Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs

Anomalous Paramagnetic Effects in the Mixed State of LuNi2B2C

Anomalous paramagnetic effects in dc magnetization were observed in the mixed state of LuNi2B2C, unlike any reported previously. It appears as a kink-like feature for H > 30 kOe and becomes more prominent with increasing field. A specific heat jump at the corresponding temperature suggests that the anomaly is due to a true bulk transition. A magnetic flux transition from a square to an hexagonal lattice is consistent with the anomaly.Comment: 5 pages, 4 figure

A Novel Dielectric Anomaly in Cuprates and Nickelates: Signature of an Electronic Glassy State

The low-frequency dielectric response of hole-doped insulators La_{2}Cu_{1-x}Li_{x}O_{4} and La_{2-x}Sr_{x}NiO_{4} shows a large dielectric constant \epsilon ^{'} at high temperature and a step-like drop by a factor of 100 at a material-dependent low temperature T_{f}. T_{f} increases with frequency and the dielectric response shows universal scaling in a Cole-Cole plot, suggesting that a charge glass state is realized both in the cuprates and in the nickelates.Comment: 5 pages, 4 figure

Examining the content and moderators of women's fears for giving birth: A meta-synthesis

Aims and objectives: This meta‐synthesis aimed to identify key elements contributing to FOC derived from women's own reports. Background: Fear of childbirth (FOC) encompasses fear or anxiety about giving birth, which can resemble a phobic response. FOC holds implications for women's antenatal and postnatal well‐being, and decisions made about the birth but a clear definition of the construct does not exist. Method: A meta‐synthesis was conducted by searching databases (Web of Knowledge, CINAHL, EBSCO, MEDLINE, PsychInfo and PsychArticles) for qualitative studies describing women's perspectives with respect to fear, anxiety, concerns, phobia or stress about birth. A total of 25 papers, reporting findings from 24 studies, fulfilled eligibility criteria and were included in the synthesis. Results: Six key elements of FOC were identified; fears of the unknown, potential for injury, pain, capacity to give birth, losing control and adequacy of support from care providers. A single overarching theme linking all elements was “the unpredictability of childbirth.” Three moderators of FOC were also identified; awareness of negative birthing experiences, information received about birth and support received from care providers. Conclusions: Findings highlight the role of uncertainty in the birthing process as an overarching theme underpinning women's fears. Enhancing tolerance of uncertainty may be a way to reduce women's FOC. Relevance to clinical practice: Identification of the elements and moderators of FOC provide an insight into the potential mechanisms that contribute to women's fears, which can be used to inform methods of identifying women with FOC or a basis upon which to base supportive strategies to reduce women's fears for giving birth

High pressure investigation of the heavy-fermion antiferromagnet U_3Ni_5Al_19

Measurements of magnetic susceptibility, specific heat, and electrical resistivity at applied pressures up to 55 kbar have been carried out on single crystals of the heavy-fermion antiferromagnet U_3Ni_5Al_19, which crystallizes in the Gd_3Ni_5Al_19 orthorhombic structure with two inequivalent U sites. At ambient pressure, a logarithmic T-dependence of the specific heat and T-linear electrical resistivity below 5 K indicates non-Fermi liquid (NFL) behavior in the presence of bulk antiferromagnetic order at T_N=23 K. Electrical resistivity measurements reveal a crossover from non-Fermi liquid to Fermi liquid behavior at intermediate pressures between 46 kbar and 51 kbar, followed by a return to NFL T^{3/2} behavior at higher pressures. These results provide evidence for an ambient pressure quantum critical point and an additional antiferromagnetic instability at P_c=60 kbar.Comment: 12 pages, 5 figure

Correlation Effects on Optical Conductivity of FeSi

Effects of electron correlation in FeSi are studied in terms of the two-band Hubbard model with the density of states obtained from the band calculation. Using the self-consistent second-order perturbation theory combined with the local approximation, the correlation effects are investigated on the density of states and the optical conductivity spectrum, which are found to reproduce the experiments done by Damascelli et al. semiquantitatively. It is also found that the peak at the gap edge shifts to lower energy region by correlation effects, as is seen in the experiments.Comment: 4 pages, 3 figure

Slovenian midwifery professionalisation: Perception of midwives and related health professions

Introduction: This article presents research into the professionalisation of midwifery in Slovenia. Since recognition by related occupations is important for professions, this comparative study asked doctors and nurses in Slovenia about their perceptions of the status of midwifery. Method: A questionnaire survey was conducted with 300 Slovenian midwives, 666 nurses and 416 obstetricians. The questionnaire included statements covering traditional sociological notions of the profession (ethics, theory, power), and three notions based on new elements of professionalism (reflective practice, interdisciplinary working and partnership with clients). Results: Results suggest that nurses perceived themselves to be less autonomous than midwives, and this partly explains why most nurses thought that midwifery should be a specialised course of study, after the general nursing diploma. Obstetricians claimed to support midwives, however they did not give midwives credit for basic midwifery competencies and did not feel midwifery to be equal to their profession. Midwives revealed not to feel autonomous; they felt that nursing and obstetrics is jeopardizing independent midwifery practice. Discussion with conclusion: Slovenian midwifery was poorly evaluated in some attributes of professionalism, especially knowledge and autonomy. Even midwives themselves consider midwifery more occupation than profession. The autonomy of midwifery will be hard to achieve in the institutions of medical dominance. The study revealed that participants of all three groups are in a competitive relation and are poorly aware of the roles and competencies of other two professions. Therefore, partially joined education might be beneficial in order to promote interprofessional collaboration in the future