Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

OBJECTIVES: To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized. STUDY DESIGN: We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index. RESULTS: Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births. CONCLUSIONS: Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception. IMPLICATIONS: The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology

Nanoindentation Of Si Nanostructures: Buckling And Friction At Nanoscales

A nanoindentation system was employed to characterize mechanical properties of silicon nanolines (SiNLs), which were fabricated by an anisotropic wet etching (AWE) process. The SiNLs had the linewidth ranging from 24 nm to 90 nm, having smooth and vertical sidewalls and the aspect ratio (height/linewidth) from 7 to 18. During indentation, a buckling instability was observed at a critical load, followed by a displacement burst without a load increase, then a full recovery of displacement upon unloading. This phenomenon was explained by two bucking modes. It was also found that the difference in friction at the contact between the indenter and SiNLs directly affected buckling response of these nanolines. The friction coefficient was estimated to be in a range of 0.02 to 0.05. For experiments with large indentation displacements, irrecoverable indentation displacements were observed due to fracture of Si nanolines, with the strain to failure estimated to be from 3.8% to 9.7%. These observations indicated that the buckling behavior of SiNLs depended on the combined effects of load, line geometry, and the friction at contact. This study demonstrated a valuable approach to fabrication of well-defined Si nanoline structures and the application of the nanoindentation method for investigation of their mechanical properties at the nanoscale.Microelectronics Research Cente

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie

Breeding limits foraging time : evidence of interrupted foraging response from body mass variation in a tropical environment

Funds were received from the Ubbo Emmius grant, Univ. of Groningen and also from the Univ. of St Andrews.Birds should store body reserves if starvation risk is anticipated; this is known as an ‘interrupted foraging response’. If foraging remains unrestricted, however, body mass should remain low to limit the predation risk that gaining and carrying body reserves entails. In temperate environments mass gain in female birds during breeding is often attributed to egg formation and mass loss after incubation to flight adaptation or the effect of reproductive workload, rather than as a result of an adaptive interrupted foraging response to the limited foraging time or unpredictable foraging conditions that breeding demands. In tropical environments, foraging conditions vary more within the breeding season than in temperate environments, and so studies in tropical environments are more suited to decouple the potentially confounded effects of increase in body reserves versus egg formation on the body mass of breeding birds. In this study, we test whether breeding results in an interrupted foraging response in a tropical savannah system using body mass data collected over a 15-year period from female Common Bulbuls Pycnonotus barbatus. This species breeds both in the wet and dry season, despite fewer resources being available in the dry season. Breeding stage predicted female body mass: body mass peaked abruptly during incubation, but was not closely associated with the egg-laying stage, and declined during brood rearing. Breeding females were heavier in the dry season than in the wet season. In the dry season, heavier birds were more likely to incubate eggs or brood chicks. These observations suggest that increased body reserves are required to buffer the consequence of limited foraging time or impoverished foraging conditions, which may be most pronounced during incubation and in the dry season, respectively. Such mass increases are consistent with an interrupted foraging response, which may apply to temperate zone birds experiencing foraging restrictions during breeding.PostprintPeer reviewe

The Dynamical Origin of the Multi-Planetary System HD45364

The recently discovered planetary system HD45364 which consists of a Jupiter and Saturn mass planet is very likely in a 3:2 mean motion resonance. The standard scenario to form planetary commensurabilities is convergent migration of two planets embedded in a protoplanetary disc. When the planets are initially separated by a period ratio larger than two, convergent migration will most likely lead to a very stable 2:1 resonance for moderate migration rates. To avoid this fate, formation of the planets close enough to prevent this resonance may be proposed. However, such a simultaneous formation of the planets within a small annulus, seems to be very unlikely. Rapid type III migration of the outer planet crossing the 2:1 resonance is one possible way around this problem. In this paper, we investigate this idea in detail. We present an estimate for the required convergent migration rate and confirm this with N-body and hydrodynamical simulations. If the dynamical history of the planetary system had a phase of rapid inward migration that forms a resonant configuration, we predict that the orbital parameters of the two planets are always very similar and hence should show evidence of that. We use the orbital parameters from our simulation to calculate a radial velocity curve and compare it to observations. Our model can explain the observational data as good as the previously reported fit. The eccentricities of both planets are considerably smaller and the libration pattern is different. Within a few years, it will be possible to observe the planet-planet interaction directly and thus distinguish between these different dynamical states.Comment: 9 pages, 9 figures - accepted for publication in Astronomy and Astrophysic

The effect of flight line spacing on radioactivity inventory and spatial feature characteristics of airborne gamma-ray spectrometry data

Airborne Gamma Spectrometry (AGS) is well suited to the mapping of radioactivity in the environment. Flight parameters (e.g. speed and line spacing) directly affect the rate of area coverage, cost, and data quality of any survey. The influences of line spacing have been investigated for data from inter‐tidal, coastal and upland environments with a range of <sup>137</sup>Cs activity concentrations and depositional histories. Estimates of the integrated <sup>137</sup>Cs activity (‘inventory’) within specified areas and the shapes of depositional features were calculated for subsets of the data at different line spacings. Features with dimensions greater than the line spacing show variations in inventory and area of less than 3%, and features with dimensions less than the line spacing show larger variations and a decreased probability of detection. The choice of line spacing for a task is dependent on the dimensions of the features of interest and required edge definition. Options for line spacing for different tasks are suggested. It is noted that for regional mapping, even 5–10 km line spacing can produce useful data

Implementation and adoption of nationwide electronic health records in secondary care in England: Final qualitative results from prospective national evaluation in "early adopter" hospitals

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.Objectives: To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design: Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting: 12 “early adopter” NHS acute hospitals and specialist caresettings studied over two and a half years. Data sources: Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researcher’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results: Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals. Conclusions: Implementation of the NHS Care Records Service in “early adopter” sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution

Secondary resonances of co-orbital motions

The size distribution of the stability region around the Lagrangian point L4 is investigated in the elliptic restricted three-body problem as the function of the mass parameter and the orbital eccentricity of the primaries. It is shown that there are minimum zones in the size distribution of the stability regions, and these zones are connected with secondary resonances between the frequencies of librational motions around L4. The results can be applied to hypothetical Trojan planets for predicting values of the mass parameter and the eccentricity for which such objects can be expected or their existence is less probable.Comment: 9 pages, 7 figures, accepted for publication in MNRA

Characteristics of neonatal near-miss in hospitals in Benin, Burkina Faso and Morocco in 2012-2013.

: The objective of this study is to explore the usefulness of neonatal near miss in low- and middle-income countries by examining the incidence of neonatal near miss and pre-discharge neonatal deaths across various obstetric risk categories in 17 hospitals in Benin, Burkina Faso and Morocco. : Data were collected on all maternal deaths, maternal near miss, neonatal near miss (based on organ-dysfunction markers), Caesarean sections, stillbirths, neonatal deaths before discharge and non-cephalic presentations, and on a sample of births not falling in any of the above categories. : The burden of stillbirth, pre-discharge neonatal death or neonatal near miss ranged from 23 to 129 per 1000 births in Moroccan and Beninese hospitals, respectively. Perinatal deaths (range 17-89 per 1000 births) were more common than neonatal near miss (range 6-43 per 1000 live births), and between a fifth and a third of women who had suffered a maternal near miss lost their baby. Pre-discharge neonatal deaths and neonatal near miss had a similar distribution of markers of organ dysfunction, but unlike pre-discharge neonatal deaths most neonatal near miss (63%, 81% and 71% in Benin, Burkina Faso and Morocco, respectively) occurred among babies who were not considered premature, low birthweight or with a low 5-min Apgar score as defined by WHO's pragmatic markers of severe neonatal morbidity. : Whether the measurement of neonatal near miss adds useful insights into the quality of perinatal or newborn care in settings where facility-based intrapartum and early newborn mortality is very high is uncertain. Perhaps the greatest advantage of adding near miss is the shift in focus from failure to success so that lessons can be learned on how to save lives even when clinical conditions are life-threatening.<br/

Sound archaeology: terminology, Palaeolithic cave art and the soundscape

This article is focused on the ways that terminology describing the study of music and sound within archaeology has changed over time, and how this reflects developing methodologies, exploring the expectations and issues raised by the use of differing kinds of language to define and describe such work. It begins with a discussion of music archaeology, addressing the problems of using the term ‘music’ in an archaeological context. It continues with an examination of archaeoacoustics and acoustics, and an emphasis on sound rather than music. This leads on to a study of sound archaeology and soundscapes, pointing out that it is important to consider the complete acoustic ecology of an archaeological site, in order to identify its affordances, those possibilities offered by invariant acoustic properties. Using a case study from northern Spain, the paper suggests that all of these methodological approaches have merit, and that a project benefits from their integration