Unexplained Factors Research Articles

Does an FSH surge at the time of hCG trigger improve IVF/ICSI outcomes? A randomized, double-blinded, placebo-controlled study.

Does an artificially induced FSH surge at the time of hCG trigger improve IVF/ICSI outcomes? An additional FSH bolus administered at the time of hCG trigger has no effect on clinical pregnancy rate, embryo quality, fertilization rate, implantation rate and live birth rate in women undergoing the long GnRH agonist (GnRHa) protocol for IVF/ICSI. Normal ovulation is preceded by a surge in both LH and FSH. Few randomized clinical trials have specifically investigated the role of the FSH surge. Some studies indicated that FSH given at hCG ovulation trigger boosts fertilization rate and even prevents ovarian hyperstimulation syndrome (OHSS). This was a randomized, double-blinded, placebo-controlled trial conducted at a single IVF center, from June 2012 to November 2013. A sample size calculation indicated that 347 women per group would be adequate. A total of 732 women undergoing IVF/ICSI were randomized, using electronically randomized tables, to the intervention or placebo groups. Participants and clinical doctors were blinded to the treatment allocation. Patients aged ≤42 years who were treated with IVF/ICSI owing to tubal factor, male factor, unexplained, endometriosis and multiple factors were enrolled in this trial. Subjects all received a standard long GnRHa protocol for IVF/ICSI and hCG 6000-10 000 IU to trigger oocyte maturation. A total of 364 and 368 patients were randomized to receive a urinary FSH (uFSH) bolus (6 ampules, 450 IU) and placebo, respectively, at the time of the hCG trigger. The primary outcome measure was clinical pregnancy rate. The secondary outcome measures were FSH level on the day of oocyte retrieval, number of oocytes retrieved, good-quality embryo rate, live birth rate and rate of OHSS. There were no significant differences in the baseline demographic characteristics between the two study groups. There were also no significant differences between groups in cycle characteristics, such as the mean number of stimulation days, total gonadotrophin dose and peak estradiol. The clinical pregnancy rate was 51.6% in the placebo group and 52.7% in the FSH co-trigger group, with an absolute rate difference of 1.1% (95% CI -6.1% to 8.3%). The number of oocytes retrieved was 10.47 ± 4.52 and 10.74 ± 5.01 (P = 0.44), the rate of good-quality embryos was 37% and 33.9% (P = 0.093) and the implantation rate was 35% and 36% (P = 0.7) in the placebo group and the FSH co-trigger group, respectively. This was a single-center study, which may limit its effectiveness. The use of uFSH is a limitation, as this is not the same as the natural FSH. We did not collect follicular fluid for further study of molecular changes after the use of uFSH as a co-trigger. Based on previous data and our results, an additional FSH bolus administered at the time of hCG trigger has no benefit on clinical pregnancy rates in women undergoing the long GnRHa protocol in IVF/ICSI: a single hCG trigger is sufficient. This study was supported by the National Key Research and Development Program of China (2016YFC1000205); Sun Yat-Sen University Clinical Research 5010 Program (2016004); the Science and Technology Project of Guangdong Province (2016A020216011 and 2017A020213028); and Science Technology Research Project of Guangdong Province (S2011010004662). There are no conflicts of interest to declare. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-12002246). 20 May 2012. 10 June 2012.

An investigation into the association of the physical fitness of equestrians and their riding performance: a cross-sectional study

Poor riding performance may be due to medical issues with the horse or a variety of other factors, such as inadequate equipment or deficiencies in training. The physical fitness of the equestrian is one of the most unexplained factors of current research. The aim of this study is to investigate the association between the physical fitness of the equestrian and riding performance. 115 equestrians were assessed for physical fitness and riding performance. Seven components of physical fitness (balance, endurance, flexibility, reaction, speed, strength, symmetry) were measured by a physiotherapist using equestrian-specific tests. Based on a video-recorded riding test, individual riding performance was rated by two equestrian judges. The riding test included the horse and rider performing a walk, sitting trot, rising trot and canter in both directions. A linear model for riding performance, including the domains of physical fitness and potential confounders (body-mass-index, riding experience, hours of riding per week, and test-motivation), was fitted to the data. Inter-rater reliability of the judges was investigated by calculating the intraclass correlation coefficient (ICC). Endurance, reaction and strength were positively associated with riding performance, whereas flexibility had a negative association. The final model could explain 16.7% of the variance in riding performance. The effects of endurance and strength were significant (P<0.05), but not that of reaction. No association with riding performance was found for the components of balance, speed and symmetry. The inter-rater reliability of judges was confirmed to be ‘good’ to ‘excellent’ (ICC=0.9, 95% confidence interval: 0.86-0.93). Findings suggest that physical fitness is positively associated with riding performance. Fitness-training for equestrians should be included in current training concepts. Future research should investigate whether similar associations exist for junior and elite athletes.

Body condition score, parity, shelter cleanliness and male proximity: Highly associated non-genetic factors with post-partum anestrus in Murrah buffalo in field conditions

Postpartum anestrus (PPA) is a major reproductive problem in buffalo. Although both genetic and non-genetic factors influence the incidence of PPA, identifying associated non-genetic factors would be helpful for effective management of this problem. No systematic study, however, has been conducted to identify the association of non-genetic factors with PPA in buffalo, especially in field conditions. Data for 39 variables affecting postpartum anestrus interval (PPAI), health, nutrition, management and environmental status of the animals were collected on 575 buffalo from 15 villages. Data were analyzed using a general linear model considering PPAI as a dependent variable and the remaining 38 non-genetic parameters as independent variables. The results from the analysis indicated body condition score (BCS) variables, such as pelvic girdle score (P < 0.0001) and girth (P < 0.05), parity (P < 0.0001), shelter cleanliness (P < 0.001), male proximity (P < 0.005), amount and frequency of concentrate feeding during the early postpartum period (P < 0.05), general feeding frequency in a day (P < 0.05) and the treatments with oxytocin at the time of milking to facilitate milk release from the udder (P < 0.05) were associated with PPAI in Murrah buffalo. Plotting the PPAI residuals indicated the possibility of other unexplained factors, including genetics, that could also affect the differences in values for this variables in Murrah buffalo. In conclusion, a greater understanding of associated non-genetic factors with PPAI would help farmers in conducting proper managemental practices for early induction of reproductive cycles following parturition in Murrah buffalo.

Decomposing Differences in Poor Self-rated Health between Those in Agriculture and Natural Resource Occupations and the Rest of the Labor Force

ABSTRACT Objective: Occupations in agriculture and natural resources persistently have some of the highest rates of injury and illness. Additionally, these fields are dominated by segments of the population known to demonstrate poorer health, such as those with less education, lower family income, and more irregular labor force participation. Thus, it is unclear if health disparities between those in these sectors and the rest of the labor force are unique to these occupations, or a reflection of their demographic composition. The objective of this study was to determine how much of the difference in self-rated health between those who work agriculture and natural resource occupations – meaning farming, forestry, fishing, hunting, and resource extraction – and the rest of the labor force was due to demographic characteristics versus unexplained factors unique to the occupations. Methods: Using the National Health Interview Survey from 2008 to 2017, a two-way Oaxaca–Blinder decomposition of linear probability models predicting poor self-rated health between those reporting agriculture and natural resource occupations and other working adults with sociodemographic characteristics was performed. Results: Results show more than the total difference in the probability of poor self-rated health between the two groups (0.0173) can be explained by demographic composition (0.0303). If the agriculture and natural resource workforce had the average demographic composition between them and the rest of the labor force, they would have lower rates of poor self-rated health than the broader labor force. Conclusion: While agriculture and natural resource occupations are hazardous, the prevalence of poor self-rated health in the labor force is not unique to these occupations, but appears common among all occupations dominated by those with low income and education.

Antibody response among nucleic acid amplification test confirmed COVID-19-positive patients: A cross-sectional study

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has caused immense loss of lives, enormous devastation, and has affected lives globally. Timely diagnosis is necessary to contain its spread. While it is important to test symptomatic individuals and high-risk contacts through reliable and confirmatory test (nucleic acid amplification test [NAAT]) to find out the positive cases of COVID-19, it is also vital to check their immunity status through the serological tests to find out the varied immunological response in the affected population. Materials and Methods: All NAAT confirmed COVID-19 patients were included in the study. With a repeat respiratory sample for NAAT, simultaneous serum sample was taken for the detection of IgM and IgG antibodies. Data were compiled and analyzed statistically. Results: During the first repeat NAAT, 71.43% had mounted an antibody response, whereas 28.57% had no response. Irrespective of the antibody status, 68.57% tested positive for SARS-CoV-2 virus in NAAT. Although the number dwindled on second repeat NAAT, it raised important questions regarding humoral response and its clinical and diagnostic applicability. Conclusion: Not all, COVID-19 patients mount a humoral response due to yet unexplained factors. Furthermore, exclusive dependence on serology assays will miss the diagnosis in these patients. More research is needed for description and applicability of humoral response in COVID-19 patients.

Pengaruh Iklan Televisi Teh Botol Sosro Versi “Semeja Bersaudara” Dan Iklan Instagram Versi “Serunya Jalan Terus” Terhadap Citra Merek

This study aimed to determine the effect of Television Advertisement Version “Semeja Bersaudara” And Instagram Advertisement Version “Serunya Jalan Terus” On Teh Botol Sosro Brand Image. The study method used is quantitative methods. Data collection techniques used in the questionnaire form and literature. The population of this study from STIAMI Institute student. The sampling technique in this research is nonprobability sampling with the accidental sampling method. A sample of 100 samples has been obtained. The data analysis used is multiple linear regression analysis using IBM Statistic version 22. The results showed that the Television Advertisement Version “Semeja Bersaudara” has an influence on Brand Image Teh Botol Sosro of 44,3%. Instagram Advertisement Version “Serunya Jalan Terus” has an influence on Brand Image Teh Botol Sosro of 40,1%. Television Advertisement Version “Semeja Bersaudara” and Instagram Advertisement Version “Serunya Jalan Terus” significantly influence on Teh Botol Sosro Brand Image. Television Advertisement Version “Semeja Bersaudara” and Instagram Advertisement Version “Serunya Jalan Terus” affect the variants of Teh Botol Sosro Brand Image simultaneously with value 0f 0,471 or 47,1% and there are 52,9% other unexplained factors not included in this study.

Alpha Globin Gene Copy Number Is Associated with Kidney Disease Among Black Individuals

Introduction: In addition to forming hemoglobin in red blood cells, alpha globin (HBA) has non-erythroid effects and is expressed in vascular endothelial cells where it interacts with endothelial nitric oxide (NO) synthase (eNOS) to limit nitric oxide diffusion across the myoendothelial junction. Reduced expression of HBA or disruption of HBA/eNOS interactions increases endothelial nitric oxide signaling. Humans have 0 to 3 copies of HBA per chromosome and Black individuals have increased variation in HBA allele count. Moreover, Black individuals are more likely to develop end-stage kidney disease (ESKD) and unexplained genetic factors may contribute to racial disparities in kidney disease not attributable to socioeconomic factors. Given that decreased endothelial NO signaling accelerates renal disease in mouse models, we hypothesized that lower HBA gene copy number would be associated with lower risk of kidney disease among Black individuals. Methods: We used droplet digital PCR to measure HBA copy number in Black individuals enrolled in the REasons for Geographic and Racial Differences in Stroke cohort. This national, prospective observational study enrolled 30,239 men and women &gt;45 years of age from the 48 contiguous United States. Prevalent chronic kidney disease (CKD) was defined as eGFR &lt;60 ml/min/1.73m2or urine albumin/creatinine ratio ≥30 mg/g at enrollment. Incident end-stage kidney disease (ESKD) was identified by linkage to the United States Renal Data System. The relative risk (RR) of prevalent CKD was calculated using modified Poisson multivariable regression employing a linear effect of HBA allele count and adjusting for 13 pre-specified genetic, biomedical, and socioeconomic factors. The hazard ratio (HR) for incident ESKD was calculated using Cox proportional hazards regression with the same covariates. Results: HBA copy number ranged from 2 to 6 among 9,918 Black participants (4% with 2 copies, 28% with 3, 67% with 4, and 1% with ≥ 5), with 25% of all participants having CKD at baseline. Participants were followed for a median (25th, 75thpercentile) of 10.1 (5.5, 12.5) years for the development of ESKD, with 2.4% of all participants developing ESKD. As shown in the table, after multivariable adjustment and calculated relative to the most common copy number (4), model-estimated CKD risk was 23% lower among those with 2 copies and 12% lower among those with 3 copies of HBA, while CKD risk was 14% higher among those with 5 or 6 copies of HBA. In addition, relative to 4 copies, ESKD risk was 40% lower among those with 2 copies and 22% lower among those with 3 copies, while the risk of ESKD increased by 29% in those with 5 or 6 copies of HBA. Conclusions: We identified a novel, independent genetic association of HBA copy number with CKD prevalence and ESKD incidence among Black individuals in a national, prospective cohort study in the US. The findings are consistent with our hypothesis that decreased alpha globin gene expression could increase endothelial NO signaling in small renal arteries and confer protection against renovascular injury, while increased alpha globin gene expression couldlimit endothelial NO signaling. These findings suggest that further study of the impact of HBA expression on normal renal physiology and susceptibility to injury is needed. Disclosures Naik: Elsevier: Other: Content Editor.

Evaluating weather influences on transmission line failure rate based on scarce fault records via a bi‐layer clustering technique

In a common practice of power system reliability management, scarcity of malfunction information leads to incomplete knowledge of the failure reasons, and thus results in ambiguous failure rate models for the time being. This study proposes a methodology of quantifying weather influence on transmission line failure rate in terms of the effects of unexplained factors originating from a scarcity of weather-fault-correlating information. A model to quantify the referred weather influence is derived from a conceptual full failure rate model and parameterised by an exponential function. The concerned unknown parameters, besides some recourse covariates introduced to account for absent information on unexplained factors, are together trained by means of the maximum likelihood estimation based on available weather-fault-correlating information about both normal and failure-causing weather conditions for pooled transmission lines. Theoretical foundation and numerical results are given for illustrating a relationship between the proposed model and traditional weather-dependent failure rate models. Applications are also demonstrated in virtue of practical data from the Xinjiang Autonomous Region of China.

The role of natural factors in constraining long-term tropospheric ozone trends over Southern China

Southern China has experienced severe photochemical pollution events in recent years, and the tropospheric ozone has emerged as the major pollutant of concern. Despite some recent efforts, the role of natural factors in constraining long-term trends of ozone in this region is poorly understood. In this study, we addressed this issue using tropospheric column ozone (TCO) datasets (2005–2017) from the Ozone Monitoring Instrument/Microwave Limb Sounder (OMI/MLS) and surface ozone datasets from 16 monitoring stations in Southern China (2006–2016). Consequently, we studied the influence of atmospheric dynamical factors, such as solar cycle, El-Nino Southern Oscillation (ENSO), Quasi-Biennial Oscillation (QBO), and Arctic Oscillation (AO), and local-scale meteorological factors, such as precipitation, surface temperature, planetary boundary layer height, and horizontal winds, on regional ozone trends. Stepwise multivariate regression analysis and harmonic function fitting were adopted to quantitatively simulate the influence of these natural drivers on ozone change. We found that within our research periods, both surface ozone and TCO in Southern China had a significant upward trend, with slopes of 0.97% y−1 (0.23 ppbv y−1) and 0.82% y−1 (0.28 DU y−1), respectively. Natural factors explained 44.4% of the TCO uptrend and 27.0% of the surface ozone uptrend. Among the natural factors, the solar cycle plays the most important role in tropospheric and surface ozone modulation. Its 11-year cycle had a large impact on TCO for 2–7 DU and on surface ozone for 3–8 ppbv. However, the ENSO, QBO, and AO indices did not affect tropospheric ozone trends significantly. In addition, we showed that precipitation and wind fields associated with the Asian summer monsoon played a critical role in lowering ozone levels over Southern China, accounting for 24.8% and 81.5% of summertime TCO and surface ozone variability, respectively. Finally, a significant fraction of TCO and surface ozone uptrends (55.6% and 73.0%, respectively) remained unexplained even after consideration of these natural factors in the periods 2005–2017 and 2006–2016, respectively. These unexplained factors are most likely related to anthropogenic emissions and should be studied further.

Resource Gap Analysis in Nepalese Budgetary System

Resource gap analysis in the Nepalese budget system has attempted to focus on both the situation at the current level and the estimated future value. Therefore, the study has applied both the OLS and ECM models, to look at the GNS and GCF relation to GNI. The result has been compared to the current situation and the target level of performance in the future. With the analysis of unexplained residual factors, RGA in budgetary operation has been examined between GNI as a resource and what rate of resource would be needed to satisfy future needs at the national level. However, these models gave the same conclusion that resource gaps have got irregular with the rate of 12 per cent speed of disequilibrium. With this performance of resource gap, the government agency and others rigorously understood the resource it currently has and the need for resources to meet the goal. The forecasting further would also provide valuable suggestions for expanding other areas of development by diverting their capacity to correct the resource gap in the budgetary system.

A RETROSPECTIVE STUDY OF OBSTETRICAL OUTCOME IN ART AND SPONTANEOUS PREGNANCIES.

Background: Infertility tends to be one of the emerging health concern withtoday’s world .It is a common condition affecting approx 8-9% ofreproductive age group. Infertility diagnosis is divided into etiologies ofovulatory dysfunction, tubal endometriosis, and uterine, unexplained andmale factors. Certain type of infertility such as severe male factors andcomplete tubal obstruction will require ART.Objective:To study obstetrical outcome in pregnancy conceived with assistedreproductive techniques .Materials and Methods: A Retrospective study was done and data wascollected of patients, who have conceived through assisted reproductivetechniques admitted and delivered at tertiary care hospital from January2017 to June 2017.Results: They were anaemia 25(24.27%) and 17(16.19%) in ART andspontaneous conception respectively (p- value&lt;0.147), hypothyroid40(38.83%) and 14(13.33%) in ART and spontaneous conception respectively(p- value&lt;0.0001, highly significant), chronic hypertension 27(26.21%) and4(3.81%) in ART and spontaneous conception respectively (p- value&lt;0.0001,highly significant), DM Type-2 10(9.71%) and 0(0.00%) in ART andspontaneous conception respectively (p- value&lt;0.280, not significant). Studyalso showed that various obstetrical complications common in ART group.They were preterm birth, PIH, Polyhydramnios, Placenta previa, APH,Oligohydromnios, PPROM, GDM, Multiple pregnancies.Conclusion: There was a significant association between obstetricalcomplications with age. Maternal pre-existing disease like anaemia, chronichypertension, hypothyroidism and diabetes mellitus should be treated beforeconception, to improve maternal and perinatal outcome.Keywords: Assisted reproductive technology, SpontaneousConception,Pregnancy.

Application of PETCT imaging information combined with tumor markers in etiological screening of infectious and non-infectious ascites

In order to study the application value of PETCT image information combined with tumor markers in etiological screening of infectious and non-infectious ascites, ascites patients with unexplained etiological factors from the The Affiliated Hospital, Southwest Medical University were selected as the research objects, who were submitted to PET/CT scans and CT morphological scans for the semi-quantitative analysis of ascitic focus; in addition, the research objects were also submitted to chemiluminescence for the detection of concentrations of tumor markers in ascitic fluid, including carcinoembryonic antigen (CEA), alpha fetal protein (AFP), cancer antigen 125 (CA125), and carbohydrate antigen 19-9 (CA19-9). The results have shown that among the tumor markers CEA, AFP, CA125, and CA19-9, the tumor markers CEA, AFP, and CA19-9 had diagnostic reliability; in addition, compared with pure PET/CT imaging and ascites tumor marker detection, the combination of PET/CT imaging and tumor marker detection has more diagnostic value in infectious and non-infectious ascites etiology screening. Despite the deficiencies in the research process, it has provided a certain basis and ideas for subsequent research.

PENGARUH CORPORATE GOVERNANCE, STRUKTUR KEPEMILIKAN, HAK ARUS KAS, DAN DISCLOSURE OF RPT TERHADAP TRANSAKSI PIHAK BERELASI

The purpose of this research is 1) to obtain empirical evidence of Corporate Governance influence on Related Party Transaction, 2) to obtain empirical evidence of the influence of Ownership Structure on Related Party Transaction, 3) to obtain empirical evidence of the influence of Cash Flow Right to Related Party Transaction, 4) to obtain empirical evidence of Disclosure of rpt influence on the Related Party Transaction, 5) to obtain empirical evidence of Corporate Governance, Ownership Structure, Cash Flow Right, Disclosure of rpt to Related Party Transaction. The result of the research is that there is no influence of corporate governance to related party transaction, there is positive influence of ownership structure to related party transaction, there is positive influence of cash flow right to related party transaction, there is positive influence of disclosure of rpt to related party transaction, there is influence of Corporate Governance, Ownership Structure, Cash Flow Right, Disclosure of rpt to Related Party Transaction. The value of determination coefficient obtained is 0.314. it can be concluded that the contribution of corporate governance variable. Ownership structure, cash flow right, and disclosure of rpt to related party transaction amounted to 31.4% while 68.6% was caused by other unexplained factors. Keywords : Corporate Governance, Ownership Structure, Cash Flow Right, Disclosure of rpt, Related Party Transaction.

RESIDENTIAL PROPERTY PRICE HIKE AND SPECULATION

This study analyzes the behaviour of property price in Malaysia by examining factors influencing the residential property prices. It aims to determine whether property prices hike in Malaysia can be explained by the fundamental factors or it is due to other unexplained factors, such as speculation. Findings from the study reveal that most of the factors did have significant influence on property price. In addition, the cointegration analysis indicates that the property price and its factors are cointegrated for all property market segments across states. This implies the presence of a long run relationship between the property price and its determining factors, despite slow adjustment of property price towards equilibrium in the long run. This study concludes that the residential property price hike in Malaysia is impacted by fundamental factors and is not speculative in nature.

RESIDENTIAL PROPERTY PRICE HIKE AND SPECULATION

This study analyzes the behaviour of property price in Malaysia by examining factors influencing the residential property prices. It aims to determine whether property prices hike in Malaysia can be explained by the fundamental factors or it is due to other unexplained factors, such as speculation. Findings from the study reveal that most of the factors did have significant influence on property price. In addition, the cointegration analysis indicates that the property price and its factors are cointegrated for all property market segments across states. This implies the presence of a long run relationship between the property price and its determining factors, despite slow adjustment of property price towards equilibrium in the long run. This study concludes that the residential property price hike in Malaysia is impacted by fundamental factors and is not speculative in nature.

Determinants of Infertility in Couples

Background: Infertility is defined as a couple’s inability to conceive after a period of twelve months of regular unprotected intercourse. Infertility globally affects approximately 10-15% of couples. This study was carried out to find out the determinants of infertility among infertile couples.Methods: This is a retrospective review of records of 3231 infertile couples in the Department of Obstetrics and Gynecology, Dhulikhel Hospital from January 1, 2008 to June 30, 2018. A total of 3231 infertile couples were evaluated by reviewing their case history including demographic parameters and investigations performed.Results: Mean age of female cases seeking infertility treatment was 26.85 (±4.78) years and that of male cases was 29.81±3.18 years. About three quarter (74.7%) of the cases was of primary type. Almost half of infertility cases (48.8%) were having only female factor. Of the female contributory factors, half of them (52.12%) had ovulatory cause. Male factors contributed 23.9% of cases and 22.7% cases had abnormality in semen analysis while 1.2% had other sexual dysfunction. Mixed type of infertility was seen in 26.6% and unexplained factors had contribution of 14.4%. Conclusions: Primary infertility cases are three times more common in Dhulikhel hospital.Ovulatory cause was the most common contributory factors among female infertile cases while abnormality in semen parameter was the commonest problem among male infertile cases. Thorough evaluation and repeated visits were required to find out the apparent determinants of infertility problem.Keywords: Female factor; hysterosalpingography; infertility; ovulatory dysfunction; semen analysis.

Determinants of Infertility in Couples.

Infertility is defined as a couple's inability to conceive after a period of twelve months of regular unprotected intercourse. Infertility globally affects approximately 10-15% of couples. This study was carried out to find out the determinants of infertility among infertile couples. This is a retrospective review of records of 3231 infertile couples in the Department of Obstetrics and Gynecology, Dhulikhel Hospital from January 1, 2008 to June 30, 2018. A total of 3231 infertile couples were evaluated by reviewing their case history including demographic parameters and investigations performed. Mean age of female cases seeking infertility treatment was 26.85 (±4.78) years and that of male cases was 29.81±3.18 years. About three quarter (74.7%) of the cases was of primary type. Almost half of infertility cases (48.8%) were having only female factor. Of the female contributory factors, half of them (52.12%) had ovulatory cause. Male factors contributed 23.9% of cases and 22.7% cases had abnormality in semen analysis while 1.2% had other sexual dysfunction. Mixed type of infertility was seen in 26.6% and unexplained factors had contribution of 14.4%. Primary infertility cases are three times more common in Dhulikhel hospital.Ovulatory cause was the most common contributory factors among female infertile cases while abnormality in semen parameter was the commonest problem among male infertile cases. Thorough evaluation and repeated visits were required to find out the apparent determinants of infertility problem.

Primary Care Nurse Practitioner Wage Differences by Employment Setting

Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists. This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics. Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings. A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners. Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences.The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors. A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings.

Partitioning the functional variation of tree seedlings during secondary succession in a tropical lowland rainforest

AbstractThe seedling stage is a key phase in the regeneration dynamics of forest communities. The functional diversity of tree seedlings is closely related to the structuring and functioning of forest ecosystems. Here, we examined and partitioned variations of tree seedlings in functional diversity over a chronosequence (younger secondary forest, 18–30 yr; older secondary forest, 60 yr; and old growth forest) after shifting cultivation in a tropical lowland rainforest area on Hainan Island, China. Results showed that the variations of seedling functional diversities revealed a unimodal pattern during the secondary succession. The functional diversities of seedlings were overall lower in the secondary than in old growth forests. The relative role of edaphic factors and tree community factors changed with the successional process. The variations in functional diversity explained by edaphic factors were higher than those by tree community factors in the younger secondary forest. However, with the procession of secondary succession, variations in functional diversities of seedlings explained by tree community factors were increasing. The determinants for functional diversities of seedlings varied with successional stages. Seedling functional diversities were affected by edaphic factors in the younger secondary growth forest. Meanwhile, in the older secondary forest, seedling functional diversities were affected mostly by soil nutrients and tree community factors. In the old growth forest, seedling functional diversities were affected by available nitrogen and tree community factors. Our results suggest that edaphic factors play an important role in the younger secondary forest, while tree community factors in the older secondary forest and unexplained factors in the old growth forest.

Unexplained absence resulting in deaths of nursing home residents in Australia-A 13-year retrospective study.

To examine deaths of Australian nursing home (NH) residents following an unexplained absence. Population based cross-sectional study was conducted using coronial data from the National Coronial Information System. Participants are residents of accredited NHs if death followed an unexplained absence and was reported to the Coroner between July 1, 2000 and June 30, 2013. Individual, organisational, environmental, and unexplained absence event factors were extracted from coronial records. Data were analysed using descriptive statistics. Of 21672 NH deaths, 24 (0.1%) followed an unexplained absence. This comprised 17 unintentional external (injury-related) causes and 7 natural cause deaths. Drowning was the most frequent external cause of death (59%, n=10). Deaths occurred more frequently in males (83.3%, n=20), and in the age group 85-94years (37.5%, n=9). The majority of NH residents, for whom data were available (n=15), had a diagnosis of dementia (86.7%, n=13). Most residents were found in waterways (41.7%, n=10). Median distance travelled was 0.5km (IQR: 0.25-2.4km), with almost 70% of residents found within 1.0km of their NH. Most residents left the NH by foot (88.2%, n=15). Half of the residents were found within 6hours of time last seen (median: 6hours, 40minutes; IQR: 6.0-11.45hours). Unexplained absences in elderly NH residents are a relatively common event. This study provides valuable information for aged care providers, governments, and search and rescue teams, and should contribute to debates about balancing issues of safety with independence.