How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan

Background: Limited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities. Methods and findings: A system dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse and switch antenatal care services in four provider sectors: public, private, traditional and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different subgroups by geographical locations and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences on if, when and where to seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within trimester 2, but for rural women within trimester 1. Antenatal care access delayed to trimester 3 had no protective impact on neonatal mortality. Conclusions: System dynamics modelling enables capturing the complexity of health-seeking behaviours and impact on outcomes, informing intervention design, implementation of targeted policies and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts and strong social network influences

Using case studies in management education: the student perspective.

Case studies are widely used in management education. Most of the literature discussing the case study method has reflected the perspective of the teacher, implying a teacher-centred view of the case study as a learning strategy. Little is known about the student perspective on case studies. If we are to use the case study method as a component of a student-centred learning experience, then we must know how students perceive case studies, and understand the differences in attitude towards case studies that are found between different groups within the student body. This paper reports on a study of 288 final-year undergraduate students at two UK higher education institutions and is designed to uncover their views about the case study method. All of the respondents were currently enrolled on a strategic marketing or strategic management module on which case studies were used as a key component of the teaching and learning strategy. In general, students believed case studies to be useful as a method of acquiring skills and knowledge. The inherent ambiguity of the complex case study, grounded in business realities, can cause anxiety among some students. There is evidence of marked differences in attitude towards case studies between students with different entry qualifications and with different ethnic backgrounds. Older students are found to have more favourable attitudes to case studies than younger students. These findings have practical implications for the effective use of the case study method. Lecturers using this approach need to be aware of the likely differences of attitude towards case studies of students in their class, and consider these when designing appropriate teaching and learning strategies

AMCTD: Adaptive Mobility of Courier nodes in Threshold-optimized DBR Protocol for Underwater Wireless Sensor Networks

In dense underwater sensor networks (UWSN), the major confronts are high error probability, incessant variation in topology of sensor nodes, and much energy consumption for data transmission. However, there are some remarkable applications of UWSN such as management of seabed and oil reservoirs, exploration of deep sea situation and prevention of aqueous disasters. In order to accomplish these applications, ignorance of the limitations of acoustic communications such as high delay and low bandwidth is not feasible. In this paper, we propose Adaptive mobility of Courier nodes in Threshold-optimized Depth-based routing (AMCTD), exploring the proficient amendments in depth threshold and implementing the optimal weight function to achieve longer network lifetime. We segregate our scheme in 3 major phases of weight updating, depth threshold variation and adaptive mobility of courier nodes. During data forwarding, we provide the framework for alterations in threshold to cope with the sparse condition of network. We ultimately perform detailed simulations to scrutinize the performance of our proposed scheme and its comparison with other two notable routing protocols in term of network lifetime and other essential parameters. The simulations results verify that our scheme performs better than the other techniques and near to optimal in the field of UWSN.Comment: 8th International Conference on Broadband and Wireless Computing, Communication and Applications (BWCCA'13), Compiegne, Franc

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

Risk perception of antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Background Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients. Methods In this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics. Results Between January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception. Conclusions The perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors

A Unified Approach towards Describing Rapidity and Transverse Momentum Distributions in Thermal Freeze-Out Model

We have attempted to describe the rapidity and transverse momentum spectra, simultaneously, of the hadrons produced in the Ultra-relativistic Nuclear Collisions. This we have tried to achieve in a single statistical thermal freeze-out model using single set of parameters. We assume the formation of a hadronic gas in thermo-chemical equilibrium at the freeze-out. The model incorporates a longitudinal as well as a transverse hydrodynamic flow. We have also found that the role of heavier hadronic resonance decay is important in explaining the particle spectra.Comment: 22 pages, 11 figure

Doppler cooling with coherent trains of laser pulses and tunable "velocity comb"

We explore the possibility of decelerating and Doppler cooling of an ensemble of two-level atoms by a coherent train of short, non-overlapping laser pulses. We develop a simple analytical model for dynamics of a two-level system driven by the resulting frequency comb field. We find that the effective scattering force mimics the underlying frequency comb structure. The force pattern depends strongly on the ratio of the atomic lifetime to the repetition time and pulse area. For example, in the limit of short lifetimes, the frequency peaks of the optical force wash out. We show that laser cooling with pulse trains results in a "velocity comb", a series of narrow peaks in the velocity space

Writing Electronic Devices on Paper with Carbon Nanotube Ink

The normal paper used in any printer is among the cheapest flexible organic materials that exist. We demonstrate that we can print on paper high-frequency circuits tunable with an applied dc voltage. This is possible with the help of an ink containing functionalized carbon nanotubes and water. After the water is evaporated from the paper, the nanotubes remain steadily imprinted on paper, showing a semiconducting behaviour and tunable electrical properties

Particle Ratios as a Probe of the QCD Critical Temperature

We show how the measured particle ratios can be used to provide non-trivial information about the critical temperature of the QCD phase transition. This is obtained by including the effects of highly massive Hagedorn resonances on statistical models, which are used to describe hadronic yields. The inclusion of Hagedorn states creates a dependence of the thermal fits on the Hagedorn temperature, $T_H$, which is assumed to be equal to $T_c$, and leads to an overall improvement of thermal fits. We find that for Au+Au collisions at RHIC at $\sqrt{s_{NN}}=200$ GeV the best square fit measure, $\chi^2$, occurs at $T_c \sim 176$ MeV and produces a chemical freeze-out temperature of 172.6 MeV and a baryon chemical potential of 39.7 MeV.Comment: 6 pages, 4 figure