Obstetric audit in resource-poor settings: lessons from a multi-country project auditing 'near miss' obstetrical emergencies.

This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations

Evaluation of the Linear Relationship Between Pulse Arrival Time and Blood Pressure in ICU Patients: Potential and Limitations

A variety of techniques based on the indirect measurement of blood pressure (BP) by Pulse Transit Time (PTT) have been explored over the past few years. Such an approach has the potential in providing continuous and non-invasive beat to beat blood pressure without the use of a cuff. Pulse Arrival Time (PAT) which includes the cardiac pre-ejection period has been proposed as a surrogate of PTT, however, the balance between its questioned accuracy and measurement simplicity has yet to be established. The present work assessed the degree of linear relationship between PAT and blood pressure on 96 h of continuous electrocardiography and invasive radial blood pressure waveforms in a group of 11 young ICU patients. Participants were selected according to strict exclusion criteria including no use of vasoactive medications and presence of clinical conditions associated with cardiovascular diseases. The average range of variation for diastolic BP was 60 to 79 mmHg while systolic BP varied between 123 and 158 mmHg in the study database. The overall Pearson correlation coefficient for systolic and diastolic blood pressure was −0.5 and −0.42, respectively, while the mean absolute error was 3.9 and 7.6 mmHg. It was concluded that the utilization of PAT for the continuous non-invasive blood pressure estimation is rather limited according to the experimental setup, nonetheless the correlation coefficient performed better when the range of variation of blood pressure was high over periods of 30 min suggesting that PAT has the potential to be used as indicator of changes relating to hypertensive or hypotensive episodes

Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale

Background: The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments. Furthermore, we have limited insight into the role of the family in promoting adjustment. Methods: The purpose of this study was to develop and initially validate the Psychosocial Adjustment to Hereditary Diseases (PAHD) scale. This scale consists of two subscales, the Burden of Knowing (BK) and Family Connectedness (FC). Items for the two subscales were generated from a qualitative data base and tested in a sample of 243 participants from families with LS. Results: The Multitrait/Multi-Item Analysis Program-Revised (MAP-R) was used to evaluate the psychometric properties of the PAHD. The findings support the convergent and discriminant validity of the subscales. Construct validity was confirmed by factor analysis and Cronbach’s alpha supported a strong internal consistency for BK (0.83) and FC (0.84). Conclusion: Preliminary testing suggests that the PAHD is a psychometrically sound scale capable of assessing psychosocial adjustment. We conclude that the PAHD may be a valuable monitoring tool to identify individuals and families who may require therapeutic interventions

Environmental controls on the stable isotopic composition of Mercenaria mercenaria: Potential application to paleoenvironmental studies

We have investigated the environmental controls of seasonally resolved records of oxygen and carbon isotopes of modern Mercenaria mercenaria bivalves collected live from five coastal sites along the east coast of North America. Seasonal profiles of δ18O and δ13C obtained by subsampling the incremental growth layers of aragonite were compared with in situ historical records of temperature and salinity. We show that M. mercenaria δ18O profiles track accurately the seasonal variations of water temperature and that variations in growth rates do not affect the shell δ18O values. Growth rates are strongly reduced or interrupted below water temperatures ranging from 8 to 10°C, implying that only bivalves sampled in tropical areas track the full amplitude of seasonal variations. Although further measurements of water δ18O and a better understanding of seasonal variations of the water δ18O-salinity relationships are necessary, Mercenaria mercenaria bivalves appear to precipitate their shell close to isotopic equilibrium. Whereas the amplitude of the seasonal profiles of δ18O reflects variations in water temperature, the annual average δ18O decreases with latitude, reflecting the trend of rainfall and riverwater δ18O with latitude over the Northern American continent

Computing the Affective-Aesthetic Potential of Literary Texts

In this paper, we compute the affective-aesthetic potential (AAP) of literary texts by using a simple sentiment analysis tool called SentiArt. In contrast to other established tools, SentiArt is based on publicly available vector space models (VSMs) and requires no emotional dictionary, thus making it applicable in any language for which VSMs have been made available (>150 so far) and avoiding issues of low coverage. In a first study, the AAP values of all words of a widely used lexical databank for German were computed and the VSM’s ability in representing concrete and more abstract semantic concepts was demonstrated. In a second study, SentiArt was used to predict ~2800 human word valence ratings and shown to have a high predictive accuracy (R2 > 0.5, p < 0.0001). A third study tested the validity of SentiArt in predicting emotional states over (narrative) time using human liking ratings from reading a story. Again, the predictive accuracy was highly significant: R2adj = 0.46, p < 0.0001, establishing the SentiArt tool as a promising candidate for lexical sentiment analyses at both the micro- and macrolevels, i.e., short and long literary materials. Possibilities and limitations of lexical VSM-based sentiment analyses of diverse complex literary texts are discussed in the light of these results

Children\u27s learning of anxiety sensitivity : a preliminary study using a sample of youths referred for anxiety disorders

The purpose of the present study was to examine the origins of anxiety sensitivity (AS) by assessing youths\u27 learning experiences in relation to their AS symptoms and anxiety symptoms. Participants were 33 youths between 7 to 13 years old (M = 9.39 years, SD = 2.01). Youths were assessed using a structured interview and self-report measures. Chi-square analyses revealed no statistically significant differences in the proportions of boys vs. girls, Hispanic vs. non-Hispanic, and married vs. non-married. Pearson correlation analyses revealed that youths\u27 AS learning experiences were significantly related to youths\u27 AS and to youths\u27 anxiety symptoms scores. Partial correlations between youths\u27 learning experiences associated with AS symptoms in relation to AS scores controlling for anxiety symptoms effects were statistically significant. Findings were consistent with theory and suggest that learning mechanisms may be involved in AS acquisition and maintenance. The findings\u27 implications are discussed regarding possible learning experiences\u27 role in the development of AS

Gapless phases of colour-superconducting matter

We discuss gapless colour superconductivity for neutral quark matter in &#946; equilibrium at zero as well as at nonzero temperature. Basic properties of gapless superconductors are reviewed. The current progress and the remaining problems in the understanding of the phase diagram of strange quark matter are discussed

Inverse cascades and resonant triads in rotating and stratified turbulence

Kraichnan’s seminal ideas on inverse cascades yielded new tools to study common phenomena in geophysical turbulent flows. In the atmosphere and the oceans, rotation and stratification result in a flow that can be approximated as two-dimensional at very large scales but which requires considering three-dimensional effects to fully describe turbulent transport processes and non-linear phenomena. Motions can thus be classified into two classes: fast modes consisting of inertia-gravity waves and slow quasi-geostrophic modes for which the Coriolis force and horizontal pressure gradients are close to balance. In this paper, we review previous results on the strength of the inverse cascade in rotating and stratified flows and then present new results on the effect of varying the strength of rotation and stratification (measured by the inverse Prandtl ratio N/f, of the Coriolis frequency to the Brunt-Väisäla frequency) on the amplitude of the waves and on the flow quasi-geostrophic behavior. We show that the inverse cascade is more efficient in the range of N/f for which resonant triads do not exist, /2≤N/f≤21/2≤N/f≤2. We then use the spatio-temporal spectrum to show that in this range slow modes dominate the dynamics, while the strength of the waves (and their relevance in the flow dynamics) is weaker.Fil: Oks, D.. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; ArgentinaFil: Mininni, Pablo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; ArgentinaFil: Marino, R.. Universite Lyon 2; FranciaFil: Pouquet, A.. State University of Colorado Boulder; Estados Unido

Implementation, context and complexity

Background - Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. Discussion - We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. Conclusion - Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems