Do not attempt resuscitation : the importance of consensual decisions

Aims: To describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (cpr / do not attempt resuscitation (dnar) decisions; to analyse decision patterns; and understand the practical implications. Design: A qualitative grounded theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in German-speaking Switzerland. Results: Establishing dnar orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of cpr predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit dnar decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. Conclusion: Establishing dnar orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education

Electrical transport and optical studies of ferromagnetic Cobalt doped ZnO nanoparticles exhibiting a metal-insulator transition

The observed correlation of oxygen vacancies and room temperature ferromagnetic ordering in Co doped ZnO1-o nanoparticles reported earlier (Naeem et al Nanotechnology 17, 2675-2680) has been further explored by transport and optical measurements. In these particles room temperature ferromagnetic ordering had been observed to occur only after annealing in forming gas. In the current work the optical properties have been studied by diffuse reflection spectroscopy in the UV-Vis region and the band gap of the Co doped compositions has been found to decrease with Co addition. Reflections minima are observed at the energies characteristic of Co+2 d-d (tethrahedral symmetry) crystal field transitions, further establishing the presence of Co in substitutional sites. Electrical transport measurements on palletized samples of the nanoparticles show that the effect of a forming gas is to strongly decrease the resistivity with increasing Co concentration. For the air annealed and non-ferromagnetic samples the variation in the resistivity as a function of Co content are opposite to those observed in the particles prepared in forming gas. The ferromagnetic samples exhibit an apparent change from insulator to metal with increasing temperatures for T>380K and this change becomes more pronounced with increasing Co content. The magnetic and resistive behaviors are correlated by considering the model by Calderon et al [M. J. Calderon and S. D. Sarma, Annals of Physics 2007 (Accepted doi: 10.1016/j.aop.2007.01.010] where the ferromagnetism changes from being mediated by polarons in the low temperature insulating region to being mediated by the carriers released from the weakly bound states in the higher temperature metallic region.Comment: 7 pages, 6 figure

Electronic structure studies of Fe- ZnO nanorods by x-ray absorption fine structure

We report the electronic structure studies of well characterized polycrystalline Zn_{1-x}Fe_xO (x = 0.0, 0.01, 0.03, and 0.05) nanorods synthesized by a co-precipitation method through x-ray absorption fine structure (XAFS). X-ray diffraction (XRD) reveals that Fe doped ZnO crystallizes in a single phase wurtzite structure without any secondary phase. From the XRD pattern, it is observed that peak positions shift towards lower 2\theta value with Fe doping. The change in the peak positions with increase in Fe contents clearly indicates that Fe ions are replacing Zn ions in the ZnO matrix. Linear combination fittings (LCF) at Fe K-edge demonstrate that Fe is in mixed valent state (Fe3+/Fe2+) with a ratio of ~ 7:3 (Fe3+:Fe2+). XAFS data is successfully fitted to wurtzite structure using IFEFFIT and Artemis. The results indicate that Fe substitutes Zn site in the ZnO matrix in tetrahedral symmetry.Comment: 7 pages, 5 figures, 2 tables, regular articl

Bulk and Surface Magnetization of Co atoms in Rutile Ti_[1-x]Co_xO_[2-delta] Thin Films Revealed by X-Ray Magnetic Circular Dichroism

We have studied magnetism in Ti_[1-x]Co_xO_[2-\delta] thin films with various x and \delta by soft x-ray magnetic circular dichroism (XMCD) measurements at the Co L_[2,3] absorption edges. The estimated ferromagnetic moment by XMCD was 0.15-0.24 \mu\beta/Co in the surface, while in the bulk it was 0.82-2.25 \mu\beta/Co, which is in the same range as the saturation magnetization of 1.0-1.5 \mu\beta/Co. Theseresults suggest that the intrinsic origin of the erromagnetism. The smaller moment of Co atom at surface is an indication of a magnetically dead layer of a few nm thick at the surface of the thin films.Comment: This Paper is accepted in J. of Phys: Conds. Matte

Ab initio study of magnetism at the TiO2/LaAlO3 interface

In this paper we study the possible relation between the electronic and magnetic structure of the TiO2/LaAlO3 interface and the unexpected magnetism found in undoped TiO2 films grown on LaAlO$_3$. We concentrate on the role played by structural relaxation and interfacial oxygen vacancies. LaAlO3 has a layered structure along the (001) direction with alternating LaO and AlO2 planes, with nominal charges of +1 and -1, respectively. As a consequence of that, an oxygen deficient TiO2 film with anatase structure will grow preferently on the AlO2 surface layer. We have therefore performed ab-initio calculations for superlattices with TiO2/AlO2 interfaces with interfacial oxygen vacancies. Our main results are that vacancies lead to a change in the valence state of neighbour Ti atoms but not necessarily to a magnetic solution and that the appearance of magnetism depends also on structural details, such as second neighbor positions. These results are obtained using both the LSDA and LSDA+U approximations.Comment: Accepted for publication in Journal of Materials Scienc

Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: a qualitative evaluation

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. Methods: A qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya. Results: The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services. Conclusions: The above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.The Bill and Melinda Gates Foundatio

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh

<p>Abstract</p> <p>Background</p> <p>Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services.</p> <p>Methods/Design</p> <p>Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed.</p> <p>Discussion</p> <p>This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality.</p

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia

Background: Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by government and/or development partners. Broadly termed “demand-side financing” or “output-based aid,” these strategies include a range of interventions that channel government or donor subsidies to the user rather than the service provider. Initial pilot assessments of reproductive health voucher programs suggest that they can increase access, reduce inequities, and enhance program efficiency and service quality. However, there is a paucity of evidence describing how these programs function in different settings for various reproductive health services. Methods/Design: Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the “voucher and accreditation” approaches to improving the reproductive health of low-income women in Cambodia. The study comprises four populations: facilities, providers, women of reproductive age using facilities, and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in a sample of 20 health facilities that are accredited to provide maternal and newborn health and family planning services to women holding vouchers from operational districts in three provinces: Kampong Thom, Kampot, and Prey Veng and a matched sample of non-accredited facilities in three other provinces. Health facility assessments will be conducted at baseline and endline to track temporal changes in quality of care, client out-of-pocket costs, and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3,000 respondents will also be conducted in areas where vouchers are distributed and similar non-voucher locations. Discussion: A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status, and reducing inequities at the population level and assess effects on access, equity, and quality of care at the facility level. If the voucher scheme in Cambodia is found effective, it may help other countries adopt this approach for improving utilization and access to reproductive health and family planning services

Transposon mutagenesis in Mycobacterium kansasii links a small RNA gene to colony morphology and biofilm formation and identifies 9,885 intragenic insertions that do not compromise colony outgrowth

Mycobacterium kansasii (Mk) is a resilient opportunistic human pathogen that causes tuberculosis-like chronic pulmonary disease and mortality stemming from comorbidities and treatment failure. The standard treatment of Mk infections requires costly, long-term, multidrug courses with adverse side effects. The emergence of drug-resistant isolates further complicates the already challenging drug therapy regimens and threatens to compromise the future control of Mk infections. Despite the increasingly recognized global burden of Mk infections, the biology of this opportunistic pathogen remains essentially unexplored. In particular, studies reporting gene function or generation of defined mutants are scarce. Moreover, no transposon (Tn) mutagenesis tool has been validated for use in Mk, a situation limiting the repertoire of genetic approaches available to accelerate the dissection of gene function and the generation of gene knockout mutants in this poorly characterized pathogen. In this study, we validated the functionality of a powerful Tn mutagenesis tool in Mk and used this tool in conjunction with a forward genetic screen to establish a previously unrecognized role of a conserved mycobacterial small RNA gene of unknown function in colony morphology features and biofilm formation. We also combined Tn mutagenesis with next-generation sequencing to identify 12,071 Tn insertions that do not compromise viability in vitro. Finally, we demonstrated the susceptibility of the Galleria mellonella larva to Mk, setting the stage for further exploration of this simple and economical infection model system to the study of this pathogen