Unlike traditional offshore oil and gas projects which generally involve a limited number of structures and are confined to a relatively small seabed footprint, renewable energy projects such as ...offshore wind farms can comprise many tens or even hundreds of structures dispersed across an extensive area. Driven by the need for offshore wind to reduce costs while also minimising project risk, there is currently a strong focus within the offshore industry on identifying new ways to extract the full benefit from all available site investigation data and carry this benefit through to engineering design. This paper provides a demonstration of two such approaches that utilise geo-data from offshore Western Australia, potentially representative of conditions of future offshore wind farms; the first is an integrated approach combining geophysical and geotechnical data through a seismic inversion process, while the second encompasses statistical analysis of geotechnical cone penetrometer and soil strength test data combined with a Bayesian compressive sampling-based spatial interpolation method. The demonstrations yielded useful findings about the methodologies and associated input requirements. It is envisaged this work will lead to the development of an efficient integrated framework for interpreting geo-data that will inform future offshore site investigation and geotechnical design practice.
•There is currently a focus within the offshore industry on identifying new ways to extract the full benefit from site investigation data. This paper provides a demonstration of two such approaches that utilise geo-data from offshore Western Australia. The first approach combines geophysical and geotechnical data through a seismic inversion process. The second approach encompasses statistical analysis of geotechnical cone penetrometer and soil strength test data. It is envisaged the study findings will feed into future site investigation practice and development of integrated interpretation approaches. These approaches will lead to a framework for integrating geophysical and geotechnical data and implementing the output into foundation design.
•Use of ObsQoR-11 in an enhanced recovery after caesarean (ERAC) programme.•Implementation of an ERAC programme resulted in improved ObsQoR-11 scores.•Introduction of ERAC resulted in reduced ...postoperative opioid consumption.•Introduction of ERAC resulted in shorter length of hospital stay.•Improvements in multiple process measures with introduction of ERAC.
Enhanced recovery after caesarean (ERAC) has been shown to postoperatively reduce opioid consumption, reduce pain scores, and shorten hospital stay. Arguably, none of these measures provide for a patient-centred approach. We believe that patient-reported outcome measures (PROMs) represent a more holistic approach to the reporting of outcomes. One such PROM is the Obstetric Quality-of-Recovery Score (ObsQoR-11). This has been shown to be a valid and reliable assessment of recovery after elective caesarean section.
This before-and-after quality improvement programme studied consecutive patients undergoing elective caesarean section. We implemented an ERAC pathway with the aim of improving quality of recovery and patient satisfaction. Our primary outcome was the change in the ObsQoR-11 score.
A total of 318 medical records were reviewed (n = 93 before ERAC, n = 225 after ERAC). There was a significant improvement in ObsQoR-11 score in ERAC patients compared with pre-ERAC patients (85.0 vs 82.3, P < 0.001). Morphine consumption (MMEQ) was reduced by 10% overall in the ERAC group, with no increase in pain scores at day 1 postoperatively and a decrease in pain scores on day 2 in the ERAC group (P = 0.02). The length of hospital stay was significantly shorter in ERAC patients (63.1 h vs 79.9 h, P < 0.001).
Our study demonstrated an improved ObsQoR-11 score after ERAC implementation. This is the first example in the literature of using ObsQoR-11 in ERAC. We believe this is a more comprehensive way to assess patient recovery and the impact of an ERAC programme.
To investigate the effects of maternal iron deficiency and anaemia on the placenta the composition and vascularization of the placental labyrinth was investigated in iron-restricted rats. Rats in the ...experimental groups were placed on iron-restricted diets either 1 or 2 weeks before mating and continued on these diets throughout gestation. Placentae were studied at day 21 of gestation. Tissue sections were stained with lectin to allow identification of fetal capillaries and analyzed using stereological techniques. Capillary surface area density and total capillary surface area were decreased in both iron-restricted groups compared with the control group. Capillary length density was decreased in both iron-restricted groups compared with the control group. Total capillary length was significantly reduced in the 1-week, but not in the 2-week, iron-restricted group compared with the control group. Endothelial cell volume was increased in both iron-restricted groups compared to the controls. There were no significant differences in the volume of fetal capillaries, the volume of the maternal blood spaces or the surface area of the maternal–fetal interface between the control and iron-restricted groups. Labyrinthine volume, labyrinthine tissue volume and the surface area of the maternal fetal interface were increased in the 2-week group when compared with the 1-week group. These changes in placental vascularization may contribute to the fetal growth retardation observed in iron-restricted litters.
Screening of a compound library led to the identification of 2-amino-6-(2,6-dichlorophenyl)-8-methylpyrido2,3-dpyrimidine (1) as a inhibitor of the platelet-derived growth factor receptor (PDGFr), ...fibroblast growth factor receptor (FGFr), and c-src tyrosine kinases (TKs). Replacement of the primary amino group at C-2 of 1 with a 4-(N,N-diethylaminoethoxy)phenylamino group yielded 2a, which had greatly increased activity against all three TKs. In the present work, variation of the aromatic group at C-6 and of the alkyl group at N-8 of the pyrido2,3-dpyrimidine core provided several analogues that retained potency, including derivatives that were biased toward inhibition of the TK activity of PDGFr. Analogues of 2a with a 3-thiophene or an unsubstituted phenyl group at C-6 were the most potent inhibitors. Compound 54, which had IC50 values of 31, 88, and 31 nM against PDGFr, FGFr, and c-src TK activity, respectively, was active in a variety of PDGF-dependent cellular assays and blocked the in vivo growth of three PDGF-dependent tumor lines.
Intrauterine devices (IUDs), long‐acting and reversible contraceptives, induce a number of immunological and biochemical changes in the uterine environment that could affect endometrial cancer (EC) ...risk. We addressed this relationship through a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We combined individual‐level data from 4 cohort and 14 case‐control studies, in total 8,801 EC cases and 15,357 controls. Using multivariable logistic regression, we estimated pooled odds ratios (pooled‐ORs) and 95% confidence intervals (CIs) for EC risk associated with ever use, type of device, ages at first and last use, duration of use and time since last use, stratified by study and adjusted for confounders. Ever use of IUDs was inversely related to EC risk (pooled‐OR = 0.81, 95% CI = 0.74–0.90). Compared with never use, reduced risk of EC was observed for inert IUDs (pooled‐OR = 0.69, 95% CI = 0.58–0.82), older age at first use (≥35 years pooled‐OR = 0.53, 95% CI = 0.43–0.67), older age at last use (≥45 years pooled‐OR = 0.60, 95% CI = 0.50–0.72), longer duration of use (≥10 years pooled‐OR = 0.61, 95% CI = 0.52–0.71) and recent use (within 1 year of study entry pooled‐OR = 0.39, 95% CI = 0.30–0.49). Future studies are needed to assess the respective roles of detection biases and biologic effects related to foreign body responses in the endometrium, heavier bleeding (and increased clearance of carcinogenic cells) and localized hormonal changes.
What's new?
Are IUDs associated with endometrial cancer? Around the world, the intrauterine device is gaining popularity as a long‐term birth control strategy. Positioned as it is embedded in the uterine lining, an IUD could affect endometrial tissue. This study builds on previous work by considering the type of device used, in addition to factors such as duration of use. The authors found that women who had used an IUD, particularly an inert IUD, had less risk of endometrial cancer. The longer the device was used, they found, the more the cancer risk decreased.
The aim of this study was to describe growth during puberty in young people with vertically acquired HIV.
Pooled data from 12 paediatric HIV cohorts in Europe and Thailand.
One thousand and ...ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters.
At ART initiation, median age and HAZ was 6.4 interquartile range (IQR): 2.8, 9.0 years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean.
Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age.
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