A randomised controlled trial to compare the effectiveness of ice-packs and Epifoam with cooling maternity gel pads at alleviating postnatal perineal trauma

This is the author's PDF version of an article published in Midwifery© 2000. The definitive version is available at http://www.elsevier.comOBJECTIVE: To evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). DESIGN: A randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. SETTING: A midwifery unit in the north of England and then continued in the women's own homes. PARTICIPANTS: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. MEASUREMENTS AND FINDINGS: The ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours (p = 0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema (p = 0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain (p = 0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours (p < 0.0005). The bruising was significantly less in the gel-pad group in women who initially had no bruising (p = 0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups (p < 0.0005). KEY CONCLUSIONS: This trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.Elizabeth Clark Charitable Trus

Photoperiod sensitivity affects flowering duration in wheat

Flowering and successful pollination in wheat are key determinants of both quantity and quality of grain. Bread wheat line ‘Paragon’, introgressed with single or multiple day length insensitivity alleles was used to dissect the effects on the timing and duration of flowering within a hierarchical plant architecture. Flowering of wheat plants was observed in a series of pot-based and field experiments. Ppd-D1a was the most potent known allele affecting the timing of flowering, requiring the least thermal time to flowering across all experiments. The duration of flowering for individual lines was dominated by the shift in the start of flowering in later tillers and the number of tillers per plant, rather than variation in flowering duration of individual spikes. There was a strong relationship between flowering duration and the start of flowering with the earliest lines flowering for the longest. The greatest flowering overlap between tillers was recorded for the Ppd-1b. Across all lines, a warmer environment significantly reduced the duration of flowering and the influence of Ppd-1a alleles on the start of flowering. These findings provide evidence of pleiotropic effects of the Ppd-1a alleles, and have direct implications for breeding for increased stress resilient wheat varieties

In-situ removal and characterisation of uranium-containing particles from sediments surrounding the Fukushima Daiichi Nuclear Power Plant

AbstractTraditional methods to locate and subsequently study radioactive fallout particles have focused heavily on autoradiography coupled with in-situ analytical techniques. Presented here is the application of a Variable Pressure Scanning Electron Microscope with both backscattered electron and energy dispersive spectroscopy detectors, along with a micromanipulator setup and electron-hardening adhesive to isolate and remove individual particles before synchrotron radiation analysis. This system allows for a greater range of new and existing analytical techniques, at increased detail and speed, to be applied to the material. Using this method, it was possible to erform detailed energy dispersive spectroscopy and synchrotron radiation characterisation of material likely ejected from the Fukushima Daiichi Nuclear Power Plant found within a sediment sample collected from the edge of the 30km exclusion zone. Particulate material sub-micron in maximum dimension examined during this work via energy dispersive spectroscopy was observed to contain uranium at levels between 19.68 and 28.35 weight percent, with the application of synchrotron radiation spectroscopy confirming its presence as a major constituent.With great effort and cost being devoted to the remediation of significant areas of eastern Japan affected by the incident, it is crucial to gain the greatest possible understanding of the nature of this contamination in order to inform the most appropriate clean-up response

Natural selection towards wild-type in composite cross populations of winter wheat

Most of our crops are grown in monoculture with single genotypes grown over wide acreage. An alternative approach, where segregating populations are used as crops, is an exciting possibility, but outcomes of natural selection upon this type of crop are not well understood. We tracked allelic frequency changes in evolving composite cross populations of wheat grown over ten generations under organic and conventional farming. At three generations, each population was genotyped with 19 SSR and 8 SNP markers. The latter were diagnostic for major functional genes. Gene diversity was constant at SSR markers but decreased over time for SNP markers. Population differentiation between the four locations could not be detected, suggesting that organic vs. non-organic crop management did not drive allele frequency changes. However, we did see changes for genes controlling plant height and phenology in all populations independently and consistently. We interpret these changes as the result of a consistent natural selection towards wild-type. Independent selection for alleles that are associated with plant height suggests that competition for light was central, resulting in the predominance of stronger intraspecific competitors, and highlighting a potential trade-off between individual and population performanc

Combinatorial RNA Design: Designability and Structure-Approximating Algorithm

In this work, we consider the Combinatorial RNA Design problem, a minimal instance of the RNA design problem which aims at finding a sequence that admits a given target as its unique base pair maximizing structure. We provide complete characterizations for the structures that can be designed using restricted alphabets. Under a classic four-letter alphabet, we provide a complete characterization of designable structures without unpaired bases. When unpaired bases are allowed, we provide partial characterizations for classes of designable/undesignable structures, and show that the class of designable structures is closed under the stutter operation. Membership of a given structure to any of the classes can be tested in linear time and, for positive instances, a solution can be found in linear time. Finally, we consider a structure-approximating version of the problem that allows to extend bands (helices) and, assuming that the input structure avoids two motifs, we provide a linear-time algorithm that produces a designable structure with at most twice more base pairs than the input structure.Comment: CPM - 26th Annual Symposium on Combinatorial Pattern Matching, Jun 2015, Ischia Island, Italy. LNCS, 201

Feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline):trial protocol

BACKGROUND: Relapse prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web-based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders. METHODS/DESIGN: This protocol describes the development and feasibility testing of the ERPonline web-based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding of the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates. DISCUSSION: The findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web-based interventions designed to support people with mental health problems

3 to 12 millimetre studies of dense gas towards the western rim of supernova remnant RX J1713.7-3946

The young X-ray and gamma-ray-bright supernova remnant RXJ1713.7-3946 (SNR G347.3-0.5) is believed to be associated with molecular cores that lie within regions of the most intense TeV emission. Using the Mopra telescope, four of the densest cores were observed using high-critical density tracers such as CS(J=1-0,J=2-1) and its isotopologue counterparts, NH3(1,1) and (2,2) inversion transitions and N2H+(J=1-0) emission, confirming the presence of dense gas >10^4cm^-3 in the region. The mass estimates for Core C range from 40M_{\odot} (from CS(J=1-0)) to 80M_{\odot} (from NH3 and N2H+), an order of magnitude smaller than published mass estimates from CO(J=1-0) observations. We also modelled the energy-dependent diffusion of cosmic-ray protons accelerated by RXJ1713.7-3946 into Core C, approximating the core with average density and magnetic field values. We find that for considerably suppressed diffusion coefficients (factors \chi=10^{-3} down to 10^{-5} the galactic average), low energy cosmic-rays can be prevented from entering the inner core region. Such an effect could lead to characteristic spectral behaviour in the GeV to TeV gamma-ray and multi-keV X-ray fluxes across the core. These features may be measurable with future gamma-ray and multi-keV telescopes offering arcminute or better angular resolution, and can be a novel way to understand the level of cosmic-ray acceleration in RXJ1713.7-3946 and the transport properties of cosmic-rays in the dense molecular cores.Comment: 17 pages, 13 figures and 5 tables. Accepted for publication in MNRAS 2012 February 1

Evaluating Atezolizumab in Patients with Urinary Tract Squamous Cell Carcinoma (AURORA): Study Protocol for a Single Arm, Open-Label, Multicentre, Phase II Clinical Trial

BACKGROUND: Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC. Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene expression consistent with a tumour/immune microenvironment predicted to be susceptible to immune checkpoint directed immunotherapy which we will evaluate in the AURORA trial. METHODS: AURORA is a single arm, open-label, multicentre,UK phase II clinical trial. 33 patients will be recruited from UK secondary care sites. Patients with UTSCC, suitable for treatment with palliative intent, will receive atezolizumab PD-L1 directed immunotherapy (IV infusion, 1680 mg, every 28 days) for one year if tolerated. Response assessment, by cross sectional imaging will occur every 12 weeks. AURORA uses a Simon\u27s 2-stage optimal design with best overall objective response rate (ORR, by RECIST v1.1) at a minimum of 12 weeks from commencing treatment as the primary endpoint. Secondary endpoints will include overall survival, progression-free survival, duration of response, magnitude of response using waterfall plots of target lesion measurements, quality of life using the EORTC QLQ-C30 tool, safety and tolerability (CTCAE v5) and evaluation of potential biomarkers of treatment response including PD-L1 expression. Archival tumour samples and blood samples will be collected for translational analyses. DISCUSSION: If this trial shows atezolizumab to be safe and effective it may lead to a future late phase randomised controlled trial in UTSCC. Ultimately, we hope to provide a new option for treatment for such patients