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The effect of the 2004 Italian legislation on perinatal outcomes following assisted reproduction technology
No full textObjective: To assess the perinatal outcomes of the first three years under the 2004 Italian reproductive legislation obligating transfer of all embryos resulting from insemination of ≤3 oocytes. Study design: We compared the perinatal results of clinical assisted reproductive technology (ART) pregnancies during the three years following the new Italian legislation with the previous three years. Results: There were 583 and 571 clinical pregnancies during the respective periods. Before the law, the overall embryonic and fetal loss rates were significantly higher resulting in a significantly lower rate of live born infants and significantly fewer clinical pregnancies with at least one live born infant. Quadruplet and quintuplet pregnancies were entirely eliminated following the 2004 law but the neonatal mortality rate was not different between the two study periods. Conclusion: The 2004 Italian infertility legislation led to improved quantitative and qualitative outcomes of ART. © 2009 by Walter de Gruyter
High risk of unexpected late fetal death in monochorionic twins despite intensive ultrasound surveillance: A cohort study
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A Personal Perspective on Multiple Pregnancy and Birth
No full textIn my role as the author of this chapter, I would like
to be a voice for the parents who are asking for help
from medical professionals as they seek to realize the
best possible outcomes of their multiple-gestation,
high-risk pregnancies. I speak from personal experience, having given birth to triplets born at 29 weeks’
gestation over 21 years ago, as well as from contact
with and the detailed medical questionnaires from
approximately 1500 expectant parents of multiple
births each year (more than 30 000 since 1983). Our
detailed medical questionnaires are completed by
members and are sent to The Triplet Connection,
the largest organization of its kind in the world.
From this ‘bird’s-eye’ perspective, I try to keep
abreast of what is going on in the medical field
of obstetrics concerning multiple births, as well as
to read and hear comments and perspectives from
thousands of women for whom I act as a quasispokesperson. I know of their fears, their need for
knowledge and involvement, their sensitivity and
need for compassionate and expert care, and of their
desire to have healthy outcomes as well as adequate
support and resources during pregnancy and afterward. From the beginning of pregnancy to the care
of their multiple-birth offspring, these women desperately need the understanding and positive support of those who will guide them through one of the
most emotionally charged and physically challenging
experiences they will ever undergo
Monozygotic twin differences in perceived age
No full textOne of the possibilities to assess differences between monozygotic (MZ) twins, theoretically identical, is the perceived age as an estimate of biological age between MZ pairs. When we consider a lifelong exposure to environmental influences and insults of any sort, the initial more pronounced similarity between MZ twins will increasingly diverge with age. Despite the high heritability in perceived age, there is still a big absolute intrapair variation in this parameter between MZ twin pairs. Still the intrapair correlation was high even after age 70. Using data derived from the Danish Twin Registry, the authors investigated the relative influence of genetic and environmental factors on aging phenotypes. This chapter focuses on perceived age of MZ twins older than 70 years as a biomarker of aging and discuss how perceived age is associated with health and survival.</p
Psychological vulnerability of singleton children after the 'vanishing' of a co-twin following assisted reproduction
Get PDFWe test the hypothesis that parents who conceived twins by assisted reproduction technology (ART), but experienced loss of one twin, have a different parental-child relationship compared with ART parents following a singleton pregnancy. We used the 1994-2005 ART database of the Centre for Infertility of the Arcispedale Santa Maria Nuova in Reggio Emilia, Italy to identify families of 53 singleton births after the 'vanishing' twin syndrome. The controls comprised 106 families who conceived and delivered singletons, matched for gestational age (≥ 28 ≤ 31, ≥ 32 ≤ 36, ≥ 37 weeks), maternal age ( 40 years), child's age (1-3, 4-6, and 7-11 years) and child's gender. We completed 3 tests: a sociodemographic questionnaire, the QUIT - Italian Questionnaires of Temperament - motor scale, and the Child Vulnerability Scale. We found that children in the study had significantly more difficulties at the beginning of nursery school (p = .002) and kindergarten (p = .0005), with more frequent anxiety of separation from the parents (nursery school, p = .009; kindergarten, p = .001). We found a lower mean QUIT motor score for the 7- to 11-year-old children when compared to the general Italian normative values, suggesting that parents perceived their children as having more motor difficulties. In contrast, analysis of the Child Vulnerability Scale showed that significantly more parents (15.1%) from the controls perceived their child as vulnerable compared to those from the study group (3.8%), p = .034. We conclude that despite the perceived motor difficulties and the difficulties in the process of individuation-separation that appear at the beginning of the different educational circumstances, parents of singletons following the 'vanishing' twin syndrome perceive their children as 'invincible', and thus less vulnerable compared to controls
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Timing and mode of delivery in twins : the ongoing controversy
No full textTese de doutoramento, Medicina (Ginecologia e Obstetrícia), Universidade de Lisboa, Faculdade de Medicina, 2014Twins occur when more than one offspring is produced in the same pregnancy. They can result from one or several zygotes – Monozygotic (MZ) and Dizygotic (DZ) twins. DZ twins are always dichorionics (DC) with as many placentas and amniotic sacs as the number of fetuses. MZ twins can also be dichorionic (18-30%) or have only one placenta – monochorionic (MC). This last kind of twins might have one amniotic sac for each fetus (60-70%) – MC-DA twins, or only one amniotic sac for both fetuses – MCMA twins (1-2%). In our days, twin births represent 30‰ of all births in Portugal. Twin gestation is a high risk pregnancy whose successful outcome depends on timely diagnosis of several maternal or fetal problems. In this thesis, we try to establish the best sonographic measurements to identify twin pairs with an intertwin weight discordance >25%, we analyze the benefit of changes in BMI to mothers carrying DC twins, and we evaluate the risk factors and the outcomes of twin pregnancies with gestational diabetes mellitus. However the main goal of this work is to determine the optimal time of delivery for an uncomplicated twin gestation, the safety of labor induction and the puerperal morbidity of cesarean (CS) delivery in twins. Current recommendations suggest the optimal time of delivery for DC twins is at 37-38 wks, at 36-37 wks for MC-DA twins and at 32-34 wks for MC-MA twins. A vaginal delivery could be considered for vertex-vertex twins and vertex-non vertex twins, when the provider’s skills and experience allow, and is safe in MC-DA twins. Protocol for induction of labor used in singletons is applicable in twins and misoprostol is safe for labor induction. A Cesarean section is recommended in MC-MA, non - vertex presenting twins, when the second twin is ≥40% larger than the presenting twin and women with a uterine scar. Patients should receive thorough information about the risks of vaginal and CS deliveries and the vaginal route should be performed by a medical team with experience in obstetric maneuvers.Chamam-se gémeos às crianças nascidas de uma mesma gravidez. Podem resultar de um zigoto - Monozigóticos (MZ), ou de vários zigotos - Dizigóticos (DZ). Os gémeos DZ possuem tantas placentas e bolsas amnióticas como fetos - Dicoriónicos (DC). Os gémeos MZ são também DC em 18 a 30% dos casos e nos restantes têm uma só placenta para todos os fetos – Monocoriónicos (MC). Neste último tipo de gémeos, em 60-70% dos casos cada feto tem a sua bolsa amniótica – gémeos MC diamnióticos (DA) e em 1 a 2% dos casos existe apenas uma única bolsa – gémeos MC monoamnióticos (MA). Os partos gemelares representam na atualidade 30‰ de todos os partos em Portugal. A gravidez múltipla é uma gravidez de alto risco e o seu sucesso obstétrico depende do diagnóstico atempado das diversas complicações maternas e fetais. Nesta tese tentámos estabelecer um método ecográfico eficaz para identificar a existência de discordância de peso entre os gémeos superior a 25%. Analisar o efeito das variações no Índice de massa corporal nas grávidas de gémeos e avaliar os fatores de risco e o impacto da diabetes gestacional. Contudo o principal objetivo desta tese foi determinar a idade gestacional adequada para o parto nas gravidezes múltiplas sem complicações, a segurança da indução do trabalho de parto e a morbilidade materna do parto por cesariana (CS). A nossa experiência e as recomendações atuais sugerem efetuar o parto nos gémeos DC com 37-38 semanas, nos MC-DA com 36-37 e nos MC-MA com 32-34 semanas. O parto vaginal induzido com protocolo idêntico ao da gravidez simples pode ser considerado nos gémeos DC e MC-DA, cefálico-cefálico e cefálico-não cefálico. O misoprostol é uma droga segura na indução de trabalho de parto em gémeos. A CS é recomendada para os MC-MA, quando o 1º gémeo não é cefálico, quando o 2º gémeo é ≥40% maior que o 1º e no útero com cirurgia prévia. Temos sempre o dever de informar os casais sobre o risco do parto vaginal e da CS e a via de parto deve ter em linha de conta a experiência em manobras obstétricas da equipa que o vai realizar
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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