Health care providers' knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study

BACKGROUND: Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide despite its often-preventable nature. Understanding health care providers' knowledge of clinical protocols is imperative for improving quality of care and reducing mortality. This is especially pertinent in referral and teaching hospitals that train nursing and medical students and interns in addition to managing emergency and referral cases. METHODS: This study aimed to (1) measure health care providers' knowledge of clinical protocols for risk assessment, prevention, and management of PPH in 3 referral hospitals in Kenya and (2) examine factors associated with providers' knowledge. We developed a knowledge assessment tool based on past studies and clinical guidelines from the World Health Organization and the Kenyan Ministry of Health. We conducted in-person surveys with health care providers in three high-volume maternity facilities in Nairobi and western Kenya from October 2018-February 2019. We measured gaps in knowledge using a summative index and examined factors associated with knowledge (such as age, gender, qualification, experience, in-service training attendance, and a self-reported measure of peer-closeness) using linear regression. RESULTS: We interviewed 172 providers including consultants, medical officers, clinical officers, nurse-midwives, and students. Overall, knowledge was lowest for prevention-related protocols (an average of 0.71 out of 1.00; 95% CI 0.69-0.73) and highest for assessment-related protocols (0.81; 95% CI 0.79-0.83). Average knowledge scores did not differ significantly between qualified providers and students. Finally, we found that being a qualified nurse, having a specialization, being female, having a bachelor's degree and self-reported closer relationships with colleagues were statistically significantly associated with higher knowledge scores. CONCLUSION: We found gaps in knowledge of PPH care clinical protocols in Kenya. There is a clear need for innovations in clinical training to ensure that providers in teaching referral hospitals are prepared to prevent, assess, and manage PPH. It is possible that training interventions focused on learning by doing and teamwork may be beneficial

Pennsylvania Folklife Vol. 31, No. 3

• Jamison City • Domestic Architecture in Lancaster County • Conversation with Marguerite de Angeli • Who Put the Turnip on the Grave? • Pennsylfawnisch Deitsch un Pfalzer: Dialect Comparisons Old and New • John Philip Boehm: Pioneer Pennsylvania Pastor • The Search for our German Ancestors • Aldes un Neieshttps://digitalcommons.ursinus.edu/pafolklifemag/1095/thumbnail.jp

Rosetta-Alice Observations of Exospheric Hydrogen and Oxygen on Mars

The European Space Agency's Rosetta spacecraft, en route to a 2014 encounter with comet 67P/Churyumov-Gerasimenko, made a gravity assist swing-by of Mars on 25 February 2007, closest approach being at 01:54UT. The Alice instrument on board Rosetta, a lightweight far-ultraviolet imaging spectrograph optimized for in situ cometary spectroscopy in the 750-2000 A spectral band, was used to study the daytime Mars upper atmosphere including emissions from exospheric hydrogen and oxygen. Offset pointing, obtained five hours before closest approach, enabled us to detect and map the HI Lyman-alpha and Lyman-beta emissions from exospheric hydrogen out beyond 30,000 km from the planet's center. These data are fit with a Chamberlain exospheric model from which we derive the hydrogen density at the 200 km exobase and the H escape flux. The results are comparable to those found from the the Ultraviolet Spectrometer experiment on the Mariner 6 and 7 fly-bys of Mars in 1969. Atomic oxygen emission at 1304 A is detected at altitudes of 400 to 1000 km above the limb during limb scans shortly after closest approach. However, the derived oxygen scale height is not consistent with recent models of oxygen escape based on the production of suprathermal oxygen atoms by the dissociative recombination of O2+.Comment: 17 pages, 8 figures, accepted for publication in Icaru

Risk-shifting Through Issuer Liability and Corporate Monitoring

This article explores how issuer liability re-allocates fraud risk and how risk allocation may reduce the incidence of fraud. In the US, the apparent absence of individual liability of officeholders and insufficient monitoring by insurers under-mine the potential deterrent effect of securities litigation. The underlying reasons why both mechanisms remain ineffective are collective action problems under the prevailing dispersed ownership structure, which eliminates the incentives to moni-tor set by issuer liability. This article suggests that issuer liability could potentially have a stronger deterrent effect when it shifts risk to individuals or entities holding a larger financial stake. Thus, it would enlist large shareholders in monitoring in much of Europe. The same risk-shifting effect also has implications for the debate about the relationship between securities litigation and creditor interests. Credi-tors’ claims should not be given precedence over claims of defrauded investors (e.g., because of the capital maintenance principle), since bearing some of the fraud risk will more strongly incentivise large creditors, such as banks, to monitor the firm in jurisdictions where corporate debt is relatively concentrated

Australian Education Joins the OECD : Federalism, Regionalization, and the Role of Education in a Time of Transition

This chapter argues that Australian interactions with the Organisation for Economic Co-operation and Development (OECD) in the field of education in the mid- to late-1970s pointed in two separate but not yet incompatible directions—one equity-oriented and the other more in line with the standardization and accountability regime typically identified with the OECD’s current policies—both of which favored a shift of authority toward the national level in educational policy-making. In the process, the chapter highlights the importance of considering movements between different spatial levels of analysis when tracing the ability of international organizations to get their ideas and visions “out of house.” The chapter first outlines the international and domestic contexts for Australia’s early involvement in the OECD, followed by a discussion of the negotiations of state and federal interests on the Australian Commonwealth Department of Education’s advisory committee on OECD matters. This discussion, in turn, frames the last three analytical sections of the chapter, on interactions between the OECD and the Australian education authorities at different levels on initiatives negotiating both the location of authority between these levels and the role of education at a time when the relation between its social and economic potential was up for revision.Non peer reviewe

A Prompt to the Web: The Media and Health Information Seeking Behaviour

UNLABELLED: OBJECTIVE, DESIGN, SETTING AND PARTICIPANTS: The objective was to investigate media influence on consumers' health related behaviours. A cross-sectional survey of randomly selected adults (18+ years) residing in the Hunter Region of New South Wales Australia was conducted. The sample was selected using a combination of the white pages and random digit dialling. MAIN OUTCOME MEASURES: The proportions of respondents who recalled seeing or hearing about conditions or treatments in the media over the 12 months prior to interview (August 2009-August 2010) and their subsequent health related behaviour. RESULTS: Although most survey participants reported seeking health information from their doctors, around two-thirds of survey participants (551, 68.8%) recalled hearing, seeing or reading about one or more medical conditions (total = 1097 instances) in the mainstream media over the past 12 months. Almost 40% of respondents (307, 38.4%) stated that they had looked for more information about a condition as a result of hearing about it in the media, and most used the internet (269, 87.4%). More than a quarter of respondents (215, 26.9%) indicated that they had asked their doctor about a condition they had heard about in the media. Around half of those who asked their doctor (109, 50.6%) reported that their inquiry resulted in them receiving treatment, of whom almost half (53, 48.3%) reported being prescribed a medicine. CONCLUSION: The survey results show that consumers become aware of medicines through traditional media and then to learn more often turn to the internet where quality of information may be poor

In and around: identifying predictors of theft within and near to major mass underground transit systems

This article identifies factors that encourage or reduce pick-pocketing at underground rail stations through a case study analysis of the London Underground. Negative binomial Poisson regression models found predictor variables of pick-pocketing selected from the internal characteristics of stations and features of their nearby surroundings. Factors that increased risk were those associated with greater congestion inside stations including lifts, waiting rooms and fewer platforms; and increased levels of accessibility near stations, more paths and roads. Features that reduced risk were those likely to encourage detection and guardianship; stations with more personal validators, staffing levels and shop rentals; and the presence of more domestic buildings nearby. Station type was also influential; those that were ‘attractors’ of crime and those frequently used by tourists were at greater risk. The findings suggest a transmission of theft risk between the internal settings of underground stations and their nearby surroundings

What is a Cool-Core Cluster? A Detailed Analysis of the Cores of the X-ray Flux-Limited HIFLUGCS Cluster Sample

We use the largest complete sample of 64 galaxy clusters (HIghest X-ray FLUx Galaxy Cluster Sample) with available high-quality X-ray data from Chandra, and apply 16 cool-core diagnostics to them, some of them new. We also correlate optical properties of brightest cluster galaxies (BCGs) with X-ray properties. To segregate cool core and non-cool-core clusters, we find that central cooling time, t_cool, is the best parameter for low redshift clusters with high quality data, and that cuspiness is the best parameter for high redshift clusters. 72% of clusters in our sample have a cool core (t_cool < 7.7 h_{71}^{-1/2} Gyr) and 44% have strong cool cores (t_cool <1.0 h_{71}^{-1/2} Gyr). For the first time we show quantitatively that the discrepancy in classical and spectroscopic mass deposition rates can not be explained with a recent formation of the cool cores, demonstrating the need for a heating mechanism to explain the cooling flow problem. [Abridged]Comment: 45 pages, 19 figures, 7 tables. Accepted for publication in A&A. Contact Person: Rupal Mittal ([email protected]