Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials.

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/ ). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.

Perspectives of nurse managers on information communication technology and e-Leadership.

AIM: We sought nurse managers' perspectives on challenges and opportunities with technology and how it may influence communication and leadership. BACKGROUND: e-Leadership is a conceptual framework used to understand and teach organisational leaders about the application of technology to leadership. Technology is integral to leadership, yet little is understood about how nurse managers may use this technology and how they negotiate the complexity of the multiple communication systems currently in use. METHODS: Sixteen nurse managers from individual hospitals within a large US healthcare system participated in qualitative open-ended interviews and focus groups. RESULTS: Four themes emerged from the qualitative data regarding the nurse managers' perspectives of e-Leadership and their use of information and communication technologies: (a) Can't live without it, (b) Too much, too many, (c) Poor onboarding education and (d) Difficulty maintaining virtual relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Effective and safe patient care is dependent on multiple technology applications that require significant knowledge and practice. Nursing leadership may consider the need for more supported mentorship, and engaging programs to educate nurse managers about the dozens of applications required to effectively manage and lead. For technology to be used to its full potential it should be designed with nursing involvement.

Factors Associated with Interventions after Laser Peripheral Iridotomy for Primary Angle-Closure Spectrum Diagnoses.

PURPOSE: To assess factors associated with receipt of subsequent medical, laser, or surgical interventions after laser peripheral iridotomy (LPI). DESIGN: Retrospective review. PARTICIPANTS: A total of 1271 eyes in 692 subjects with narrow angles (NAs) that were treated with LPI. METHODS: Demographic and clinical factors associated with primary angle-closure (PAC) or PAC glaucoma (PACG) versus PAC suspect (PACS) diagnosis and use of glaucoma medications at the time of LPI, as well as factors predictive of subsequent addition of glaucoma medications, and receipt of selective laser trabeculoplasty (SLT), cataract surgery, and glaucoma surgery were assessed using logistic regression with generalized estimating equations. Kaplan-Meier curves and Cox proportional-hazards regression analysis were used to assess baseline factors affecting the time to SLT, cataract surgery, or glaucoma surgery. MAIN OUTCOME MEASURES: Diagnosis of PAC/PACG and medical, laser, or surgical interventions after LPI. RESULTS: African Americans (odds ratio [OR], 2.12; P < 0.001) were significantly more likely than whites to have PAC/PACG than PACS and to already be taking glaucoma medications (OR, 2.25, P < 0.001) at the time of LPI. In multivariable logistic regression analysis, African Americans were significantly more likely to be prescribed additional glaucoma medications after LPI (OR, 1.73; P = 0.025) and receive glaucoma surgery (OR, 2.7; P = 0.007), but were less likely to receive SLT (OR, 0.37; P = 0.009). In multivariate Cox proportional-hazards regression analysis, African Americans had longer time to SLT than whites (hazard ratio [HR], 0.41; P = 0.022), but a shorter time to glaucoma surgery (HR, 2.57; P = 0.004). There was no significant association between race and the likelihood of cataract surgery or time to cataract surgery (P > 0.10). CONCLUSIONS: African Americans were more likely than whites to carry a diagnosis of PAC or PACG at the time of LPI and were significantly more likely to be prescribed additional glaucoma medications and require glaucoma surgery after LPI. Improved screening methods that target African Americans with NAs are needed so that preventive interventions such as LPI can be performed earlier to decrease the risk of progression.

Risk Factors Associated with Missed Diagnoses of Narrow Angles by the Van Herick Technique.

PURPOSE: To identify which factors are associated with a deep-appearing anterior chamber on slit-lamp examination by the Van Herick (VH) technique in eyes with a diagnosis of narrow angle (NA) on gonioscopy. DESIGN: Retrospective review. PARTICIPANTS: One thousand three hundred fourteen eyes in 696 participants with NA on indirect gonioscopy. METHODS: All included eyes were graded as narrow with iridotrabecular contact on indirect gonioscopy in a darkened room by a single trained glaucoma specialist. Before gonioscopy, eyes were graded as narrow or deep by VH slit-lamp examination technique. Demographic and clinical factors predictive of a deep VH grading were assessed using logistic regression with generalized estimating equations. MAIN OUTCOME MEASURES: Factors associated with deep versus narrow VH grade. RESULTS: Using the VH technique, 13.7% of eyes (n = 180/1314) with NA on gonioscopy were classified as deep. Eyes with primary angle-closure glaucoma (PACG; odds ratio, 2.43; P < 0.001) and primary angle closure (PAC; odds ratio, 1.38; P = 0.006) were significantly more likely to be graded as deep by the VH technique relative to eyes that were primary angle-closure suspects (PACSs). In multivariate analysis, male gender (odds ratio, 2.22; P < 0.001), myopia (odds ratio, 1.4; P = 0.048), and black (odds ratio, 4.11; P < 0.001) and Asian (odds ratio, 2.24; P = 0.044) race were independent risk factors for a deep grading with the VH technique in eyes with NA on gonioscopy. CONCLUSIONS: Patients with NAs on gonioscopy who are men, myopic, and of black or Asian race are at increased risk of being misdiagnosed with deep angles if examined with the VH technique alone. Eyes with PACG and PAC may be more likely than those with PACS to be misdiagnosed as deep with the VH technique. It is possible that by being missed by the VH technique, these eyes could have progressed from PACS to PAC and PACG. Patients with these demographic and clinical characteristics in the presence of other risk factors for glaucoma should undergo careful gonioscopy.

Organizational learning in a college of nursing: A learning history.

BACKGROUND: College of nursing leaders can foster organizational learning as a means of achieving their desired organizational outcomes. Organizational learning has not previously been studied in colleges of nursing, leaving college administrators and faculty little guidance as they strive to improve outcomes in their own colleges. OBJECTIVES: The purpose of this study was to discover new insights related to organizational learning in a college of nursing. DESIGN: The learning history method was used to document and describe organizational learning in a college of nursing. SETTING: This study was conducted with a college of nursing situated in a private, religious-based university in the western United States. PARTICIPANTS: Six stakeholders and 16 individuals familiar with the college's history were purposively recruited for this study. Participants included college administrators, faculty, students, alumni, and individuals with university-level responsibilities related to the college. METHODS: Semi-structured interviews and college artifacts were used to gather data. Data was reviewed and themes identified through a process called "distillation." FINDINGS: The college's vision, "Learning the Healer's Art" provides purpose and motivation within the college. Four themes provide additional insight into how the college established a learning culture and fosters behavior conducive to organizational learning: (1) Character and Quality, (2) Long-Term Perspective, (3) Collaborative Leadership and Adaptation, and (4) Mentoring. CONCLUSION: College of nursing leaders can foster organizational learning and pursue improvement within their colleges. Recommended actions include developing a shared vision for the college, building a cadre of qualified faculty and students who have strong personal character, maintaining a long-term perspective, using a collaborative approach to leadership and adaptation, and facilitating mentoring.

HIV Risk Behavior and Prevention Considerations Among Military Personnel in Three Caribbean Region Countries: Belize, Barbados, and the Dominican Republic.

BACKGROUND: We review research findings and the limitations of recent qualitative and quantitative studies of HIV prevalence and risk behaviors in military populations in three Caribbean countries (Dominican Republic, Belize, and Barbados). METHODS: This research shows how mental health issues, disordered substance use, and structuring aspects of the occupational field produce and reproduce patterns of risk behaviors. RESULTS: We discuss the use of formative research, the Positive Health, Dignity, and Prevention framework, and the use of implementation science (including research methods that employ alternative methodological assumptions to better elucidate both cultural nuances and unknown components of program impact in different military populations) as a means to tailor individual prevention strategies to military populations. CONCLUSION: We conclude that greater adaption and ingenuity in prevention could improve behavioral prevention of HIV among military personnel in the Caribbean region.

Effects of PCSK9 Inhibition With Alirocumab on Lipoprotein Metabolism in Healthy Humans.

BACKGROUND: Alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), lowers plasma low-density lipoprotein (LDL) cholesterol and apolipoprotein B100 (apoB). Although studies in mice and cells have identified increased hepatic LDL receptors as the basis for LDL lowering by PCSK9 inhibitors, there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism. In particular, it is not known whether inhibition of PCSK9 has any effects on very low-density lipoprotein or intermediate-density lipoprotein (IDL) metabolism. Inhibition of PCSK9 also results in reductions of plasma lipoprotein (a) levels. The regulation of plasma Lp(a) levels, including the role of LDL receptors in the clearance of Lp(a), is poorly defined, and no mechanistic studies of the Lp(a) lowering by alirocumab in humans have been published to date. METHODS: Eighteen (10 F, 8 mol/L) participants completed a placebo-controlled, 2-period study. They received 2 doses of placebo, 2 weeks apart, followed by 5 doses of 150 mg of alirocumab, 2 weeks apart. At the end of each period, fractional clearance rates (FCRs) and production rates (PRs) of apoB and apo(a) were determined. In 10 participants, postprandial triglycerides and apoB48 levels were measured. RESULTS: Alirocumab reduced ultracentrifugally isolated LDL-C by 55.1%, LDL-apoB by 56.3%, and plasma Lp(a) by 18.7%. The fall in LDL-apoB was caused by an 80.4% increase in LDL-apoB FCR and a 23.9% reduction in LDL-apoB PR. The latter was due to a 46.1% increase in IDL-apoB FCR coupled with a 27.2% decrease in conversion of IDL to LDL. The FCR of apo(a) tended to increase (24.6%) without any change in apo(a) PR. Alirocumab had no effects on FCRs or PRs of very low-density lipoproteins-apoB and very low-density lipoproteins triglycerides or on postprandial plasma triglycerides or apoB48 concentrations. CONCLUSIONS: Alirocumab decreased LDL-C and LDL-apoB by increasing IDL- and LDL-apoB FCRs and decreasing LDL-apoB PR. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition. The increase in apo(a) FCR during alirocumab treatment suggests that increased LDL receptors may also play a role in the reduction of plasma Lp(a). CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01959971.

Introducing a New Surgical Technology: Controversies in Femtosecond Laser-assisted Cataract Surgery and Impact on Resident Surgical Training.

Femtosecond laser-assisted cataract surgery is becoming more widely available as an option for patients considering cataract surgery. Controversies exist around determining the best platform for LCS, the potential global role and cost to the health care system of LCS, as well as the future of LCS in resident surgical training.

Refractory open-angle glaucoma after neodymium-yttrium-aluminum-garnet laser lysis of vitreous floaters.

PURPOSE: To illustrate 3 cases of chronic open-angle glaucoma secondary to the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis procedure for symptomatic vitreous floaters. DESIGN: Observational case series. METHODS: Location of the study was the Doheny Eye Institute. Three eyes of 2 patients who developed chronic open-angle glaucoma after Nd:YAG vitreolysis for symptomatic floaters presenting with very high intraocular pressure (IOP >40 mm Hg) were selected. The time from the laser treatment to the onset of elevated pressure ranges from 1 week to 8 months. There was no associated inflammation, steroid use, or other identifiable cause of chronic IOP elevation. RESULTS: All eyes were treated initially with glaucoma medication, followed by selective laser trabeculoplasty (SLT) and eventually glaucoma surgery (Trabectome) in 2 eyes for disease management. In all eyes, intraocular pressures were eventually stabilized within a normal pressure range from 18 to 38 months following Nd:YAG vitreolysis. At the latest follow-up post surgery, all eyes had intraocular pressures of 22 mm Hg or less with or without medications. CONCLUSIONS: Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore this complication may be permanent and require chronic medical therapy or glaucoma surgery.

e-Leadership: Leading in a Virtual Environment--Guiding Principles For Nurse Leaders.

Health care organizations have yet to appreciate the unique challenges associated with leading virtual teams. Nurse leaders are faced with managing some aspect of virtual teams that require a new way of leading. Nursing leadership will need to integrate and leverage technology to meet the growing demands of the health care industry. Guiding principles can help nurse leaders effectively guide their organizations in a virtual environment. It is important for e-leaders to create a social presence and build trusting relationships with all members of the virtual team.

Lessons from Hurricane Sandy: a community response in Brooklyn, New York.

The frequency and intensity of extreme weather events have increased in recent decades; one example is Hurricane Sandy. If the frequency and severity continue or increase, adaptation and mitigation efforts are needed to protect vulnerable populations and improve daily life under changed weather conditions. This field report examines the devastation due to Hurricane Sandy experienced in Red Hook, Brooklyn, New York, a neighborhood consisting of geographically isolated low-lying commercial and residential units, with a concentration of low-income housing, and disproportionate rates of poverty and poor health outcomes largely experienced by Black and Latino residents. Multiple sources of data were reviewed, including street canvasses, governmental reports, community flyers, and meeting transcripts, as well as firsthand observations by a local nonprofit Red Hook Initiative (RHI) and community members, and social media accounts of the effects of Sandy and the response to daily needs. These data are considered within existing theory, evidence, and practice on protecting public health during extreme weather events. Firsthand observations show that a community-based organization in Red Hook, RHI, was at the center of the response to disaster relief, despite the lack of staff training in response to events such as Hurricane Sandy. Review of these data underscores that adaptation and response to climate change and likely resultant extreme weather is a dynamic process requiring an official coordinated governmental response along with on-the-ground volunteer community responders.

Literature review and risk mitigation strategy for unintended consequences of computerized physician order entry.

Computerized physician order entry (CPOE) is a form of patient management health technology software used for providers to enter medical orders into a computer system. CPOE is a health care solution used to improve patient safety and quality of care, decrease costs, and reduce the risk of medical errors. However, there are unintended consequences to electronic health records that can actually cause an increase in medical errors. Two areas of concern that risk management practitioners need to monitor and analyze are the effects of CPOE on nurse-physician communication and operational workflows. A strategic proactive plan will reduce the likelihood of adverse events, specifically medication errors. Providers and nurses will require focused education on effective communication strategies and leadership will need to promote a culture of safety.

Condom use following a pilot test of the Popular Opinion Leader intervention in the Barbados Defence Force.

Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections and HIV. However, few evidence based behavioral interventions for the prevention of HIV and STIs have been rigorously evaluated in military personnel. We adapted the Popular Opinion Leaders (POL) intervention and piloted the adapted program with the Barbados Defence Force at one military base in Barbados. Popular Opinion Leaders were selected and trained to focus conversations on condom use. Behavioral questionnaires were administered using audio computer-assisted self interview at baseline (n = 256) and 6-month follow-up (n = 303). Mid-point focus groups were conducted with a sample of 15 POLs at a 3 month mid-point assessment. Quantitative data showed moderate increases in condom use at 6-months, and significant uptake of condom use during oral-genital contact in female personnel. A subgroup analysis suggests that this change was partially mediated by post-intervention changes in injunctive norms surrounding condom use in women. Focus groups revealed that POLs were heavily focusing on condom demonstrations, condom provision within social networks, speaking with coworkers about pleasure associated with condom use, and that the most common venues for conversations included those where alcohol was consumed. During the intervention, POLs dispersed from the intervention site as a result of normal personnel movement across bases, resulting in our having to use a pre and post intervention design across the population. It is likely that larger effect sizes would be observed in efforts that account for the natural dispersion of personnel across bases.

Is sperm DNA damage associated with IVF embryo quality? A systematic review.

PURPOSE: Sperm DNA damage is common amongst infertile men and may adversely impact natural reproduction, IUI-assisted reproduction and to a lesser degree IVF pregnancy. The objective of this study was to examine the influence of sperm DNA damage on embryo quality and/or development at IVF and ICSI. METHODS: We conducted a systematic review of studies that evaluated sperm DNA damage and embryo development and/or quality after IVF and/or ICSI. RESULTS: We identified 28 studies (8 IVF, 12 ICSI and 8 mixed IVF-ICSI studies) that evaluated the relationship between sperm DNA damage and embryo quality. These 28 studies evaluated 3226 treatment cycles (1033 IVF and 873 ICSI, 1320 mixed IVF-ICSI cycles) and demonstrated highly variable characteristics. In 11 of the 28 studies (1/8 IVF, 5/12 ICSI and 5/8 mixed IVF-ICSI studies), sperm DNA damage was associated with poor embryo quality and/or development, whereas the remaining 17 studies showed no relationship between sperm DNA damage and embryo quality and/or development. CONCLUSIONS: This systematic review indicates that the evaluable studies are heterogeneous and that overall, there is no consistent relationship between sperm DNA damage and embryo quality and/or development. The data also suggest that the influence of sperm DNA damage on embryo quality/development may be more significant in ICSI compared to IVF cycles.

Assisted reproductive technologies (ART) in Canada: 2007 results from the Canadian ART Register.

OBJECTIVE: To present a report on assisted reproductive technologies (ART) cycles performed in 2007 in Canada and show trends in outcomes over time. This is the seventh annual report from the Canadian ART Register (CARTR). DESIGN: Prospective cohort study. SETTING: Twenty-six of 26 ART centers in Canada. PATIENT(S): Couples undergoing ART treatment in Canada during 2007. INTERVENTION(S): ART treatments, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and frozen embryo transfer (FET). MAIN OUTCOME MEASURE(S): Clinical pregnancy, live-birth, and multiple-birth rates. RESULT(S): A total of 13,482 ART cycles was reported to CARTR. In 8,972 IVF/ICSI cycles using the woman's own oocytes, per cycle started, the clinical pregnancy rate was 35.6% (41.0% per ET), and the live-birth rate was 28.6%; the multiple-birth rate per delivery was 30.2%, with a high-order multiple-birth rate of 1.1%. In 68% of cycles ICSI was performed. One or two embryos were transferred in 69% of cycles. In 404 IVF/ICSI cycles using donor oocytes, the clinical pregnancy rate was 44.6%, and the live-birth rate was 36.1%; the multiple-birth rate was 26.5%, with no triplet birth. In 3,224 FET cycles using the woman's own oocytes, the clinical pregnancy rate was 23.7%, and the live-birth rate was 17.8%; the multiple-birth rate was 24.1%, with a triplet birth rate of 0.2%. Birth outcomes were unknown for 2.0% of ongoing pregnancies. CONCLUSION(S): For 2007, CARTR achieved 100% voluntary participation from Canadian ART centers for the fifth consecutive year. Clinical pregnancy and live-birth rates continued to increase in 2007 compared with previous years, with a decrease in high-order multiple births.

Will DNA methylation inhibitors work in solid tumors? A review of the clinical experience with azacitidine and decitabine in solid tumors.

The recent approval of azacitidine (Vidaza®), decitabine (Dacogen®) and vorinostat (Zolinza™) for myelodysplastic syndrome and cutaneous T-cell lymphoma has led to a wave of interest in epigenetic therapy. These DNA methylation inhibitors and the histone deacetylase inhibitor clearly have demonstrated activity in hematologic malignancies, but the future role of epigenetic therapy in solid tumors is still unknown. What is not commonly known is that azacitidine and decitabine were originally developed as cytotoxic nucleoside analogs and clinical trials were previously conducted in a variety of cancer types prior to the knowledge of their ability to inhibit DNA methylation. We review the experience of azacitidine and decitabine in early clinical trials and demonstrate the activity of epigenetic therapy in solid tumors.

Assisted reproductive technologies (ART) in Canada: 2006 results from the Canadian ART Register.

OBJECTIVE: To present a report on assisted reproductive technologies (ART) cycles performed in 2006 in Canada and show trends in outcomes over time. This is the sixth annual report from the Canadian ART Register (CARTR). DESIGN: Prospective cohort study. SETTING: Twenty-five of 25 ART centers in Canada. PATIENT(S): Couples undergoing ART treatment in Canada during 2006. INTERVENTION(S): ART treatments, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and frozen embryo transfer (FET). MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, and multiple birth rates. RESULT(S): A total of 12,052 ART cycles was reported to CARTR. In 8278 IVF/ICSI cycles using the woman's own oocytes, the clinical pregnancy rate per cycle started was 33.7% (38.6% per ET), and the live birth rate was 27.1%; the multiple birth rate per delivery was 30.3%, with a high-order multiple birth rate of 1.5%. In 64% of cycles, ICSI was performed. One or two embryos were transferred in 67% of cycles. In 350 IVF/ICSI cycles using donor oocytes, the clinical pregnancy rate was 42.3%, and the live birth rate was 33.6%; the multiple birth rate was 37.3%, with no triplet birth. In 2838 FET cycles using the woman's own oocytes, the clinical pregnancy rate was 24.3%, and the live birth rate was 18.6%; the multiple birth rate was 22.5%, with a triplet birth rate of 0.6%. Birth outcomes were unknown for 3.6% of ongoing pregnancies. CONCLUSION(S): For 2006, CARTR achieved 100% voluntary participation from Canadian ART centers for the fourth consecutive year. Clinical pregnancy and live birth rates continued to increase in 2006 compared with previous years, but multiple birth rates decreased only slightly.

Assisted reproductive technologies in Canada: 2005 results from the Canadian Assisted Reproductive Technologies Register.

OBJECTIVE: To present a report on assisted reproductive technologies (ART) cycles performed in 2005 in Canada. This is the fifth annual report from the Canadian ART Register (CARTR). DESIGN: Prospective cohort study. SETTING: Twenty-five of 25 ART centers in Canada. PARTICIPANT(S): Couples undergoing ART treatment in Canada during 2005. INTERVENTION(S): ART treatments, including IVF, intracytoplasmic sperm injection (ICSI), and frozen ET (FET). MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, and multiple birth rates. RESULT(S): A total of 11,414 ART cycles was reported to CARTR. In 8195 IVF/ICSI cycles using the women's own oocytes, the clinical pregnancy rate per cycle started was 32.1% (37.5% per ET procedure), and the live birth rate was 25.6%; the multiple birth rate per delivery was 30.8%, with a triplet birth rate of 1.4%. IVF was performed in 40% of cycles and ICSI in 60% with similar pregnancy rates. One or two embryos were transferred in 68% of cycles; transferring more embryos did not increase the pregnancy rate. In 301 IVF/ICSI cycles using donor oocytes, the clinical pregnancy rate was 46.5%, and the live birth rate was 35.2%; the multiple birth rate was 33.3%, with no triplet birth. In 2498 FET cycles using the woman's own oocytes, the clinical pregnancy rate was 22.8%, and the live birth rate was 17.4%; the multiple birth rate was 24.5%, with a triplet birth rate of 1.6%. Compared with singletons, babies from multiple births had higher risks for preterm birth, low birth weight, and perinatal death. CONCLUSION(S): For 2005, CARTR achieved 100% voluntary participation from Canadian ART centers for the third consecutive year. Clinical pregnancy and live birth rates continued to increase in 2005 compared with previous years.