Perinatal hospice care in the opinion of nurses and midwives

Objectives: Perinatal medicine is a relatively new, dynamically developing branch of medicine. Its main purpose is takingcare of a woman in the pre-conception period, pregnancy and delivery, as well as taking care of a newborn baby.The main aim of the study was to assess the state of knowledge and opinion on hospice perinatal care of professionallyactive nurses and midwives.Material and methods: An original and anonymous questionnaire containing 30 questions was used for the study. 572 nursesand midwives from the Silesian Voivodeship took part in the study. The obtained data were analyzed.Results: Only 31.6% of respondents defined the level of their knowledge of pregnancy and neonatal care as high. 12.8%of respondents were able to indicate the definition of perinatal care and accurately determine its goals. The women participatingin the study were in favor of enclosing the information about not attempting resuscitation (DNAR) in medicalrecord of children with incurable disease diagnosed in fetal life (99.3%).Conclusions: The study showed deficits in practical and theoretical knowledge of nurses and midwives in the area ofhospice perinatal care. Lack of proper preparation is also one of the most frequently mentioned difficulties in taking careof a child and family with poor prognosis

Approximant-based orientation determination of quasicrystals using electron backscatter diffraction

Orientation mapping of quasicrystalline materials is demonstrated using crystalline approximant structures in the technique of electron backscatter diffraction (EBSD). The approximant-based orientations are symmetrised according to the rotational point group of the quasicrystal, including the visualization of orientation maps using proper colour keys for quasicrystal symmetries. Alternatively, approximant-based orientation data can also be treated using pseudosymmetry post-processing options in the EBSD system software, which enables basic grain size estimations. Approximant-based orientation analyses are demonstrated for icosahedral and decagonal quasicrystals

The comparison of intensity modulated radiotherapy (IMRT) and conformal radiotherapy (CFRT) in planning of adiuvant radiotherapy for patients with pancreatic cancer

Wstęp. Rak trzustki jest szóstą przyczyną zgonów z powodu nowotworów złośliwych w Polsce. Wyniki leczenia są złe,a rokowanie niepomyślne. Podstawową metodą leczenia jest operacja i adiuwantowa chemio- lub radiochemioterapia.Znaczny postęp technologiczny, jaki dokonał się w ciągu ostatnich kilkunastu lat, umożliwia przeprowadzenie radioterapiiw sposób bardziej bezpieczny i precyzyjny dzięki zastosowaniu nowych technik w planowaniu radioterapii,obrazowaniu i prowadzeniu napromieniania.Cel. Celem badania jest porównanie radioterapii wiązką z modulacją intensywności dawki (IMRT) i radioterapii konformalnej3D (CFRT) u chorych na raka trzustki.Materiał i metoda. U każdego z piętnastu chorych wykonano cztery plany leczenia: techniką dwóch pól naprzeciwległych(2P), dwóch pól naprzeciwległych i jednego pola skośnego (3P), dwóch pól naprzeciwległych i dwóch pólskośnych (4P) oraz z zastosowaniem techniki z modulacją intensywności dawki (IMRT).Planowanie wykonano zgodnie z zaleceniami protokołu ICRU 50 i 62 w celu uzyskania dawki minimalnej w obszarzePTV nie niższej aniżeli 95% dawki całkowitej. Plany leczenia zostały porównane przy użyciu histogramów rozkładudawki w jej objętości (DVH — Dose Volume Histogram). Wyznaczono parametry V20 dla każdej z nerek, V30 dla wątroby,dawkę maksymalną dla rdzenia kręgowego i jelit, dawkę minimalną w obszarze PTV, dawkę średnią dla całej wątrobyoraz obu nerek. Obliczono wartości procentowego współczynnika pokrycia objętości tarczowej (PTC), indeksukonformalności (CI) oraz indeksu homogenności (HI). Celem porównania poszczególnych technik przeprowadzonoanalizę statystyczną przy pomocy nieparametrycznego testu Wilcoxona.Wyniki. Dawka minimalna w obszarze PTV (PTVmin) dla techniki dwupolowej wynosiła 42,8 Gy, dla techniki 3P— 42,9 Gy, 4P — 43,2 Gy oraz 43,2 Gy dla IMRT (p = 0,006). Dawka maksymalna w rdzeniu kręgowym była akceptowalnadla wszystkich technik planowania (3P — 44 Gy, 4P — 42 Gy, IMRT — 45 Gy) z wyjątkiem techniki dwupolowej2P — 47,7 Gy (2P vs IMRT p = 0,00065, 3P vs IMRT p = 0,95, 4P vs IMRT p = 0,005). Wartości parametru V20 dla nerekbyły porównywalne we wszystkich planach konformalnych. Dla lewej nerki wynosiły odpowiednio: 44,7%, 41%,40% w oparciu o techniki 2P, 3P i 4P oraz 11,3%, 10,7%, 9,2% dla nerki prawej. Wartości parametru V20 dla lewej nerkiwynosiły 18% i 6% dla nerki prawej po zastosowaniu planowania techniką IMRT (p < 0,002). Parametr V30 dla wątrobybył porównywalny we wszystkich wykonanych planach leczenia: 2P — 8,3%, 3P — 8%, 4P — 7% oraz IMRT — 7%.(2P vs IMRT p = 0,015, 3P vs IMRT p = 0,04, 4P vs IMRT p = 0,36). Dawka maksymalna w objętości jelit była porównywalnai akceptowalna po zastosowaniu każdej z technik napromieniania: 2P — 48,5 Gy, 3P — 47,0 Gy, 4P — 46,7 Gy,IMRT — 48,0 Gy (p = 0,001).Wnioski. Zastosowanie IMRT w planowaniu uzupełniającej radioterapii u chorych na raka trzustki pozwala na uzyskanielepszego rozkładu dawki i lepszą ochronę nerek w porównaniu z innymi technikami konformalnymi. Wszystkiezastosowane techniki pozwalają na uzyskanie porównywalnych rozkładów dawek w obszarze wątroby i jelit.Introduction. Pancreatic cancer is the sixth highest cause of mortality in patients with malignant neoplasms in Poland.The results of treatment are poor and prognosis unfavourable. The basic method of treatment is surgery withadjuvant chemo or radiochemotherapy.Aim. The aim of the study was to compare CFRT (2F, 3F, 4F) and IMRT in planning of adiuvant radiotherapy for fi fteenpatients with pancreatic cancer.Material and method. For each patient from this group four treatment plans were performed: three for CFRT andone for IMRT. The CFRT plans consisted of two opposite fi elds (2F), two opposite fi elds and one oblique fi elds (3F),two lateral and two oblique fi elds (4F) and the IMRT plan. The treatment plans were performed to achieve a minimumdose to the PTV which was no lower than 95% of the total prescribed dose. Treatment plans were compared usingdose-volume histograms (DVH) and using V20 parameter for left (LK) and right kidney (RK), V30 for liver (L), maximaldose for spinal cord (SC), maximal dose for intestines (IN), mean dose for whole liver and each kidney. The PTC (PercentTarget Coverage), CI (Conformity Index) and HI (Homogenity Index) parameters were evaluated for each plan. For theevaluation of statistical signifi cance the nonparametric Wilcoxon’s test was performed.Results. The minimum dose in the PTV (PTVmin) for 2F plan was: 42.8 Gy, 3F — 42.9 Gy, 4F — 43.2 Gy and in IMRT— 43.2 Gy (p = 0.006). The maximal dose for spinal cord was acceptable in all plans (3F — 44 Gy, 4F — 42 Gy, IMRT— 45 Gy) except in 2F — 47.7 Gy (2F vs IMRT p = 0.00065, 3F vs IMRT p = 0.95, 4F vs IMRT p = 0.005). The median volumefor each kidney V20 was comparable for all conformal plans. For the left kidney 44.7%, 41%, 40% for 2F, 3F and4F respectively and 11.3%, 10.7%, 9.2% for the right kidney. The V20 for the left kidney was 18% and 6% for the rightkidney using the IMRT plans (p < 0.002). The V30 for the liver was comparable for each of the plans: 2F — 8,3%, 3F— 8%, 4F — 7% and IMRT — 7%. (2F vs IMRT p = 0.015, 3F vs IMRT p = 0.04, 4F vs IMRT p = 0.36). The maximal doseto the intestines was acceptable in all plans 2F — 48.5 Gy, 3F — 47.0 Gy, 4F — 46.7 Gy, IMRT — 48.0 Gy (p = 0.001).Conclusions. Using IMRT in the planning of adjuvant radiotherapy for patients after surgery for pancreatic cancerachieves a better dose distribution and protection of kidneys compared to standard conformal planning. All techniquesachieved a similar dose distribution in the liver and intestines

Ultrastructural visualization of 3D chromatin folding using volume electron microscopy and DNA in situ hybridization.

The human genome is extensively folded into 3-dimensional organization. However, the detailed 3D chromatin folding structures have not been fully visualized due to the lack of robust and ultra-resolution imaging capability. Here, we report the development of an electron microscopy method that combines serial block-face scanning electron microscopy with in situ hybridization (3D-EMISH) to visualize 3D chromatin folding at targeted genomic regions with ultra-resolution (5 × 5 × 30 nm in xyz dimensions) that is superior to the current super-resolution by fluorescence light microscopy. We apply 3D-EMISH to human lymphoblastoid cells at a 1.7 Mb segment of the genome and visualize a large number of distinctive 3D chromatin folding structures in ultra-resolution. We further quantitatively characterize the reconstituted chromatin folding structures by identifying sub-domains, and uncover a high level heterogeneity of chromatin folding ultrastructures in individual nuclei, suggestive of extensive dynamic fluidity in 3D chromatin states

Zagrożenia zdrowotne wśród dzieci i młodzieży. T. 1

Praca recenzowana / Peer-reviewed pape

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Influence of InGaN waveguide on injection efficiency in III-nitride laser diodes

The influence of using InGaN waveguides on blue laser diodes was theoretically studied using 1D drift diffusion model and 2D optical mode calculation. Despite of the known effect of increased confinement of an optical mode, especially for long wavelengths, an unexpected influence on the efficiency of carrier injection into the active region is discussed. It is found that InGaN-AlGaN interface is crucial to achieving high injection efficiency. A numerical model is created, which describes the influence of InGaN waveguide and Mg doping of electron blocking layer on basic properties of laser diodes. It is found that an increase of injection efficiency allows to reduce the doping level in an electron blocking layer and take advantage of decreased optical losses

Dependence of InGaN Quantum Well Thickness on the Nature of Optical Transitions in LEDs

The design of the active region is one of the most crucial problems to address in light emitting devices (LEDs) based on III-nitride, due to the spatial separation of carriers by the built-in polarization. Here, we studied radiative transitions in InGaN-based LEDs with various quantum well (QW) thicknesses&mdash;2.6, 6.5, 7.8, 12, and 15 nm. In the case of the thinnest QW, we observed a typical effect of screening of the built-in field manifested with a blue shift of the electroluminescence spectrum at high current densities, whereas the LEDs with 6.5 and 7.8 nm QWs exhibited extremely high blue shift at low current densities accompanied by complex spectrum with multiple optical transitions. On the other hand, LEDs with the thickest QWs showed a stable, single-peak emission throughout the whole current density range. In order to obtain insight into the physical mechanisms behind this complex behavior, we performed self-consistent Schrodinger&ndash;Poisson simulations. We show that variation in the emission spectra between the samples is related to changes in the carrier density and differences in the magnitude of screening of the built-in field inside QWs. Moreover, we show that the excited states play a major role in carrier recombination for all QWs, apart from the thinnest one