H2-fueled high-bypass turbofan

The study developed preliminary design concepts for the exploitation of the properties of LH2 in a turbofan engine intended for air transport use, and showed the benefits which accrue in reduction of aircraf direct operating cost. Design concepts for the engine fuel delivery and control system, including the engine high pressure fuel pump, were developed, and general concept feasibility was shown. For both the engine and the fuel delivery and control system, recommendations were made for the advanced development which is necessary to bring the technology to a state of readiness for design application. The study was of necessity abbreviated in nature: more intensive study of both the engine and fuel delivery and control system is recommended

Parents’ and carers’ experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting:A qualitative systematic review

Objectives: To explore parents’ experiences of transition and aftercare following their child’s discharge from a pediatric intensive care unit to an inpatient ward.Methods: A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach.Results: Four studies were included in the final review that included a total of 95 participants. Fortynine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions; and (4) Transition as a physical, emotional and social balancing act.Conclusion: Transitioning from the pediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced

The Value of Evidence-Based Computer Simulation of Oral Health Outcomes for Management Analysis of the Alaska Dental Health Aide Program

Objectives: To create an evidence‐based research tool to inform and guide policy and program managers as they develop and deploy new service delivery models for oral disease prevention and intervention. Methods: A village‐level discrete event simulation was developed to project outcomes associated with different service delivery patterns. Evidence‐ based outcomes were associated with dental health aide activities, and projected indicators (DMFT, F+ST, T‐health, SiC, CPI, ECC) were proxy for oral health outcomes. Model runs representing the planned program implementation, a more intensive staffing scenario, and a more robust prevention scenario, generated 20‐year projections of clinical indicators; graphs and tallies were analyzed for trends and differences. Results: Outcomes associated with alternative patterns of service delivery indicate there is potential for substantial improvement in clinical outcomes with modest program changes. Not all segments of the population derive equal benefit when program variables are altered. Children benefit more from increased prevention, while adults benefit more from intensive staffing. Conclusions: Evidence‐ based simulation is a useful tool to analyze the impact of changing program variables on program outcome measures. This simulation informs dental managers of the clinical outcomes associated with policy and service delivery variables. Simulation tools can assist public health managers in analyzing and understanding the relationship between their policy decisions and long‐term clinical outcomes.The Ford Foundation

Use of labour induction and risk of cesarean delivery: A systematic review and meta-analysis

Background: Induction of labour is common, and cesarean delivery is regarded as its major complication. We conducted a systematic review and meta-analysis to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management. Methods: We searched 6 electronic databases for relevant articles published through April 2012 to identify randomized controlled trials (RCTs) in which labour induction was compared with placebo or expectant management among women with a viable singleton pregnancy. We assessed risk of bias and obtained data on rates of cesarean delivery. We used regression analysis techniques to explore the effect of patient characteristics, induction methods and study quality on risk of cesarean delivery. Results: We identified 157 eligible RCTs (n = 31 085). Overall, the risk of cesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk [RR] 0.88, 95% confidence interval [CI] 0.84-0.93; I2 = 0%). The effect was significant in term and post-term gestations but not in preterm gestations. Meta-regression analysis showed that initial cervical score, indication for induction and method of induction did not alter the main result. There was a reduced risk of fetal death (RR 0.50, 95% CI 0.25-0.99; I2 = 0%) and admission to a neonatal intensive care unit (RR 0.86, 95% CI 0.79-0.94), and no impact on maternal death (RR 1.00, 95% CI 0.10-9.57; I2 = 0%) with labour induction. Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death. © 2014 Canadian Medical Association or its licensors

The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications : a meta-analysis.

Obesity is rising in the obstetric population, yet there is an absence of services and guidance for the management of maternal obesity. This systematic review aimed to investigate relationships between obesity and impact on obstetric care. Literature was systematically searched for cohort studies of pregnant women with anthropometric measurements recorded within 16-weeks gestation, followed up for the term of the pregnancy, with at least one obese and one comparison group. Two researchers independently data-extracted and quality-assessed each included study. Outcome measures were those that directly or indirectly impacted on maternity resources. Primary outcomes included instrumental delivery, caesarean delivery, duration of hospital stay, neonatal intensive care, neonatal trauma, haemorrhage, infection and 3rd/4th degree tears. Meta-analysis shows a significant relationship between obesity and increased odds of caesarean and instrumental deliveries, haemorrhage, infection, longer duration of hospital stay and increased neonatal intensive care requirement. Maternal obesity significantly contributes to a poorer prognosis for mother and baby during delivery and in the immediate post-partum period. National clinical guidelines for management of obese pregnant women, and public health interventions to help safeguard the health of mothers and their babies are urgently required

The Importance of Measuring the Delivery of Services via Commercial Presence of Offshore Foreign Affiliates: Some Case Studies from Australian Business Experience

There are major difficulties associated with measurement of each of the four modes of services trade delivery as defined in the General Agreement on Trade in Services (GATS): cross-border supply, consumption abroad, commercial presence, and movement of natural persons. The consequence is that the extent of global trade in services is hugely underestimated and the services sector does not receive the trade and economic policy attention it deserves. Australia is one of the world’s most services-intensive economies. This paper highlights recent business case studies in Australia, which demonstrates the importance of intensifying official efforts to enhance collections of services export data and to measure specifically “Mode 3” (Commercial Presence) delivery of international services.services sector; trade in services; services intensive economies; australia services sector; services export data

Making co-enrolment feasible for randomised controlled trials in paediatric intensive care.

Enrolling children into several trials could increase recruitment and lead to quicker delivery of optimal care in paediatric intensive care units (PICU). We evaluated decisions taken by clinicians and parents in PICU on co-enrolment for two large pragmatic trials: the CATCH trial (CATheters in CHildren) comparing impregnated with standard central venous catheters (CVCs) for reducing bloodstream infection in PICU and the CHIP trial comparing tight versus standard control of hyperglycaemia