Introduction
Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ...ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators.
Material and methods
We used aggregate data from national routine statistics available in the Euro‐Peristat project. We compared rates of severe (third‐ and fourth‐degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho).
Results
In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non‐instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28).
Conclusions
The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.
The aim of the study was to evaluate the corrosion properties of three different grades of high-speed steel following a heat treatment procedure involving deep cryogenic treatment after quenching and ...to investigate how these properties are connected to the microstructure and hardness of the material. The hardness of steels was measured, and microstructural properties were determined through observation of the metallographically prepared steels using scanning electron microscopy. These studies were complemented corrosion evaluation by the use of corrosion potential measurement and linear polarization measurement of steels in a sodium tetraborate buffer at pH 10. The results showed that the deep cryogenic procedure of high-speed steel changed the microstructure and consequently affected the hardness of the investigated steels to different extents, depending on their chemical composition. Corrosion studies have confirmed that some high-speed steels have improved corrosion properties after deep cryogenic treatment. The most important improvement in corrosion resistance was observed for deep cryogenically treated high-speed steel EN 1.3395 (M3:2) by 31% when hardened to high hardness values and by 116% under lower hardness conditions. The test procedure for differentiating corrosion properties of differently heat-treated tool steels was established alongside the investigation.
The surface of bronze undergoes changes when it is exposed to a polluted atmosphere, and bronze should therefore be protected from this natural deterioration. The most common protective coating ...currently in use is Incralac, which includes toxic components and is reported to dissolve a few months after application. This work therefore investigates a fluoropolymer-based coating (FA-MS), and compares it to the protection offered by Incralac. Bronze samples (non-patinated, sulphide-patinated or chloride-patinated) were exposed to simulated urban rain for four months. The corrosion products formed were characterised using SEM/EDS and Raman analyses. To study the protection efficiency of the newly developed fluoropolymer coating (FA-MS) and Incralac protection, various electrochemical methods were used: measurements of open circuit potential linear polarisation and potentiodynamic measurements. Findings show that the FA-MS coating provides a protection efficiency of 71 % for chloride-patinated bronze and 99.5 % for sulphide-patinated bronze. Contact angles of the FA-MS samples were higher than those of the unprotected samples or the samples protected by Incralac, indicating better hydrophobic properties of the FA-MS coating.
When bronze or artificially patinated bronze is exposed to an outdoor environment that contains aggressive ions such as sulphates, nitrates, and carbonates, the surface of the bronze changes its ...appearance due to the formation of corrosion products on the surface. Research is being conducted on versatile protective measures that can be used to protect the surface from these changes. A recently synthesised fluoropolymer-based coating with mercaptopropyl groups, i.e. a 3-component fluoropolymer coating FA-MS-SH (silane-modified poly methylmethacrylate (MS) with added mercaptopropyltrimethoxy silane (SH) and a fluoroacrylate (FA)) was explored in detail in this work where its protective mechanism on sulphide patinated bronze was investigated. Electrochemical tests were conducted on the sulphide patinated bronze with and without the 3-component coating FA-MS-SH. Furthermore, FA, MS and SH alone and various combinations and concentrations of FA-MS were studied in order to determine the protective effect and properties of each component. Colour change and contact angle measurements were also defined. FIB-SEM measurements and GCIB-XPS depth profiles were carried out to study surface bonding with the sulphide patina in detail.
A mechanism for the protection of sulphide patinated bronze was presented through the use of a multi-analytical tool approach. It was shown that FA physisorbed on the patinated surface, while MS and blends of the components chemisorbed on the layer of sulphide patinated bronze, also resulting in the surface being efficiently protected from corrosion processes.
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•Coatings for artificial patina for outdoor application were developed.•A 3-component fluoropolymer coating on sulphide patina was studied.•Single and combined blends were electrochemically evaluated.•The fluoropolymer coating efficiently protected brown patinated bronze.•The mechanism of protection was suggested by the use of GCIB-XPS depth profiling.
Izvleček
Uvod:
Učenje in ocenjevanje profesionalnega odnosa in obnašanja sta enako pomembna kot ocenjevanje
teoretičnega znanja in veščin, vendar se malokrat izvaja.
Metode: Specializant razdeli ...ocenjevalne obrazce, ki jih ocenjevalci izpolnjene in podpisane pošljejo nacionalni
koordinatorici; ko dobi deset ocen in samooceno, povabi specializanta na pogovor s presojo.
Rezultati: V 6 ciklusih 360-stopinjskega ocenjevanja je bilo opravljenih 118 pogovorov. Večina je bila ocenjena
dobro. V manj kot 10 % je bila ocena »sem zaskrbljen« in »sem hudo zaskrbljen«.
Razprava: Večina specializantov je bila prijetno presenečena nad pohvalami, ki so jih napisali sodelavci. Osem
specializantov so opozorili na manjše pomanjkljivosti v odnosu in obnašanju, ki se jih specializanti niso zavedali. Do
naslednjega ocenjevanja so pomanjkljivosti večinoma odpravili. Specializanti, ocenjeni s »sem hudo zaskrbljen«, so
bili redki, vendar so se pri njih take ocene ponavljale; niso bili samokritični in pogovora z odzivom niso sprejemali
kot dobronamernega.
Zaključki: V specializacijo porodništva in ginekologije so uvedli ocenjevanje odnosa in obnašanja specializantov.
Hkrati z ocenjevanjem so uvedli tudi druga orodja, ki vodijo k zavedanju profesionalizma: učiteljsko tutorstvo
na Medicinski fakulteti v Ljubljani z delavnicami samorefleksije in delavnice treniranja trenerjev. Poudarek na
profesionalizmu naj bo vidnejši v izbirnem postopku za specializacijo, uvodnem intervjuju s specializantom in v
pogovorih s presojo z glavnim mentorjem v rednih presledkih, v večji komunikaciji med glavnimi in neposrednimi
mentorji ter v ocenjevanju mentorjev. Na uvedbo še čaka pogovor o profesionalizmu ob sprejemu na medicinsko
fakulteto ter predmet profesionalizem na medicinskih fakultetah in med specializacijo.
Patient-Centred Acute Care Training (PACT) is the on line, modular programme for Intensive Care medicine of the European Society of Intensive Medicine (ESICM). It has been designed as an educational ...tool to improve and harmonize the quality of critical care delivery and training.
Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps ...in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper). In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length), 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers), gestational diabetes and obesity (body mass index, waist – hips ratio) and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention) should be used.
To evaluate associated factors for preeclampsia in twin gestations and to compare incidences of pregnancy complications among twin pregnancies with vs. without preeclampsia.
We performed a ...case-control study using a population dataset of twin pregnancies delivered after 24 weeks of gestation, in Slovenia, between 1997 and 2009. Cases were twin gestations complicated by preeclampsia and controls were cases matched by gestational age, parity, and chorionicity.
We identified 181 cases (4.7%) of preeclampsia among 3885 twins and 542 matched controls. High pre-pregnancy body mass index (BMI) and gestational diabetes were significantly associated with preeclampsia odds ratio (OR) 1.8, 95% CI 1.26, 2.77 for overweight (BMI 25.0–29.9); OR 4.72, 95% CI 2.83, 7.89 for obese (BMI≥30), and OR 2.19, 95% CI 1.03, 4.68 for gestational diabetes. The association was not significant for preexisting hypertension, maternal age, smoking, and pregnancy following assisted reproduction. Placental complications (previa, abruption, or adherent placenta) were more common, and low birth weight less common in the preeclampsia group (P=0.03 and P=0.01, respectively).
High pre-pregnancy BMI carries an especially high risk for the development of preeclampsia and its complications in twin gestation.
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