bluuebunny/crossref_metadata_2025 huggingface dataset:
Response of Separated Boundary Layers to Steady and Pulsated Flow Injection
Authors: Nowak Hunter D. , Lluesma-Rodriguez Federico , Rahbari Iman , Clark John P. , Paniagua Guillermo
Published: November 2022

A new class of power generation devices that experiences increased losses due to bulk flow separation in segments of their expected in-flight regime is emerging. As such, active flow control becomes increasingly relevant to mitigate these losses and reclaim the entire flight envelope. This study explores the effect of flow injection on transonic flows experiencing bulk separation. Reynolds-averaged Navier–Stokes simulations of a 3D wall-mounted hump at low Reynolds numbers are conducted to assess the response of transonic bulk separation to flow injection. Unsteady simulations are performed to understand the differences between slot and discrete port injection and determine optimum forcing frequencies. Discrete ports require higher pressures to overcome the momentum deficit associated with the smaller injection area relative to the width of the domain. Steady and unsteady injections are found viable strategies for mitigating the extent (or appearance) of bulk separation. Experiments are conducted with discrete injection for a range of Mach and Reynolds numbers. The response of the bulk separation to said injection is evaluated by analyzing both local pressure measurements and schlieren imaging. The study shows that the required pressure of injection is strongly correlated to the length scale of the uncontrolled separation. With large-eddy simulations, the flow separation and frequency content within the separated region can be reasonably predicted. This study aims to take further steps to establish guidelines for applying flow control to the emerging class of power generation devices experiencing losses from bulk separation.
Numerical Study on Method for Reducing Film Pressure and Its Fluctuation due to Surface Roughness in Elastohydrodynamic Lubrication Contact
Authors: Kaneta Motohiro , Matsuda Kenji
Published: November 2022

One of the methods to avoid rolling contact fatigue is to reduce the film pressure due to surface roughness and the magnitude of its fluctuation. The roughness on rolling/sliding concentrated contacting surfaces has generally different asperity heights. In this study, it has been clarified, using a fully flooded non-Newtonian thermal elastohydrodynamic lubrication analysis in contact between materials with different thermal conductivities and roughness asperity heights, which surface velocity should be increased and which roughness asperity height should be lowered to reduce the magnitudes of film pressure and its fluctuation. The results obtained will make a new contribution to the combination of roughness heights on the EHL contact surfaces.
An Improved Time-Domain Equivalent Source Method for Accurate Indoor Simulation of Pass-By Noise
Authors: Liu Ce , Zhang Xiaozheng , Zhang Yongbin
Published: November 2022

Time-domain equivalent source method (TDESM) has been employed for indoor simulation of pass-by noise (PBN). Despite removing the requirement of dedicated large semi-anechoic chambers for the microphone array technique, it is still difficult to obtain high simulation accuracy due to the existence of signal splicing error and ill consideration of Doppler effect induced by the vehicle motion. In this article, the TDESM is developed to improve the simulation accuracy of PBN. Unlike the previous TDESM, the improved TDESM (I-TDESM) models the PBN by superposing the contributions of an array of moving equivalent sources, which can take the influence of vehicle motion into account. The PBN at the receivers can be directly reconstructed via the sound field calculation of moving sources. Numerical studies and real vehicle experiments are implemented to demonstrate the feasibility of the I-TDESM. Simulation results show that the I-TDESM can naturally incorporate the Doppler effect and effectively eliminate the signal splicing error, thus improving the simulation accuracy. The experiment results of real vehicle further validate the I-TDESM.
Secondary sonic boom predictions for U.S. coastlines
Authors: Riegel Kimberly A. , Sparrow Victor W.
Published: November 2022

This study examines the behavior of secondary sonic booms on United States (U.S.) coastlines to have a more complete understanding of the impact of supersonic travel on communities. Secondary sonic booms occur when the atmospheric conditions are such that the atmospheric refraction causes the sound that would ordinarily not reach the ground to bend toward the ground. NASA's PCBoom software is a preferred simulation tool to predict the location and pressure signatures of sonic booms. It was expanded to include secondary boom propagation but has not yet been rigorously used for secondary sonic booms in a variety of conditions. This study looks at how secondary sonic booms change throughout the year and how they behave at different U.S. coastline locations. A detailed analysis of the variability of the atmospheric conditions and how they affect the arrival locations of secondary sonic booms is provided. Good agreement is found between PCBoom and previous work for the arrival locations of secondary sonic booms, which are shown to affect the U.S. east coast predominantly during the summer months and the U.S. west coast during the winter months for projected U.S. inbound supersonic flight scenarios of potential overseas travel.
Dynamics of annular solvent droplets under capillary thinning of non-entangled polymer solution
Authors: Subbotin Andrey V. , Semenov Alexander N.
Published: November 2022

Formation and coalescence of solvent droplets on a thread of polymer solution at the final stage of capillary pinching is studied theoretically. It is considered that macromolecules are already almost completely stretched along the extension axis and their contour length exceeds the diameter of the thread. In this regime, the radius of polymer string decreases slowly with time under the action of capillary forces and the solvent squeezes out to the thread surface forming annular droplets of different sizes. The thinning process stops when the capillary pressure is balanced by the osmotic pressure of the polymer. As a result, a quasistationary two-phase structure of polydisperse solvent droplets on a polymer string is formed. We develop a rigorous theory showing that the polymer core is swollen in the droplet regions but still remains much thinner than the solvent phase. We also demonstrate that such a blistering structure is unstable with respect to droplet coalescence and elucidate two mechanisms of this process due to the solvent flow between the droplets and due to diffusion of solvent droplets along the polymer string. Both mechanisms lead to the same long-time power law (t1/7) for the droplet radius. It is shown that a breakage of the polymer string may occur at time scales exceeding the Rouse time of polymer chains.
Metabolite activation of tumorigenic signaling pathways in the tumor microenvironment
Authors: Low Vivien , Li Zhongchi , Blenis John
Published: November 2022

The role of metabolites exchanged in the tumor microenvironment is largely thought of as fuels to drive the increased biosynthetic and bioenergetic demands of growing tumors. However, this view is shifting as metabolites are increasingly shown to function as signaling molecules that directly regulate oncogenic pathways. Combined with our growing understanding of the essential role of stromal cells, this shift has led to increased interest in how the collective and interconnected metabolome of the tumor microenvironment can drive malignant transformation, epithelial-to-mesenchymal transition, drug resistance, immune evasion, and metastasis. In this review, we discuss how metabolite exchange between tumors and various cell types in the tumor microenvironment—such as fibroblasts, adipocytes, and immune cells—can activate signaling pathways that drive cancer progression.
Molecular Characterization of Clinical Rel Mutations and Consequences for Resistance Expression and Fitness in Staphylococcus aureus
Authors: Deventer Ashley T. , Bryson Duncan , Shortill Mathew , Boraston Alisdair B. , Hobbs Joanne K.
Published: November 2022

The stringent response (SR) is a universal stress response that acts as a global regulator of bacterial physiology and virulence, and is a contributor to antibiotic tolerance and resistance. In most bacteria, the SR is controlled by a bifunctional enzyme, Rel, which both synthesizes and hydrolyzes the alarmone (p)ppGpp via two distinct catalytic domains.
Pseudomonas aeruginosa Phosphate Transporter PitA (PA4292) Controls Susceptibility to Aminoglycoside Antibiotics by Regulating the Proton Motive Force
Authors: Zhao Xinrui , Jin Yongxin , Bai Fang , Cheng Zhihui , Wu Weihui , Pan Xiaolei
Published: November 2022

Pseudomonas aeruginosa
is an opportunistic Gram-negative bacterium that causes nosocomial infections in immunocompromised patients. β-lactam and aminoglycoside antibiotics are commonly used in the treatment of
P. aeruginosa
infections. Previously, we found that mutation in a
PA4292
gene increases bacterial resistance to β-lactam antibiotics.
ZER1 Contributes to the Carcinogenic Activity of High-Risk HPV E7 Proteins
Authors: Nouel Joangela , White Elizabeth A.
Published: November 2022

HPV16 is highly carcinogenic and is the most predominant HPV genotype associated with human cancers. The mechanisms that underlie differences between high-risk HPV genotypes are currently unknown, but many of these differences are likely attributable to the activities of the oncogenic HPV proteins, including E7.
Association of lipid-lowering drugs and antidiabetic drugs with age-related macular degeneration: a meta-analysis in Europeans
Authors: Mauschitz Matthias M , Verzijden Timo , Schuster Alexander K , Elbaz Hisham , Pfeiffer Norbert , Khawaja Anthony , Luben Robert N , Foster Paul J , Rauscher Franziska G , Wirkner Kerstin , Kirsten Toralf , Jonas Jost B , Bikbov Mukharram M , Hogg Ruth , Peto Tunde , Cougnard-Grégoire Audrey , Bertelsen Geir , Erke Maja Gran , Topouzis Fotis , Giannoulis Dimitrios A , Brandl Caroline , Heid Iris M , Creuzot-Garcher Catherine P , Gabrielle Pierre-Henry , Hense Hans-Werner , Pauleikhoff Daniel , Barreto Patricia , Coimbra Rita , Piermarocchi Stefano , Daien Vincent , Holz Frank G , Delcourt Cecile , Finger Robert P
Published: November 2022

Background/aims

To investigate the association of commonly used systemic medications with prevalent age-related macular degeneration (AMD) in the general population.

Methods

We included 38 694 adults from 14 population-based and hospital-based studies from the European Eye Epidemiology consortium. We examined associations between the use of systemic medications and any prevalent AMD as well as any late AMD using multivariable logistic regression modelling per study and pooled results using random effects meta-analysis.

Results

Between studies, mean age ranged from 61.5±7.1 to 82.6±3.8 years and prevalence ranged from 12.1% to 64.5% and from 0.5% to 35.5% for any and late AMD, respectively. In the meta-analysis of fully adjusted multivariable models, lipid-lowering drugs (LLD) and antidiabetic drugs were associated with lower prevalent any AMD (OR 0.85, 95% CI=0.79 to 0.91 and OR 0.78, 95% CI=0.66 to 0.91). We found no association with late AMD or with any other medication.

Conclusion

Our study indicates a potential beneficial effect of LLD and antidiabetic drug use on prevalence of AMD across multiple European cohorts. Our findings support the importance of metabolic processes in the multifactorial aetiology of AMD.
Experience and perspectives on palliative or end-of-life care of Chinese people and their families as immigrants to high-income countries: a systematic review and thematic synthesis
Authors: Kwok Harley H Y , Low Joesph , Devakumar Delan , Candy Bridget
Published: November 2022

Background

A sizeable cohort of Chinese migrants in high-income non-Asian countries is reaching old age and many will develop life-limiting illnesses. They may benefit from palliative care, which is integrated into universal health coverage in many of these countries, but the uptake of this care among migrant communities remains low. Cultural differences between the Chinese and the host community, and poor language skills may be barriers to access, yet understanding the reasons hindering uptake are obscure.

Aims

To understand the cultural perspective of how first generation Chinese migrants and their families perceive the provision of palliative care, to identify what exists which may limit their access in high-income non-Asian countries.

Design

A systematic review and three-stage thematic synthesis of qualitative studies. Citations and full texts were reviewed against predefined inclusion criteria. All included studies were appraised for quality.

Data source

MEDLINE, EMBASE, PsycINFO, CINAHL and PubMed were searched to July 2019.

Results

Seven qualitative studies were identified (from USA, UK, Canada and Australia). Across the studies analytical themes that impacted on the use of palliative care services were identified: (1) migrants’ intrinsic perceptions of cultural practices, (2) their expectations of and preparation for care at the end of life, (3) perspectives and influences of family and (4) knowledge and communication with palliative care providers in the host country. Key elements found that challenge access to palliative care services in the host countries were: Chinese culture is rooted in the core values of the family as opposed to the individual; migrants’ limited experience in their place of origin in accessing healthcare; and practical issues including a lack of language skills of their host country.

Conclusions

Palliative care services do not always match the needs of Chinese migrants in non-Asian high-income countries. Engagement and education on multiethnic cultural awareness in both the host non-migrant and the migrant communities is needed.
Communication skills: simulated patient goals of care workshop for acute care clinicians
Authors: White David , Kilshaw Lucy , Eng Derek
Published: November 2022

Background

Appropriate and timely goals of patient care (GoPC) discussions are associated with improved health outcomes near the end-of-life among patients with serious illness, however, acute care clinicians report a lack of training in conducting GoPC conversations.

Objectives

A half-day GoPC communication workshop for acute care clinicians was delivered and evaluated. Participants were instructed in the use of communication frameworks and practiced skills in clinical scenarios with a simulated patient.

Method

Expert facilitators guided feedback towards learner identified goals during simulated GoPC discussions. Self-reported confidence in communication skills was measured with a pre-post questionnaire, which was repeated 2 months following the workshop.

Results

50 clinicians completed the workshop and questionnaire. A mean improvement in confidence in communication skills of 35% (p<0.001) was identified following participation, which remained elevated at 2 months (p<0.001). All participants responded that they would recommend the workshop to a colleague, and more than two-thirds went on to share their learnings with other clinicians.

Conclusion

The use of a simulated patient, communication frameworks and an expert facilitator were associated with durable improvement in confidence in GoPC communication among acute care clinicians. A half-day workshop was feasible and acceptable to participants.
Designing of Integrated Tactical Production-Quality Planning in a Rolling Horizon Under Demand Uncertainty: Case Study in the Automotive Wire Harness Industry
Authors: Mansouri Samiha , Ouzizi Latifa , Aoura Youssef , Douimi Mohammed
Published: November 2022

To minimize waste and scrap, reworking becomes an integral part of many manufacturing companies. In this study, the integrated production-quality planning in the tactical horizon considering the customer demand uncertainty is presented. A mixed-integer programming model is developed to find optimal dynamic planning production which minimizes costs and reduces the scrap. After each production cycle, the quality indicators and relative costs for good and poor quality are performed. These indicators are introduced into the developed model to determine the optimal production orders and stock levels considering the reworked and scrapped products. A real case study is presented to illustrate the applicability of the proposed model. By comparing the obtained results with real results from studied company, we proved that this new model gives an optimal production plan.
Some features of Kaniadakis holographic dark energy model
Authors: Dubey Vipin Chandra , Kumar Mukesh , Sharma Lokesh Kumar , Sharma Umesh Kumar
Published: November 2022

In this study, the Kaniadakis holographic dark energy (KHDE) model is investigated within the framework of a flat FLRW universe by using an infrared cut-off as Hubble horizon. For the different values of the Kaniadakis parameter [Formula: see text] and [Formula: see text], we perform an analysis on the deceleration, the equation of state and the energy density parameters. The current phase shift of the Cosmos may be rationalized by the change in sign of the deceleration parameter in the KHDE model, which went from [Formula: see text] to [Formula: see text], signifying a move from a phase of deceleration to one of acceleration. In order to get an understanding of the geometrical behavior shown by the KHDE model, we compute and show the statefinder evolutionary trajectory for the pairs [Formula: see text] and [Formula: see text]. The evolutionary trajectory of [Formula: see text] reveals that the [Formula: see text] crosses the phantom divide line [Formula: see text] at a late period in the evolutionary process. It has also been determined, by examination of the KHDE models stability analysis, that the model has behaved in an unstable manner during the whole course of the history of the universe. In addition to this, we optimized the model parameters by making use of the distance modulus measurement that was taken from the most current Union 2.1 dataset of supernovae.
China’s Evolving Perspectives on the Quad
Authors: LIN Minwang
Published: November 2022

The revival of the Quad with an “Indo-Pacific strategy” was initially not taken seriously by China. However, after the COVID-19 pandemic erupted in 2020, especially after the China-US trade war, the Quad is increasingly moving in a strategic direction aimed at containing China. From China’s perspective, the United States is staging a “five-four-three-two” formation in the Asia-Pacific, a form of an Asian NATO. In response, China’s diplomatic efforts will focus on breaking the strategic containment of the US-led Quad.
Lessons of the Ukraine Crisis for Canada’s Relations with China
Authors: NARINE Shaun
Published: November 2022

The United States has used the Ukraine conflict to highlight Russia’s close economic and strategic ties with China and charge that China is responsible for enabling Russia’s aggression. Canada is highly dependent on the United States and Canada-China relations are tense. However, uncertainty about American reliability, and Canada’s racial and ethnic diversity, suggest that Canada has to consider the neutrality of the non-Western world on the Ukraine conflict as it positions itself for a changing world order.
Posthumous Collection of Oocytes
Authors: BOOTHROYD Clare , KRUGER Peter
Published: November 2022

Background: We report a case of posthumous oocyte retrieval from a female of reproductive age diagnosed with brain death after a vascular injury.

Aim: To report on posthumous collection of oocytes.

Method and Results: Intensive care support was lengthened by thirteen (13) days to allow follicular stimulation of thirteen (13) oocytes from which three euploid blastocysts were obtained and cryostored. GnRH antagonist was not required. Consultation with two hospital ethics committees and legal advice were obtained prior to oocyte retrieval and fertilization of oocytes.

Conclusion: The case highlights the need for multidisciplinary protocols and harmonization of (clinical) ethics committees and legislation. Significant gaps in funding exist which potentially preclude Australians from accessing what is now feasible and likely to be increasingly requested. There is a need for public consultation to guide political and medical leaders in the posthumous use of gametes.
Donors: To Pay, or Not to Pay
Authors: GOEDEKE S. , RODINO I. , SHEPHERD D.
Published: November 2022

Attitudes towards and concerns about recognition and payment options for donation in New Zealand and Australia

Commercial inducement for the provision of gametes is prohibited in New Zealand and Australia. This has been argued to limit access to donor gametes and contribute to the pursuit of potentially unregulated cross-border reproductive care by domestic patients. 434 participants, including those with infertility and treatment experience, donors, recipients and clinic professionals, completed an online questionnaire assessing their support for a range of recognition and payment options, and their concerns about payment constituting financial reward. Overall, participants supported the reimbursement of direct costs associated with donation, including medical expenses, travel time, and unpaid time away from work relating to treatment. Nonmaterial forms of recognition or tokens of thanks received less support. Lowest ratings of support were noted for the outright payment of donors for the supply of their gametes. Concerns about payment related to assumptions about the type of donor motivated by financial reward, and the possibility that if paid donors might be more likely to conceal relevant treatment information. Further concerns included the increased financial burden for recipients and concern for donor-offspring wellbeing. Support for payment over and above reimbursement of costs was related to a belief that payment was necessary to ensure gamete supply.

Sonja Goedeke: Sonja’s research focuses on the psychosocial and ethical implications of assisted reproductive technologies. She has published, presented and supervised projects related to egg and embryo donation, the concept of gifting in donation, counselling, cross border reproductive care, mild stimulation protocols, social egg freezing, policy/legislation, parenting/remaining child ‘free’ after IVF, embryo disposal decisions and the recognition/compensation of donors.
Clinical IVM in Australia: Results and Future Prospects
Authors: HART Roger
Published: November 2022

This presentation will discuss whether there is a place for in-vitro maturation of oocytes (IVM) in Australia, in contrast to employing standard ovarian stimulation for all our patients. Particularly, when we are fortunate to have such excellent tools to minimise the risk of ovarian hyperstimulation syndrome (OHSS), such as; accurate drug dosing with follicular stimulating hormone, the use of antagonists for pituitary down-regulation in conjunction with an agonist trigger for follicular maturation. With the recourse to adjuvant treatments such as metformin and cabergoline to reduce the risk of developing OHSS, along with the option to cryopreserve all embryos developed. The presentation will conclude that it has a place, although the indications are perhaps rather limited.
Genetics of Male Infertility
Authors: HOUSTON Brendan J. , O’BRYAN Moira K.
Published: November 2022

Background: Male infertility is a common condition that affects at least 7% of men in Western countries and is associated with an elevated risk of comorbidities and mortality. While genetics is predicted to play a role in a significant percentage of cases, the aetiology of male infertility remains largely unknown. In light of this, the International Male Infertility Genomics Consortium (IMIGC) was founded, with the goals of recruiting large cohorts of infertile men, use next generation sequencing to identify high-confidence genetic causes of their infertility, and validate these genetic causes using replication studies and/or animal models. A number of working groups within the IMIGC are beginning to identify several novel genetic variants causative of human male infertility, and thus, essential male fertility genes. The requirement of these poorly characterised genes for male fertility is being further tested in mice and flies, including the identification of their molecular function(s) across the discrete phases of spermatogenesis and sperm function. These studies will ultimately transform the diagnosis of male infertility from a phenotypic description to a molecular diagnosis. These findings will also allow more realistic predictions regarding the consequences of using gametes from men with genetic variants in assisted reproductive technologies, and will likely identify avenues for therapeutic intervention.
Audit and Accreditation of ART Facilities in Japan; JISART’s Commitment Focusing on Quality Management Systems (QMS) and Patient Satisfaction
Authors: KURAMOTO Takeshi
Published: November 2022

In Japan in 2018, 247,402 cycles of oocyte retrieval were performed at 592 facilities and 56,979 ART babies were born. 1 in 16 new births were as a result of ART. There is presently no law regulating ART and each facility operates under a system of self-regulation based on the requirements of the Japan Society of Obstetrics and Gynaecology. In 2000, systems for staffing, quality and safety management were not clearly structured.

JISART (The Japanese Institution for Standardizing Assisted Reproductive Technology) was set up in 2003 with a view to improving quality of treatment and patient satisfaction. It is comprised of 31 private clinics with over 500 annual oocyte retrievals and all members are ISO9001 certified. With the Reproductive Technology Accreditation Committee playing a central role, a Code of Practice, guidelines for quality and safety management in ART, and audit checklists have been created. Specialist physicians, embryologists, nurses, administration staff and a patient support group conduct audits triennially, covering some 245 points. With respect to physicians, the audits look at whether there are systems in place for patient examinations and professional development, and at treatment outcomes and risk management. For embryologists and nurses, they examine qualifications, knowledge and technique along with records of equipment inspections and consent forms. Further, patients are interviewed to ascertain their satisfaction with and suggested areas for improvement to facilities and personnel.

In Japan, the situation regarding ART is undergoing great changes, with audits having changed from on-site to online due to the COVID-19 pandemic and the government considering whether ART should be covered by national health insurance. In the conference, I will talk about the current situation regarding audits and suggest issues for further consideration.
Impact of Serum P Levels on Pregnancy Outcome in ART
Authors: LABARTA Elena
Published: November 2022

Background: The role of mid luteal progesterone (P) levels has gained interest in the last years. Low serum P levels significantly decrease the chances of ongoing pregnancy, mainly in artificial cycles for embryo transfer. Our prospective studies have found that patients with low serum P levels on the day of ET had a significantly lower live birth rate, either when using own or donated oocytes.

Aim: To summarize the current evidence about the impact of serum P levels on pregnancy outcome in ART; and the proposed strategies to overcome this situation.

To differentiate the PK and PD of the different routes of exogenous P and how this influence on the interpretation of results.

Method: Review of the literature. The research leaded by the lecturer will be presented.

Results: In artificial cycles, there is a minimum threshold of serum P levels that needs to be reached. Approximately 30% of women show inadequate levels of serum P after receiving the standard dose of vaginal P. Individualization of luteal phase support by routinely measuring P levels, allows to detect which patients need raised P in order to optimise their outcome. Addition of extra doses of P seems to overcome this detrimental effect, ideally associating other routes of P.

Conclusion: Low P levels on the day of ET decrease live birth rates. If outcomes are to be optimised, a minimal threshold of serum P values on the day of ET must be reached. Personalization of luteal phase support is advisable to optimize the results.
Pushing the Limits: Day 7 Embryo Culture
Authors: LEE Lisa Y. S.
Published: November 2022

Improvements in embryo culture systems, based on the dynamic metabolic requirements of the embryo have facilitated the extension of embryo culture to the blastocyst stage. In the last 20 years, there has been a shift to blastocyst culture and single blastocyst transfer around the world, especially in Australia and New Zealand. Notably, this practice has led to significantly increased implantation and pregnancy rates, by improving embryo selection and embryo-uterine environment synchrony.

Interestingly, the time taken for a human embryo to develop into a blastocyst can vary. Blastocysts are typically selected for transfer, biopsy or vitrification on days 5 and 6 of embryo development, and embryos which do not reach a suitable developmental stage and/or quality are typically discarded. Over the last decade, multiple groups have challenged this ‘norm’. It has been determined that slow-growing embryos that only reach the blastocyst stage on day 7 have the ability to attain a good morphological grade, successively undergo biopsy and vitrification, and most importantly, can result in healthy live births following transfer. With the advent of time-lapse microscopy, we can now closely examine the timings of embryo development. Here, the development and incidence of day 7 blastocysts, metabolic requirements, rate of euploidy, reproductive potential and laboratory experience of extending embryo culture to day 7 are considered.
Uterus Transplantation and Pregnancy Induction: An Approved Protocol at Royal Prince Alfred Hospital (RPA)
Authors: GEORGEVSKY Dana , LI Ying , PATHER Selvan , TEJADAS-BERGES Trevor , ROBINSON David , LAURENCE Jerome , CAMPBELL Neil , WYBURN Kate , LIYANAGAMA Keith , NARAYAN Rajit , LUTZ Tracey , CHAN Agnes , HEANEY Sally-Ann , KITZING Yu Xuan , ANDERSON Lyndal , TESTA Giuliano , JOHANNESSON Liza , MARREN Anthony
Published: November 2022

Background: Absolute Uterine Factor infertility (AUFI) can be congenital such as Mayer-Rokitansky Küster syndrome (MRKH), or acquired resulting from conditions rendering the uterus non-functional or hysterectomy. Prior to the year 2014, women with AUFI had limited opportunities to have a child with the options being either surrogacy or adoption. In 2014 the first successful uterus transplant (UT) was achieved in Sweden. RPA was the first site in Australia to receive ethical approval for a UT trial.

Objectives: To determine if UT is an effective, safe, and operationally viable option for women with AUFI in order to achieve live birth.

Methodology: Potential donor/recipient pairs will undertake a comprehensive screening process to assess suitability. The process will then involve:

1. Creation of embryos via IVF;

2. Donor Hysterectomy and Recipient Transplant;

3. Recovery with immunosuppression;

4. Embryo transfer;

5. Pregnancy care and delivery;

6. Post-delivery, potential second pregnancy, and explant with follow-up.

Conclusion: UT is a novel and promising procedure for women with AUFI to achieve parenthood. The process involves a comprehensive workup to assess suitability. A multidisciplinary team within a tertiary centre is essential for establishing a successful UT program. Due to the infancy of UT all centres need to be diligent in reporting clinical outcomes to establish the feasibility of UT as a future treatment option for AUFI.
The Role of the Epididymis in Linking the Legacy of Paternal Exposures to Alteration of the Sperm Epigenome
Authors: NIXON Brett
Published: November 2022

In what has become a well-established paradigm, paternal exposure to a range of environmental stressors is known to elicit distinct changes to the sperm small noncoding RNA (sncRNA) profile; modifications that can have significant post-fertilization consequences. Despite this knowledge, there remains limited mechanistic understanding of how paternal exposures modify the sperm sncRNA landscape. To address this question, our laboratory has exploited a tractable exposure model in which male mice were subjected to acute administration of the reproductive toxicant, acrylamide; a challenge that elicited robust changes to their sperm sncRNA profile. Further, we traced the differential accumulation of acrylamide-responsive sncRNAs to coincide with sperm transit of the proximal (caput) segment of the epididymis, wherein acrylamide exposure altered the expression of several transcription factors implicated in the expression of acrylamide-sensitive sncRNAs. We have also identified extracellular vesicles (epididymosomes) secreted from the caput epididymal epithelium in relaying altered sncRNA profiles to maturing spermatozoa, the implications of which manifest in the form of dysregulated gene expression during early embryonic development following fertilization by acrylamide-exposed sperm. Overall, these data provide mechanistic links to account for how environmental insults can alter the sperm epigenome and compromise the transcriptomic profile of early embryos.
Debate: Are We Limiting the Potential of Oocytes by Not Using ICSI for All? - ICSI for Some
Authors: NORMAN Robert
Published: November 2022

Intracytoplasmic sperm injection (ICSI) was invented nearly thirty years ago and the first pregnancies in Australia were obtained at the Queen Elizabeth Hospital in the University of Adelaide’s Reproductive Medicine Program. Since then, ICSI has become the predominant method of fertilisation for IVF in cycles in Australia and in many parts of the world used for 100% of all cycles. While its value for male factor infertility, IVM egg fertilisation and injection into previously frozen eggs have been validated, the use of ICSI for non-male-factor infertility remains controversial and unproven. Given the significant concerns about the potential effects of ICSI on the health of children conceived by this method, a debate about its use in an excessive number of IVF cycles is warranted.

The first randomised control trial of ICSI versus standard IVF fertilisation for unexplained infertility occurred more than twenty years ago and showed a lower ongoing pregnancy rate for those who received the ICSI form of fertilisation. Despite this evidence, ICSI continued to grow in prevalence across Europe, North America, the Middle East, Asia, and Australia for non-male factor infertility. Significant cohort studies started to emerge from the US and from Europe that showed either no benefit from ICSI for unexplained infertility, or indeed harm, in terms of ongoing pregnancy rates. This year we published in The Lancet, a randomised control trial where couples with unexplained infertility and a normal total sperm count and motility were randomised to receive either ICSI or standard IVF as a fertilisation method. No significant benefit of using ICSI was found with respect to ongoing pregnancy or live birth. The potential health benefits to the child and the cost effectiveness of the treatment weigh against the routine use of ICSI in the presence of normal sperm. Other cohort studies show that there is no benefit of ICSI for low egg numbers, advanced maternal age, or preimplantation genetic diagnosis.

Examination of the use of ICSI across Australia, shows enormous variations between states and within the same state. It is clear, that members of the Society have very heterogeneous view of the use of ICSI and my intention in this talk is to encourage everyone to be more critical of its use when there is no sperm abnormality. I would encourage clinicians to use the normal natural processes of sperm selection which occur in routine IVF without sperm injection.
The Patient Perspective: Why Patients Need These Tools and How Can We Maximize the Benefit to Them
Authors: PICKENS Maree
Published: November 2022

ACCESS, Australia’s National Infertility Network is a consumer-controlled, not-for-profit charity that for nearly 30 years has been the voice of patients needing medical assistance to have a child. Years ago, ACCESS met patients’ demand for information by producing a detailed Fact Sheet “How to choose an IVF Clinic and understand success rates”. It lists the many questions patients should ask when choosing an IVF clinic. The YourIVFSuccess website is now another tool that empowers patients with Australian fertility clinics’ success information as well as an estimator tool based on Australian data. It’s a site that patients have contributed to developing, and will continue to influence through consultation, research and representation on the YourIVFSuccess Advisory Group.

This presentation will provide patient insights from focus groups and surveys conducted during the websites’ development and 6 months post launch - what they wanted to see, what they value most and what they want to see improved with future developments.
Cumulus Cell Analysis for Prediction of Oocyte Quality in IVF and IVM
Authors: SMITZ Johan E.J.
Published: November 2022

Background: In order to promote single embryo transfer (SET) in in vitro fertilization (ICSI) and In Vitro Maturation (IVM) supplementary analysis beyond morphological scoring is needed. The symbiosis between oocyte and cumulus during different stages of follicle development suggests the cumulus as an obvious specimen for molecular analysis. Over the last decade several studies have shown the potential of quantitative RT-PCR to measure predictive genes in ART. However, few prospective studies have validated this potential in routine embryology.

Aim: Summarize the potential clinical use of cumulus gene testing from studies in routine human IVF and IVM.

Methods: Pubmed search and own unpublished data.

Results: So far few prospective studies (Adriaenssens et al., 2019; Van Vaerenbergh et al., 2021) have validated the approach for SET on Day 3 in a selected group of IVF (ICSI) patients in an interventional, non-randomized, assessor-blinded cohort study, by using normalized values of three predictive genes. The outcome demonstrated a significant increase in live birth when selecting single day 3 embryo in the first ICSI fresh transfer cycle based on cumulus gene-expression (of transferable embryos) versus SET based on morphology-only (from 27% to 50%; p<0.0001). A similar non-invasive approach could be developed for the decision making in IVM culture-type (depending on GV maturity grade) and to pinpoint the single IVM embryo to transfer.

Conclusion: Cumulus analysis proves to be a reliable non-invasive technology with promising applications for the routine embryology laboratory.
Addressing Anxiety Using Music and Music Therapy for Women Undergoing Gynaecological and Fertility Treatments
Authors: ANDREADIS Natasha , SHORT Alison , CHEUNG Geena
Published: November 2022

Background: The significant anxiety experienced by women undergoing fertility treatments typically relates to the nature of procedures and examinations, concerns around invasiveness of the procedures, uncertainty around what to expect, and exposing intimate parts of the body. The physiological and psychological consequences of this anxiety may affect the outcomes of fertility procedures. However, music is known to be effective in distracting from worries and concerns, allowing for relaxation and the release of mood-altering chemicals via the parasympathetic nervous system. Based on numerous applications of music therapy, it has been demonstrated that the use of music can effectively address the stress and anxiety associated with medical treatments. However, scant evidence exists about the efficacy of music in reducing anxiety experienced by women undergoing fertility and gynaecological procedures.

Aim: This presentation outlines a funded collaborative research project investigating uses of music and music therapy by women attending a fertility specialist, specifically examining the effects of music listening on anxiety before and during gynaecology and fertility procedures, and a further role for facilitated music therapy sessions.

Method: Women attending office, day surgery and other hospital procedures completed validated self-report surveys before and after procedures and listened to specific music via devices including the Music Star (Lund, Bertelsen & Bonde, 2016). Measures included the State Trait Anxiety Inventory (STAI-6) and the Strategies Used by People to Promote Health questionnaire (SUPPH), supported by additional questions and field notes.

Results: Results indicated that the very high anxiety baseline levels for the 43 participants were significantly reduced by the use of music, and many positive comments were documented.

Conclusion: Additional pilot music therapy sessions indicated a need for further research to understand the way that carefully selected and applied music can assist with the complex needs of women undergoing fertility treatments and support patients during their fertility journey.
Demographics and Cycle Outcomes of Transgender Patients Accessing Gamete Services at Monash IVF Victoria
Authors: CLEMENTS Phillippa , GREEN Mark P , ZANDER-FOX Deirdre , WESTON Gareth , ALESI Rita
Published: November 2022

Background: Since 2003 an increasing number of transgender patients are electing to store gametes prior to transitioning and/or utilising ART services at Monash IVF Victoria.

Aim: The aim of this study was to determine the number of transgender patients accessing gamete storage and utilisation services, as well as their cycle outcomes.

Methodology: A retrospective study of frozen gamete usage of 48 patients collected between 2003-2021 was undertaken.

Results: Trans-female patients were the most common cohort, with 37 patients (16-49yrs, mean age 25.9± 7.7) undertaking semen freezing and two (13yrs and 17yrs) surgical sperm retrieval prior to transitioning. Between 2003-2010 and 2011-2021 six (15.4%) and 33 (84.6%) patients respectively used this treatment. On average 2.3± 2.0 ejaculates/patient were frozen. At freezing 13 (35.1%) patients had >1 ejaculate with a low sperm count and 23 patients (62%) low sperm motility compared to WHO criteria; data were unavailable if patients had already commenced hormonal therapy. Four patients (10.8%) elected to register as sperm donors and their sperm used, while only four (10.8%) trans -female patients have returned, 2-7 years later (mean 5.3± 2.2 years) with a cis -female partner to utilise their gametes; two achieving a live birth.

In contrast, nine trans -male patients (20-29yrs, mean age 23.9± 2.6yrs) undertook oocyte collection; one (11.1%) had treatment in 2003-2010 and eight (88.9%) between 2011-2021. On average 1.4± 0.7 egg freezing cycles/patient were conducted, with 4-30 eggs frozen/collection (mean 14.4± 7.1). One patient donated their oocytes to their cis- female partner in an ICSI cycle 7 years after freezing and achieved one live birth.

Conclusion: Gamete cryopreservation is a valuable service for transitioning patients wishing to preserve fertility; numbers are increasing, with low utilisation to date and successful outcomes recorded. Exploring transgender patient experiences and ART service uptake will provide vital feedback to tailor an inclusive fertility journey at our clinics.
Anti-Mullerian Hormone (AMH) Test Information on Australian and New Zealand Fertility Clinic Websites: A Content Analysis
Authors: COPP Tessa , NICKEL Brooke , LENSEN Sarah , HAMMARBERG Karin , LIEBERMAN Devora , DOUST Jenny , MOL Ben W. , MCCAFFERY Kirsten J.
Published: November 2022

Background: The Anti-Mullerian hormone (AMH) test is promoted to women as a way to find out how long they have left to have children. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility clinic websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence.

Aim: To systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites.

Method: Data were extracted from accredited Australian and New Zealand fertility clinic websites between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, were analysed and the content categorised.

Results: 25 clinic websites included information about the AMH test. The available information embodied four overarching categories; 1) the utility of the AMH test, 2) who the test is suitable for, 3) possible actions in response to the test, and 4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not supported by evidence (e.g. “a good snapshot of current fertility”). Whilst some websites were transparent regarding the test’s limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances (e.g. “women who would like to conceive in the future”).

Conclusion: The quality of information about the AMH test varied considerably. Several websites had statements about the AMH test that are not supported by evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their current or future fertility.
COVID 19- The Rise of Telehealth Within the Specialist Practice: Is it Here to Stay?
Authors: COSTA Samantha , GUINESS Tarryn , YAZDANI Anusch
Published: November 2022

Background: The World Health Organization declared COVID-19 a global pandemic on March 11, 2020 and the world as we knew it came to a stop as Australia entered “Lock Down”, forcing a change in how consultation was delivered to patient. Forcing the rise of Telehealth into Private Specialist practice.

Aim: To investigate the impact of COVID-19 and Telehealth on patient access to care in the Specialist Private Practice Sector.

Method: A retrospective single unit cross sectional analysis of patient consultation type, to compare patient access to telehealth pre pandemic (FY19) and subsequent pandemic financial years (FY20/21, 21/22).

Results: Results showed an increase in initial telehealth appointments by 72% in the 20/21 Financial year and 288% increase during the 21/22 Financial year. Follow up appointments via Telehealth also increase by 106% and 160% respectively. Access to telehealth appointments has also shown a decreasing trend in face-to-face appointments both with initial consultations and follow up appointments.

Conclusion: The use of telehealth appointments rose significantly during the timeframes where access to the clinic was reduced due to lockdown but continues to now be an important modality of access to care for both clinicians and patients. Further research needs to address the enablers and detractors for Telehealth and the translation of traditional face to face consultations and this modality.