Estimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching.

Obstetric care is a high-risk area in healthcare delivery, so it is essential to have up-to-date quantitative evidence in this area to inform policy decisions regarding these services. In light of this, the objective of this study is to investigate the incidence and economic burden of third and fourth-degree lacerations in the English National Health Service (NHS) using recent national data. We used coded inpatient data from Hospital Episode Statistics (HES) for the financial years from 2010/2011 to 2013/2014 for all females that gave birth during that period in the English NHS. Using HES, we used pre-existing safety indicator algorithms to calculate the incidence of third and fourth-degree obstetric tears and employed a propensity score matching method to estimate the excess length of stay and economic burden associated with these events. Observed rates per 1000 inpatient episodes in 2010/2011 and 2013/2014, respectively: Patient Safety Indicator-trauma during vaginal delivery with instrument (PSI 18)=84.16 and 91.24; trauma during vaginal delivery without instrument (PSI 19)=29.78 and 33.43; trauma during caesarean delivery (PSI 20)=3.61 and 4.56. Estimated overall (all PSIs) economic burden for 2010/2011=£10.7 million and for 2013/2014=£14.5 million, expressed in 2013/2014 prices. Despite many initiatives targeting the quality of maternity care in the NHS, the incidence of third and fourth-degree lacerations has increased during the observed period which signals that quality improvement efforts in obstetric care may not be reducing incidence rates. Our conservative estimates of the financial burden of these events appear low relative to total NHS expenditure for these years

Screening of drought oxidative stress tolerance in Serbian melliferous plant species

This study was designed to examine and compare antioxidant and free-radical scavenging activities of leaves of six different melliferous plant species (Populus alba, Robinia pseudoacacia, Sophora japonica, Euodia hupehensis, Tilia sp., Fraxinus sp.) from Serbia in order to evaluate their drought oxidative stress tolerance. Experiment was conducted during June, July and August. In this study, we reported the results concerning proline accumulation, soluble protein content, quantities of malonyldialdehyde,total antioxidant capacity determined by FRAP method and scavenger activity determined by DPPH method. According to our results, all melliferous plant species were subjected to drought oxidative stress during July when soil humidity decreased. During July, proline content and MDA quantity increased and soluble proteins decreased in all investigated species. High and permanent antioxidant activity during the whole investigated period was observed in P. alba, but insufficient to protect itsleaves from oxidative injury during the period of drought in July. The highest ability to accumulate proline and highest protein content under severe drought stress in July was observed in Fraxinus sp. Other investigated antioxidant parameters (total antioxidant and DPPH radical scavenger capacities) were high and accumulation of MDA was low which indicate high drought oxidative stress tolerance. Therefore, highest ability to adapt under severe drought stress and highest drought oxidative stresstolerance were observed in Fraxinus sp.Key words: Melliferous trees, lipid peroxidation, DPPH, FRAP, proline accumulation

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

BACKGROUND: The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease. METHODS: Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010-2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic. RESULTS: Overall, 3% were predicted to live "days"; 13% "weeks"; 28% "months"; and 56% "year/years". The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians' estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of "weeks" or "months" (32% accuracy). CONCLUSION: Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for "years"

The Role of Transformation in Learning and Education for Sustainability

Education research has acknowledged the value of transformation, which offers an opportunity for researching and rethinking how appropriate and successful educational practices may be. However, despite the role of transformation in higher education and particularly in sustainability learning, there is a paucity of studies which examine the extent to which transformation and learning on matters related to sustainable development may be integrated. Based on this perceived research need, the purpose of this article is to present how transformation in learning in education for sustainability requires the commitment of Faculty and the engament of students. To do this, a set of qualitative case studies were used in higher education institutions across seven countries (Brazil, Serbia, Latvia, South Africa, Spain, Syria, UK). The findings revealed that the concept of education for sustainable development has not been sufficiently integrated into the concept of transformation in higher education institutions. It also found that to enhance sustainability in the curricula, academics should develop collaborative approaches, and discuss how to redesign their own disciplines, and how to appreciate the epistemology and multicultural vision of sustainability, both as a topic, and as a field of education research. It was further found that reflections of the academics on their own values are crucial for developing the transformative potential of students as agents of a sustainable future. It is necessary that universities should transform to serve as models of social justice and environmental stewardship, and to foster sustainability learning

University teaching staff and sustainable development: an assessment of competences

Teaching about matters related to sustainable development requires not only a personal motivation from educators, but also a variety of competences. This paper reports on a multi-country study, which aimed at identifying the level of importance given to desired competences on sustainable development by teaching staff at a number of higher education institutions. On the basis of the findings, the paper identifies the gaps and outlines some of the needs which should be addressed, via which competence building may help to foster the educational and societal transformation towards sustainability. The implications of this paper are twofold. First, it emphasises the value of and the need for competences on sustainable development. Second, it illustrates some of the needs which should be met to provide a framework among which competences on sustainable development may be further developed

Towards a common future: revising the evolution of university-based sustainability research literature

The field of sustainability has evolved considerably since the report “Our Common Future” was published in 1987. Whereas matters related to sustainable development used to be of marginal interest in the 1980s, it has substantially evolved since, and have become mainstream. As a result, there is a plethora of research on different aspects, whose focus has also been influenced by societal developments. This line of thinking also applies to sustainability research in higher education, a special and central field. Unfortunately, the variety of research on matters of sustainable development in universities makes it difficult to obtain an insight into its current status, and to ascertain how it has evolved since 1987. Based on the perceived need to fill this gap, a study focusing on the evolution of university-based sustainability research literature has been undertaken. The study entailed approximately 1700 papers published between 1987 and 2019,  being one of the most comprehensive studies on this field ever undertaken. Apart from performing a bibliometric analysis using science mapping software tools, the research clustered the research into some key areas. The results suggest that, whereas impressive, the evolution of university-based sustainability research has been uneven, and calls for a more balanced emphasis to as to cover some research areas which have so far been neglected. The implications of this work are twofold: it will support the further development of the university-based sustainability research literature, and will help to address some thematic gaps, which are seen today, and to which greater attention is needed

Characterization of two poplar homologs of the GRAS/SCL gene, which encodes a transcription factor putatively associated with salt tolerance

To cope with soil salinity, which is one of the most severe forms of abiotic stress, efforts are being undertaken to enhance the salt tolerance of economically important poplar clones in the Vojvodina region of Serbia. One approach is to screen nucleotide diversity in candidate genes (CG) in several poplar clones of high economic importance to Serbia to search for associations with salt stress tolerance. As plant-specific GRAS/SCL transcription factors (TFs) play diverse roles in abiotic stress resistance, two poplar homologs of GRAS/SCL TFs were chosen to differentiate the species background with respect to salt tolerance. A BLAST search of the Populus trichocarpa genome using the P. euphratica gene GRAS/SCL TF_GH611858 sequence identified two putative orthologs, Scaf_5 and Scaf_7, with identities of 100% and 94%, respectively. Primers were designed in identical sequences of Scaf_5 and Scaf_7 to amplify fragments of GRAS/SCL TF orthologs in four poplar clones that are economically important to Serbia. The primers spanned regions where, at least in P. trichocarpa, single nucleotide polymorphisms (SNPs) are present, thereby increasing the probability of distinguishing Scaf_5 and Scaf_7 orthologs in the four clones. Alignments and analyses of the gene fragments revealed that both orthologs were representative of the genetic diversity between different poplar clones, and the identified SNP markers differentiated the four poplar clones with respect to salt tolerance