Assisted Reproductive Technology and Perinatal Mortality: Selected States (2006-2011).

OBJECTIVE: This study aimed to compare trends and characteristics of assisted reproductive technology (ART) and non-ART perinatal deaths and to evaluate the association of perinatal mortality and method of conception (ART vs. non-ART) among ART and non-ART deliveries in Florida, Massachusetts, and Michigan from 2006 to 2011. STUDY DESIGN: Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. RESULTS: During 2006 to 2011, a total of 570 ART-conceived perinatal deaths and 25,158 non-ART conceived perinatal deaths were identified from the participating states. Overall, ART perinatal mortality rates were lower than non-ART perinatal mortality rates for both singletons (7.0/1,000 births vs. 10.2/1,000 births) and multiples (22.8/1,000 births vs. 41.2/1,000 births). At <28 weeks of gestation, the risk of perinatal death among ART singletons was significantly lower than non-ART singletons (adjusted risk ratio [aRR] = 0.46, 95% confidence interval [CI]: 0.26-0.85). Similar results were observed among multiples at <28 weeks of gestation (aRR = 0.64, 95% CI: 0.45-0.89). CONCLUSION: Our findings suggest that ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation, which may be explained by earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies. These findings provide valuable information for health care providers, including infertility specialists, obstetricians, and pediatricians when counseling ART users on risk of treatment. KEY POINTS: · ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation.. · ART perinatal mortality rates were lower than that for non-ART perinatal mortality.. · This study used linked data to examine associations between use of ART and perinatal deaths..

Competition, insurance mandates, and clinical practices and outcomes at in vitro fertilization clinics.

PURPOSE: The high cost of in vitro fertilization (IVF) procedures coupled with public availability of success rates may influence IVF practice patterns and success rates but may be mitigated by mandated insurance coverage for IVF procedures. This study examined associations of competition with IVF practice patterns and success rates by insurance mandate status. METHODS: We used publicly available 2018 National Assisted Reproductive Technology Surveillance System data from the CDC. We defined competition as distance to nearest clinic and number of clinics within certain radii. We used linear regression to explore associations of competition, insurance mandate status, and interactions between competition and mandate status with clinical practice patterns (e.g., percentage of cycles among patients < 35 years, percentage of cycles using ICSI, average number of embryos transferred) and IVF success rates (e.g., live birth rates). We also assessed the percentage of variation in outcomes explained by our models, R2. RESULTS: For practice patterns, the largest R2 value was 0.3518, meaning only 35.18% of the variability in the practice pattern variable was explained by competition and insurance mandate status. In most cases, the R2 values were less than 0.20, indicating little to no association. Less than 10% of the variability in success rates was explained by competition and insurance mandate status. CONCLUSION: The multiple regression analyses all yielded low R2 values, indicating weak associations. These encouraging results coincide with previous studies, suggesting that competition, even by insurance mandate status, does not have a strong association with IVF practice patterns or success rates.

Vascular Risk Factor Prevalence and Trends in Native Americans with Ischemic Stroke.

INTRODUCTION: Native Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the ischemic stroke (IS) vascular risk factor prevalence in Native Americans along with a comparison to the other race-ethnic groups. METHODS: National Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized IS patients during 2000 - 2016. Prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods. Linear trends were explored using linear regression models, with differences in trends between the Native American group and the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data. RESULTS: Native Americans constituted 5472 of the 1,278,784 IS patients. The age-and-sex-standardized prevalence of hypertension (slope = 2.24, p < 0.001), hyperlipidemia (slope = 6.29, p < 0.001), diabetes (slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope= 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased among Native Americans. They showed larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all race-ethnic groups. CONCLUSION: The prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans over the last two decades. Significantly larger increases in hypertension and smoking prevalence were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.

Association Between Geographic Measures of Socioeconomic Status and Deprivation and Major Surgical Outcomes.

BACKGROUND: There is evidence suggesting higher rates of negative surgical outcomes for patients with lower socioeconomic status. OBJECTIVE: The objective of this study was to evaluate the effects of different geographic measures of socioeconomic status and deprivation on surgical outcomes in the United States. RESEARCH DESIGN: We extracted county-level, zip code-level, census block group-level and census tract-level measures of geographic risk. We evaluated associations between geographic area inequity and surgical outcomes using linear, logistic, and Poisson regression with generalized estimating equations to account for clustering by hospital. SUBJECTS: Hospital discharges (n=1,573,740) after major surgery in Arizona, Florida, Iowa, Michigan, New Jersey, New York, North Carolina, and Vermont as extracted from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database between the years 2010-2012. MEASURES: Inpatient mortality, length of stay, hospital costs, discharge status, and 30-day all-cause readmission. RESULTS: After adjusting for patient, hospital, and discharge factors, the odds of inpatient mortality significantly increased as geographic distress increased across all measures of geographic risk. Odds of routine discharge increased and the odds of 30-day all-cause readmission decreased with geographic distress for select measures of geographic inequity. The choice of measure generally did not affect the findings; the results did not conclusively support the use of measures from larger or smaller geographic units. CONCLUSIONS: There is a consistent, strong association between geographic indicators for socioeconomic status and distress with important surgical outcomes. Further work is needed to understand the source of these associations and to develop interventions and effective policies to address them.

Quality of Sleep in a Pediatric Hospital: A Descriptive Study Based on an Assessment of Interruptions, Perceptions, and the Environment.

OBJECTIVE: To investigate the amount and type of hospitalized children's nighttime sleep interruptions, perceptions, and efficiency. BACKGROUND: Sleep in hospitals is notoriously poor and impedes healing. Pediatric studies have been limited including breadth of diagnoses, age, or measures. METHODS: Actigraphy, sleep surveys, and nursing diaries were used to describe sleep on 2 nursing units along with environmental assessments. RESULTS: Ninety-five children from 1 month to 17 years with multiple diagnoses participated. The median number of awakenings was 2.7 per night. The median for the longest uninterrupted episode of sleep was 5.5 hours. Children need 8 to 17 hours of daily sleep, while this sample had a median of 7.5 hours of night sleep. Sensors showed talk as the predominant noise, whereas surveys showed alarms and vital signs awakened patients. CONCLUSIONS: Children are not getting essential, minimally interrupted sleep in hospitals. Disseminating results will increase awareness and accelerate environmental changes.

Preterm Birth and Small Size for Gestational Age in Singleton, In Vitro Fertilization Births Using Donor Oocytes.

We used 2006-2015 US National Assisted Reproductive Technology Surveillance System data to compare preterm birth and fetal growth for liveborn singletons (24-42 weeks' gestation) following in vitro fertilization with donor versus autologous oocytes. Using binary and multinomial logistic regression, we computed adjusted odds ratios and 95% confidence intervals for associations between use of donor oocytes and preterm delivery, being small for gestational age (SGA), and being large for gestational age (LGA), stratified by fresh and thawed embryo status and accounting for maternal characteristics and year of birth. There were 204,855 singleton births from fresh embryo transfers and 106,077 from thawed embryo transfers. Among fresh embryo transfers, donor oocyte births had higher odds of being preterm (adjusted odd ratio (aOR) = 1.32, 95% confidence interval (CI): 1.27, 1.38) or LGA (aOR = 1.27, 95% CI: 1.21, 1.33) but lower odds of being SGA (aOR = 0.81, 95% CI: 0.77, 0.85). Among thawed embryo transfers, donor oocyte births had higher odds of being preterm (aOR = 1.57, 95% CI: 1.48, 1.65) or SGA (aOR = 1.22, 95% CI: 1.14, 1.31) but lower odds of being LGA (aOR = 0.87, 95% CI: 0.82, 0.92). Use of donor oocytes was associated with increased odds of preterm delivery irrespective of embryo status; odds of being SGA were increased for donor versus autologous oocyte births among thawed embryo transfers only.

Assisted reproductive technology with donor sperm: national trends and perinatal outcomes.

BACKGROUND: Information regarding the use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision making. OBJECTIVES: The objectives of the study were to report national trends in donor sperm utilization and live birth rates of donor sperm-assisted reproductive technology cycles in the United States and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and nondonor sperm. We hypothesize these outcomes to be comparable between donor and nondonor sperm cycles. STUDY DESIGN: This was a retrospective cohort study using data from all US fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for ∼98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birthweight (<2500 g) were the primary outcomes measured. Treatments assessed include use of donor vs nondonor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n = 1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n = 437,569) to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles canceled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and nondonor sperm. RESULTS: Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between 1996 and 2014, 74,892 (4.4%) used donor sperm. In 2014, 7351 assisted reproductive technology cycles using donor sperm were performed, as compared with 1763 in 1996 (6.2% vs 3.8% of all cycles). Among all autologous oocyte cycles performed between 2010 and 2014, the live birth rate was lower for donor sperm (27.9%) than nondonor sperm cycles (32.5%); however, after adjustment for maternal age, donor sperm use was associated with an increased likelihood of live birth (adjusted relative risk, 1.06, 95% confidence interval, 1.01-1.10). Per transfer, there was no significant difference in live birth rates for donor vs nondonor sperm (31.9% vs 36.8%; adjusted relative risk, 1.04, 95% confidence interval, 0.998-1.09). Per singleton live birth, there was no significant difference in preterm birth (11.5% vs 11.8%; adjusted relative risk, 0.98, 95% confidence interval, 0.90-1.06); however, low birthweight delivery was slightly lower in donor sperm cycles (8.8% vs 9.4%; adjusted relative risk, 0.91, 95% confidence interval, 0.83-0.99). CONCLUSION: Donor sperm use in assisted reproductive technology has increased in the United States, accounting for approximately 6% of all assisted reproductive technology cycles in 2014. Assisted reproductive technology treatment and perinatal outcomes were clinically similar in donor and nondonor sperm cycles.

Affordability of Fertility Treatments and Multiple Births in the United States.

BACKGROUND: Affordability plays an important role in the utilisation of in vitro fertilisation (IVF) and non-IVF fertility treatments. Fertility treatments are associated with increased risk of multiple births. The objective of this study was to investigate the association between the affordability of fertility treatments across US states and the percentage of multiple births due to natural conception, non-IVF treatments, and IVF, and the association between these percentages and state-specific multiple birth rates. METHODS: State-specific per capita disposable personal income and state-specific infertility insurance mandates were used as measures of affordability. Maternal age-adjusted percentages of multiple births due to natural conception, non-IVF treatments, and IVF were estimated for each state using birth certificate and IVF data. Scatter plots and regression analysis were used to explore associations between state-level measures of affordability, the percentage of multiple births due to natural conception and fertility treatments, and state-specific multiple birth rates. RESULTS: In 2013, age-adjusted contributions of natural conception, non-IVF fertility treatments, and IVF to multiple births in US were 58.2, 22.8, and 19.0% respectively. States with greater affordability of fertility treatments had higher percentages of multiples due to IVF and lower percentages due to natural conception. Higher percentages of multiples due to IVF and lower percentages due to natural conception were associated with higher state-specific multiple birth rates. CONCLUSION: Increasing affordability of fertility treatments may increase state-specific multiple birth rates. Policies and treatment practices encouraging single-gestation pregnancies may help reduce multiple births resulting from these treatments.

Health-Related Quality of Life for Women Ever Experiencing Infertility or Difficulty Staying Pregnant.

INTRODUCTION: Information on the health-related quality of life (HRQOL) for women with infertility is limited and does not account for the co-occurrence of chronic conditions or emotional distress. METHODS: We used data from state-added questions on reproductive health included in the 2013 Behavioral Risk Factor Surveillance System in seven states. HRQOL indicators included: self-reported health status; number of days in the past 30 days when physical and mental health was not good; number of days in the past 30 days that poor physical or mental health limited activities. We computed rate ratios for HRQOL for women ever experiencing infertility or difficulty staying pregnant compared with women never reporting these conditions; interactions with chronic conditions and depressive disorders were assessed. RESULTS: Of 7,526 respondents aged 18-50 years, 387 (4.9%) reported infertility only and 339 (4.3%) reported difficulty staying pregnant only. Infertility was associated with an increase in average number of days with poor physical health for women with chronic conditions [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.04-3.29] but was protective for women without chronic conditions (RR 0.47, 95% CI 0.29-0.75). Difficulty staying pregnant was associated with an increase in average number of days of limited activity among both women with chronic conditions (RR 2.14, 95% CI 1.32-3.45) and women with depressive disorders (RR 1.72 95% CI 1.14-2.62). DISCUSSION: Many HRQOL measures were poorer for women who had infertility or difficulty staying pregnant compared to their counterparts; the association was modified by presence of chronic conditions and depressive disorders.

National trends and outcomes of autologous in vitro fertilization cycles among women ages 40 years and older.

PURPOSE: The purpose of the study was to describe trends in and investigate variables associated with clinical pregnancy and live birth in autologous in vitro fertilization (IVF) cycles among women ≥40 years. METHODS: We used autologous IVF cycle data from the National ART Surveillance System (NASS) for women ≥40 years at cycle start. We assessed trends in fresh and frozen cycles (n = 371,536) from 1996 to 2013. We reported perinatal outcomes and determined variables associated with clinical pregnancy and live birth in fresh cycles between 2007 and 2013. RESULTS: From 1996 to 2013, the total number of cycles in women ≥40 years increased from 8672 to 28,883 (p < 0.0001), with frozen cycles almost tripling in the last 8 years. Cycles in women ≥40 years accounted for 16.0% of all cycles in 1996 and 21.0% in 2013 (p < 0.0001). For fresh cycles from 2007 to 2013 (n = 157,890), the cancelation rate was 17.1%. Among cycles resulting in transfer (n = 112,414), the live birth rate was 16.1%. The following were associated with higher live birth rates: multiparity, fewer prior ART cycles, use of standard agonist or antagonist stimulation, lower gonadotropin dose, ovarian hyperstimulation syndrome, more oocytes retrieved, use of pre-implantation genetic screening/diagnosis, transferring more and/or blastocyst stage embryos, and cryopreserving more supernumerary embryos. Of the singleton infants born (n = 14,992), 86.9% were full term and 88.3% normal birth weight. CONCLUSIONS: The NASS allows for a comprehensive description of IVF cycles in women ≥40 years in the USA. Although live birth rate is less than 20%, identifying factors associated with IVF success can facilitate treatment option counseling.

Using multiple imputation to address the inconsistent distribution of a controlling variable when modeling an infrequent outcome.

Temporal changes in methods for collecting longitudinal data can generate inconsistent distributions of affected variables, but effects on parameter estimates have not been well described. We examined differences in Apgar scores of infants born in 2000-2006 to women with ovulatory dysfunction (risk) or tubal obstruction (reference) who underwent assisted reproductive technology (ART), using Florida, Massachusetts, and Michigan birth certificate data linked to the Centers for Disease Control and Prevention's National ART Surveillance System database. Florida had inconsistent information on induction of labor (a control variable) from a 2004 change in birth certificate format. Because we wanted to control for bias that may be introduced by the inconsistent distribution of labor induction in analysis, we used multiple imputation data in analysis. We used Cox-Iannacchione weighted sequential hot deck method to conduct multiple imputation for the labor induction values in Florida data collected before this change, and missing values in Florida data collected after the change and overall Massachusetts and Michigan data. The adjusted odds ratios for low Apgar score were 1.94 (95% confidence interval [CI] 1.32-2.85) using imputed induction of labor and 1.83 (95% CI 1.20-2.80) using not imputed induction of labor. Compared with the estimate from multiple imputation, the estimate obtained using not imputed induction of labor was biased towards the null with inflated standard errors, but the magnitude of differences was small.

Embryo donation: national trends and outcomes, 2000 through 2013.

BACKGROUND: Limited published data exist detailing outcomes of donor embryo cycles. Patients and clinicians would benefit from information specific to donor embryo cycles to inform fertility treatment options, counselling, and clinical decision-making. OBJECTIVE: We sought to quantify trends in donor embryo cycles in the United States, to characterize donor embryo recipients, and to report transfer, pregnancy, and birth outcomes of donor embryo transfers. STUDY DESIGN: This retrospective cohort study of frozen donor embryo transfers uses data from Centers for Disease Control and Prevention National ART Surveillance System to quantify trends in the use of donor embryos and corresponding rates of pregnancy and live birth from 2000 through 2013. For 2007 through 2013, years reflective of current practice, rates of cancellation, pregnancy, miscarriage, live birth, singleton and twin live birth, and delivery of a full-term singleton infant of normal birthweight (≥37 weeks, ≥2500 g) are reported. RESULTS: Among all frozen transfers from 2000 through 2013 (n = 391,662), the annual number of donor embryo transfers increased significantly from 332-1374, however the proportion of donor embryo transfers among all frozen transfers did not change significantly (2.3-2.6%). Both overall pregnancy and live birth rates per frozen donor embryo transfer increased significantly (33.3-49.1% and 26.5-40.8%, respectively) (P < .01). Among all initiated donor embryo cycles from 2007 through 2013 (n = 7289), the overall cancellation rate prior to transfer was 7.1%. Among all transfers from 2007 through 2013 (n = 6773), 3193 (47.2%) resulted in pregnancy and 2589 (38.2%) resulted in a live birth. Among all pregnancies, 535 (16.9%) resulted in a miscarriage. Among all live births, 1929 (74.5%) delivered a singleton of which 1482 (76.8%) were full term and normal birthweight. CONCLUSION: The increasing availability of donor embryos, low chance of cancellation, and increasing likelihood of achieving live birth can inform consumers and providers who are considering assisted reproductive technology options. Collection of data surrounding donated embryo formation would allow for additional studies that can elucidate predictors of success among donor embryo transfers.

Strategies for inclusion in play among children with physical disabilities in childcare centers: an integrative review.

The purpose of this integrative review was to examine strategies that facilitate inclusion in play among children with physical disabilities in childcare centers. Nine databases were systematically searched for peer reviewed empirical studies investigating inclusion strategies for play in childcare settings among preschoolers with physical disabilities. Nine studies met the inclusion criteria and were appraised using the McMaster Critical Review Forms. The inclusion approaches identified were grouped into relevant strategies during analysis. Two main strategies were identified: role of the adult facilitator and environmental factors. substrategies within the role of the adult facilitator included: customize approach for specific child's needs; adult facilitator self-awareness of presence; prompting and praise; and promote fairness, equity, and play interaction. Substrategies within the environmental factors included: physical setting; type of toys; and type of play activity. The findings suggest play inclusion strategies in the childcare environment. Therapists are encouraged to apply inclusion strategies to improve play opportunities for children with disabilities, but future research is necessary to confirm the effectiveness of these strategies using higher quality study designs.

Association between Flavonoid Intake and Cognitive Executive Function among African American and White Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) Study.

Healthy dietary patterns rich in flavonoids may benefit cognitive performance over time. Among socioeconomically disadvantaged groups, the association between flavonoid intake and measures of cognition is unclear. This study sought to identify associations between flavonoid intake and cognitive performance among Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants (n = 1947) across three study visits. Flavonoid intakes were assessed via two 24-h dietary recalls. Cognitive performance was assessed via the Trail Making Test (TMT)-A and TMT-B, which provide measures of attention and executive function, respectively. Mixed effects linear regression was used to model TMT scores over three study visits against visit 1 (v1) flavonoid intake, time (years from v1), and the interaction between v1 flavonoid intake and time, capturing both the cross-sectional association between flavonoid intake and time at v1 as well as the longitudinal association between v1 flavonoid intake and the change in TMT scores over time. Prior to adjustment, inverse cross-sectional associations at v1 were observed between (1) anthocyanidin intake and TMT-A scores for the overall sample and (2) total flavonoid, anthocyanidin, flavan-3-ol, flavone, and flavonol intake and TMT-B scores for the overall sample and among White adults. Only the association between anthocyanidin intake and TMT-B at v1 among White adults persisted after adjustment (for demographic characteristics such as age). One possible explanation for the few significant associations is universally low flavonoid intakes resulting from the consumption of an unhealthy dietary pattern.

Trends and outcomes for donor oocyte cycles in the United States, 2000-2010.

IMPORTANCE: The prevalence of oocyte donation for in vitro fertilization (IVF) has increased in the United States, but little information is available regarding maternal or infant outcomes to improve counseling and clinical decision making. OBJECTIVES: To quantify trends in donor oocyte cycles in the United States and to determine predictors of a good perinatal outcome among IVF cycles using fresh (noncryopreserved) embryos derived from donor oocytes. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data from the Centers for Disease Control and Prevention's National ART Surveillance System, to which fertility centers are mandated to report and which includes data on more than 95% of all IVF cycles performed in the United States. Data from 2000 to 2010 described trends. Data from 2010 determined predictors. MAIN OUTCOMES AND MEASURES: Good perinatal outcome, defined as a singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more. RESULTS: From 2000 to 2010, data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles significantly increased, from 10,801 to 18,306. Among all donor oocyte cycles, an increasing trend was observed from 2000 to 2010 in the proportion of cycles using frozen (vs fresh) embryos (26.7% [95% CI, 25.8%-27.5%] to 40.3% [95% CI, 39.6%-41.1%]) and elective single-embryo transfers (vs transfer of multiple embryos) (0.8% [95% CI, 0.7%-1.0%] to 14.5% [95% CI, 14.0%-15.1%]). Good perinatal outcomes increased from 18.5% (95% CI, 17.7%-19.3%) to 24.4% (95% CI, 23.8%-25.1%) (P < .001 for all listed trends). Mean donor and recipient ages remained stable at 28 (SD, 2.8) years and 41 (SD, 5.3) years, respectively. In 2010, 396 clinics contributed data. For donor oocyte cycles using fresh embryos (n = 9865), 27.5% (95% CI, 26.6%-28.4%) resulted in good perinatal outcome. Transfer of an embryo at day 5 (adjusted odds ratio [OR], 1.17 [95% CI, 1.04-1.32]) and elective single-embryo transfers (adjusted OR, 2.32 [95% CI, 1.92-2.80]) were positively associated with good perinatal outcome; tubal (adjusted OR, 0.72 [95% CI, 0.60-0.86]) or uterine (adjusted OR, 0.74 [95% CI, 0.58-0.94]) factor infertility and non-Hispanic black recipient race/ethnicity (adjusted OR, 0.48 [95% CI, 0.35-0.67]) were associated with decreased odds of good outcome. Recipient age was not associated with likelihood of good perinatal outcome. CONCLUSIONS AND RELEVANCE: In the United States from 2000 to 2010, there was an increase in number of donor oocyte cycles, accompanied by an increase in good outcomes. Further studies are needed to understand the mechanisms underlying the factors associated with less successful outcomes.

Idiosyncratic heart rate response in men during sexual arousal.

INTRODUCTION: Heart rate, sensitive to sympathetic activation, is known to change during sexual arousal and therefore may be a useful tool for investigating psychosomatic differences between sexually functional and dysfunctional men. However, heart rate during arousal also tends to be highly variable across individual men, making its predictability based on group patterns relatively poor. AIM: We wanted to determine whether individual men show idiosyncratic heart rate patterns during sexual arousal, that is, whether they exhibit consistent patterns across similar (though not identical) stimulus situations. MAIN OUTCOME MEASURE: Agreement between heart rates under the two conditions, visual sexual stimulation (VSS) and VSS + vibrotactile (VIB), was assessed using the concordance correlation coefficient (CCC). METHODS: Thirty-eight men, 25 of whom were diagnosed with premature ejaculation (PE), were monitored for penile response and heart rate under two similar (though not identical) conditions: a 9-minute erotic video (VSS), then a 9-minute erotic video combined with vibrotactile penile stimulation (VSS + VIB). RESULTS: CCC for men with PE was 0.65; for the sexually functional comparison group, CCC was 0.82. For both groups combined, CCC was 0.71. For all groupings, the CCC was relatively high, indicating agreement in heart rate from one session to the next within individual men. CONCLUSIONS: Despite high intersubject variation in heart rate patterns, individual men show signature heart rates across similar sexual stimulus sessions. Such stereotypy helps explain previous inconsistent findings and may also serve as a marker for the effectiveness of treatments designed to improve ejaculatory control in men with PE.

Frozen eggs: national autologous oocyte thaw outcomes.

OBJECTIVE: To characterize national outcomes of oocyte thaw (OT) cycles. DESIGN: Retrospective descriptive study. SETTING: All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2012 to 2018. PATIENT(S): All women undergoing OT cycles in the United States. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Absolute numbers of oocyte cryopreservation (OC) and OT cycles over time. Among OT cycles, patient and cycle characteristics, the ratio of the total number of oocytes thawed to the number of live births by maternal age at the time of cryopreservation (ATOC), and outcomes including pregnancy, miscarriage, live birth, and good perinatal outcome (GPO) by age ATOC. RESULT(S): From 2012 to 2018, 54,675 OC and 6,413 OT cycles were performed; the absolute numbers increased from 2,719 to 13,824 and from 348 to 1,810, respectively. The ratio of the total number of oocytes thawed to the number of live births increased significantly with increasing age ATOC, from 41.4 (age <35 years) to 122.4 (age >41 years). Among OT cycles resulting in embryo transfer, the live birth rate decreased with increasing age ATOC from 42.8% (age <35 years) to 10.8% (age >42 years). The live birth rate was higher when calculated per transfer (42.8% in women aged <35 years ATOC) rather than per thaw cycle (31.5% in women aged <35 years ATOC) because of the number of patients with no transfer. Among 1,124 cycles resulting in pregnancy, the chance of a GPO was highest among women aged <35 years ATOC (65.8%) and decreased as age at ATOC increased. CONCLUSION(S): Among reported OT cycles, the rates of pregnancy and live birth decreased as age ATOC increased. The number of oocytes thawed to achieve one live birth increased significantly with increasing age ATOC. In addition, among the resulting pregnancies, the rate of GPO decreased as age ATOC increased.

A spatiotemporal analysis of opioid poisoning mortality in Ohio from 2010 to 2016.

Opioid-related deaths have severely increased since 2000 in the United States. This crisis has been declared a public health emergency, and among the most affected states is Ohio. We used statewide vital statistic data from the Ohio Department of Health (ODH) and demographics data from the U.S. Census Bureau to analyze opioid-related mortality from 2010 to 2016. We focused on the characterization of the demographics from the population of opioid-related fatalities, spatiotemporal pattern analysis using Moran's statistics at the census-tract level, and comorbidity analysis using frequent itemset mining and association rule mining. We found higher rates of opioid-related deaths in white males aged 25-54 compared to the rest of Ohioans. Deaths tended to increasingly cluster around Cleveland, Columbus and Cincinnati and away from rural regions as time progressed. We also found relatively high co-occurrence of cardiovascular disease, anxiety or drug abuse history, with opioid-related mortality. Our results demonstrate that state-wide spatiotemporal and comorbidity analysis of the opioid epidemic could provide novel insights into how the demographic characteristics, spatiotemporal factors, and/or health conditions may be associated with opioid-related deaths in the state of Ohio.

Proposed multidimensional pain outcome methodology to demonstrate analgesic drug efficacy and facilitate future drug approval for piglet castration.

Castration of male piglets in the United States is conducted without analgesics because no Food and Drug Administration (FDA) approved products are labeled for pain control in swine. The absence of approved products is primarily due to a wide variation in how pain is measured in suckling piglets and the lack of validated pain-specific outcomes individually indistinct from other biological responses, such as general stress or inflammation responses with cortisol. Simply put, to measure pain mitigation, measurement of pain must be specific, quantifiable, and defined. Therefore, given the need for mitigating castration pain, a consortium of researchers, veterinarians, industry, and regulatory agencies was formed to identify potential animal-based outcomes and develop a methodology, based on the known scientific research, to measure pain and the efficacy of mitigation strategies. The outcome-based measures included physiological, neuroendocrine, behavioral, and production parameters. Ultimately, this consortium aims to provide a validated multimodal methodology to demonstrate analgesic drug efficacy for piglet castration.Measurable outcomes were selected based on published studies suggesting their validity, reliability, and sensitivity for the direct or indirect measurement of pain associated with surgical castration in piglets. Outcomes to be considered are observation of pain behaviors (i.e. ethogram defined behaviors and piglet grimace scale), gait parameters measured with a pressure mat, infrared thermography of skin temperature of the cranium and periphery of the eye, and blood biomarkers. Other measures include body weight and mortality rate.This standardized measurement of the outcome variable's primary goal is to facilitate consistency and rigor by developing a research methodology utilizing endpoints that are well-defined and reliably measure pain in piglets. The resulting methodology will facilitate and guide the evaluation of the effectiveness of comprehensive analgesic interventions for 3- to 5-day-old piglets following surgical castration.