Respectful Maternity Care Initiative: A Qualitative Study

AIM

To assess the available standards for respectful maternity care in a public maternity hospital by evaluation of responses to a questionnaire given to birthing women.

METHODOLOGY

Assessment was done to find out the level of respectful maternity care provided under the most sensitive and important areas, namely (1) confidentiality and privacy, (2) physical harm or ill treatment, (3) dignity and respect, (4) left without care, (5) right to information, informed consent, and choice/preferences, by obtaining the response of birthing women.

RESULTS

Confidentiality and Privacy: No birthing woman (0%) expressed her opinion that she was dissatisfied with privacy provided, at any time of her stay in the hospital. Physical harm or ill treatment: It was significant to note that no woman reported being ill-treated or physically harmed. Dignity and Respect: A response of satisfaction regarding this important aspect of maternity care was received by nearly 95% of birthing women, A very small percent of 5.1% of women were not completely satisfied. Left without care or Attention given at all times:1.9% of women felt that they were not given immediate response when they called for any need. Right to information, informed consent, and choice/preferences: The greater majority of 95.7% of women were satisfied with methods engaged by hospital staff regarding right to information, informed consent and practices.

CONCLUSION

The response from a significant majority of birthing women was that they had respectful maternity care given to them at Government hospital for Women and Children.

P14.85 Impact of the neuro-radiologist and neuro-surgeon in contouring with the neuro-oncologist on local relapse rates for brain metastases treated with stereotactic radiosurgery

BACKGROUND

The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS).

MATERIAL AND METHODS

A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months).

RESULTS

113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI<0.95). Mean GMI was 0.03 (0.0–0.65) and 17% showed significant miss (GMI>0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p<0.05). There was no significant improvement on JCI or GMI shown over time. Dosimetric analysis indicated a strong association of conformity metrics with PTV dose metrics; a 0.1 change in GTV conformity metric association with 6–17% change in dose to 95% of resulting PTV. Greater association was seen in resection cavity suggesting the geographical nature of a typical contouring error gives rise to greater potential change in dose. Clinical outcomes compared well with published series. Median survival was 20 months and local relapse free rate in the treated areas of 0.89 (0.8–0.94) at 40 months, and 0.9 (0.83–0.95) radio-necrosis free rate at 40 months with a median 17 months to developing radio-necrosis for those that did.

CONCLUSION

This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.

Operational planning steps in smart electric power delivery system

This paper presents a comprehensive review of advanced technologies with various control approaches in terms of their respective merits and outcomes for power grids. Distributed energy storage control is classified into automatic voltage regulator and load frequency control according to corresponding functionalities. These control strategies maintain a power balance between generation and demand. Besides, three basic electric vehicle charging technologies can be distinguished, i.e. stationary, quasi-dynamic and dynamic control. For realizing charge-sustaining operation at minimum cost quasi-dynamic and dynamic strategies are adopted for in-route charging, while stationary control can only be utilized when the electric vehicle is in stationary mode. Moreover, power system frequency stability and stabilization techniques in non-synchronous generator systems are reviewed in the paper. Specifically, a synchronverter can damp power system oscillations and ensure stability by providing virtual inertia. Furthermore, it is crucial to manage the massive information and ensure its security in the smart grid. Therefore, several attack detection and mitigation schemes against cyber-attacks are further presented to achieve reliable, resilient, and stable operation of the cyber-physical power system. Thus, bidirectional electrical power flows with two-way digital control and communication capabilities have poised the energy producers and utilities to restructure the conventional power system into a robust smart distribution grid. These new functionalities and applications provide a pathway for clean energy technology. Finally, future research trends on smart grids such as IoT-based communication infrastructure, distributed demand-response with artificial intelligence and machine learning solutions, and synchrophasor-based wide-area monitoring protection and control (WAMPC) are examined in the present study.

Ultrasound imaging for the differential diagnosis of periapical lesions of endodontic origin in comparison with histopathology - a systematic review and meta-analysis

BACKGROUND

Differentiating periapical lesions is important for treatment planning and subsequent treatment outcome.

OBJECTIVE

To assess the diagnostic accuracy of ultrasound imaging for the differentiation of periapical lesions in comparison with histopathology.

METHODS

PubMed, Scopus, Embase, Web of Science and ProQuest databases were searched for clinical studies published until June 2020 that evaluated the use of ultrasound (US) imaging for differential diagnosis of periapical lesions and used histopathology as the reference standard. Animal studies, laboratory-based studies, reviews and clinical studies not using a reference standard were excluded. Risk of bias (RoB) assessment was performed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The random effects model was used for quantitative analysis of the data, and the Deeks test was used for calculating publication bias. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Twelve articles were included in the systematic review, out of which ten articles were quantitatively assessed. All the articles had a high RoB and concerns regarding applicability in the patient selection domain. For the index test domain, seven articles had low and the remaining five had unclear RoB and concerns regarding applicability. In the reference standard domain, low RoB and concerns regarding applicability were observed for all the articles. The RoB was low in flow and timing domains in all the articles except for one, where it was high. Summary estimates of sensitivity and specificity of US to diagnose periapical granulomas were 0.94 and 0.98, whereas for periapical cysts it was 0.98 and 0.99, respectively. Area under the curve for diagnosis of both periapical granulomas and periapical cysts was 0.99. All the included articles had inherent publication bias. Quality of evidence using GRADE, for sensitivity, was moderate for periapical granulomas and high for periapical cysts, whereas for specificity, it was high for periapical granulomas and low for periapical cysts.

DISCUSSION

The available evidence is considered to be of low quality due to the observational nature of the studies and inherent publication bias.

CONCLUSION

Although the sensitivity and specificity for differentiating periapical cysts and periapical granulomas using US were high, taking the quality of evidence into consideration, it can serve as an additional tool in differential diagnosis of periapical lesions.

Realizing a Novel Friction Stir Processing-Enabled FWTPET Process for Strength Enhancement Using Firefly and PSO Methods

The friction welding of tube to tube plate using an external tool (FWTPET) is widely deployed in several industrial applications, such as aerospace, automotive, and power plants. Moreover, for achieving a better tensile strength and hardness in the weld zone, the friction stir processing (FSP) technique was incorporated into the FWTPET process for joining aluminum alloys (AA6063 tube, AA6061 tube plate). Furthermore, it has to be noted that FWTPET was applied for joining the AA6063 tube to the AA6061 tube plate, and FSP was deployed for reinforcing the weld zone with carbon nanotube (CNT) and silicon nitride (Si₃N₄) particles, thereby attaining the desirable mechanical properties. Subsequently, the Taguchi L₂₅ orthogonal array was used for identifying the most influential input and output FWTPET + FSP process parameters. Furthermore, particle swarm optimization (PSO) and the firefly algorithm (FFA) were deployed for determining the optimized input and output FWTPET + FSP process parameters. The input process parameters include CNT, Si₃N_4, rotational tool speed, and depth. Furthermore, the tensile strength of the welded joint was considered as the output process parameter. The process parameters predicted by PSO and FFA were compared with the experimental values. It was witnessed that deviation between the predicted and experimental values was minimal. Moreover, it was found that FFA provided a superior tensile strength prediction than PSO.

Congenital capillary hemangioma arising from palpebral conjunctiva of a neonate

Capillary hemangioma is the most common benign vascular eyelid tumor in childhood. The periocular lesion appears within the first few weeks after birth and usually has superficial or deep components. Primary conjunctival capillary hemangiomas are rarely reported. We present the case of a 2-day-old child with a pedunculated capillary hemangioma arising from superior palpebral conjunctiva. A complete surgical excision was performed under general anesthesia, and the child was asymptomatic at follow-up of two months.

Direct electron transfer with yeast cells and construction of a mediatorless microbial fuel cell

The direct electron transfer exhibited by the yeast cells, Hansenula anomala has been demonstrated using the electrochemical technique cyclic voltammetry by immobilizing the microorganisms by two different methods viz., physical adsorption and covalent linkage. The analysis of redox enzymes present in the outer membrane of the microorganisms has been carried out in this work. This paper demonstrates that yeast cells with redox enzymes present in their outer membrane are capable of communicating directly with the electrode surface and contribute to current generation in a mediatorless biofuel cells. The efficiency of current generation has been evaluated using three anode materials.