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Background Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery. Methods A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5–6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group. Discussion If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections. Trial registration ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.

Introduction/BackgroundPrimary debulking/cytoreductive surgery (PDS) is considered the optimal approach in the management of tubo-ovarian carcinoma (TOC). Neoadjuvant chemotherapy (NACT) with interval cytoreductive surgery (IDS) is not considered inferior to PDS. The aim of this study was to analyse the multidisciplinary team (MDT) decision-making process in assigning patients to PDS or NACT at this Irish tertiary gynaecological oncology centre.MethodologyThis is an observational retrospective study on consecutive patients with invasive serous and non-serous TOC, presenting from 1st January to 31st December 2018. Borderline, non-epithelial and low grade tumours were excluded. Patient demographics, staging, histology and pre-treatment biochemistry and tumour markers were reviewed. Treatment modalities (PDS, NACT-IDS, chemotherapy alone) were documented.ResultsOf 88 patients assessed by MDT, 31 were excluded. 41 patients had radiological stage III (61%, n=25) or IV disease (39%, n=16). 90% (n=37) were high-grade serous. 30 patients (52.6%) underwent PDS. 44.6% (n=14) were radiological stage III 14 (46.6%) and 3.33% Stage IV (n=1). Median age was 55.6 years and median Ca125 was 929. Complete cytoreduction was achieved in 27 patients (90%).24 patients underwent primary chemotherapy. 45.9% (n=11) were radiological stage III and 54.1% (n=13) were Stage IV. Median age was 64 years and median Ca125 was 1902. 13 patients did not progress to IDS due to suboptimal chemotherapy response (n=5) and poor surgical candidacy due to comorbidities (n=4).ConclusionHigh grade serous was the most common histology. Achieving complete cytoreduction in the majority of the PDS group suggests MDT decision was correct. Patients selected for chemotherapy were more likely to have stage IV disease, higher age and Ca125. Half of patients receiving primary chemotherapy never progressed to surgery. Their poor baseline performance status may also be as important as chemo-resistance in that outcome. Robust comparisons of outcomes for PDS vs NACT-IDS need to pay close attention to patient stratification.DisclosureNothing to disclose

Introduction/BackgroundPrimary debulking/cytoreductive surgery (PDS) is considered the optimal approach in management of tubo-ovarian carcinoma (TOC). Not all patients are suitable for primary surgery, and neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (IDS) is considered to be not inferior to PDS. At this Irish tertiary gynaecological oncology centre the treatment approach is determined by the multidisciplinary team (MDT).ObjectiveThe aim of this study was to analyse the operative outcomes of the MDT decision to assign patients to primary surgery.MethodologyAn observational retrospective study of consecutive patients with TOC presenting during 2018. Borderline, low grade and non-epithelial tumours were excluded.ResultsEighty-eight patients were assessed by MDT and of 57 eligible, radiological stage was I/II (16, 28%), III (25, 44%), IV (16, 28%). Most were high grade serous histology.Thirty patients (52.6%) had PDS. Surgery included hysterectomy (29, 96.67%), salpingo-oophorectomy (30, 100%), appendicectomy (27, 90%), omentectomy (30, 100%), small bowel resection (2, 6.67%), large bowel resection (11, 36.67%), splenectomy (3,10%), partial gastrectomy (5, 16.67%), diaphragmatic stripping (8, 26.67%), partial resection of diaphragm (7, 23.33%), pelvic lymphadenectomy (30, 100%), para-aortic lymphadenectomy (30, 100%). Complete cytoreduction was achieved in 27 (90%).Blood loss average 1361 (50–5100) mls. Duration of surgery average 207 (30–385) mins. Post operative stay average 17.7 (4–84) days. Clavien dindo scores average 2. There were two postoperative deaths. Twenty-four (80%) progressed to chemotherapy.ConclusionMost women presenting with TOC had advanced stage disease. Those assigned to primary surgery had multiple procedures but the majority achieved complete cytoreduction. Perioperative morbidity and mortality were substantial. Only 80% of PDS progressed to adjuvant chemotherapy.DisclosureNothing to disclose.

Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery. A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term ([greater than or equal to]37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group. If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections.

IntroductionSurgery for vulval cancer includes sampling diagnostic, excisional biopsy and extensive radical surgery. The vulva and perineum are innervated by branches from the ilio-inguinal and pudendal nerves. We describe our experience of axon nerve blocks and outcomes including postoperative pain scores following surgeon administered intraoperative ilio-inguinal and pudendal nerve blocks.MethodsIlio-inguinal and pudendal nerve block has become routine practice for women undergoing vulval surgery in our cancer centre. In a retrospective chart review, clinical and demographic data, postoperative visual analogue pain scores and use of analgesia were recorded.ResultsEighteen women were included in the analysis. Their median age was 67 (range 34–81) years and thirteen (72%) were over 60 years. Visual analogue scores ranged from 0 to 3 for 17 patients from day 0--1 and 15 patients from days 2--5. Two patients had pain scores > 4 on one or more postoperative day: one had chronic arthralgia and one had received a lower volume of bupivicaine compared to our routine practice. Figure 1 summarizes postoperative analgesia usage for the 18 women.Abstract 142 Figure 1ConclusionIlio-inguinal and pudendal nerve block is a feasible and effective strategy for postoperative pain management in women undergoing vulval surgery.

UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition. This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work. From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods. UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.

Bangladesh is actively diversifying its energy mix, with wind power emerging as a promising yet underutilised resource. This review evaluates the current status, challenges, and prospects of wind energy in Bangladesh, supported by comparative insights from regional leaders such as India, Vietnam, and Pakistan. Despite a theoretical potential of at least 30 GW, Bangladesh has only grid connected installed capacity of 63 MW, contributing marginally to its 28,132 MW total generation, of which total renewables account for just 3.54%. The government has set an over ambitious target of 5.0 GW of wind by 2030, with some notable projects in the coastal areas. Based on the current review there is a favourable wind conditions along the southern coastal belt, where average wind speeds range 5.5–7.2 m/s at 100 m hub heights, rising above 7.0 m/s during the monsoon (May–July). However, development is constrained by inadequate inland wind velocities, limited high-resolution data, high capital expenditures (USD 1900–2100/kW), fragile grid infrastructure, cyclone exposure, and regulatory bottlenecks. Key recommendations include expanding offshore and floating wind projects, adopting wind-solar hybrid systems with smart grids and storage, strengthening domestic R&D capacity, and implementing dedicated wind energy policies with bankable incentives such as auctions, FiTs, and green bonds. Enhancing community acceptance through participatory planning and mitigating ecological risks will also be critical. Comparative case studies show that with clear policies and investment frameworks, countries with similar constraints have achieved rapid capacity expansion. For Bangladesh, aligning policy, finance and technology with global best practices can transform wind energy into a strategic pillar of its 2041 vision of sourcing 40% of electricity from renewables.

In the past, various traditional methods used experiments and statistical data to examine and solve the occurred problem and social-environmental issue. However, the traditional method is not suitable for expressing or solving the complex dynamics of human environmental crisis (such as the spread of diseases, natural disaster management, social problems, etc.). Therefore, the implementation of computational modelling methods such as Agent-Based Models (ABM) has become an effective technology for solving complex problems arising from the interpretation of human behaviour such as human society, environment, and biological systems. Overall, this article will outline the ABM model properties and its applications in the criminology, flood management, and the COVID-19 pandemic fields. In addition, this article will review the limitations that occurred to be overcome in the further development of the ABM model.