Remote synchronous usability testing of public access defibrillators during social distancing in a pandemic

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface

Preconception knowledge, beliefs and behaviours among people of reproductive age: a systematic review of qualitative studies.

The health of parents before pregnancy influences the short- and long-term health of their offspring. This systematic review explored the preconception knowledge, beliefs and behaviours held by women and men of childbearing age. Databases were searched from 2009 to 2022 (MEDLINE, CINAHL Full-text, PsycINFO, EMBASE). Inclusion criteria specified qualitative research papers which recruited individuals of reproductive age (16–45 years) without existing chronic illnesses. Data were quality assessed and analysed using thematic synthesis. Twelve papers met inclusion criteria. Six themes were identified (cultural context, pregnancy planning, knowledge, gender roles and responsibility, information seeking, prior health behaviours) which relate to individual, social, psychological and cultural factors. Cultural context was related to all other themes. Pregnancy planners had greater motivation to optimise their health whereas those not actively planning were focused more on becoming financially stable. Women and men's knowledge of how and why to engage in health protective behaviours was limited, with health risks and behaviour change discussed in the context of pregnancy rather than preconception. Gender roles influenced individual responsibility for preparation for pregnancy, which in turn influenced information seeking behaviours and engagement in health behaviours. Online sources of support and information were seen as desirable, regardless of pregnancy planning stage. Our findings indicate that behaviour change interventions designed to support people to optimise health before conception should address cultural, individual, social and psychological factors to facilitate behaviour change. Development of online resources may help to increase accessibility for people across different cultural contexts and stages of pregnancy planning

Keck/NIRC2 Imaging of the Warped, Asymmetric Debris Disk around HD 32297

We present Keck/NIRC2 $K_{s}$ band high-contrast coronagraphic imaging of the luminous debris disk around the nearby, young A star HD 32297 resolved at a projected separation of $r$ = 0.3-2.5\arcsec{} ($\approx$ 35-280 AU). The disk is highly warped to the north and exhibits a complex, "wavy" surface brightness profile interior to $r$ $\approx$ 110 AU, where the peaks/plateaus in the profiles are shifted between the NE and SW disk lobes. The SW side of the disk is 50--100% brighter at $r$ = 35-80 AU, and the location of its peak brightness roughly coincides with the disk's mm emission peak. Spectral energy distribution modeling suggests that HD 32297 has at least two dust populations that may originate from two separate belts likely at different locations, possibly at distances coinciding with the surface brightness peaks. A disk model for a single dust belt including a phase function with two components and a 5-10 AU pericenter offset explains the disk's warped structure and reproduces some of the surface brightness profile's shape (e.g. the overall "wavy" profile, the SB peak/plateau shifts) but more poorly reproduces the disk's brightness asymmetry. Although there may be alternate explanations, agreement between the SW disk brightness peak and disk's peak mm emission is consistent with an overdensity of very small, sub-blowout-sized dust and large, 0.1-1 mm-sized grains at $\approx$ 45 AU tracing the same parent population of planetesimals. New near-IR and submm observations may be able to clarify whether even more complex grain scattering properties or dynamical sculpting by an unseen planet are required to explain HD 32297's disk structure.Comment: 19 pages, 12 figures; ApJ in press (no text changes from previous version

Quality of care in prevention, detection and management of postpartum hemorrhage in hospitals in Afghanistan:an observational assessment

Background: Hemorrhage is the leading cause of maternal mortality worldwide and accounts for 56% of maternal deaths in Afghanistan. Postpartum hemorrhage (PPH) is commonly caused by uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The purpose of this study is to examine the quality of prevention, detection and management of PPH in both public and private hospitals in Afghanistan in 2016, and compare the quality of care in district hospitals with care in provincial, regional, and specialty hospitals. Methods: This study uses a subset of data from the 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment. It covers a census of all accessible public hospitals, including 40 district hospitals, 27 provincial hospitals, five regional hospitals, and five specialty hospitals, as well as 10 purposively selected private hospitals. Results: All public and private hospitals reported 24 h/7 days a week service provision. Oxytocin was available in 90.0% of district hospitals, 89.2% of provincial, regional and specialty hospitals and all 10 private hospitals; misoprostol was available in 52.5% of district hospitals, 56.8% of provincial, regional and specialty hospitals and in all 10 private hospitals. For prevention of PPH, 73.3% women in district hospitals, 71.2% women at provincial, regional and specialty hospitals and 72.7% women at private hospital received uterotonics. Placenta and membranes were checked for completeness in almost half of women in all hospitals. Manual removal of placenta was performed in 97.8% women with retained placenta. Monitoring blood loss during the immediate postpartum period was performed in 48.4% of women in district hospitals, 36.9% of women in provincial, regional and specialty hospitals, and 43.3% in private hospitals. The most commonly observed cause of PPH was retained placenta followed by genital tract trauma and uterine atony. Conclusion: Gaps in performance of skilled birth attendants are substantial across public and private hospitals. Improving and retaining skills of health workers through on-site, continuous capacity development approaches and encouraging a culture of audit, learning and quality improvement may address clinical gaps and improve quality of PPH prevention, detection and management

Perceptions of safe staffing, self-reported mental wellbeing and intentions to leave the profession among UK social workers:a mixed methods study

The purpose of the present study was to examine social workers perceptions of safe staffing levels and correlate these perceptions with standardised measurements of wellbeing in the UK. This cross-sectional mixed methods study analysed data from 406 social workers from November 2022 until late January 2023. Data were collected using anonymous online surveys including both qualitative and quantitative methods examining mental wellbeing, burnout, and intentions to leave the profession post-COVID-19. Findings revealed that only one-third of social workers responding perceived that they work in an environment of safe staffing. There were also significant differences in wellbeing and an increase in personal, work-related, and client-related burnout in social workers who believed their service did not operate a safe staff-to-service user ratio. Likewise, compared to those who perceived their service to operate within a safe staff-to-service-user ratio, those who perceived unsafe ratios were more likely to communicate their intention to leave the profession. Qualitative findings helped contextualize the quantitative results. These findings suggest that increased demand for social work services, shortage of qualified social workers, high workloads, inadequate resources, and retention problems, contribute to additional pressure on existing staff and have implications for policy, practice, and research in social work

Quality of care in early detection and management of pre-eclampsia/eclampsia in health facilities in Afghanistan

BackgroundAfghanistan faces a high burden of maternal and neonatal morbidity and mortality. Hypertensive disorders of pregnancy, including pre-eclampsia and eclampsia (PE/E), are among the most common causes of maternal and neonatal complications. Hypertensive disorders of pregnancy can lead to fatal complications for both the mother and fetus. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment assessed quality of early detection and management of PE/E in health facilities and skilled birth attendants' (SBAs) perceptions of their working environment.MethodsAll accessible public health facilities with an average of at least five births per day (n=77), a nationally representative sample of public health facilities with less than five births per day (n=149), and 20 purposively selected private health facilities were assessed. Methods included a facility inventory and record review, interviews with SBAs, and direct clinical observation of antenatal care (ANC), intrapartum care and immediate postnatal care (PNC), as well as severe PE/E case management.ResultsMost facilities had supplies and medicines for early detection and management of PE/E.At public health facilities, 357 of 414 (86.2%) clients observed during ANC consultations had their blood pressure checked and 159 (38.4%) were asked if they had experienced symptoms of PE/E. Only 553 of 734 (72.6%) SBAs interviewed were able to correctly identify severe pre-eclampsia described in a case scenario. Of 29 PE/E cases observed, 17 women (59%) received the correct loading dose of magnesium sulfate (MgSO4) and 12 women (41%) received the correct maintenance dose of MgSO4.At private health facilities, 39 of 45 ANC clients had their blood pressure checked and 9 of 45 (20%) were asked about symptoms of PE/E. Fifty-four of 64(84.4%) SBAs in private facilities correctly identified severe pre-eclampsia described in a case scenario.ConclusionNotable gaps in SBAs' knowledge and clinical practices in detection and management of PE/E in various health facilities increase the risk of maternal and perinatal mortality. Continuing education of health care providers and increased investment in focused quality improvement initiatives will be critical to improve the quality of health care services in Afghanistan

Planet formation: The case for large efforts on the computational side

Modern astronomy has finally been able to observe protoplanetary disks in reasonable resolution and detail, unveiling the processes happening during planet formation. These observed processes are understood under the framework of disk-planet interaction, a process studied analytically and modeled numerically for over 40 years. Long a theoreticians' game, the wealth of observational data has been allowing for increasingly stringent tests of the theoretical models. Modeling efforts are crucial to support the interpretation of direct imaging analyses, not just for potential detections but also to put meaningful upper limits on mass accretion rates and other physical quantities in current and future large-scale surveys. This white paper addresses the questions of what efforts on the computational side are required in the next decade to advance our theoretical understanding, explain the observational data, and guide new observations. We identified the nature of accretion, ab initio planet formation, early evolution, and circumplanetary disks as major fields of interest in computational planet formation. We recommend that modelers relax the approximations of alpha-viscosity and isothermal equations of state, on the grounds that these models use flawed assumptions, even if they give good visual qualitative agreement with observations. We similarly recommend that population synthesis move away from 1D hydrodynamics. The computational resources to reach these goals should be developed during the next decade, through improvements in algorithms and the hardware for hybrid CPU/GPU clusters. Coupled with high angular resolution and great line sensitivity in ground based interferometers, ELTs and JWST, these advances in computational efforts should allow for large strides in the field in the next decade.Comment: White paper submitted to the Astro2020 decadal surve

Dietary Supplementation with Soluble Plantain Non-Starch Polysaccharides Inhibits Intestinal Invasion of Salmonella Typhimurium in the Chicken

Soluble fibres (non-starch polysaccharides, NSP) from edible plants but particularly plantain banana (Musa spp.), have been shown in vitro and ex vivo to prevent various enteric pathogens from adhering to, or translocating across, the human intestinal epithelium, a property that we have termed contrabiotic. Here we report that dietary plantain fibre prevents invasion of the chicken intestinal mucosa by Salmonella. In vivo experiments were performed with chicks fed from hatch on a pellet diet containing soluble plantain NSP (0 to 200 mg/d) and orally infected with S.Typhimurium 4/74 at 8 d of age. Birds were sacrificed 3, 6 and 10 d post-infection. Bacteria were enumerated from liver, spleen and caecal contents. In vitro studies were performed using chicken caecal crypts and porcine intestinal epithelial cells infected with Salmonella enterica serovars following pre-treatment separately with soluble plantain NSP and acidic or neutral polysaccharide fractions of plantain NSP, each compared with saline vehicle. Bacterial adherence and invasion were assessed by gentamicin protection assay. In vivo dietary supplementation with plantain NSP 50 mg/d reduced invasion by S.Typhimurium, as reflected by viable bacterial counts from splenic tissue, by 98.9% (95% CI, 98.1–99.7; P<0.0001). In vitro studies confirmed that plantain NSP (5–10 mg/ml) inhibited adhesion of S.Typhimurium 4/74 to a porcine epithelial cell-line (73% mean inhibition (95% CI, 64–81); P<0.001) and to primary chick caecal crypts (82% mean inhibition (95% CI, 75–90); P<0.001). Adherence inhibition was shown to be mediated via an effect on the epithelial cells and Ussing chamber experiments with ex-vivo human ileal mucosa showed that this effect was associated with increased short circuit current but no change in electrical resistance. The inhibitory activity of plantain NSP lay mainly within the acidic/pectic (homogalacturonan-rich) component. Supplementation of chick feed with plantain NSP was well tolerated and shows promise as a simple approach for reducing invasive salmonellosis