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Abstract. Ca[sub 3]Sc[sub 2]Ge[sub 3]O[sub 12] (CaSGG) single crystals with the garnet structure have been grown by means of the flux growth technique. The doping with Nd[sup 3+] and Mg[sup 2+] (as charge compensator) yields samples suitable for optical spectroscopy experiments. The absorption and emission properties have been measured at temperatures ranging from 10 to 298 K. The emission spectra give evidence of the presence of nonequivalent Nd[sup 3+] sites. The decay time of the 1.06-micro m emission band has been measured as a function of temperature and incident power. The intensities of the 298 K absorption transitions have been analyzed by means of the Judd-Ofelt theory. The radiative lifetimes, the branching ratios (beta), and the spontaneous emission probabilities have been evaluated for the 4F[sub 3/2] excited state using the calculated intensity parameters. The stimulated-emission cross sections and the branching ratios have been estimated from the experimental data for the most important laser transitions indicating that this crystal can be considered an interesting material for solid-state laser applications. [ABSTRACT FROM AUTHOR]

Objectives: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs/risks of patients. It consists of a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to assess preliminary the effectiveness of a training program on the clinical use of INTERMED. Methods: After a group training on the use of INTERMED carried out between April and September 2009, the method was applied to 30 female patients aged between 20 and 65, subsequently referring to three clinical settings: a GP clinic; a psychiatry day-care clinic; a CLP out-patient clinic. Demographic and clinical data were collected, together with administration of HADS and WHOQoL-bref. Results: The mean INTERMED score was 20.8, borderline as to definition of complex cases. Patients from the GP clinic and in the CLP setting scored lower (respectively 16.5 and 18.2) than patients from the psychiatric day-clinic (27.8), suggesting that the presence of severe psychiatric disturbances might contribute to increasing the level of case-complexity. Concordance with results at HADS and WHOQoL was high. Conclusions: A clinical practice in the use of INTERMED after the theoretical phase of the training process is necessary to reinforce effectiveness of the training. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena. [Copyright &y& Elsevier]

Objectives: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to describe the training process on the use of INTERMED and to assess its effectiveness. Methods: A training group of 9 subjects had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen''s kappa. Results: Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as satisfaction. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen''s kappa mean value of 0.80) and slightly improved during the course. Conclusions: The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice. [Copyright &y& Elsevier]

Study Question: Is Ongoing Pregnancy Rate (OPR) operator-dependent, and can experience improve embryo transfer efficiency?Summary Answer: OPR is influenced by the operators who perform the embryo transfer (ET), and experience does not assure proficiency for everyone.What Is Known Already: ET remains the critical step in assisted reproduction. Although many other factors such as embryo quality and uterine receptivity impact embryo implantation, the proper ET technique is clearly an operator-dependent variable and as such it should be objectively standardized.Study Design, Size, Duration: Retrospective comparative analysis including all fresh ETs performed between January 1996 and December 2016 at the Humanitas Fertility Center after IVF-ICSI cycles.Participants/materials, Setting, Methods: IVF/ICSI fresh ETs performed by 32 operators, 19 824 cycles in all, were analyzed. All transfers consisting of freehand insertion of a preloaded soft catheter into the uterine cavity under transabdominal ultrasound guidance were considered. Two different statistical analyses were performed. First, a logistic regression model with a random intercept for the operator was used to estimate the heterogeneity of the rate of success among operators, accounting for woman age, FSH, number of oocytes retrieved, fertilization rate, year of the procedure, number and stage of transferred embryos and operator's experience. Second, the relationship between experience and pregnancy rate was estimated separately for each operator by logistic regression, and operator-specific results were combined and compared in a random-effects meta-analysis. In both analyses, the operator's experience at time t was measured in terms of number of embryo transfers performed before t.Main Results and the Role Of Chance: The heterogeneity among operators was highly significant (P value <0.001) and explained 44.5% of the total variability. The odds ratio of success of the worst operator in respect to the mean was equal to 0.84. For the best operator, the odds ratio of success was equal to 1.13 in respect to the mean. Based on the meta-analysis of the relationship between operator's experience and success rate, it resulted that, on average, the operators' performance did not improve with additional transfers.Limitations, Reasons For Caution: At our center, operators become independent for ET's after performing between 30 and 50 transfers under supervision. It is also possible that other relevant factors, such as embryologists on duty for the ET, have not been included in the present analysis and this may represent a potential bias. Among these, it should be mentioned that the embryologists on duty for the ET were not taken into consideration.Wider Implications Of the Findings: Continued performance analysis and the use of a digital simulator could help operators to test their expertise over time and either correct poor performance or avoid doing transfers.Study Funding/competing Interest(s): None.Trial Registration Number: NCT03561129. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Was the delivery rate of ART cycles negatively affected by the enactment of the Law 40/2004 by the Italian Parliament which imposed a long list of restrictions for ART procedures? SUMMARY ANSWER This large and extensive comparative analysis of ART outcomes prior to and after the introduction of the Law 40 revealed a significant reduction in pregnancy and delivery rates per cycle, independent of age or other clinical variables, once the law went into effect. WHAT IS KNOWN ALREADY Several studies have been published on the effect of Law 40/2004 on ART outcomes, some authors demonstrating a negative impact of the Law in relation to specific etiologies of infertility, other authors showing opposite conclusions. STUDY DESIGN, SIZE, DURATION Retrospective clinical study of 3808 patients treated prior to the enactment of the Law, September 1996–March 2004 (Group I) and 6898 treated during the Law, March 2004–May 2009 (Group II). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 10 706 ART cycles were analysed, 3808 performed before and 6898 after the application of the Law. An intention-to-treat statistical analysis was performed to detect pregnancy and delivery rates (pregnancies ≥24 weeks) per started cycle. A P value of <0.05 was considered statistically significant. We analysed different outcomes: differences in fertilization, pregnancy and delivery rate, multiple pregnancies and miscarriage rates between the two time periods. MAIN RESULTS AND THE ROLE OF CHANCE The delivery rate for started cycle was 20% before and 16.0% after the introduction of the Law representing a 25% reduction (P < 0.001). The multivariate analysis, corrected by female age of >38 years, duration of infertility, basal FSH level and number of retrieved oocytes, showed a 16% lower delivery rate (odds ratio: 0.84; confidence interval: 0.75–0.94). This statistical approach removed the risk that the observed effects were due to chance and confirmed unequivocally that the Law was an independent factor responsible for the reduced likelihood of a successful outcome. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study. A prospective randomized study, with patients treated in the same time period and randomized to restrictions or not, would have minimized potential limitations due to differences in years of treatments. WIDER IMPLICATIONS OF THE FINDINGS Our findings based on the analysis of such a large number of cycles proved clearly and unequivocally that imposing restrictions on the practice of ART penalized patients. These data represent a relevant clinical contribution for countries still debating the enactment of restrictive limitations of ART. STUDY FUNDING/COMPETING INTEREST This investigation has been supported by a finalized grant from Lombardy County, Italy (DGR 7255, 3 July 2008). [ABSTRACT FROM AUTHOR]

BACKGROUND In May 2009, the Italian Constitutional Court banned most of the limitations of a restrictive law regulating assisted reproduction technology on the grounds that it limited a couple's right to have access to the best possible medical treatment and reduce any possible higher risk of complications. The aim of the study was to compare our results in fresh cycles before and after this change. MATERIALS AND METHODS We analysed retrospectively 3274 IVF cycles: 2248 before and 1026 after the law was modified. RESULTS There was no significant difference between the two groups in terms of age, basal FSH levels, years of infertility, the number of previous cycles or the number of oocytes retrieved but the number of oocytes used (2.7 ± 0.6 versus 4.6 ± 1.8; P = <0.001), the number of embryos obtained (2.0 ± 0.9 versus 3.3 ± 1.8; P = <0.001) and transferred (2.2 ± 0.7 versus 2.3 ± 0.7; P = <0.001) were all higher after the removal of the previous restrictions, as was the pregnancy rate per started cycle (23.49% versus 20.42%; P = 0.047). Before modification of the law, the pregnancies were single in 74.11% of the cases (versus 71.43% afterwards), twins in 23.44% (versus 26.89%; P = 0.318) and triplets in 2.46% (versus 1.68%; P = 0.594). CONCLUSIONS Our preliminary results after the removal of the previous legal restrictions show a higher pregnancy rate per started cycle (3.7% represents a 15% difference) and a positive (albeit non-significant) trend towards a reduction in the number of multiple pregnancies. [ABSTRACT FROM AUTHOR]

The structural and electronic properties of lithium intercalated fullerides (of which Li[sub 15]C[sub 60] is the most representative) are still puzzling and unclear. Above 520 K, x-ray/neutron diffraction shows an fcc phase in which the 15 Li atoms clusterize in the octahedral interstices. However, at lower temperatures, a change in the crystalline symmetry and also in the electronic properties takes place as observed from [sup 13]C, [sup 7]Li/[sup 6]Li NMR and x-ray diffraction measurements. X-ray diffraction data suggest the presence of two different stable structures: a tetragonal monomeric and an orthorhombic polymerised phase. Detailed [sup 13]C magic angle spinning NME experiments in the latter phase indicate sp[sup 3] bondings among the carbon atoms, whereas the relative (sp²/sp[sup 3]) intensities, together with x-ray data, suggest the C[sub 60] polymerization to be a [2 + 2] cycloaddition. Multiple quantum NMR experiments on Li confirm the presence of lithium clusters, as observed by x-ray diffraction in the high temperature phase, also at lower temperatures. However, the inferred cluster size is significantly smaller than that suggested by the stoichiometry. The distortion in the low-T structure of L[sup 15]C[sub 60] is supposed to induce the migration of Li atoms from octahedral to tetrahedral voids, thus accounting for the lower number of Li atoms in the clusters. Further evidence of this scenario is obtained also from preliminary measurements of line shapes and T[sub 1] relaxation times, which exhibit a multiexponential recovery with very different constants that are hardly compatible with a single family of Li atom sites. [ABSTRACT FROM AUTHOR]