Obstetric units' preparedness to manage critically ill women. The second report from the MaCriCare study.

PURPOSE: We aimed to describe the availability of 31 distinct services and facilities to diagnose, resuscitate, and treat critically unwell obstetric patients. METHODS: Using a network of anesthesiologists, intensive care clinicians, obstetricians, critical care nurses, and midwives (MaCriCare) from September 2021 to January 2022, we conducted a descriptive international multicenter cross-sectional survey in centers with obstetric units (OUs) in the WHO Europe Region. RESULTS: The MaCriCare network covers 26 countries and received 1133 responses, corresponding to 2.5 million annual deliveries. The survey identified significant disparities in the availability of the measured 31 services among the OUs, with some services not immediately available and some not available at all. Point-of-care hemoglobin measurements were lacking in 13.8% of OUs. 15.2% of OUs lacked pointof-care lactate measurement, and 11% lacked transfusion services. 23.8% of OUs lacked the ability to administer hypotensive agent infusions in the labor ward. Samebuilding access to cell saver and thromboelastometry was unavailable to 45.5% and 64.4% of OUs, respectively. Access to invasive ventilation was unavailable to 3.4% of OUs, 11.7% were unable to offer same-building access to non-invasive ventilation, and extracorporeal membranous oxygenation was unavailable to 38.3% of the OUs. CONCLUSION: Critically ill obstetric patients have access to markedly different resources in the WHO Europe Region depending on the OU where they are managed. Consensus on which facilities and services should be universally available is urgently needed.

Preparedness for severe maternal morbidity in European hospitals: The MaCriCare study.

PURPOSE: To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). METHODS: From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection. RESULTS: 1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database. CONCLUSION: Gaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control.

The Influence of a Fire at an Illegal Landfill in Southern Poland on the Formation of Toxic Compounds and Their Impact on the Natural Environment.

Landfill fires pose a real threat to the environment as they cause the migration of pollutants to the atmosphere and water sources. A greater risk is observed in the case of wild landfills, which do not have adequate isolation from the ground. The aim of this article is to present the results of studies on the toxicity of waste from a fire in a landfill in Trzebinia (southern Poland). Both soil and waste samples were investigated. The samples were analyzed using the GC-MS method and the leachates using ICP-OES. A total of 32 samples of incinerated waste and soil were collected. The organic compounds included naphthalene, fluorene, phenanthrene, anthracene, acenaphthene, acenaphthylene, fluoranthene, pyrene, benzo (c) phenanthrene, benzo (a) anthracene, chrysene, benzo (ghi) fluoranthene, benzo (b + k) fluoranthene, benzo (a) fluoranthene, benzo (c) fluoranthene, benzo (a) pyrene, benzo (e) pyrene, perylene, indeno[1,2,3-cd] pyrene, benzo (ghi) perylene, and dibenzo (a + h) anthracene. Among the inorganic parameters, sulfates, chlorides, arsenic, boron, cadmium, copper, lead, and zinc were taken into account. Phenanthrene reached values exceeding 33 mg/L. Fluoranthene dominated in most of the samples. Sulfates and chlorides were present in the samples in concentrations exceeding 400 and 50 mg/L, respectively. Compounds contained in burnt waste may have a negative impact on soil and water health safety. Therefore, it is important to conduct research and counteract the negative effects of waste fires.

A Novel Doppler TRPG/AcT Index Improves Echocardiographic Diagnosis of Pulmonary Hypertension after Pulmonary Embolism.

BACKGROUND: We hypothesized that a Doppler index, the ratio of tricuspid regurgitation peak gradient (TRPG) to pulmonary ejection acceleration time (AcT), improves the assessment of the echocardiographic probability of pulmonary hypertension in the identification of CTEPH and chronic thromboembolic pulmonary disease (CTED) in symptomatic patients after PE. Doppler echocardiography is recommended as the initial imaging tool for the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). METHODS: We analyzed the data from 845 consecutive PE (468 women; 61 ± 18 years) survivors who completed at least 6 months of anticoagulation therapy. Here, 555 patients (325 women; 66 ± 16 years) reporting functional impairment (FI) underwent transthoracic echocardiography. We included 506 patients (297 women; age 63.4 ± 16.6 years) in whom both AcT and TRPG were available into the current study. The presence of a minimum of intermediate echocardiographic probability of PH necessitated the diagnosis of CTEPH. RESULTS: Echocardiography revealed a high echocardiographic probability of PH in 69 (13.6%) and intermediate echocardiographic probability in 109 (21.5%) patients. CTEPH was diagnosed in 35 (6.9%) patients and CTED in 22 (4.3%) patients. TRPG/AcT was significantly higher in the combined CTEPH + CTED group than in those with other causes of FI (0.412 (0.100-2.197) vs. 0.208 (0.026-0.115), p < 0.001), and the area under the receiver operating characteristic curve of the TRPG/AcT for CTEPH + CTED was 0.804 (95% confidence interval (CI): 0.731-0.876). Importantly, multiple logistic regression showed that TRPG/AcT is a significant predictor of CTEPH + CTED after considering echocardiographic probability (odds ratio = 1.51, 95% CI: 1.25-1.91, p < 0.001). Conditional inference trees analysis revealed that TRPG/AcT > 0.595 identified patients with CTEPH or CTED with a positive predictive value of 78.6% and negative predictive value of 92.7%. CONCLUSIONS: A Doppler index TRPG/AcT improves the assessment of symptomatic PE survivors. TRPG/AcT > 0.6 indicates a high probability of CTEPH or CTED, whereas TRPG/AcT < 0.6 allows for the safe exclusion of CTEPH + CTED in patients with a low echocardiographic probability of PH.

The Use of the Contamination Index and the LWPI Index to Assess the Quality of Groundwater in the Area of a Municipal Waste Landfill.

Environmental degradation caused by the migration of pollutants from landfills is one of the biggest problems for urban areas. Systematic monitoring of groundwater in the vicinity of waste dumps allows for an assessment of the degree of risk to the soil and water environment. In this paper, spatiotemporal variation of groundwater pollution near a municipal landfill in Sosnowiec (southern Poland) was investigated. For this purpose, the monitoring results of five physicochemical indicators from 2014-2019 were used. This study presents an example of the application of the Landfill Water Pollution Index (LWPI) and the Cd Contamination Index. The obtained results indicated that the tested waters were negatively influenced by municipal landfills, especially in the southern part (piezometers P8 and P10). The values of the Contamination Index even reached a value equal of about 1400, while the values of the LWPI index reached 305. Significantly lower values of both indicators were obtained using the results of monitoring studies for other piezometers located upstream from the landfill but belonging to the observation network of a neighboring facility. The indices used permit a determination of the level of groundwater contamination from the described landfill and can be used in similar research areas.

A Review of Lysimeter Experiments Carried Out on Municipal Landfill Waste.

The groundwater risk assessment in the vicinity of landfill sites requires, among others, representative monitoring and testing for pollutants leaching from the waste. Lysimeter studies can serve as an example of dynamic leaching tests. However, due to the bacteriological composition of the municipal waste, they are rarely carried out. These tests allow for the proper design of the landfill protection system against migration of pollutants into the ground, assessment of bacteriological, biochemical and chemical risk for the groundwater, determination of the water balance of leachate as well as examination of the course of processes taking place in the waste landfill with a diversified access to oxygen. This paper addresses the issue of performing lysimeter studies on a sample of municipal waste in various scientific centers. It analyzes the size of lysimeters, their construction, the method of water supply, the duration of the experiment, the scope of research, and the purpose of lysimeter studies.

Staying Ahead of the Curve: Modified Approach to Emergency Caesarean Section Under General Anaesthesia in COVID-19 Pandemic.

The recent outbreak of SARS-CoV-2 has prompted healthcare professionals to re-design and modify the standards of care and operating procedures relevant to dealing with suspected or confirmed cases of COVID-19. The aim of this review is to highlight the key recommendations related to obstetric anaesthesia from scientific bodies in the United Kingdom and United States and to summarize recently developed and implemented clinical pathways for care of obstetric patients - specifically those requiring urgent general anaesthesia for caesarean section within a large maternity unit in London. The need to perform an emergency operative delivery in a timely manner while ensuring clinicians are suitably equipped and protected represents a uniquely challenging scenario, given the higher risk of viral transmission with aerosol generating procedures. In these settings, emphasis needs to be put on meticulous preparation, safety checklists and specific equipment and staffing adjustments. We present a structured framework comprised of four critical steps aimed to facilitate the development of local strategies and protocols.

Effect of the orientation of the optic axis on simulated scattering matrix elements of small birefringent particles.

We study how the orientation of the optic axis affects single-scattering properties for small, birefringent calcite particles simulated using DDSCAT 7.1.1. We consider two irregular model particles, a flake and a rhomboid, in either a (i) fixed or (ii) random orientation. Simulations are performed for three volume-equivalent radii of 0.1, 0.45, and 1.0 µm. For each target, we repeat the computations for three sets of orientations of the optic axis. When a fixed spatial orientation of the target is considered, the simulations are significantly affected by the orientation of the optic axis. However, the effect is considerably weaker when assuming the same targets in random spatial orientation.