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Archive for the 'legal' Category
Why Creating "McEmbryos" is Just Plain Wrong
November 21st, 2012 | Author: Admin2
Recently, Alan Zarembo of the L.A. Times released a story alleging that California Conceptions was combining donated eggs with donated sperm and called them "donated embryos." If there were leftover cryopreserved embryos, ownership of the embryos apparently went to California Cryobank (CC). If true, this is an egregious assault on reproductive ethics.
Defining embryo donation
About one-third of all patients undergoing in vitro fertilization (IVF) will have excess embryos to cryopreserve. About one-half of these will not be used for reproduction by the patients who created them. (Bangsboll et al., 2004; Lyerly et al., 2010) Embryo donation occurs when patients with unused cryopreserved embryos make the amazing decision to pay it forward and donate their embryos to patients in need. In true embryo donation, the patients own the embryos and make disposition decisions regarding their embryos. It is estimated that 2-10% of all cryopreserved embryos are donated to patients in need.
Why is creating "McEmbryos" so wrong?
Allegedly, California Conceptions would use donor sperm and donor eggs to create embryos. At times, all the resulting embryos would be transferred simultaneously to numerous couples, each receiving approximately two embryos at a time. This would commonly be called a "split donor/donor cycle." It is, however, an absolute misrepresentation to call them donated embryos. At least in this split donor/donor cycle scenario, where all the embryos were transferred, there would be no cryopreserved embryos left whose ownership was uncertain.
What if not all the embryos were transferred and some were cryopreserved? As I understand, CC transferred no more than two embryos at a time to numerous patients, with the remainder cryopreserved. The residual cryopreserved embryos became the property of CC.
According to the article, egg and sperm donor profiles are sent to prospective recipients. As soon as CC received a "buy-in" from a few patients, the "donor embryos" were created from the donor eggs and sperm. Who made the decision to combine these two donors? What happens to the left over cryopreserved embryos? The article stated that dozens of embryos would be created through the combination of a pair of donors with the embryos then frozen while CC looked for patients who wanted them. And yet, the clinic claimed to have only ten sets of cryopreserved "donated embryos" in their tanks at any given time.
While they stated they didn't want to create a bank, it would appear that this is precisely what was being done.
I feel there is a potential conflict of interest on the part of any IVF facility regarding the disposition decision of any cryopreserved embryos that they own. Patients normally have options such as using them to build their family, donation to science, donation to a laboratory for quality assurance testing and personnel training, keeping them cryopreserved forever, and finally, donating them to patients in need (embryo donation).
With the methods described in the article, a number of logistical and ethical questions arise:
Were the sperm and egg donors fully aware of what was to be done with the resulting embryos?
How did the IVF practice decide which sperm and egg donors should be combined? Was this decision made through market research? If so, who made these decisions?
Is anyone tracking where all these donor-donor conceived offspring end up?
Who ultimately owns the cryopreserved embryos? In the article, the physician interviewed said the clinic owned them when they were frozen
Who makes the disposition decisions regarding these embryos? Will the IVF facility that owns the embryos be likely to make disposition decisions that do not benefit their bottom line? Who has the best interests of the cryopreserved embryos at heart when the embryos are owned by the IVF facility? Is it possible that CC is the entity that is really "donating" their remaining cryopreserved embryos
What happens to the cryopreserved embryos if the practice closes or is sold?
Perhaps most important, although it may not be a problem presently but for the future, what happens to the cryopreserved embryos that are never chosen?
While certainly not meaning to demean the cryopreserved embryos, I can't help but think of these dono/donor cryopreserved embryos as fast food embryos or "McEmbryos." I can just see the patients coming in, looking above the cash register to the menu above and ordering a "Number 3," which has a burger (i.e., bright, blonde-haired, blue-eyed egg donor) and fries (i.e., handsome, athletic and tall sperm donor) and ends up getting the order supersized to boot (i.e., requesting twins). I should write clearly that this is not the current method CC uses to to match recipients to remaining cryopreserved embryos but the slippery slope exists and other practices may eventually emulate this process
What did EDI try to do over the past year to remedy the problem?
We suspected what might be happening at CC well over a year ago but didn't have proof. We approached the American Society for Reproductive Medicine (ASRM) who examined the information and eventually sent it on to the Society for Assisted Reproductive Technologies (SART). SART did an investigation agreeing with our preliminary assessment. Unfortunately, CC was not a member of SART so they had little influence with CC.
There was some discussion of placing CC on the Center for Disease and Control's (CDC) radar, asking that they potentially audit CC. I am not aware if this was ever done.
There was some discussion of revising the Ethic's Committee Opinion on embryo donation detailing the inappropriateness of creating "McEmbryos," but in the recent revision sent out to all ASRM members to review this past August contained no such language. I contacted ASRM and volunteered to help write the couple of paragraphs that would address the issue but I was never contacted. My current understanding is that the ASRM Ethics Committee will be taking up this issue in the beginning of 2013 and I am hopeful they will make a stand against creating "McEmbryos."
Is it really ASRM or SART's fault?
ASRM and SART are membership organizations. Anyone can join ASRM whereas SART is only open to IVF practices. These entities are not designed to truly police their members. Certainly, they can bar them from membership, but let's face it, this is really not much of a punishment. Most patients are not really aware if a practice is a member of either organization, so expulsion does more to protect ASRM and SART from criticism than it does to protect the patients.
In reality, I am not suggesting that ASRM or SART begin sanctioning their members. These organizations are made up of bright individuals wanting what is best for members and patients alike. I don't believe ASRM or SART could ever expose themselves to legal liability and try to be anything more than what they were originally designed to be.
I feel criticism towards ASRM and/or SART is potentially misplaced. While I do feel these organizations can certainly take a stand against the creation of "McEmbryos," they can only provide educational materials and information to members and patients. never entering the realm of fining, condemning practices or policing practices. That is simply not their job.
I am not being insensitive to the needs of the patients
California Conceptions is providing amazingly healthy embryos to patients in need. How could anyone not be touched the story twin girls born to a single 41 year-old woman? There is no question that the donor/donor split cycle can be far more cost effective than many other options. The ends to this process are what we all strive for – a healthy family.
Call me old-fashioned but I still feel there are instances where the ends cannot justify the means. Are we are loosing all respect for the embryos and treating them utterly as a commodity? The slippery slope is becoming quite steep. Are we ready for expanding banks of unclaimed embryos across the country owned by practices or physicians and not the patients? I'm sorry but the means being used here are fraught with uncertainty and may result in a list of unintended consequences.
What are the potential repercussions of the L.A. Times story?
At least this election year is over. I had grave concerns that the story would break early in the election cycle and would become a political football, resulting in a series of consequences around the country. I still believe we are at risk in the following ways:
• Poorly designed and reactive legislation may yet be created on state or national level
• This story may motivate the "Personhood" advocates by encouraging them to win personhood for embryos thereby protect them from becoming "McEmbryos"
• There will be "guilt by association," leaving other legitimate embryo donation facilities open to criticism and ridicule
• All of this will reflect poorly on basic IVF facilities that are frequently viewed as unregulated, even though we are accountable to more regulatory agencies than any other area of medicine
There may be significant backlash regarding this story and we should all be prepared to answer questions that may arise from the media, our peers and our patients.
How can embryo donation programs hold but not own the donated embryos?
At Embryo Donation International (EDI), the embryo donors are still able to request that their donated embryos be returned if needed. For example, if the children of an embryo donor were tragically killed in a motor vehicle accident, it seems absolutely appropriate that the cryopreserved donated embryos should be sent back to the donors. To discourage this from being done without good reason, transportation costs for returning the embryos, which is estimated to be $300, are the responsibility of the original donors.
Once the embryos are transferred into the recipients, however, they now "own" them. In this way, EDI never truly owns the donated embryos. We are the conservator and protect the embryos while never making any disposition decisions regarding their fate. We never own the donated embryos and we encourage all embryo donation facilities adopt this model of conservatorship.
What can be done to correct the current problem?
From my perspective, we have a few options:
Various membership organizations such as ARSM, Pacific Coast Fertility Society (PCFS), SART and RESOLVE could release position statements condemning the creation of "donated embryos" without a destination. This could help guide public opinion.
Perhaps the embryo donation programs would be willing to sign a contract stating that they will not participate in the creation of embryos without a destination. Programs willing to sign and honor the contract would be adhering to the highest of ethical standards.
Through the court of public opinion and if the L.A. Times article is accurate, patients may no longer want to participate in what they feel in an unethical practice.
Legislative action on the part of California may be necessary but this will take time and a great deal of expertise. We run the risk, however, of having well-meaning legislative actions spilling over and harming the process of embryo donation or IVF itself.
CC itself may need to modify its business model by allowing patients to own the cryopreserved embryos.
Something really needs to be done. I don't feel that this unethical practice should continue. A corporation, business or physician practice should never own embryos, no matter how brief. These embryos are also not truly donated unless you feel CC is able to donate the excess cryopreserved embryos. The question is if we should play an active or a passive roll in determining what takes place. I personally prefer the active roll so you can count EDI in on doing our best to guide the process.
Sour grapes? Nope, just sour taste!
CC is a potential competitor of EDI. I have made this clear to each and every person I have spoken to regarding this current dilemma. When we were contemplating the expansion of our ten-year embryo donation program into EDI, we also looked at the option of a money-back guarantee such as is offered by CC. Understanding the delivery rates for recipients of truly donated embryos ranges from 27-45%, the likelihood of returning the majority of the payments back to recipients made it unlikely we could even keep our doors open. Most "shared risk" options also charge a premium on top of the normal fees. Recalling that embryo recipients are emotionally and financially drained, the idea of tacking on a large additional fee seemed unfair to the recipients and quite impractical to the process. Embryo donation works for recipients, in part, because it is more cost-effective than many other options.
So you see, it is not "sour grapes" that is guiding my writing; it is just a sour taste. If the article was accurate, I feel strongly that creating "McEmbryos" is an affront to IVF and embryo donation programs, misleading to embryo recipients and totally unfair to the cryopreserved embryos that are currently waiting to be chosen.
If you agree, please co-sign this blog….
We are going to do something a bit different with this blog. We are strongly encouraging not just the routine comments that follow our blog but we are also asking that practices, patients and interested parties who agree that creating "McEmbryos" is ethically inappropriate sign below. By endorsing the statement below, we will hopefully begin to separate ourselves from such entities that practice the "McEmbryo" method of "embryo donation," moving forward with a resolution that will work best for all.
By signing below, I do hereby agree that creating banks of cryopreserved embryos is ethically unjustifiable and support sound solutions that will adhere to the highest of ethical standards supporting patients and cryopreserved embryos in the best possible way.
L.A. Times article
Bangsboll S, Pinborg A, Yding Andersen C, Nyboe Anderson A. Patients' attitudes towards donation of surplus cryopreserved embryos for treatment or research. Hum Reprod 2004;19(10):2415-9.
Lyerly A, Steinhaser K, Voils C, Namey E, Alexander C, Bankowski B, Cook-Deean R, Dodson W, Gates E, Jungheim E, McGovern P, Myers E, Osborn B, Schlaff W, Sugarman J, Tulsky J, Walmer D, Faden R, Wallach E. Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey. Fertil Steril 2010;93:499-509.
Ethics Committee of the American Society for Reproductive Medicine. American Society for Reproductive Medicine: defining embryo donation. Fertil Steril. 2009 Dec;92(6):1818-9.
Posted in announcement, embryo donation, embryos, family building, law, legal | Tags: disclosure, egg donation, Embryo, embryos, family building, IVF, law, legal, Professional, sperm donation | 28 Comments »
Federal Funding of Embryo Donation and "Embryo Adoption:" Is it time for the Federal Government to Reconsider Its goals?
By: Craig R. Sweet, M.D.
The "Defunding" of a Government-Supported Program
On March 2, 2012, it was reported that the Obama Administration wanted to defund the embryo donation/adoption awareness federal program that has been run by the Office of Population Affairs, part of the U.S. Department of Health and Human Services. Spokespeople from Nightlight Christian Adoptions, the National Embryo Donation Center and Snowflakes Embryo Adoption programs were quoted as opposing the defunding decision. It should be noted they all had received or were receiving funding from the federal program, so their reactions were not unexpected.
Initially, the federal program was created in response to President Bush's push to use cryopreserved embryos to create families and steer away donations from human embryonic stem cell research. Since 2002, over 22 million dollars has been spent by the federal government on the awareness programs.
The Predictable Response
Certainly during an election year, the firestorm that followed was probably predictable.
There were calls stating that the Obama Administration was "pro-abortion,"
I've never met such a person in my entire life, although many have been "pro-choice."
Congressman Chris Smith, a New Jersey Republican, was quoted a saying, "Assertions that leftover embryos are better off dead so that their stem cells can be derived is dehumanizing and cheapens human life."
Come on now… this decision does not mean that all cryopreserved will be destroyed. It simply means that all of us who are dedicated to the concept of embryo donation need to work harder and smarter with non-federal funds to make certain patients are aware of the embryo donation option.
Mailee Smith, staff counsel at the "pro-life" Americans United for Life, was quoted, "What we're seeing is the elimination of the moral solution."
Nothing could be further from the truth. Many programs throughout the country offer embryo donation and will continue to do so long after federal funding disappears.
Could we all just trim the hyperbole a bit?
Is it a Coincidence that the Phrase "Embryo Adoption" Predated the Personhood Amendments?
I suggest paying less attention to the hype and instead examine the realities of the ways that federal funding can influence the competitive free market with unintended consequences. The propagation of the term "embryo adoption" sprouted the appearance of the personhood amendments and legislation, which are focused on declaring that eight-cell early embryos are people. The consequences of these enactments are far reaching, including monumental legislative changes, restrictions on the care of women, and severe restrictions to the treatment of the infertile patient. (See my previous blog on the Mississippi Amendment here.)
Not Sour Grapes but Concerns Regarding Discrimination
Let it be understood that Embryo Donation International (EDI) applied last year for the federal funding in question, but we were not awarded a grant. In partnership with professors at Florida Gulf Coast University, we proposed thirteen different fresh and innovative projects to increase awareness, as well as provide embryo donation services. While we were disappointed, we were not surprised that the organizations, for the most part, receiving funding had been granted it before and this was our first submission. EDI was not previously dependent on the funding so there were no significant changes in our day-to-day operations. The projects are slowly being rolled out, funded instead by SRMS/EDI.
What bothered us was that over the years some of the organizations receiving the bulk of the funding were faith-based and discriminated against some patients. While the projects themselves were potentially more neutral, the organizations were not. Health and Human Services (HHS) apparently looked only at the proposals in determining the awards, making the awarding of grants potentially flawed.
The grant process essentially compartmentalized the proposals. If an organization provided certain services, which the federal government did not fund directly, but the organization was awarded a grant to provide other services, the government essentially compartmentalized the grant money separate from the procedures it didn't directly support. I understand the concept but do not feel the grant committees should have made the decision based only on the grant proposals. They also needed to take into account the overall views and beliefs of the organization requesting funding. There needs to be times when the government must look at the trees and not just the leaves.
I believe there were instances where the funds should be withheld. The funded organizations should have provided a minimum standard of practice guidelines in line with the non-discrimination clauses outlined in the grants. Entities awarded the grants should not have discriminated with regards to race, religion, ancestry, gender, marital status or sexual preference.
Being a faith-based embryo donation/embryo adoption organization also directly or indirectly excludes some patients, making it uncertain if the federal government should directly support such facilities, especially taking into account the separation of church and state. I know that faith-based embryo donation/embryo adoption entities were strongly supported by past administrations but should a neutral organization that does not discriminate and makes all faiths feel totally welcome be placed at a higher priority now? Is this more ethical and fair? Is this a better use of the shrinking tax dollars? Is it time for the federal government to reconsider their goals?
If both discrimination and faith-based issues were actually taken into account, many of the organizations discussed here never would have received the original federal funds.
It is not that I want these organizations to go away. Quite the contrary, they often do a great job, provide excellent services and fill a much-needed niche. Their funding should, however, be through sources other than the federal government because of the bias inherent to their provision of services.
Can the Government Afford Providing the Grants?
Understanding that the U.S. is running a severe deficit, when are we ever going to be willing to make difficult decisions? How are we ever going to get control of the budget if we can't trim existing programs that may serve an important few when the many need assistance? We all need to look at the big picture and understand that "business as usual" is not practical in the current economic climate. I may be falling on the sword a bit, but shouldn't we all be willing to sacrifice? Hey, I'm all for creating little taxpayers to help pay off the deficit. I'm just not sure that we can afford to do so through a government in the red. To do so with organizations that discriminate makes absolutely no sense at all.
If federal funding is to continue, it needs to be provided to organizations, and not necessarily my own, which do not discriminate and are not faith-based. In addition, giving "embryo adoption" programs federal funds so they can support personhood amendments should be reconsidered. Having the government eventually spend even more money and time contesting the amendments and statutes in court defies understanding. Perhaps the congressional appropriations committees, who will make the final decision regarding federal funding, will take the concepts of non-discrimination and non faith-based alternatives into account and fund the programs with new and fairer goals.
Rest assured, unlike the rhetoric would lead one to believe, embryo donation is here to stay, regardless of the decisions of Congress and the grant process. How do we know? We've been providing the service for 11 years and will continue to do so in the years ahead, without cessation, as long as there are cryopreserved embryos available to donate.
www.EmbryoDonation.com
Posted in cryopreservation, embryo adoption, embryo donation, Federal, law, legal, Religious | Tags: cryopreservation, embryo adoption, embryo donation, law, legal, religion | 2 Comments »
Georgia Law: The First Salvo Towards Embryo Personhood
December 1st, 2011 | Author: Admin2
A Guest Post by: Harold Eskin, Esq.
New laws are beginning to appear on the books of many states that support "embryo adoption." "Embryo Adoption" is placed in quotation marks because that phrase alone has unique connotations that I discuss briefly below. The term embryo "donation" is also a commonly used expression describing giving one patient's/couple's cryopreserved (frozen) embryo(s) to another patient/couple trying to expand their family, but who otherwise have been unsuccessful through natural and/or advanced reproductive techniques.
Georgia was the first state to pass an embryo adoption bill (2009) that provided an opportunity for intended parents to go through an adoption procedure to obtain the right to gestate a thawed frozen embryo. Other states, such as Florida, have embryo donation statutes on its books, which allow a couple to receive a donation from another (open or anonymous) of a frozen embryo. While the end results may appear to be the same, the road getting there and implications of using the different phrases are vastly different.
The Georgia law, which was championed by Right to Life groups, treated a frozen embryo in much the same way as it would a child already born. The new law and procedures mimic that of other adoption provisions and gives the frozen embryo many of the same rights and considerations of a born child, including using a "best interest of the child" standard in the adoption analysis. This philosophy is consistent with the concept that a child's rights (as compared to the mother's) begins at conception rather than birth and has implications in the abortion-right to choose/right to life arguments ongoing disagreements and potential laws expressing same.
Florida and many other states have historically treated frozen embryos as the property of the parents, who have the right to donate or dispose of the frozen embryos as they saw fit. The recipients received the frozen embryos as property under the respective laws of their state and could use or dispose of the frozen embryos as they saw fit. This process allowed for freer access to unused frozen embryos and discouraged the abandonment/discarding of them.
The agenda of the Georgia law was not necessarily meant to "protect" the frozen embryos but was designed to advance a political agenda of creating additional barriers to a women's right to choose (i.e. restrict abortion) and to further control the reproductive rights of patients by discouraging the use of advanced reproductive techniques, such as in vitro fertilization as well as the cryopreservation and storage of excess embryos.
Up to now, there have been few attempts to export the Georgia concept in other states. This is perhaps due to the country's economic challenges, but this possible trend needs to be closely monitored. The implications of providing "personhood" to embryos are far and wide and the Georgia statute is one of the first successful salvos to be launched with others most certainly to follow. Mississippi is currently targeted for a constitutional amendment to give embryos personhood and many other states are next in line for challenges that may significantly impair the health and reproductive care of women.
Harold Eskin, Esq.
www.LegalSurrogacy.com
HalEskin@LegalSurrogacy.com
1420 SW 47th Street
Georgia Statute:
http://statutes.laws.com/georgia/title-19/chapter-8/article-2/19-8-41
Florida Statute:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0700-0799/0742/Sections/0742.14.html
Posted in embryo adoption, embryo donation, embryo donor, embryo recipient, embryos, family building, law, legal | Tags: disclosure, Embryo, embryo adoption, embryo donation, embryo recipient, embryos, family building, law, legal, legality | 2 Comments »
Disclosure Issues in Embryo Donation: Summary Comments
November 2nd, 2011 | Author: Admin2
Embryo donors and recipients are faced with a number of life-changing decisions as they contemplate disclosure. This is the final segment of a five-part series summarizing the complex decisions surrounding the disclosure of the genetic origins of embryo donor-conceived individuals to family, friends and the offspring themselves.
What are some of the questions that embryo donors and recipients must explore before deciding to disclose or not?
Embryo donors must decide if they want a relationship with the donor-conceived individual being raised by another family. Are the donors willing to disclose their donation of embryos, which may have taken place years ago, to friends and family, including their existing children? At what age would they want the donor-conceived individual to contact them?
Recipients need to ask related questions about whether they should tell their embryo donor-conceived children about their origins. If they want to do so, when should they tell and what information should they share? Are the recipients comfortable letting their family members and friends know of their infertility history? Will the recipients and offspring be criticized, ostracized or, even, excommunicated by these same people or by their religion? Are they comfortable with their child contacting and potentially having a relationship with the embryo donors and their blood siblings?
Can an understanding of adoption disclosure be used in the world of embryo donation?
It is understandable, but potentially misguided, that some professionals believe embryo donation is identical to the adoption of a live child. I have written about this topic before. While the American Society for Reproductive Medicine (ASRM) states that the term "embryo adoption" should not be used, some facilities do so openly.
However, regardless of the legal differences, there also are a number of very practical differences:
Because the embryo recipient carries and delivers the child, her pregnancy may look natural, making disclosure by the recipients optional. Adoption is much more difficult to hide.
Disclosure of the embryo donation process may not be well accepted by friends, family and some religions. While not universally accepted, adoption may be better tolerated.
As with sperm donation, single women and lesbian couples who conceive with donated embryos are more likely to disclose because the fatherhood issue inevitably arises. Heterosexual couples, however, are the least likely to disclose.
How often is disclosure currently revealed?
There is a growing body of data that suggests only a minority of the embryo donor-conceived children are told of their origins. In an English study of 17 embryo donation families with donor offspring between five and nine years old, only 18% of the recipient parents had told their children (MacCallum F. et al. 2008). An additional 24% planned on telling, 12% were undecided and 47% stated they would not tell. The reality is that many of those who planned on telling or were undecided may eventually decide against disclosure as the child ages and enters the more difficult years of adolescence. This seemed to be different than other donor procedures where 46% of donor sperm insemination parents and 56% of egg donation parents planned to disclose (Golombok S, et al. 2004).
Why has anonymity been the norm in embryo donation?
The concept of anonymity in egg/sperm/embryo donation has its roots in the physician/patient relationship to meet a series of needs (Daniels K. 1997). To assume that it should be discontinued for everyone doesn't take into account the ethical, social and religious circumstances of different patients.
Since the medical profession assumes parents are able to make, without question, thousands of different choices for their children, assuming they are incapable of making a decision, such as disclosure which affects both the child and parents, is simplistic and rather paternalistic.
Why not disclose?
Let's face it; there might indeed be a lack of societal approval of offspring who originated from donor material. Many people are judgmental regarding embryo donation, especially in cultures and religions that emphasize genetic inheritance. Recipients have legitimate reasons to fear the potential damage to themselves and their children from other people's negative reactions, social stigma and resulting isolation (Shehab D, et al. 2008).
Some of the reasons recipients do not want to disclose include protecting their children and family relationships from rejection, not feeling a need to disclose or uncertainty about how to approach the matter (MacCallum F, et al. 2007, Jadva V, et al. 2009 & Mahlstedt PP, et al. 2010). Disclosing also will broadcast their infertility issues, which they may have kept quite private in the past (Klock SC. 1997). Another common reason given for not disclosing is fear that they as non-genetic parents will be rejected. Actually, there is no data to support or deny this last very human concern.
Unlike adoption, it is doubtful that the offspring of embryo donation will have to resolve the "history of rejection" unlike adopted children who were separated from their birth parents (Widdows H, et al. 2002). Families created through embryo donation are a product of a loving gift and not formed from perceived rejection. Therefore, some of the motivation to disclose in adoption simply does not exist in embryo donation.
Why should parents disclose?
The most common reason for embryo recipients to disclose is a fear that the child will accidently discover the facts at a later date (MacCallum F, et al. 2007). One study of adult offspring of sperm donation found that about 1/3rd of the individuals learned of their donor origins after an argument, from another person or they just figured it out themselves (Mahlstedt PP, et al. 2010). In a recent study, about 10% (47/458) of the sperm donor offspring who were searching for their donors and half-siblings found out by accident (Beeson DR, et al. 2011). They were apparently told by siblings, family or friends; discovered paperwork or inheritable medical issues that their recipient parents did not have; inadvertently overheard their parents talk about it; or it was revealed as a consequence of divorce. Recipients who tell family and friends but not the child are asking for future problems. When examining these two studies, it is clear there is a reasonable risk that the offspring will discover their origins, even under the best of circumstances. It also is important to realize that sperm, egg and embryo donation procedures are different when analyzing the study results.
There are some embryo donation recipients who feel it is simply best to not have secrets in the home. Others believe the embryo donor-conceived children have a moral right to know their origins. Some feel it is important that the children understand and connect to their genetic inheritance beyond the family who raised them.
What should be disclosed?
There are three decision levels in disclosure: 1) To decide to disclose, 2) To decide what age to disclose, and 3) To decide what information is to be provided. One can simply tell the child he or she was embryo donor-conceived but the child is certain to have more questions. At the very least, I believe providing the donors' photographs (when they are available) as well as their medical, surgical, psychiatric, family and social histories are needed. However, providing actual identifying information needs to be handled carefully and thoughtfully.
When should disclosure take place?
Disclosure early in the child's development, certainly before age ten, would seem to be ideal. Some mental health professionals (MHP's) feel it should be discussed as early as possible. If disclosure occurs in adolescence or later, young adults may feel mistrust, alienation, identity confusion, frustration and even hostility towards their family (Ethics Committee, 2004 & Mahlstedt PP, et al. 2010). About 46% of donor sperm offspring who were told at the age of 18 or older stated they were confused. It is probably best to tell the child before the age of 10 than wait until later where there is a doubling of the number of children who were unsettled with the information.
Why do embryo donor-conceived individuals want to know their genetic origins?
Many embryo donor-conceived individuals may be curious about their donors' physical characteristics and original motivation to donate, as well as possess a desire to know their genetic identity and, perhaps, provide an ancestral history for their own children. (Ravitsky V, et al. 2010 & Mahlstedt PP, et. al. 2010).
For many, the search for their donors may go well beyond just seeking simple information. In two recent studies of offspring searching for their donor sperm fathers, 80-88% were intensely curious about their donor and wanted to contact him. Up to one-third desired an actual relationship with the sperm donor (Beeson DR. 2011 & Mahlstedt PP, et al. 2010). It should be understood, however, that studies such as these might not represent a balanced patient sample. Only offspring searching for information contributed to those studies. There wasn't a practical way to capture the opinions of those offspring who were not part of the Internet support groups, who may indeed represent a very silent majority.
Do embryo donor-conceived offspring have the right to know their origins?
Many donor-conceived individuals feel they have a right to know their genetic origins (Shehab D, et al. 2008). Embryo donors and recipients, who may prefer an anonymous process, have rights that compete with those of the donor-conceived individuals. Embryo donors and recipients have legal rights that are in direct contrast to the offspring's moral view that family secrets shouldn't be kept. There is no easy way to reconcile these contrasting legal rights and moral perspectives. Most agree, at the risk of offending those who feel differently, that in a society ruled by law, a legal right ultimately trumps a perceived moral right. Thus, the legal rights of donors and recipients continue to prevail in this country.
Should disclosure be mandated?
There is a stronger preference to discard or abandon the embryos than there is to donate them. Placing any impediments on embryo donation, such as mandating disclosure, may not only reduce the number of embryos donated but will almost certainly result in a greater number of embryos discarded or abandoned. I cannot imagine the well-meaning individuals who are asking for mandated disclosure would want the loss of embryos and potential families to be an almost certain unintended consequence.
Parents who used donor material feel the decision to disclose is private, highly personal and should be left to the discretion of the individual families and not regulated in any way (Shehab D, et al. 2008). A dual-track of disclosure/nondisclosure system will most meet the needs of everyone (De Jonge C, et al. 2006). We need to educate, guide and support, but not force these processes.
What happens to children who learn or don't learn about their origins?
Interestingly, children do not seem to be harmed if disclosure does not take place.
Warm parent-child relationships and positive child development have been documented, although few of these donor embryo-conceived children have yet entered adolescence (Golombok S, et al. 2006). While more data and follow up studies are certainly needed, embryo donation children do not seem to be at increased risk for developing psychological problems during early and middle childhood, regardless of disclosure decisions. Supporting these findings about early disclosure, neither the children nor the family seem to be harmed (MacCallum F, et al. 2007 & 2008). While not definitive, the research we have so far suggests that disclosure decisions, either for or against, will not cause irreparable harm to the embryo donor-conceived individuals or the parents who raised them.
Interestingly, research shows that embryo donation families are more child-centered than adoptive and, even, other IVF families, regardless of their disclosure status (MacCallum F, et al. 2007 & 2008). This may be due in part to the recipients' older age and maturity compared to younger IVF and adoptive parents. Embryo donation-conceived children are tremendously appreciated, greatly desired and hard fought for by their parents. This should give embryo donors confidence that donor-conceived offspring will be well cared for by wonderful recipient families.
What should be considered if embryo donor-conceived individuals meet the donors?
If donor-conceived individuals connect their donors and/or blood siblings, it is important that everyone's expectations be reasonable. Members of donor-linked families may have a significant mismatch regarding their levels of hope and expectation about contact (Scheib JE, et al. 2008). Some of the participants may have a tendency to romanticize the first meeting and future relationship. The participants should move slowly and carefully, without inappropriate expectations.
It is exceedingly important that the relationship between the parents who raised the child and the embryo donor-conceived offspring not be harmed, as this is the basis for the child's stability and home life. The fear that this relationship will be damaged is one of the main reasons recipients prefer to not disclose, so it must be protected.
Long-term data regarding the relationships between embryo donors and embryo donor-conceived individuals is not yet available, so we simply are unable to tell any of the participants what the outcome may be (Grotevant HD, et al, 2008). The parents who raised the donor-conceived child may feel threatened by the relationship between the donors and offspring. It would be irresponsible for us as clinicians to assume that all will go well. We must remain cautious and counsel our patients carefully and individually until we have more information to guide them.
Can recipients get help in deciding if disclosure should take place?
Consultation with a mental health professional (MHP) regarding disclosure is strongly encouraged but the counselor must understand the subtle differences between embryo donation and adoption, where disclosure is the norm. Neutrality is required and finding a skilled and experienced MHP is important. Many patients resent direct suggestions about disclosing and far prefer a discussion that examines their own needs and perspectives (Klock SC, 1997). In reality, it is really not appropriate to give a uniform recommendation that does not take into account the personal, ethical and religious views of the embryo recipients.
Even more important, embryo recipients may want to hear from other recipients, people who have worked through the issues or are struggling with making the decision (Klock SC, 1997).
In our three recent surveys examining the perspectives of potential embryo donors, recipients and offspring, there were a few consistent findings:
From the embryo donor perspective, the majority polled desired an open process.
From the embryo recipient perspective, the majority polled desired anonymity.
The majority of potential embryo donors and embryo recipients would disclose to their friends and family.
If open-identity was available, the majority felt information should be shared and potential contact be made before the age of 18, which may differ in adoption proceedings.
Are reproductive facilities prepared for disclosure?
A medical providers' first reaction will be to protect their patients: the embryo donors and recipients. State and federal statutes protect confidentiality and clear consent must always be provided before medical/identifying information is released to a third party. The reproductive facilities also will want to be insulated from any legal consequences should disclosure occur.
Some medical practices will be operationally challenged to have records available years after procedures are performed. Many states require that medical records be retained for seven years. The Federal Drug Administration (FDA) requires practices to retain for ten years the medical records of patients involved in third party conception, while the ASRM suggests the records be stored indefinitely. Being able to identify those particular charts from others that would otherwise routinely be discarded is a logistical challenge. In my practice, we color-code the charts involving any type of donor material, making them easy to pull and save.
I also feel embryo recipients have a responsibility to keep the information they were originally provided about their embryo donors protected and safe in case the practice's medical records are ever lost or deleted.
Regardless, the facilities have a responsibility to assure charts are available and that systems are in place to make disclosure possible. Policies and procedures will need to be created so that they are ready when the requests come. Mirroring the adoption world in this instance may be of use.
How do recipients disclose?
Experienced MHP's can provide invaluable assistance in helping embryo recipients present this sensitive information. Reproductive endocrinologists, well versed in this topic, may also be very useful in deciding how and when to tell the children. Forums where parents can discuss these issues with other parents who have lived them also may be indispensible. While few books exist on the topic, I will be reviewing one quite soon that does. Please stay tuned.
Using the following phrases and ideas in the discussion may be useful:
We wanted you to be in our lives so much, we had to travel far and wide to find you.
The people who gave us their embryos, which included you, gave us the most wonderful gift in the world. They loved you so much that they wanted you to enjoy life with us.
I got to carry and protect you, giving you all the love I could.
Remember that eggs, sperm and embryos don't make a family any more than bricks make a happy home. What makes a family is how we support and love each other.
A good way to start this conversation is by emphasizing love, your commitment to find them, the amount of time, effort and emotion you invested in bringing them into the world, and the fact that genetics doesn't necessarily make a family. I'm sure MHP's will offer recipients some great phrases and ideas, which I will encourage that they share with us on this blog.
What are the long-term consequences of disclosure?
Research is needed to find out more about long-term disclosure outcomes. It is difficult to ascertain how children are fairing who are not told about their origins fare because these individuals are not readily accessible to research. Also, what happens over time with open donation is largely unknown. I feel it is unrealistic to assume that everyone will live together as one big happy family. I suspect, however, that the donor-conceived children will benefit in establishing connections with blood siblings.
If disclosure occurs and the offspring are destined to contact their genetic parents, their reunion should not be romanticized. They will not necessarily be welcomed with open arms up to two decades later by the donors. In fact, we don't have any idea how well or how disruptive these reunions will be. Once again, research is desperately needed.
Is there a disclosure compromise available?
The idea of open-identity is a fascinating concept for embryo donation. This would allow donors to be contacted if the recipients eventually disclose the genetic origins to their donor-conceived offspring. According to our recent surveys, most respondents wanted disclosure with open-identity to occur before the children turn 18 and have the ability to contact the donors. But what harm will come to the child if disclosure and contact are done earlier in the formative years? Would there be some advantages to knowing earlier rather than later in adulthood?
It would seem that if recipients are disclosing for the sake of the child, it may truly be best to allow disclosure and open-identity earlier rather than later. I hope to pose this question to MHPs in the months to come.
I feel it is far better that we design programs with open-identity options but not legislate them. Legislation, especially if it is retroactive, will inject uncertainty about every current rule governing the practice of egg/sperm/embryo donation (Guido P, 2001). Legislation will do more to shut donation processes down than any other development. I understand there are some donor-conceived individuals who feel that all information should be open to review, but past contracts were doubtfully formulated that way. Although unpopular with some, the perceived rights of the donor offspring should not be allowed to circumvent the true legal rights of the donors and recipients.
At a recent ASRM meeting, some MHPs and reproductive attorneys lamented that anonymous embryo donations are allowed to continue. I explained that if they want to change physicians' and patients' perspectives on anonymity, they would only succeed with data showing the long-term benefits of disclosure. Until that time, clinicians and patients alike will be hesitant to adopt a stance that is not yet supported by unbiased research. We should tread lightly and make very few assumptions when it comes to issues so important as disclosure or we risk doing harm to our patients. We all need a bit more information in caring for our embryo donors and recipients. We must never forget, however, that embryo donation-conceived individuals, who were never our actual patients, and are still owed thoughtful care and tremendous compassion. We must keep an open mind and learn from their perspective.
There will always be a group of patients who will want anonymity and we all need to respect their wishes. Everyone involved in this debate needs to take a breath and step back. I grow weary of a very vocal group of patients who believe their way is the single right way. This is not a black and white issue. We should instead see the disclosure controversy in shades of grey. Compromise these days seems to be viewed as form of weakness in our country's politics. This country was founded on the basis of choice and I feel strongly that we should design systems that will allow for choice while educating the participants of embryo donation about their options and the potential results of both disclosure and non-disclosure to embryo donor-conceived individuals. It is our responsibility.
As always I welcome a respectful dialogue, especially from those who disagree. I look forward to reviewing research studies that will guide all of us so we may better counsel embryo donors, embryo donor recipients and especially the embryo donor-conceived individuals, who remain the final focus of this entire discussion.
Associated Blog Segments:
Introduction: Disclosure Issues in Embryo Donation
Embryo Donor Perspective
Survey Results: Imagine you are an Embryo Donor
Blog: Disclosure Issues From the Perspective of the Embryo Donor (Part 1 & Part 2)
Embryo Recipient Perspective
Survey Results: Imagine you are an Embryo Recipient
Blog: Disclosure Issues From the Perspective of the Embryo Recipient (Part 1 & Part 2)
Embryo Donor Offspring Perspective
Survey Results: Imagine you are an Embryo Donor Offspring
Blog: Disclosure Issues From the Perspective of the Embryo Donor Offspring (Part 1 & Part 2)
Registry Links:
The Donor Sibling Registry: https://www.donorsiblingregistry.com/
UK Donor Link: http://ukdonorlink.org.uk/ (funding uncertain)
Western Australia's Voluntary Register for Donors, Offspring and their Families: http://www.voluntaryregister.health.wa.gov.au/home/
BCdonorconception, British Columbia donor offspring: http://groups.yahoo.com/group/BCdonorconception/
Donor Sperm Facility Registries:
California Cryobank's Sibling Registry: http://www.sibling-registry.com/
Fairfax Cryobank: Donor Sibling Groups: http://www.donorsiblinggroups.com/Home_Page.html
General Third Party Conception Support:
Donor Conception Support Group: http://www.dcsg.org.au/
PCVAI, People Conceived via Donor Insemination: http://groups.yahoo.com/group/PCVAI/
International Donor Offspring Alliance: http://www.idoalliance.org/
The Donor Conception Support Group of Australia Inc: http://www.clan.org.au/dcsg/index.html
Canadian Donor Offspring: http://www.canadiandonoroffspring.ca/
Germany: http://www.spenderkinder.de/
Beeson DR, Jennings PK, Kramer W. Offspring searching for their sperm donors: how family type shapes the process. Hum Reprod. 2011 Sep;26(9):2415-24.
Daniels K. The controversy regarding privacy versus disclosure among patients using donor gametes in assisted reproductive technology. J Assist Reprod Genet. 1997 Aug;14(7)-373-5.
De Jonge C, Barratt CL. Gamete donation- a question of anonymity. Fertil Steril. 2006 Feb;85(2)-500-1.
Klock SC. The controversy surrounding privacy or disclosure among donor gamete recipients. J Assist Reprod Genet. 1997 Aug;14(7)-378-80.
Ethics Committee of the American Society for Reproductive Medicine. Informing offspring of their conception by gamete donation. Fertil Steril. 2004 Sep;82 Suppl 1-S212-6.
Ethics Committee of the ASRM. Informing Offspring of their conception by gamete donation. Fertil Steril 2004;81(3):527-31.
Golombok S, Lycett E, MacCallum F, Jadva V, Murray C, Rust J, Abdalla H, Jenkins J, Margara R. Parenting infants conceived by gamete donation. J Fam Psychol. 2004 Sep;18(3):443-52
Golombok S, Murray C, Jadva V, Lycett E, MacCallum F, Rust J. Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3. Hum Reprod. 2006 Jul;21(7):1918-24.
Grotevant HD, Wrobel GM, Von Korff L, Skinner B, Newell J, Friese S, McRoy RG. Many Faces of Openness in Adoption: Perspectives of Adopted Adolescents and Their Parents. Adopt Q. 2008 Jul 1;10(3 & 4):79-101.
Guido P. The reduction of sperm donor candidates due to the abolition of the anonymity rule: Analysis of an argument. J Assist Reprod Genet. 2001 Nov;18(11)-617-22.
Jadva V, Freeman T, Kramer W, Golombok S. The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type. Hum Reprod. 2009 Aug;24(8):1909-19.
Klock SC. The controversy surrounding privacy or disclosure among donor gamete recipients. J Assist Reprod Genet. 1997 Aug;14(7)-378-80.pdf
MacCallum F, Golombok S, Brinsden P. Parenting and child development in families with a child conceived through embryo donation. J Fam Psychol. 2007 Jun;21(2):278-87.
MacCallum F, Keeley S. Embryo donation families: a follow-up in middle childhood. J Fam Psychol. 2008 Dec;22(6):799-808.
Mahlstedt PP, LaBounty K, Kennedy WT. The views of adult offspring of sperm donation: essential feedback for the development of ethical guidelines within the practice of assisted reproductive technology in the United States. Fertil Steril. 2010 May 1;93(7):2236-46.
Ravitsky, V. & Scheib, J.E. (2010). Donor-conceived individuals' right to know. Hastings Center Bioethics Forum 2010;40:(4).
Scheib JE, Ruby A. Contact among families who share the same sperm donor. Fertil Steril. 2008 Jul;90(1):33-43.
Shehab D, Duff J, Pasch LA, Mac Dougall K, Scheib JE, Nachtigall RD. How parents whose children have been conceived with donor gametes make their disclosure decision: contexts, influences, and couple dynamics. Fertil Steril. 2008 Jan;89(1):179-87.
Widdows H, MacCallum F. Disparities in parenting criteria: an exploration of the issues, focusing on adoption and embryo donation. J Med Ethics 2002;28:139-42.
Posted in Disclosure, embryo adoption, embryo donation, embryo donor, embryo recipient, embryos, family building, law, legal | Tags: disclosure, Embryo, embryo adoption, embryo donation, embryo recipient, embryos | 11 Comments »

redpajama_set_name: RedPajamaCommonCrawl


Winter is almost here! No, we aren't talking about the weather. We know how happy you are about Spring finally blooming outside. We are talking about the winter for which you have been waiting for eight long years now. Yes, the Game of Thrones (GoT) finale season will start airing from 14 April 2019, a date marked in every fans' calendars for over two years now. Fingers crossed, all our questions and prayers will be answered.
With the extended trailer already out, most fans are dying in anticipation. And we know how hard the final week of wait is. But don't worry, we have a superb solution to make the countdown a little easier. We promise this will also be a great way to set your mood for the upcoming episodes. What we are hinting at is the Game of Thrones slot game from Microgaming.
With 3D graphics from the original series and the theme song by Ramin Djawadi playing in the background, this medium variance video slot is already a hit among many GoT fans. Our advice? Try spinning it in between episodes or during the boring commercial breaks. And you might just stumble upon the purest Lannister gold.
Get ready to roll with the Baratheon Stag, the Lannister Lion, the Stark Direwolf and the Targaryen Dragon symbols. The seven kingdoms come alive in two versions: a 15-payline version, which you can play from £/€/$ 0,15 to £/€/$ 3 a spin or you can opt for the bigger 243-payline version, which starts from £/€/$ 0,30 and your bets can go up to £/€/$ 6 a spin.
Two scatter symbols launch the Gamble Trail mini-game in which you toss a coin and travel along a map with each correct guess, collecting winnings as you do. Once you have understood the lay of the land, you'll be asked to pick a side.
Three or more scatter symbols launch the Free Spins — a feature where you are asked to choose your house from the famous four houses of Westeros. Each of them has its own characteristics with differing free spins, multiplier and stacked symbols. So choose wisely! After you have chosen a side, you get rewarded for trying to defeat the other three houses.
At 95%, the game's RTP was probably set by a Lannister. However, the maximum leverage of 20.166x your bet seems to be bestowed by a big-hearted Baratheon or a Stark. This means that there is a possibility of netting a maximum of 750.000 gold coins. You can play conservatively for 15 coins or decide it to be a red wedding with 150 coins. But as Cersei says, "When you play the game of thrones, you win or you die." So, there isn't any middle ground anyway.
Ready to claim the Iron Throne?
Microgaming has a demo version of the game. So, if you want to practice and sharpen your swords before you start spinning for real money, you can always do that. However, you need to log in even to play the free version.
Once you are ready for some real bloody action, the game is available on PlayFrank online casino for all our players. Sign up and get ready to win battles. We hope you find your iron throne. Seven Blessings!


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"The Lincoln Lawyer" Coming to TV
Published at 8:15 am on August 9, 2011
Mickey Haller's signature automobile is about to get a lot more mileage.
Variety is reporting that ABC and Lionsgate are currently developing a TV series based on "The Lincoln Lawyer," the Michael Connelly-penned series of novels about Michael "Mickey" Haller, a lawyer who conducts his business from the back of a Lincoln Town Car. Haller, of course, was portrayed by Matthew McConaughey in the film adaptation back in March.
"The Lincoln Lawyer" would be joined by another legal thriller-novel-turned-movie-turned-TV-series when NBC brings "The Firm" to TVs mid-season.
The good news for fans of the series is that Connelly himself will be involving in writing the series pilot.
No word on McConaughey's involvement but looking at his upcoming slate of movies....he might want to consider taking a meeting.


BI success requires more than just a strong technology platform. It takes laser focus on processes and personnel — and a business-first approach to gaining insights from data.
A business intelligence strategy is key to staying competitive, but there's more to it than just implementing technology. That's the easy part, according to Boris Evelson, vice president and principal analyst at Forrester Research. It will require a firm strategy, regular maintenance and constant improvement.
Here are seven essential steps for creating a successful business intelligence strategy, according to experts.
While business intelligence technology typically falls under IT's domain, most tools are intuitive enough for non-IT business users to navigate. When departments need data in real time, it makes sense to give them direct access to business intelligence tools instead of leaving them solely under IT's control.
Evelson suggests monitoring business intelligence usage to find patterns and to see which tools are being utilized and how they can be improved. These insights allow IT to adjust priorities to make sure the most-used tools get the right attention.
It's tempting to deploy multiple tools at once, but you want to go for quality over quantity, says Chris Hagans, vice president of operations for WCI Consulting. It's important to trust the tools accessing company data – and you also want to be able to trust the data those tools produce.
To avoid getting trapped under too much data, Evelson suggests starting with a top-down approach. Identify a business problem first and then determine which metrics you'll use to measure and pull the data to address the issue.
A good business intelligence strategy evolves and grows over time, it's not something you can implement and ignore. You want to go into it with firm priorities but expect those priorities to shift and change. The strategy should evolve with the needs of the users and the growth of the business, says Hagans.
Data is only useful if it's being analyzed, so Todd Nash, president and principal of CBGI Consulting suggests encouraging employees to think creatively and develop narratives around data. It can help make connections between data and business priorities, so everyone can see and understand the value of data.


We feel truly honored to be the recipient of one of Karen's amazing pies.
You guys were so generous to let us stay at Casa Saylor… we had a lovely escape and are very grateful. I hope your kitty was okay… she was quite vocal and so we let her out of her room and kept the pooch in the car when we were not downstairs. Thank you, thank you, thank you!
Or perhaps a little bit crazy?


BimaAFYA is a mobile micro-health insurance product specifically targeting the poor and the informal sector population. It offers a platform to the user to enquire about the product, register for a policy, select cover they can afford, make payment for the premium via mobile money and access their bimaAFYA benefit wallet via mobile phone.
BimaAFYA is a completely paperless product from registration to health service access, which means the user doesn't require one-to-one interaction with the insurer at any point. Instead, they can complete the entire process from home, work or any location.


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Stand Up To Cancer works relentlessly to offer the newest, most effective, and most promising cancer treatments to patients quickly by bringing together the best minds to collaborate, innovate, and share cancer research.
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Stand Up To Cancer enables scientific breakthroughs by funding collaborative, multidisciplinary, multi-institutional scientific cancer research teams and investigators. Thanks to the support of our dedicated partners and the entertainment community, SU2C is able to bring widespread attention to cancer research and treatments.
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We're all in this together! Learn how to get involved and make a monumental impact. Join our community of passionate supporters who are committed to helping patients gain rapid access to better treatments.
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Stand Up To Cancer was created to accelerate groundbreaking cancer research that will get promising new cancer treatments to patients quickly. We won't stop until every cancer patient is a long-term cancer survivor.
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Adaptive bitrate streaming provides the best video quality and viewer experience possible — no matter the connection, software, or device. Called ABR for short, the majority of these streams are delivered via HTTP-based technologies such as MPEG DASH and Apple's HLS.
In this blog, we'll discuss why adaptive bitrate streaming matters and how it works. But first, let's segue into the details by looking at one of the most-watched live broadcasts in the United States: The Super Bowl.
Despite attracting one of the lowest television audiences in years, a game-changing seven million viewers streamed this year's Super Bowl.
Well, the viewership wasn't actually game-changing. A winning record was in the Tom Brady's favor from the get-go. But the real MVP was adaptive bitrate streaming.
Why? This marked a 70 percent increase in streaming spectators from 2018. And these viewers weren't tethered to their couches, either. Some were streaming the game on a laptop while waiting to board a delayed flight. Others were hiding from the Polar Vortex in a ski lodge with the game on their cell phones. And some were on the beach in Cabo squinting at a sandy iPad.
Even so, the streams made it to their screens with minimal buffering and near-real-time delivery. So what's the Super Bowl have to do with adaptive bitrate streaming? In 2019, everything.
Different screens and varying internet speeds were no match for Adam Levine's bare chest. Both mobile devices and 4K home theaters displayed adequate-enough streams to entice seven million viewers. Adaptive bitrate streaming provided a solid user experience despite varying conditions.
Why Does Adaptive Bitrate Streaming Matter?
Thanks to adaptive bitrate technology, streams of the 2018 Super Bowl dynamically adapted to fit the screen size and internet speed of everyone watching. Mobile viewers with poor connections didn't have to wait for the game to load. For those plugged into high-speed internet, a higher resolution alternative played.
To connect with users — no matter where they are — you need adaptive bitrate streaming.
That way, you can deliver high-quality streams to users with outstanding bandwidth and processing power, while also accommodating those lacking in the speed and power department.
Rather than creating one live stream at one bitrate, a transcoder is used to create multiple streams at different bitrates and resolutions. This is easily done with a media server software.
Multiple renditions allow for playback on different bandwidths. The media server then sends the highest-quality stream possible for each viewer's device and connection speed. And this is all done in the most efficient manner possible.
The result? No buffering or stream interruptions. Plus, as a viewer's signal strength goes from two bars to three, the stream dynamically adjusts to the deliver a superior rendition.
Adaptive bitrate streaming is vital to anyone trying to reach their target viewers. Why? Because viewers no longer notice it. They simply expect it.
How Does Adaptive Bitrate Streaming Work?
To optimize the viewing experience across a variety of devices and connection speeds, you'll need a transcoding solution like the Wowza Streaming Engine™ software or Wowza Streaming Cloud™ service.
Transcoding allows you to create multiple files from a single source through the process of transrating and transizing.
Transcoding: An umbrella term for taking a compressed/encoded file and decompressing/decoding it to alter it in some way. The manipulated file is then recompressed for delivery. Transrating and transizing are both subcategories of transcoding.
Transrating: Changing the bitrate of the decompressed file to accommodate different connection speeds. This can include changing the frame rate or changing the resolution.
Transizing: Resizing the video frame — or resolution — to accommodate different screens.
Transrating and transizing are critical to adaptive bitrate streaming. The two also overlap. For example, taking a 4k video input stream at 13 Mbps and converting it to a 1080p stream at 4300 kbps would be an example of both transrating and transizing.
The spectrum of transcoded files created would then fall on an encoding ladder. At the top, a high-bitrate, high-frame-rate, high-resolution stream is output for viewers with the highest-tech setups. At the bottom of the ladder, the same video in low quality is available viewers with small screens and crappy service.
The transcoder breaks these renditions into chunks that are 2-10 seconds in length. These allow the player to dynamically shift between the different encodings depending on available resources.
The video player can then use whichever rendition is best suited for its display, processing power, and connectivity. If power and connectivity change mid-stream, the video will automatically switch to another step on the ladder.
It's worth noting that adaptive bitrate streaming also helps minimize distribution costs. By limiting the bandwidth required to deliver streams across a content delivery network (CDN), distributors optimize connectivity expenses.
In the early days, RTMP (Real-Time Messaging Protocol) was the go-to method for streaming over the internet. Sending linear streams via RTMP enabled lightning-fast video delivery. That said, the protocol encountered issues getting through firewalls.
RTMP streams were encoded at a bitrate that was comfortably less than the bandwidth of target viewers. These were then delivered via a dedicated streaming server as a continuous stream of date.
The industry eventually shifted in favor of HTTP-based (Hypertext Transfer Protocol) technologies. These streams were not technically "streams." Rather, they were progressive downloads sent via regular web servers.
This delivery method works by downloading the video as you watch it. The content could be cached on local servers and encountered less trouble getting through firewalls. But, this didn't optimize for screen size or connectivity.
Then came adaptive bitrate streaming. Content distributors encoded streams into many different bitrates and broke them into fragments. These multi-bitrate chunks would then be indexed in a manifest file and delivered to the player.
The result? Very little buffering, fast start time, and a good experience for both high- and low-end connections.
Unlike progressive download, where the user would have to wait for the video to buffer if encoded at too high of a bitrate, adaptive bitrate streaming switches dynamically behind the scenes, without any user interaction.
As mentioned, the majority of ABR streams today are delivered via HTTP-based technologies such as MPEG DASH and Apple's HLS. RTMP streams can also be configured for adaptive bitrate streaming, but it's not nearly as easy.
We've said it before and we'll say it again: The streaming industry's influence on everyday life is at its zenith.
Ever-increasing connectivity and more sophisticated technology have heightened customer expectations. Nobody's going to stick around when faced with the dreaded buffering icon.
Luckily, adaptive bitrate streaming is easy. You can use the Wowza Streaming Engine™ software for adaptive bitrate delivery using your own servers — whether they're on premises or in a third-party cloud platform. For those who want to get up and running quickly without any hassles, the Wowza Streaming Cloud™ service might be a better fit.
It's up to you: adapt or get out. Just make sure you start with adaptive bitrate streaming. And Wowza.


Published by Elliot Mercier, at Wednesday, October 03rd , 2018 - 17:10:08 PM, in DIY & Créativité category.
Published by Villetta Perrin, at Friday, October 19th , 2018 - 18:58:08 PM, in DIY & Créativité category.
Published by Elayna Roux, at Friday, October 19th , 2018 - 17:11:37 PM, in Création de Maison Créative category.


text:
BiH:
 Durakovići (Trnovo FBiH, BiH), naselje u općini Trnovo (FBiH)
 Durakovići (Vlasenica, BiH), naselje u općini Vlasenica
 Durakovići (Bugojno, BiH), biše samostalno naselje u općini Bugojno

redpajama_set_name: RedPajamaWikipedia


living in florence, italy: i love our city.
While I was away in Philadelphia for a few days last week, Rob was a man about town! He wandered around and took some really amazing photos. I love Florence and it inspires me daily, but so often I limit myself to seeing it through my own lens. When I came home and saw all of his wonderful photos it made me smile and feel so blessed that I live here. He sees details in life that I would normally just pass on by.


Whether it's your first Disney College Program or your fourth, there's one day that likely stands above the rest in terms of excitement and anticipation: your arrival day! Getting the keys to your apartment, meeting your new roommates, and finding out your work location are all huge milestones that many anticipate for months.
Just as Walt wanted to continually experiment and improve every facet of his business, we're constantly looking for ways to make your first day with us memorable and exciting! When I first arrived on my Disney College Program back in January of 2009, I was so nervous and excited about what I was about to experience. I had found a roommate I wanted to live with ahead of time, but didn't have a way of formally linking up with him in the system to ensure we got an apartment together. Instead, we stood in line together at Vista Way to make sure we told the person assigning apartments our roommate preferences (as well as where we wanted to live). Back in 2009, there wasn't even apartment pre-registration – everything was taken care of when you arrived! Since we didn't know where we would be living yet, that meant every single person checking in that day was meeting at the Vista Way Pavilion for one big administrative party!
After taking care of our apartment assignments and getting our ID photos taken, we then did some important onboarding paperwork and completed our background checks (things that are now done at Casting). Once we wrapped up with our paperwork and background checks, we were free to go to our apartments and start moving in and meeting our friends for the rest of the day.
For you seasoned pros that might be reading this, you may be wondering why I didn't mention getting my work location and meeting with training. All of that juicy info came on Day 2 of check-in!
Yes, it's true – we had to wait until our second day of check-in before we found out where we'd be working (I KNOW…)! The struggle was real. Believe me, it's all I could think about that first night in my new apartment. I remember seeing a sticker next to my name when I got my apartment on Day 1 that indicated I was working at Magic Kingdom Park. The sticker was partially covered, so all I could see was the park name and "T_______." My mind was racing the entire first day. "What areas in Magic Kingdom start with a 'T'?" I asked myself. "Maybe I read it wrong. Maybe I'm not even at Magic Kingdom!" The only "T" my racing mind could come up with was "Toontown" (for Mickey's Toontown Fair) and I was getting a little worried. I didn't know if I was going to like Toontown, and I knew I didn't like the costume. It wasn't until Day 2 of check-in that I was reminded by a trainer that Tomorrowland existed. I was elated! As a roller coaster fanatic, I was hoping that I'd get the chance to work at Space Mountain.
I wouldn't know my specific attraction for a few more days, though. I first had to attend our company-orientation, Traditions. Following Traditions, I'd need to attend my Magic Kingdom property orientation and my Tomorrowland orientation before I'd find out exactly which attraction I'd get to work. By this point, I was no longer stressed. I had a blast in all of my orientation classes and was learning so much about a company I loved. Finally, at the end of my Tomorrowland orientation, we were called up, group by group (based on attraction) to meet our specific trainers. I waited with as many fingers and toes crossed as I possibly could until I heard my name. I was working Space Mountain!
If you were anywhere within a 12-mile radius of the Magic Kingdom Park on that day, you may have heard angels singing, horns blasting, and bells ringing (and it wasn't a parade!) My wish had been granted, and so started my career with The Walt Disney Company.
I've held many roles since my time in Tomorrowland, but none of been far from my home with the College Program team. I've been fortunate to see (or even lead) some of the process changes and improvements that we've implemented to make your time here on the College Program a positive one! Our team doesn't look back – always forward! As you can tell from my story, the process I went through for check-in was longer than what you experience today. It wasn't bad, just different!
We're always looking for new ways to surprise and delight our participants, even as business needs and processes shift. I can't wait to see where the next 8 years take us! I look forward to meeting you during your check-in!


5.Good international reputation our company. was established in 2002. We are a professional manufacturer and distributor of electronic components, modules and triodes & diodes, capacitors & resistors, and others in Shenzhen, China.


text:
import proto  # type: ignore

__protobuf__ = proto.module(
    package="google.ads.googleads.v12.errors",
    marshal="google.ads.googleads.v12",
    manifest={"AudienceErrorEnum",},
)

class AudienceErrorEnum(proto.Message):
    r"""Container for enum describing possible audience errors.
    """

    class AudienceError(proto.Enum):
        r"""Enum describing possible audience errors."""
        UNSPECIFIED = 0
        UNKNOWN = 1
        NAME_ALREADY_IN_USE = 2
        DIMENSION_INVALID = 3
        AUDIENCE_SEGMENT_NOT_FOUND = 4
        AUDIENCE_SEGMENT_TYPE_NOT_SUPPORTED = 5
        DUPLICATE_AUDIENCE_SEGMENT = 6
        TOO_MANY_SEGMENTS = 7
        TOO_MANY_DIMENSIONS_OF_SAME_TYPE = 8
        IN_USE = 9

__all__ = tuple(sorted(__protobuf__.manifest))

redpajama_set_name: RedPajamaGithub


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Low Surface Temperature Radiators
Low surface temperature radiators, otherwise known as LST radiators, are designed for use when safety is a priority. While traditional radiators can reach up to between 60 and 80 degrees celsius, LST radiators do not get any hotter than 43 degrees celsius to the touch. Worried this will result in a colder room? Don't be! While they do have a lower surface temperature, these radiators use convection heat to deliver an equally satisfying output.
LST Radiators at Plumbworld
Whatever the reason why you are looking for low surface temperature radiators, Plumbworld has a range that is sure to help you out. Easy to fit and install in many homes or commercial properties, we have a choice of sizes to suit your needs which all meet NHS surface temperature requirements. With our LST standard range, you also have the option of installing your own thermostatic radiator valve, adding further efficiency to your heating system. Perfect for busy areas where you don't want to risk burns, shop low surface temperature radiators online at Plumbworld today.
Double Panel Plus (47) Single Panel (38) Double Panel (38)
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Integrated TRV
Low Surface Temperature Radiators - Type 11
Sort by Price Low to High Price High to Low Best seller
Stelrad 145000 Type 11 LST Standard Radiator 500 x 560mm
Extended Lead Time, 14 Days+
Manufacturer Direct in 2 - 7 Days
Stelrad 145200 Type 11 LST I Plus Radiator 500 x 650mm
Stelrad 145003 Type 11 LST Standard Radiator 500 x 1160mm
Stelrad 145202 Type 11 LST I Plus Radiator 500 x 1050mm
1 - 33 of 123 products
all_product_ids: 125


text:
CISAC Congratulates 2019 Honors Graduates
rsd19_046_0252a.jpg
Congratulations to CISAC honors program Class of 2019! On June 14, students in the CISAC Interschool Honors Program in International Studies graduated in a conferral of honors ceremony on the front lawn of Encina Hall.
CISAC is proud to add our 11 new graduates to our expanding list of alumni. The CISAC honors program, launched in 2001, consists of a two-week honors college program in Washington D.C., tours of government agencies, meetings with influential policy makers, and weekly seminars with CISAC faculty. Honors students are also required to research and complete an original thesis on an important national security issue. The 2019 program was co-directed by Professors Martha Crenshaw and Coit "Chip" Blacker. The occasion marked their last year teaching in the program, as both are retiring this year.
The graduates are heading to a wide variety of careers, from graduate education to investment banking. A sample of this class's upcoming plans includes:
graduate degrees from Trinity College, Dublin, Harvard, Stanford, and Cambridge Universities;
a position on the Senate Committee on Foreign Relations Minority staff;
an assistant product manager at Schmidt Futures;
a reporter at Wall Street Journal's Washington bureau; and
an investment associate at Bridgewater Associates.
Several honors students also won awards for their outstanding work as undergraduates.
Philip Clark, '19, won the Terman Award in Management Science & Engineering, the Kennedy Honors Thesis Prize, and the Hoefer Prize. The Terman Award is presented to the top five percent of each year's School of Engineering seniors. The Kennedy Prize is awarded annually to the single best thesis in each of the four areas of humanities, social sciences, natural sciences, and engineering and applied sciences. Recipients of this award have accomplished exceptionally advanced research in the field and have shown strong potential for publication in peer-reviewed scholarly works. The Hoefer Prize recognizes outstanding Stanford undergraduate writing in Writing in the Major courses
Andrew Milich, '19, won the Terman Award in Computer Science and the William J. Perry Prize. The William J. Perry Prize is awarded by CISAC to a student for excellence in policy-relevant research in international security studies.
Kaylana Mueller-Hsia, '19, won the John Holland Slusser World Peace Prize. The Slusser Prize is awarded by the John Holland Slusser World Peace Fund to the thesis that best demonstrates excellence in the analysis of one or more steps towards world peace.
Read below for more on this year's graduates and their theses:
Philip Clark
Climbing to "Strategic Commanding Heights": Understanding Chinese Technology Investment in the United States
Thesis Advisor: Amy Zegart
"The rise of China ranks among the most important American foreign policy challenges. Philip's path-breaking thesis finds that one of Beijing's most powerful tools to secure commercial and military advantage is perfectly legal and largely overlooked: venture capital investment in American high-tech startups. The thesis creates and analyzes two original datasets linking Chinese venture capital investment to the technological priorities of the US and Chinese military. It uncovers patterns of investor ties to the Chinese Communist Party. And in two richly researched case studies, Philip develops a new theoretical model explaining when, why, and how China succeeded in surging its investment in a coordinated fashion. Philip has produced the best analysis of the topic yet written in the academy or government, and its implications are both important and unsettling."
Alexa Corse
Election Cybersecurity: Assessing the Roles of Federalism and Partisanship
Thesis Advisor: Andrew Hall
"Securing America's elections is one of the most pressing and salient policy challenges facing the country today. Why are we struggling to do it? A common narrative is that partisanship is to blame, but Alexa's thesis raises important doubts about this account. Her thesis sheds light on the fiercely independent views of election administrators and their suspicion of national interventions into the electoral system, and, through a series of case studies, shows that this suspicion is likely more important than simple partisan disagreement in frustrating the federal government's efforts to offer a unified approach to election security. In offering a masterful account of this process, Alexa's thesis makes us rethink the problem of election security---no small feat for a thesis project, and an accomplishment she should take great pride in having achieved."
Federico Derby
A Green Light at the End of Kim's Dock? North Korea and International Cooperation on the Environment
Thesis Advisor: Siegfried Hecker
"Federico's thesis on North Korea's compliance with multinational environmental agreements is a tour de force. He conceived and developed a novel multispectral satellite imagery analysis technique to gather information on agreement compliance that is outside the reach of normal confirmation mechanisms in such a closed and isolated country. He combined this innovative technical approach with meticulously researched understanding of international environmental agreements to conclude that North Korea complied with such agreements when compliance supported the stability of the Kim regime. His study represents an outstanding example CISAC's objectives of combining the best of the technical and social sciences."
Jake Dow
A Path Dependent Prerogative: Why British Prime Ministers Gave Up Their War Powers
Thesis Advisor: Kenneth Schultz
"Jake's thesis explains a remarkable development. Before 2003, the British parliament had never taken a vote to authorize the use of military force before an operation commenced; the power to start a war was held by the Crown and delegated to the prime minister. Starting with the Iraq War in 2003, however, every use of British military force has been preceded by a parliamentary vote. By examining parliamentary debates and reports, public statements, and government documents, Jake shows how a decision made for short-term political benefit in 2003 unexpectedly led to a durable change in how war powers are wielded. The unprecedented vote on Iraq changed beliefs about the legitimate role of parliament, leading subsequent PMs to expect political risks from acting approval. Jake's thesis is an excellent example of careful research presented through compelling historical narrative."
Megan Haines
The French Fourth Republic's Decision to Build a Bomb: Prestige, Politics, and Alliances
Thesis Advisor: Coit Blacker
"The decision by French policymakers to acquire nuclear weapons is said to reflect France's determination to restore the country's prestige and to assure its great-power status following its defeat and occupation in World War II. In this carefully researched and insightful thesis, Megan presses beyond this conventional wisdom to determine what role other factors may have played in France's decision "to go nuclear." She finds that while prestige did in fact constitute a kind of permissive condition, two other factors – France's deep suspicions about the commitment of its NATO allies to come the country's defense and the determination of conservative politicians to press ahead with nuclearization – provide a valuable lens through which to view and understand the decision. It's a fascinating story, told with a keen sensitivity to the highly contingent way in which the French nuclear weapons program unfolded and the many obstacles that both civilian and military decisionmakers faced in achieving their goal."
Katherine Irajpanah
War Power Moves: Executive Incentives for Unilateral Action
Thesis Advisors: Condoleezza Rice and Kenneth Schultz; Robert Rakove
"Katherine's thesis wrestles with a core challenge in today's foreign policy debates: who has the power to wage war? If policy-makers want to know how Congress can constrain America's growing military footprint, they will be well-served by this important piece of research. I have advised numerous theses in my career. Katherine's is among the two or three best that I have seen in 30 years. Not only is the product good, but she has tackled it with rigor and enthusiasm. She is a superlative student and full of exceptional promise as she heads to Harvard for graduate school."
Irene Kim
Keen to Screen: The European Union Response to Growing Chinese Investment
Thesis Advisors: Martha Crenshaw, Christophe Crombez
"In her Honors Thesis 'Keen to Screen: the European Union Response to Growing Chinese Investment' Irene Kim presents a thorough analysis of the EU's efforts to develop a framework for the screening of foreign direct investment in the EU. The thesis examines the divergent opinions and interests that are typically at play in international politics and EU decision-making, in this case concerns for national security, protectionist impulses, the desire to grow and attract foreign investment, and free-trade economic liberalism. Irene clearly shows how the new framework represents a rather toothless compromise that reflects these rivaling concerns, and can thus be considered a glass half empty, or half full."
Andrew Milich
Free, Open-Source, and Anonymous: Why Deep Learning Regulators Are in Deep Water
"Artificial intelligence provokes fear and wonder in equal measure – conjuring the specter of killer robots and the promise of driverless cars. Andrew's thesis examines the spread of one aspect of AI breakthroughs: deep learning facial recognition technology. He asks two critical questions: what does the proliferation process of deep learning look like? And what can be done to prevent its malicious use? Andrew offers the first-ever analysis of deep learning proliferation. He compares deep learning to other dual-use technologies such as nuclear and chemical weapons. And he develops an award-winning technical model that undermines the accuracy of facial recognition applications. Andrew finds that past approaches like export controls are unlikely to curb the spread of deep learning, but technical countermeasures hold considerable promise to protect privacy and mitigate the risks of this technology. The thesis makes cutting-edge contributions to both engineering and policy and is poised to garner significant attention among senior U.S. officials."
Kaylana Mueller-Hsia
Servers and Sovereignty: Explaining the Rise of Data Localization Laws
Thesis Advisors: Andrew Grotto, David Cohen
"Kaylana's thesis explored why some democracies mandate that certain data be stored within their national borders, despite compelling economic and other reasons for why these data localization mandates can harm their citizens and businesses. These data localization practices are becoming more common internationally, creating new challenges for governments, civil society and businesses. Kaylana made original contributions to our understanding of how notions of sovereignty, under the right conditions, can influence governments' evaluation of the pros and cons of data localization. I couldn't be prouder of the efforts she put into this thesis and the final work product."
Elizabeth Shneider
The Iranian Rubik's Cube: Understanding the Impacts of Pressure, Engagement, and Domestic Determinants on Nuclear Negotiations with Iran
Thesis Advisors: Colin Kahl, Tess Bridgeman
"Under what conditions can states with profound conflicts of interest and deep historical enmity reach a peaceful accommodation? Elizabeth's terrific thesis draws on a wide range of primary and secondary source material and an impressive series of interviews to explain how nuclear negotiations succeeded in producing the Iran Nuclear Deal after more than a decade of failed negotiations. She convincingly rebuts the conventional wisdom that U.S.-led sanctions were sufficient to produce a deal. Instead, she persuasively argues that it required a combination of five factors—economic pressure, broad international diplomatic isolation of Iran, a willingness to compromise, a prioritization of direct engagement, and a conducive domestic political environment in both countries—that finally produced an agreement. The absence of one or more of these factors frustrated nuclear diplomacy prior to 2013-2015 and, today, it suggests that President Trump's current policy of "maximum pressure" toward Iran is unlikely to produce a "better deal."
Matthew Bryan Wigler
Compact and Consensus: American Foreign Policy and the Partisan Tide at the Water's Edge
Thesis Advisor: Colin Kahl
"For decades, even as political polarization and partisanship has grown the United States, it was presumed that this divide had less impact on foreign policy than domestic affairs. Matthew's excellent thesis questions that assumption. It draws the crucial distinction between ideological polarization, on the one hand, and affective polarization, on the other. Through detailed case studies, Matthew convincingly traces the rise and fall of U.S. foreign policy consensus and compact over the past seven decades. His analysis shows that today, neither ideological or personal clashes stop at the water's edge, contributing to an erosion of support for liberal internationalism and a profound dysfunction in contemporary U.S. foreign policy."


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