Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries.

INTRODUCTION: Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. METHODS: We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. RESULTS: In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. CONCLUSION: Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators

Co-occurrence of Fe and P stress in natural populations of the marine diazotroph Trichodesmium

Trichodesmium is a globally important marine microbe that provides fixed nitrogen (N) to otherwise N-limited ecosystems. In nature, nitrogen fixation is likely regulated by iron or phosphate availability, but the extent and interaction of these controls are unclear. From metaproteomics analyses using established protein biomarkers for nutrient stress, we found that iron–phosphate co-stress is the norm rather than the exception for Trichodesmium colonies in the North Atlantic Ocean. Counterintuitively, the nitrogenase enzyme was more abundant under co-stress as opposed to single nutrient stress. This is consistent with the idea that Trichodesmium has a specific physiological state during nutrient co-stress. Organic nitrogen uptake was observed and occurred simultaneously with nitrogen fixation. The quantification of the phosphate ABC transporter PstA combined with a cellular model of nutrient uptake suggested that Trichodesmium is generally confronted by the biophysical limits of membrane space and diffusion rates for iron and phosphate acquisition in the field. Colony formation may benefit nutrient acquisition from particulate and organic sources, alleviating these pressures. The results highlight that to predict the behavior of Trichodesmium, both Fe and P stress must be evaluated simultaneously

European Cystic Fibrosis Society Standards of Care: Framework for the Cystic Fibrosis Centre

A significant increase in life expectancy in successive birth cohorts of people with cystic fibrosis (CF) is a result of more effective treatment for the disease. It is also now widely recognized that outcomes for patients cared for in specialist CF Centres are better than for those who are not. Key to the effectiveness of the specialist CF Centre is the multidisciplinary team (MDT), which should include consultants, clinical nurse specialist, microbiologist, physiotherapist, dietitian, pharmacist, clinical psychologist, social worker, clinical geneticist and allied healthcare professionals, all of whom should be experienced in CF care. Members of the MDT are also expected to keep up to date with developments in CF through continued professional development, attendance at conferences, auditing and involvement in research. Specialists CF Centres should also network with other Centres both nationally and internationally, and feed Centre data to registries in order to further the understanding of the disease. This paper provides a framework for the specialist CF Centre, including the organisation of the Centre and the individual roles of MDT members, as well as highlighting the value of CF organisations and disease registries

Laatujohtaminen valmistavassa teollisuudessa : Toimintajärjestelmän uudistaminen

Opinnäytetyön toimeksiantajana oli Savonlinnassa toimiva lujitemuovituotteisiin erikoistunut valmistusyritys Oy Esmarin Composites Ltd. Yrityksellä on ollut SFS-EN ISO 9001:2008 -mukainen sertifiointi vuodesta 2012. Yrityksen laatujärjestelmä kattaa kaikki yrityksen toiminnot, ja ne on dokumentoitu toimintakäsikirjaan. Opinnäytetyön tavoitteena oli perehtyä laatujohtamiseen valmistavassa teollisuudessa ja uudistaa yrityksen toimintajärjestelmää. Yrityksen selainpohjaisella alustalla oleva toimintakäsikirja liitteineen siirrettiin uudelle alustalle. Toimenpiteen tavoitteena oli toimintakäsikirjan käytön selkeyttäminen ja maksullisesta selainpohjaisesta dokumentoinnista eroon pääseminen. Toimintakäsikirjan ja sen liitteiden uusiksi alustoiksi valikoituivat Microsoft Office –ohjelmistot yleisyytensä vuoksi. Toimintakäsikirjan tekstidokumentaatioiden ulkoasu päivitettiin ja tarvittavia tiedonkeruulomakkeita tehtiin Microsoft Wordin ja Excelin avulla; muun muassa poikkeamista johtuvien kustannusten seurantaan asiakaskohtaisesti tehtiin Excelillä toimiva tiedonkeruumenetelmä. Opinnäytetyön teon aloitusajankohdan vuoksi opinnäytetyössä ei ole vielä otettu huomioon SFS-EN ISO 9001:2015:n päivityksiä. Yrityksen on nyt kuitenkin selkeämmän dokumentaation avulla helpompi päivittää johtamisjärjestelmäänsä uusien vaatimuksien mukaiseksi.This thesis was commissioned by Oy Esmarin Composites Ltd. The company specializes in the manufacture of reinforced plastic products and the company has had ISO 9001:2008 standardization since 2012. The company’s quality management system covers all the company’s operations and they are documented in the operations manual. Aim of this thesis was familiarize to quality management in the manufacturing industry and transfer the company’s web-based platform operating manual with attachments to a new platform. The purpose was to clarify the use of the operations manual and replace the browser-based documentation. Microsoft Office software was selected to new platform for the operations manual and its attachments, because they are public software. The layout of the operations manual was updated and the necessary data collection forms were made in Microsoft Word and Excel, for example a separate Excel program was made to calculate the cost of deviations. Because this thesis was started in the beginning of the year 2015 update from ISO 9001:2008 standard to ISO 9001:2015 has not yet been taken into consideration. The company’s operations manual is now clearer and easy to use so updating the management system according to the requirements is easier

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially