Are we overusing IVF?

Peer reviewedPublisher PD

Magnetic monopole and string excitations in a two-dimensional spin ice

We study the magnetic excitations of a square lattice spin-ice recently produced in an artificial form, as an array of nanoscale magnets. Our analysis, based upon the dipolar interaction between the nanomagnetic islands, correctly reproduces the ground-state observed experimentally. In addition, we find magnetic monopole-like excitations effectively interacting by means of the usual Coulombic plus a linear confining potential, the latter being related to a string-like excitation binding the monopoles pairs, what indicates that the fractionalization of magnetic dipoles may not be so easy in two dimensions. These findings contrast this material with the three-dimensional analogue, where such monopoles experience only the Coulombic interaction. We discuss, however, two entropic effects that affect the monopole interactions: firstly, the string configurational entropy may loose the string tension and then, free magnetic monopoles should also be found in lower dimensional spin ices; secondly, in contrast to the string configurational entropy, an entropically driven Coulomb force, which increases with temperature, has the opposite effect of confining the magnetic defects.Comment: 8 pages. Accepted by Journal of Applied Physics (2009

Optical detection of a <i>Noctiluca scintillans</i> bloom

Noctiluca scintillans blooms are often observed as reddish patches in Belgian waters in June-July in calm weather. The possibility of mapping these blooms is investigated here. In June 2005 a dataset of in situ measured reflectance spectra, airborne hyperspectral images, experimental reflectance and absorption spectra of Noctiluca scintillans was collected. The strong optical signature of dense Noctiluca scintillans blooms suggests that mapping these blooms should be feasible. A detection algorithm is proposed based on a combination of a high reflectance threshold with a condition of sharp increase in reflectance in the range 520-580 nm. This algorithm will detect only intense blooms but should distinguish between Noctiluca scintillans and both intense phytoplankton blooms and very turbid water. Noctiluca scintillans detection by optical sensors mounted on ships and airplanes has been confirmed for the June 2005 bloom in Belgian waters. Detection from satellites should also be feasible but only if suitable wavelengths are available and only if the spatial resolution is sufficiently high. The optical properties of this species are thought to be related to gut content. The applicability of this algorithm to other regions and situations therefore remains to be tested

Chlorophyll-a, total suspended matter and sea surface temperature maps of the North Sea available through the BELCOLOUR project

Since the launch of the first Ocean Colour sensors at the end of the previous century, much research has been devoted to transform Top of Atmosphere radiance measurements into reliable concentration maps of oceanographic parameters at the sea surface like e.g. chlorophyll content, total amount of suspended matter, sea surface temperature. While algorithms to determine chlorophyll in clear open water (so-called case 1 waters) are well established because this is the only parameter changing the spectral signal, they fail in coastal and turbid waters where the spectral signal is the result of the optical properties of a variety of constituents. The BELCOLOUR project improved the theoretical base for establishing concentration maps in coastal waters and developed quality control algorithms. Non reliable or unrealistic data are masked out in the final products to avoid misinterpretation of the data. The BELCOLOUR project worked mainly on satellite imagery from the Ocean Colour sensors SeaWiFS, MERIS and MODIS. All satellite data of the North Sea of these sensors (if not completely clouded) have been processed and transformed into quasi-true colour (RGB), chlorophyll (CHL), total suspended matter (TSM) and, for MODIS, sea surface temperature (SST) maps and made available for public through an easy browsing system on http://www.mumm.ac.be/BELCOLOUR. The satellite data of MERIS and MODIS are processed in near real time in an automated way and the products are presented one day after the acquisition in the Near Real Time Database on the BELCOLOUR website (http://www.mumm.ac.be/BELCOLOUR/EN/Products/NRT/index.php), where they stay for 14 days. Later the data are reprocessed and archived in the BELCOLOUR Image Database (http://www.mumm.ac.be/BELCOLOUR/EN/OCDB/browse.php), also accessible through the BELCOLOUR website. The images are available for different standard geographical areas (North Sea, Southern North Sea and the Channel, Southern North Sea) with both linear and logarithmical scales and are presented as jpeg-files. Different areas and file-formats can be processed by the Remote Sensing and Ecosystem Modelling team of MUMM on request

Cost-effectiveness of ovarian stimulation agents for IUI in couples with unexplained subfertility

Acknowledgements The authors wish to thank M.P. Diamond, R.S. Legro, K. Peeraer, M. Erdem, T. Dankert, and R. Ecochard, on behalf of the IUI IPDMA collaboration, for providing data from their RCTs for the IPDMA of which the results are used in a sensitivity analysis. Funding This work was supported by ZonMw Doelmatigheidsonderzoek, grant 80-85200-98-91072. The funder had no role in the design, conduct or reporting of this work. B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548).Peer reviewedPublisher PD

Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility:when to start treatment?

STUDY QUESTION Over a time period of 3 years, which order of expectant management (EM), IUI with ovarian stimulation (IUI-OS) and IVF is the most cost-effective for couples with unexplained subfertility with the female age below 38 years? SUMMARY ANSWER If a live birth is considered worth Euro32 000 or less, 2 years of EM followed by IVF was the most cost-effective, whereas above Euro32 000 this was 1 year of EM, 1 year of IUI-OS and then 1 year of IVF. WHAT IS KNOWN ALREADY IUI-OS and IVF are commonly used fertility treatments for unexplained subfertility although many couples can conceive naturally, as no identifiable barrier to conception could be found by definition. Few countries have guidelines on when to proceed with medically assisted reproduction (MAR), mostly based on the expected probability of live birth after treatment, but there is a lack of evidence to support the strategies proposed by these guidelines. The increased uptake of IUI-OS and IVF over the past decades and costs related to reimbursement of these treatments are pressing concerns to health service providers. For MAR to remain affordable, sustainable and a responsible use of public funds, guidance is needed on the cost-effectiveness of treatment strategies for unexplained subfertility, including EM. STUDY DESIGN, SIZE, DURATION We developed a decision analytic Markov model that follows couples with unexplained subfertility of which the woman is under 38 years of age for a time period of 3 years from completion of the fertility workup onwards. We divided the time axis of 3 years into three separate periods, each comprising 1 year. The model was based on contemporary evidence, most notably the dynamic prediction model for natural conception, which was combined with MAR treatment effects from a network meta-analysis on randomized controlled trials. We changed the order of options for managing unexplained subfertility for the 1 year periods to yield five different treatment policies in total: IVF-EM-EM (immediate IVF), EM-IVF-EM (delayed IVF), EM-EM-IVF (postponed IVF), IUIOS-IVF-EM (immediate IUI-OS) and EM-IUIOS-IVF (delayed IUI-OS). PARTICIPANTS/MATERIALS, SETTING, METHODS The main outcomes per policy over the 3-year period were the probability of live birth, the average treatment and delivery costs, the probability of multiple pregnancy, the incremental cost-effectiveness ratio (ICER) and finally, which policy yields the highest net benefit in which costs for a policy were deducted from the health effects, i.e. live births gained. We chose the Dutch societal perspective, but the model can be easily modified for other locations or other perspectives. The probability of live birth after EM was taken from the dynamic prediction model for natural conception and updated for Years 2 and 3. The relative effects of IUI-OS and IVF in terms of odds ratios, taken from the network meta-analysis, were applied to the probability of live birth after EM. We applied standard discounting procedures for economic analyses for Years 2 and 3. The uncertainty around effectiveness, costs and other parameters was assessed by probabilistic sensitivity analysis in which we drew values from distributions and repeated this procedure 20 000 times. In addition, we changed model assumptions to assess their influence on our results. MAIN RESULTS AND THE ROLE OF CHANCE From IVF-EM-EM to EM-IUIOS-IVF, the probability of live birth varied from approximately 54-64% and the average costs from approximately Euro4000 to Euro9000. The policies IVF-EM-EM and EM-IVF-EM were dominated by EM-EM-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. The policy IUIOS-IVF-EM was dominated by EM-IUIOS-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. After removal of policies that were dominated, the ICER for EM-IUIOS-IVF was approximately Euro31 000 compared to EM-EM-IVF. The range of ICER values between the lowest 25% and highest 75% of simulation replications was broad. The net benefit curve showed that when we assume a live birth to be worth approximately Euro20 000 or less, the policy EM-EM-IVF had the highest probability to achieve the highest net benefit. Between Euro20 000 and Euro50 000 monetary value per live birth, it was uncertain whether EM-EM-IVF was better than EM-IUIOS-IVF, with the turning point of Euro32 000. When we assume a monetary value per live birth over Euro50 000, the policy with the highest probability to achieve the highest net benefit was EM-IUIOS-IVF. Results for subgroups with different baseline prognoses showed the same policies dominated and the same two policies that were the most likely to achieve the highest net benefit but at different threshold values for the assumed monetary value per live birth. LIMITATIONS, REASONS FOR CAUTION Our model focused on population level and was thus based on average costs for the average number of cycles conducted. We also based the model on a number of key assumptions. We changed model assumptions to assess the influence of these assumptions on our results. The change in relative effectiveness of IVF over time was found to be highly influential on results and their interpretation. WIDER IMPLICATIONS OF THE FINDINGS EM-EM-IVF and EM-IUIOS-IVF followed by IVF were the most cost-effective policies. The choice depends on the monetary value assigned to a live birth. The results of our study can be used in discussions between clinicians, couples and policy makers to decide on a sustainable treatment protocol based on the probability of live birth, the costs and the limitations of MAR treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the ZonMw Doelmatigheidsonderzoek (80-85200-98-91072). The funder had no role in the design, conduct or reporting of this work. B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck KGaA and Guerbet and travel and research support from ObsEva, Merck and Guerbet. TRIAL REGISTRATION NUMBER N/A

Imaging dielectric relaxation in nanostructured polymers by frequency modulation electrostatic force microscopy

We have developed a method for imaging the temperature-frequency dependence of the dynamics of nanostructured polymer films with spatial resolution. This method provides images with dielectric compositional contrast well decoupled from topography. Using frequency-modulation electrostatic-force-microscopy, we probe the local frequency-dependent (0.1–100 Hz) dielectric response through measurement of the amplitude and phase of the force gradient in response to an oscillating applied electric field. When the phase is imaged at fixed frequency, it reveals the spatial variation in dielectric losses, i.e., the spatial variation in molecular/dipolar dynamics, with 40 nm lateral resolution. This is demonstrated by using as a model system; a phase separated polystyrene/polyvinyl-acetate (PVAc) blend. We show that nanoscale dynamic domains of PVAc are clearly identifiable in phase images as those which light-up in a band of temperature, reflecting the variations in the molecular/dipolar dynamics approaching the glass transition temperature of PVAc