Clinical readiness for essential maternal and child health services in Kenya: A cross-sectional survey

High rates of maternal and neonatal morbidity and mortality in Kenya may be influenced by provider training and knowledge in emergency obstetric and neonatal care in addition to availability of supplies necessary for this care. While post-abortion care is a key aspect of life-saving maternal health care, no validated questionnaires have been published on provider clinical knowledge in this arena. Our aim was to determine provider knowledge of maternal-child health (MCH) emergencies (post-abortion care, pre-eclampsia, postpartum hemorrhage, neonatal resuscitation) and determine factors associated with clinical knowledge. Our secondary aim was to pilot a case-based questionnaire on post-abortion care. We conducted a cross-sectional survey of providers at health facilities in western Kenya providing maternity services. Providers estimated facility capacity through perceived availability of both general and specialized supplies. Providers reported training on the MCH topics and completed case-based questions to assess clinical knowledge. Knowledge was compared between topics using a linear mixed model. Multivariable models identified variables associated with scores by topic. 132 providers at 37 facilities were interviewed. All facilities had access to general supplies at least sometime while specialized supplies were available less frequently. While only 56.8% of providers reported training on post-abortion care, more than 80% reported training on pre-eclampsia, postpartum hemorrhage, and neonatal resuscitation. Providers’ clinical knowledge across all topics was low (mean score of 63.3%), with significant differences in scores by topic area. Despite less formal training in the subject area, providers answered 71.6% (SD 16.7%) questions correctly on post-abortion care. Gaps in supply availability, training, and clinical knowledge on MCH emergencies exist. Increasing training on MCH topics may decrease pregnancy and postpartum complications. Further, validated tools to assess knowledge in post-abortion care should be created, particularly in sub-Saharan Africa where legal restrictions on abortion services exist and many abortions are performed in unsafe settings

Challenges in mathematical cognition: a collaboratively-derived research agenda

This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education, psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into six broad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition

Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum

Background: To standardize research terminology and reduce unanticipated placenta accreta spectrum (PAS), the European Working Group for Abnormally Invasive Placenta (EW-AIP) developed a consensus checklist for reporting PAS suspected on antenatal ultrasound. The diagnostic accuracy of the EW-AIP checklist has not been assessed. Objective: To test the performance of the EW-AIP sonographic checklist in predicting histologic PAS. Study Design: This is a multi-site, blinded, retrospective review of transabdominal ultrasound studies performed between 26-32 weeks gestation for subjects with histologic PAS between 2016-2020. We matched a 1:1 control cohort of subjects without histologic PAS. To reduce reader bias, we matched the control cohort for known risk factors including previa, number of prior cesarean deliveries, prior dilation and curettage (D&C), in vitro fertilization (IVF), and clinical factors affecting image quality including multiple gestation, body mass index (BMI) and gestational age at the ultrasound. Nine sonologists from 5 referral centers, blinded to the histologic outcomes, interpreted the randomized ultrasound studies using the EW-AIP checklist. The primary outcome was the sensitivity and specificity of the checklist to predict PAS. Two separate sensitivity analyses were performed: 1) we excluded subjects with mild disease (i.e. only assessed subjects with histologic increta and percreta); 2) we excluded interpretations from the 2 most junior sonologists. Results: 78 subjects were included (39 PAS, 39 matched control). Clinical risk factors and image quality markers were statistically similar between cohorts. The checklist sensitivity (95% Confidence Interval, CI) was 76.6% (63.4%-90.6%) and specificity (95% CI) was 92.0% (63.4%-99.9%), with a positive and negative likelihood ratio of 9.6 and 0.3, respectively. When we excluded subjects with mild PAS disease, the sensitivity (95% CI) increased to 84.7% (73.6%-96.4%) and specificity was unchanged at 92.0% (83.2%-99.9%). Sensitivity and specificity were unchanged when the interpretations from the 2 most junior sonologists were excluded. Conclusion: The 2016 EW-AIP checklist for interpreting PAS has a reasonable performance in detecting and excluding histologic placenta accreta spectrum

Weber and church governance: religious practice and economic activity

The debate about the relationship between religion and economic activity in the wake of Weber has been cast largely in terms of belief and values. This article suggests an alternative focus on practice. It argues that taken for granted practices of church governance formed to-hand resources for the organization of economic activity. The argument is developed through an examination of the historical development of church governance practices in the Presbyterian Church of Scotland, with particular emphasis on the way in which theological belief gave rise to practices of accountability and record keeping. In turn such practices contributed to a ‘culture of organization’ which had implications for economic activity. A focus on governance practices can help to illuminate enduring patterns of difference in the organization of economic activity

Rotation of planet-harbouring stars

The rotation rate of a star has important implications for the detectability, characterisation and stability of any planets that may be orbiting it. This chapter gives a brief overview of stellar rotation before describing the methods used to measure the rotation periods of planet host stars, the factors affecting the evolution of a star's rotation rate, stellar age estimates based on rotation, and an overview of the observed trends in the rotation properties of stars with planets.Comment: 16 pages, 4 figures: Invited review to appear in 'Handbook of Exoplanets', Springer Reference Works, edited by Hans J. Deeg and Juan Antonio Belmont

Clean, cleaved surfaces of the photovoltaic perovskite

The surface of a material is not only a window into its bulk physical properties, but also hosts unique phenomena important for understanding the properties of a solid as a whole. Surface sensitive techniques, like ARPES (Angle-resolved photoemission spectroscopy), STM (Scanning tunneling microscopy), AFM (Atomic force microscopy), pump-probe optical measurements etc. require flat, clean surfaces. These can be obtained by cleaving, which is usually possible for layered materials. Such measurements have proven their worth by providing valuable information about cuprate superconductors, graphene, transition metal dichalcogenides, topological insulators and many other novel materials. Unfortunately, this was so far not the case for the cubic, organo-metallic photovoltaic perovskite which morsels during the cleavage. Here we show a method which results in flat, clean surfaces of CH3NH3PbBr3 which allows surface sensitive measurements, badly needed for the understanding and further engineering of this material family

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

In Vitro Analysis of Integrated Global High-Resolution DNA Methylation Profiling with Genomic Imbalance and Gene Expression in Osteosarcoma

Genetic and epigenetic changes contribute to deregulation of gene expression and development of human cancer. Changes in DNA methylation are key epigenetic factors regulating gene expression and genomic stability. Recent progress in microarray technologies resulted in developments of high resolution platforms for profiling of genetic, epigenetic and gene expression changes. OS is a pediatric bone tumor with characteristically high level of numerical and structural chromosomal changes. Furthermore, little is known about DNA methylation changes in OS. Our objective was to develop an integrative approach for analysis of high-resolution epigenomic, genomic, and gene expression profiles in order to identify functional epi/genomic differences between OS cell lines and normal human osteoblasts. A combination of Affymetrix Promoter Tilling Arrays for DNA methylation, Agilent array-CGH platform for genomic imbalance and Affymetrix Gene 1.0 platform for gene expression analysis was used. As a result, an integrative high-resolution approach for interrogation of genome-wide tumour-specific changes in DNA methylation was developed. This approach was used to provide the first genomic DNA methylation maps, and to identify and validate genes with aberrant DNA methylation in OS cell lines. This first integrative analysis of global cancer-related changes in DNA methylation, genomic imbalance, and gene expression has provided comprehensive evidence of the cumulative roles of epigenetic and genetic mechanisms in deregulation of gene expression networks

A large scale hearing loss screen reveals an extensive unexplored genetic landscape for auditory dysfunction

The developmental and physiological complexity of the auditory system is likely reflected in the underlying set of genes involved in auditory function. In humans, over 150 non-syndromic loci have been identified, and there are more than 400 human genetic syndromes with a hearing loss component. Over 100 non-syndromic hearing loss genes have been identified in mouse and human, but we remain ignorant of the full extent of the genetic landscape involved in auditory dysfunction. As part of the International Mouse Phenotyping Consortium, we undertook a hearing loss screen in a cohort of 3006 mouse knockout strains. In total, we identify 67 candidate hearing loss genes. We detect known hearing loss genes, but the vast majority, 52, of the candidate genes were novel. Our analysis reveals a large and unexplored genetic landscape involved with auditory function