Responsiveness of emergency obstetric care systems in low- and middle-income countries: a critical review of the "third delay".

We reviewed the evidence on the duration, causes and effects of delays in providing emergency obstetric care to women attending health facilities (the third delay) in low- and middle-income countries. We performed a critical literature review using terms related to obstetric care, birth outcome, delays and developing countries. A manual search of reference lists of key articles was also performed. 69 studies met the inclusion criteria. Most studies reported long delays in providing care, and the mean waiting time for women admitted with complications was as much as 24 h before treatment. The three most cited barriers to providing timely care were shortage of treatment materials, surgery facilities and qualified staff. Existing evidence is insufficient to estimate the effect of delays on birth outcomes. Delays in providing emergency obstetric care seem common in resource-constrained settings but further research is necessary to determine the effect of the third delay on birth outcomes

The Precautionary Principle and Radiation Protection

The authors examine the application of the precautionary principle through a case study of ionizing radiation control and suggest a reevaluation of current radiation safety standards and practices

Local cooling for relieving pain from perineal trauma sustained during childbirth

Background: Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. Objectives: To evaluate the effectiveness and side effects of localised cooling treatments compared with no treatment, other forms of cooling treatments and non-cooling treatments. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), CINAHL (1982 to January 2007) and contacted experts in the field. Selection criteria: Published and unpublished randomised and quasi-randomised trials (RCTs) that compared localised cooling treatment applied to the perineum with no treatment or other treatments applied to relieve pain related to perineal trauma sustained during childbirth. Data collection and analysis: At least two independent authors performed data extraction for each study. Analyses were performed on an intention-to-treat basis where data allowed. We sought additional information from the authors of three trials. Main results: Seven published RCTs were included, comparing local cooling treatments (ice packs, cold gel pads or cold/iced baths) with no treatment, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam [Epifoam] or warm baths. The RCTs reported on a total of 859 women. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.41 to 0.91). Women preferred the utility of the gel pads compared with ice packs or no treatment, although no differences in pain relief were detected between the treatments. None of our comparisons of treatments resulted in differences detected in perineal oedema or bruising. Women reported more pain (RR 5.60, 95% CI 2.35 to 13.33) and used more additional analgesia (RR 4.00, 95% CI 1.44 to 11.13) following the application of ice packs compared with PET. Authors' conclusions: There is only limited evidence to support the effectiveness of local cooling treatments (ice packs, cold gel pads, cold/iced baths) applied to the perineum following childbirth to relieve pain

Evidence to improve maternal and newborn health in Ethiopia, North East Nigeria and Uttar Pradesh, India

IDEAS aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. One research question is"Do enhanced interactions lead to increased coverage of interventions?

An fMRI study of joint action–varying levels of cooperation correlates with activity in control networks

As social agents, humans continually interact with the people around them. Here, motor cooperation was investigated using a paradigm in which pairs of participants, one being scanned with fMRI, jointly controlled a visually presented object with joystick movements. The object oscillated dynamically along two dimensions, color and width of gratings, corresponding to the two cardinal directions of joystick movements. While the overall control of each participant on the object was kept constant, the amount of cooperation along the two dimensions varied along four levels, from no (each participant controlled one dimension exclusively) to full (each participant controlled half of each dimension) cooperation. Increasing cooperation correlated with BOLD signal in the left parietal operculum and anterior cingulate cortex (ACC), while decreasing cooperation correlated with activity in the right inferior frontal and superior temporal gyri, the intraparietal sulci and inferior temporal gyri bilaterally, and the dorsomedial prefrontal cortex. As joint performance improved with the level of cooperation, we assessed the brain responses correlating with behavior, and found that activity in most of the areas associated with levels of cooperation also correlated with the joint performance. The only brain area found exclusively in the negative correlation with cooperation was in the dorso medial frontal cortex, involved in monitoring action outcome. Given the cluster location and condition-related signal change, we propose that this region monitored actions to extract the level of cooperation in order to optimize the joint response. Our results, therefore, indicate that, in the current experimental paradigm involving joint control of a visually presented object with joystick movements, the level of cooperation affected brain networks involved in action control, but not mentalizing

Enhanced conceptual understanding in first year mechanics through modelling

As part of the National HE STEM programme, we have developed and implemented a modelling curriculum in first year mechanics to overcome well known conceptual difficulties. By modelling, we mean more than just the development of mathematical equations to describe the evolution of a physical system; we also mean the use of multiple representations both to understand the problem at hand as well as to develop a solution. We have developed a structured approach to both teaching and assessing the use of such representations through the ACME protocol: Assess the problem, Conceptualise the Model, and Evaluate the solution. This paper describes the implementation of this protocol within a conventional lecture setting during a single semester of the 2011-12 academic session and demonstrates the impact on conceptual understanding of 42 students though pre-course and post-course testing using the Force Concept Inventory (FCI). Detailed analysis shows that on virtually every question in the FCI student performance improved, with questions 4 and 15, relating to Newton’s third law, showing especially large gains. The average FCI score rose from 17.7 (out of 30) to 22.5, with the distribution of post-instruction scores being statistically significantly different (p=0.0001) from the distribution of pre-instruction scores

Screening of a HUVEC cDNA library with transplant-associated coronary artery disease sera identifies RPL7 as a candidate autoantigen associated with this disease.

A HUVEC cDNA library was screened with sera from two patients who had developed transplant-associated coronary artery disease (TxCAD) following cardiac transplantation. A total of six positive clones were isolated from a primary screen of 40 000 genes. Subsequent DNA sequence analysis identified these to be lysyl tRNA synthetase, ribosomal protein L7, ribosomal protein L9, beta transducin and TANK. Another gene whose product could not be identified showed homology to a human cDNA clone (DKFZp566M063) derived from fetal kidney. Full-length constructs of selected genes were expressed as his-tag recombinant fusion proteins and used to screen a wider patient base by ELISA to determine prevalence and association with TxCAD. Of these ribosomal protein L7 showed the highest prevalence (55.6%) with TxCAD sera compared to 10% non-CAD

Asteroseismic test of rotational mixing in low-mass white dwarfs

We exploit the recent discovery of pulsations in mixed-atmosphere (He/H), extremely low-mass white dwarf precursors (ELM proto-WDs) to test the proposition that rotational mixing is a fundamental process in the formation and evolution of low-mass helium core white dwarfs. Rotational mixing has been shown to be a mechanism able to compete efficiently against gravitational settling, thus accounting naturally for the presence of He, as well as traces of metals such as Mg and Ca, typically found in the atmospheres of ELM proto-WDs. Here we investigate whether rotational mixing can maintain a sufficient amount of He in the deeper driving region of the star, such that it can fuel, through HeII-HeIII ionization, the observed pulsations in this type of stars. Using state-of-the-art evolutionary models computed with MESA, we show that rotational mixing can indeed explain qualitatively the very existence and general properties of the known pulsating, mixed-atmosphere ELM proto-WDs. Moreover, such objects are very likely to pulsate again during their final WD cooling phase.Comment: accepted for publication in A&A Letter

Self-Paced Endurance Performance and Cerebral Hemodynamics of the Prefrontal Cortex: A Scoping Review of Methodology and Findings.

Recent research has suggested that top-down executive function associated with the prefrontal cortex is key to the decision-making processes and pacing of endurance performance. A small but growing body of literature has investigated the neurological underpinnings of these processes by subjecting the prefrontal cortex to functional near-infrared spectroscopy (fNIRS) measurement during self-paced endurance task performance. Given that fNIRS measurement for these purposes is a relatively recent development, the principal aim of this review was to assess the methodological rigor and findings of this body of research. We performed a systematic literature search to collate research assessing prefrontal cortex oxygenation via fNIRS during self-paced endurance performance. A total of 17 studies met the criteria for inclusion. We then extracted information concerning the methodology and findings from the studies reviewed. Promisingly, most of the reviewed studies reported having adopted commonplace and feasible best practice guidelines. However, a lack of adherence to these guidelines was evident in some areas. For instance, there was little evidence of measures to tackle and remove artifacts from data. Lastly, the reviewed studies provide insight into the significance of cerebral oxygenation to endurance performance and the role of the prefrontal cortex in pacing behavior. Therefore, future research that better follows the guidelines presented will help advance our understanding of the role of the brain in endurance performance and aid in the development of techniques to improve or maintain prefrontal cortex (PFC) oxygenation to help bolster endurance performance