Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions.

BackgroundThis study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension.MethodsWe used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors.ResultsThe average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33).ConclusionQuality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities

Description of a new approach for great auricular and auriculotemporal nerve blocks: A cadaveric study in foxes and dogs

Otitis externa is a painful condition that may require surgical intervention in dogs. A balanced analgesia protocol should combine systemic analgesic agents and local anaesthesia techniques. The aim of the study was to find anatomical landmarks for the great auricular and the auriculotemporal nerves that transmit nociceptive information from the ear pinna and to develop the optimal technique for a nerve block. The study consisted of two phases. In phase I, one fox cadaver was used for dissection and anatomical localization of the auricular nerves to derive landmarks for needle insertion. Eight fox cadavers were subsequently used to evaluate the accuracy of the technique by injecting methylene blue bilaterally. In phase II findings from phase I were applied in four Beagle canine cadavers. A block was deemed successful if more than 0.6 cm of the nerve's length was stained. Successful great auricular nerve block was achieved by inserting the needle superficially along the wing of the atlas with the needle pointing towards the jugular groove. For the auriculotemporal nerve block the needle was inserted perpendicular to the skin at the caudal lateral border of the zygomatic arch, close to the temporal process. The overall success rate was 24 out of 24 (100%) and 22 out of 24 (91%) for the great auricular and the auriculotemporal nerves, respectively, while the facial nerve was stained on three occasions. Our results suggest that it is feasible to achieve a block of the auricular nerves, based on anatomical landmarks, without concurrently affecting the facial nerv

Crossover Scales at the Critical Points of Fluids with Electrostatic Interactions

Criticality in a fluid of dielectric constant D that exhibits Ising-type behavior is studied as additional electrostatic (i.e., ionic) interactions are turned on. An exploratory perturbative calculation is performed for small ionicity as measured by the ratio of the electrostatic energy to the strength of the short-range nonionic (i.e., van der Waals) interactions in the uncharged fluid. With the aid of distinct transformations for the short-range and for the Coulombic interactions, an effective Hamiltonian with coefficients depending on the ionicity is derived at the Debye-Hueckel limiting-law level for a fully symmetric model. The crossover between classical (mean-field) and Ising behavior is then estimated using a Ginzburg criterion. This indicates that the reduced crossover temperature depends only weakly on the ionicity (and on the range of the nonionic potentials); however, the trends do correlate with the, much stronger, dependence observed experimentally.Comment: 25 pages, 4 figure; submitted to J. Chem. Phy

Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries.

BACKGROUND:mHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries' perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described. METHODS:A qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose. FINDINGS:The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries' views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS. CONCLUSIONS:mHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members

Stochastic Lag Time in Nucleated Linear Self-Assembly

Protein aggregation is of great importance in biology, e.g., in amyloid fibrillation. The aggregation processes that occur at the cellular scale must be highly stochastic in nature because of the statistical number fluctuations that arise on account of the small system size at the cellular scale. We study the nucleated reversible self-assembly of monomeric building blocks into polymer-like aggregates using the method of kinetic Monte Carlo. Kinetic Monte Carlo, being inherently stochastic, allows us to study the impact of fluctuations on the polymerisation reactions. One of the most important characteristic features in this kind of problem is the existence of a lag phase before self-assembly takes off, which is what we focus attention on. We study the associated lag time as a function of the system size and kinetic pathway. We find that the leading order stochastic contribution to the lag time before polymerisation commences is inversely proportional to the system volume for large-enough system size for all nine reaction pathways tested. Finite-size corrections to this do depend on the kinetic pathway

Chain-Length-Dependent Termination in Radical Polymerization of Acrylates

The technique of SP PLP EPR, which is single-pulse pulsed-laser polymerization (SP PLP) in conjunction with electron paramagnetic resonance (EPR) spectroscopy, is used to carry out a detailed investigation of secondary (chain-end) radical termination of acrylates. Measurements are performed on methyl acrylate, n-butyl acrylate and dodecyl acrylate in bulk and in toluene solution at –40 °C. The reason for the low temperature is to avoid formation of mid-chain radicals, a complicating factor that has imparted ambiguity to the results of previous studies of this nature. Consistent with these previous studies, composite-model behavior for chain-length-dependent termination rate coefficients, kt i,i, is found in this work. However, lower and more reasonable values of α s, the exponent for variation of kt i,i at short chain lengths, are found in the present study. Most likely this is because of the absence of mid-chain radicals, thereby validating the methodology of this work. Family-type termination behavior is observed, with the following average parameter values adequately describing all results, regardless of acrylate or the presence of toluene: α s = 0.79, α l = 0.21 (long chains) and ic ≈ 30 (crossover chain length). All indications are that these values carry over to termination of acrylate chain-end radicals at higher, more practical temperatures. Further, these values largely make sense in terms of what is understood about the physical meaning of the parameters. Variation of the rate coefficient for termination between monomeric radicals, kt 1,1, is found to be well described by the simple Smoluchowski and Stokes-Einstein equations. This allows easy prediction of kt 1,1 for different alkyl acrylates, solvent and temperature. Through all this the unrivalled power of SP PLP EPR for measuring and understanding (chain-length-dependent) termination rate coefficients shines through

Recent Advances in the Understanding of Termination in Radical Polymerization from Using the SP-PLP-EPR Technique

Since at least the 1940s, workers have been seeking to understand the kinetics of the fundamental radical-polymerization reaction of termination. This quest has not proven to be easy. Just under a decade ago, two game-changing advances were made that have unleashed rapid progress in the field: (1) The so-called ‘composite model’ was proposed: short radicals and long radicals are characterized by different scaling-law behavior in their rate of termination. (2) Single-pulse pulsed-laser polymerization (SP PLP) was coupled with electron paramagnetic resonance (EPR) spectroscopy to produce a remarkably potent new method for measuring chain-length-dependent termination (CLDT) rate coefficients, in particular those of short radicals. Essentially without exception, the SP-PLP-EPR method has revealed termination behavior in accord with the composite model. Here we summarize three recent SP-PLP-EPR studies, all involving new directions for the application of this technique

Ultrasonographic evaluation of tracheal collapse in dogs

Tracheal ultrasonography was performed to measure the width of the tracheal ring shadow and to assess the clinical relevance of these measurements for identifying tracheal collapse. The first tracheal ring width (FTRW) and thoracic inlet tracheal ring width (TITRW) were measured on both expiration and inspiration. The mean of the FTRW width (129 dogs) was greater in expiration (10.97 ± 1.02 mm, p = 0.001) than that in inspiration (9.86 ± 1.03 mm). For 51 normal dogs, the mean of the TITRW width was greater in expiration (9.05 ± 1.52 mm, p = 0.001) than in inspiration (8.02 ± 1.43 mm). For 78 tracheal collapse dogs, the mean of the TITRW width was greater in expiration (15.89 ± 1.01 mm, p = 0.001) than in inspiration (14.85 ± 1.17 mm). The TITRW/FTRW ratio of the normal dogs was higher (p = 0.001) in expiration (0.81 ± 0.09) than that in inspiration (0.79 ± 0.10). When compared between the normal and tracheal collapse dogs, the TITRW/FTRW ratio was also increased (p = 0.001) both in expiration (1.54 ± 0.09) and inspiration (1.47 ± 0.08), respectively. Based on these results, the cutoff level of the TITRW/FTRW ratio was statistically analyzed according to the receiver operating characteristic curve and it could be set at 1.16 in expiration and at 1.13 in inspiration. We have demonstrated that tracheal ultrasonography is a useful technique for the evaluation of tracheal collapse and it can be a supportive tool together with the radiographic findings for making the correct diagnosis