Use of labour induction and risk of cesarean delivery: A systematic review and meta-analysis

Background: Induction of labour is common, and cesarean delivery is regarded as its major complication. We conducted a systematic review and meta-analysis to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management. Methods: We searched 6 electronic databases for relevant articles published through April 2012 to identify randomized controlled trials (RCTs) in which labour induction was compared with placebo or expectant management among women with a viable singleton pregnancy. We assessed risk of bias and obtained data on rates of cesarean delivery. We used regression analysis techniques to explore the effect of patient characteristics, induction methods and study quality on risk of cesarean delivery. Results: We identified 157 eligible RCTs (n = 31 085). Overall, the risk of cesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk [RR] 0.88, 95% confidence interval [CI] 0.84-0.93; I2 = 0%). The effect was significant in term and post-term gestations but not in preterm gestations. Meta-regression analysis showed that initial cervical score, indication for induction and method of induction did not alter the main result. There was a reduced risk of fetal death (RR 0.50, 95% CI 0.25-0.99; I2 = 0%) and admission to a neonatal intensive care unit (RR 0.86, 95% CI 0.79-0.94), and no impact on maternal death (RR 1.00, 95% CI 0.10-9.57; I2 = 0%) with labour induction. Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death. © 2014 Canadian Medical Association or its licensors

Nicral ternary alloy having improved cyclic oxidation resistance

NiCrAl alloys are improved by the addition of zirconium. These alloys are in the Beta or gamma/gamma' + Beta region of the ternary system. Zirconium is added in a very low amount between 0.06 and 0.20 weight percent. There is a narrow optimum zirconium level at the low value of 0.13 weight percent. Maximum resistance to cyclic oxidation is achieved when the zirconium addition is at the optimum value

Effect of Vinyl and Silicon Monomers on Mechanical and Degradation Properties of Bio-Degradable Jute-Biopol® Composite

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Composites of jute fabrics (Hessian cloth) and Biopol® were prepared by compression molding process. Three types of Biopol® (3-hydroxbutyrate-co-3-hydroxyvalarate) such as D300G, D400G and D600G, depending on the concentration of 3-hydroxyvalarate (3HV) in 3-hydroxbutyrate (3HB) were taken for this purpose. Mechanical properties such as tensile strength (TS), bending strength (BS), elongation at break (Eb) and impact strength (IS) of the jute-Biopol® composites were studied. It was found that the composite with D400G produced higher mechanical properties in comparison to the other two types of Biopol®. To increase mechanical properties as well as interfacial adhesion between fiber and matrix, 2-ethyl hydroxy acrylate (EHA), vinyl tri-methoxy silane (VMS) and 3-methacryloxypropyl tri-methoxy silane (MPS) were taken as coupling agents. Enhanced mechanical properties of the composites were obtained by using these coupling agents. Biopol® D400G composites showed the highest mechanical properties. Among the coupling agents EHA depicts the highest increase of mechanical properties such as tensile strength (80%), bending strength (81%), elongation at break (33%) and impact strength (130%) compared pure Biopol. SEM investigations demonstrate that the coupling agents improve the interfacial adhesion between fiber and matrix. The surface of the silanized jute was characterized by FTIR and found the deposition of silane on jute fiber was observed. Soil degradation test proved that the composite prepared with EHA treated jute exhibits better degradation properties in comparison to pure Biopol®

Prototyping Incentive-based Resource Assignment for Clouds in Community Networks

Wireless community networks are a successful example of a collective where communities operate ICT infrastructure and provide IP connectivity based on the principle of reciprocal resource sharing of network bandwidth. This sharing, however, has not extended to computing and storage resources, resulting in very few applications and services which are currently deployed within community networks. Cloud computing, as in today's Internet, has made it common to consume resources provided by public clouds providers, but such cloud infrastructures have not materialized within community networks. We analyse in this paper socio-technical characteristics of community networks in order to derive scenarios for community clouds. Based on an architecture for such a community cloud, we implement a prototype for the incentive-driven resource assignment component, deploy it in a testbed of community network nodes, and evaluate its behaviour experimentally. Our evaluation gives insight into how the deployed prototype components regulate the consumption of cloud resources taking into account the users' contributions, and how this regulation affects the system usage. Our results suggest a further integration of this regulation component into current cloud management platforms in order to open them up for the operation of an ecosystem of community cloud

Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Aims: Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L. Methods: This is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG. Results: In total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L. Conclusions: This analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff