46 research outputs found
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
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OASI2: a hybrid effectiveness implementation RCT to inform scale up of care bundle to reduce obstetric anal sphincter injury (OASI) caused during childbirth
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
Proceedings of the Virtual 3rd UK Implementation Science Research Conference : Virtual conference. 16 and 17 July 2020.
Economic evaluation of subirrigation of meadows situated on peat-moorsh soils
W pracy zbadano metodą kalkulacyjną efektywność ekonomiczną czterech wariantów produkcji siana na łąkach torfowo-murszowych: bez nawadniania i nawożenia, z nawożeniem mineralnym bez nawadniania, z nawadnianiem bez nawożenia i z nawadnianiem i nawożeniem mineralnym. Ocenę wykonano dla trzech grup lat: bardzo suchych, średnio suchych i średnich. W analizie uwzględniono także trzy poziomy wykorzystania ciągników i maszyn rolniczych: niski, średni i wysoki. Celem analizy ekonomicznej był wybór najkorzystniejszego wariantu nawodnień w produkcji siana łąkowego na tle braku nawożenia i pełnego nawożenia mineralnego w modelowym gospodarstwie rolnym. Analizę wykonano na przykładzie gospodarstwa rodzinnego o powierzchni 10 ha użytków rolnych oraz ściśle określonej technologii zbioru siana. Dokonano szczegółowej analizy zapotrzebowania na robociznę oraz pracę ciągników i maszyn towarzyszących. Za główne kryterium oceny przyjęto koszty produkcji jednostki paszy w produkcji siana do zużycia wewnętrznego w gospodarstwie rolnym. Najmniejszy koszt produkcji jednostki paszy uzyskano w wariancie z nawadnianiem i nawożeniem mineralnym w latach bardzo suchych, w warunkach wysokiego stopnia wykorzystania maszyn i ciągników rolniczych.Economic efficiency of four variants of hay production on peat-moorsh meadows (without irrigation and fertilisation, without irrigation but with mineral fertilisation, with irrigation but without fertilisation and with both irrigation and fertilisation) were calculated in this paper. An assessment was made for three groups of years: very dry, moderately dry and medium. Low, medium and high intensity of tractor and machines utilisation were also taken into account. The analysis was aimed at selecting most favourable variant of irrigation at varying fertilisation rates in meadow hay production in a model farm. The analysis was made based on a 10 ha family farm under strictly defined technology of hay harvesting. Detailed analysis was performed of labour consumption and the work of tractors and accompanying machines. Costs of production of a fodder unit in hay production intended for internal consumption in a farm were taken as the main criterion of assessment. The lowest cost of fodder unit production was obtained in the variant with irrigation and mineral fertilisation in very dry years at high intensity of machines and tractors utilisation
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
Laboratory tests of prototypical vibration isolation used at railway permanent way
W artykule przedstawiono wyniki badań laboratoryjnych wibroizolacji wykonanych ze zużytych opon samochodowych. określono sztywności statyczne i dynamiczne w różnych temperaturach. Sztywności dynamiczne podano w zależności od częstotliwości. Przedstawiono również wpływ obciążeń zmęczeniowych i próby mrozoodporności na parametry statyczne i dynamiczne badanego materiału.This paper presents the results of laboratory tests for vibration-isolation made from used car tires. The static and dynamic stiffness at different temperatures have been determined. The dynamic stiffness has been given depending on frequency. The impact of fatigue loads and of freeze resistance trials on the static and dynamic parameters of the tested material have been also presented
Yielding of the energy willow under differentiated soil-water conditions
Celem badań, przeprowadzonych na plantacjach produkcyjnych, było określenie wpływu czynnika wodnego oraz rodzaju gleby na plon wierzby wiciowej (Salix viminalis L.) w warunkach lekkich gleb mineralnych i gleb pobagiennych. Największe plony wierzby, dochodzące do 30 t*ha-1*rok-1, uzyskano na obrzeżach torfowiska, na glebie murszowatej z poziomem wody gruntowej 0,5-1,0 m, a najmniejsze, wynoszące 6-8 t*ha-1*rok-1 - na glebie mineralnej brunatnej, wytworzonej z piasku, w warunkach zalegania zwierciadła wody gruntowej ponad 2,0 m poniżej powierzchni terenu. Na torfowisku o płytkiej glebie torfowo-murszowej z poziomem wody gruntowej 0,2-0,6 m, odpowiednim dla użytku zielonego, nadmiar wody wpływał ujemnie na plon wierzby, który wynosił ok. 10 t*ha-1*rok-1.The studies conducted in producing plantations aimed at determination of water factor and soil kind effects on the yield of energy willow (Salix viminalis L.) cultivated on light mineral soils and post-boggy soils. The highest willow yields, reaching up to 30 t*ha-1 per year, were obtained on the peatmoor borders, on muck soil with ground water level of 0.5-1.0 m; whereas the lowest yields reaching 6-8 t*ha-1 per year - on the mineral brown soil of sandy origin, under conditions of ground water level 2.0 m deep. On the peatbog of shallow peat-muck soil with ground water 0.2-0.6 m deep, suitable for grassland, the surplus of water negatively affected the willow yield which amounted to about 10 t*ha-1 per year
Mechanizm zrównoważenia obciążenia w równoległej implementacji rozwoju sieci naczyń krwionośnych
In this paper, load balancing mechanisms in a parallel algorithm of vascular network development are investigated. The main attention is focused on the perfusion process (connection of new cells to vascular trees) as it is the most time demanding part of the vascular algorithm. We propose several techniques that aim at balancing load among processors, decreasing their idle time and reducing the communication overhead. The core solution is based on the centralized dynamic load balancing approach. The model behaviors are analyzed and a tradeoff between the different mechanisms is found. The proposed mechanisms are implemented on a computing cluster with the use of the message passing interface (MPI) standard. The experimental results show that the introduced improvements provide a more efficient solution and consequently further accelerate the simulation process.W artykule rozważane są mechanizmy zrównoważające obciążenie w równoległym algorytmie rozwoju sieci naczyń krwionośnych. Główną uwagę zwrócono na proces perfuzji (podłączanie nowych komórek do drzew krwionośnych) jako, że proces ten jest najbardziej czasochłonnym fragmentem rozpatrywanego algorytmu. Zaproponowane przez autorów rozwiązania mają na celu zrównoważenie obciążenia pomiędzy procesorami, skrócenie ich czasu bezczynności oraz zredukowanie narzutu komunikacyjnego. Jądro rozwiązania jest oparte na scentralizowanym dynamicznym podejściu równoważenia obciążenia. Zachowania modelu zostały przeanalizowane i kompromis pomiędzy różnymi technikami został zaproponowany. Przedstawione mechanizmy zostały zaimplementowane na klastrze obliczeniowym przy wykorzystaniu standardu MPI. Otrzymane rezultaty jednoznacznie pokazuja˛ iż wprowadzone usprawnienia zapewniają bardziej efektywne rozwiązanie co w konsekwencji pozwala na jeszcze większe przyśpieszenie procesu symulacji