Effect of temperature on the CO2 splitting rate in a DBD microreactor.

A novel plate-to-plate dielectric barrier discharge microreactor (micro DBD) has been demonstrated in CO2 splitting. In this design, the ground electrode has a cooling microchannel to maintain the electrode temperature in the 263-298 K range during plasma operation. A small gap size between the electrodes of 0.50 mm allowed efficient heat transfer from the surrounding plasma to the ground electrode surface to compensate for heat released in the reaction zone and maintain a constant temperature. The effect of temperature on CO2 conversion and energy efficiency was studied at a voltage of 6-9 kV, a frequency of 60 kHz and a constant CO2 flow rate of 20 ml min-1. The CO2 decomposition rate first increased and then decreased as the electrode temperature decreased from 298 to 263 K with a maximum rate observed at 273 K. Operation at lower temperatures enhanced the vibrational dissociation of the CO2 molecule as opposed to electronic excitation which is the main mechanism at room temperature in conventional DBD reactors, however it also reduced the rate of elementary reaction steps. The counterplay between these two effects leads to a maximum in the reaction rate. The power consumption monotonously increased as the temperature decreased. The effective capacitance of the reactor increased by 1.5 times at 263 K as compared to that at 298 K changing the electric field distribution inside the plasma zone.

Physiotherapy training and education prior to elective Caesarean section and its impact on post-natal quality of life: a secondary analysis of a randomized controlled trial.

BACKGROUND: Caesarean section (CS) is associated with numerous complications that lead to the delayed return to functional activities that have a negative influence on the post-natal quality of life (QOL). It is evident that providing regular evidence-based physiotherapy training and education prior to elective CS helps to enhance the post-natal QOL by improving physical, mental, social, and general well-being. The purpose of this study was to examine the effectiveness of physiotherapy training and education prior to elective CS on post-natal QOL. METHODS: This single-blind parallel randomized controlled study was carried out at De Soysa Hospital for Women (DSHW), Colombo. The study enrolled 54 women who were scheduled to undergo elective CS. The intervention group (n = 27) of women received physiotherapy training and education, while the control group (n = 27) received standard nursing care. In addition to the primary outcome measures, post-natal QOL was measured. The results were examined using descriptive statistics and the independent samples t-test in IBM SPSS 20. RESULTS: The intervention group showed a higher post-natal QOL for the domains of physical function, role limitation due to physical health, energy/fatigue, and pain than the control group (p < 0.05). CONCLUSION: Physiotherapy training and education prior to elective CS play a pivotal role in improving the physical health-related domains of QOL following CS. TRIAL REGISTRATION: The Sri Lanka Clinical Trials Registry ( https://www.slctr.lk ). REGISTRATION NUMBER: SLCTR/2019/029-APPL/2019/028; Registration date: 6th of September 2019.

Impacts of disrespectful care and abusive care practices in maternity units and potential interventions to improve the quality of care in low- and middle-income countries: A narrative review.

This review article explored the impacts of disrespectful care and abusive care practices and the potential interventions to eliminate those practices. Respectful maternity care is a fundamental right for all women. It ensures that women are able to exercise their rights in maternity care. However, research studies have shown the recent prevalence of poor-quality care for women in maternity units in low- and middle-income countries. The literature on this topic was searched on PubMed, Medline, Google Scholar, Cochrane, Science Direct/ Elsevier, and SCOPUS. A total of 24 qualitative and quantitative research articles were included. Thematic analysis was conducted by using the six steps. Impacts are coded on topics including psychological impacts due to disrespectful and abusive care practices, impact on the care process, normalization of the absence of care, suppression of knowledge regarding the labor process, and poor obstetric outcomes. Interventions are coded on topics including programs for health professionals to improve care, education and empowerment programs targeting the women and community, enacting policies and guidelines regarding disrespectful and abusive care practices and improving the facilities in the healthcare system. The majority of the evidenced-based interventions were multi-component and tailored to the needs of a particular setting. More research evidence is needed to inform the healthcare authorities and policymakers to transform these potential interventions into practice. Future research should clearly document the effectiveness of various combinations of interventions, feasibility, cost-effectiveness, and outcomes.

Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka.

OBJECTIVES: The World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is a common practice. This study compares maternal/newborn outcomes after IOL at 40 GW (IOL40) or 41 GW (IOL41) versus spontaneous onset of labour (SOL). METHODS: Data were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression. RESULTS: Of 13,670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75-2.77, p < 0.001 and OR = 1.91, 95%CI = 1.47-2.48, p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71-2.77, p < 0.001 and OR = 2.34, 95%CI = 1.78-3.07, p < 0.001 respectively) and caesarean section (OR = 2.75, 95%CI = 2.07-3.65, p < 0.001 and OR = 3.01, 95%CI = 2.21-4.12, p < 0.001 respectively). Results did not change in secondary and sensitivity analyses. CONCLUSIONS: Both IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings.

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions.

INTRODUCTION: Placenta accreta spectrum (PAS) is associated with a multitude of maternal and fetal complications. Events related to its management have resulted in significant psychological morbidity, with lifelong consequences which warrant continuous support to cope with their lives. The objective of the study is to highlight the importance of multidisciplinary holistic care and explore room for improvement in the provision of care for women with PAS. METHODS: Our study was conducted on deliveries complicated with PAS from January 2019 to June 2021. 27 women were diagnosed with PAS during this period and received treatment. Impact of life event scale- revised (IES-R) and short form health survey-36(SF-36) questionnaires were administered to assess the impact of PAS on their lives. In depth interviews were conducted with the women. A multidisciplinary team meeting was later conducted to formulate a comprehensive care plan for women with PAS. RESULTS: The response rate was 96.2%. Mean age of the sample is 34.1 years (SD 4.3). Interval to current pregnancy varies from 0.6 years to 10 years with mean of 4.6 years. Mean gestational age of diagnosis of PAS was 25.4(SD 6.7) weeks. The care bundle provided for women with PAS was evaluated in all cases. Surgery was conducted electively in 82% of patients. Blood transfusions were noted in 85%. Mean pre-operative stay was 9.5 days (SD 8.3) and mean post-operative stay was 8.8 days (SD 8). Total hospital stay ranged from 6 to 48 days (mean 19.5 days, SD 11.4). IES-R scores were significant in 4/26 patients. There was no correlation with the interval from the surgery with any of the subscales or with the total scores. The lapsed time after the surgery had a significant correlation with physical functioning and pain domains of the SF-36 questionnaire. Description of the experience, loss of femininity with loss of the uterus, concerns and fears about the future and measures to improve the quality of care were the themes identified and described. A multidisciplinary team meeting, consisting of consultant obstetricians performing surgery for PAS, anesthetists, hematologist, transfusion medicine specialist, urologist, physiotherapist, nutritionist and nursing officers from ICU and wards, was held and their contributions helped to map out a definitive care plan. CONCLUSIONS: PAS is associated with long term physical and psychological morbidity. Continuous support through quarterly clinic visits and telephone conversations may alleviate the psychological trauma. However, some physical disabilities may be lifelong and life changing. Importance of reducing primary caesarean section and promoting trial of labour after caesarean delivery should be promoted among patients and caregivers.

Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial.

BACKGROUND: Caesarean Section (CS) is associated with numerous post-operative problems. The current literature reveals that physiotherapy interventions such as pelvic floor rehabilitation and post-surgical rehabilitation enable enhanced recovery in the post-operative period. The purpose of this study was to investigate the effectiveness of face-to-face physiotherapy training and education prior to elective CS in improving post-operative outcomes. METHODS: A single blind parallel randomized controlled study was carried out at De Soysa Hospital for Women (DSHW), Colombo. Fifty-four women who were to undergo elective CS were recruited to the study. The women in the intervention group (n = 27) received face-to-face physiotherapy training and education; the control group (n = 27) received only the standard nursing care. Outcome measures such as perception of post-operative pain, dosage of additional analgesics required, pain upon returning to functional activities and lengths of hospital stay were collected. Results were analyzed using IBM SPSS 20 using descriptive statistics and independent samples t-test. RESULTS: Mean post-operative pain score (control group; 4.2±0.46 vs. intervention group; 1.7±0.7) and doses of additional analgesics required were significantly higher in the control group than that of the intervention group. Pain upon returning to functional activities decreased significantly within 2 days in both groups, and values were lower in the intervention group. The intervention group showed a shorter hospital stay than the control group (control group;3.9 ± 0.3 vs. intervention group;3.00 ± 0.0) (p < 0.05). CONCLUSIONS: Face-to-face physiotherapy training and education prior to elective CS appears to be a promising intervention to improve the post-operative outcomes by reducing post-operative pain, doses of additional analgesics required, pain upon returning to functional activities and lengths of hospital stay. TRIAL REGISTRATION: SLCTR/2019/029-APPL/2019/028 ; Registered on 6th of September 2019.

An Unusual Presentation of COVID-19 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A) in a Pregnant Woman.

Based on available literature, pregnant women are at an increased risk of severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, compared to nonpregnant women. Consequences of coronavirus disease 2019 (COVID-19) in pregnancy have many implications in women's lives other than unfavorable obstetric outcomes. In addition to managing acute respiratory illness and symptoms, caregivers should be equipped to detect and manage the short-term, intermediate, and long-term consequences of SARS-CoV-2 infection as well. Many pregnant women can remain asymptomatic and continue their pregnancy without being diagnosed. Pregnancy outcomes and consequences of SARS-CoV-2 infected yet asymptomatic mothers have not been very well explained. Reports of a new multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 have been described. However, MIS-A in pregnancy is an extremely rare presentation that can cause a huge diagnostic dilemma to caregivers. We describe the successful management of a pregnant woman with MIS-A following SARS-CoV-2 infection.

Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report.

BACKGROUND: Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstruction can result in a diuretic phase which may be self-limiting or pathological. However, occurrence of pathological post-obstructive diuresis as a result of severe constipation is an extremely rare complication during pregnancy and puerperium which can even be fatal if not promptly diagnosed and adequately monitored and timely intervened. We describe the management of a pathological post-obstructive diuresis which occurred in the immediate postpartum period after treatment of severe constipation and obstructive uropathy. CASE PRESENTATION: A woman who had undergone an emergency caesarean section due to deep transverse arrest 1 week ago, presented with fecal impaction and anuria. On relief of urinary obstruction which had developed secondary to fecal impaction, she developed pathological post-obstructive diuresis. Careful and timely monitoring with exact fluid replacement, correction of electrolyte imbalances and multidisciplinary care ensured complete recovery of the patient. CONCLUSIONS: Despite obstructive uropathy being uncommon in obstetric practice, clinicians need to have a high index of suspicion to monitor and promptly manage the potentially life-threatening condition of post-obstructive diuresis in pregnant and puerperal women undergoing urinary tract decompression. Due to unreliability of laboratory cutoff values in pregnancy and puerperium, a more vigilant and multidisciplinary approach with lower threshold for intervention is more prudent in the management of these patients.

Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka.

Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

Use of Collection Condoms to Retrieve Sperms in a Patient with Idiopathic Anejaculation/Anorgasmia and Infertility.

Male factor infertility can be challenging to treat. Anejaculation/anorgasmia in men can be distressing for them specially when it is coupled with fertility desires. Understanding the pathophysiology of the condition requires careful evaluation. Although novel techniques exist to retrieve sperms form men suffering from anejaculation/anorgasmia, simple and inexpensive methods should be tried in every possible case.

Hyperechoic amniotic fluid in a term pregnancy.

The presence of highly echogenic amniotic fluid (AF) is uncommon, and presence creates a dilemma in the mind of the clinician. Echogenic AF has been attributed to meconium, blood, and vernix caseosa. Many studies have shown that the presence of meconium is unlikely in most cases. We report a case of highly echogenic AF detected at 37 weeks which was managed conservatively with careful fetal monitoring for further 2 weeks expecting spontaneous onset of labor. Labor was induced due to reduced fetal movements at 39 weeks. Healthy baby weighing 3130 g was delivered by cesarean section after a failed induction with prostaglandin.

Take-home experience of overseas doctors at the end of their two years training placements in the International Doctors Training Programme in Obstetrics and Gynaecology in the United Kingdom: A questionnaire-based study.

This was a questionnaire-based study of overseas doctors, who came to the United Kingdom through the International Doctors Training Programme (IDTP) of Obstetrics and Gynaecology during the period of 2009-2012. The study was conducted at the end of their two-years training placement to find out what went well, what did not go well, where problems were encountered, and how they could have been avoided. We traced 48 overseas doctors, 35 (73%) responded to our questionnaire. Only 30% (9) felt that less than 50% of their expectations were met during their training period, 73.3% (22) of them received adequate help and support from their supervisors and 83.3% (25) would recommend IDTP to their colleagues. In conclusion, identification of the educational needs of international trainees, establishing a framework for their effective supervision and streamlining their training programme, in collaboration with the Royal College, regional deaneries and hosting hospitals are essential pre-requisites for overseas doctors to get the most out of their training.

Spectroscopic investigation of the molecular vibrations of 1,4-dihydronaphthalene in its ground and excited electronic States.

A comprehensive spectroscopic study of 1,4-dihydronaphthalene (14DHN) has been carried out for its ground and S(1)(pi,pi*) electronic states using infrared, Raman, ultraviolet, and laser-induced fluorescence (LIF) spectroscopic techniques. The experimental work was complemented by ab initio and DFT calculations. For the ground state excellent agreement between observed and calculated values was attained. For the S(1)(pi,pi*) excited state 19 of the vibrational modes were clearly determined and excited vibronic levels for a number of these were also identified. A detailed energy map for the low-frequency modes in both electronic states was established. 14DHN is very floppy in its S(0) ground state but less so in its excited state. The floppiness relaxes C(2v) selection rules for the S(0) state.

Ultraviolet cavity ringdown spectra and the S1(n,pi) ring-inversion potential energy function for 2-cyclohexen-1-one-d0 and Its 2,6,6-d3 isotopomer.

The cavity ringdown spectra of 2-cyclohexen-1-one (2CHO) and its 2,6,6-d3 isotopomer (2CHO-d3) have been recorded in the spectral region near their S1(n,pi)<--S0 band origins which are at 26,081.3 and 26,075.3 cm-1, respectively. The data allow several of the quantum states of nu39, the ring inversion, to be determined for both the ground and excited electronic states. These were utilized to calculate the one-dimensional potential energy functions which best fit the data. The barriers to inversion for the S0 and S1(n,pi) states were found to be 1,900 +/- 300 and 3,550 +/- 500 cm-1, respectively. Density functional theory calculations predict values of 2,090 and 2,265 cm-1, respectively.

Vibrational spectra, DFT calculations, unusual structure, anomalous CH2 wagging and twisting modes, and phase-dependent conformation of 1,3-disilacyclobutane.

Our previously published infrared and Raman spectra of 1,3-disilacyclobutane (13DSCB) and its 1,1,3,3-d4 isotopomer have been reexamined and partially reassigned on the basis of DFT and ab initio calculations. The calculations confirm previous microwave work that the CSiC angles in the ring are unexpectedly larger than the SiCSi angles. This may arise from the partial charges on the ring atoms. The calculations are in excellent agreement with the observed spectra in both frequency and intensity. They also demonstrate that this molecule has CH2 wagging and twisting vibrations with frequencies below 1000 cm-1, about 200 cm-1 lower than expected. These unprecedented low values can be explained by the decreased slope in the potential energy curves for these vibrations as the sideways motions of the CH2 groups result in attractive forces between the positively charged hydrogens on the carbon atoms and the negatively charged hydrogens on the silicon atoms. The theoretical calculations also confirm the previous conclusions that the individual molecules (vapor) have C2v symmetry whereas in the solid the molecules become planar with D2h symmetry. The vibrational coupling between the ring-angle bending mode and the SiH2 in-phase rocking, which is present for the C2v structure, is forbidden for D2h and hence disappears.