Delivery Rate Research Articles

Optimized Adaptive Multi-Scale Dual An for Multi-Objective CHS and Energy-Aware Routing in 6G WC

In this research work, an Adaptive Multi-Scale Dual Attention Network with ZOA for Multi-Objective CHS with energy-aware routing in 6G wireless Communication (CHS-EAR-AM-SDAN-6G) is proposed to secure the data transmission by selecting optimum cluster heads in the 6G Wireless Communication network. Initially, the nodes are gathered together to form a cluster using an Adaptive Multi-Scale Dual Attention Network (AM-SDAN). The Zebra Optimization Algorithm (ZOA) strategically selects Cluster Heads (CHs) in wireless networks based on a multi-objective fitness function (MoFF) that minimizes energy consumption while considering factors, like distance, delay, and traffic density. The path and minimum value of fitness are recognized as the routing path and statistics are promoted to the sink node through the cluster head. The proposed scheme has been applied in Python and productivity of the proposed method is predictable with the help of several performances they are energy consumption, detection rate, computational time, packet delivery rate, number of alive nodes, and security. The performance of the proposed CHS-EAR-AMSDAN-6G method attains 25.93%, 24.81%, and 23.38% of alive nodes, 24.45%, 26.71% and 21.32% lower packet delivery rate, 27.56%, 26.43%, and 28.61% low computational period, related with three current methods, such as Generative Adversarial Learning for ITM in 6G Wireless Communication Networks (CHS-EAR-GAL-ITM-6G), ML Algorithms for the Future 6G WCN (CHS-EAR-ML-6G), Energy Efficient Distributed Federated Learning to the 6G Wireless Communication Networks (CHS-EAR-EEDFL-6G), respectively.

Use of vaginal dinoprostone for women with term prelabor rupture of membranes and an unfavorable cervix within 6 h versus within 6–24 h

BackgroundMost guidelines propose inducing labor within 24 h following term (37 or more weeks of gestation) prelabor rupture of membranes (PROM). However, the exact timing for initiating induction within the 24 h period remains unknown. This study aims to comparatively assess the efficacy and safety of the use of vaginal dinoprostone within 6 h versus within 6–24 h for singleton pregnancies with PROM and an unfavorable cervix (Bishop score < 6).MethodsThis was a retrospective cohort study including singleton pregnancies with PROM and an unfavorable cervix (Bishop score < 6) in which labor was induced using vaginal dinoprostone. Women were divided into two groups according to the timing of the use of induction (within 6 h versus within 6–24 h after PROM). Baseline maternal data, maternal and neonatal outcomes were recorded for statistical analysis.Results450 women were included, 146 (32.4%) of whom were induced within 6 h of PROM and 304 (67.6%) were induced within 6–24 h. Cesarean delivery rate (15.8% versus 29.3%, p = 0.002) and nonreassuring fetal heart rate tracing (4.8% versus 10.5%, p = 0.043) in group with vaginal dinoprostone within 6 h were significantly lower than those in group with vaginal dinoprostone within 6–24 h. There was no significant differences in terms of duration from IOL to vaginal delivery.ConclusionInduction of labor within 6 h with vaginal dinoprostone after PROM for singleton pregnancies with an unfavorable cervix (Bishop score < 6) significantly associated with less cesarean section, less nonreassuring fetal heart rate tracing, compared to induction of labor within 6–24 h after PROM.

Effectiveness of men in maternity health (MiM) intervention on male involvement in maternal health care to improve maternal health outcomes in Naypyitaw, Myanmar

Background Maternal health care (MHC) is critical for safe motherhood and preventing maternal deaths in Myanmar, but the institutional delivery rates are not yet optimal, increasing preventable maternal deaths. To address this issue, involving men in supporting MHC has been recognized as a strategy to improve MHC outcomes. This study aimed to assess the effectiveness, acceptability, and feasibility of men in maternity health (MiM) intervention on male involvement in MHC and its influence on knowledge, attitudes, and practices related to maternal health and institutional delivery rates in Naypyitaw, Myanmar. Methods This study employed a mixed-methods approach with quantitative surveying of the male partners and qualitative interviewing of both male and female partners and health stakeholders. A 6-month MiM education program on pregnancy complications, antenatal care, delivery care, and birth preparedness was provided to the intervention group. Before and after the intervention, comparisons between intervention and control groups were made. Results The socio-demographic characteristics of male partners were comparable between the intervention and control groups during the pre-intervention assessment. Before MiM intervention, notable differences in male partners’ knowledge, attitudes, birth preparedness and complication readiness practices regarding MHC were not evident between these two groups. After completing the MiM, significant score improvement, including higher ID rates compared to the control group (p&lt;0.001), was observed. The acceptability and feasibility of the MiM program were contributed by positive responses from qualitative findings, highlighting remarkable changes in the perspectives of male partners in supporting MHC. However, challenges, including financial limitations, cultural influences and a shortage of trained personnel, were encountered. Conclusion The MiM program effectively promotes male involvement in MHC, leading to improved MHC outcomes. The MiM intervention offers a promising, evidence-based model to enhance ID rates in Myanmar, requiring tailored approaches to address cultural and financial factors.

Unified modeling of photothermal and photochemical damage.

Correlating damage outcomes to a retinal laser exposure is critical for diagnosis and choosing appropriate treatment modalities. Therefore, it is important to understand the causal relationships between laser parameters, such as wavelength, power density, and length of exposure, and any resulting injury. Differentiating photothermal from photochemical processes in an in vitro retinal model using cultured retinal pigment epithelial cells would be a first step in achieving this goal. The first-order rate constant of Arrhenius has been used for decades to approximate cellular thermal damage. A modification of this equation, called the damage integral (Ω), has been used extensively to predict the accumulation of laser damage from photothermal inactivation of critical cellular proteins. Damage from photochemical processes is less well studied and most models have not been verified because they require quantification of one or more uncharacterized chemical species. Additionally, few reports on photochemical damage report temperature history, measured or simulated. We used simulated threshold temperatures from a previous in vitro study to distinguish between photothermal and photochemical processes. Assuming purely photochemical processes also inactivate critical cellular proteins, we report the use of a photothermal Ω and a photochemical Ω that work in tandem to indicate overall damage accumulation. The combined damage integral (ΩCDI) applies a mathematical switch designed to describe photochemical damage relative to wavelength and rate of photon delivery. Although only tested in an in vitro model, this approach may transition to predict damage at the mammalian retina.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study.

International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))? In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data. During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status. Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

The impact of antenatal cluster management on maternal delivery and postpartum rehabilitation

ObjectivePregnancy care can improve maternal pregnancy outcomes. Cluster nursing, an evidence-based, patient-centered model, enhances pregnancy care, can provide patients with high-quality nursing services, has been widely used in clinical practice in recent years. However, most previous studies evaluated cluster nursing program only for a single clinical scenario. In this study, we developed and implemented a antenatal cluster care program for various prenatal issues faced by puerpera to analyze its application effect.MethodsThis is a historical before and after control study. 89 expectant mothers who had their prenatal information files registered in the outpatient department of a grade III, level A hospital from June 2020 to September 2021 were finally enrolled in observation group, and received prenatal cluster management. Another set of 89 expectant mothers from January 2019 to December 2019 were included in the control group and received traditional routine prenatal management. The effect of cluster nursing management on maternal delivery and postpartum rehabilitation was evaluated and compared between the two groups.ResultsCompared with the control group, the observation group had a significantly higher natural delivery rate, better neonatal prognosis, higher rates of exclusive breastfeeding, lower incidence of postpartum complications, shorter postpartum hospital stay, better postpartum health status, and higher satisfaction with nursing services. Compared with before intervention, the SAS and SDS scores of the observation group showed significant improvement after intervention.ConclusionAntenatal cluster care is beneficial to improve maternal and neonatal outcomes, and can have positive effects on natural pregnancy and breastfeeding, while improving the multimedia health education ability of medical care and emphasizing the importance of social support.

The amplitude of low-frequency fluctuations is correlated with birth trauma in patients with postpartum post-traumatic stress disorder

Postpartum post-traumatic stress disorder (PP-PTSD) is a severe mental disorder worldwide. In recent years, some studies have reported that PP-PTSD stems from birth trauma. The present study was dedicated in finding ways to predict the occurrence of emergency caesarean section (ECS), trying to analyze the methods to reduce incidence of PP-PTSD on this basis, further exploring the neuroimaging changes in PP-PTSD. A total of 245 primiparas with intention of vaginal delivery were recruited. The internal tocodynamometry measurement was performed during labor for all mothers, and respectively taken at 3–5 cm, 5–8 cm, and 8–10 cm of cervical dilation. The receiver operating characteristic (ROC) curve and Binary logistic regression analyses were also performed to identify fetal head descending thrust that might help in the prediction of ECS. Resting-state magnetic resonance imaging (MRI) was performed on 26 patients diagnosed with PP-PTSD of 245 mothers, the amplitude of low-frequency fluctuations (ALFF) technology was used to observe the spontaneous neural activity of all PP-PTSD patients and correlation analyses were performed. We found that the natural delivery rate of mothers with fetal head descending thrust <16.29 N (5–8 cm), 26.36 N (8–10 cm) were respectively lower than other mothers with fetal head descending thrust ≥16.29 N (5–8 cm), 26.36 N (8–10 cm) (P < 0.05). The ROC curve analysis showed that the area under the receiver operating characteristic curve (AUC) value of thrust (5–8 cm) was 0.896 (95% CI: 0.854–0.938, p < 0.001), AUC of thrust(8–10 cm) was 0.786 (95% CI: 0.714–0.858, p < 0.001), which showed strong potential for predicting ECS. In addition, the Binary logistic regression analysis showed thrust (5-8 cm) and thrust (8–10 cm) were independent correlates of ECS. The resting-state functional magnetic resonance imaging (rs-fMRI) results indicated that PP-PTSD group showed decreased ALFF in the bilateral insula cortex (IC), right anterior cingulate cortex (ACC), and left midcingulate cortex (MCC) compared with healthy postpartum women (HPW) (false discovery rate (FDR) correction q-value < 0.05). The ALFF value of the right ACC was positively correlated with the Perinatal Post-traumatic stress disorder Questionnaire (PPQ) score (r = 0.4046 p = 0.0403) and Posttraumatic Stress Disorder Checklist–Civilian Version (PCL–C) score (r = 0.3909 p = 0.0483). The internal tocodynamometry measurement can serve as a predictive tool for ECS, on this basis, the implementation of effective emotional support may help to reduce the incidence of PP-PTSD. Besides, this study has verified the presence of altered ALFF in the brain regions of PP-PTSD patients, mainly involving the bilateral IC, right ACC, and left MCC, that might be associated with emotion, cognition, and memory disorders functions in PP-PTSD patients.

Artificial Intelligence-Empowered Doppler Weather Profile for Low-Earth-Orbit Satellites.

Low-Earth-orbit (LEO) satellites are widely acknowledged as a promising infrastructure solution for global Internet of Things (IoT) services. However, the Doppler effect presents a significant challenge in the context of long-range (LoRa) modulation uplink connectivity. This study comprehensively examines the operational efficiency of LEO satellites concerning the Doppler weather effect, with state-of-the-art artificial intelligence techniques. Two LEO satellite constellations-Globalstar and the International Space Station (ISS)-were detected and tracked using ground radars in Perth and Brisbane, Australia, for 24 h starting 1 January 2024. The study involves modelling the constellation, calculating latency, and frequency offset and designing a hybrid Iterative Input Selection-Long Short-Term Memory Network (IIS-LSTM) integrated model to predict the Doppler weather profile for LEO satellites. The IIS algorithm selects relevant input variables for the model, while the LSTM algorithm learns and predicts patterns. This model is compared with Convolutional Neural Network and Extreme Gradient Boosting (XGBoost) models. The results show that the packet delivery rate is above 91% for the sensitive spread factor 12 with a bandwidth of 11.5 MHz for Globalstar and 145.8 MHz for ISS NAUKA. The carrier frequency for ISS orbiting at 402.3 km is 631 MHz and 500 MHz for Globalstar at 1414 km altitude, aiding in combating packet losses. The ISS-LSTM model achieved an accuracy of 97.51% and a loss of 1.17% with signal-to-noise ratios (SNRs) ranging from 0-30 dB. The XGB model has the fastest testing time, attaining ≈0.0997 s for higher SNRs and an accuracy of 87%. However, in lower SNR, it proves to be computationally expensive. IIS-LSTM attains a better computation time for lower SNRs at ≈0.4651 s, followed by XGB at ≈0.5990 and CNN at ≈0.6120 s. The study calls for further research on LoRa Doppler analysis, considering atmospheric attenuation, and relevant space parameters for future work.

Oxygen accumulation and associated dangers in rescue helicopters

BackgroundAt the time of the COVID-19 pandemic, devastating incidents increased due to frequent oxygen administration to patients. The dangers associated with the use of oxygen, especially through local enrichments and formation of “oxygen clouds”, have been well understood for years. Nevertheless, dramatic incidents continue to occur, since fire hazard increases exponentially with oxygen concentrations above 23%. Rescue helicopters are at a particular high risk, because of technical reasons such as oxygen use in a very small space, surrounded by kerosene lines, electronic relays and extremely hot surfaces.MethodsIn this study three different sized rescue helicopter models (Airbus H135, H145 and MD902) were examined. Oxygen enrichment in the cabin was measured with an oxymeter during a delivery rate of 15 l/min constant flow for 60 min. Furthermore, the clearance of the enriched atmosphere was tested in different situations and with different ventilation methods. To make the airflow visible, a fog machine was used to fill the helicopter cabin.ResultsOxygen accumulation above 21% was detected in every helicopter. After 10–15 min, the critical 23% threshold was exceeded in all three aircrafts. The highest concentration was detected in the smallest machine (MD902) after 60 min with 27.4%. Moreover, oxygen clouds persisted in the rear and the bottom of the aircrafts, even when the front doors were opened. This was most pronounced in the largest aircraft, the H145 from Airbus Helicopters. Complete and rapid removal of elevated oxygen concentrations was achieved only by cross-ventilation within 1 min.ConclusionsOxygen should be handled with particular care in rescue helicopters. Adapted checklists and precautions can help to prevent oxygen accumulation, and thus, fatal incidents. To our knowledge, this is the first study, which analyzed oxygen concentrations in different settings in rescue helicopters.

Non-criteria and criteria antiphospholipid antibodies and their association with pregnancy outcomes in women with a history of miscarriage: A retrospective study

IntroductionThe objective of this study was to investigate both antiphospholipid antibodies (aPLs) and non-criteria aPLs (NC-aPLs) in relation with pregnancy outcomes. MethodsWe retrospectively analyzed 1574 pregnant women with experienced at least one miscarriage who were tested for aPLs and NC-aPLs, and compared their clinical characteristics, immune biomarkers, and pregnancy outcomes. The χ2 test or Fisher’s exact test compared pregnancy outcomes among patients negative for all aPLs, positive for NC‑aPLs subtypes, and positive for criteria aPLs subtypes. ResultsMultivariate logistic regression analysis indicated that positive aPLs (OR = 2.216, 95 % CI 1.381–3.558), and positive NC-aPLs (OR = 1.619, 95 % CI 1.245–2.106) are linked to adverse outcomes. For fetal loss, positive aPLs (OR = 2.354, 95 % CI 1.448–3.829), NC-aPLs (OR = 1.443, 95 % CI 1.076–1.936) were significant. Premature delivery was associated with positive NC-aPLs (OR = 2.102, 95 % CI 1.452–3.043). In the NC-aPLs positive group, the rate of adverse outcomes was higher in the multiple-positive subgroup (77.8 %) compared to the double-positive (52.3 %) and single-positive (37.0 %) subgroups. The rates of fetal loss and premature delivery were also higher in the multiple-positive NC-aPLs subgroup compared to the single-positive subgroup (48.1 % vs. 22.6 % for fetal loss and 57.1 % vs. 16.5 % for premature delivery). DiscussionOur findings suggest that both aPLs and NC-aPLs are associated with an increased incidence of adverse pregnancy outcomes, and patients presenting with multiple NC-aPLs positivity were found to have a higher incidence of adverse outcomes compared to their single-positive counterparts.

Variability of Care Practices for Extremely Early Deliveries.

Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2-at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center.

A stochastic model-based control methodology for glycemic management in the intensive care unit

Introduction: Intensive care unit (ICU) patients exhibit erratic blood glucose (BG) fluctuations, including hypoglycemic and hyperglycemic episodes, and require exogenous insulin delivery to keep their BG in healthy ranges. Glycemic control via glycemic management (GM) is associated with reduced mortality and morbidity in the ICU, but GM increases the cognitive load on clinicians. The availability of robust, accurate, and actionable clinical decision support (CDS) tools reduces this burden and assists in the decision-making process to improve health outcomes. Clinicians currently follow GM protocol flow charts for patient intravenous insulin delivery rate computations.Methods: We present a mechanistic model-based control algorithm that estimates the optimal intravenous insulin rate to keep BG within a target range; the goal is to develop this approach for eventual use within CDS systems. In this control framework, we employed a stochastic model representing BG dynamics in the ICU setting and used the linear quadratic Gaussian control methodology to develop a controller.Results: We designed two experiments, one using virtual (simulated) patients and one using a real-world retrospective dataset. Using these, we evaluated the safety and efficacy of this model-based glycemic control methodology. The presented controller avoids hypoglycemia and hyperglycemia in virtual patients, maintaining BG levels in the target range more consistently than two existing GM protocols. Moreover, this methodology could theoretically prevent a large proportion of hypoglycemic and hyperglycemic events recorded in a real-world retrospective dataset.Discussion: The current version of the methodology shows potential usefulness in GM of ICU patients. However, it is limited to a subgroup of the ICU patient population, who are fed through and enteral tube and delivered intravenous insulin. After extending to a broader ICU patient population who can consume oral nutrition and are delivered subcutaneous insulin for GM, the methodology could be tested with pilot studies and clinical trials for eventual use as a CDS tool.

Correlation Between the First Trimester Two-Hour Postprandial Blood Glucose Greater Than 110 mg/dL for the Prediction of Gestational Diabetes Mellitus.

To determine the correlation between first-trimester two-hour postprandial blood glucose (PPBG) > 110 mg/dL for predicting gestational diabetes mellitus (GDM). This prospective cohort study enrolled 200 women between 8 and 10 weeks of gestation from February 2022 to February 2024. All recruited pregnant women underwent testing for two-hour PPBS at 8-10 weeks and were followed up till delivery. GDM screening was done during 14-16, 24-28, and 32-34 weeks of gestation. Amongst women having PPBS > 110 mg/dL, 95.9% developed GDM, while in the group with PPBS < 110 mg/dL, only 4% developed GDM. In the PPBS > 110 mg/dL group, a significantly higher number of women were in the older age group (p < 0.049), had a higher BMI (p < 0.001), a family history of diabetes (p < 0.001), and previous history of abortion (p < 0.001). Women with PPBS > 110 mg/dL had significantly higher rates of cesarean section (p < 0.01), preterm delivery (p < 0.001), and macrosomia (p < 0.001). A positive correlation (r = 0.677; p < 0.001) was observed between first trimester two-hour PPBS and cord blood glucose levels. Similarly, a positive correlation (r = 0.465; p < 0.001) was present between insulin levels measured during the first trimester with cord blood insulin. The area under the curve (AUC) for PPBS was 0.969 (p < 0.001) with 95% CI: 0.933-0.988. PPBS > 110 mg/dL has a sensitivity of 95.9%, specificity of 95.6%, positive predictive value (PPV) of 95.9%, negative predictive value (NPV) of 95.7%, and diagnostic accuracy of 95.77% to predict GDM. PPBS > 110 mg/dL at two hours exhibits high levels of diagnostic accuracy for the prediction of GDM and is associated with adverse fetomaternal outcomes. PPBG is a superior, physiologic, and low-cost option compared to HbA1c for early prediction of GDM and can also be performed as a simple point-of-care test with a glucometer at home or in the periphery by healthcare workers (HCW) and in wellness centers.

The mode of delivery after operative fixation of pelvic ring fractures-a retrospective observational study.

The purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum. All women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36months. A total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware. Women with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed. Level III.

PCD-CT enables contrast media reduction in abdominal imaging compared to an individualized kV-adapted contrast media injection protocol on EID-CT

ObjectivesThis study aims to demonstrate reduced iodine contrast media (CM) in routine abdominal CT scans in portal venous phase (PVP) using a photon-counting detector CT (PCD-CT) compared to total body weight (TBW) and kV-adapted CM injection protocols on a state-of-the-art energy-integrating detector CT (EID-CT) while maintaining sufficient image quality (IQ). Materials and MethodsConsecutive contrast-enhanced abdominal PVP CT scans from an EID-CT (Nov 2022-March 2024) and a PCD-CT (Sep 2023-Dec 2023) were compared. CM parameters (total iodine load (TIL), iodine delivery rate (IDR) and dosing factor (DF)) were reported. An individualized acquisition and CM injection protocol based on TBW and kV was applied for the EID-CT and a TBW adapted CM injection protocol was used for the PCD-CT. Objective IQ was evaluated with mean attenuation (Hounsfield Units, HU), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)). Subjective IQ was assessed via a 5-point Likert scale by 2 expert readers based on diagnostic confidence. ResultsBased on 91 EID-CT scans and 102 PCD-CT scans a TIL reduction of 20.1 % was observed for PCD-CT. PCD-CT demonstrated significantly higher SNR (9.9 ± 1.7 vs. 9.1 ± 1.8, p < 0.001) and CNR (5.1 ± 1.7 vs. 4.3 ± 1.3, p < 0.001) compared to EID-CT. Subjective IQ assessment showed that all scans had sufficient diagnostic IQ. ConclusionsPCD-CT allows for CM reduction while providing higher SNR and CNR compared to EID-CT, using clinical individualized scan and CM injection protocols.

AIDA (Artificial Intelligence Dystocia Algorithm) in Prolonged Dystocic Labor: Focus on Asynclitism Degree.

Asynclitism, a misalignment of the fetal head with respect to the plane of passage through the birth canal, represents a significant obstetric challenge. High degrees of asynclitism are associated with labor dystocia, difficult operative delivery, and cesarean delivery. Despite its clinical relevance, the diagnosis of asynclitism and its influence on the outcome of labor remain matters of debate. This study analyzes the role of the degree of asynclitism (AD) in assessing labor progress and predicting labor outcome, focusing on its ability to predict intrapartum cesarean delivery (ICD) versus non-cesarean delivery. The study also aims to assess the performance of the AIDA (Artificial Intelligence Dystocia Algorithm) algorithm in integrating AD with other ultrasound parameters for predicting labor outcome. This retrospective study involved 135 full-term nulliparous patients with singleton fetuses in cephalic presentation undergoing neuraxial analgesia. Data were collected at three Italian hospitals between January 2014 and December 2020. In addition to routine digital vaginal examination, all patients underwent intrapartum ultrasound (IU) during protracted second stage of labor (greater than three hours). Four geometric parameters were measured using standard 3.5 MHz transabdominal ultrasound probes: head-to-symphysis distance (HSD), degree of asynclitism (AD), angle of progression (AoP), and midline angle (MLA). The AIDA algorithm, a machine learning-based decision support system, was used to classify patients into five classes (from 0 to 4) based on the values of the four geometric parameters and to predict labor outcome (ICD or non-ICD). Six machine learning algorithms were used: MLP (multi-layer perceptron), RF (random forest), SVM (support vector machine), XGBoost, LR (logistic regression), and DT (decision tree). Pearson's correlation was used to investigate the relationship between AD and the other parameters. A degree of asynclitism greater than 70 mm was found to be significantly associated with an increased rate of cesarean deliveries. Pearson's correlation analysis showed a weak to very weak correlation between AD and AoP (PC = 0.36, p < 0.001), AD and HSD (PC = 0.18, p < 0.05), and AD and MLA (PC = 0.14). The AIDA algorithm demonstrated high accuracy in predicting labor outcome, particularly for AIDA classes 0 and 4, with 100% agreement with physician-practiced labor outcome in two cases (RF and SVM algorithms) and slightly lower agreement with MLP. For AIDA class 3, the RF algorithm performed best, with an accuracy of 92%. AD, in combination with HSD, MLA, and AoP, plays a significant role in predicting labor dystocia and labor outcome. The AIDA algorithm, based on these four geometric parameters, has proven to be a promising decision support tool for predicting labor outcome and may help reduce the need for unnecessary cesarean deliveries, while improving maternal-fetal outcomes. Future studies with larger cohorts are needed to further validate these findings and refine the cut-off thresholds for AD and other parameters in the AIDA algorithm.

Revealing the Effects of Polymer Additives on Zn Dendrite Suppression in Aqueous Zn Batteries via in-Situ EC-AFM

Polyethylene glycol (PEO) is a commonly used polymer in the field of batteries for achieving flat and uniform electrodes to enhance the performance of batteries, such as lithium batteries and zinc (Zn) batteries. However, the impact of PEO on the electrochemical deposition of Zn metal on electrodes remains uncertain. In this study, we selected ZnSO4 solution as electrolyte and copper (Cu) substrates as electrodes, which are widely applied in Zn batteries. We used in situ electrochemical atomic force microscopy (EC-AFM) to observe the nucleation and growth of Zn metal plates on the Cu substrate in the presence of different concentrations of ZnSO4 and PEO additives. Our results indicate that PEO biases the crystallographic orientation of the initially deposited Zn metal nuclei, but does not have an obvious influence on subsequent growth. Based on our findings, we hypothesize that PEO primarily interacts with the Cu substrate to adjust the interfacial energy of the Cu-electrolyte interfaces. In contrast, due to the lack of apparent change in the Zn growth rate, we postulate that PEO does not affect the delivery rate of Zn2+ to the electrode surface. The consistent aspect ratio of the Zn plates combined with the lack of an effect on growth rates further suggests that PEO does not interact significantly with the surface of the newly formed Zn plates. The Zn metal will undergo surface reorganization in a mildly acidic aqueous solution as a result of oxidation of Zn, which is not affected by PEO adsorption. Our findings provide both insight into the underlying mechanism by which PEO promotes electrode flattening in Zn batteries and a standardized protocol for elucidating the impact of additives on the morphological evolution of interfaces during electrochemical deposition.Work by C.O. was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

Engineering Water-Lotus-like Iridium-Cobalt Carbonate Hydroxides on Plasma-Treated Carbon Fibers for Enhanced Electrocatalytic Oxygen Evolution.

The sluggish kinetics of the oxygen evolution reaction (OER) in alkaline water electrolysis remains a significant challenge for developing high-efficiency electrocatalytic systems. In this study, we present a three-dimensional, micrometer-sized iridium oxide (IrO2)-decorated cobalt carbonate hydroxide (IrO2-P-CoCH) electrocatalyst, which is engineered in situ on a carbon cloth (CC) substrate pretreated with atmospheric-pressure dielectric barrier discharge (DBD) plasma (PCC). The electrocatalyst features petal-like structures composed of nanosized rods, providing abundant reactive areas and sites, including the oxygen vacancy caused by the air-DBD plasma. As a result, the IrO2-P-CoCH/PCC electrocatalyst demonstrates an outstanding OER performance, with overpotentials of only 190 and 300 mV required to achieve current densities of 10 mA cm-2 (j10) and 300 mA cm-2 (j300), respectively, along with a low Tafel slope of 48.1 mV dec-1 in 1.0 M KOH. Remarkably, benefiting from rich active sites exposed on the IrO2-P-CoCH (Ir) heterostructure, the synergistic effect between IrO2 and CoCH enhances the charge delivery rates, and the IrO2-P-CoCH/PCC exhibits a superior electrocatalytic activity at a high current density (300 mV/j300) compared to the commercial benchmarked RuO2/PCC (470 mV/j300). Furthermore, the IrO2-P-CoCH/PCC electrocatalyst shows exceptional OER stability, with a mere 1.3% decrease with a current density of j10 for 100 h testing, surpassing most OER catalysts based on CC substrates. This work introduces a novel approach for designing high-performance OER electrocatalysts on flexible electrode substrates.

Fetal major anomalies and related maternal, obstetrical, and neonatal outcomes.

To examine maternal, obstetrical, and neonatal outcomes of pregnancies complicated by major fetal anomalies. A 10year retrospective cohort study at a tertiary university hospital compared maternal and obstetrical outcomes between women with singleton pregnancies complicated by major fetal anomalies, and a control group with non-anomalous fetuses. For the study compared to the control group, the median gestational age at delivery was lower: 37.0 vs. 39.4weeks (p < 0.001); and the preterm delivery rates were higher, both at < 37weeks (46.2 vs. 6.2%, p < 0.001) and < 32weeks (15.4 vs. 1.2%, p < 0.001). For the study compared to the control group, the placental abruption rate was higher (6.8 vs. 0.9%, p = 0.002); 87.5 vs. 100% occurred before labor. For the respective groups, the mean gestational ages at abruption were 32.8 ± 1.3 and 39.9 ± 1.7weeks (p = 0.024); and cesarean section and postpartum hemorrhage rates were: 53.8 vs. 28.3% (p < 0.001) and 11.3 vs. 2.8% (p = 0.001), respectively. For the respective groups, hypertensive disorders of pregnancy rates were 9.5 vs. 2.1% (p = 0.004), stillbirth rates were 17.1 vs. 0.3% (p < 0.001), and neonatal death rates 12.5 vs. 0.0% (p < 0.001). Major fetal anomalies were found to be associated with adverse maternal outcomes (OR = 2.47, 95% CI 1.50-4.09, p < 0.001). Polyhydramnios was identified as an independent risk factor in a multivariate analysis that adjusted for fetal anomalies, conception by IVF, and primiparity for adverse maternal outcomes (OR = 4.7, 95% CI 1.7-13.6, p < 0.001). Pregnancies with major fetal anomalies should be treated as high-risk due to the increased likelihood of adverse maternal and neonatal outcomes.

Leveraging the dynamics of microalgal CO2 capture to estimate the maximum inherent photosynthetic potential

AbstractBACKGROUNDNatural photosynthesis, utilizing intelligent molecular machinery to harness sunlight, stands as the benchmark for efficient energy generation. Despite its high quantum efficiency compared to synthetic methods, challenges persist due to dynamic nutritional and light requirements in plant, microalgae, and cyanobacteria‐driven processes. Reported microalgae CO2 uptake rates rely on biomass dry cell weight measurement after certain incubation period and systematic study of required CO2 concentrations for optimal photobioreactor operation remaining unexplored. This research is thus aimed at evaluating the critical dissolved CO2 (Ccrit ∙ CO2) concentration and specific CO2 uptake rates (SCUR) of Chlorella minutissima (CM) culture in the presence of surplus light and other nutrients by online monitoring and measuring the dynamic CO2 uptake rates which will help in maintaining the optimal rate of CO2 delivery for continuous cultivation of microalgae while minimizing the escape of CO2.RESULTSDissolved Ccrit ∙ CO2 was determined to be in the range of 16–20 mg/L, and the maximum SCUR in BBM (Bold Basal Medium) was found to be 0.73 mg CO2 (mg dcw ∙ h)−1. Interestingly, this SCUR value is nearly three times greater than that of the most efficient in vitro artificial photosynthetic novel pathway reported so far.CONCLUSIONFrom the calculated SCUR values, it may be noted that 9.6 g of biomass can be obtained from 1 g of microalgal inoculum in a day, thereby setting a benchmark for the scientists working in the areas of bioprocess engineering, synthetic biology, and metabolic engineering to comply. © 2024 Society of Chemical Industry (SCI).