Managing infertility in primary care

Couples may be reluctant to disclose they are experiencing infertility. Helen Allan and Ginny Mounce provide a discussion on the anxiety couples experience and how to care for these patient

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of ‘mazing’ (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals

Preconception care for infertile couples: nurses' and midwives' roles in promoting better maternal and birth outcomes

Introduction Preconception care promotes better maternal outcomes, may assist in preventing birth defects and improves fertility awareness among healthy childbearing couples. Yet the significance of preconception care for infertile couples is undeveloped area of practice in Europe. Aim We discuss the importance of nurses and midwives in providing preconception care to infertile couples in the United Kingdom and Spain. Design Discursive paper Method A comparison of different midwifery and nursing approaches to preconception care for infertile couples in two European countries. Findings At present infertile couples’ needs for preconception care are not routinely identified or understood. There is an opportunity for these needs to be considered and identified by nurses at the time of investigation for infertility or when planning pregnancy with assisted conception. Conclusions We argue that by providing preconception care, nurses and midwives have an opportunity to deliver important advice to infertile couples in both primary care and specialist infertility services

Transition to parenthood after successful non-donor in vitro fertilisation: The effects of infertility and in vitro fertilisation on previously infertile couples' experiences of early parenthood

Recent social science research in the field of parenting following assisted conception has focused on the experiences of donor assisted conception and surrogacy. This paper draws from a study which explored the experiences of the transition to early parenthood in 16 heterosexual non-donor couples and includes a specific consideration of the experiences of men as they navigate this journey. We argue that these couples’ transition to early parenthood can be as complex and provisional as in other newer forms of family making as they struggle with an emerging identity as a parent after successful non-donor IVF following their experiences of infertility. Their family making is contingent upon their ability to work at integrating their experiences of infertility and IVF into their emerging identity as a parent. This struggle is prominent when they contemplate a further pregnancy. Considering a sibling causes them further uncertainty and anxiety because it reminds them of their infertile identify and the possibility of further IVF. We report novel findings about the experiences of this transition to parenthood: how couples’ identity as parents is shaped by the losses and grief of infertility and the anxiety of IVF. We argue that their struggle with an emerging parenthood identity challenges the normative, naturalised view of non-donor heterosexual IVF parenthood. Our work contributes to the work on identity in parenthood after IVF in an ongoing effort to understand how assisted technologies shape infertile parents’ lives. This paper reports a small study with a relatively homogenous sample recruited from one fertility clinic. Nevertheless as an exploratory study of an under researched topic, we discuss useful insights and ideas for further research with larger and more diverse samples

Predicting combined sewer overflows chamber depth using artificial neural networks with rainfall radar data

Combined sewer overflows (CSOs) represent a common feature in combined urban drainage systems and are used to discharge excess water to the environment during heavy storms. To better understand the performance of CSOs, the UK water industry has installed a large number of monitoring systems that provide data for these assets. This paper presents research into the prediction of the hydraulic performance of CSOs using artificial neural networks (ANN) as an alternative to hydraulic models. Previous work has explored using an ANN model for the prediction of chamber depth using time series for depth and rain gauge data. Rainfall intensity data that can be provided by rainfall radar devices can be used to improve on this approach. Results are presented using real data from a CSO for a catchment in the North of England, UK. An ANN model trained with the pseudo-inverse rule was shown to be capable of providing prediction of CSO depth with less than 5% error for predictions more than one hour ahead for unseen data. Such predictive approaches are important to the future management of combined sewer systems

An integrative literature review of psychosocial factors in the transition to parenthood following non-donor-assisted reproduction compared with spontaneously conceiving couples

An integrative literature review of research into the psychosocial factors which shape the transition to parenthood in couples following non-donor in vitro fertilisation in comparison with spontaneously conceiving couples was undertaken following adapted PRISMA guidelines. Nineteen papers of non-donor IVF and SC mothers and fathers were included in the review. This is the first review to report on research comparing the transition to parenthood of couples following successful non-donor singleton AR and SC couples. The small number of studies were over reliant on survey methodologies. Differences between groups were reported on a range of psychosocial measures during the transition from pregnancy to parenthood: locus of control, parental adjustment and child behaviour, parental stress, parental investment in the child, self-esteem and self-efficacy, greater levels of protectiveness (separation anxiety) towards child, marital and family functioning, family alliance, marital satisfaction and communication as well anxiety, indirect aggression and less respect for child. We have conceptualised these differences as three substantive themes which reflect psychosocial factors shaping transition to parenthood in parents after non-donor AR: social support, relationships, and emotional well-being which are in turn intersected by gender differences. These findings have implications for health care professionals’ assessment of individual couples’ support needs

Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: An exemplar applied to oesophagogastric cancer

This is the final version. Available on open access from Elsevier via the DOI in this recordBackground Current methods for estimating the timeliness of cancer diagnosis are not robust because dates of key defining milestones, for example first presentation, are uncertain. This is exacerbated when patients have other conditions (multimorbidity), particularly those that share symptoms with cancer. Methods independent of this uncertainty are needed for accurate estimates of the timeliness of cancer diagnosis, and to understand how multimorbidity impacts the diagnostic process. Methods Participants were diagnosed with oesophagogastric cancer between 2010 and 2019. Controls were matched on year of birth, sex, general practice and multimorbidity burden calculated using the Cambridge Multimorbidity Score. Primary care data (Clinical Practice Research Datalink) was used to explore population-level consultation rates for up to two years before diagnosis across different multimorbidity burdens. Five approaches were compared on the timing of the consultation frequency increase, the inflection point for different multimorbidity burdens, different aggregated time-periods and sample sizes. Results We included 15,410 participants, of which 13,328 (86.5 %) had a measurable multimorbidity burden. Our new maximum likelihood estimation method found evidence that the inflection point in consultation frequency varied with multimorbidity burden, from 154 days (95 %CI 131.8–176.2) before diagnosis for patients with no multimorbidity, to 126 days (108.5–143.5) for patients with the greatest multimorbidity burden. Inflection points identified using alternative methods were closer to diagnosis for up to three burden groups. Sample size reduction and changing the aggregation period resulted in inflection points closer to diagnosis, with the smallest change for the maximum likelihood method. Discussion Existing methods to identify changes in consultation rates can introduce substantial bias which depends on sample size and aggregation period. The direct maximum likelihood method was less prone to this bias than other methods and offers a robust, population-level alternative for estimating the timeliness of cancer diagnosis.National Institute for Health Research (NIHR)Cancer Research U

Magnetic Impurities in the Pnictide Superconductor Ba1−x_{1-x}Kx_{x}Fe2_{2}As2_{2}

NMR measurements have been performed on single crystals of Ba$_{1-x}$K$_{x}$Fe$_2$As$_2$ (x = 0, 0.45) and CaFe$_2$As$_2$ grown from Sn flux. The Ba-based pnictide crystals contain significant amounts of Sn in their structure, $\sim 1$%, giving rise to magnetic impurity effects evident in the NMR spectrum and in the magnetization. Our experiments show that the large impurity magnetization is broadly distributed on a microscopic scale, generating substantial magnetic field gradients. There is a concomitant 20% reduction in the transition temperature which is most likely due to magnetic electron scattering. We suggest that the relative robustness of superconductivity ($x=0.45$) in the presence of severe magnetic inhomogeneity might be accounted for by strong spatial correlations between impurities on the coherence length scale.Comment: 14 pages, 6 figures (submitted to New Journal of Physics

The Lantern Vol. 18, No. 1, Fall 1949

• Want, an Old Freedom Unused • Is History Bunk? • How Things Grow • A Real Gone Poem • Hish Proves Himself • Death? Not Yet! • On the Neglect of Victorian Literature • The Tradition Lives On • To the Other Side • Autumn\u27s Panorama • Autumn Treasure • A Walk • Leaves • The Moment • Dawn • Sentiments • Dustinghttps://digitalcommons.ursinus.edu/lantern/1049/thumbnail.jp