Factors associated with the donation and non-donation of embryos for research: a systematic review

Background: Systematic knowledge on the factors that influence the decisions of IVF users regarding embryo donation for research is a core need for patient-centred policies and ethics in clinical practice. However, no systematic review has been provided on the motivations of patients who must decide embryo disposition. This paper fills this gap, presenting a systematic review of quantitative and qualitative studies, which synthesizes the current body of knowledge on the factors and reasons associated with IVF patients’ decisions to donate or not to donate embryos for research. Methods: A systematic search of studies indexed in PubMed, ISIWoK and PsycINFO, published before November 2013, was conducted. Only empirical, peer-reviewed, full-length, original studies reporting data on factors and reasons associated with the decision concerning donation or non-donation of embryos for research were included. Eligibility and data extraction were performed by two independent researchers and disagreements were resolved by discussion or a third reviewer, if required. The main quantitative findings were extracted and synthesized and qualitative data were assessed by thematic content analysis. Results: A total of 39 studies met the inclusion criteria and were included in the review. More than half of the studies (n ¼ 21) used a quantitative methodology, and the remaining were qualitative (n ¼ 15) or mixed-methods (n ¼ 3) studies. The studies were derived mainly from European countries (n ¼ 18) and the USA(n ¼ 11). The proportion of IVF users who donated embryos for research varied from 7% in a study in France to 73% in a Swiss study. Those who donate embryos for research reported feelings of reciprocity towards science and medicine, positive views of research and high levels of trust in the medical system. They described their decision as better than the destruction of embryos and as an opportunity to help others or to improve health and IVF treatments. The perception of risks, the lack of information concerning research projects and the medical system and the conceptualization of embryos in terms of personhood were the most relevant motives for not donating embryos for research. Results relating to the influence of sociodemographic characteristics and reproductive and gynaecological history were mostly inconclusive. Conclusions: Three iterative and dynamic dimensions of the IVF patients’ decision to donate or not to donate embryos for research emerged from this review: the hierarquization of the possible options regarding embryo disposition, according to the moral, social and instrumental status attributed to embryos; patients’ understanding of expectations and risks of the research on human embryos; and patients’ experiences of information exchange and levels of trust in the medical-scientific institutions.

Breastfeeding and postpartum depression: state of the art review

Objective: To review the literature on the association between breastfeeding and postpartum depression. Sources: A review of literature found on MEDLINE/ PubMed database. Summary of findings: The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother’s self efficacy and her emotional involvement with the child, reducing the child’s temperamental difficulties, and promoting a better interaction between mother and child. Conclusions: Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

Fetal behavior and heart rate in twin pregnancy: a review

Fetal movements and fetal heart rate (FHR) are well-established markers of fetal well-being and maturation of the fetal central nervous system. The purpose of this paper is to review and discuss the available knowledge on fetal movements and heart rate patterns in twin pregnancies. There is some evidence for an association or similarity in fetal movement incidences or FHR patterns between both members of twin pairs. However, the temporal occurrence of these patterns seems to be for the most part asynchronous, especially when stricter criteria are used to define synchrony. The available data suggest that fetal behavior is largely independent of sex combination, fetal position, and presentation. Conversely, chorionicity appears to have some influence on fetal behavior, mainly before 30 weeks of gestation. There is preliminary evidence for the continuity of inter-individual differences in fetal activity and FHR patterns over pregnancy. Comparisons between studies are limited by large methodological differences and absence of uniform concepts and definitions. Future studies with high methodological quality are needed to provide a more comprehensive knowledge of normal fetal behavior in twin pregnancy.

Friedreich's Ataxia: Cardiac Evaluation of 25 Patients with Clinical Diagnosis and Literature Review

OBJECTIVE - Cardiac evaluation (clinical, electrocardiographic and echocardiographic) of 25 Brazilian patients with clinical diagnosis of Friedreich's ataxia (FA) related to the frequency and the size of GAA repeats (unstable expansion of trinucleotide repeats that results in the disease). METHODS - Clinical and cardiac study including electrocardiogram and echocardiogram of all patients and molecular analysis to detect the frequency and the size of GAA expansion, by polymerase chain reaction analysis. RESULTS - Homozygous GAA expansion was detected in 17 patients (68%) -- all typical cases. In 8 (32%) cases (6 atypical and 2 typical), no GAA expansion was observed, therefore it was not considered Friedreich's ataxia. All patients with GAA expansion (100%) had electrocardiographic abnormalities, and only 25% of the cases without GAA expansion had some abnormality on this exam. However, only 6% of all patients revealed some signals/symptoms suggestive of cardiac involvement. CONCLUSION - A molecular analysis is essential to confirm the diagnosis of Friedreich's ataxia; however, an adequate cardiac evaluation, including an electrocardiogram, was extremely useful to better screening the patients which should perform these molecular analysis.

Cardiac Damage from Chronic Use of Chloroquine: A Case Report and Review of the Literature

Chloroquine has been widely used in rheumatological treatment, but potential severe side effects require careful follow-up. Cardiac damage is not a common consequence, but its clinical relevance has not yet been described. We report the case of a 58-year-old woman with rheumatoid arthritis, in whom chronic chloroquine use resulted in major irreversible cardiac damage. She presented with syncopal episodes due to complete atrioventricular block confirmed by electrophysiological study whose changes were concluded to be irreversible and a permanent pacemaker was indicated. Endomyocardial biopsy was also performed to search for histopathological and ultrastructural cardiac damage. We also reviewed the 22 cases of chloroquine-induced cardiopathy described to date as well as its pathophysiology.

Iglesia argentina y memoria de las víctimas de la última dictadura militar. Revisión del discurso y de la praxis eclesial de reconciliación, a partir de determinados aportes de la Escuela de Frankfurt y de la Nueva Teología Política. Argentine Church and Memory of the Victims of the Military Dictatorship. Review of the Ecclesiastic Discourse and Praxis of Reconciliation.

En el marco de la recuperación de la memoria en relación con los hechos de la última dictadura militar es importante determinar los motivos ideológico-teológicos y prácticos que dificultaron una oposición significativa por parte de la jerarquía de la iglesia a la violación de los derechos humanos, e individualizar los argumentos que impulsaron un discurso y una praxis de reconciliación que privilegió el olvido de las víctimas y apoyó acríticamente los «proyectos de olvido», como la ley de punto final, entre otros. Para analizar dichos discursos y praxis se recurre principalmente a Johann Metz, quien, vinculado a la Escuela de Frankfurt, propone una razón anamnética del sufrimiento ajeno. La originalidad del proyecto es doble, por su contenido y por su enfoque: la confrontación del «servicio de reconciliación» eclesial con la «memoria de las víctimas». Hipótesis de trabajo: el discurso y la praxis eclesial en relación al «servicio de reconciliación» realizado por el Episcopado argentino a partir de 1981, pone de manifiesto: primero, que siguieron vinculados a la idea de "nación católica" (Zanatta 1996, Dri 1997, Esquivel 2004), lo que dificultó, junto a otros factores, la visibilización de las víctimas; segundo, a su vez, analizados a la luz de los aportes filosófico-teológicos mencionados, muestran una notable carencia en la valoración de la memoria de las víctimas, esperable en una reconciliación. Objetivo general: realizar un análisis crítico de los discursos y prácticas institucionales oficiales de la Iglesia católica en Argentina en relación con la memoria de las víctimas de la última dictadura militar. Objetivos específicos: confrontar las experiencias eclesiales argentinas recientes, y sus conceptualizaciones y tipos de argumentación, con una tradición de pensamiento que en relación al acontecimiento del Holocausto sitúa en el centro de la reflexión temas como el de la memoria, el sufrimiento de las víctimas, y un modo peculiar de tratamiento de los hechos históricos; además, individualizar y analizar los argumentos que dificultaron la búsqueda de la justicia y la memoria de las víctimas. Metodología y etapas. 1° Etapa: analizar y sistematizar algunos aspectos de las teorías del conocimiento histórico y de la razón comunicativa en determinadas obras de Benjamin, Bloch y Habermas; posteriormente, precisar la apropiación conceptual de las categorías histórico-filosóficas de dichas corrientes llevada a cabo por Metz para elaborar su «memoria de las víctimas». 2° Etapa: revisar el discurso y la praxis eclesial a partir de 1981 a la luz del marco teórico ya estudiado. Será necesario, por una parte, detenerse en las declaraciones eclesiales oficiales referidas al retorno de la democracia, a las leyes de punto final y obediencia debida, como así también, en el reconocimiento y pedido de perdón por las culpas del pasado.

A review of the development of regional sludge treatment centres and a baseline characterisation of Irish sewage sludges

This Study assessed the development of sludge treatment and reuse policy since the original 1993 National Sludge Strategy Report (Weston-FTA, 1993). A review of the 48 sludge treatment centres, current wastewater treatment systems and current or planned sludge treatment and reuse systems was carried out Sludges from all Regional Sludge Treatment Centres (areas) were characterised through analysis of selected parameters. There have been many changes to the original policy, as a result of boundary reviews, delays in developing sludge management plans, development in technology and changes in tendering policy, most notably a move to design-build-operate (DBO) projects. As a result, there are now 35 designated Hub Centres. Only 5 of the Hub Centres are producing Class A Biosolids. These are Ringsend, Killamey, Carlow, Navan and Osberstown. Ringsend is the only Hub Centre that is fully operational, treating sludge from surrounding regions by Thermal Drying. Killamey is producing Class A Biosolids using Autothermal Thermophilic Aerobic Digestion (ATAD) but is not, as yet, treating imported sludge. The remaining three plants are producing Class A Biosolids using Alkaline Stabilisation. Anaerobic Digestion with post pasteurisation is the most common form of sludge treatment, with 11 Hub Centres proposing to use it. One plant is using ATAD, two intend to use Alkaline Stabilisation, seven have selected Thermal Drying and three have selected Composting. While the remaining plants have not decided which sludge treatment to select, this is because of incomplete Sludge Management Plans and on DBO contracts. Analysis of sludges from the Hub Centres showed that all Irish sewage sludge is safe for agricultural reuse as defined by the Waste Management Regulations {Use of Sewage Sludge in Agriculture) (S.I. 267/2001), providing that a nutrient management plan is taken into consideration and that the soil limits of the 1998 (S.I. 148/1998) Waste Management Regulations are not exceeded.

The Nature-study review : devoted to all phases of nature-study in elementary schools.

v. 9 (1913)

The natural history review.

1862

The Nature-study review : devoted to all phases of nature-study in elementary schools.

v. 2 (1906)

The Nature-study review : devoted to all phases of nature-study in elementary schools.

v. 1 (1905)

The Nature-study review : devoted to all phases of nature-study in elementary schools.

v. 3 (1907)

Clinical and echocardiographic predictors of mortality in chagasic cardiomyopathy - systematic review

Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.