Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya.

BACKGROUND: In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. METHODS: This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2-6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. RESULTS: Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others\u27 perspectives on delivery location and lack of aides/escorts. CONCLUSIONS: Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women\u27s preferences

Near-field imaging and frequency tuning of a high-Q photonic crystal membrane microcavity

We discuss experimental studies of the interaction between a nanoscopic object and a photonic crystal membrane resonator of quality factor Q=55000. By controlled actuation of a glass fiber tip in the near-field of a photonic crystal, we constructed a complete spatio-spectral map of the resonator mode and its coupling with the fiber-tip. On the one hand, our findings demonstrate that scanning probes can profoundly influence the optical characteristics and the near-field images of photonic devices. On the other hand, we show that the introduction of a nanoscopic object provides a low-loss method for on-command tuning of a photonic crystal resonator frequency. Our results are in a very good agreement with the predictions of a combined numerical/analytical theory.Comment: 9 pages, 4 figure

Study on Magnesium based Pyrotechnic Composition as a Priming Charge

A new pyrotechnic composition containing Mg/KNO3/phenolic resin has been formulated and studied in detail for its sensitivity, mechanical and thermal properties, moisture and environmental effects and performance in a closed vessel. The data generated reveal that this composition shows superior performance, better mechanical properties and less susceptibility to moisture as compared to gunpowder. In addition, performance of the composition under extreme hot (45 degree centigrade) and cold (-26 degree centigrade) environmental conditions is not affected at all. Differential thermal analyser results indicate that phenolic resin plays a vital role in reducing the ignition temperature of Mg/KNO/sub 3/ system

Kidney injury molecule-1: a urinary biomarker for contrast induced acute kidney injury.

Back ground: Urinary kidney injury molecule 1 (KIM-1) is early biomarker for renal damage. A few studies have been published analyzing the potential use of urinary kidney injury molecule-1 (KIM-1) as a biomarker for acute kidney injury. However no study has been done related to Acute Kidney Injury associated with contrast administration. Aim: To search for new markers to identify Acute Kidney Injury (ARF) associated with contrast administration earlier than serum creatinine. Material and Methods: We studied 100 consecutive patients with normal serum creatinine undergoing angiographic procedure. We assessed urine KIM-1, at 4h, 8h, and 24 hours after the angiographic procedure. Serum creatinine was measured at basal, 24h and 48 hours after the procedure. Results: There was a significant rise in urinary KIM-1 levels at 24 hours after the angiographic procedure. The presence of contrast induced nephropathy associated with acute Kidney Injury was 12%. Conclusion: The present study highlighted the importance of urinary KIM-1 in detecting Acute Kidney Injury associated with contrast administration earlier than Serum creatinine. Key words: Neutrophil-gelatinase-associated lipocalin. Contrast-induced nephropathy. Cystatin C. Glomerular Filtration Rate (GFR), Kidney injury molecule -1 (KIM-1)

Optimal operation of a multibasin reservoir system

A simulation-optimization procedure is presented for evaluating the extent of interbasin transfer of water in the Peninsular Indian river system consisting of 15 reservoirs on four river basins. A system-dependent simulation model is developed incorporating the concept of reservoir zoning to facilitate releases and transfers. The simulation model generates a larger number of solutions which are then screened by the optimization model. The Box complex nonlinear programming algorithm is used for the optimization. The performance of the system is evaluated through simulation with the optimal reservoir zones with respect to four indices, reliability, resiliency, vulnerability and deficit ratio. The results indicate that by operating the system of 15 reservoirs as a single unit the existing utilization of water may be increased significantly

A qualitative study on the impact of long-distance travel for gynecologic cancer care

Background: Women with gynecologic malignancies experience improved clinical outcomes when they are treated by gynecologic oncologists and in high-volume cancer centers. However, geography is a major barrier to high-volume care for patients. This qualitative study was undertaken to identify facilitators and barriers to patients traveling long distances for gynecologic cancer care. Methods: Semi-structured interviews were conducted with 19 women with gynecologic malignancies traveling \u3e50 miles for treatment at Wake Forest Comprehensive Cancer Center. Eight interviews included caregivers. Four interview domains focused on personal challenges and coping strategies related to accessing cancer care. Results: Mean distance traveled for care was 87 miles (range: 54-218). Most participants reported that recommendations from physicians, friends, and family motivated travel. 10/19 participants were aware of closer sites for cancer care; 5 had unfavorable experiences elsewhere. Barriers to travel included time, cost, childcare, difficulty navigating, and physical discomfort. Social support was an important facilitator of travel for care; some patients utilized loaned money or vehicles. Participants reported significant energy expenditure scheduling travel, coordinating time off work, and arranging overnight stays near the cancer center. Suggestions for care improvement included travel vouchers, transportation assistance, signage and personnel to help with navigation, and appointments later in the day. Participants supported in-person oncologist outreach to rural areas and appointments via telemedicine; few preferred the current infrastructure. Conclusion: Patients who travel long distances for gynecologic cancer care encounter significant burdens and rely heavily on social and financial support. Interventions should be developed and evaluated to reduce the burden of long-distance travel and develop efficient methods of outreach, including telemedicine

Regional climate messages for South Asia

It was essential to understand the extent of climatic variability and the associated biophysical response to ascertain appropriate entry points for the RRP phase. To enhance our understanding of historical climate change and climate variability in the three ASSAR sub-regions, we investigated trends in temperature and precipitation in the broader landscape surrounding the sub-regions (hereafter ASSAR sub-region envelopes).International Development Research Centre (IDRC) - CanadaUK's Department for International Development (DFID) UKCollaborative Adaptation Research Initiative in Africa and Asia (CARIAA