Infertility is a global health challenge affecting millions worldwide, and in vitro fertilization (IVF) remains the main treatment option. The increasing demand for IVF necessitates innovations that improve access, efficiency and outcomes. To address this need, we developed a microfluidic device (FIND-Chip) that automates the isolation and denudation of oocytes from follicular fluid (FF), a critical step in IVF workflow. In a clinical study involving 582 patients from four IVF centers, FIND-Chip was utilized to perform automated oocyte recovery from FF and revealed that in more than 50% of the cases functional and mature oocytes are inadvertently discarded under current clinical practice. These undetected oocytes successfully developed into high-quality blastocysts, thereby substantially expanding the embryo pool available for patients' treatment. Notably, an oocyte that was retrieved by FIND-Chip from a clinically screened and discarded FF sample led to a live birth, highlighting the potential of microfluidic automation to enhance IVF success rates.
Access to hypertension care remains insufficient, particularly in remote rural areas in resource-limited settings. Community health workers (CHWs), lay providers living in the communities they serve, may help close this gap, but the effectiveness and safety of lay CHW-led hypertension care-including independent initiation and titration of medication-remain uncertain. We conducted a 1:1 cluster-randomized trial nested within the Community-Based Chronic Care Lesotho (ComBaCaL) cohort study in 103 rural villages in Lesotho. Following community-based hypertension screening, 547 nonpregnant adults with blood pressure (BP) ≥140/90 mm Hg were enrolled (274 control and 273 intervention). In intervention clusters, lay CHWs independently prescribed and titrated a fixed-dose combination of amlodipine and hydrochlorothiazide, guided by a mobile clinical decision support system. In control clusters, participants were referred to health facilities for standard care. The primary objective was to assess the effectiveness and safety of lay CHW-led care, with the primary outcome defined as BP <140/90 mm Hg at 12 months. In the intention-to-treat analysis (543 participants with 4 exclusions owing to intercurrent pregnancy), BP control was achieved by 156/271 (58%) versus 130/272 (48%) in intervention and control arms, respectively (adjusted odds ratio 1.52, 95% confidence interval 1.01 to 2.29, P = 0.046). A predefined complete case analysis yielded consistent results. No relevant differences in safety outcomes were observed. Among people with uncontrolled hypertension, lay CHW-led, CDSS-supported care was safe and more effective than referral to facility-based professional care. These findings support expanding first-line hypertension management by lay CHWs in remote, resource-limited settings. Clinicaltrials.gov registration: NCT05684055 .
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：