Embryo and uterine influences on IVF outcomes: an analysis of a UK multi-centre cohort.

BACKGROUND: In order to optimize IVF strategies, particularly with the use of single embryo transfer, good predictive models are required. Here, we develop a model to allow such prediction, and the structure of the models point to more general conclusions about the mode of action of prognostic factors. METHODS: Anonymized data from consecutive embryo transfers in five IVF centres in the UK for the 2000-2005 period were extracted and the morphological grade based on common scoring criteria was included. There were 16 096 (12 487 fresh and 3609 frozen) transfers, for 8775 couples, available for analysis. Live birth data were fitted to a model with separate sub-models for embryo and recipient effects [the 'Embryo-Uterus' (EU) model]. All covariates were included, with sub-model selection using Akaike's information criterion. RESULTS: Age, number of embryos created, attempt number, previous history of pregnancy, duration of infertility, day of transfer and tubal diagnosis were all identified as significant prognostic factors, along with embryo grade and growth rate. Frozen transfers were substantially less likely to lead to a live birth with odds ratios of 1/3 to 1/2 compared with fresh transfers, with no evidence of differential loss for any particular patient group. Age acts predominantly through the embryo component with only a weak effect on the uterus. The embryo number, attempt number, previous pregnancies and duration of infertility act predominantly through the uterine environment. Both sub-models show significant heterogeneity between centres. CONCLUSIONS: The EU modelling framework has generated a model for predicting outcomes of embryo-transfer procedures, subject to the limitations of routinely collected data. With this large data set, the model allows identification of factors that act specifically on embryo viability or maternal receptivity. Variability in the two components between centres with similar overall outcomes suggests scope for further optimization of IVF treatment.

Are speed enforcement cameras more effective than other speed management measures? The impact of speed management schemes on 30 mph roads.

This paper presents the results of an evaluation of the impact of various types of speed management schemes on both traffic speeds and accidents. The study controls for general trends in accidents, regression-to-mean effects and migration, separately estimating the accident changes attributable to the impact of the schemes on traffic speed and on traffic volume. It was found that, when judged in absolute terms, all types of speed management scheme have remarkably similar effects on accidents, with an average fall in personal injury accidents of about 1 accident/km/year. In terms of the percentage accident reduction, however, engineering schemes incorporating vertical deflections (such as speed humps or cushions) offer the largest benefits: at 44%, the average reduction in personal injury accidents attributable to such schemes, is twice that at sites where safety cameras were used to control speeds (22%) and they were the only type of scheme to have a significant impact on fatal and serious accidents. Other types of engineering scheme (with a fall of 29% in personal injury accidents) were on average less effective in reducing accidents than schemes with vertical features but more effective than cameras. All types of scheme were generally effective in reducing speeds, with the largest reductions tending to be obtained with vertical deflections and the smallest with other types of engineering schemes.

Are speed enforcement cameras more effective than other speed management measures? An evaluation of the relationship between speed and accident reductions.

In this paper, models are developed which enable a prediction of how the impact of speed management schemes on accidents varies both with speed changes and with site and scheme characteristics. It was found that, the impact of schemes with vertical deflections is independent of the change in mean speed: an accident reduction of 44% is predicted by the model irrespective of the impact on speed. For cameras and other types of engineering schemes, a simple relationship between the change in mean speed and the consequent change in accidents is available. For the range of mean speeds typically found on 30 mph roads, the percentage accident reduction per 1 mph speed reduction is around 4% for cameras and 7-8% for schemes with horizontal features. While larger percentage accident reductions are achieved per 1 mph speed reduction on lower speed roads, larger speed reductions and larger overall percentage accident reductions are obtained on roads with higher before mean speeds. It is possible to predict both changes in speeds and accidents before treatment using the models derived from this study and these models confirm that schemes with vertical deflections are most effective in reducing both speeds and accidents.

Sources of error in road safety scheme evaluation: a quantified comparison of current methods.

This paper considers the various factors that can have a confounding effect in the evaluation of road safety schemes and examines the extent to which current methods can effectively deal with these. A modification to current methods is proposed which allows the reduction in accidents attributable to risk and flow changes to be separately evaluated. Data are presented to demonstrate the relative magnitudes of the various sources of error. It is shown that a principal source of error is normally regression-to-mean (RTM) and a correction for this effect should always be applied. Changes in traffic flow can also result in substantial accident changes and it is important to establish whether flow changes have occurred and if they are attributable to the effect of the scheme.

Sources of error in road safety scheme evaluation: a method to deal with outdated accident prediction models.

This paper considers the errors that arise in using outdated accident prediction models in road safety scheme evaluation. Methods to correct for regression-to-mean (RTM) effects in scheme evaluation normally rely on the use of accident prediction models. However, because accident risk tends to decline over time, such models tend to become outdated and the estimated treatment effect is then exaggerated. A new correction procedure is described which can effectively eliminate such errors.

A systematic compilation and classification of the literature on lameness in cattle.

This paper presents the first systematic review of the literature on lameness in cattle. It identifies, tabulates and classifies relevant published work and was conducted using electronic reference databases (BIDS ISI, BIOSIS, MEDLINE and the CAB Abstracts CD-ROM). A total of 1373 unique references were obtained from 1981 to 2000, of which 914 were written in the English language. A written search protocol was designed to ensure transparency and repeatability. Pilot studies were undertaken to create search terms that minimised bias and ensured relevance. Electronic files of the search terms allow the database to be updated in future. A further 93 references were included from the most recent international conference on lameness giving a total of 1007 English language references. The systematic review process is described, including a method of classifying papers according to their study design and statistical analysis, and it is hoped that other veterinary researchers will conduct similar reviews in their fields. The compiled and classified references are available as a searchable database through the web-sitehttp://cattle-lameness.dhs.org/. The review may be used in several ways; to identify practical interventions to reduce lameness in dairy cows and to use the resultant web-site as the basis of a decision support system for farmers, veterinarians and advisors.

Generalised additive models and hierarchical logistic regression of lameness in dairy cows.

We examined the relationship between lameness (defined by locomotion score) and four time-related variables using data collected from a study of cattle lameness conducted in the UK from 1998 to 1992. The data were 19,667 locomotion scores for 1790 cows from 27 dairy herds; the four variables were time-from-calving, time of year, parity and time spent in the study. The shape of the relationships between calving and temporal variables and lameness were assessed using loess smoothed terms in a multivariable logistic generalised additive model (GAM). Polynomial relationships derived from the GAM then were included in a Bayesian hierarchical logistic-regression model incorporating between-herd, between-cow and within-cow random effects. The final hierarchical multivariable model showed that the most important variable influencing the probability of lameness was the time of scoring in the study; but, parity, time of year and time-from-calving also were significant. Between-herd and between-cow effects were of roughly equal importance.

A mixed-effects time-to-event analysis of the relationship between first-lactation lameness and subsequent lameness in dairy cows in the UK.

Data for 611 second-lactation and 251 third-lactation cows were examined using mixed-effects time-to-event models to determine the shape of the hazard, quantify relative risk and estimate herd- and sire-level variation in time to lameness. The semi-parametric Cox and fully parametric Weibull models were suggested from univariable Kaplan-Meier plots. Time to all-lameness, claw-horn lameness and skin lameness were modelled. Explanatory variables were season of current-lactation calving, age at first calving and first-lactation lameness history (whether all-lameness or claw-horn and skin lameness). In mixed-effects models of lactation-2 lameness, previously lame cows had a significantly increased hazard (hazard ratio (HR)=2.0 for all types of lameness and HR=3.2 for claw-horn lameness) compared to those not previously lame. These relationships were less marked in the third lactation. There was little evidence for an effect of age at first calving, whilst possible differences between calving seasons were observed. The hazard function suggested that the rate of lameness was roughly flat across each lactation. Herd-level variation was more evident for infectious foot diseases. The contribution of the sire increased with parity and might be important for sole ulcer and white-line disease.

Smallholder dairy farming in the Chikwaka communal land, Zimbabwe: birth, death and demographic trends.

A study of mortality, morbidity and productivity of cattle on smallholder dairy farms was conducted in Chikwaka communal land, Zimbabwe. We estimated the frequency and determinants of mortality in DDP cattle and explored demographic trends. Using Cox proportional-hazards modelling (with the farm as a random effect), the animal-level variables associated with mortality were age, sex and breed. Calf mortality was 35% of calves within the first year of life. This was nearly five-times higher than adult mortality (relative risk (RR) 4.73, 95% CI 2.12, 10.6). Females had lower mortality than males (RR=0.25, 95% CI 0.11, 0.56). After adjusting for the confounding effects of age, Jersey breeding was associated with higher mortality (RR=2.89, 95% CI 1.16, 7.22) whereas Red Dane breeding was associated with lower mortality (RR=0.27, 95% CI 0.11, 0.69). Farms with a higher ratio of non-DDP:DDP cattle had higher mortality in their DDP cattle. Leslie-matrix models simulated population growth and showed that (at the current levels of mortality and fertility) the population would double in approximately 10 years.