Home births in the Mosvold health ward of KwaZulu

A community survey was carried out to determine the frequency and the methods of home deliveries in the Mosvold health ward in northern KwaZulu. Of a sample of 210 mothers interviewed 46% had given birth at home, and of these 48% were delivered by traditional birth attendants; 84% gave birth in a kneeling or sitting position. In 32% of cases handling of the umbilical stump was unhygienic and potentially tetanogenic. Asked their reason for giving birth at home, most mothers gave transport problems and' sudden or unexpected onset of labour as their main reason, although a majority of grand multiparas expressed a preference for home delivery. Various recommendations are made on the basis of these findings

Improved outer boundary conditions for Einstein's field equations

In a recent article, we constructed a hierarchy B_L of outer boundary conditions for Einstein's field equations with the property that, for a spherical outer boundary, it is perfectly absorbing for linearized gravitational radiation up to a given angular momentum number L. In this article, we generalize B_2 so that it can be applied to fairly general foliations of spacetime by space-like hypersurfaces and general outer boundary shapes and further, we improve B_2 in two steps: (i) we give a local boundary condition C_2 which is perfectly absorbing including first order contributions in 2M/R of curvature corrections for quadrupolar waves (where M is the mass of the spacetime and R is a typical radius of the outer boundary) and which significantly reduces spurious reflections due to backscatter, and (ii) we give a non-local boundary condition D_2 which is exact when first order corrections in 2M/R for both curvature and backscatter are considered, for quadrupolar radiation.Comment: accepted Class. Quant. Grav. numerical relativity special issue; 17 pages and 1 figur

Testing outer boundary treatments for the Einstein equations

Various methods of treating outer boundaries in numerical relativity are compared using a simple test problem: a Schwarzschild black hole with an outgoing gravitational wave perturbation. Numerical solutions computed using different boundary treatments are compared to a `reference' numerical solution obtained by placing the outer boundary at a very large radius. For each boundary treatment, the full solutions including constraint violations and extracted gravitational waves are compared to those of the reference solution, thereby assessing the reflections caused by the artificial boundary. These tests use a first-order generalized harmonic formulation of the Einstein equations. Constraint-preserving boundary conditions for this system are reviewed, and an improved boundary condition on the gauge degrees of freedom is presented. Alternate boundary conditions evaluated here include freezing the incoming characteristic fields, Sommerfeld boundary conditions, and the constraint-preserving boundary conditions of Kreiss and Winicour. Rather different approaches to boundary treatments, such as sponge layers and spatial compactification, are also tested. Overall the best treatment found here combines boundary conditions that preserve the constraints, freeze the Newman-Penrose scalar Psi_0, and control gauge reflections.Comment: Modified to agree with version accepted for publication in Class. Quantum Gra

Stigmatic attitudes towards mentally ill patients in Hungary between 2001 and 2015: results of a time-trend analysis

Background: Stigmatic attitudes towards people with the diagnosis of mental illness are widespread in the general public [1] and are the major obstacle for successful treatment, rehabilitation and reintegration of patients into the society [2]. Given the magnitude of this issue, and in the effort to develop effective anti stigma intervention programs, trend analysis studies were conducted, examining the changes in attitudes over the years [3]. The construct of social distance, which involves the desire to avoid contact with a particular group of people was commonly used to assess stigma. These studies have consistently reported that despite the improvement in mental health literacy of the public, social distance preferences concerning mentally ill patients have not changed over the last 20 years, and in some cases have even increased [3]. However, the number of studies using trend analysis is scarce and mainly limited to wealthier countries because such studies are both costly and time intensive. Consequently, most studies to date have been carried out in North Western Europe whereas data from Central and Eastern European countries, especially from former communist countries, is lacking [4,5]. Objective: In the face of underfinanced mental health system and the lack of any national anti-stigma programs or research, the aim of this study is to shed light into mental illness stigma in Hungary. More specifically, this study aimed to explore for the first time, potential changes concerning attitudes of the Hungarian population towards mentally ill patients. Method: National representative surveys (N=7605) of adults aged 18-53 years were carried out in Hungary in 2001, 2003, 2007 and 2015. An interview was conducted, asking for socio-demographic information and participants' desire for social distance from mentally ill patients, measured by Bogardus social distance scale. In order to put into context the stigmatic attitudes towards mentally ill patients, participants were also asked to report on their social distance preferences towards other minorities in the Hungarian society. Trend analysis was performed to examine the trends of social distance. Results: Time-trend analysis indicated a significant (positive) trend in public preferences for social distance towards more accepting attitudes during the years of 2001-2015. However, closer examination reveals that the effect size is very small (0.05) and the 2015 rejection level is still high (57%) compared to over 60% in both 2001 and 2003. Moreover, during a period of 15 years, mentally ill patients are among the three most rejected groups in the society (with only alcoholics and drug users being more rejected). Conclusions: As was found in other countries around the world, in Hungary as well, stigmatic attitudes towards mentally ill patients are highly prevalent, and have not changed over the last decade. While stressing a worrisome reality in Hungary, where no efforts to tackle mental illness stigma were done, this study also verifies the enormity of the stigma phenomenon. It is evident, maybe more than anything, that much effort is needed in Hungary, but also worldwide, in order to understand and defeat mental illness stigma

An axisymmetric evolution code for the Einstein equations on hyperboloidal slices

We present the first stable dynamical numerical evolutions of the Einstein equations in terms of a conformally rescaled metric on hyperboloidal hypersurfaces extending to future null infinity. Axisymmetry is imposed in order to reduce the computational cost. The formulation is based on an earlier axisymmetric evolution scheme, adapted to time slices of constant mean curvature. Ideas from a previous study by Moncrief and the author are applied in order to regularize the formally singular evolution equations at future null infinity. Long-term stable and convergent evolutions of Schwarzschild spacetime are obtained, including a gravitational perturbation. The Bondi news function is evaluated at future null infinity.Comment: 21 pages, 4 figures. Minor additions, updated to agree with journal versio

Adaptive Mesh Refinement for Characteristic Grids

I consider techniques for Berger-Oliger adaptive mesh refinement (AMR) when numerically solving partial differential equations with wave-like solutions, using characteristic (double-null) grids. Such AMR algorithms are naturally recursive, and the best-known past Berger-Oliger characteristic AMR algorithm, that of Pretorius & Lehner (J. Comp. Phys. 198 (2004), 10), recurses on individual "diamond" characteristic grid cells. This leads to the use of fine-grained memory management, with individual grid cells kept in 2-dimensional linked lists at each refinement level. This complicates the implementation and adds overhead in both space and time. Here I describe a Berger-Oliger characteristic AMR algorithm which instead recurses on null \emph{slices}. This algorithm is very similar to the usual Cauchy Berger-Oliger algorithm, and uses relatively coarse-grained memory management, allowing entire null slices to be stored in contiguous arrays in memory. The algorithm is very efficient in both space and time. I describe discretizations yielding both 2nd and 4th order global accuracy. My code implementing the algorithm described here is included in the electronic supplementary materials accompanying this paper, and is freely available to other researchers under the terms of the GNU general public license.Comment: 37 pages, 15 figures (40 eps figure files, 8 of them color; all are viewable ok in black-and-white), 1 mpeg movie, uses Springer-Verlag svjour3 document class, includes C++ source code. Changes from v1: revised in response to referee comments: many references added, new figure added to better explain the algorithm, other small changes, C++ code updated to latest versio

Targeting angiogenesis as a therapeutic means to reinforce osteocyte survival and prevent nonunions in the aftermath of radiotherapy

BackgroundRadiotherapy (XRT) exerts detrimental collateral effects on bone tissue through mechanisms of vascular damage and impediments to osteocytes, ultimately predisposing patients to the debilitating problems of late pathologic fractures and nonunions. We posit that angiogenic therapy will reverse these pathologic effects in a rat model of radiated fracture healing.MethodsThree groups of rats underwent mandibular osteotomy. Radiated groups received a fractionated 35‐Gy dose before surgery. The deferoxamine (DFO) group received local injections postoperatively. A 40‐day healing period was allowed before histology. Analysis of variance (ANOVA; p < .05) was used for group comparisons.ResultsRadiated fractures revealed a significantly decreased osteocyte count and corresponding increase in empty lacunae when compared to nonradiated fractures (p = .001). With the addition of DFO, these differences were not appreciated. Further, a 42% increase in bony unions was observed after DFO therapy.ConclusionTargeting angiogenesis is a useful means for promoting osteocyte survival and preventing bone pathology after XRT. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1261–1267, 2015Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113164/1/hed23744.pd

The paradoxical role of insight in mental illness: the experience of stigma and shame in schizophrenia, mood disorders, and anxiety disorders

This study examined the factor structure of the Hungarian version of the Birchwood Insight Scale (BIS) and analyzed its association with socio-demographics, diagnosis, internalized stigma, and shame using confirmatory factor analysis (CFA) with covariates. Mentally ill patients (N = 200) completed self-report questionnaires. CFA supported a two-factor structure. While previous hospitalizations and diagnosis were associated with insight, insight predicted higher internalized stigma and shame. Efforts to increase insight should be matter of importance in the wider spectrum of mental diagnoses. However, such efforts should be conducted with special care as further research is needed to understand the impact of insight on wellbeing

Constraint-preserving boundary treatment for a harmonic formulation of the Einstein equations

We present a set of well-posed constraint-preserving boundary conditions for a first-order in time, second-order in space, harmonic formulation of the Einstein equations. The boundary conditions are tested using robust stability, linear and nonlinear waves, and are found to be both less reflective and constraint preserving than standard Sommerfeld-type boundary conditions.Comment: 18 pages, 7 figures, accepted in CQ