Pictorial Overview Research Articles

Midwives’ Knowledge, Perceptions and Practices on Utilization of the Partograph at Mbuya Nehanda Maternity Hospital

Globally, maternal death has been an issue of concern, while obstructed and prolonged labour are among the top five causes of these deaths in Africa and Zimbabwe particularly. Proper and effective utilization of the Partograph significantly helps in preventing and reducing the high numbers of birthing complications of such a nature. A Partograph is a labour monitoring chart that provides a pictorial overview of maternal and foetal well-being during the intrapartum period. The study aimed to assess the knowledge, perceptions, and practices on the utilization of the Partograph among midwives working at Mbuya Nehanda Maternity Hospital. A descriptive cross sectional design was used, and a semi-structured questionnaire was administered to 60 participants chosen using the purposive sampling technique. Data were collected and analysed using the Statistical Package for Social Sciences (SPSS version 22) and presented using charts, tables, and narration. The study identified that midwives were knowledgeable, although they had a negative attitude towards the Partograph attributed by a lack of motivation caused by the absence of support from mentors and supervisors, lack of workshops, and on-the-job training on the use of the graphical chart. Underutilization of the tool, which pointed to poor practice, was attributed to understaffing of midwives, high workload, and burnout syndrome among the labour ward midwives. These implications could lead to omissions, litigations, poor maternal service delivery, and lawsuits. Periodic workshops, symposiums, on-the-job training would go a long way in improving attitudes. The study concluded that the Partograph is a very important tool that should be effectively used in the labour ward so that complications are picked up early, thereby improving maternal outcomes. Support for the midwives, supervision, mentorship, non-monetary incentives, and increased staffing with an acceptable midwife-patient ratio of probably 1:2 would improve practice and yield a positive birthing outcome of a live and healthy mother and baby.

Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study.

In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.

WHO-modified Partogram versus Paperless Partogram for Effective Management of Labour: A Research Protocol

Introduction: The partograph is a simple, inexpensive tool that provides a continuous pictorial overview of labour. It helps to identify obstructed or prolonged labour and determines when appropriate actions should be taken to prevent complications. The partograph is a valuable tool for making early decisions, including transferring patients to higher-level centres when labour is not progressing. Need for the study: This research aims to contribute to the development of a standardised approach for healthcare personnel to ensure accuracy and reliability in observations and data collection. Aim: This study will compare the efficacy of the World Health Organisation (WHO)-modified partograph versus the paperless partograph. Materials and Methods: This will be a prospective interventional study conducted at the Department of Obstetrics and Gynaecology, JNMC, Wardha, Maharashtra, India over a two-year duration from January 2024 to January 2026. The study will include 200 pregnant women who will be divided into two groups. One group will use the WHO-modified partograph, while the other group will use the paperless partograph. The comparison will be based on the effective management of labour using the action and alert line Estimated Time of Delivery (ETD) between the two partographs. The overall usefulness will be evaluated using the Chi-square test/Fisher’s-exact test, with a statistical value of <0.05 considered significant.

To study the clinical utility of WHO modified and paperless partograph in the management of labour and its outcome

Early detection of abnormal progress of labour and prevention of prolonged labour significantly improves pregnancy outcomes. Partograph is a simple and important tool which can provide a continuous pictorial overview of labour on a single sheet of paper and is essential to monitor labour. (1) To study the progress of labour using WHO modified partograph in terms of alert line and action line and using paperless partograph in terms of alert and action estimated time of delivery and detect any deviation from normal progress of labour. (2) To evaluate the duration of labour, mode of delivery and perinatal outcome in both the groups.It was a prospective observational study which was conducted over a period of 18months on 200 antenatal patients admitted to the Department of Obstetrics and Gynaecology at Christian Medical College and Hospital, Ludhiana. Antenatal patients with singleton term pregnancy with cephalic presentation in active phase of labour were included in the study. The WHO modified partograph was plotted for 100 cases (Group I) and the paperless partograph was recorded for the other group of 100 patients (Group II) and their outcomes were compared. The p value <0.05 was considered to be significant.In our study we noted that the findings were similar in the WHO modified partograph group and the paperless partograph group in terms of duration of labour, progress of labour, mode of delivery and neonatal outcomes with no statistically significant difference between both the groups.Our study concluded that the paperless partograph is as good as the WHO modified partograph in predicting the labour outcomes and identifying labour abnormalities. The paperless partograph does not need graphical representation and therefore can be adopted as an alternative to the WHO modified partograph in busy labour room settings.

A Pictorial Review of Cranial Nerves Imaging Anatomy and Pathology: Part 1—Anatomy

The anatomy of cranial nerves is complex and its knowledge is a crucial first step in identifying nerve-related pathology. This article provides a comprehensive pictorial overview of cranial nerves using high-resolution steady-state free precession MRI sequences (SSFP).

A numerical study of hybrid nanofluids near an irregular 3D surface having slips and exothermic effects

The current article presents a comprehensive investigation of MHD viscous flow of hybrid-nanofluids (Al2O3 − Ag/ water and (Al2O3 − Cu/) over a horizontally irregular 3D plane with non-uniform thickness combined with slip effects. The foremost aim of conducting this study is to enhance thermal transportation. Based on the following novelties, the subject study holds tremendous significance: i. A comparative analysis of two hybrid nanofluids with hybrid-base fluid together with slip effects ii. An exclusive study where the Tiwari and Das nanofluid model is employed combined with Fourier's heat flux model iii. Development of finite-difference code which implements the three-stage Lobatto IIIa approach for the designed problem. We have used suitable scaling transformations to convert the three-dimensional conservation equations of mass, momentum, and energy into a dimensionless system of boundary layer equations. The numerical solution of the coupled non-linear boundary layer problem is determined using the built-in finite-difference code designed to employ the three-stage Lobatto IIIa formula. A comprehensive assessment is carried out in how the velocity components, temperature, skin friction, and heat transfer rate are affected by the physical parameters of interest. The same is presented through graphs and in tabular form to offer a pictorial overview. The fluctuating trends of skin friction coefficients (x, y-directions) and Nusselt number are investigated to explore the physical landscape of the current study. The findings of this study offer a noticeable contrast to their existing counterparts.

Recognizing and Minimizing Artifacts at Dual-Energy CT.

Dual-energy CT (DECT) is an exciting innovation in CT technology with profound capabilities to improve diagnosis and add value to patient care. Significant advances in this technology over the past decade have improved our ability to successfully adopt DECT into the clinical routine. To enable effective use of DECT, one must be aware of the pitfalls and artifacts related to this technology. Understanding the underlying technical basis of artifacts and the strategies to mitigate them requires optimization of scan protocols and parameters. The ability of radiologists and technologists to anticipate their occurrence and provide recommendations for proper selection of patients, intravenous and oral contrast media, and scan acquisition parameters is key to obtaining good-quality DECT images. In addition, choosing appropriate reconstruction algorithms such as image kernel, postprocessing parameters, and appropriate display settings is critical for preventing quantitative and qualitative interpretive errors. Therefore, knowledge of the appearances of these artifacts is essential to prevent errors and allows maximization of the potential of DECT. In this review article, the authors aim to provide a comprehensive and practical overview of possible artifacts that may be encountered at DECT across all currently available commercial clinical platforms. They also provide a pictorial overview of the diagnostic pitfalls and outline strategies for mitigating or preventing the occurrence of artifacts, when possible. The broadening scope of DECT applications necessitates up-to-date familiarity with these technologies to realize their full diagnostic potential.

4-hourly action line on WHO modified partograph, and maternal and neonatal outcomes

Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Objectives of the study were to evaluate outcome of labour in terms of action line crossed and augmentation of labour and in whom labour has been managed with 4-hour vs no-hour action line on WHO modified partograph. Methods: Every 8th primigravida mother fulfilling the inclusion criteria was enrolled for the study alternatively for 4 hourly and no partogram reading. Results were compared between Group A, with 50 cases, in whom labour has been managed with WHO modified Partograph with 2-hour action line and Group B, with 50 cases, in whom labour has been managed with that of no action line. Results: The present study shows that more women in 2-hour arm crossed the action line, compared with the no partograph arm, and therefore received more interventions to augment labour. Rate of caesarean section was more in group B than in group A which is statistically nonsignificant. Conclusions: Partograph with 4-hour action line did not show any superiority over that of no partograph line but to be associated with higher incidence of intervention. Further research is required in this field of active management.

A pictorial review of brain arterial spin labelling artefacts and their potential remedies in clinical studies.

Arterial spin labelling is an emerging non-invasive magnetic resonance imaging technique for estimating the cerebral perfusion without the requirement for gadolinium-based intravenous contrast agents. Despite the wide range of applications in epilepsy, dementia, brain tumours, vascular malformations and stroke imaging, obtaining clinically useful arterial spin labelling data is technically challenging and prone to numerous artefacts. The objective of this review is to provide a comprehensive pictorial overview of the various artefacts associated with arterial spin labelling, particularly three-dimensional fast spin echo pseudocontinuous arterial spin labelling with spiral readout. These artefacts could be broadly classified as those occurring during the magnetic labelling, arterial transit or image acquisition. Arterial spin labelling artefacts of clinical diagnostic utility are also elaborated. A thorough knowledge of the basis of these artefacts will avoid diagnostic pitfalls while interpreting arterial spin labelling images. Important tips to reduce or overcome these artefacts are also discussed.

Time dependent non-Newtonian nano-fluid (blood) flow in w-shape stenosed channel; with curvature effects

Simultaneous effects of non-Newtonian and curvature on unsteady nano-fluid flow through overlapping stenosed channel have been investigated in this letter. In this numerical investigation, a mathematical formulation is developed in order to analyze the influence of blood shear thinning/thickening effects on the rheology of the nano-fluid within curved channel which is not explored yet. Moreover, the numerical solutions for temperature, velocity and concentration equations are obtained and discussed its hemodynamic effects due to the curvature of the stenosed channel. Graphical results are designed in such way to comprehend its complete theoretical assessment. The graphical streamlines would give pictorial overview of the nano-fluid flow through stenosed cress section under the influence of the emerging parameters variation. The pattern of the results instigates the change in the size of trapping bolus for different value of the specified parameters; these will give the pictorial understanding to the general readers. Apart from this, the obtained numerical results are also validated.

Phenotype variability of autoinflammatory disorders in the pediatric patient: A pictorial overview.

Disruption of innate immunity leading to systemic inflammation and multi-organ dysfunction is the basilar footprint of autoinflammatory disorders (AIDs), ranging from rare hereditary monogenic diseases to a large number of common chronic inflammatory conditions in which there is a simultaneous participation of multiple genetic components and environmental factors, sometimes combined with autoimmune phenomena and immunodeficiency. Whatever their molecular mechanism, hereditary AIDs are caused by mutations in regulatory molecules or sensors proteins leading to dysregulated production of proinflammatory cytokines or cytokine-inducing transcription factors, fever, elevation of acute phase reactants, and a portfolio of manifold inflammatory signs which might occur in a stereotyped manner, mostly with overactivity or misactivation of different inflammasomes. Symptoms might overlap in the pediatric patient, obscuring the final diagnosis of AIDs and delaying the most appropriate treatment. Actually, the fast-paced evolution of scientific knowledge has led to recognize or reclassify an overgrowing number of multifactorial diseases, which share the basic pathogenetic mechanisms with AIDs. The wide framework of classic hereditary periodic fevers, AIDs with prominent skin involvement, disorders of the ubiquitin-proteasome system, defects of actin cytoskeleton dynamics, and also idiopathic nonhereditary febrile syndromes occurring in children is herein presented. Interleukin-1 dependence of these diseases or involvement of other predominating molecules is also discussed.

Utilization of Partograph and its associated factors among midwives working in public health institutions, Addis Ababa City Administration,Ethiopia,2017

BackgroundPartograph is cost effective and affordable tool designed to provide a continuous pictorial overview and labour progress used to prevent prolonged and obstructed labour. It consists of key information about progress of labour, fetal condition and maternal condition. Its role is to improve outcomes and predict the progress of labour. The aim of this study was to assess utilization of partograph and its predictors among midwives working in public health facilities, Addis Ababa city administration, Ethiopia, 2017.MethodsAn institution based cross-sectional study design was conducted in Addis Ababa, Ethiopia from 15/10/2017–15/12/2017.Simple random sampling under multistage sampling technique was applied to select a total of 605 midwives working in maternity unit of selected public health facilities. Data were collected using structured self-administered questionnaire. Checklist based direct observations were made to all midwife participants to determine the actual practical use of partograph. Data first entered in to EpiInfo version 3.5.1 and transported to SPSS Version 21.Descriptive statistics such as frequency, percentage, mean, and median were calculated. Biviriate and multivariable logistic regression analysis were applied. Any personal identification of the study participants was not recorded during data collection to ensure confidentiality of information.ResultsIn this study, the utilization of partograph was 409(69%) out of 594 study participants. Being mentored(AOR = 3.1; 95% CI: 1.7, 5.3),received training (AOR = 2.4; 95% CI:1.5,3.6),being knowledgeable about partograph (AOR = 1.6; 95% CI: 1.1, 2.5), health center workers(AOR = 12.6; 95% CI:5.1,31.6),supportive supervision 4 times per year (AOR = 18.6; 95% CI: 6.6,25),supportive supervision twice per a year (AOR = 4.7; 95% CI: 1.9, 11.3),supportive supervision once per year (AOR =3.8;95% CI:1.7,8.8) were positive predictors of partograph utilization. Two midwives per shift (AOR = 0.101; 95% CI: 0.05, 0.65), and 4 per shift (AOR = 0.105, 95% CI: 0.03, 0.40) were protective predictors of partograph utilization.ConclusionsMore than half of the respondents utilized partograph. All public health institutions avail partograph in their laboring room but didn’t utilize it according to WHO recommended standard. Working facility, supportive supervision, mentoring, training on partograph, number of midwives working per shift, and knowledge were factors affecting partograph utilization. Encouraging interventions are recommended to the response of the above significantly associated factors.

Instabilities of Nonconservative Fluid-Loaded Systems

Nonlinear bifurcations and instabilities of autonomous nonconservative systems, mainly involving the fluid loading of a solid or structure, are reviewed and described in this accessible, pictorial overview. In contrast to the earlier papers in this series (focusing on the instability of elastic deformable systems, and low-order periodically-forced mechanical systems), we focus on a handful of case studies in which the loss of stability is primarily driven by nonconservative forces, i.e. path-dependent forces not associated with a potential. Many systems involving fluid-structure interaction can lose stability under changing conditions in which there is a net flow of energy from the fluid to the structure, sometimes resulting in growing oscillatory behavior. Again, the generic manifestations of instability typically occur within the framework of bifurcation theory. Progression is from simple local bifurcations to more complex global events, and all are related to instructive and intriguing applications. Hopf bifurcations are presented in the context of the galloping and flutter of cables and pipes. Next, Neimark bifurcations appear in aircraft applications involving the free-play fluttering of aerofoils and the wing rock of the Harrier jump-jet. Turning to ships in wind and waves, a homoclinic saddle connection governs the surging and surf-riding of a vessel in stern seas, while an omega flow explosion can compromise the course-keeping of a passenger ferry in a side wind. Recent work on the dynamic step-buckling of a spherical shell illustrates the role of a center manifold, and the paper ends with a careful study of dissipation-generated instabilities, drawing on the historical struggles to understand the evolution of spinning liquid planets.

A Pictorial Ultrasound Essay of Gestational Trophoblastic Disease.

Gestational trophoblastic disease (GTD) includes a wide variety of clinical and histopathologic entities that require prompt identification and definition by the integration of clinical, laboratory, and imaging data. Recently, the role of grayscale ultrasound and spectral and power/color Doppler techniques has become pivotal in the diagnosis, staging, and management of GTD, thanks to both technical improvements and the growing expertise of dedicated operators. The aim of this essay is to summarize the most recent data on the ultrasound and Doppler findings of GTD and to provide a pictorial overview, including useful prognostic and therapeutic implications for clinical practice.

Applications of Bifurcation: Nonautonomous Periodically-Excited Systems

This paper reviews some examples of bifurcation in low-order, periodically driven dynamical systems. The generic loss of stability is a key component in dynamical systems theory, and provides a central pillar in assessing qualitative changes in system dynamics. Although bifurcation tends to be thought of in rather abstract, theoretical terms, we show that it also provides a compelling framework to guide laboratory-based experiments. Both local and global stability transitions and their connection are illustrated in this accessible, review-like pictorial overview of simple mechanical/structural systems driven toward instability.

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.

Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial.

Backgound Partographs are used in many labour settings to provide a pictorial overview of a woman's cervical dilation pattern in the first stage of labor and to alert clinicians to slow progress possibly requiring intervention. Recent reviews called for large trials to establish the efficacy of partographs to improve birth outcomes whilst highlighting issues of clinician compliance with use. Previous studies have also reported issues with participant recruitment related to concerns regarding the possibility of a longer labour. Objectives We sought to compare a standard partograph with an action line, to a newly designed partograph with a stepped line, to determine the feasibility of recruitment to a larger clinical trial. Methods A pragmatic, single-blind randomised trial wherein low-risk, nulliparous women in spontaneous labour at term were randomized to an action-line or stepped-line partograph. First stage labour management was guided by the allocated partograph. Primary outcomes included the proportion of eligible women recruited, reasons for failed recruitment and compliance with partograph use. Secondary outcomes included rates of intervention, mode of birth, maternal and neonatal outcomes. Results Of the 384 potentially eligible participants, 38% (149/384) were approached. Of these 77% (116/149) consented, with 85% (99/116) randomized, only nine women approached (6%) declined to participate. A further 9% (14/149) who were consented antenatally were not eligible at onset of labor and 7% (10/149) of women approached in the birth suite but did not meet the inclusion criteria. Compliance with partograph completion was 65% (action) versus 84% (dystocia line). Conclusions for Practice Participant recruitment to a larger randomized controlled trial comparing new labour management guidelines to standard care is feasible. Effective strategies to improve partograph completion compliance would be required to maintain trial fidelity.

Exoanal Imaging of the Anal Sphincters.

Since its introduction in the early 1990s, endoanal sonography has become the mainstay of morphologic assessment of the anal canal and sphincter, especially for obstetric anal sphincter trauma. Lack of availability of suitable systems and the invasive nature of the method have limited uptake and clinical utility. More recently, exoanal or transperineal/translabial tomographic imaging has been developed as a noninvasive alternative. This pictorial overview aims to introduce the reader to this new diagnostic modality and to demonstrate common findings in asymptomatic and symptomatic women.

Potential pitfalls in the anorectal region during CT colonography: A discussion and pictorial overview of common pitfalls

Common potential anorectal pitfalls are presented with accompanying CT colonography images. Although most lesions are benign, care must be taken in not missing an underlying cancer.

Clinical Applications of a CT Window Blending Algorithm: RADIO (Relative Attenuation-Dependent Image Overlay).

A methodology is described using Adobe Photoshop and Adobe Extendscript to process DICOM images with a Relative Attenuation-Dependent Image Overlay (RADIO) algorithm to visualize the full dynamic range of CT in one view, without requiring a change in window and level settings. The potential clinical uses for such an algorithm are described in a pictorial overview, including applications in emergency radiology, oncologic imaging, and nuclear medicine and molecular imaging.