Quality of comprehensive emergency obstetric care through the lens of clinical documentation on admission to labour ward

Background: Clinical documentation gives a chronological order of procedures and activities that a patient is given during their management.Objective: To determine the level of quality of comprehensive emergency obstetric care, through the lens of clinical documentation of process indicators of selected emergency obstetric conditions that mostly cause maternal mortality on admission to labour wardDesign: Multi-site cross sectional survey.Setting: Twenty two Government Hospitals in Kenya with capacity to offer comprehensive emergency obstetric care.Subjects: Process variables were abstracted from patient’ case records with a diagnosis of normal vaginal delivery, obstetric haemorrhage, severe pre eclampsia/eclampsia and emergency cesarean section.Results: Availability of structure indicators were graded excellent and good except for long gloves, misoprostol, ergometrin and parenteral cefuroxime that were graded low. A total of 1,216 records were abstracted for process analysis. The median (IQR) for the: six variables of obstetric history was five (4-5); five variables of antenatal profile was four (1-5); five variables of vital signs documentation was three (2-4); five variables for obstetric exam was four (4-5); seven variables of vaginal examination one (0-2); ten variables for partograph was seven (2-9); five variables for obstetric hemorrhage was three (2-4) and eleven variables for severe pre-eclampsia/eclampsia was five (3-6). The median (IQR) from decision-to-operate to caesarean section was three (2-4) hours.Conclusion: Quality of emergency obstetric care based on documentation depicts inadequacy. There is an urgent need to objectively address the need for proper clinical documentation as an indicator of quality performance

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013.

SETTING: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN: Retrospective cross-sectional study using routine programme data. RESULTS: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions

Use of Sleeve Nets to Improve Survival of the Boisduval Silkworm, Anaphe panda, in the Kakamega Forest of Western Kenya

Prospects for development of a wild silk industry in Africa would be improved if silkworm survival during mass production could be improved. A study on the survival of the Boisduval silkworm, Anaphe panda (Boisduval) (Lepidoptera: Thaumetopoeidae) was conducted with and without protection by net sleeves in two different forest habitats (natural and modified) in the Kakamega forest of western Kenya. Overall, cohort survival was significantly higher (P < 0.001) in the natural than in the modified forest, but larval survival was improved over three-fold by protection with net sleeves in both habitat types. In the modified forest, only 16.8% of unprotected larvae survived to the pupal stage and formed cocoons, whereas 62.3% survived in the same environment when they were protected with net sleeves. In the natural forest, 20.4% of unprotected larvae survived, whereas 67.7% survived in net sleeves. There was also a significant effect of season; cohorts of larvae that eclosed in the wet season had significantly lower survival than those eclosing in the dry season (P = 0.02). Sources of mortality appeared to be natural enemies (parasites, predators and diseases) and climatic factors

Preventive control alternatives to routine foliar spray against Thrips tabaci in onions

No Abstract.Journal of Agriculture, Science and Technology Vol. 10 (1) 2008: pp. 26-4

Biology of the Wild Silkmoth Anaphe panda (Boisduval) in the Kakamega Forest of Western Kenya

A study on the life cycle of the silkmoth Anaphe panda (Boisduval) was conducted in two different habitats of the Kakamega Forest in western Kenya: Ikuywa, an indigenous forest, and Isecheno, a mixed indigenous forest. Eggs were laid in clusters, and the incubation period ranged from 40 to 45 days. Larvae fed on Bridelia micrantha (Hochst) and passed through seven instars. The developmental period took between 83 to 86 days in the dry season and 112 to118 days in the rainy season. The pupal period ranged between 158 and 178 days in the rainy season and, on the other hand, between 107 and 138 days in the dry season. But the later caught up in development with those that formed earlier. Moths emerged from mid-October until mid-May. Longevity of adult Anaphe panda moths took between 4 and 6 days, but generally females seemed to live longer than males. The moth also seems to have higher lifespan in the indigenous forest compared to the mixed indigenous forest

The sting of death: a case report of breaking bad news with maternal death

Maternal death stings core deep for the relatives and the service providers in an obstetric unit where they had anticipated a joyful experience from childbirth. We describe a case of death disclosure and breaking bad news in our unit. This was a case of a 34 year old, Para 1+0, who underwent elective caesarean section at term, secondary to one previous scar. The operation was successfully conducted and was discharged to the postnatal ward two hours after the surgery in stable condition. Four hours later, the patient was wheeled back to the labor ward gasping. Despite emergency resuscitative measures the patient succumbed. Death was disclosed to the immediate relative in privacy, after a summary of chronology of events, assembling a disclosure team and taking cognizance of emotional reactions. This case is presented to suggest guidelines for breaking bad news upon maternal death to minimize families’ suffering from long-term emotionalconsequences, pathologic grief reactions and cases of medical litigationKeywords: Maternal death disclosure, Breaking bad news, Guideline

Robust Handwritten Text Recognition in Scarce Labeling Scenarios : Disentanglement, Adaptation and Generation

Els documents escrits a mà no només es conserven en arxius històrics, sinó que també s'utilitzen àmpliament en documents administratius, com ara xecs o formularis. Amb l'auge de de l'anomenat aprenentatge profund (Deep Learning), s'ha aconseguit un bon rendiment en conjunts de dades específics per al reconeixement de text manuscrit. Tot i això, encara és difícil resoldre casos d'ús reals a causa de la variació entre estils d'escriptura de diferents escriptors i el fet de tenir dades etiquetades limitades. Per tant, es requereix explorar arquitectures de reconeixement d'escriptura més sòlides així com proposar mètodes per disminuir la bretxa entre conjunts de dades font i objectiu de manera no supervisada. En aquesta tesi, en primer lloc, explorem noves arquitectures per al reconeixement de text manuscrit, un mètode Sequence-to-Sequence amb mecanisme d'atenció i un mètode basat en transformadors no recurrents. En segon lloc, ens centrem en la disminució de la bretxa de rendiment entre les dades d'origen i les de destinació de manera no supervisada. Finalment, proposem un grup de mètodes generatius per a imatges de text manuscrits, que es poden utilitzar per augmentar el conjunt d'entrenament per obtenir un reconeixement més robust. A més, simplement modificant el mètode generatiu i unint-lo amb un reconeixedor, acabem amb un mètode de desenredament eficaç per destil·lar contingut textual d'estils d'escriptura a mà per aconseguir un rendiment de reconeixement generalitzat. Superem el rendiment dels reconeixedors de text manuscrit de l'estat de l'art en els resultats experimentals entre diferents conjunts de dades científics i industrials, que demostren l'eficàcia dels mètodes proposats. Tant ell reconeixement no recurrent com el mètode de desenredament són les primeres contribucions al camp del reconeixement d'escriptura a mà. A més, hem esbossat les línies de recerca potencials, que serien interessants explorar en el futur.Los documentos manuscritos no solo se conservan en archivos históricos, sino que también se usan ampliamente en documentos administrativos como cheques y reclamaciones. Con el auge de las redes neuronales profundas, muchas técnicas del estado del arte han obtenido un buen rendimiento en conjuntos de datos específicos para el reconocimiento de texto manuscrito (HTR). Sin embargo, los casos de uso reales todavía son un desafío debido a la variabilidad de estilos de escritura de diferentes escritores y la cantidad limitada de datos etiquetados. Por lo tanto, es necesario explorar tanto arquitecturas para reconocimiento de texto manuscrito más robustas como proponer métodos para disminuir la brecha entre los datos de origen y destino de una manera no supervisada. En esta tesis, en primer lugar, exploramos arquitecturas novedosas para el HTR, desde el método secuencia-a-secuencia (Seq2Seq) con mecanismo de atención, hasta el método no recurrente basado en Transformers. En segundo lugar, nos centramos en reducir la brecha de rendimiento entre los datos de origen y de destino mediante métodos no supervisados. Finalmente, proponemos un grupo de métodos generativos para imágenes de texto manuscrito, que pueden usarse para aumentar el conjunto de entrenamiento y obtener un reconocedor más robusto. Además, simplemente modificando el método generativo y uniéndolo con un reconocedor, obtenemos un método eficaz para destilar el contenido textual de los estilos de escritura para lograr un rendimiento de reconocimiento generalizado. En resultados experimentales obtenemos rendimientos en HTR que superan los del estado del arte en diferentes conjuntos de datos científicos e industriales, los cuales demuestran la efectividad de los métodos propuestos. Hasta donde sabemos, el reconocedor no recurrente y el método de para destilar son contribuciones originales en el campo de reconocimiento de texto manuscrito. Finalmente, hemos esbozado posibles líneas de investigación que sería interesante explorar en el futuro.Handwritten documents are not only preserved in historical archives but also widely used in administrative documents such as cheques and claims. With the rise of the deep learning era, many state-of-the-art approaches have achieved good performance on specific datasets for Handwritten Text Recognition (HTR). However, it is still challenging to solve real use cases because of the varied handwriting styles across different writers and the limited labeled data. Thus, both exploring a more robust handwriting recognition architectures and proposing methods to diminish the gap between the source and target data in an unsupervised way are demanded. In this thesis, firstly, we explore novel architectures for HTR, from Sequence-to-Sequence (Seq2Seq) method with attention mechanism to non-recurrent Transformer-based method. Secondly, we focus on diminishing the performance gap between source and target data in an unsupervised way. Finally, we propose a group of generative methods for handwritten text images, which could be utilized to increase the training set to obtain a more robust recognizer. In addition, by simply modifying the generative method and joining it with a recognizer, we end up with an effective disentanglement method to distill textual content from handwriting styles so as to achieve a generalized recognition performance. We outperform state-of-the-art HTR performances in the experimental results among different scientific and industrial datasets, which prove the effectiveness of the proposed methods. To the best of our knowledge, the non-recurrent recognizer and the disentanglement method are the first contributions in the handwriting recognition field. Furthermore, we have outlined the potential research lines, which would be interesting to explore in the future.Universitat Autònoma de Barcelona. Programa de Doctorat en Informàtic