World Health Organization (WHO) modified partogram fill audit at Matam Communal Medical Center

Objective: To assess the quality of filling of the modified partograph from WHO at CMC Matam. Methods: This was a retrospective descriptive study by clinical audit (AC), carried out on a sample of obstetric records of parturients who gave birth in the maternity unit of the CMC of Matam from January 1 to December 31, 2020, it consisted of a evaluation of the use of the partograph using an audit sheet prepared for this purpose. The random sampling with one step in ten 1/10 was used for the sampling. The parameters related to the performance of the partograph, the progress of labor (hourly rate, fetal state, materno-fetal outcome.) Were evaluated, the traceability of events related to maternal condition, acts and treatments carried out during labor as well as immediate postpartum surveillance data. Data was collected and analyzed using SPSS 20.0 and MS Excel 2010 software. Results: We retained 470 files. The sample represented 87.45% of all parturients whose monitoring required the opening of a partograph during the study period; its behavior met the standard in more than 87, 41% of cases; The hourly rhythm, and the precise moment of each act were notified and respected in 66.60% of the cases, the progress of the work was correctly notified and respected in 28.72% of the cases; the presentation level and the fetal heart rate were reported and respected in 28.78% and 85.96% respectively; the method of entering into labor was notified and complied with in 95.7% of cases. Conclusion: The modified WHO partograph has some shortcomings in relation to its performance, which can be corrected by supportive supervision.

2. Funding Litigation

This chapter discusses the issue of funding litigation. Solicitors have a professional duty to advise clients on litigation funding options. The advice and agreed funding method should be confirmed in writing in a ‘client care letter’. Most commercial clients pay their lawyers under the traditional retainer, normally with an agreed hourly rate. Conditional free agreements (CFAs) or ‘no win, no fee’ agreements allow a lawyer to agree not to charge the client if the proceedings are unsuccessful, but to charge an uplift or ‘success fee’ of up to 100 per cent over the solicitor’s usual costs if the proceedings are successful. Damages-based agreements (DBAs) are a form of contingency fee agreement under which the lawyer is paid out of the sums recovered in the proceedings. Public funding through legal aid is restricted to individuals with modest income and capital, and there are wide exclusions from the scheme.

Does Mandatory IFRS Adoption Affect Audit Hours and the Effectiveness to Constrain Earnings Management? Evidence from Italy

We examine the effect IFRS adoption has had on audit effort and the effectiveness of greater audit effort on constraining earnings management. While prior studies have examined the costs of IFRS adoption, it is unclear whether IFRS adoption affects audit effort and whether extra audit effort results in higher audit quality. We find that following Italy's adoption of IFRS, audit hours (but not the hourly rate) increased, suggesting that audit effort (in audit hours) increased following IFRS adoption. We then examine whether more audit hours are associated with improved audit quality in the IFRS regime. Consistent with prior literature (Caramanis and Lennox 2008), we find that more audit effort is associated with lower abnormal accruals in the period before IFRS adoption. Interestingly, after Italy adopted IFRS, abnormal accruals are lower, but audit hours were less associated with lower abnormal accruals, implying that more audit hours are needed to constrain earnings management. Collectively, our empirical analysis suggests that while audit effort increased with mandatory IFRS adoption, the effectiveness of audit effort to constrain earnings management decreased.

Perforation rate after a diagnosis of uncomplicated appendicitis on CT

Background Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis. Methods Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014–2015 were analysed for patient characteristics, preoperative delay and outcomes. Results Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively. Conclusion A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.

2. Funding Litigation

This chapter discusses the issue of funding litigation. Solicitors have a professional duty to advise clients on litigation funding options. The advice and agreed funding method should be confirmed in writing in a ‘client care letter’. Most commercial clients pay their lawyers under the traditional retainer, normally with an agreed hourly rate. Conditional free agreements (CFAs) or ‘no win, no fee’ agreements allow a lawyer to agree not to charge the client if the proceedings are unsuccessful, but to charge an uplift or ‘success fee’ of up to 100 per cent over the solicitor’s usual costs if the proceedings are successful. Damages-based agreements (DBAs) are a form of contingency fee agreement under which the lawyer is paid out of the sums recovered in the proceedings. Public funding through legal aid is restricted to individuals with modest income and capital, and there are wide exclusions from the scheme.

Stability of bicarbonate in normal saline: a technical report

BACKGROUND: The benefit of intravenous sodium bicarbonate administration in patients with severe metabolic acidosis remains controversial, partly due to lack of double-blind trials. From a practical viewpoint, such blinding requires testing of the stability of sodium bicarbonate in polyolefin bags. METHODS: We examined seven samples of 100 mL 8.4% sodium bicarbonate diluted in 150 mL normal saline within a 250 mL polyolefin bag at time 0, 24 and 48 hours after preparation. We measured pH, Pco2, and bicarbonate concentration. RESULTS: Over a period of 48 hours, both pH and Pco2 decreased significantly (hourly rate of change, -0.001 [P = 0.043] and -0.098 [P < 0.001] respectively). However, the concentration of bicarbonate did not decrease, with an hourly rate of change of only -0.009 (P = 0.42). CONCLUSION: When 100 mL of 8.4% sodium bicarbonate are diluted in 150 mL of normal saline within a 250 mL polyolefin bag, changes in pH and Pco2 over a 48-hour period are small and bicarbonate concentration remains stable.

A Study on Cost Optimization of External Cylindrical Grinding

Grinding cost is an essential factor in a grinding process. In external cylindrical grinding, there has been an absence of various input grinding process parameters which have significant effects on the grinding cost. This paper presents an optimization of the grinding cost to determine the optimum exchanged grinding wheel diameter based on the seven input grinding parameters consisting of the initial grinding wheel diameter, the grinding wheel width, the wheel life, the radial grinding wheel wear per dress, the total depth of dressing cut, the machine tool hourly rate, and the grinding wheel cost. Combined with the screening experiments, the influence of the grinding parameters on the optimum exchanged grinding wheel diameter for the external cylindrical grinding process was examined. In addition, the effect of the interactions between the input grinding parameters was also evaluated. Finally, the regression equation for computing the optimum exchanged grinding wheel diameter was introduced. Therefore, the proposed model can be further applied for the external grinding process effectively.