Studies on the factors that improve the outcome of IVF-ET

The overall purpose of this thesis was to identify factors which influence the outcome of IVF treatment and which might be amenable to modification in order to improve pregnancy rates following this form of treatment. To this end I performed a historical review of the advances that have been made in reproductive treatment since before the birth of Louise Brown in 1978, and a retrospective analysis of the result of a single IVF unit over a 6 year period from 1999 to 2005. This identified a number of factors on which IVF pregnancy rates depend.I found that there is a decrease in the pregnancy and implantation rates and an increase in the abortion rates with a consequent decrease in the live birth rate with an increase in the female age. The data demonstrated that the pregnancy, implantation, abortion, and live birth rates for female age 20-25 years was 42%, 21.95%, 37.5%, and 26.3% respectively. For the age of 26-30 years the comparative figures were 44.5%, 27.4%,12.34%, and 39%, for the age of 31-35 years 35.7%, 22%,16%, and 29.9%, for the age of 36-39 years 27%, 13.9%, 22.7%, and 20.5% and for patients who were 40 years and above 17%, 7.4%, 27.3%, and 12.9%. (P0.05) for the abortion rate. In addition, I found that there is a decrease in the pregnancy rate with increasing age of the male partner although this did not reach a statistically significant level. For male patients whose age was between 20-30 years the pregnancy rate was 42.7% compared with 37.8% if they were between 31-44 years and 31.6% if they were 45 years or above (P >0.05).I found that the outcome of IVF-ET is affected by the number of embryos transferred, and whether the embryos are fresh or cryopreserved. The data showed that the pregnancy and implantation rates for single embryo transfer were 16.9%; for double embryo transfer were 37.3% and 23.22% respectively, and for triple embryo transfer 27.12% and 11.64% respectively. In addition, I found that the difference in the twin and triplet rates were 0% and 0% respectively for single embryo transfer, 24.5 and 0.02% respectively for double embryo transfer, and 26.8% and 1.5% respectively for triple embryo transfer. The differences in pregnancy and implantation rates between the transfer of two fresh and two frozen embryos were 37.3% versus 27.3% (P>0.05) and 23.22% versus 16.36% (P>0.05).The outcome of IVF-ET was also found to be affected by the grade and cleaving rate of embryos. The differences in the pregnancy and implantation rates between the transfer of high-grade and low grade embryos were 61.4% versus 11.5%, and 35.8% versus 6.96% (P0.05, live birth rates 26.5% versus 32.25%, P>0.05.Finally, I found that abortion rates were higher and consequently live birth rates were lower with increasing age of recipient. The abortion and live birth rates according to the recipient age were 18.75%, 30.95% respectively for recipients less than 35 years, 28.57%,26.31% respectively for those 36-39 years and 31.56%, 23.21% respectively for those 40 years and above, P>0.05. In addition, I found that the outcome is better when egg recipient patients have ovarian function as compared with egg recipient patients with no ovarian function, and the pregnancy rate was 41.3% for the first group and 29.62% for the second group, P>0.05. Egg sharing patients were found to have lower pregnancy and implantation rates while the live birth rate of egg sharing is virtually the same as standard IVF patients. The difference in the pregnancy, implantation, abortion, and live birth rates between the two groups was (35.52% versus 40.7%), (18.3% versus 25.61%), (9% versus 20.46%), and (32.25% versus 32.29%). Hence, egg sharing has no detrimental effect on the outcome for egg sharing patients.The only factor amenable to modification for each and every couple was identified as the technique of embryo transfer. Hence, I undertook a literature search to identify the effects of the technique that might be relevant. I also used time-lapsed ultrasound video imaging of the uterus as a means of identifying those cycles that might have a favourable or unfavourable outcome as a result of a good or poor ET technique. My results show that exaggerated junctional zone contractions do indeed have a detrimental effect on the outcome of IVF-ET our data shows that the pregnancy rate for those who had less than 5 uterine contractions per 2 minutes as compared to the pregnancy rate for patients who had more than 5 uterine contractions per 2 minutes was 29.7% versus 0% respectively p=0.026, but an easy embryo transfer did not appear to change the character or the frequency of junctional zone contractions

Secondary bacterial and fungal infections in critically ill COVID‐19 patients: Impact on antimicrobial resistance

Background: The primary burden among severely ill COVID-19 cases allocated to ICUs is secondary bacterial and fungal infections. Antimicrobial resistance is aggravated more likely by empiric overusing of antimicrobials. This study aimed to assess the microbiological profile of fungal and bacterial superinfections in laboratory confirmed COVID-19 cases and their antimicrobial susceptibility pattern. Methods: Various clinical samples were obtained from 117 critically ill COVID-19 patients in the clinical suspicion of secondary infections for assessing the pathogens accountable for the superinfections and their antimicrobial susceptibility pattern according to standard microbiological procedures. Results: Among 117 COVID-19 patients allocated to ICU, 68 (58%) had secondary infections. The most prevalent infection was of the lower respiratory tract. Most infections were bacterial 85.8%. Gram-negative isolates were the most predominant strains, accounting for 71.7%. among them, Klebsiella pneumoniae 43.4 % and Acinetobacter baumannii 20.7% were the most predominant. Majority of the bacterial strains were multidrug-resistant, all gram-negative strains showed one hundred percent resistance rate to cephalosporins, amoxicillin, and amoxicillin-clavulanic. The lowest resistance was observed for tigecycline. All gram-positive strains were susceptible to linezolid and vancomycin. Additionally, all candida isolates were susceptible to the tested antifungals. Conclusions: In hospitalized severely ill COVID-19 patients, secondary infections are most frequently caused by Gram-negative pathogens exhibiting high rate of antibiotic resistance and are associated with poor outcomes. Strict adherence to infection control measures as well as regular microbiological surveillance are required

Effect of Training Exercise Program on Functional Outcomes for Patients with Hand Burns

Context: The outcome of hand burns can significantly impact daily function and overall health-related quality of life. A crucial issue in hand burns is proper management of hands treatment and care for maximizing the normal function of the burned hand.Aim: To evaluate the effect of training exercise program on functional outcomes for patients with hand burns.Methods: A quasi-experimental design (study/control group) was utilized to achieve the aim of this study. This study was conducted at the burn unit at Benha Teaching Hospital. A purposive sample of 60 conscious adult patients who suffered from hand burns. They were divided equally into the study and control group, 30 patients in each. Two tools were used. The structured interview questionnaire to assess patients' knowledge regarding burn injury. Functional outcome scale involving: Jebson-Taylor hand function test (JTHFT) and observational checklist for assessing the hand’s range of motion. Results: Showed that there was highly statistically significant improvement in patients’ knowledge score among the study group compared to the control group, as well as there was an improvement in the function of hand and range of motion in the study group rather than in the control group with highly statistically significant differences between both groups.Conclusions: Implementing a designed training exercise program for patients with hand burns effectively improved knowledge, function of the hand, and range of motion among the study group than in the control group. The study recommended that post-burn programs should be initiated by a multidisciplinary team and continued after discharge to provide support, education, prevention of complications, and motivation for burn patients

Comparative Evaluation of Statistical Dependence Measures

Measuring and testing dependence between random variables is of great importance in many scientific fields. In the case of linearly correlated variables, Pearson’s correlation coefficient is a commonly used measure of the correlation strength. In the case of nonlinear correlation, several innovative measures have been proposed, such as distance-based correlation, rank-based correlations, and information theory-based correlation. This thesis focuses on the statistical comparison of several important correlations, including Spearman’s correlation, mutual information, maximal information coefficient, biweight midcorrelation, distance correlation, and copula correlation, under various simulation settings such as correlative patterns and the level of random noise. Furthermore, we apply those correlations with the overall best performance to a real genomic data set, to study the co-expression between genes in serous ovarian cancer

Effect of Crack-Reducing Technologies and Supplementary Cementitious Materials on Settlement Cracking of Plastic Concrete and Durability Performance of Hardened Concrete

The effects of crack-reducing technologies and supplementary cementitious materials on plastic settlement cracking and the durability of concrete subjected to freezing and thawing were evaluated. The study of settlement cracking included 86 concrete mixtures containing internal curing (IC), a shrinkage-reducing admixture (SRA), optimized and non-optimized aggregate gradations, or the supplementary cementitious materials (SCMs) slag cement and silica fume. Some concrete mixtures contained combinations of these technologies, such as supplementary cementitious materials and internal curing. Both crack length and width were measured. The study of durability included 28 concrete mixtures, divided into three programs. Program 1 involved concrete containing different dosage rates of one of two shrinkage-reducing admixtures. Program 2 involved concrete containing different volume replacements of Class F and Class C fly ash and different combinations of a rheology-modifying admixture (RMA) with and without Class C fly. Program 3 involved concrete containing different dosage rates of one of two shrinkage compensating admixtures, one based on MgO that also incorporated a shrinkage-reducing admixture and one based on CaO. The study evaluated the effect of the technologies and materials on freeze-thaw durability, based on ASTM C666 Procedure B, scaling resistance, based on a modified version of Canadian Test BNQ NQ 2621-900 Annex B, and characteristics of the air-void system, obtained following ASTM C457. The research also examined the correlation between air-void characteristics, compressive strength, freeze-thaw durability, and scaling resistance for the mixtures. All mixtures experienced increased settlement cracking as slump increased; the increase, however, was very low for the concrete containing both slag cement and silica fume, with or without internal curing. All crack reducing technologies and supplementary cementitious materials tested resulted in a reduction in settlement cracking at all slumps compared to mixtures without these technologies and materials. The use of a non-optimized aggregate gradation increased settlement cracking compared to mixtures with an optimized gradation. The combination of slag cement and silica fume in concrete provided a greater reduction in settlement cracking than slag cement alone. In terms of durability, mixtures with an average air-void spacing factor of 0.007 in. (0.18 mm) or less performed well in the freeze-thaw test. Mixtures with an average air-void iv spacing factor of 0.007 in. (0.18 mm) or less and a compressive strength greater than 4000 psi (27.6 MPa) performed well in the scaling test. In terms of specific performance, one SRA had no effect on freeze-thaw durability, while the other caused reduced durability. Concrete with either SRA exhibited a reduction in scaling resistance. Mixtures containing Class F fly ash, RMA, or Class C fly ash in conjunction with RMA at all dosages studied performed well in the freeze-thaw test if the air-void spacing factor was 0.007 in. (0.18 mm) or less. Class F or Class C fly ash alone had no effect on scaling resistance when the concrete had an air-void spacing factor of 0.0071 in. (0.18 mm) or less. The RMA without and with Class C fly ash resulted in reduced scaling resistance. This reduction was in all cases associated with a concrete compressive strength below 4000 psi (27.6 MPa). An SCA based on CaO had no effect on the freeze-thaw durability at the dosage used in this study. The SCA based on MgO resulted in lower freeze-thaw durability, but only in mixtures that had increased air-void spacing; the increased air-void spacing may have been due to the shrinkage-reducing admixture incorporated in the admixture, which can reduce the stability of the air-void system. With the exception of one mixture with high air-void spacing factor [0.0096 in. (0.24 mm)], the two SCAs had no effect on scaling resistance at all dosages used in this study. All mixtures exhibited a lower air content in the hardened concrete than in the plastic concrete. This reduction in air content was significantly greater for mixtures containing high dosages of SRAs or the RMA.ACI Foundation's Strategic Development Council (SDC)

EFFECT OF CRACK-REDUCING TECHNOLOGIES AND SUPPLEMENTARY CEMENTITIOUS MATERIALS ON SETTLEMENT CRACKING OF PLASTIC CONCRETE AND DURABILITY PERFORMANCE OF HARDENED CONCRETE

ABSTRACT The effects of crack-reducing technologies and supplementary cementitious materials on plastic settlement cracking and the durability of concrete subjected to freezing and thawing were evaluated. The study of settlement cracking included 86 concrete mixtures containing internal curing (IC), a shrinkage reducing admixture (SRA), optimized and non-optimized aggregate gradations, or the supplementary cementitious materials (SCMs) slag cement and silica fume. Some concrete mixtures contained combinations of these technologies, such as supplementary cementitious materials and internal curing. Both crack length and width were measured. The study of durability included 28 concrete mixtures, divided into three programs. Program 1 involved concrete containing different dosage rates of one of two shrinkage reducing admixtures. Program 2 involved concrete containing different volume replacements of Class F and Class C fly ash and different combinations of a rheology-modifying admixture (RMA) with and without Class C fly. Program 3 involved concrete containing different dosage rates of one of two shrinkage compensating admixtures, one based on MgO that also incorporated a shrinkage reducing admixture and one based on CaO. The study evaluated the effect of the technologies and materials on freeze-thaw durability, based on ASTM C666 Procedure B, scaling resistance, based on a modified version of Canadian Test BNQ NQ 2621-900 Annex B, and characteristics of the air-void system, obtained following ASTM C457. The research also examined the correlation between air-void characteristics, compressive strength, freeze-thaw durability, and scaling resistance for the mixtures. All mixtures experienced increased settlement cracking as slump increased; the increase, however, was very low for the concrete containing both slag cement and silica fume, with or without internal curing. All crack reducing technologies and supplementary cementitious materials tested resulted in a reduction in settlement cracking at all slumps compared to mixtures without these technologies and materials. The use of a non-optimized aggregate gradation increased settlement cracking compared to mixtures with an optimized gradation. The combination of slag cement and silica fume in concrete provided a greater reduction in settlement cracking than slag cement alone. In terms of durability, mixtures with an average air-void spacing factor of 0.007 in. (0.18 mm) or less performed well in the freeze-thaw test. Mixtures with an average air-void spacing factor of 0.007 in. (0.18 mm) or less and a compressive strength greater than 4000 psi (27.6 MPa) performed well in the scaling test. In terms of specific performance, one SRA had no effect on freeze-thaw durability, while the other caused reduced durability. Concrete with either SRA exhibited a reduction in scaling resistance. Mixtures containing Class F fly ash, RMA, or Class C fly ash in conjunction with RMA at all dosages studied performed well in the freeze-thaw test if the air-void spacing factor was 0.007 in. (0.18 mm) or less. Class F or Class C fly ash alone had no effect on scaling resistance when the concrete had an air-void spacing factor of 0.0071 in. (0.18 mm) or less. The RMA without and with Class C fly ash resulted in reduced scaling resistance. This reduction was in all cases associated with a concrete compressive strength below 4000 psi (27.6 MPa). An SCA based on CaO had no effect on the freeze-thaw durability at the dosage used in this study. The SCA based on MgO resulted in lower freeze-thaw durability, but only in mixtures that had increased air-void spacing; the increased air-void spacing may have been due to the shrinkage reducing admixture incorporated in the admixture, which can reduce the stability of the air-void system. With the exception of one mixture with high air-void spacing factor [0.0096 in. (0.24 mm)], the two SCAs had no effect on scaling resistance at all dosages used in this study. All mixtures exhibited a lower air content in the hardened concrete than in the plastic concrete. This reduction in air content was significantly greater for mixtures containing high dosages of SRAs or the RMA

On the applicability of numerical tools for simulating wave-ports close to the cutoff frequency

This paper focuses on a common drawback in electromagnetic numerical computer aided design computer aided design (CAD) tools: high frequency structure simulator (HFSS), computer simulation technology (CST) and FEKO, where the excitation by using a wave-port below and close to the cutoff frequency has unreliable values for the reflection coefficient. An example for such problem is presented in the design of a dual horn antenna fed by two different waveguide sections. To overcome this numerical error in the results of these CAD tools, a tapered waveguide section is used in the simulation as an excitation mechanism to the feeding waveguide. The cross section of the input port at this tapered waveguide section is designed to have a cutoff frequency smaller than the lowest frequency under investigation for the original problem. Then, by extracting the effect of the tapered section from the obtained reflection coefficient, it would be possible to obtain the reflection coefficient of the original problem

Technology impacts academia\u27s day-to-day activities: association between musculoskeletal body injuries and nursing faculties’ knowledge and practice on workstation ergonomics

Introduction: A poorly designed workplace and improper physical alignment during computer use for long durations may result in poor health outcomes and occupational disability. The study aims to identify the association between nursing faculty members\u27 knowledge and practice of computer workstation ergonomics and musculoskeletal body injuries. Methods: A descriptive cross-sectional study was conducted at the Faculty of Nursing, Alexandria University, Egypt. A convenience sampling of 133 nursing faculty members reported their knowledge of workstation ergonomics and rated their musculoskeletal pain (MSP) location and severity on valid and reliable self-administered questionnaires designed for the purpose. Those with musculoskeletal disorders were excluded. Results: Nursing faculty members had good and very good levels of knowledge about computer workstation ergonomics (58.6% and 13.5%). Most reported pain in their neck, shoulder, lower back, lower arm, and wrist (88.0%, 81.2%, 73.7%, and 71.4%, respectively). There is a significant positive correlation between computer use practices and MSP severity in most body parts in the questionnaire. Regression analysis revealed that the duration of computer use and keying were significant risk factors for developing MSPs. Conclusion: Nursing faculties are advised to apply the principles of computer workstation ergonomics, practice stretching exercises, and take frequent breaks and these principles are included in the workplace orientation training of new staff nurses and refresher training for existing staff nurses to prevent injuries, discomfort and distress and loss of productive hours to the workplace

Assessment of knowledge, attitude and behavior towards antibiotic use in primary health care patients in Fayoum Governorate, Egypt

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Medical students’ attitudes towards patient-centered care, Fayoum Medical School, Egypt

Background: Patient-centered care has been considered the foundation of healthcare quality and the core competency of the doctor-patient relationship.Aims: To assess the attitudes of medical students toward a patient-centered approach and identify the predictors of patient-centeredness scores.Methods: A cross-sectional study was carried out in Fayoum Medical School/Egypt using a validated Arabic version of the Patient-Practitioner Orientation Scale (PPOS).Results: The total PPOS score showed variable score as the grades move up. The total PPOS ranged from 0.05 to 4.39 with an average score of (2.71 ± 0.66) for the entire sample. The sharing and caring subscale score ranged from 0.56 to 4.44 and 0.44 to 5.33 with an average score of (2.33 ± 0.49) and (3.09 ± 0.92) respectively.Conclusion: Medical students had low patient-centered attitude. Medical curricula should be redesigned, and medical students may also benefit from engagement in patient healthcare service