The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya

Background Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women’s decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors. Methods Between 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys. Results Overall D & A decreased from 20–13 % (p < 0.004) and among four of the six typologies D & A decreased from 40–50 %. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0–0.8 %, though this was partially attributable to the 2013 national free delivery care policy. Conclusion Although a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings

Class Based Multi Stage Encryption for Efficient Data Security in Cloud Environment Using Profile Data

The security issues in the cloud have been well studied. The data security has much importance in point of data owner. There are number of approaches presented earlier towards performance in data security in cloud. To overcome the issues, a class based multi stage encryption algorithm is presented in this paper. The method classifies the data into number of classes and different encryption scheme is used for different classes in different levels. Similarly, the user has been authenticated for their access and they have been classified into different categories. According to the user profile, the method restricts the access of user and based on the same, the method defines security measures. A system defined encryption methodology is used for encrypting the data. Moreover, the user has been returned with other encryption methods which can be decrypted by the user using their own key provided by the system. The proposed algorithm improves the performance of security and improves the data security

Cell wall protection by the Candida albicans class I chitin synthases

Open Access funded by Medical Research Council Acknowledgments We thank Kevin Mackenzie in the Microscopy and Histology Core Facility (Institute of Medical Sciences, University of Aberdeen), and Donna MacCallum for helpful statistical advice. This work was supported by grants from the Wellcome Trust (0868827 and 080088) including a Wellcome Trust Strategic Award (097377) and an Investigator Award to NG (101873), an MRC New Investigator Award to ML (MR/J008230/1) and a PhD scholarship awarded to KP from the Ministry of Sciences and Technology and Chiang Mai University, Thailand. Author contributions are as follows: KP constructed strains, performed the majority of the experiments, analyzed the data and contributed to the preparation of the manuscript. JA produced Fig. S1 using the data from the phosphoproteomic analysis conducted by SP and AB. NG conceived and designed experiments, analyzed data and commented on drafts of the manuscript. ML constructed strains, conceived, designed and performed experiments, analyzed data and wrote the manuscript.Peer reviewedPublisher PD

Theoretical description of adiabatic laser alignment and mixed-field orientation: the need for a non-adiabatic model

We present a theoretical study of recent laser-alignment and mixed-field-orientation experiments of asymmetric top molecules. In these experiments, pendular states were created using linearly polarized strong ac electric fields from pulsed lasers in combination with weak electrostatic fields. We compare the outcome of our calculations with experimental results obtained for the prototypical large molecule benzonitrile (C$_7$H$_5$N) [J.L. Hansen et al, Phys. Rev. A, 83, 023406 (2011)] and explore the directional properties of the molecular ensemble for several field configurations, i.e., for various field strengths and angles between ac and dc fields. For perpendicular fields one obtains pure alignment, which is well reproduced by the simulations. For tilted fields, we show that a fully adiabatic description of the process does not reproduce the experimentally observed orientation, and it is mandatory to use a diabatic model for population transfer between rotational states. We develop such a model and compare its outcome to the experimental data confirming the importance of non-adiabatic processes in the field-dressed molecular dynamics.Comment: 11 pages, 9 figure

A systematic overview of reviews of the effectiveness and cost effectiveness of interventions to promote healthy lifestyle behaviours in people living with or beyond cancer

An overview of systematic reviews synthesised evidence on the relationship between smoking, physical activity, dietary behaviours and alcohol consumption and important outcomes for people living with and beyond cancer. That review demonstrated that some lifestyle behaviours may be associated with important outcomes in people living with and beyond cancer (PLWBC). However it did not inform us of whether specifically delivering interventions aimed at modifying lifestyle behaviours effectively improve outcomes for PLWBC. How to promote and sustain healthy lifestyle behaviours in cancer populations is not well understood. A single, overarching summary of evidence from published systematic reviews of lifestyle interventions which compares and contrasts findings can provide policy and practice professionals with the evidence needed for more effective decision making. This overview of systematic reviews provides a synthesis of evidence on the effectiveness and cost-effectiveness of interventions aimed at altering lifestyle behaviours for improving outcomes for people living with and beyond cancer

Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counselling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and new-born. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement

Does a voucher program improve reproductive health service delivery and access in Kenya?

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. Methods - A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analysed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Results - Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Conclusions - Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.This work was supported by the Bill and Melinda Gates Foundation to the Population Council as part of a multi country study evaluation of voucher-andaccreditation interventions. Grant number 51761

The criterion validity of willingness to pay methods: A systematic review and meta-analysis of the evidence

© 2019 The Authors. Background: The contingent valuation (CV) method is used to estimate the willingness to pay (WTP) for services and products to inform cost benefit analyses (CBA). A long-standing criticism that stated WTP estimates may be poor indicators of actual WTP, calls into question their validity and the use of such estimates for welfare evaluation, especially in the health sector. Available evidence on the validity of CV studies so far is inconclusive. We systematically reviewed the literature to (1) synthesize the evidence on the criterion validity of WTP/willingness to accept (WTA), (2) undertake a meta-analysis, pooling evidence on the extent of variation between stated and actual WTP values and, (3) explore the reasons for the variation. Methods: Eight electronic databases were searched, along with citations and reference reviews. 50 papers detailing 159 comparisons were identified and reviewed using a standard proforma. Two reviewers each were involved in the paper selection, review and data extraction. Meta-analysis was conducted using random effects models for ratios of means and percentage differences separately. Meta-bias was investigated using funnel plots. Results: Hypothetical WTP was on average 3.2 times greater than actual WTP, with a range of 0.7–11.8 and 5.7 (0.0–13.6) for ratios of means and percentage differences respectively. However, key methodological differences between surveys of hypothetical and actual values were found. In the meta-analysis, high levels of heterogeneity existed. The overall effect size for mean summaries was 1.79 (1.56–2.04) and 2.37 (1.93–2.80) for percent summaries. Regression analyses identified mixed results on the influence of the different experimental protocols on the variation between stated and actual WTP values. Results indicating publication bias did not account for differences in study design. Conclusions: The evidence on the criterion validity for CV studies is more mixed than authors are representing because substantial differences in study design between hypothetical and actual WTP/WTA surveys are not accounted for.Brunel University London, Health Economics Research Group

Infrequent Mutation of Lysophosphatidic Acid Receptor-1 Gene in Hamster Pancreatic Duct Adenocarcinomas and Established Cell Lines

To evaluate the involvement of lysophosphatidic acid receptor-1 (LPA1) gene alteration in pancreatic carcinogenesis, we investigated mutations in the LPA1 gene in hamster pancreatic duct adenocarcinomas (PDAs) and established cell lines. Female Syrian golden hamsters received 30 mg/kg of N-nitrosobis(2-oxopropyl)amine (BOP) followed by repeated exposure to an augmentation pressure regimen consisting of a choline-deficient diet combined with DL-ethionine and then L-methionine and a further administration of 20 mg/kg BOP. A total of 10 PDAs obtained 10 weeks after beginning the experiment and three cell lines established from subcutaneously transplantable PDAs in syngeneic hamsters were examined for mutations using reverse transcription-polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP) analysis. A mutation was detected in only one PDA (1/10, 10%) in the form of a GGA to GTA (Gly to Val) transversion at codon 355, and no mutations were detected in the three cell lines. These results suggest that the LPA1 gene mutation may play roles in a limited fraction of BOP-induced pancreatic duct carcinogenesis in hamsters

The characteristics of solar x-class flares and CMEs: a paradigm for stellar superflares and eruptions?

This paper explores the characteristics of 42 solar X-class flares that were observed between February 2011 and November 2014, with data from the Solar Dynamics Observatory (SDO) and other sources. This flare list includes nine X-class flares that had no associated CMEs. In particular our aim was to determine whether a clear signature could be identified to differentiate powerful flares that have coronal mass ejections (CMEs) from those that do not. Part of the motivation for this study is the characterization of the solar paradigm for flare/CME occurrence as a possible guide to the stellar observations; hence we emphasize spectroscopic signatures. To do this we ask the following questions: Do all eruptive flares have long durations? Do CME-related flares stand out in terms of active-region size vs. flare duration? Do flare magnitudes correlate with sunspot areas, and, if so, are eruptive events distinguished? Is the occurrence of CMEs related to the fraction of the active-region area involved? Do X-class flares with no eruptions have weaker non-thermal signatures? Is the temperature dependence of evaporation different in eruptive and non-eruptive flares? Is EUV dimming only seen in eruptive flares? We find only one feature consistently associated with CME-related flares specifically: coronal dimming in lines characteristic of the quiet-Sun corona, i.e. 1 – 2 MK. We do not find a correlation between flare magnitude and sunspot areas. Although challenging, it will be of importance to model dimming for stellar cases and make suitable future plans for observations in the appropriate wavelength range in order to identify stellar CMEs consistently