Congenital Anomalies Following Assisted Reproductive Technology

Most of the 5 million children that saw the light thanks to assisted reproductive technologies (ART) were born healthy. Th e incidence of major congenital birth defects in this group of neonates is low: 4% to 6% [ 1 ]. Yet, that is 30% higher than the incidence of congenital anomalies in children born aft er spontaneous conception [ 2 ]. Th e increased risk for congenital anomalies aft er ART is not only the subject of ongoing scientifi c research, but is also an issue in public debates about these techniques [ 3 ]. For physicians, it is oft en unclear whether various ART processes hold diff erent risks and which congenital birth defects can be expected. What concrete associations have been studied? For scientists, the question whether the subfertility of the couple that conceives aft er medical intervention accounts for this observation or whether intervening with natural conception itself augments the incidence of congenital birth defects remains unanswered. Should we adapt our techniques and could a decrease in the incidence of congenital anomalies thus be expected? For future parents, birth defects are one of many concerns when considering ART [ 4 ]. Th ey will ask their doctor about it. It is important that physicians can provide a balanced answer. Th e following chapter aims to guide the reader through the important questions on the association of congenital anomalies and ART; from bedside to bench and back again

Predictive value of developmental testing in the second year for cognitive development at five years of age

There is mixed evidence about the predictive validity of the Griffiths mental developmental scales. This study aimed to assess the predictive value of developmental assessments of children in their second year using the Griffiths mental development scales for neuro-developmental status at five years using the Wechsler preschool and primary scale of intelligence, revised (WPPSI-R). In a longitudinal study 253 children were assessed in their second year of life using the Griffiths scales and again at five years using the WPPSI-R. The scores were compared and the predictability of the WPPSI-R outcome on the basis of Griffiths scores was assessed. The WPPSI-R full scale IQ and the performance IQ at age five could be predicted moderately by the Griffiths general quotient (GQ) and by the personal/social scale. The Griffiths GQ was not a significant predictor of verbal IQ at age 5. The Griffiths performance scale predicted subsequent WPPSI-R performance IQ, and marginally the Full Scale IQ. For the early identification of children at risk for language delay, the Griffiths scales may not be suitable. However, a shortened form would be useful to predict overall cognitive development from the second year to school entry, focussing on the personal-social and performance scales

Parental attitudes toward disclosure of the mode of conception to their child conceived by in vitro fertilization

OBJECTIVES: To survey the level of disclosure of conception method within families of children conceived using conventional IVF or ICSI and to examine the factors that may influence parental attitudes and plans for disclosure. DESIGN: An in-depth questionnaire. SETTING: Participants recruited through UK fertility clinics. PATIENTS: Parents of IVF/ICSI children aged 5-6 years (n=181, 51%). INTERVENTION: Mothers and fathers of IVF/ICSI children were sent questionnaires to complete and return in a reply paid envelope. MAIN OUTCOME MEASURES: Completion of the questionnaire. RESULTS: Most parents had told somebody about their child’s method of conception, mostly close friends and family. Fewer (26% mothers/17% fathers) had already discussed the child’s mode of conception with their child. 58% mothers/57% fathers intended to tell their child at some point. 16% mothers/21% fathers were undecided. 4% fathers never wanted to discuss the subject with their child. Children were more likely to be told if conception was ICSI, rather than conventional IVF, and if an only child. 29% undecided fathers and 36% undecided mothers stated that they would tell their child if appropriate child-friendly explanatory literature was available. CONCLUSIONS: The majority of parents wish to tell their child at some point but are unsure about the most appropriate timing and method of disclosure. Fertility clinics may have a role in providing the necessary support. Child-friendly literature may be helpful

A novel complete-surface-finding-algorithm for online surface scanning with limited view sensors

Robotised Non-Destructive Testing (NDT) has revolutionised the field, increasing the speed of repetitive scanning procedures and ability to reach hazardous environments. Application of robot-assisted NDT within specific industries such as remanufacturing and Aersopace, in which parts are regularly moulded and susceptible to non-critical deformation has however presented drawbacks. In these cases, digital models for robotic path planning are not always available or accurate. Cutting edge methods to counter the limited flexibility of robots require an initial pre-scan using camera-based systems in order to build a CAD model for path planning. This paper has sought to create a novel algorithm that enables robot-assisted ultrasonic testing of unknown surfaces within a single pass. Key to the impact of this article is the enabled autonomous profiling with sensors whose aperture is several orders of magnitude smaller than the target surface, for surfaces of any scale. Potential applications of the algorithm presented include autonomous drone and crawler inspections of large, complex, unknown environments in addition to situations where traditional metrological profiling equipment is not practical, such as in confined spaces. In simulation, the proposed algorithm has completely mapped significantly curved and complex shapes by utilising only local information, outputting a traditional raster pattern when curvature is present only in a single direction. In practical demonstrations, both curved and non-simple surfaces were fully mapped with no required operator intervention. The core limitations of the algorithm in practical cases is the effective range of the applied sensor, and as a stand-alone method it lacks the required knowledge of the environment to prevent collisions. However, since the approach has met success in fully scanning non-obstructive but still significantly complex surfaces, the objectives of this paper have been met. Future work will focus on low-accuracy environmental sensing capabilities to tackle the challenges faced. The method has been designed to allow single-pass scans for Conformable Wedge Probe UT scanning, but may be applied to any surface scans in the case the sensor aperture is significantly smaller than the part

Autonomous, digital-twin free path planning and deployment for robotic NDT : introducing LPAS : Locate, Plan, Approach, Scan Using Low Cost Vision Sensors

Robotised Non Destructive Testing (NDT) presents multifaceted advantages, saving time and reducing repetitive manual workloads for highly skilled Ultrasonic Testing (UT) operators. Due to the requisite accuracy and reliability of the field, robotic NDT has traditionally relied on digital twins for complex path planning procedures enabling precise deployment of NDT equipment. This paper presents a multi-scale and collision-free path planning and implementation methodology enabling rapid deployment of robotised NDT with commercially available sensors. Novel algorithms are developed to plan paths over noisy and incomplete point clouds from low-cost sensors without the need for surface primitives. Further novelty is introduced in online path corrections utilising laser and force feedback while applying a Conformable-Wedge probe UT sensor. Finally, a novel source of data beneficial to automated NDT is introduced by collecting frictional forces of the surface informing the operator of the surface preparation quality. The culmination of this work is a new path-planning free, single-shot automated process removing the need for complex operator-driven procedures with a known surface, visualising collected data for the operator as a three-dimensional C-scan model. The dynamic robotic control enables a move to the industry 4.0 model of adaptive online path planning. Experimental results indicate the flexible and streamlined pipeline for robotic deployment, and demonstrate intuitive data visualisation to aid highly skilled operators in a wide field of industries

National Trends in Preterm Infant Mortality in the United States by Race and Socioeconomic Status, 1995-2020

Importance: Inequalities in preterm infant mortality exist between population subgroups within the United States. // Objective: To characterize trends in preterm infant mortality by maternal race and socioeconomic status to assess how inequalities in preterm mortality rates have changed over time. // Design, Setting, and Participants: This was a retrospective longitudinal descriptive study using the US National Center for Health Statistics birth infant/death data set for 12 256 303 preterm infant births over 26 years, between 1995 and 2020. Data were analyzed from December 2022 to March 2023. // Exposures: Maternal characteristics including race, smoking status, educational attainment, antenatal care, and insurance status were used as reported on an infant’s US birth certificate. // Main Outcomes and Measures: Preterm infant mortality rate was calculated for each year from 1995 to 2020 for all subgroups, with a trend regression coefficient calculated to describe the rate of change in preterm mortality. // Results: The average US preterm infant mortality rate (IMR) decreased from 33.71 (95% CI, 33.71 to 34.04) per 1000 preterm births per year between 1995-1997, to 23.32 (95% CI, 23.05 to 23.58) between 2018-2020. Black non-Hispanic infants were more likely to die following preterm births than White non-Hispanic infants (IMR, 31.09; 95% CI, 30.44 to 31.74, vs 21.81; 95% CI, 21.43 to 22.18, in 2018-2020); however, once born, extremely prematurely Black and Hispanic infants had a narrow survival advantage (IMR rate ratio, 0.87; 95% CI, 0.84 to 0.91, in 2018-2020). The rate of decrease in preterm IMR was higher in Black infants (−0.015) than in White (−0.013) and Hispanic infants (−0.010); however, the relative risk of preterm IMR among Black infants compared with White infants remained the same between 1995-1997 vs 2018-2020 (relative risk, 1.40; 95% CI, 1.38 to 1.44, vs 1.43; 95% CI, 1.39 to 1.46). The rate of decrease in preterm IMR was higher in nonsmokers compared with smokers (−0.015 vs −0.010, respectively), in those with high levels of education compared with those with intermediate or low (−0.016 vs – 0.010 or −0.011, respectively), and in those who had received adequate antenatal care compared with those who did not (−0.014 vs −0.012 for intermediate and −0.013 for inadequate antenatal care). Over time, the relative risk of preterm mortality widened within each of these subgroups. // Conclusions and Relevance: This study found that between 1995 and 2020, US preterm infant mortality improved among all categories of prematurity. Inequalities in preterm infant mortality based on maternal race and ethnicity have remained constant while socioeconomic disparities have widened over time

Defining Coordinated Care for People with Rare Conditions: A Scoping Review.

INTRODUCTION: To coordinate care effectively for rare conditions, we need to understand what coordinated care means. This review aimed to define coordinated care and identify components of coordinated care within the context of rare diseases; by drawing on evidence from chronic conditions. METHODS: A systematic scoping review. We included reviews that reported or defined and outlined components of coordinated care for chronic or rare conditions. Thematic analysis was used to develop a definition and identify components or care coordination. Stakeholder consultations (three focus groups with patients, carers and healthcare professionals with experience of rare conditions) were held to further explore the relevance of review findings for rare conditions. RESULTS: We included 154 reviews (n = 139 specific to common chronic conditions, n = 3 specific to rare conditions, n = 12 both common/rare conditions). A definition of coordination was developed. Components were identified and categorised by those that: may need to be coordinated, inform how to coordinate care, have multiple roles, or that contextualise coordination. CONCLUSIONS: Coordinated care is multi-faceted and has both generic and context-specific components. Findings outline many ways in which care may be coordinated for both rare and common chronic conditions. Findings can help to develop and eventually test different ways of coordinating care for people with rare and common chronic conditions

Factors Influencing the Use of a Mobile App for Reporting Adverse Drug Reactions and Receiving Safety Information:A Qualitative Study

Introduction A mobile app may increase the reporting of adverse drug reactions (ADRs) and improve the communication of new drug safety information. Factors that influence the use of an app for such two-way risk communication need to be considered at the development stage. Objective Our aim was to reveal the factors that may influence healthcare professionals (HCPs) and patients to use an app for two-way risk communication. Methods Focus group discussions and face-to-face interviews were conducted in the Netherlands, Spain and the UK. Patients with type 2 diabetes mellitus, patients with a rare disease or their caregivers and adolescents with health conditions were eligible to participate. HCPs included pharmacists, paediatricians, general practitioners, internists, practice nurses and professionals caring for patients with a rare disease. Patients and HCPs were recruited through various channels. The recorded discussions and interviews were transcribed verbatim. The dataset was analysed using thematic analysis and arranged according to the Unified Theory of Acceptance and Use of Technology. Results Seven focus group discussions and 13 interviews were conducted. In total, 21 HCPs and 50 patients participated. Identified factors that may influence the use of the app were the type of feedback given on reported ADRs, how ADR reports are stored and the type of drug news. Also mentioned were other functions of the app, ease of use, type of language, the source of safety information provided through the app, security of the app, layout, the operating systems on which the app can be used and the costs. Conclusions Further research is needed to assess associations between user characteristics and the direction (positive or negative) of the factors potentially influencing app use

Childhood outcomes after low-grade intraventricular haemorrhage: A systematic review and meta-analysis

Aim: To undertake a systematic review and meta-analysis exploring school-age neurodevelopmental outcomes of children after low-grade intraventricular haemorrhage (IVH). Method: The published and grey literature was extensively searched to identify observational comparative studies exploring neurodevelopmental outcomes after IVH grades 1 and 2. Our primary outcome was neurodevelopmental impairment after 5 years of age, which included cognitive, motor, speech and language, behavioural, hearing, or visual impairments. Results: This review included 12 studies and over 2036 infants born preterm with low grade IVH. Studies used 30 different neurodevelopmental tools to determine outcomes. There was conflicting evidence of the composite risk of neurodevelopmental impairment after low-grade IVH. There was evidence of an association between low-grade IVH and lower IQ at school age (−4.23, 95% confidence interval [CI] –7.53, −0.92, I2 = 0%) but impact on school performance was unclear. Studies reported an increased crude risk of cerebral palsy after low-grade IVH (odds ratio [OR] 2.92, 95% CI 1.95, 4.37, I2 = 41%). No increased risk of speech and language impairment or behavioural impairment was found. Few studies addressed hearing and visual impairment. Interpretation: This systematic review presents evidence that low-grade IVH is associated with specific neurodevelopmental impairments at school age, lending support to the theory that low-grade IVH is not a benign condition