Retreating to nature : rethinking 'therapeutic landscapes'

There is a long history of removing oneself from ‘society’ in order to recuperate or repair. This paper considers a yoga and massage retreat in Southern Spain, and what opportunities this retreat experience might offer for recuperation and the creation of healthy bodies. The paper positions ‘nature’ as an active participant, and as ‘enrolled’ in the experiences of the retreat as a ‘therapeutic landscape’, and questions how and what particular aspects of yoga practice (in intimate relation with place) give rise to therapeutic experiences

ADIÇÃO DE APARAS DE PAPEL RECICLÁVEL NA FABRICAÇÃO DE CHAPAS DE MADEIRA AGLOMERADA

Neste trabalho, foram analisadas as propriedades físico-mecânicas de chapas aglomeradas produzidas com dois tipos de papel reciclável (papel jornal e offset) e partículas de madeira de Pinus elliottii Engelm. As aparas de papel foram usadas no colchão em dois diferentes formatos (tiras ou moídas) e em diferentes proporções: 0, 20, 40, 60 e 100% do peso seco das partículas. Utilizoaram-se 10% de adesivo à base de tanino-formaldeído na proporção 100:10. O experimento foi estabelecido segundo modelo fatorial, com três repetições. Os testes físico-mecânicos das chapas foram realizados segundo a norma ASTM D1037 (1995). Chapas aglomeradas produzidas tanto pela inclusão de papel jornal quanto offset no formato de tiras apresentaram tendência ao estouro durante a abertura dos pratos da prensa, causado pelo alto teor de umidade do colchão. A inclusão de aparas de papel prejudicaram a maioria das propriedades analisadas, fazendo com que não atendessem aos valores estabelecidos pelas normas DIN 68761 (1)-1961, (3)-1971 e ANSI A 208.1 (1987). A absorção d’água após 24 horas de imersão, a ligação interna e a resistência ao arrancamento de parafusos foram as propriedades mais prejudicadas. De modo geral, o uso de papel jornal se mostrou mais promissor do que o papel offset

Contribution of cryopreservation to the cumulative live birth rate: a large multicentric cycle-based data analysis from the Italian National Registry

Purpose: To estimate the contribution of cryopreservation to the cumulative live birth rate (CLBR) after law modification in Italy in the era of vitrification and freeze-all. Methods: The Italian National Registry performed a cycle-based data collection. Nine Italian IVF clinics were involved incorporating a total of 10,260 fresh cycles performed between January 2015 and April 2016 resulting in 9273 oocyte retrievals and 3266 subsequent warming cycles from the same oocyte retrievals performed up to December 2016. Mean female age was 37 \ub1 4.3\ua0years. Primary outcome measure was CLBR per oocyte retrieval. Confounding factors were tested in multivariate regression analysis, and the relative impact of cryopreservation to the CLBR in different patient categories was calculated. Results: CLBR per oocyte retrieval was 32.6%, 26.5%, 18.7%, 13.0%, and 5.5% for women younger than 36, aged 36\u201339, 40\u201341, and older than 41\ua0years, respectively. The total relative contribution of oocyte/embryo cryopreservation was 40.6% (95% CI 38.41\u201342.75). An association between maternal age, number of oocytes retrieved, fertilization rate, cryopreservation, and cumulative live birth was shown. When adjusted for confounders, a 2.3-fold increase was observed in the chance of live birth when cryopreservation was performed (OR 2.3; 95% CI 1.99\u20132.56). In high responder patients (> 15 oocytes retrieved) where freeze-all was applied in 67.6% of cycles to avoid the risk of hyper stimulation syndrome, the relative contribution of vitrification to the CLBR was 80.6%. Conclusions: Cryopreservation is essential in IVF and should always be available to patients to optimize success rates. Multicentric, cycle-based data analyses are crucial to provide infertile couples, clinicians, and regulatory bodies with accurate information on IVF effectiveness including fresh and cryopreserved cycles

Valor nutritivo de pastagens de capim-elefante manejadas sob sistema convencional e agroecológico.

O capim-elefante é utilizado, na sua grande maioria, em sistemas convencionais de produção animal. O objetivo deste trabalho foi comparar o valor nutritivo do capimelefante em sistemas de manejo agroecológico e convencional, quanto a proteína bruta (PB), fibra em detergente neutro (FDN) e digestibilidade in vitro da matéria seca (DIVMS). Foram usados quatro piquetes, com 0,12ha cada um. No sistema convencional, o capim-elefante foi estabelecido singularmente. No sistema agroecológico, o plantio foi feito em linhas afastadas de 3m. Nas entrelinhas, estabeleceu-se a aveia e o azevém no período hibernal, enquanto que no período estival permitiu-se o desenvolvimento de espécies espontâneas. A adubação foi feita com fertilizantes orgânicos (150kg ha-1 de N). No sistema agroecológico, foram conduzidos sete pastejos, de 24/04/2004 a 05/05/2005. Na pastagem convencional, usouse a mesma quantidade de N (uréia), sendo conduzidos quatro ciclos de pastejo, de 06/10/2004 a 05/05/2005. Para ambos os sistemas foram utilizadas vacas da raça Holandês, recebendo complementação alimentar de 3,5kg dia-1 de concentrado com 20% de proteína bruta, constituindo-se nos animais experimentais. Nas avaliações, considerou-se a massa de forragem inicial com base na matéria seca (MS), os componentes botânicos da pastagem e estruturais do capimelefante. As análises de qualidade foram feitas em amostras de pastejo simulado. O delineamento experimental foi o inteiramente casualizado com dois tratamentos, convencional e agroecológico, duas repetições (piquetes) e em parcelas incompletas subdivididas no tempo (pastejos). Houve interação (P<0,05) entre tratamentos e pastejos em todas as variáveis. Na pastagem agroecológica, o modelo que melhor se ajustou foi o cúbico para todas as variáveis, em função do tempo de pastejo. Na pastagem convencional, a PB e a DIVMS ajustaram-se melhor ao modelo linear, com taxa positiva de crescimento, sendo observado comportamento inverso para FDN, com o decorrer dos pastejos. Tanto na pastagem convencional quanto na agroecológica encontraram-se associações negativas entre lâmina foliar do capim-elefante com PB e DIVMS e positiva com FDN. Ambos os sistemas apresentaram teores qualitativos elevados das pastagens, considerando-se a adubação, o manejo e o tempo de utilização

Oocyte and ovarian tissue cryopreservation in European countries : statutory background, practice, storage and use

STUDY QUESTION: What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and ‘non-medical’) and specific number of cycles? SUMMARY ANSWER: Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for ‘non-medical’ OoC. WHAT IS ALREADY KNOWN: The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries. STUDY DESIGN, SIZE, AND DURATION: A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015. PARTICIPANTS/MATERIALS, SETTING AND METHODS: All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, ‘other medical’ reasons as part of an ART cycle, as well as for ‘non-medical reasons’ or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was ‘serious disease’ such as cancer in 10.9% of cycles, other medical indications as ‘part of an ART cycle’ in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues. LIMITATIONS, REASONS FOR CAUTION: Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC. WIDER IMPLICATIONS OF THE FINDINGS: There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by ESHRE. There are no conflicts of interest.peer-reviewe

Is "option B+" also being adopted in pregnant women in high-income countries? Temporal trends from a national study in Italy

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Pregnancy outcomes and cytomegalovirus DNAaemia in HIV infected pregnant women with CMV

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Rate , correlates and outcomes of repeat pregnancy in HIV-infected women

Objectives: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Methods: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. Results: The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10–1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35–2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06–1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Conclusions: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies