The OASI care bundle quality improvement project: lessons learned and future direction.

Rising rates of obstetric anal sphincter injury (OASI) led to a collaborative effort by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to develop and evaluate the OASI Care Bundle (OASI-CB). The OASI-CB comprises four practices (antenatal discussion about OASI, manual perineal protection, mediolateral episiotomy at 60° from the midline, and systematic examination of the perineum, vagina and ano-rectum after vaginal birth) and was initially implemented as part of a quality improvement (QI) project-"OASI1"-in 16 maternity units across Great Britain. Evaluation of the OASI1 project found that the care bundle reduced OASI rates and identified several barriers and enablers to implementation. This paper summarises the key findings, including strengths, limitations and lessons learned from the OASI1 QI project, and provides rationale for further evaluation of the OASI-CB

OASI2: a cluster randomised hybrid evaluation of strategies for sustainable implementation of the Obstetric Anal Sphincter Injury Care Bundle in maternity units in Great Britain.

BACKGROUND: The Obstetric Anal Sphincter Injury (OASI) Care Bundle comprises four primary and secondary prevention practices that target the rising rates of severe perineal tearing during childbirth, which can have severe debilitating consequences for women. The OASI Care Bundle was implemented in 16 maternity units in Britain in the OASI1 project (2017-2018), which demonstrated the care bundle's effectiveness in reducing OASI rates. In OASI2, the care bundle will be scaled up to 20 additional National Health Service (NHS) maternity units in a hybrid effectiveness-implementation study that will examine the effectiveness of strategies used to introduce, implement and sustain the care bundle. METHODS: OASI2 is a two-arm cluster-randomised control trial (C-RCT) of maternity units in England, Scotland and Wales, with an additional non-randomised study arm. C-RCT arm 1 (peer support, n = 10 units) will be supported by 'buddy' units to implement the OASI Care Bundle. C-RCT arm 2 (lean implementation, n = 10 units) will implement without external support. The additional study arm (sustainability, n = 10 units) will include some original OASI1 units to evaluate the care bundle's sustainability and OASI rates over time, from before OASI1 and through the end of OASI2. Units in all three study arms will receive an Implementation Toolkit with training resources and implementation support. The C-RCT arms will be compared in terms of OASI rate reduction (primary effectiveness outcome) and clinicians' adoption of the care bundle (primary implementation outcome). Clinical data will be collated from maternity information systems; implementation data will be collected through validated surveys with women and clinicians, supplemented by qualitative methods. Descriptive statistics and regression modelling will be used for analysis. Emergent themes from the qualitative data will be assessed using framework analysis. DISCUSSION: OASI2 will study the impact of various implementation strategies used to introduce and sustain the OASI Care Bundle, and how these strategies affect the bundle's clinical effectiveness. The study will generate insights into how to effectively scale-up and sustain uptake and coverage of similar interventions in maternity units. A locally adaptable 'implementation blueprint' will be produced to inform development of future guidelines to prevent perineal trauma. TRIAL REGISTRATION: ISRCTN26523605

Antioksidativni učinci N-acetilcisteina, lipoične kiseline, taurina i kurkumina u mišićnom tkivu šarana (Cyprinus carpio L.) tretiranih kadmijem

We investigated the muscle tissue of a teleost Cyprinus carpio L. to find out whether N-acetylcysteine (NAC), alpha-lipoic acid (LA), taurine (TAU), and curcumin (CUR) were able to counteract oxidative stress induced by acute exposure to cadmium (Cd). The muscle tissue was dissected 96 h after a single intraperitoneal injection of Cd (5 mg kg-1) and of antioxidant substances (50 mg kg-1). Using spectrophotometry, we determined the glutathione redox status, lipid peroxidation levels and the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione disulphide reductase (GR). Accumulation of Cd in the muscle was analysed using inductively coupled plasma - optical emission spectrometry (ICP-OES). All substances lowered Cd levels in the following order of effi ciency; LA=NAC>TAU=CUR. Cadmium increased SOD activity, but CAT activity declined, regardless of antioxidant treatment. Treatment with CUR induced GPx activity. Treatment with TAU lowered Cd due to higher total glutathione (tGSH). The most effective substances on lipid peroxidation were LA and NAC due to a greater Cd-lowering potential. It seems that the protective role of TAU, LA, and NAC is not necessarily associated with antioxidant enzymes, but rather with their own activity.Cilj istraživanja bio je utvrditi mogu li N-acetilcistein (NAC), α-lipoična kiselina (LA), taurin (TAU) i kurkumin (CUR) svojim antioksidativnim djelovanjem smanjiti razinu oksidativnog stresa u mišićnom tkivu šarana (Cyprinus carpio L.) akutno otrovanih kadmijem. Uzorci mišićnog tkiva skupljeni su 96 h nakon što su ribama intraperitonealno injicirani kadmij (5 mg kg-1) i ispitivani antioksidansi (50 mg kg-1). Primjenom spektrofotometrijskih metoda izmjereni su redoks status glutationa, razine lipidne peroksidacije te aktivnosti enzima superoksid dismutaze (SOD), katalaze (CAT), glutation peroksidaze (GPx) i glutation disulfi d reduktaze (GR). Maseni udio kadmija u mišićnom tkivu izmjeren je s pomoću metode induktivno spregnute plazme – optičke emisijske spektrometrije (ICP-OES). Ispitivani spojevi smanjili su nakupljanje kadmija u tkivu šarana sljedećim redoslijedom: LA=NAC>TAU=CUR. Tretman šarana kadmijem izazvao je porast aktivnosti SOD, ali se aktivnost CAT smanjila bez obzira na primjenu antioksidativnih spojeva. Dodatak CUR pojačao je aktivnost GPx. Dodatak TAU povećao je razinu ukupnoga glutationa te smanjio nakupljanje kadmija. Svi spojevi osim CUR smanjili su razinu lipidne peroksidacije te pretpostavljamo da su LA i NAC pridonijeli detoksifi kaciji kadmija. Rezultati istraživanja upućuju na to da testirani spojevi, osim CUR, imaju antioksidativni učina

Maternal blood cadmium, lead and arsenic levels, nutrient combinations, and offspring birthweight

Abstract Background Cadmium (Cd), lead (Pb) and arsenic (As) are common environmental contaminants that have been associated with lower birthweight. Although some essential metals may mitigate exposure, data are inconsistent. This study sought to evaluate the relationship between toxic metals, nutrient combinations and birthweight among 275 mother-child pairs. Methods Non-essential metals, Cd, Pb, As, and essential metals, iron (Fe), zinc (Zn), selenium (Se), copper (Cu), calcium (Ca), magnesium (Mg), and manganese (Mn) were measured in maternal whole blood obtained during the first trimester using inductively coupled plasma mass spectrometry. Folate concentrations were measured by microbial assay. Birthweight was obtained from medical records. We used quantile regression to evaluate the association between toxic metals and nutrients due to their underlying wedge-shaped relationship. Ordinary linear regression was used to evaluate associations between birth weight and toxic metals. Results After multivariate adjustment, the negative association between Pb or Cd and a combination of Fe, Se, Ca and folate was robust, persistent and dose-dependent (p < 0.05). However, a combination of Zn, Cu, Mn and Mg was positively associated with Pb and Cd levels. While prenatal blood Cd and Pb were also associated with lower birthweight. Fe, Se, Ca and folate did not modify these associations. Conclusion Small sample size and cross-sectional design notwithstanding, the robust and persistent negative associations between some, but not all, nutrient combinations with these ubiquitous environmental contaminants suggest that only some recommended nutrient combinations may mitigate toxic metal exposure in chronically exposed populations. Larger longitudinal studies are required to confirm these findings

Exploaitation in II-order graben – selection of mining works technology for securing exploitation up to ordinate -110 m a.s.l.

W artykule przedstawiono problemy związane z zabezpieczeniem eksploatacji w zachodniej części rowu II-rzędu, gdzie stwierdzono występowanie struktury geologicznej, w granicach której wydzielono dwa rejony zagrożeń, rejon X/S (w zakresie rzędnych +90/ -25 m n.p.m.) oraz rejon XV/S (20/ -110 m n.p.m.) W trakcie prowadzenia eksploatacji w piętrach VII i VIII, dochodziło do rozwoju niewielkich osuwisk oraz obserwowano reakcje reperów powierzchniowej sieci obserwacyjnej. W marcu 2011 roku, w czasie realizacji zabierki w piętrze VIII (eksploatacja do rzędnej +20 m n.p.m.), doszło do rozwoju osuwiska i strefowego wyparcia poziomu na wysokość ok. 3-4 m . Obserwacje wskazywały na możliwość rozwoju wieloskarpowego osuwiska, które utrudni eksploatację w strefie do rzędnej -110 m n.p.m. Podczas eksploatacji w VIII i IX piętrze górniczym, poprzez zestramianie zbocza oraz kontrolowane prowokowanie pełzania osuwającego się fragmentu zbocza, wyeksploatowano znaczny fragment osuniętych gruntów. Pozwoliło to na ograniczenie zagrożeń dla eksploatacji w zakresie rzędnych -20/-110 m n.p.m.Problems connected with securing exploitation in the western part of II-order graben were presented in paper. Occurrence of geological structure was noted in that area, in which two hazardous areas were distinguished. Area X/S (ordinate +90/-25 m a.s.l) and area XV/S (20/-110 m a.s.l). During exploitation in levels VII and VIII, expansion of small landslides and reaction of superficial observation network bench marks occurred. In march 2011, during exploitation in level VIII (exploitation to ordinate +20 m a.s.l), expansion of landslide and zonal displacement of level, up to 3-4 m occurred. Observations showed possibility of multiscarp landslide, that will make exploitation difficult in zone, up to ordinate -110 m a.s.l. During level VIII and IX exploitation, sloping of slide and controlled provoking of crawling of sliding bevel was performed. During that, part of slided part was exploited. That allowed to limit the hazards for exploitation in ordinates -20/-110 m a.s.l

Project competencies in Podlasie companies

Budowa i wzmocnienie kompetencji projektowych jest jednym z kluczowych aspektów determinujących skuteczność realizacji projektów rozwojowych przedsiębiorstw, a co za tym idzie - osiągania i utrzymywania przez przedsiębiorstwo przewagi konkurencyjnej. Rozwój kompetencji projektowych przedsiębiorstw staje się niezwykle istotny w kontekście trwającego w ostatnich latach w Polsce spowolnienia wzrostu gospodarczego z jednej strony i z drugiej -nowych możliwości realizacji projektów rozwojowych w ramach budżetu polityki spójności na lata 2014-2020.Building and strengthening the project’ competencies is one of the key aspects that determine the efficiency of the implementation of innovation projects in enterprises and thus achieve and maintain the company's competitive advantage. Development of project competencies becomes particularly important in the context of ongoing in Poland economic slowdown and new opportunities of development projects that come up with financial perspective and cohesion policy of the EU for 2014-2020

Practical experience of use of waste from the recycled car tires as the filler of road embankments construction

W artykule przedstawiono przykład możliwości wykorzystania materiału odpadowego pochodzącego ze zużytych opon samochodowych do budowy nasypów drogowych. Artykuł opracowano na podstawie wyników pełnego zakresu badań laboratoryjnych, polowych oraz monitoringu wykonanego odcinka pilotażowego. Autorzy przedstawili zarówno zalety zastosowania odpadów gumowych, jak i bariery ograniczające tą technologię w realizacjach infrastruktury drogowej w naszym kraju.The purpose of this paper is to assess the possibility of using waste material derived from the recycling of used car tires as filler of road embankments. The case study was done on the basis of the results of a full range of laboratory tests, field trials and monitoring of existing pilot objects. The document highlights the potential for the application of waste rubber in the achievements of road infrastructure in our country