Rotational Delivery Research Articles

Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries.

Several studies recently confirmed the emergence of resistance to antimalarial drugs in sub-Saharan Africa. Multiple first-line treatment (MFT) is one of the measures envisaged to respond to the emergence and spread of this resistance. The aim of this study was to identify the perceived advantages and disadvantages of several MFT deployment strategies and to better understand potential implementation drivers and barriers. A qualitative survey was conducted in seven sub-Saharan countries amongst key opinion leaders, national decision makers, and end users. A total of 200 individual interviews were conducted and findings were analyzed following a thematic inductive approach. From a policy perspective, the new MFT intervention would require endorsement at the global, national, and regional levels to ensure its inclusion in guidelines. Funding of the MFT intervention could be a bottleneck due to costs associated with additional training of healthcare workers, adaptation of drug delivery mechanisms, and higher costs of drugs. Concerning the MFT deployment strategies, a slight preference for the segmentation strategy was expressed over the rotation and geographic approaches, due to the perception that a segmentation approach is already in place at country level. The findings highlighted the need for a collective approach to MFT deployment through the engagement of stakeholders at all levels of malaria management.

Soil Health and Nutrient Management

Soil health and appropriate nutrient management are critical components of sustainable agriculture, influencing crop yield, environmental sustainability, and overall food security. The ability of soil to function as a living ecosystem is referred to as soil health. supports plant and animal life while protecting the environment. It refers to how physical, chemical, and biological activity interact in the soil. Mineral matter, organic matter, water, and air are all critical components of soil health, and each contributes to plant growth. Soil health indicators include physical, chemical, and biological factors that help assess the soil's state. For optimal soil health, these indicators must be balanced.
 However, there are significant issues to address, such as decreased soil organic matter, declining soil fertility due to nutrient deficits, physical soil degradation, and chemical soil degradation caused by excessive chemical use. Practices for sustainable soil management are critical for addressing these concerns. Balanced fertilization, organic matter incorporation, crop rotation, cover cropping, reduced tillage, and precision nutrient delivery are examples of these. Mitigating issues such as nutrient pollution, soil erosion, and soil deterioration is critical to maintaining agriculture's long-term viability.

Characteristics of High-Pressure Injection Pump Operated with Renewable Fuel for Diesel Engines

The use of renewable fuels for internal combustion engines marks a significant stride towards sustainability in transportation and power generation. Ensuring the compatibility of these fuels with existing diesel engines and infrastructure is paramount for a smooth transition. Diesel engines capable of harnessing the advantages of alternative fuels without extensive modifications offer a pragmatic approach to sustainable power for vehicles and industries. This article investigates the impact of carbon-neutral renewable fuel types (hydrogenated vegetable oils, or HVOs, and biodiesel) on the operation of a high-pressure injection pump, focusing on rotational speed and delivery pressure as key parameters. Our investigation, based on pump operating cycle analysis and volumetric efficiency measurements, aimed to investigate to what extent shaft speed and fuel type influence pump performance. Hydrogenated carbon-neutral fluids (HVOs) demonstrate adequate hydraulic capabilities compared to conventional fossil fuels. The findings underscore that while the fluids under consideration vary in viscosity and compressibility modulus, it is the compressibility modulus that predominantly affects the pump’s operation cycle. Diesel (fossil) fluid exhibits intermediate characteristics compared to hydrogenated fossil diesel fluids and biodiesel. The differences in terms of volumetric efficiency are finally reported, showing that hydrogenated carbon-neutral fluids do not significantly hinder the pump’s flow rate transfer capability.

Using the AquaCrop model to assess the cotton yield response to three irrigation schedules in the Río Dulce Irrigation System, Santiago del Estero, Argentina

This work evaluates the cotton response to irrigation scheduling using AquaCrop, in the Río Dulce Irrigation System (SRRD), Santiago del Estero, Argentina. The model was calibrated and validated to simulate the cotton´s growth and yield for the SRRD, where most of the cotton is grown in a cropping system called narrow rows (0.52 to 0.76 meter between rows, 200,000 to 220,000 plants per hectare). The model adaptation to different cultivars and agronomical practices was noteworthy. Then, the impact of three different irrigation schedules on cotton production was assessed using a series of 35 years of daily climatic data. The irrigation scenarios were defined based on the farmers’ practices and on the rotational water delivery of the SRRD. The highest yields were attained when irrigation was applied at 25 and 55 days after sowing (DAS), followed by 55 DAS, and, finally, 55 and 85 DAS. Considering both the yields and the water use, irrigating at 25 and 55 DAS would be the best option for a normal season in the SRRD. This work shows the usefulness of combining the use of crop simulation models, field measurements and long-term weather data to analyze yield trends and irrigation water use under different scenarios.

Maternal and Neonatal Complications Following Kielland's Rotational Forceps Delivery: A Systematic Review and Meta-analysis

(Abstracted from BJOG 2023;130:856–864) Fetal malposition as labor advances can contribute to many risks and adverse outcomes. One method of management is Kielland rotational forceps delivery (KRFD); previous research has yielded conflicting evidence about the safety and effectiveness of KRFD compared with other delivery methods.

Dosimetric impact of rotational errors in trigeminal neuralgia radiosurgery using CyberKnife.

Trigeminal neuralgia (TN) can be treated on the CyberKnife system using two different treatment delivery paths: the general-purpose full path corrects small rotations, while the dedicated trigeminal path improves dose fall-off but does not allow rotational corrections. The study evaluates the impact of uncorrected rotations on brainstem dose and the length of CN5 (denoted as Leff) covered by the prescription dose. A proposed model estimates the delivered dose considering translational and rotational delivery errors for TN treatments on the CyberKnife system. The model is validated using radiochromic film measurements with and without rotational setup error for both paths. Leff and the brainstem dose is retrospectively assessed for 24 cases planned using the trigeminal path. For 15 cases, plans generated using both paths are compared for the target coverage and toxicity to the brainstem. In experimental validations, measured and estimated doses agree at 1%/1mm level. For 24 cases, the treated Leff is 5.3±1.7mm, reduced from 5.9±1.8mm in the planned dose. Constraints for the brainstem are met in 23 cases for the treated dose but require frequent treatment interruption to maintain rotational corrections<0.5° using the trigeminal path. The treated length of CN5, and plan quality metrics are similar for the two paths, favoring the full path where rotations are corrected. We validated an analytical model that can provide patient-specific tolerances on rotations to meet plan objectives. Treatment using the full path can reduce treatment time and allow for rotational corrections.

The Art of Kielland rotational forceps delivery. Do we need more training or should we abandon it? That is the question: A retrospective observational study

The Art of Kielland rotational forceps delivery. Do we need more training or should we abandon it? That is the question: A retrospective observational study

Forceps Use in Rotational and Non-Rotational Vaginal Delivery

Forceps are a commonly used instrument for assisting vaginal delivery. Accepted indications include prolonged labour, suspected fetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomized trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less fetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications, and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.

The Use of the Obstetric Vacuum Extractor for Rotational and Non-Rotational Vaginal Delivery

Vacuum-assisted birth is a safe delivery method when performed by a skilled provider. Vacuum extraction can prevent prolonged second stage of labor, birth asphyxia in the presence of fetal distress, or when maternal pushing is contraindicated. However, vacuum-assisted births, especially those involving mid-pelvic rotational deliveries, have increasingly been replaced by cesarean sections, even though they generally carry a potentially higher risk for women and future children. This article provides detailed information on the indications and contraindications of vacuum-assisted birth, as well as the basic principles of the vacuum technique. It also includes a dedicated section on vacuum extraction for rotational births. When obstetric caregivers are knowledgeable, trained, and experienced in these techniques, vacuum extraction can greatly enhance the safety of childbirth.

A personal audit of private obstetric practice.

This is a retrospective review of 7398 deliveries under the direct care of the author over 25 years, from data input on personal handheld computers at the time of delivery. A more detailed look at 409 deliveries over 2.5 years where all the case notes were studied was also undertaken. The rate of cesarean section is outlined. For the last 10 years of the study, the rate of cesarean section was maintained at 19%. This was in quite an elderly population. Two main factors seemed responsible for the relatively low rate of cesarean: vaginal births after cesarean (VBACs) and rotational Kiwi deliveries.

Maternal and neonatal complications following Kielland's rotational forceps delivery: A systematic review and meta-analysis.

There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non-rotational forceps delivery (NRFD) or a second-stage caesarean section (CS), from a systematic review and meta-analysis of the literature. Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Case series, prospective or retrospective cohort studies and population-based studies. A meta-analysis using a random-effects model was used to derive weighted pooled estimates of maternal and neonatal complications. Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non-rotational forceps (RR0.79, 95%CI 0.65-0.95) and second-stage CS (RR0.45, 95%CI 0.36-0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR1.79, 95%CI 1.08-2.98), but rates of neonatal birth trauma were lower (RR0.49, 95%CI 0.26-0.91). There were no differences seen in the rates of 5-min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second-stage CS (RR0.47, 95%CI 0.23-0.97). Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour.

Virtual Ophthalmology Rotation for Visiting Medical Students: An Opportunity to Enhance Diversity in the Workforce.

Introduction We created a virtual rotation to facilitate the exposure of ophthalmology to medical students and serve as a pilot program to help attract students from under-represented in medicine (URM) backgrounds. In addition to the rotation eliminating the financial burdens associated with in-person away rotations, we offered a not-for-credit (i.e., drop-in) option that included sessions outside the typical clinic hours. This option reduced scheduling conflicts as a barrier to enrollment and allowed junior medical students and postgraduates to participate and hopefully further develop an interest in ophthalmology. Methods Before the rotation, participants completed a pre-test and a survey to collect data on learners' backgrounds and interest in applying for ophthalmology residency. The rotation included live lectures, case-based discussions, chart reviews, and guided self-study. Following the rotation, participants completed a post-test and a survey to query applicants on the online rotation's utility and delivery. Results Eleven learners enrolled in the course and completed the prerotation survey and test. Approximately one-third (4/11; 36%) were URM students and two-thirds (7/11; 64%) were female. All responded they were planning to apply for ophthalmology residency. All responded they strongly agreed that the rotation increased their general knowledge in ophthalmology, and 89% (9/11) strongly agreed that it improved their ability to diagnose and manage actual patients. Nearly all (7/8; 87.5%) strongly agreed the rotation provided the opportunity to seek support for the residency application process, and all found the online platform reliable and easy to access. Exam scores improved significantly from pre- to post-tests (60 vs. 79%; p < 0.01). Conclusions The rotation attracted a substantial proportion of URM students. Learners reported that the virtual rotation effectively taught and supported their endeavors to become ophthalmologists. Virtual rotations for visiting students can reduce barriers such as travel, financial costs, and time constraints that might otherwise hinder exposure to specialty training that is not offered or is underrepresented at students' home institutions. Increasing exposure and offering mentorship through this novel platform deserves further study to enhance diversity and inclusion in medicine.

Stereotactic body radiotherapy using helical tomotherapy for hepatocellular carcinoma: clinical outcome and dosimetric comparison of Hi-ART vs. Radixact.

Helical tomotherapy (HT), a unique rotational dose delivery machine, has been updated from Hi-ART to Radixact. We retrospectively evaluated the treatment outcomes of stereotactic body radiotherapy (SBRT) using HT for hepatocellular carcinoma (HCC) and compared the dosimetric details of Hi-ART and Radixact. Between April 2014 and November 2020, 28 patients with HCC were treated with SBRT using HT for a cure at Soonchunhyang University College of Medicine, Bucheon. According to the Barcelona Clinic Liver Cancer classification, 9 patients had stage 0 disease, 12 had stage A, 4 had stage B, and 3 had stage C. The tumor size ranged from 1 cm to 8 cm (median, 2 cm). The SBRT dose ranged from 40 to 60 Gy (median, 48 Gy) with 4 fractions. Twenty-three patients were treated with Hi-ART and 5 patients were treated with Radixact. To compare the dosimetric parameters between Hi-ART and Radixact, we created treatment plans with the same constraints, pitch, modulation factor, and field width for the same patient in pairs. The median follow-up time from the date of SBRT administration was 24 months (range, 3-67 months). The local failure-free survival and intrahepatic failure-free survival rates were 96% and 58% at 1 year, 84% and 36% at 2 years, and 76% and 18% at 3 years, respectively. The overall survival rate was 93% at 1 year, 93% at 2 years, and 53% at 3 years, respectively. When the paired treatment plans were reviewed, the beam-on time and intermediate dose-spillage were found to be significantly reduced in Radixact than Hi-ART (P<0.001). With regard to normal organ sparing, the irradiated dose to the total liver, normal liver, heart, and kidney was significantly lower with Radixact (P<0.001). SBRT using HT for HCC showed favorable treatment outcomes. Radixact, the latest version, physically improved treatment efficiency by reducing treatment time and provided better organ sparing than Hi-ART.

Important Factors in Remote Experiential Education.

Onsite and in-person experiential education has been well established to prepare practice-ready healthcare professionals, such as pharmacists. From COVID-19, the integration of remote educational delivery has occurred. As healthcare disciplines adjust to new experiential styles and innovate traditional methods, this paper highlights key areas for remote experiential education that can influence student experiences. Factors that are of importance to continuous quality improvement are described. A survey, utilizing the cloud-based software platform Qualtrics® headquartered in the United States, was developed to evaluate whether remote rotation delivery was comparable to traditional onsite experiential education, to assist with quality improvement for virtual experiential education, and to ensure the redesigned educational model meets accreditation standards for two schools of pharmacy. Numerous factors including work, time zone, Office of Experiential Education and preceptor responsiveness, and technology, were examined. Chi-Square test, t-test for proportions and odds ratios were utilized to evaluate results. Students with technology concerns throughout a remote rotation had a more than two-fold increase in identifying the virtual experience as worse than most/all other in-person rotations (p = 0.01). Preceptor responsiveness to questions and concerns significantly impact student perceptions of educational quality (p < 0.05). The majority of students perceived remote experiential education is equal to onsite experiences. Since continuous quality improvement is required by pharmacy accreditors and many other healthcare programs offering clinical opportunities, identifying factors is of importance to make future interventions in the remote experiential education delivery. This type of experiential learning became essential with COVID-19 impacting onsite clinical placements, and information can be used across health science disciplines at large.

Rotation cycle time and delivery decision for a multi-item producer-retailer integrated system featuring overtime and random scrap

A multi-item producer-retailer integrated system featuring overtime and random scrap is studied. The objectives are to jointly decide the most economic rotation fabrication cycle time and distribution of products. In order to meet the increasing demands of diversified end items, production managers today need to plan a multiproduct fabrication schedule and to expedite both manufacturing and transportation times so that they can meet product demands as quickly as possible. Also, due to potential uncontrollable reasons, scrap items are generated randomly in a real fabrication process. To address the aforementioned issues, this study examines a multi-item producer-retailer integrated system featuring overtime and random scrap. We build a mathematical model to interpret the proposed multi-item producer-retailer integrated system which incorporates shipping and retailer’s holding cost. The Hessian matrix equations are used for solving the optimality of the system. Diverse important system information can now be exposed to backing managerial decision makings, which includes individual and combined influences of variations in particular system factor(s) (such as scrap rate and overtime related parameters) on the specific system performance.

Pilot Study: Increasing Confidence in Obstetrics and Gynecology Applicants Through a Prep Course Prior to Audition Rotations.

Introduction: As more medical schools schedule the United States Medical Licensing Examination (USMLE) Step 1 after the completion of clinical rotations in their curriculum, students are finding themselves increasingly removed from the clinical setting prior to their audition rotations. In the military, these audition rotations are important for matching into competitive specialties, such as Obstetrics and Gynecology (Ob-Gyn). This pilot study explores the confidence and audition readiness of prospective candidates through their participation in an Ob-Gyn preparatory course.Methods: Rising fourth year medical students applying for an Ob-Gyn residency attended an in-person review session. It consisted of four interactive presentations addressing rotation resources, labor and delivery triage, postpartum care, laparoscopic anatomy review, and concluded with a resident question and answer panel. These attendees completed a pre- and post-course survey on Google Forms. Categorical answers were recorded as response frequency and Likert scales were converted into a 5-point system for analysis.Results: A 100% response rate from attendees revealed pre-course 81.8% confidence in performing well on an audition rotation with only 27% feeling prepared in terms of their medical knowledge. After completion of the course, all participants reported increased medical knowledge and recommended the course to other students.Conclusions: Preparatory courses for Ob-Gyn residency candidates can increase confidence and preparedness for audition rotations and, ultimately, internship. As the residency application process becomes more competitive, departments can take steps such as hosting a preparatory course to best assist their students into matching and provide skills that they can practice heading into internship.

A before and after study of the impact of simulation training on practitioner confidence in complex operative deliveries

The aim of this before and after study was to evaluate the efficacy of a complex operative obstetrics course in improving practitioner confidence. The course covered rotational instrumental vaginal delivery, vaginal breech delivery, cervical cerclage, management of postpartum haemorrhage, and complex caesarean section. Participants filled in a pre- and postcourse questionnaire using a Likert scale to rate confidence from 1 (not confident) to 5 (very confident) in 15 key skills. Data were analysed using a two-sample t-test for comparison of means. Data were collected from 67 participants. Practitioner confidence increased across all skills studied. The largest increases in mean confidence scores were seen in classical caesarean section (score increase 2.45; p < 0.05) and management of head entrapment at breech (score increase 2.24; p < 0.05). The course was successful in improving practitioner confidence across a range of obstetric skills. Impact statement What is already known on this subject? Team-based training for obstetric emergencies has been shown to improve practitioner knowledge, team behaviours and patient outcomes. Simulation training in operative vaginal delivery improves operator technique and reduces adverse outcomes for mothers and babies. What do the results of this study add? Hands-on simulator training in complex operative obstetrics improves practitioner confidence in managing a range of obstetric emergencies including those less frequently encountered. These include rotational instrumental delivery, vaginal breech delivery, complex caesarean section, postpartum haemorrhage and cervical cerclage. What are the implications of these findings for clinical practice and/or future research? This study supports the increased use of simulation in advanced obstetric training with an easily replicated cost efficient course. Further research is warranted to determine whether simulation training improves practitioner competence and patient outcomes.

Mitigating the stress of transition: An exploration of the effects and effectiveness of a preparatory course for junior obstetric trainees transitioning to senior training roles

BackgroundAttrition amongst obstetrics trainees is high worldwide and attributed to sources of stress and burnout. The role of formal education and simulation as a means to prepare trainees for stressful periods such as transition into senior roles is underexplored. ObjectiveThis study set out to explore whether the creation of a dedicated educational intervention might positively influence burnout and self-estimated preparedness for practice among obstetric trainees transitioning into more senior roles. Study designA six-week preparatory training programme for year 2 trainees was created specifically for this study. The intervention used the flipped classroom design incorporating online learning that prepared participants for six simulation-based workshops. Participants were randomised by training cluster into an intervention group (n = 4) who participated in the educational intervention and a control group (n = 7) who received standard online and workplace training. The effects on trainee well-being was assessed using the Maslach burnout inventory (MBI) and a self-report questionnaire estimating preparedness for practice. Technical and non-technical skills were assessed using standardised OSAT and NOTSS assessment tools. The primary outcomes were MBI and preparedness for practice scores. Secondary outcomes included OSAT and NOTSS scores. Group comparisons were made using by t-test or Pearson Chi2 analysis where appropriate. ResultsThe study indicated a positive, non-significant trend in pre-post burnout scores in the intervention group. The following improving trends were noted in all subscales: emotional exhaustion 21.5 ± 2.6 (pre-intervention 23 ± 6.2); depersonalisation 9.8 ± 4.0 (pre-intervention 12.3 ± 2.8); personal accomplishment 35.5 ± 6.51 (pre-intervention 33 ± 5.5). The educational intervention engendered an increase in self estimated preparedness for practice amongst the intervention group (p = 0.006). From a training perspective, increased preparedness was noted for the following practical skills: forceps delivery (p = 0.0001), rotational forceps delivery (p = 0.02), delivery of twins vaginally (p = 0.0007) and performing a pudendal block (p = 0.001). ConclusionThis is one of the first studies to investigate whether the provision of a targeted training module can improve burnout scores and preparedness for practice amongst obstetrics trainees at an important time of transition. The positive but largely non-significant findings of this study should be examined in larger longitudinal and adequately powered studies.

Evaluation of linear lesion formation and thermodynamics by dragging ablation with the third-generation laser balloon.

BackgroundThe lesion formation properties of a motorized rotational delivery (RAPID) mode, third-generation laser balloon (LB3) ablation compared to point-by-point laser ablation in patients with atrial fibrillation remain unclear.ObjectiveThe purpose of this study was to assess lesion characteristics and thermodynamics in LB3 ablation with a RAPID mode in vitro model.MethodsChicken muscles were cauterized using LB3 in RAPID mode with 13 W and 15 W and 50% overlapped point-by-point fashion with 7 W/30 seconds, 8.5 W/20 seconds, 10 W/20 seconds, and 12 W/20 seconds. Lesion depth, width, and continuity were compared. Lesion continuity was classified by the visible gap degree categorized from 1 (perfect) to 3 (poor). Thermodynamics and maximum tissue temperatures were assessed under infrared thermographic monitoring. Fifteen and 5 lesions were evaluated per ablation protocol for measurement of lesion size and continuity and for thermographic assessment, respectively.ResultsLesion depth and width were smaller in RAPID mode laser ablation than point-by-point laser ablation (P <.001). However, RAPID mode laser ablation revealed sufficient mean lesion depth of 5 mm or more. Lesion continuity was 1 (perfect) in all samples in RAPID mode laser ablation and point-by-point laser ablation (P = 1). Infrared thermographic observation demonstrated fast and gapless linear lesion formation with thermal stacking in RAPID mode laser ablation. Maximum tissue temperature was lower in RAPID mode laser ablation than point-by-point laser ablation (P <.001).ConclusionRAPID mode LB3 ablation could provide fast, gapless, and acceptable lesion formation with thermal stacking and moderate tissue temperature rise.

309 Keillands forceps: Is it a useful or dangerous instrument? A retrospective analysis of 46 deliveries in sunderland royal hospital between september 2019 - February 2020

Introduction: Kielland’s forceps were introduced by Christian Kielland in 1908 for the delivery of babies with malposition, especially those with asynclitism. Kielland’s forceps were introduced for the management of rotational deliveries, since this kind of forceps doesn’t have the pelvic curvature and allows the obstetrician to be able to turn the baby in case of malposition and correct the asynclitism. For years Kielland’s forceps were not in practise because they were accused by the scientific community for significant increase in the perinatal morbidity and mortality, However, recent years there is an ample scientific evidence that Kielland’s forceps in the competent hands is a useful tool that can help avoid second stage caesarean sections, which increase significant the perinatal morbidity and mortality for both the mother and the baby.