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Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.

To determine the effect of pooling of patients for elective non-instrumented lumbar decompression on patient satisfaction and waiting times.We performed a retrospective review of Spine Tango and Theatre Databases of our Neurosurgical unit for patients who underwent elective primary non-instrumented lumbar decompression between January 2012 and 2016. Patient satisfaction scores at 3 and 12 months post-surgery were collected from the Spine Tango Registry, and patients categorised as pooled/non-pooled by searching theatre databases to determine their named listing and operating consultants. Results were analysed numerically and by performing chi-squared testing to determine if pooling affected patient satisfaction. Theatre records were analysed between January 2004-2006, January 2009-2011 and 2014-2016 to determine what effect implementation of the 18-week wait target system (2009) and of our pooled system (2012) had on waiting times to operation for patients undergoing elective primary non-instrumented lumbar decompression.There is no significant difference in patient satisfaction levels between pooled and non-pooled patients at 3 (p = .052) and 12 months (p = .5) post primary elective lumbar decompression (significance p .05). There was no difference in average waiting time between the pooled and non-pooled groups. Both setting of 18-week targets and pooling improved waiting times. Setting of 18-week targets affected average waiting times markedly while pooling most notably reduced the variability in waiting times between patients for the same procedure.Pooling of patients for elective non-instrumented lumbar decompression in our unit has improved waiting times, particularly the variability in them, with no detriment to patient satisfaction. We would recommend other units to consider developing a system of pooling such as ours, to help maximise use of their current resources and avoid highly variable waiting times for patients for the same procedure within the same department.

Introduction: Vestibular schwannomas (VS) account for approximately 85% of tumors in the cerebello-pontine angle, with a lifetime incidence of approximately 1 in 1000. Most are sporadic, with approximately 5% related to the tumor predisposition syndrome Neurofibromatosis Type 2 (NF2). The mainstays of management strategies are: observation, surgery, radiosurgery/radiotherapy and, for patients with NF2 and rapidly growing tumors or deteriorating neurologic function the targeted therapy bevacizumab. While morbidity and mortality rates related to treatment of VS have improved dramatically over the last decades, there are still significant improvements that could be made, in particular with regards to long-term facial nerve and hearing outcomes.Areas covered: The epidemiology and diagnosis of VS are discussed, followed by the different management strategies and outcomes of those for both sporadic and NF2 related tumors. An extensive literature review has been performed to inform this review article using PubMed and Google Scholar.Expert commentary: The future direction of VS management lies in obtaining longer-term follow-up data for patients with treated VS, and in improved understanding of cellular pathways and targeted therapies.

Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.

Objective: To investigate the age at which young adults recalled learning about being assistive reproductive technologies (ART)-conceived and the association with subjective well-being and parental relationship. Background: The use of ART is increasing. Parents are encouraged to tell children about the way they were conceived when they are young. Little is known about whether age when learning about being ART-conceived influences adult well-being. Methods: A structured interview was conducted with women who gave birth as a result of ART in Victoria, Australia 1982–1992 and their young adult offspring. The young adults’ interview included questions about age when learning about ART conception and perceived quality of the parental relationship, and a standardised measure of subjective well-being. Results: 547/594 (92%) young adults agreed to participate. Of these, 10.6% (n = 58) were conceived with donor gametes; 77% had been informed about their ART-conception before the age of 12, 18% when they were betwe...

Scanning of post-operative meningioma patients to detect tumour recurrence is common practice. There are however no guidelines for how often this should be performed for meningiomas of differing Simpson Grades of surgical removal and World Health Organisation (WHO) histological grades. A literature search reveals no studies investigating its role in post-operative care. The objective of this study was to determine current post-operative scanning use, in particular its timing and frequency in relation to meningioma recurrence rate. We performed a retrospective analysis of the surgical records of patients that underwent meningioma excision between 1998 and 2003 in Addenbrookes Hospital, and their follow-up scans up to 9 years post-surgery. Age at surgery, Simpson grade of surgical removal, tumour location, WHO histological grade, post-surgical radiotherapy, dates of meningioma recurrences, and dates of post-operative CT and MRI scans up to present, were recorded for each patient. A total of 283 records were analysed. Using logistic regression we found that WHO grade and post-surgical radiotherapy were the strongest predictors of meningioma recurrence. We found that timing and frequency of scans between patients of the same stage and grade is highly variable. Data suggests that the role for regular short term post-operative scanning of WHO grade 1 meningioma patients, a group that form the bulk of meningioma patients, is limited, and should only be performed in select, clinically indicated cases. A time and cost analysis reveals that significant savings can be made by adopting this policy. Data from a greater number of patients with WHO grade 2 and 3 meningiomas needs to analysed before definite conclusions can be made about the regularity of post-operative scanning in these patients. Our audit study has revealed an opportunity for significant monetary and time savings to be made without any compromise of patient care.

This questionnaire-based study in Victoria, Australia, examined the responses of pregnant women, aged 37 years and over, to a question about what they expected prenatal testing (screening and/or diagnosis) for birth defects to tell them about their pregnancy. Content analysis showed that, of the 432 tested women, 61.3% mentioned Down syndrome, chromosomal abnormalities or trisomies. Women undergoing both screening and diagnosis were more likely than those having one or other test to mention Down syndrome (adjusted OR = 1.6, P = 0.06), having adjusted for age, marital status, education, residence and parity. Similarly, those from an English-speaking background were more likely to mention Down syndrome, etc. compared to women from a non-English-speaking background (adjusted OR = 3.5, P < 0.001). Down syndrome, a fundamental piece of information about prenatal tests, was not mentioned in nearly 40% of women's responses. This suggests that pregnant women need clearer information about prenatal testing, including the conditions that might be detected.

In this paper, we examine reasons for declining both prenatal screening, and diagnosis among a small group of pregnant women in Victoria, Australia. Semi-structured questionnaires were used to elicit women's account of their refusals of offers during pregnancy. Previous literature suggests that women decline prenatal screening and diagnosis because they are against abortion and the medicalisation of pregnancy, and have conoerns about the health and well-being of their fetuses. Women in this study had similar reasons but they also had other reasons for declining. Most clearly was that related to 'risk' brought about by the prospect of knowledge gained from undertaking prenatal screening and diagnostic tests, which would cause emotional distress and lead to further difficult decisions. The results have implications for the development and expansion of prenatal screening and diagnosis for pregnant women in Australia and elsewhere. We are not suggesting that prenatal screening and diagnosis is a problem for all women or even most women. However, health service providers must provide information about prenatal screening and diagnosis that is appropriate for all pregnant women, presenting all options, including that of not having any screening or diagnostic test. In doing so we will be facilitating the opportunity for women to make an informed choice and acknowledging the existence and importance of this small, but concerned group of women.

A total of 6085 adult Trichoptera (excluding Hydroptilidae) representing 12 families, 31 genera, and 56 species were collected by a combination of Malaise net and light trapping from July 1998 to July 1999 at three hill‐country sites of contrasting catchment land use (100% native forest, a pasture site with native forest headwaters, and 100% pasture) in the Waikato, northern New Zealand. Forty‐eight species of Trichoptera were collected from Malaise nets and 45 species from light traps. Eleven species of Trichoptera were only ever collected from the Malaise nets and seven species from only the light traps. At the native forest site, Malaise nets collected more species and taxa of conservation interest than did light traps, possibly reflecting diurnal activity or non‐attraction to light by some species. Several species of Trichoptera showed site specificity and most of these were found at the native forest site. Twenty‐eight species were active for at least 6 months of the year with at least four ...

Stream invertebrates were collected from 24 sites surrounded by a mixture of native forest and pasture in the Mangaotama catchment near Hamilton, Waikato, between 1992 and 1999. Sampling methods used included Surber sampling for benthic invertebrates, pump sampling, freeze coring and colonisation baskets for hyporheic invertebrates, and light, sticky and Malaise trapping for winged adults.A total of 188 stream invertebrate taxa were identified during the course of this work, the greatest number reported for any catchment in New Zealand. Of these, 85% were insects comprising largely Trichoptera (68 taxa or 36%), followed by Diptera (40 taxa, 21%) and then Ephemeroptera (23 taxa, 12%). Light-trapping in summer on four occasions coupled with benthic sampling once in summer yielded 81% of total recorded taxa. Streams that drained catchments entirely in pasture or native forest had similar percentages of total invertebrate taxa, and of the Coleoptera, Diptera and Ephemeroptera faunas. However, native forest si...

Three first‐order, hill country, pasture streams in Waikato, New Zealand, were chosen to investigate the effects of patches of late‐succession indigenous riparian forest on water quality, epilithon, stream morphology, and aquatic macro‐invertebrates. Sites were situated in open pasture and at two distances (c. 50 and 300 m) into a forest remnant on each stream. Shade, channel width, and epilithon biomass were restored to conditions similar to a native forest control site within 300 m of the streams entering the native forest remnants, whereas water chemistry and levels of surficial fine sediment changed more slowly. Invertebrate community composition showed shifts towards the native forest condition just 50 m into the forest remnants, and full recovery had occurred within 300 m. Results from this study suggest that discontinuous restoration of riparian margins could mitigate some changes associated with pastoral land use, but sediment and water quality problems may not be solved.

Cerebral aspergillosis is rare and presents a high mortality. We report a case of cerebral aspergillosis following elective clipping of an intracerebral aneurysm and review the literature surrounding the topic. Early diagnosis and aggressive treatment maximizes survival rates.