A research agenda to improve incidence and outcomes of assisted vaginal birth.

Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Herd-Level Risk Factors for Lameness, Leg Injuries, Thin Body Condition and Mastitis on Algerian Dairy Farms

This present study aims to investigate the relationship of herd characteristics and management practices with the prevalence of clinical and severe lameness, hock and knee injuries, thin cows, and mastitis at the herd level on Algerian dairy farms. Altogether 1210 dairy cows from 107 farms were examined and the clinical aspects related to studied affections were recorded. Multivariable regression models were built to analyse the relationship between the risk factors and the occurrence of health indicators. Overlay, the health outcomes were multifactorial, with pasture access (P < 0.001), scraping frequency (P < 0.01), and floor regularity (P = 0.05) as the main factors causing lameness. Factors associated with both hock and knee injuries (score ≥ 2) were lower cow number (P < 0.01), more days spent on pasture (P < 0.001), and poorer straw amount for bedding (P < 0.001). Some farming practice, in particular, providing proper amount of concentrate feeds (P < 0.001), higher scraping frequency (P < 0.01), thicker bedding (P < 0.001), and having younger dairy cows (P = 0.058), were associated with a lower within-herd prevalence of thin cows. While, more days on pasture increased the percentage of under-conditioned cows (P < 0.01). The inadequate hygienic conditions of the floor (P < 0.001), improper milking procedures (P < 0.05), and shorter dry period (P < 0.05) increased the clinical mastitis occurrence. Our results highlighted the specific management practices responsible for increasing health risks and provided useful information for the farmers and veterinarians to make preventive and controlling strategies for lameness, leg injuries, low body condition and mastitis on dairy farms

Camel herds’ reproductive performance in Algeria: Objectives and thresholds in extreme arid conditions

A survey was carried out for evaluating camel herd's fertility and fecundity under Algerian extreme arid conditions. Progeny History Testing data obtained from 14 camel herds (78 females and 20 males) were analyzed and compared with standard objectives and thresholds. The age at first rut, the first oestrus, first male and female mating (months ± SD) were 37.2 ± 16.29, 31.07 ± 8.97, 42.6 ± 14.28 and 35.52 ± 8.55, respectively. The birth conception interval, open days, age at first calving and calving interval were 40.35 ± 9.41 months, 340 ± 203 days, 51.05 ± 9.59 months and 22.32 ± 5.63 months. The mean male to female ratio was 1:40. Pregnancy diagnosis was performed 21.81 ± 16.4 (days) post-mating and the duration of pregnancy was on average 12.80 ± 0.30 months. The mean herd's annual fertility was 56.2 ± 6.6%; the mean culling age of males per herd was 15.30 ± 2.47 years whereas females were culled at 23.31 ± 5.64 years with a mean number of 5.23 ± 2.91 lactations. The observed reproductive traits were acceptable when compared to the fixed objectives for pastoral livestock. However, all the considered herds showed annual fertility out of threshold. The lack of significant strategy to improve age at first calving, calving interval and reasoned use of dromedary bulls, is likely to affect fertility and productivity of Algerian camel herds. Such negative trend could hamper the genetic improvement of autochthonous camel ecotypes and compromise the camel sector and the ecosystemic services provided by local cameleers

Cross-national differences in consumers’ willingness to pay (WTP) more for green hotels

This paper examines valuable main predictors of the so-called green consumption and drivers of consumers' capabilities to pay more for eco-green accommodation services across seven countries, utilizing a sample of 5270 consumers. SEM approach was utilised in assessing the significant of model's relations and research constructs. The main findings revealed that subjective norm, perceived consumer's effectiveness, personal moral norm, environmental concerns, extraversion, agreeableness, attitudes, and intentions are main motivations of customers' capable to pay more across countries. Moreover, results showed that the idiom term “one-size-fits-all” technique is inadequate for accounting diversity for different customers in different nations. A multigroup investigation highlighted considerably various results and associations, in what way subjective norm, perceived consumers effectiveness, environmental concerns, agreeableness, attitudes, and intentions influence purchasers of green hotels products to pay more across countries. The implications of the current research for practice have great values for hotels and rural accommodations in addition to other tourism businesses in action maximize different green policies and efforts to encourage enviro-green responsible purchasing decisions.</p