Constructing evidence-based clinical intrapartum care algorithms for decision-support tools

AimTo describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours.PopulationSingleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility.SettingHealth facilities in low- and middle-income countries.Search strategyLiterature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google.Case scenariosNine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes.ConclusionsIntrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts.Tweetable abstractEvidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience

Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS)

Background: LS women have a 40-60 % lifetime risk of endometrial cancer (EC). Most international guidelines recommend screening. However, data on efficacy are limited. Purpose: To assess the performance of OHES for EC screening in LS and compare it with transvaginal ultrasound (TVS) alone. Methods: A prospective observational cohort study of LS women attending a tertiary high-risk familial gynaecological cancer clinic was conducted. LS women opting for EC screening underwent annual OHES and TVS. Histopathological specimens were processed using a strict protocol. Data of women screened between October 2007 and March 2010 were analysed from a bespoke database. Histology was used as the gold standard. Diagnostic accuracy of OHES was compared with TVS using specificity, and positive (PLR) and negative (NLR) likelihood ratios. Results: Forty-one LS women underwent 69 screens (41 prevalent, 28 incident). Four (three prevalent, one incident) women were detected to have EC/atypical endometrial hyperplasia (AEH), five had endometrial polyps and two had endometrial hyperplasia (EH) on OHES. TVS detected two of four EC/AEH. OHES had similar specificity of 89.8 % (CI 79.2, 96.2 %), but higher PLR 9.8 (CI 4.6, 21) and lower NLR (zero) compared to TVS: specificity 84.75 %(CI 73, 92.8 %), PLR 3.28 (CI 1.04, 10.35) and NLR 0.59 (CI 0.22, 1.58). No interval cancers occurred over a median follow-up of 22 months. The annual incidence was 3.57 % (CI 0.09, 18.35) for EC, 10.71 % (CI 2.27, 28.23) for polyps and 21.4 % (CI 8.3, 40.1) for any endometrial pathology. Conclusions: Our findings suggest that in LS, annual OHES is acceptable and has high diagnostic accuracy for EC/AEH screening. Larger international studies are needed for confirmation, given the relatively small numbers of LS women at individual centres. It reinforces the current recommendation that endometrial sampling is crucial when screening these women. © 2012 Springer-Verlag

Preparation of stable acrylate/montmorillonite nanocomposite latex via in situ batch emulsion polymerization: Effect of clay types

WOS: 000280886500029Nanocomposites based on acrylic (butyl acrylate-co-methyl methacrylate-co-acrylamide) terpolymer and various commercial montmorillonites were synthesized by an "in situ" batch emulsion polymerization method. A complex emulsifier system containing sodium dodecyl sulphate (SDS) and a polymeric stabilizer was used in the polymerization. The minimum emulsifier concentration necessary to obtain stable latex depended on nanoparticle type and was established by several trials. Based on the experimental data two groups of stable latexes were obtained and characterized. The first nanocomposite latex group (Group A) was obtained by using lower emulsifier content and included Cloisite 93A, Cloisite 30B, Nanomer 1.31 PS, Cloisite Na(+) clays while the second group (Group B) had higher emulsifier content including Cloisite 15A, Cloisite 20A, Dellite 67G and Nanomer 1.44P clays. The nanocomposite emulsions were characterized by means of particle size and zeta potential analyzes. The intercalation/exfoliation of the nanoparticles in acrylic latex was assessed by XRD and SEM. The structural characterizations of the nanocomposite films were performed by FTIR, mechanical properties were tested by DMTA and thermal behavior was analyzed by DSC and TGA. The zeta potential and particle size analysis showed that nanocomposite latexes were electrostatically stable and they had fine particle sizes varying between 94 and 174 nm with narrow distributions. DMTA results indicated significantly enhanced elastic moduli values for the nanocomposites except of those containing the clays having a relatively more hydrophilic nature (DOB, CNa(+)). The nanocomposite films also exhibited increased thermal stabilities. It was concluded that the clay type used in the preparation of nanocomposites and the emulsifier content in emulsion polymerization play important roles in determining latex and polymer properties of the nanocomposites and they should be predetermined for each application field. (C) 2010 Elsevier B.V. All rights reserved.EOL [FP7-NMP-2007-CSA-1]The authors acknowledge the support of the EOL through the FP7-NMP-2007-CSA-1 project NaPolyNet: Setting up research-intensive clusters across the EU on characterization of polymer nanostructure for performing several analyses (XRD, DSC, Particle size analysis, etc.)

Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study

Summary: Background: Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries. Methods: In this cross-sectional, observational study, we recruited children aged 0–42 months and their caregivers between March 3, 2011, and May 18, 2015, at 22 health clinics in Argentina, India, South Africa, and Turkey. We obtained a healthy subsample, which excluded children with a low birthweight, perinatal complications, chronic illness, undernutrition, or anaemia, and children with missing health data. Using the Guide for Monitoring Child Development, caregivers described their child's development in seven domains: expressive and receptive language, gross and fine motor, play, relating, and self-help. Clinicians examining the children also completed a checklist about the child's health status. We used logit and probit regression models based on the lowest deviance information criterion to generate Bayesian point estimates and 95% credible intervals for the 50th percentile ages of attainment of 106 milestones. We assessed the significance of differences between sexes and countries using predefined criteria and regions of practical equivalence. Findings: Of 10 246 children recruited, 4949 children (48·3%) were included in the healthy subsample. For the 106 milestones assessed, the median age of attainment was equivalent for 102 (96%) milestones across sexes and 81 (76%) milestones across the four countries. Across countries, median ages of attainment were equivalent for all play milestones, 20 (77%) of 26 expressive language milestones, ten (67%) of 15 receptive language milestones, nine (82%) of 11 fine motor milestones, 14 (88%) of 16 gross motor milestones, and eight (73%) of 11 relating milestones. However, across the four countries the median age of attainment was equivalent for only two (22%) of nine milestones in the self-help domain. Interpretation: The ages of attainment of developmental milestones in healthy children, and the similarities and differences across sexes and country samples might aid the development of international tools to guide policy, service delivery, and intervention research, particularly in low-income and middle-income countries. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Bioenergy production from diluted poultry manure and microbial consortium inside Anaerobic Sludge Bed Reactor at sub-mesophilic conditions

In this study, anaerobic treatability of diluted chicken manure (with an influent feed ratio of 1 kg of fresh chicken manure to 6 L of tap water) was investigated in a lab-scale anaerobic sludge bed (ASB) reactor inoculated with granular seed sludge. The ASB reactor was operated at ambient temperature (17-25 degrees C) in order to avoid the need of external heating up to higher operating temperatures (e. g., up to 35 degrees C for mesophilic digestion). Since heat requirement for raising the temperature of incoming feed for digestion is eliminated, energy recovery from anaerobic treatment of chicken manure could be realized with less operating costs. Average biogas production rates were calculated ca. 210 and 242 L per kg of organic matter removed from the ASB reactor at average hydraulic retention times (HRTs) of 13 and 8.6 days, respectively. Moreover, average chemical oxygen demand (COD) removal of ca. 89% was observed with suspended solids removal more than 97% from the effluent of the ASB reactor. Influent ammonia, on the other hand, did not indicate any free ammonia inhibition due to dilution of the raw manure while pH and alkalinity results showed stability during the study. Microbial quantification results indicated that as the number of bacterial community decreased, the amount of Archaea increased through the effective digestion volume of the ASB reactor. Moreover, the number of methanogens displayed an uptrend like archaeal community and a strong correlation (-0.645) was found between methanogenic community and volatile fatty acid (VFA) concentration especially acetate

New Possibilities of Raw Cotton Pre-treatment before reactive dyeing

18th World Textile Conference (AUTEX) -- JUN 20-22, 2018 -- Istanbul Tech Univ, Textile Technologies & Design Fac, Istanbul, TURKEYWOS: 000461176700026Cotton fiber is one of the most used materials among other natural fibers in the textile and clothing industry. On the other hand, environmental pollutants are formed during the processing of cotton industry especially in conventional wet processes such as bleaching, scouring for raw cotton. In order to make alteration to those processes enzymes can be also used in some of them such as: bleaching and scouring. Due to the fact that conventional textile finishing processes with intensive energy, water and chemical consumption are not environmentally friendly; it is necessary to develop more "green" and economic production methods. Plasma technology and enzymes are promising techniques to support eco-friendly production in textile industry. These eco-friendly methods can also be combined to produce high quality materials and to reduce production cost. The aim of this study is to investigate the effect of plasma treatment combined with enzymatic bioscouring system over raw cotton fabric. Several techniques of characterization were used to study the effects caused by the interaction between plasma discharge/enzymes and cotton fabric, such as: static and dynamic contact angle, Scanning Electron Microscopy (SEM), Fourier Transform Infrared Spectrometer (FTIR) and reflectance spectrophotometer. All analyses performed in this study showed that DBD plasma discharge combined with enzymes, when applied on cotton fiber, produces significant modifications on the surface of this substrate, improving hydrophilicity and whiteness without altering its intrinsic properties. Thus, proving the effectiveness of the synergy of two important technologies to textile industry.FEDER funds through Operational Programme for Competitiveness Factors - COMPETE; National Funds through FCT - Foundation for Science and Technology [POCI-01-0145-FEDER-007136, UID/CTM/00264]This work is supported by FEDER funds through Operational Programme for Competitiveness Factors - COMPETE and National Funds through FCT - Foundation for Science and Technology within the scope of the projects POCI-01-0145-FEDER-007136 and UID/CTM/00264

Inappropriate Antimicrobial Use In Turkish Pediatric Hospitals: A Multicenter Point Prevalence Survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.WoSScopu