is perceived through the prism of a constructivist approach. The article analyzes 1) the problems of the inability of nationalism to become the dominant and determining political force that constructs the main features of the development of society and the state in Iran, 2) the features of the development and transformation of the traditions of political and ethnic nationalism, 3) the role of the ruling Qajar and Pahlavi dynasties in implentation of various strategies of nationalist modernization. The article also shows the potential of a comparative analysis of various historical forms of Iranian nationalisms in contexts of a constructivist approach. The results of the study suggest that 1) the causes and forms of the crisis of the nationalist project in Iran can be described and analyzed adequately with use of Ruritania and Megalomania concepts as ideal types of nationalism development, formulated by Ernest Gellner in contexts of social and cultural histories as confrontations between the political principles of the nation and religious principles and ideals of the Ummah; 2) Iranian modern system emerged as an attempt to institutionalize a compromise between a civilized modernized Megalomania and traditional Shia Ruritania, which led to a combination of political nationalism with an internationally declared recognition of the primacy of Shiism.

Howard Lune. Transnational Nationalism and Collective Identity among the American Irish.

In this slim volume, Howard Lune tells historians of Irish America—and Irish American nationalists—a story that they know much of already, but he does it in an engaging and conceptually intriguing manner that prioritizes the history of organizations over that of individuals or ideologies. Lune, a sociologist, brings to bear his knowledge of organizational theory to study the deep continuity of conviction on the part of Irish and Irish American people who “saw themselves as a nation with or without a state of their own” (3). Lune emphasizes the creation and maintenance of an “organizational field” (4) of Irish nationalism that extended beyond Ireland itself to a larger diaspora of Irish emigrants and their descendants. Over seven chapters, Lune gives us a brisk and readable narrative of nationalist organizing in the United States and Ireland, stretching from the efforts of the United Irishmen in the late-eighteenth century through to the formation of the Irish Free State. After an introductory chapter, chapter 2 focuses on the social imaginary of the United Irishmen and their success in creating a framework for future nationalist efforts despite the failure of their immediate goals. Chapter 3 investigates the role of United Irish émigrés in remaking Irish American associational life and carries the story through the repeal movement of the 1840s. Chapter 4 focuses on nativist pressures and the impact that they had on Irish American organizational life. The fifth chapter focuses on the Fenian movement and the ambiguous relationship between Irish- and US-based physical-force nationalists in the 1860s, after which Lune turns to the period between the Land War of the early 1880s and the Easter Rising of 1916. A final chapter offers him a chance to step back from the narrative and think more generally about the “continuous social movement for Irish independence”—and specifically the ongoing conviction that there was an Irish nation—sustained by various organizations with different immediate goals—from which specific efforts to realize that independence emerged.

Psychotropic Medication Prescribing to Patients with Dementia Admitted to Acute Hospitals in Ireland.

Psychotropic medications are commonly prescribed to people with dementia (PwD) for non-cognitive symptoms of dementia (NCSD), but have significant risks. A national audit was performed in acute hospitals in the Republic of Ireland (ROI) to establish baseline practice prior to the launch and implementation of a National Clinical Guideline on the appropriate prescribing of psychotropic medications for NCSD. The objective of this study was to analyse psychotropic prescribing patterns and compare these with international data and with existing (limited) data from a previous audit round. The pooled anonymous dataset from the second round of the Irish National Audit of Dementia Care (INAD-2) was analysed. The audit had collected retrospective data from 30 random healthcare records from each of 30 acute hospitals in 2019. Inclusion criteria were a clinical diagnosis of dementia of any type, hospital stay of 72 hours or more, and discharge or death within the audit period. Most hospitals (87%) self-audited their healthcare records, but a random sample of six healthcare records (20%) from each hospital were re-audited by a highly trained healthcare auditor. The audit tool was based on a tool used in the England and Wales National Audit of Dementia audit rounds (Royal College of Psychiatrists), adapted to the Irish healthcare setting and national priorities. In total, 893 cases were included, as one hospital could not retrieve 30 cases even within a more prolonged audit period. The sample comprised 55% females and 45% males; the median age was 84 years (interquartile range 79-88 years) and the majority (89.6%) were >75 years of age. Only 52% of healthcare records specified the type of dementia; within these, the most common diagnosis was Alzheimer's disease (45%). Most PwD (83%) were receiving psychotropic medication on admission; 40% were prescribed new or increased psychotropic medication during admission, mainly for medical indications, including end-of-life care and delirium. Anticonvulsants or cognitive enhancers were rarely prescribed for NCSD in hospital. However, new/increased antipsychotic medication was prescribed for NCSD in 11.8-17.6% of the total cohort, while 4.5-7.7% were prescribed a benzodiazepine for anxiety or NCSD. Overall, there was poor documentation of risk/benefit, or of discussion with the patient/family, and apparently inadequate review for efficacy and tolerability. Concurrently, acetylcholinesterase inhibitors appeared to be underused for cognitive impairment in the community. This audit provides baseline data on psychotropic medication prescription for NCSD in Irish hospitals prior to a specific Irish guideline on this topic. Reflecting this, most PwD were receiving psychotropic medications on admission, and many were prescribed new/increased psychotropic medication in hospital, often without evidence of appropriate decision making and prescribing processes.

Credible Serological Evidence of Latent Toxoplasma Infection Among Women with Primary Infertility: A Ten-Year Registry-Based Study.

Some evidence reveled that chronic infection with Toxoplasma gondii (T. gondii) has recently been associated with infertility in human and experimental model. This baseline study aimed to investigate serological evidence of Toxoplasma infection among infertile women who admitted to the in vitro fertilization (IVF) clinic at Imam Khomeini Hospital, Mazandaran province, Sari, northern Iran. In this retrospective (descriptive-analytical) study, all infertile women referred to the IVF clinic during 2010-2019 (10years), constitute the study population. All data including demographic and some related characteristics were collected into a questionnaire and registered at the Iranian National Registry Center for Toxoplasmosis (INRCT) at the Mazandaran University of Medical Sciences, northern Iran. The existence of anti-Toxoplasma antibodies (IgG and IgM) was explored using a commercially available enzyme-linked immune sorbent assay (ELISA) kit (PishtazTeb, Iran), based on the manufacturer's protocol. Of 520 infertile women, anti-T. gondii IgG, IgM and both IgG and IgM antibodies were detected among 342/520 (65.77%), 1/520 (0.19) and 4/520 (0.77) infertile women, respectively. Primary and secondary infertility was detected in 74.56% and 25.44% of IgG seropositive infertile women, respectively. Also, most of the IgG seropositive subjects had no history of abortion, polycystic ovary syndrome (PCO), fibroma, contraceptive use and varicocele in spouse as primary cause of infertility. Furthermore, serum levels of prolactin and antimullerian (AMH) hormones were normal in 81.29 and 80.12% of infertile women with anti- T. gondii IgG, respectively. There was also a statistically significant difference between the seroprevalence of Toxoplasma infection and these variables associated to primary infertility (P < 0.05). According to the high prevalence (about two thirds) of chronic T. gondii infection among infertile women, particularly those with a history of abortion and primary infertility, it can be concluded that latent Toxoplasma infection pose a risk to infertile woman in the study area. Therefore, we advise that screening and treatment of Toxoplasma infection among infertile women must be favorably considered.

Choroidal structure investigated by choroidal vascularity index in patients with inherited retinal diseases

PurposeTo evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI).MethodsThe present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients’ data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group.ResultsThe IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P < 0.001). Accordingly, the average of TCA and LA were 2.32 ± 0.63 and 1.52 ± 0.44 mm [1] in patients with IRDs, respectively. The measurements for the TCA and the LA were significantly lower in all subtypes of IRD (P-values < 0.05).ConclusionCVI is significantly lower in patients with IRD than in healthy age-matched individuals. Choroidal changes in IRDs may be related to the changes in the lumen of the choroidal vessels rather than the stromal changes.

Strong recommendations from low certainty evidence: a cross-sectional analysis of a suite of national guidelines

BackgroundClinical guidelines should be based on a thorough evaluation of the evidence and generally include a rating of the quality of evidence and assign a strength to recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against making strong recommendations when the certainty of the evidence is low or very low, but has identified five paradigmatic situations (e.g. life-threatening situations) where this may be justified.Aims and objectivesWe aimed to characterize the strength of recommendations and certainty of the evidence in Irish National Clinical Guidelines using the GRADE approach.MethodsAll National Clinical Guidelines from the National Clinical Effectiveness Committee (NCEC) website using the GRADE approach (fully or partially) were included. All recommendations and their corresponding certainty of the evidence, strength of recommendations and justifications were extracted. Authors classified instances of strong recommendations with low certainty evidence (referred to as discordant recommendations) into one of the five paradigmatic situations. Descriptive statistics were calculated.ResultsFrom the 29 NCEC Clinical Guidelines available at the time of analysis, we identified 8 guidelines using GRADE with a total of 240 recommendations; 38 recommendations did not use the GRADE approach and were excluded. Half of the included guidelines focused on emergency situations. In the final dataset of 202 recommendations, 151 (74.7%) were classified as strong and 51 (25.3%) as conditional. Of the 151 strong recommendations, 55 (36.4%) were supported by high or moderate certainty evidence and 96 (63.6%) by low or very low certainty evidence and were considered discordant. Of these 96 discordant recommendations, 55 (73.7%) were consistent with one of the five paradigmatic situations. However, none were specifically described as such within the guidelines.ConclusionsThe proportion of discordant recommendations identified in this analysis was higher than some previous international studies (range of all strong recommendations being discordant 30–50%), but similar to other guidelines focused on emergency situations. The majority of discordant recommendations could be mapped to one of the five situations, but no National Clinical Guideline explicitly referenced this. Guideline developers require further guidance to enable greater transparency in the reporting of the reasons for discordant recommendations.