Therapeutic effect of prolonged testosterone pretreatment in women with poor ovarian response: A randomized control trial.

PURPOSE: This study compared the therapeutic effects of transdermal testosterone gel (TTG) application at 4 and 6 weeks before controlled ovarian hyperstimulation (COH) in women with poor ovarian response (POR). METHODS: In this randomized control trial, infertile women with POR who underwent in vitro fertilization (IVF) were recruited and randomly classified into 4 week (n = 42) and 6 week (n = 38) TTG treatment groups and control group (n = 42). The primary outcome was total number of retrieved mature oocytes. The secondary outcomes were the biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate. RESULTS: No significant differences were observed in the number of oocytes retrieved, mature oocytes and embryos between all groups. Human chorionic gonadotropin (hCG) positive, clinical, and ongoing pregnancy rates were significantly higher in the TTG pretreatment groups than in the control group but no differences were observed between the 4- and 6 week groups. CONCLUSIONS: Applying TTG in infertile women with POR may ameliorate the outcomes of IVF. The extended application of TTG to 6 weeks did not improve the response to ovarian stimulation regarding the number of retrieved oocytes nor pregnancy outcomes compared to the 4 week pretreatment.

Financial viability of electric vehicle lithium-ion battery recycling.

Economically viable electric vehicle lithium-ion battery recycling is increasingly needed; however routes to profitability are still unclear. We present a comprehensive, holistic techno-economic model as a framework to directly compare recycling locations and processes, providing a key tool for recycling cost optimization in an international battery recycling economy. We show that recycling can be economically viable, with cost/profit ranging from (-21.43 - +21.91) $·kWh-1 but strongly depends on transport distances, wages, pack design and recycling method. Comparing commercial battery packs, the Tesla Model S emerges as the most profitable, having low disassembly costs and high revenues for its cobalt. In-country recycling is suggested, to lower emissions and transportation costs and secure the materials supply chain. Our model thus enables identification of strategies for recycling profitability.

The EV revolution: The road ahead for critical raw materials demand.

Mass adoption of electric vehicles (EVs) is anticipated in the years ahead, driven primarily by policy incentives, rising incomes, and technological advancements. However, mass adoption is predicated on the availability and affordability of the raw materials required to facilitate this transformation. The implications of material shortages are currently not well understood and previous research tends to be limited by weak representation of technological change, a lack of regional disaggregation, often inflexible and opaque assumptions and drivers, and a failure to place insights in the broader context of the raw materials industries. This paper proposes a CoMIT (Cost, Macro, Infrastructure, Technology) model that can be used to analyse the impact of mass EV adoption on critical raw materials demand and forecasts that, by 2030, demand for vehicles will increase by 27.4%, of which 13.3% will be EVs. The model also predicts large increases in demand for certain base metals, including a 37 and 18-fold increase in demand for cobalt and lithium (relative to 2015 levels), respectively. Without major changes in certain technologies, the cobalt and lithium supply chains could seriously constrain the widespread deployment of EVs. Significant demand increases are also predicted for copper, chrome and aluminium. The results also highlight the importance of China in driving demand for EVs and the critical materials needed to produce them.

Update on Medical Education, Insurance Coverage, and Health Care Policy for Lesbian, Gay, Bisexual, Transgender, Questioning, Intersexual, and Asexual Patients.

There are important gaps in LGBTQIA knowledge, clinical competency, and cultural sensitivity, as well as attitudes among health care professionals, medical educators, and those in the public and insurance policy sectors. These are not only professional deficiencies but also perpetuate discrimination, limit access to health care, and lead to poor health outcomes. Research supports the notion that acquiring skills and knowledge through dedicated training programs leads to more compassionate and competent care for LGBTQIA patients.

Supreme Laryngeal Mask Airway versus Face Mask during Neonatal Resuscitation: A Randomized Controlled Trial.

OBJECTIVE: To assess the effectiveness of supreme laryngeal mask airway (SLMA) over face mask ventilation for preventing need for endotracheal intubation at birth. STUDY DESIGN: We report a prospective, randomized, parallel 1:1, unblinded, controlled trial. After a short-term educational intervention on SLMA use, infants ≥34-week gestation and/or expected birth weight ≥1500 g requiring positive pressure ventilation (PPV) at birth were randomized to resuscitation by SLMA or face mask. The primary outcome was the success rate of the resuscitation devices (SLMA or face mask) defined as the achievement of an effective PPV preventing the need for endotracheal intubation. RESULTS: We enrolled 142 patients (71 in SLMA and 71 in face mask group, respectively). Successful resuscitation rate was significantly higher with the SLMA compared with face mask ventilation (91.5% vs 78.9%; P = .03). Apgar score at 5 minutes was significantly higher in SLMA than in face mask group (P = .02). Neonatal intensive care unit admission rate was significantly lower in SLMA than in face mask group (P = .02). No complications related to the procedure occurred. CONCLUSIONS: In newborns with gestational age ≥34 weeks and/or expected birth weight ≥1500 g needing PPV at birth, the SLMA is more effective than face mask to prevent endotracheal intubation. The SLMA is effective in clinical practice after a short-term educational intervention. TRIAL REGISTRATION: Registered with ClinicalTrials.gov: NCT01963936.