Duration Of Delivery Research Articles

Duration of morning hyperinsulinemia determines hepatic glucose uptake and glycogen storage later in the day.

The second-meal phenomenon refers to the improvement in glucose tolerance seen following a second identical meal. We previously showed that 4 h of morning hyperinsulinemia, but not hyperglycemia, enhanced hepatic glucose uptake (HGU) and glycogen storage during an afternoon hyperinsulinemic-hyperglycemic (HIHG) clamp. Our current aim was to determine if the duration or pattern of morning hyperinsulinemia is important for the afternoon response to a HIHG clamp. To determine this, the same total amount of insulin was administered either over 2 h in the first (Ins2h-A) or second (Ins2h-B) half of the morning or over the entire 4 h (Ins4h) of the morning. In the 4-h afternoon period, all three groups had 4x-basal insulin, 2x-basal glycemia, and portal glucose infusion to expose the liver to the primary postprandial regulators of hepatic glucose metabolism. During the afternoon clamp, there was a marked increase in HGU and hepatic glycogen synthesis in the Ins4h group compared with the Ins2h-A and Ins2h-B groups, despite matched hepatic glucose loads and total insulin infusion rates. Thus, the longer duration (Ins4h) of lower hyperinsulinemia in the morning seems to be the key to much greater liver glucose uptake during the afternoon clamp.NEW & NOTEWORTHY Morning insulin exposure primes the liver for increased hepatic glucose uptake and glycogen storage during a subsequent hyperinsulinemic-hyperglycemic clamp. This study addressed whether the pattern and/or duration of insulin delivery in the morning influences insulin's ensuing priming effect. We found that despite receiving equal total doses of insulin in the morning, a prolonged, lower rate of morning insulin delivery improved afternoon liver glucose metabolism more effectively than a shorter, higher rate of delivery.

Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

In vitro characterization of radiofrequency ablation lesions in equine and swine myocardial tissue

Radiofrequency ablation is a promising technique for arrhythmia treatment in horses. Due to the thicker myocardial wall and higher blood flow in horses, it is unknown if conventional radiofrequency settings used in human medicine can be extrapolated to horses. The study aim is to describe the effect of ablation settings on lesion dimensions in equine myocardium. To study species dependent effects, results were compared to swine myocardium. Right ventricular and right and left atrial equine myocardium and right ventricular swine myocardium were suspended in a bath with circulating isotonic saline at 37 °C. The ablation catheter delivered radiofrequency energy at different-power-duration combinations with a contact force of 20 g. Lesion depth and width were measured and lesion volume was calculated. Higher power or longer duration of radiofrequency energy delivery increased lesion size significantly in the equine atrial myocardium and in equine and swine ventricular myocardium (P < 0.001). Mean lesion depth in equine atrial myocardium ranged from 2.9 to 5.5 mm with a diameter ranging from 6.9 to 10.1 mm. Lesion diameter was significantly larger in equine tissue compared to swine tissue (P = 0.020). Obtained data in combination with estimated wall thickness can improve lesion transmurality which might reduce arrhythmia recurrence. Optimal ablation settings may differ between species.

Cesarean delivery, labor duration, and mothers’ mortality risk over 50 years of follow-up

BackgroundPregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality. ObjectiveTo examine whether labor duration and mode of delivery were associated with all-cause and cause-specific mortality. Study DesignParticipants were mothers from the multisite Collaborative Perinatal Project (CPP) cohort (1959–1966; n=43,646, limited to last CPP delivery). We ascertained all-cause and specific causes of death as of 2016 via linkage to the National Death Index and Social Security Death Master File. Hazard ratios (HR) testing mode of delivery and labor duration were estimated using Cox proportional hazards models adjusted for demographic and clinical characteristics. We further stratified analyses by parity. ResultsAmong participants with a recorded delivery mode, 5.9% (2486/42,335) had a cesarean delivery. Participants who had a cesarean were older (26.9 vs 24.3 years), with higher body mass index (24.0 vs 22.7 kg/m2), were less likely to be nulliparous (21% vs 30%), and more likely to have a household income of at least $6000 (22% vs 17%), to smoke ≥1 pack/d (18% vs 15%), to have diabetes mellitus (12% vs 1%) and to have a prior medical condition (47% vs 34%), compared to participants with a vaginal delivery. Delivery mode was similar by race/ethnicity, marital status, and education. Median labor duration was 395 minutes among participants who had an intrapartum cesarean delivery and 350 minutes among participants delivered vaginally. By 2016, 52.2% of participants with a cesarean delivery and 38.5% of participants with a vaginal delivery had died. Cesarean vs vaginal delivery was significantly associated with increased risk for all-cause mortality (HR=1.16 (95% confidence interval [CI]: 1.09, 1.23); in nulliparas, HR=1.27 (95% CI: 1.09, 1.47); in multiparas, HR=1.13 (95% CI: 1.06, 1.21) as well as increased risk of death from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease. Associations with death from cardiovascular disease, infection, and kidney disease were stronger for multiparas than nulliparas, though the association with death from diabetes was stronger among nulliparas. Labor duration was not significantly related to overall mortality. ConclusionIn a historic United States cohort with a low cesarean delivery rate, cesarean delivery was an indicator for subsequent increased mortality risk, particularly related to cardiovascular disease and diabetes. Future studies with long-term follow-up are warranted given the current high prevalence of cesarean delivery.

Dexamethasone acetate loaded poly(ε-caprolactone) nanofibers for rat corneal chemical burn treatment

Topical eye drop approaches to treat ocular inflammation in dry eyes often face limitations such as low efficiency and short duration of drug delivery. Nanofibers serve to overcome the limitation of the short duration of action of topical eye drops used against ocular inflammation in dry eyes. Several attempts to develop suitable nanofibers have been made; however, there is no ideal solution. Here, we developed polycaprolactone (PCL) nanofibers loaded with dexamethasone acetate (DEX), prepared by electrospinning, as a potential ocular drug delivery platform for corneal injury treatment. Thirty-nine Sprague Dawley rats (7 weeks old males) were divided into four treatment groups after alkaline burns of the cornea; negative control (no treatment group); dexamethasone eyedrops (DEX group); PCL fiber (PCL group); dexamethasone loaded PCL (PCL + DEX group). We evaluated therapeutic efficacy of PCL + DEX by examining the epithelial wound healing effect, the extent of corneal opacity and neovascularization. Additionally, various inflammatory factors, including IL-1β, were investigated through immunochemistry, western blot analysis, and quantitative real-time RT-PCR (qRT-PCR). PCL + DEX group showed histologically alleviated signs of corneal inflammation compared with DEX group, which showed a decrease in IL-1β and MMP9 in the corneal stroma. The quantitative expression on day 1 after alkaline burn of pro-inflammatory markers, including IL-1β and IL-6, in the PCL + DEX group was significantly lower than that in the DEX group. Notably, PCL + DEX treatment significantly suppressed neovascularization, and enhanced the anti-inflammatory function of DEX during the acute phase of ocular inflammation. Collectively, these findings suggest that PCL + DEX may be a promising approach to effective drug delivery in corneal burn injuries.

Prospective Approaches of Herbal Novel Delivery System with Special Reference to the Herbal Nanosciences

: Medicinal and culinary uses of plants date back centuries. Projects on a global scale are conducting laboratory research to identify plants with therapeutic properties, with the ultimate goal of developing such compounds into medicines with acceptable drug delivery mechanisms and bringing them to market. Non-synthetic medications derived from plant or herbal sources have attracted a lot of interest because of their high tolerability and low likelihood of adverse medication reactions. All diseases, the theory goes, can be cured by something found in nature. Medicines can be taken in a wide variety of forms, including tablets, capsules, powders, semi-liquid extracts, tinctures, decoctions, medicinal teas, solutions, and more. Longer release, patient adherence, and other objectives necessitate adjustments to herbal medications. Researchers into novel drug delivery systems had hitherto overlooked herbal remedies due to a lack of scientific validation and the challenges inherent in processing, standardizing, extracting, and identifying them. Transdisciplinary research and cuttingedge isolation, purification, and identification techniques have led to the development of novel herbal compositions. Bioactive plant extracts and phytoconstituents are used in a wide variety of Nano- Emulsions, microspheres, transferosomes, implants, and ethosomes. Compared to herbal remedies, novel formulations fared better. Among these advantages are increased solubility, bioavailability, toxicity, pharmacological activity, stability, delivery duration, and resistance to physical and chemical degradation. As a result, the pharmacokinetic and pharmacodynamic properties of herbal medications can be enhanced by the use of novel drug delivery systems, making them safer and more effective. : This article aims to provide a concise description of the many new drug delivery techniques that have been created for the administration of herbal medications. The ultimate goal is to increase the efficacy of therapies and to learn more about their significance and worldwide appeal.

Machine learning approach to investigate pregnancy and childbirth risk factors of sleep problems in early adolescence: Evidence from two cohort studies

BackgroundThis study aimed to predict early adolescent sleep problems using pregnancy and childbirth risk factors through machine learning algorithms, and to evaluate model performance internally and externally. MethodsData from the China Jintan Child Cohort study (CJCC; n=848) for model development and the US Healthy Brain and Behavior Study (HBBS; n=454) for external validation were employed. Maternal pregnancy histories, obstetric data, and adolescent sleep problems were collected. Several machine learning techniques were employed, including least absolute shrinkage and selection operator, logistic regression, random forest, naïve bayes, extreme gradient boosting, decision tree, and neural network. The area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, and root mean square of residuals were used to evaluate model performance. ResultsKey predictors for CJCC adolescents’ sleep problems include gestational age, birthweight, duration of delivery, and maternal happiness during pregnancy. In HBBS adolescents, the duration of postnatal depressive emotions was the primary perinatal predictor. The prediction models developed in the CJCC had good-to-excellent internal validation performance but poor performance in predicting the sleep problems in HBBS adolescents. ConclusionThe identification of specific perinatal risk factors associated with adolescent sleep problems can inform targeted interventions during and after pregnancy to mitigate these risks. Health providers should consider integrating these predictive factors into routine pre- and postnatal assessments to identify at-risk populations. The variability in model performance across different cohorts highlights the need for context-specific models and the cautious application of predictive analytics across diverse populations. Future research should focus on refining predictive models to account for such variations, potentially through the incorporation of additional socio-cultural factors and genetic markers. This study emphasizes the importance of personalized and culturally sensitive approaches in the prediction and management of adolescent sleep problems, leveraging advanced computational methods to enhance maternal and child health outcomes.

Mechanistic Differences between Torsemide and Furosemide.

Torsemide is proposed to have clinically important pharmacokinetic and pharmacodynamic advantages over furosemide. However, clinical outcomes did not differ in the Torsemide Comparison with Furosemide for Management of Heart Failure (TRANSFORM-HF) randomized trial. We conducted a multicenter mechanistic substudy of patients with heart failure randomized to oral furosemide or torsemide (TRANSFORM-Mechanism). At baseline and 30 days, participants underwent detailed assessments of pharmacokinetic and pharmacodynamic parameters. TRANSFORM-Mechanism enrolled 88 participants. Kidney bioavailability, or the proportion of dose delivered to the tubular site of action, was significantly less with torsemide compared to furosemide [median 17.1%, (IQR 12.3, 23.5%) vs. 24.8% (16.6, 34.1%), p < 0.001]. Furosemide had a longer duration of kidney drug delivery and duration of natriuresis (p≤0.004 for both). Prescribed doses of furosemide and torsemide in TRANSFORM-Mechanism were similar to TRANSFORM-HF, with providers on average using a 2:1 dose equivalence conversion between drugs. However, these doses resulted in a substantially greater natriuresis with torsemide (p<0.001). A dose equivalence of ∼4:1 resulted in similar natriuresis. Higher diuretic doses in the torsemide group resulted in mild perturbations in kidney function and significant increases in renin, aldosterone, and norepinephrine (p<0.05 for all). Plasma volume (p=0.52) and body weight (p=0.89) did not improve with torsemide vs. furosemide. We observed no meaningful pharmacokinetic/pharmacodynamic advantages for torsemide vs. furosemide. The greater natriuresis from higher diuretic doses in the torsemide group was offset by greater neurohormonal activation and kidney dysfunction.

Duration of Morning Hyperinsulinemia Determines Hepatic Glucose Uptake and Glycogen Storage Later in the Day.

Morning insulin exposure primes the liver for increased hepatic glucose uptake and glycogen storage during a subsequent hyperinsulinemic-hyperglycemic clamp. This study addressed whether the pattern and/or duration of insulin delivery in the morning influences insulin's ensuing priming effect. We found that despite receiving equal total doses of insulin in the morning, a prolonged, lower rate of morning insulin delivery improved afternoon liver glucose metabolism more effectively than a shorter, higher rate of delivery.

Nurse-Led Advance Care Planning in Adults in the U.S.- A Scoping Review.

Advance care planning involves discussing individuals' future medical treatment and care preferences. Nurses, due to their close relationships with patients and families, may be well-positioned to lead these discussions. Exploring the components and characteristics of nurse-led ACP interventions is essential for enhancing their implementation, effectiveness, and sustainability. This scoping review aimed to explore the characteristics of nurse-led ACP interventions in adult patients, identify the populations and settings where these interventions have been utilized, and the outcomes of these interventions in the U.S. A scoping review was conducted following Arksey and O'Malley's five-stage framework. Using keywords related to nurse-led ACP interventions, a comprehensive search was performed across PubMed, Web of Science, CINAHL, EMBASE, and PsycINFO databases. Twelve studies met the inclusion criteria. These studies were conducted in varied settings. Registered nurses, oncology nurse navigators, and other specialized nurses primarily delivered nurse-led ACP interventions. The interventions ranged from one to two sessions and utilized various models and resources such as the Five Wishes and Respecting Choices. Nurse-led ACP interventions have shown significant positive outcomes, including increased engagement in ACP, improved attitudes towards ADs, higher completion rates of ADs, and enhanced patient-surrogate congruence. These interventions are well-received by patients and can be implemented in diverse settings. However, a general guideline regarding nurse-led ACP interventions is needed to address the specific duration, sessions, and mode of delivery required for their optimal effectiveness.

A comparison of 1- versus 3-month regional anatomy exposure on learning outcomes of undergraduate medical students.

Regional anatomy teaching forms a cornerstone of undergraduate medical education. Owing to an increase in teaching and learning content throughout the medical curriculum in recent years, contact hours and overall course durations in anatomy are under review worldwide. This study aimed to assess whether shortening the course content duration impacts learning gain and the ability to identify anatomical structures correctly. Undergraduate medical students of the Johannes Kepler University Linz (JKU; n = 310) and at the Medical University of Graz (MUG; n = 156) participating in regional anatomy courses were included. Whole body regional anatomy courses, including hands-on dissection and accompanying lectures, were delivered over one or three months. Course content and examination mode were kept consistent, while the duration of knowledge delivery was one or three months, respectively. Objective structured practical examinations (OSPE) were then carried out on prosections for the neck, thorax, and abdomen. 3-month course exposure resulted in significantly higher OSPE scores for the neck (49 vs. 37%), thorax (65 vs. 54%), and abdomen (65 vs. 45%), respectively. Further evaluation of the utility of different embalming types yielded higher 3-month scores in the neck and thorax regions with Thiel-embalmed tissues and thorax and abdomen regions in ethanol-glycerin-embalmed tissues. Course exposure over a more extended period, like three months, appearsto be highly beneficial.

ORGANIZATION OF DELIVERY OF THE COMPANY'S PRODUCTS BY OWN VEHICLES

Purpose. The purpose of the work is the formation and analysis of options for the organization of the delivery of the machine-building enterprise's products by its own vehicles. Methodology. The main stages of choosing a rational technology for the organization of product transportation by own transport based on the developed schedules have been formed. The research was performed on the basis of the analysis of graphs of the dependence of motor vehicle operation indicators on the technology of organizing the transportation of the company's products. Findings. The article develops and analyzes work schedules for the delivery of the company's products by tractor-trailer trucks with semi-trailers. According to the schedules, the duration of delivery of one product in a ready-to-install condition to the consignee, the maximum possible annual volumes of transportation, the maximum and actual average annual operating costs for the delivery of the company's products by its own vehicles are determined. Practical value. The results of the research can be used to make a decision on the expediency of refusing the services of logistics companies to organize the delivery of the company's products to customers.

Programmed Intermittent Epidural Boluses of 0.1% Ropivacaine Versus 0.2% Ropivacaine for the Maintenance of Epidural Analgesia in Labor.

Objective The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either bybolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs. Methods A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns. Results All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed bythe obstetrician. Conclusion Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.

NGO Capacity Building Initiatives: Impacts and Constraints in Enhancing Teachers’ Competence for Managing Learning Environments in Tanzanian Public Secondary Schools

This study employed a qualitative research approach with a case study design to investigate capacity-building programmes (CBPs) provided by nongovernmental organisations (NGOs) in Tanzanian public secondary schools. Specifically, the study focused on the NGOs’ initiatives, impacts, and constraints towards enhancing teachers’ competence in managing the learning environment. In-depth interviews and focused group discussions were used to collect data from 50 teachers. The findings revealed that the CBPs improved teachers’ competence in designing and organising physical learning spaces, cultivating positive classroom relationships, and leveraging information and communication technology to enrich the learning environment. However, the programmes were constrained by a short duration of delivery and a lack of continued support. The study recommends the adoption of appropriate interventions by NGOs and the government to ensure the sustainability of NGO-supported capacity-building programmes, thereby fostering lasting impacts on teachers’ capacity to manage the learning environment in public secondary schools.

Communication Effectiveness Millennial Agriculture Forum (MAF) in Growing Entrepreneurial Motivation of Medan Agricultural Development Polytechnic Students

The aim of the research is to analyze the effectiveness of Millennial Agriculture Forum (MAF) communication in fostering entrepreneurial motivation and analyzing MAF communication barriers in fostering entrepreneurial motivation for Medan Agricultural Development Polytechnic students. Qualitative research method using the constructivism paradigm. The informants in this research were 7 (seven) students because the data was saturated with the criteria for being a student in Semester VIII for the 2023/2024 academic year. The results of the research show that MAF is effective in fostering entrepreneurial motivation because students actively receive information from resource persons, the contents of messages related to entrepreneurship are delivered using the Zoom Meeting application, held on Saturdays with a delivery duration of 2 (two) hours and messages are delivered through slide shows and videos

Understanding Age-Driven Preferences: A Weighted Sum Analysis of Consumer Behavior in E-commerce

Consumer activity in online commerce plays a crucial role in modern business functions, impacting market trends and guiding approaches for digital merchants. This research utilizes the weighted sum technique to assess consumer actions among different age brackets, emphasizing significant indicators like Average Order Value, Satisfaction with Customer Support, Timeliness of Delivery, and Rate of Product Returns. The results underscore unique preferences and performance patterns across age segments, offering actionable intelligence for e-commerce enterprises aiming to refine their tactics. The examination indicates that individuals aged 45-54 stand out as the leading performers across every metric, showcasing the highest expenditure, most satisfactory customer support ratings, swiftest delivery times, and minimal product return rates. Conversely, the 35-44 age bracket displays the lowest overall performance, marked by comparatively lower spending, moderate satisfaction with customer support, extended delivery durations, and elevated rates of product returns. Intermediate groups include the 18-24 and 55-65 age groups, with the former showing strong overall performance and the latter displaying good customer support satisfaction and reasonable delivery times but lower spending and slightly higher return rates compared to the top performers. Additionally, the 25-34 age group performs moderately well, with decent customer support satisfaction and delivery times but lower spending and higher product return rates. These findings provide invaluable direction for e-commerce enterprises aiming to customize their strategies adeptly for diverse age segments. By comprehending the unique preferences and actions of each demographic, businesses can refine their online shopping offerings, elevate customer contentment, bolster retention figures, and foster comprehensive advancement within the competitive e-commerce.

Comparative study of lesions obtained with radiofrequency between irrigated ablation catheter with flexible tip and non-irrigated catheter in ex vivo porcine heart slices

Abstract Background Lesion formation through radiofrequency (RF) is related to various parameters, including power, contact force, duration of energy delivery and temperature. Notably, the characteristics of the lesions differ when comparing irrigated to non-irrigated catheters. Non-irrigated catheter lesions present a larger surface area and shallower depth, while irrigated catheters induce deeper lesions with higher volumes. Particularly, flexible-tip open-irrigated catheter exhibit unique irrigation characteristics and the resulting lesions may show a reduced surface area but extend deeper into the tissue. Main drawbacks of using non-irrigated catheter are the risk of clot formation and of steam pops, both possibly avoidable with an irrigated catheter. Purpose The aim of the study was to demonstrate that flexible-tip open-irrigated catheter generate lesions with a smaller surface area and deeper extension when compared to non-irrigated catheter. Methods An ex vivo model consisting of porcine heart slices in a warmed saline chamber was used. A flexible-tip open-irrigated ablation catheter and a non-irrigated catheter were positioned with a stable tissue contact weight ranging from 10 to 20 g of force in perpendicular position. RF was delivered at powers of 20, 30 and 40 Watt for 60s. Lesion dimensions were analyzed. The occurrence of steam pop was registered. Results The ablations were conducted using flexible-tip open-irrigated (n=55) and non-irrigated (n=39) catheters in a power-control mode. Superficial length and width of lesions were greater with the non-irrigated catheter than with the irrigated catheter, irrespective of the power delivered (superficial length: p=0,0001 at 20W, p=0,002 at 30 W and p=0,0001 at 40 W; superficial width: p=0,001 at 20 W, p=0,019 at 30 W and p=0,003 at 40 W). When computing superficial areas, lesions performed with the non-irrigated catheter were significantly wider, regardless of the power delivered (p=0,001 at 20 W, p=0,005 at 30 W and p=0,001 at 40 W). The irrigated catheter determined significantly greater values of lesion maximum depth at high power delivery (40 W, p=0.007). No steam pop was observed using the irrigated ablation catheter, while 12 steam pops occurred with the non-irrigated catheter. Conclusions This study highlights that RF ablation using flexible-tip open-irrigated catheter has the potential to generate smaller lesion areas when compared to a non-irrigated tip. Furthermore, it may contribute to decrease steam pops, even with escalating power output. This irrigated catheter might be a preferable choice when precision is crucial, particularly in determining superficial area of lesions. Specifically, it might be advantageous for procedure as atrioventricular nodal reentry tachycardia (AVNRT) ablation, minimizing the risk of iatrogenic conduction disturbance related to RF delivery in the region of the compact AV node, located superficially at a millimeter distance from the ablation site.Experiment setting, lesion measurementsLesion superficial area

Measuring and Comparing Service Delivery Time in Government and Outsourced Health Posts Affiliated with Tehran University of Medical Sciences

Background: The duration of healthcare services has a significant impact on the quality of care and patient's satisfaction. Having information on service delivery time in both government and outsourced Health Posts (HPs) can contribute to evidence-based policymaking and better resource management. Therefore, this study aims to estimate and compare service delivery time in government and outsourced HPs. Methods: This descriptive-analytical cross-sectional study was conducted in six affiliated HPs under Tehran University of Medical Sciences in 2019–2020. Data were collected through a census using a stopwatch and a time recording form during one working week. The average duration of each service (in minutes) was obtained. The results were reported using descriptive statistics and were analyzed using SPSS24 software and multivariate analysis of variance (ANOVA). Results: The total mean of duration of services provided in government HPs (777.6 minutes) was greater than that in outsourced HPs (788.5 minutes). Among the 10 services provided, the average duration of services for adolescents (20.4±4.5 minutes), young adults (20.5±5.6 minutes), middle-aged adults (26.1±10.4 minutes), and elderly individuals (24.3±13.6 minutes) in government HPs was significantly longer than in outsourced HPs (p&lt;0.05). Additionally, the average duration of health education services (23.1±10.5 minutes) and health ambassador training (36.1±13.7 minutes) in private HPs was significantly longer than in government HPs (p&lt;0.05). Conclusion: In outsourced HPs, it is important to focus on creating a balance between the number of visits and the staff available for services which target adolescents, young adults, middle-aged adults, and elderly individuals. In government HPs, emphasis should be placed on increasing the time allocated for educational and promotional health services. By considering the importance of service delivery time and the observed differences in findings of this study, it is crucial to prioritize the duration of service delivery as an important performance measure when comparing government and outsourced HPs.

Pulmonary Vein Isolation for Atrial Fibrillation: Comparison of a Very High-Power Very Short-Duration (vHPvSD) Ablation Protocol versus a Hybrid Ablation Approach-Procedural and Mid-Term Outcome Data.

Background: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is a standard-of-care treatment in the rhythm control strategy of symptomatic atrial fibrillation (AF). Ablation protocols, varying in the power and duration of energy delivery, have changed rapidly in recent years. Very high-power very short-duration ablation (vHPvSD) is expected to shorten procedural times compared to conventional ablation approaches. However, the existing data suggest that this might come at the cost of lower first-pass isolation rates, a predictor of poor ablation long-term outcomes. This study aims to compare a vHPvSD protocol to a hybrid strategy, in which the power and duration of the energy transfer are adapted depending on the anatomical location. Methods: We retrospectively analyzed procedural and outcome data from 93 patients (55 vHPvSD vs. 38 hybrid) scheduled for de novo pulmonary vein isolation. A vHPvSD ablation protocol (90 Watt (W), 4 s) was compared to a hybrid protocol using vHPvSD on the posterior wall and 50 W HPSD (high-power short-duration) ablation guided by the Ablation Index along the remaining spots. Results: Ablation times were significantly shorter in the vHPvSD cohort (5.4 min. vs. 14.2 min, p < 0.001), thus resulting in a significant reduction in the overall procedural duration (91 min vs. 106 min, p = 0.003). The non-significant slightly higher first-pass isolation rates in the vHPvSD cohort (85% vs. 76%, p = 0.262) did not affect freedom from AF 6 months after the procedure (83% vs. 87%, p = 0.622). Conclusions: vHPvSD helps in shortening the PVI procedural duration, thus neither affecting first-pass isolation rates nor freedom from atrial tachyarrhythmia recurrence at 6 months after the index procedure.

Snoezelen therapy for pain, labor outcome and maternal satisfaction among parturient at tertiary hospital, South India

IntroductionLabor is a physiological process that causes severe discomfort, leading to maternal dissatisfaction. Snoezelen therapy, a multisensory complementary therapy, promotes comfort and relaxation by releasing endorphins, thereby improving satisfaction during the labor process. ObjectiveTo assess the effectiveness of Snoezelen therapy on pain perception, labor outcomes, and maternal satisfaction among parturients. MethodsAn experimental pretest-posttest control design was conducted among 74 parturient selected using consecutive sampling techniques in South India. Baseline observations were obtained at the beginning of the active stage, after which the study group parturient were subjected to Snoezelen therapy until reaching 10cm of cervical dilatation. Hourly assessments of pain, using a numerical pain scale, were performed. Labor outcomes were measured in terms of labor duration and mode of delivery. Maternal satisfaction with the birth experience and satisfaction with Snoezelen therapy components were collected 24 h after delivery. Descriptive and inferential statistics were used for data analysis. ResultsA statistically significant decrease in pain perception (p < 0.001) and an increase in maternal satisfaction (p < 0.001) were noted among parturient who underwent Snoezelen therapy. Parturient expressed high satisfaction with the use of aroma, music, and massage. There was no statistical significance in the duration of delivery and mode of delivery between the study and control groups. ConclusionSnoezelen therapy reduces pain perception and increases maternal satisfaction during the active stage of labor. Thus, Snoezelen therapy can be implemented as part of nursing care during the labor process.