EVALUATING THE USE OF MOBILE PHONE TECHNOLOGY TO ENHANCE POSTNATAL CARE IN SOUTH AFRICA

EVALUATING THE USE OF MOBILE PHONE TECHNOLOGY TO ENHANCE POSTNATAL CARE IN SOUTH AFRICA Kemunto Mokaya*, Elsie Etsane**, Jannie Hugo**, Jenny D. Makin**, Anne-Marie Bergh**, Robert C. Pattinson** and Brian W. Forsyth* *Department of Pediatrics, Yale University School of Medicine, New Haven, CT **Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa. Maternal and child care in South Africa is sub-optimal, contributing to the maternal mortality and high infant mortality rates in the country. About a third of these deaths are due to modifiable factors, some of which are related to poor communication between healthcare providers and patients. A potential intervention that could reduce some of these modifiable factors is the incorporation of mobile phone technology. The goal of this study was to determine the feasibility and effectiveness of incorporating mobile phone technology in postnatal care. The specific objectives were: to determine patterns and preferences of cell phone use among mothers; to determine healthcare staff attitudes towards the use of mobile phone technology in postnatal care; to determine whether a mobile phone intervention using SMS and phone call reminders will increase rates of attendance in postnatal clinics; to determine the cost-effectiveness of these reminders; and to determine the patients satisfaction with their reminders. The study was divided into 3 sub-projects. (i) In sub-project A, cross-sectional questionnaires were used to determine patterns and preferences of mobile phone use among mothers. (ii) In sub-project B, cross-sectional questionnaires were used to determine staff attitudes regarding use of mobile phones to enhance communication. (iii) In sub-project C, a randomized controlled trial (RCT) was carried out to determine the impact of a mobile phone intervention on rates of postnatal clinic attendance. (i) 375 mothers participated in sub-project A. Of these, 98% had access to a mobile phone, and 83% owned personal mobile phones. 86% of the mothers had positive attitudes towards the use of mobile phones for patient: provider communication. (ii) 135 healthcare workers participated in sub-project B. Of these, 75% reported willingness to use a mobile phone to communicate with patients. (iii) In the RCT involving 415 mothers, the use of phone call/SMS reminder significantly increased rates of patient attendance at their 3-day appointment from 45% in controls to 72% and 81% in mothers who received phone calls and SMS reminders, respectively (p \u3c0.001). SMS reminders were more cost-effective than phone calls. 94% of mothers who got reminders were satisfied with them. Mobile phone technology can effectively be used to enhance communication between healthcare providers and patients in South Africa due to its high reach and acceptability among patients and healthcare staff. Additionally, mobile phone technology is simple to use and cost-effective. Mobile phone technology may effectively be used not only for appointment reminders, but also in other areas such as health education/awareness, chronic disease management, and HIV medication monitoring and compliance

Mode of delivery and outcome of patients with a previous scar at Charlotte Maxeke Johannesburg academic hospital

Research report submitted to the University of the Witwatersrand in partial fulfilment for the degree of Masters of Medicine (Obstetrics and Gynaecology)The setting of this study was at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) a tertiary referral and teaching hospital attached to the University of Witwatersrand situated in Parktown, Johannesburg. The hospital manages all high risk pregnancy including previous caesarean sections. This study evaluated women with one previous scar at CMJAH for their: antenatal choice of delivery method, eventual delivery method and pregnancy outcome. Over the years there has been a significant uptrend of caesarean sections and consequently also an increasing number of women with one previous scar with subsequent pregnancies. Objectives: 1) To obtain the indication for the mothers’ first caesarean section, 2) To determine the mothers’ choice of delivery method following their first caesarean section, 3) To determine the actual mode of delivery and factors that influenced it, 4) To establish short term neonatal outcome following delivery, 5) To establish short term maternal outcome following delivery. Methodology: The study was a prospective cohort study of women with one previous scar who attended the antenatal clinic at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The aim was to compare their antenatal choice of delivery to how they eventually delivered. 100 women were recruited from the antenatal clinic from 1st July 2016 to 30th September 2016. Data was collected via interviewing the mothers and also from hospital records; this was captured on a data sheet. Data was then analysed using STATA software. Results: One hundred women were followed up to delivery. 63 wanted to deliver via vaginal birth after caesarean section (VBAC) during their antenatal period, 35 wanted a repeat caesarean section and two were still undecided on their preferred mode of delivery. 22 women eventually managed to have VBAC (including 4 assisted deliveries). There were a total of 78 deliveries via caesarean section 46 being emergency caesarean sections and 32 being elective caesarean sections. The attempted VBAC success rate was 35% (including assisted deliveries) the remainder receiving emergency caesarean sections. Of the patients who wanted repeat caesarean section, 94.3% delivered by caesarean section. 76% of babies had no adverse short term outcome while 87% of mothers had no short term complications post-delivery. There was statistically no difference between short term complications of mother and foetus in both modes of delivery. VI Conclusion: Women who choose caesarean section delivery during their antenatal period are much more likely to deliver via their preferred mode compared to women who choose VBAC as their mode of delivery, statistically significant, P<0.001.The main reasons for conversion of a VBAC to caesarean section observed were foetal distress and poor progress. Overall outcomes of mother and foetus were not statistically significant between vaginal and caesarean section delivery routes, though the most severe maternal complications were observed in emergency caesarean section deliveries.GR201

A Critique of the International Legal Regime Applicable to Terrorism

Terrorism is a global phenomenon that permeates state borders and predominantly causes immeasurable suffering to civilians. The need for international cooperation and concerted efforts in combating terrorism cannot be gainsaid. Already, sectoral instruments have been passed to regulate certain aspects of terrorism. However, without a single terrorism specific instrument, acts of terrorism generally classified will fall under spheres of international law which include; public international law, international criminal law, international humanitarian law, human rights and refugee law. This paper makes a critical analysis of these spheres of international law and how they apply to states’ counter-terrorism efforts

Modeling and Simulation of a Process That Converts Ethane to Ethylene and Ethylene to Low Density Polyethylene

Ethylene is a critical feedstock and a major building block in the petrochemical industry that is used in synthesizing important products like polyethylene, ethanol, ethylene oxide, ethylene dichloride and ethylbenzene. With increasing demand of plastics, production of ethylene and subsequently polyethylene has increased globally. This thesis conducts the modeling and simulation of an integrated process that utilizes ethane as the primary feedstock to produce ethylene and the subsequent polymerization of ethylene to low-density polyethylene (LDPE). The process combines two different processes into one integrated process: (1) conversion of ethane to ethylene and (2) conversion of ethylene to LDPE. First, a steady-state simulation for converting ethane gas from a shale gas processing plant into ethylene is developed and a sensitivity analysis with respect to variation in design operating conditions of different unit operations is performed. Second, a steady-state simulation for converting ethylene to LDPE is developed and a sensitivity analysis with respect to variation in design operating conditions of different unit operations and initiator concentration is performed. A heat integration approach for the whole process is utilized to minimize the utility costs and increase the efficiency of the process

Lived Experiences of Congolese Women Refugees Living in Indianapolis: Voices of Women

The Democratic Republic of Congo (DRC) has been at war for decades. Since its self rule in 1960, the country has been dealing with civil war, and has the largest number of refugees from Africa to the United States. Mineral wise it is the richest country in Africa, and yet it is the poorest in the standard of living. In this dissertation, I sought to research the lived experiences of Congolese women refugees settled in Indianapolis, Indiana. The purpose of this study was to explore, through their own voices, the challenges these women face as they resettle in a new country, with new people, and a new culture. These women are expected to be self-reliant within three months (90 days) with the help of resettlement agencies. A priority is that they are expected to learn a new language to enable them to move on to a life on their own. This is a challenge for these women who never had a formal education. Some of the challenges they face are the language barrier, living in a new country, new people, new environment, and the generational gap. Their challenge is to overcome these barriers. The study aims to share the women\u27s voices firsthand. From the findings, awareness will be brought to the inefficiencies of the ninety day period of service from the resettlement agencies. Another finding is that the women refugees were not comfortable with the idea of being resettled in the United States. An additional finding is that the research participants condemned the separation that took place in the family when some of them were resettled in the US and some were left in Africa

Increasing Knowledge and Awareness of Expedited Partner Therapy among Providers

Abstract Background: In the past six years, there has been a steady rise in the number of reported cases of chlamydia and gonorrhea in the United States. Expedited partner therapy (EPT) refers to the practice of treating partners of patients diagnosed with specific treatable sexually transmitted infections without first evaluating them. This treatment was recommended by the Centers for Disease Control and Prevention in 2006 and it is currently legalized in 45 states and the District of Columbia. However, many health care providers (HCPs) do not have knowledge of EPT therefore do not make use of it. Purpose: This quality improvement (QI) project provided education on expedited partner therapy to providers at a community health center in Maryland. The goal was to increase awareness and knowledge of expedited partner therapy, and the intention to utilize EPT to improve its use. Methods: Recruitment of the participants involved providing an overview of the project during staff meetings followed by sending emails to the clinicians. Pre and post intervention surveys were sent to clinicians via SurveyMonkey for data collection. The education intervention was through PowerPoint. Results: Using the Wilcoxon signed rank test, the intervention resulted in statistically significant results when current EPT use was compared to future plan to use EPT. Results for most of the other variables were not statistically significant. Conclusion: Increase knowledge and awareness of EPT can result in improved use. However, the outcome for most variables were not statistically significant, but future projects or studies could use larger samples to determine significance of the other variables. Keywords: Expedited partner therapy, sexually transmitted infections, chlamydia, treatmen

Predictable and targeted activation of biomass to carbons with high surface area density and enhanced methane storage capacity

© The Royal Society of Chemistry. A challenge in the synthesis of activated carbons is that currently there is no way to prepare materials with predictable and targeted properties. In particular, there are no material parameters or characteristics of the starting carbonaceous matter that can be used to predict the porosity and packing density of the activated carbon. Here we report on the synthesis of biomass-derived activated carbons with targeted porosity and packing density that is suitable for methane storage. We show that the ratio of elemental oxygen to elemental carbon (i.e., O/C atomic ratio) of the precursor can be used as a universal predictor of the nature of porosity generated in an activated carbon. We use date seeds (Phoenix dactylifera) as an example of how biomass starting material with a very low O/C ratio, along with choice of mode of carbonisation, can be used to synthesise activated carbons with optimised porosity, as defined by the surface area density, and high packing density that is suitable for methane storage. The carbons store up to 222 cm3 (STP) cm-3 methane at 25 °C and 35 bar, which is much higher than any value reported to date for porous carbons, and is comparable to the best metal-organic-framework (MOF). However, the activated carbons are much cheaper (≤1$per kg) compared to at best 10-20$ per kg for MOFs. Our findings present important insights on directed synthesis of optimised activated carbons and represent a significant step in the development of cheap porous carbons for high volumetric methane (or natural gas) storage. The findings are also applicable to informing the optimised preparation of activated carbons with targeted properties for other applications in energy storage and environmental remediation. This journal i

Ultra-high surface area mesoporous carbons for colossal pre combustion CO2 capture and storage as materials for hydrogen purification

Carbon capture and storage (CCS) by solid adsorbents is currently attracting a great deal of attention. In this study, a new direction in the treatment of activateable carbon-containing precursors generated a family of mesoporous carbons that possess extremely high mesopore volume and hardly any microporosity. The mesoporous carbons, with up to 95% mesoporosity, have ultra-high surface area (2800 – 4000 m2g-1) and pore volume (2.5 – 3.6 cm3g-1). The porosity of the carbons, i.e., mesopores of size 25 - 50 Å and hardly any micropores, is favourable for CO2 uptake under conditions that are relevant to pre combustion CCS, i.e., 25 oC and pressure of 20 to 50 bar. The best performing carbons have near total absence of micropores; our findings suggest that the presence of microporosity is a limiting factor in the CO2 uptake capacity especially at high pressure (30 – 50 bar). The gravimetric (mmol g-1) CO2 uptake capacity of the mesoporous carbons is impressive; up to 28 (20 bar), 37 (30 bar), 46 (40 bar) and 55 (50 bar), which is equivalent to 2.42 g of CO2 per g of carbon. Furthermore, due to their packing density (0.25 – 0.4 g cm-3), the mesoporous carbons exhibit colossal volumetric CO2 uptake (in g l-1) of up to 480 (20 bar), 640 (30 bar), 780 (40 bar) and 930 (50 bar). The performance of the mesoporous carbons is such that, at 30 bar, they can hold more than 10 times the CO2 in a pressurized cylinder, and at 50 bar can store up to 470 cm3 cm-3. The all-round pre combustion CCS performance of the mesoporous carbons is significantly higher than that of the best carbons to date, and outperforms that of benchmark materials such as metal organic frameworks (MOFs). The carbons are highly suited, in terms of their CO2 adsorption capacity and CO2 selectivity over H2, as materials for hydrogen purification under syngas flow conditions

Pre-mixed precursors for modulating the porosity of carbons for enhanced hydrogen storage: towards predicting the activation behaviour of carbonaceous matter

Highly porous carbons prepared from pre-mixtures of polypyrrole and raw sawdust or sawdust hydrochar achieve much higher surface area than is possible from single use of any one of the precursors. The pre-mixed precursors offer carbons with ultrahigh surface area (up to 3815 m2 g−1) and pore volume (up to ∼2.6 cm3 g−1) comprising two pore systems in the micropore (6–12 Å) and mesopore (22–28 Å) range. The porosity can be tailored via choice of pre-mix precursor ratios such that it is possible, under identical activation conditions, to generate carbons that are either microporous or mesoporous. The elemental composition of the precursors, in particular the molar ratio of oxygen to carbon (i.e., O/C molar ratio), is a key variable in determining the development of mesopores, with a high ratio favouring greater mesoporosity. The resulting activated carbons are homogeneous regardless of the pre-mix precursor ratios, and exhibit excellent hydrogen storage capacity that is much higher than can be attained by single-precursor derived samples. The carbons have excess hydrogen uptake (at −196 °C) of up to 3.6 wt% (at 1 bar) and 6.7 wt% (at 20 bar). The total hydrogen uptake is up to 8.1 wt% (at 20 bar), and 10 wt% (at 40 bar), which is much higher than that of most currently available benchmark porous materials. Due to their lower mesoporosity, the pre-mix samples have improved packing density, which means that their volumetric hydrogen uptake (at 40 bar) is much greater (ca. 40 g L−1) than that of single precursor samples (ca. 28 g L−1). The carbons are comparable to or outperform many benchmark materials such as MOFs in terms of their hydrogen uptake, including gravimetric uptake, volumetric uptake and deliverable hydrogen capacity (100 to 5 bar at 77 K). The carbons also have attractive room temperature hydrogen storage capacity. Our findings provide a new method for modulating the porosity of carbons that goes beyond current practice. Furthermore, the new insights on the effect of the O/C ratio make it possible to predict the activation behaviour of precursors in a manner that allows optimising porosity of carbons to match specific applications as demonstrated here for hydrogen storage