"One for Sorrow, Two for Joy?": American embryo transfer guideline recommendations, practices and outcomes for gestational surrogate patients

In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multipleembryo transfers in the context of U.S. surrogacy arrangements. Offering an original analysis of data obtained from the U.S. national assisted reproduction registry, it examines single- and multiple-embryo transfer trends over an eleven-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in less than 42% of cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemente

O que os usuários pensam e falam do Sistema Único de Saúde? Uma análise dos significados à luz da carta dos direitos dos usuários What do the users think and say about the Brazilian Health System (SUS)? An analysis of meanings based on the users' rights booklet

O presente estudo é fruto de um projeto ampliado de pesquisa-ação que tem por objetivo apresentar e discutir as opiniões, percepções e/ou experiências de um grupo de usuários do SUS sobre a cartilha dos direitos dos usuários. Os encontros foram realizados semanalmente e, posteriormente, a coleta seguiu-se com os procedimentos de análise dos dados das pesquisas qualitativas, até alcançar as unidades temáticas. Os resultados demonstram que não basta garantir o acesso ao sistema público de saúde. É preciso criar uma consciência política para que os usuários não se tornem meros receptores ou interlocutores das propostas governamentais. É preciso que todos os atores sociais estejam engajados e comprometidos, por meio de seus direitos e deveres, na luta pela transformação da sociedade.<br>This study is the result of an expanded research-action project aimed at presenting and discussing the main thematic units that emerged from discussions conducted with a group of users about booklet regarding users' rights from the SUS (Brazilian Health System). Between May and July 2007, weekly meetings were held, recorded and followed by qualitative research data analysis until reaching the thematic units. The results show that granting access to the public health system is not enough. We must create political awareness so that users do not become mere recipients or interlocutors of government proposals. We must ensure that all social actors engage themselves in the fight for the transformation of society by making use of their rights and fulfilling their duty

Stochastic Algorithms For Exploratory Data Analysis: Data Clustering And Data Visualization

. Iterative, EM-type algorithms for data clustering and data visualization are derived on the basis of the maximum entropy principle. These algorithms allow the data analyst to detect structure in vectorial or relational data. Conceptually, the clustering and visualization procedures are formulated as combinatorial or continuous optimization problems which are solved by stochastic optimization. 1. INTRODUCTION Exploratory Data Analysis addresses the question of how to discover and model structure hidden in a data set. Data clustering (JD88) and data visualization are important algorithmic tools in this quest for explanation of data relations. The structural relationships between data points, e.g., pronounced similarity of groups of data vectors, have to be detected in an unsupervised fashion. This search for prototypes poses a delicate tradeoff: a sufficiently rich modelling approach should be able to capture the essential structure in a data set but we should restrain ourselves from ..