The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces.

OBJECTIVES, PURPOSE, OR AIM: This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals. BACKGROUND: Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users' health. METHOD: A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates. RESULTS AND DISCUSSION: The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people's behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives' hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements. CONCLUSIONS: The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers

Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Background In patients with out‐of‐hospital cardiac arrest without ST‐segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out‐of‐hospital cardiac arrest. Methods and Results A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost‐prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND‐36 and collected at 12‐month follow‐up. Overall total mean costs were similar between both groups (EUR 33 575±19 612 versus EUR 33 880±21 044; P=0.86). Generalized linear model: (β, 0.991; 95% CI, 0.894–1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 versus EUR 3028±4220; P<0.001). Costs concerning intensive care unit and ward stay did not show any significant difference. The RAND‐36 questionnaire did not differ between both groups. Conclusions The mean total costs between patients with out‐of‐hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered. Registration URL: https://trialregister.nl; Unique identifier: NL4857

Mossbauer mineralogy of rock, soil, and dust at Meridiani Planum, Mars: Opportunity's journey across sulfate-rich outcrop, basaltic sand and dust, and hematite lag deposits

The M&ouml;ssbauer (MB) spectrometer on Opportunity measured the Fe oxidation state, identified Fe-bearing phases, and measured relative abundances of Fe among those phases at Meridiani Planum, Mars. Eight Fe-bearing phases were identified: jarosite (K,Na,H3O)(Fe,Al)(OH)6(SO4)2, hematite, olivine, pyroxene, magnetite, nanophase ferric oxides (npOx), an unassigned ferric phase, and metallic Fe (kamacite). Burns Formation outcrop rocks consist of hematite-rich spherules dispersed throughout S-rich rock that has nearly constant proportions of Fe3+ from jarosite, hematite, and npOx (29%, 36%, and 20% of total Fe). The high oxidation state of the S-rich rock (Fe3+/FeT&nbsp;~&nbsp;0.9) implies that S is present as the sulfate anion. Jarosite is mineralogical evidence for aqueous processes under acid-sulfate conditions because it has structural hydroxide and sulfate and it forms at low pH. Hematite-rich spherules, eroded from the outcrop, and their fragments are concentrated as hematite-rich soils (lag deposits) on ripple crests (up to 68% of total Fe from hematite). Olivine, pyroxene, and magnetite are primarily associated with basaltic soils and are present as thin and locally discontinuous cover over outcrop rocks, commonly forming aeolian bedforms. Basaltic soils are more reduced (Fe3+/FeT ~&nbsp;0.2&ndash;0.4), with the fine-grained and bright aeolian deposits being the most oxidized. Average proportions of total Fe from olivine, pyroxene, npOx, magnetite, and hematite are 33%, 38%, 18%, 6%, and 4%, respectively. TheMB parameters of outcrop npOx and basaltic-soil npOx are different, but it is not possible to infer mineralogical information beyond octahedrally coordinated Fe3+. Basaltic soils at Meridiani Planum and Gusev crater have similar Fe-mineralogical compositions.Additonal co-authors: P Gütlich, E Kankeleit, T McCoy, DW Mittlefehldt, F Renz, ME Schmidt, B Zubkov, SW Squyres, RE Arvidso

The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review

Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the post-resuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population

The effect of the localisation of an underlying ST-elevation myocardial infarction on the VF-waveform: A multi-centre cardiac arrest study

Introduction: In cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI). Observational studies report lower AMSA-values in patients with than without underlying MI. Moreover, experimental studies with 12-lead ECG-recordings show lowest VF-characteristics when the MI-localisation matches the ECG-recording direction. However, out-of-hospital cardiac arrest (OHCA)-studies with defibrillator-derived VF-recordings are lacking. Methods: Multi-centre (Amsterdam/Nijmegen, the Netherlands) cohort-study on the association between AMSA, ST-elevation MI (STEMI) and its localisation. AMSA was calculated from defibrillator pad-ECG recordings (proxy for lead II, inferior vantage point); STEMI-localisation was determined using ECG/angiography/autopsy findings. Results: We studied AMSA-values in 754 OHCA-patients. There were statistically significant differences between no STEMI, anterior STEMI and inferior STEMI (Nijmegen: no STEMI 13.0mVHz [7.9–18.6], anterior STEMI 7.5mVHz [5.6–13.8], inferior STEMI 7.5mVHz [5.4–11.8], p = 0.006. Amsterdam: 11.7mVHz [5.0–21.9], 9.6mVHz [4.6–17.2], and 6.9mVHz [3.2–16.0], respectively, p = 0.001). Univariate analyses showed significantly lower AMSA-values in inferior STEMI vs. no STEMI; there was no significant difference between anterior and no STEMI. After correction for confounders, adjusted absolute AMSA-values were numerically lowest for inferior STEMI in both cohorts, and the relative differences in AMSA between inferior and no STEMI was 1.4–1.7 times larger than between anterior and no STEMI. Conclusion: This multi-centre VF-waveform OHCA-study showed significantly lower AMSA in case of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Confirmative studies on the impact of STEMI-localisation on the VF-waveform are warranted, and might contribute to earlier diagnosis of STEMI during VF

The role of nature and environment in behavioural medicine

The Society of Behavioural Medicine (www.sbm.org) defines behavioural medicine as an “interdisciplinary field concerned with the development and integration of behavioural, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation”. From the perspective of behavioural medicine, many health problems depend on undesirable behaviour and thus better health may be achieved by changing behaviour. Until now, behavioural medicine has mainly focused on behaviours with a direct impact on human health and well-being. However, more recently, environmentally-related behaviour, especially pro-environmental behaviour, has achieved attention as an indirect pathway to better health. Pro-environmental behaviour can be defined as the propensity to take actions and decisions with an ecologically sustainable impact and is commonly understood as a consequence of concerns regarding ecosystem destruction, climate change, and other harmful impacts of anthropogenic actions (Stern 2000). Proenvironmental behaviour is related to decisions such as active transport (e.g. biking) instead of passive (e.g. car driving), recycling, or reduced red meat consumption. Several pathways are suggested for explaining a relation between proenvironmental behaviour and health. In the following, a few of these pathways are outlined. In addition, various potential mechanisms for inducing or changing environmentally-related behaviours are discussed