What number of staff is sufficient to perform increasingly complicated processes in today's modern ART laboratories?
The adequate number of personnel required for the efficient and safe operation of ...modern ART laboratories needs to be calculated.
In today's modern ART laboratories, the amount of time required to perform increasingly complicated processes has more than doubled, with a downward trend in the amount of work an embryologist can do. Different workload unit values have been used to evaluate each workload task and efficiency in a particular ART laboratory, as well as to occasionally compare one laboratory with another.
Seven senior embryologists working at different IVF centers, three public and four private centers, participated in this multicenter study conducted between 2019 and 2020. We prepared a survey to create a calculator for staff using the average (of three attempts) time spent in every laboratory by each embryologist of the center to perform any ART process.
Different laboratory processes and activities related to quality control, time spent and conventional human double witnessing were included in the survey. To calculate the number of processes that each embryologist can perform per year, an embryologist was considered to be having a full-time contract and working 7 or 8 h/day. The times included in the calculation of each task were those corresponding to the 95th percentile. For the calculations, Microsoft® Office Excel® Professional Plus 2019 was used.
The survey showed that the time needed per embryologist to perform the different processes necessary for a classic IVF cycle without time lapse (TL) was 8.11 h, and with TL, it was 10.27 h. The calculated time also considered the time spent in documentation handling, cycle preparation, database management and conventional human double witnessing verification. An ICSI without TL needed 8.55 h, and with TL, it needed 10.71 h. An ICSI-PGT without a TL cycle needed 11.75 h, and with TL, it needed 13.91 h. Furthermore, 1.81 h should be added for every vitrification support needed. The time needed to control more than 200 critical steps, including equipment control and culture parameters, was 30 min per day plus 3.9 min per device to control.The time spent in semen analysis (including documentation handling, cycle preparation and database management) or intrauterine insemination with a partner sperm was 2.7 h. For donor sperm, an additional hour was required for the management involved. The time required to perform a testicular biopsy and cryopreserve the sample was 4 h. Similarly, the time required to perform seminal cryopreservation was 3.7 h.
The study was conducted considering a full-time contract embryologist working 7 or 8 h/day, 5 days a week, with days off according to the Spanish regulations. However, our findings can be adapted to foreign regulations using the developed online calculation platform.
A new advanced staff calculator allows any IVF laboratory to estimate the minimum number of embryologists necessary without compromising the security or success of the results. Nevertheless, we recommend a minimum of two qualified embryologists in every laboratory, regardless of the workload.
This work was funded by the Asociación para el Estudio de la Biología de la Reproducción (ASEBIR). None of the authors has any conflict of interest to declare.
N/A.
Hepatitis C virus (HCV) management in Inflammatory Bowel Disease (IBD) is uncertain. The ECCO guidelines 2021 recommended HCV treatment but warn about the risk of IBD reactivation. We aimed to ...evaluate 1) the effectiveness and safety of direct-acting antivirals (DAAs) in IBD; 2) the interaction of DAAs with IBD drugs.
Multicentre study of IBD patients and HCV treated with DAAs. Variables related to liver diseases and IBD, as well as adverse events (AEs) and drug interactions, were recorded. McNemar's test was used to assess differences in the proportion of active IBD during the study period.
We included 79 patients with IBD and HCV treated with DAAs from 25,998 IBD patients of the ENEIDA registry. Thirty-one (39.2 %) received immunomodulators/biologics. There were no significant differences in the percentage of active IBD at the beginning (n = 11, 13.9 %) or at the 12-week follow-up after DAAs (n = 15, 19 %) (p = 0.424). Sustained viral response occurred in 96.2 % (n = 76). A total of 8 (10.1 %) AEs occurred and these were unrelated to activity, type of IBD, liver fibrosis, immunosuppressants/biologics, and DAAs.
We demonstrate a high efficacy and safety of DAAs in patients with IBD and HCV irrespective of activity and treatment of IBD.
In this paper we present measurements performed with a Micromegas X-ray detector setup. The detector is a prototype in the context of the BabyIAXO helioscope, which is under construction to search ...for an emission of the hypothetical axion particle from the Sun. An important component of such a helioscope is a low background X-ray detector with a high efficiency in the 1–10 keV energy range. The goal of the measurement was to study techniques for background discrimination. In addition to common techniques we used a multi-layer veto system designed to tag cosmic-ray induced neutron background. Over an effective time of 52 days, a background level of 8.6 × 10 −7 counts keV −1 cm −2 s −1 was reached in a laboratory at above ground level. This is the lowest background level achieved at surface level. In this paper we present the experimental setup, show simulations of the neutron-induced background, and demonstrate the process to identify background signals in the data. Finally, prospects to reach lower background levels down to 10 –7 counts keV −1 cm −2 s −1 are discussed.
A
bstract
This article describes BabyIAXO, an intermediate experimental stage of the International Axion Observatory (IAXO), proposed to be sited at DESY. IAXO is a large-scale axion helioscope that ...will look for axions and axion-like particles (ALPs), produced in the Sun, with unprecedented sensitivity. BabyIAXO is conceived to test all IAXO subsystems (magnet, optics and detectors) at a relevant scale for the final system and thus serve as prototype for IAXO, but at the same time as a fully-fledged helioscope with relevant physics reach itself, and with potential for discovery. The BabyIAXO magnet will feature two 10 m long, 70 cm diameter bores, and will host two detection lines (optics and detector) of dimensions similar to the final ones foreseen for IAXO. BabyIAXO will detect or reject solar axions or ALPs with axion-photon couplings down to
g
aγ
∼ 1
.
5 × 10
−
11
GeV
−
1
, and masses up to
m
a
∼ 0
.
25 eV. BabyIAXO will offer additional opportunities for axion research in view of IAXO, like the development of precision x-ray detectors to identify particular spectral features in the solar axion spectrum, and the implementation of radiofrequency-cavity-based axion dark matter setups.
Background
Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are ...clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.
Methods
This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.
Results
2213 patients were enrolled and analyzed in the study. The median interquartile range amount of fluid given during an FC was 500 ml (500–1000). The median time was 24 min (40–60 min), and the median rate of FC was 1000 500–1333 ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57–61 %). In 43 % (CI 41–45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34–37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20–24 %). No safety variable for the FC was used in 72 % (CI 70–74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.
Conclusions
The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account.
Purpose
The asthma stepwise treatment approach recommended is based on monitoring patients’ symptoms. The Asthma Research in Children and Adolescents (ARCA) cohort was created to provide evidence ...about the evolution of persistent asthma. This manuscript describes the development of an electronic health tool, comprising a mobile health application for patients with asthma and its associated online platform for pediatricians to monitor them.
Methods
The development process followed 7 phases: the first 5 (Conceptualization, Preparation, Assessment scheduling, Image and user interface, and Technical development) defined and designed the tool, followed by a testing phase (functionality assessment and pilot test with ARCA patients), and a last phase which evaluated usability. Since the target population was aged 6–16 years, three versions were designed within the same smartphone application: parents/proxy, children, and adolescents. The online platform for pediatricians provides real-time information from the application: patients’ responses over time with color-coded charts (red/amber/green, as in traffic lights).
Results
The pilot test through semi-structured phone interviews of the first 50 participants included in the ARCA study (
n
= 53) detected their misunderstandings. Pediatricians were trained to emphasize that the application is free of charge and requires monthly answers. Median of the System Usability Scale scores (
n
= 85), ranging 0 (negative)–100 (positive), was > 93 in the three age versions of the application.
Conclusions
Technology has the capability of transforming the use of patient-reported outcomes. Describing all the development phases of a mobile health application for monitoring children and adolescents with asthma may increase the knowledge on how to design applications for young patients.
X-ray detectors for the BabyIAXO solar axion search Altenmüller, K.; Biasuzzi, B.; Castel, J.F. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
03/2023, Letnik:
1048
Journal Article
Recenzirano
Odprti dostop
BabyIAXO is a helioscope under construction to search for an emission of the axion particle from the Sun. At the same time it serves as an intermediate stage towards the International Axion ...Observatory (IAXO). An integral component of this experiment is a low background X-ray detector with a high efficiency in the 1–10 keV energy range. Micromegas detectors are considered as baseline technology for BabyIAXO thanks to the relatively high efficiency and very low background level. Other detector technologies developed to reach better energy resolution while maintaining high efficiency and low background level are also under study. In this paper, we review the BabyIAXO design and present the analysis of data taken with the prototype of an IAXO Micromegas detector. A background level of 8.8×10−7counts keV−1cm−2s−1 was reached.
Survivin is a member of inhibitors of apoptosis proteins family. There are not data about the association between mortality of septic patients and blood survivin concentrations. Therefore, the ...objective of this study was to determine whether exist that association.
Observational and prospective study.
Three Spanish Intensive Care Units.
Patients with sepsis or septic shock according to Sepsis-3 Consensus criteria.
Serum survivin concentrations were determined at moment of sepsis diagnosis.
Mortality at 30 days.
A total of 204 patients were included in the study, of which 75 (36.8%) died in the first 30 days. Lower age (p<0.001), serum lactic acid levels (p=0.001), rate of septic shock (p=0.001) and SOFA (p<0.001), and higher serum survivin levels (p=0.001) exhibited surviving (n=129) than non-surviving patients (n=75). We found in multiple logistic regression analysis an association between serum survivin concentrations and mortality independently of SOFA, lactic acid, age, INR, activated partial thromboplastin time (aPTT) and empiric antimicrobial treatment adequate (OR=0.968; 95% CI=0.946–0.990; p=0.005), and also independently of APACHE-II, lactic acid, platelet, INR, aPTT and empiric antimicrobial treatment adequate (OR=0.966; 95% CI=0.943–0.989; p=0.004).
There is an association between septic patient mortality and low blood survivin concentrations.
Survivina es un miembro de la familia de proteínas inhibidoras de apoptosis. No existen datos sobre la asociación entre la mortalidad de los pacientes sépticos y las concentraciones de survivina en sangre. Por tanto, el objetivo de este estudio fue determinar si existe esa asociación.
Estudio observacional y prospectivo.
Tres Unidades de Cuidados Intensivos españolas.
Pacientes con sepsis o shock séptico según criterios del Consenso Sepsis-3.
Se determinaron las concentraciones séricas de survivina en el momento del diagnóstico de la sepsis.
Mortalidad a los 30 días.
Un total de 204 pacientes se incluyeron en el estudio, 75 (36,8%) de los cuales fallecieron en los primeros 30 días. Menor edad (p<0,001), niveles séricos de ácido láctico (p=0,001), tasa de shock séptico (p=0,001) y SOFA (p<0,001), y mayores niveles de survivina en suero (p=0,001) exhibieron los pacientes supervivientes (n=129) en comparación con los fallecidos (n=75). El análisis de regresión logística múltiple mostró una asociación entre las concentraciones séricas de survivina y la mortalidad independientemente del SOFA, ácido láctico, edad, INR, tiempo de tromboplastina parcial activada (aPTT) y tratamiento antimicrobiano empírico adecuado (OR=0,968; IC 95%=0,946-0,990; p=0,005), y también independientemente del APACHE-II, ácido láctico, plaquetas, INR, aPTT y tratamiento antimicrobiano empírico adecuado (OR=0,966; IC 95%=0,943-0,989; p=0,004).
Existe una asociación entre la mortalidad de los pacientes sépticos y las concentraciones bajas de survivina en sangre.
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