Redemption and Nutopia:The Scope of Nuclear Critique in International Studies

What should the scope of nuclear critique within international studies be? This article addresses that question by making two interrelated arguments. First that political programmes of international nuclear order are crucially underpinned by what is termed here as ‘nutopianism’: a mode of understanding nuclear power that is imbued with a spirit of technological optimism in relation to ‘peaceful’ nuclear power, but simultaneously qualified by an awareness of the destructive uses and catastrophic potentialities of nuclear weapons. Second, that such nutopianism is in turn predicated on the ‘saving power’ of ‘the atom’: the assumption that nuclear power has redeeming features crucial to human progress and economic prosperity, the development of which should be facilitated within the structures of international order. The article makes the case that although critical thought within international studies focuses on nuclear weapons within international order, it has tended to remain largely silent on the issue of ‘civil’ nuclear power beyond nuclear weapons and the complex imbrication between the two. On that basis the article considers whether a more holistic and expansive form of nuclear critique is both possible and necessary. </jats:p

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania. Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis. Results: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby’s condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed. Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training

Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania

Background: Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania. Methods: A qualitative design was used to collect data. Five focus group discussions and 10 semi-structured indepth interviews were carried out. In total, 28 medical doctors and nurse/midwives participated in the study. The data was analyzed using qualitative content analysis. Results: The participants in the study perceived that the device was a useful tool that made it possible to monitor several laboring women at the same time and to react faster to fetal distress alerts. It was also perceived to improve the care provided to the laboring women. Prior to the introduction of Moyo, the participants described feeling overwhelmed by the high workload, an inability to adequately monitor each laboring woman, and a fear of being blamed for negative fetal outcomes. Challenges related to use of the device included a lack of adherence to routines for use, a lack of clarity about which laboring women should be monitored continuously with the device, and misidentification of maternal heart rate as fetal heart rate. Conclusion: The electronic strap-on fetal heart rate monitor, Moyo, was considered to make labor monitoring easier and to reduce stress. The study findings highlight the importance of ensuring that the device’s functions, its limitations and its procedures for use are well understood by users

“I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania

To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this study was to explore the attitudes and perceptions of women who had worn the monitor continuously during their most recent delivery and perceptions about how it affected care. This knowledge is important to identify barriers towards adaptation in order to introduce new technology more effectively. We carried out 20 semi-structured individual interviews post-labor at two hospitals in Tanzania. A thematic content analysis was used to analyze the data. Our results indicated that the use of the monitor positively affected the women’s birth experience. It provided much-needed reassurance about the wellbeing of the child. The women considered that wearing Moyo improved care due to an increase in communication and attention from birth attendants. However, the women did not fully understand the purpose and function of the device and overestimated its capabilities. This highlights the need to improve how and when information is conveyed to women in labor

Acquiring Knowledge about the Use of a Newly Developed Electronic Fetal Heart Rate Monitor: A Qualitative Study Among Birth Attendants in Tanzania

In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor ward at two health facilities in Tanzania. The FGDs were analyzed using qualitative content analysis. The study revealed that the participants experienced the training about the device as useful but inadequate. Due to high turnover, a frequently mentioned challenge was that many of the birth attendants who were responsible for training others, were no longer working in the labor ward. Many participants expressed a need for refresher trainings, more practical exercises and more theory on labor management. The study highlights the need for frequent trainings sessions over time with focus on increasing overall knowledge in labor management to ensure correct use of the monitor over time

Fear, blame and transparency: Obstetric caregivers\u27 rationales for high caesarean section rates in a low-resource setting

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers\u27 rationales for their hospital\u27s CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital\u27s CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have

Soil carbon budget account for the sustainability improvement of a Mediterranean vineyard area

Sustainable viticulture is suggested as an interesting strategy for achieving the objectives of global greenhouse gas (GHG) emission reduction in terms of mitigation and adaptation. However, knowledge and quantification of the contribution of sustainable vineyard management on climate change impact are needed. Although it is widely assessed by several authors that the agricultural stage has a great impact in the wine chain, very few studies have evaluated the greenhouse gas emission in this phase including the ability of soil to sequester carbon (C) or the off-farm C loss by erosion. This work aimed to provide a vineyard carbon budget (vCB) tool to quantify the impact of grape production on GHG emission including the effects of environmental characteristics and agricultural practices. The vCB was estimated considering four different soil management scenarios: conventional tillage (CT), temporary cover crop with a leguminous species in alternate inter-rows (ACC), temporary cover crop with a leguminous species (CC), permanent cover crop (PCC). The estimation of vCB was applied at territory level in a viticulture area in Sicily (2468 ha of vineyard) using empirical data. Results of the present study showed that the environmental characteristics strongly affect the sustainability of vineyard management; the highest contribution to total CO2 emission is, in fact, given by the C losses by erosion in sloping vineyards. Soils of studied vineyards are a source of CO2 due to the low C inputs and high mineralization rate, except for soil managed by CC which can sequester soil C, contributing positively to vCB. The highest total CO2 emission was estimated in vineyards under CT management (2.31 t ha−1y−1), followed by CC (1.27 t ha−1y−1), ACC (0.69 t ha−1y−1) and PCC (0.64 t ha−1y−1). Findings of vCB applied at territory level highlighted the key role of the evaluation of carbon budget (CB) on a larger scale to identify the CO2 emission in relation to climatic and environmental factors. The present study could contribute to provide suggestions to policymakers and farmers for reducing GHG emissions and promote more sustainable grape production practices

The probable role of cannibalism in spreading Trichinella papuae infection in a crocodile farm in Papua New Guinea

Between 2003 and 2007, 83 (50%) of 167 crocodiles ( Crocodylus porosus) purchased as juveniles by a crocodile farm 3 or 4 years earlier from Kikori, Gulf Province, were found to be infected with Trichinella papuae. Between 2005 and 2007 infection was detected in a number of crocodiles at the farm obtained from six localities other than Kikori, as well as in a few animals born on the farm. Up to 2004, all juveniles at the farm, whether wild- or farm-born, were penned together; the practice was then stopped to prevent possible infection through cannibalism. The last infected animal from Kikori was seen in 2007, 4 years after the purchase of crocodiles from there ceased. The last non-Kikori infected crocodile was seen, also, in 2007. None of the 1972 crocodiles (comprising wild- and farm-born animals) tested from 2008 to 2013, using the digestion method, was infected with T. papuae. This indicates that infection of non-Kikori crocodiles was the result of cannibalism within the farm during the years up to 2004 when juvenile crocodiles were kept together, and that the farm is now free of the infection