Barriers to obstetric care among maternal near-misses

Background. There are several factors in the healthcare system that may influence a woman’s ability to access appropriate obstetric care.Objective. To determine the delays/barriers in providing obstetric care to women who classified as a maternal near-miss.Methods. This was a descriptive observational study at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. One hundred maternal near-misses were prospectively identified using the World Health Organization criteria. The ‘three-delays model’ was used to identify the phases of delay in the health system and recorded by the doctor caring for the patient.Results. One or more factors causing a delay in accessing care were identified in 83% of near-miss cases. Phase I and III delays were the most important causes of barriers. Lack of knowledge of the problem (40%) and inadequate antenatal care (37%) were important first-phase delays. Delay in patient admission, referral and treatment (37%) and substandard care (36%) were problems encountered within the health system. The above causes were also the most important factors causing delays for the leading causes of maternal near-misses – obstetric haemorrhage, hypertension/pre-eclampsia, and medical and surgical conditions.Conclusions. Maternal morbidity and mortality rates may be reduced by educating the community about symptoms and complications related to pregnancy. Training healthcare workers to identify and manage obstetric emergencies is also important. The frequency of antenatal visits should be revised, with additional visits in the third trimester allowing more opportunities for blood pressure to be checked and for identifying hypertension

A Comparative Study on the Energy Consumption of PHP Single and Double Quotes

This paper is an enhanced version of the paper presented at the SEEDS Conference (Olaoluwa, et. al, 2015). The increasing rate of carbon dioxide and other greenhouse gas emission resulting from the use of IT and other human activities to the atmosphere has become a major source of concern. It is imperative for the IT sector to ensure that its products are effective and energy efficient accompanied by mitigated negative impact on the environment. Reducing energy consumption of IT products is a key to contributing towards a greener environment. Another alternative is to produce energy efficient codes for software applications. In programming or scripting languages, an end result can be achieved in more than one way. For example, in PHP, a print command can be executed using a single quote and can also be achieved using a double quote. They have similar functions with similar quality of the intended outcomes. The aim of this research is conduct an investigation on the energy consumption of selected PHP scripts that perform similar functions: print single and double quote; echo single and double quote, etc… The Joulemeter energy measuring tool is used to measure the amount of energy consumed when run the various PHP scripts

Fretting wear behaviour of MoS2 dry film lubricant

Dry film lubricants (DFL) are used as palliative coatings to prevent fretting wear. In this work fretting tests are carried out on coated Ti6Al4V cylinders on coated flat samples under dry sliding conditions, using an amplitude of 300 µm, 2.5 Hz frequency and 575 N normal loads. During the tests the coefficient of friction (CoF) was monitored, with tests being terminated when the coefficient of friction reached 0.7. Wear scars were analysed by profilometry and SEM to elucidate wear mechanisms. Results show that CoF initially increases rapidly to 0.4, this is then followed by a plateau region that finishes in a sudden step decrease in CoF following which CoF rises steadily. This behaviour is shown to be characteristic and interrupted tests are presented to allow elucidation of the wear scar at different stages in the lifetime and thus aid an understanding of the mechanisms of degradation which control the tribological behaviour

Evaluation of a strict protocol approach in managing women with severe disease due to hypertension in pregnancy: A before and after study

BACKGROUND: To evaluate whether the introduction of a strict protocol based on the systemic evaluation of critically ill pregnant women with complications of hypertension affected the outcome of those women. METHOD: Study group: Indigent South African women managed in the tertiary hospitals of the Pretoria Academic Complex. Since 1997 a standard definition of women with severe acute maternal morbidity (SAMM), also referred to as a Nearmiss, has been used in the Pretoria Academic Complex. All cases of SAMM and maternal deaths (MD) were entered on the Maternal Morbidity and Mortality Audit System programme (MaMMAS). A comparison of outcome of severely ill women who had complications of hypertension in pregnancy was performed between 1997–1998 (original protocol) and 2002–2003 (strict protocol). Data include women referred from outside the Pretoria Academic Complex area to the tertiary hospitals. RESULTS: Between 1997–1998 there were 79 women with SAMM and 18 maternal deaths due to complications of hypertension, compared with 91 women with SAMM and 13 maternal deaths in 2002–2003. The mortality index (MI) declined from 18.6% to 12.5% (OR 0.62, 95% CI 0.27–1.45). Statistically significant fewer women had renal failure (RR 0.37, 95% CI 0.21 – 0.66) and cerebral complications (RR 0.52, 95%CI 0.34 – 0.81) during the second period, and liver dysfunction (RR 0.27 95%CI 0.06 – 1.25) tended to be lower. However, there tended to be an increase in the number of women, who had immune system failure (RR 4.2 95%CI 0.93 – 18.94) and respiratory failure (RR 1.42 95%CI 0.88 – 2.29) although it did not reach significance. Cardiac failure remained constant (RR 0.84 95%CI 0.54 – 1.30). CONCLUSION: The strict protocol approach based on the systemic evaluation of severely ill pregnant women with complications of hypertension and an intensive, regular feedback mechanism has been associated with a reduction in the number of patients with renal failure and cerebral compromise

Maternal near miss and maternal death in the Pretoria Academic Complex, South Africa: A population-based study

Background. In order to reduce maternal mortality in South Africa (SA), it is important to understand the process of obstetric care, identify weaknesses within the system, and implement interventions for improving care.Objective. To determine the spectrum of maternal morbidity and mortality in the Pretoria Academic Complex (PAC), SA.Methods. A descriptive population-based study that included all women delivering in the PAC. The World Health Organization definition, criteria and indicators of near miss and maternal death were used to identify women with severe complications in pregnancy.Results. Between 1 August 2013 and 31 July 2014, there were 26 614 deliveries in the PAC. The institutional maternal mortality ratio was 71.4/100 000 live births. The HIV infection rate was 19.9%, and 2.7% of women had unknown HIV status. Of the women, 1 120 (4.2%) developed potentially life-threatening conditions and 136 (0.5%) life-threatening conditions. The mortality index was 14.0% overall, 30.0% for non-pregnancy-related infections, 2.0% for obstetric haemorrhage and 13.6% for hypertension. Of the women with life-threatening conditions, 39.3% were referred from the primary level of care. Vascular, uterine and coagulation dysfunctions were the most frequent organ dysfunctions in women with life-threatening conditions. The perinatal mortality rate was 26.9/1 000 births overall, 23.1/1 000 for women with non-life-threatening conditions, and 198.0/1 000 for women with life-threatening conditions.Conclusion. About one in 20 pregnant women in the PAC had a potentially life-threatening condition; 39.3% of women presented to a primary level facility as an acute emergency and had to be transferred for tertiary care. All healthcare professionals involved in maternity care must have knowledge and skills that equip them to manage obstetric emergencies. Review of the basic antenatal care protocol may be necessary

Swimming against the tide: a study of a neighbourhood trying to rediscover its ‘reason for being’– the case of South Bank, Redcar and Cleveland.

Many of the programmes and initiatives to regenerate deprived neighbourhoods appear to have had limited lasting impact. It has been argued that one reason for this is that we still have little real understanding of the nature and scale of the problems some communities face (Bernt, 2009). This article attempts to add to our knowledge through close study of an area with multiple problems and a history of failed regeneration attempts. An in-depth case study, undertaken to explore the current situation and future prospects of South Bank, a small neighbourhood in the North East of England, highlights transferable knowledge which may be applied to other regeneration areas. The analysis considers the nature and consequences of industrial decline; entrenched deprivation; the stigmatization of communities; the value of community consultation and the potential impact of retail-led regeneration. We question whether negative stigma attached to places can be changed and we ask what the future may hold for deprived communities now that public sector funding has largely dried up, and we consider an alternative approach: the potential impacts of private sector retail-led regeneration in the absence of public sector funding

Encapsulation and sedimentation of nanomaterials through complex coacervation

Altres ajuts: the ICN2 is funded by the CERCA programme/Generalitat de Catalunya.Hypothesis: Nanoparticles removal from seawage water is a health and environmental challenge, due to the increasing use of these materials of excellent colloidal stability. Herein we hypothesize to reach this objective through complex coacervation, a straightforward, low-cost process, normally accomplished with non-toxic and biodegradable macromolecules. Highly dense polymer-rich colloidal droplets (the coacervates) obtained from a reversible charge-driven phase separation, entrap suspended nanomaterials, allowing their settling and potential recovery. Experiments: In this work we apply this process to highly stable aqueous colloidal dispersions of different surface charge, size, type and state (solid or liquid). We systematically investigate the effects of the biopolymers excess and the nanomaterials concentration and charge on the encapsulation and sedimentation efficiency and rate. This strategy is also applied to real laboratory water-based wastes. Findings: Long-lasting colloidal suspensions are succesfully destabilized through coacervate formation, which ensures high nanomaterials encapsulation efficiencies (~85%), payloads and highly tranparent supernatants (%T ~90%), within two hours. Lower polymer excess induces faster clearance and less sediments, while preserving effective nanomaterials removal. Preliminary experiments also validate the method for the clearance of real water residuals, making complex coacervation a promising scalable, low-cost and ecofriendly alternative to concentrate, separate or recover suspended micro/nanomaterials from aqueous sludges

Defining the need for surgical intervention following a snakebite still relies heavily on clinical assessment: The experience in Pietermaritzburg, South Africa

Background. This audit of snakebites was undertaken to document our experience with snakebite in the western part of KwaZulu-Natal (KZN) Province, South Africa (SA).Objective. To document our experience with snakebite in the western part of KZN, and to interrogate the data on patients who required some form of surgical intervention.Methods. A retrospective study was undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, SA. The Hybrid Electronic Medical Registry was reviewed for the 5-year period January 2012 - December 2016. All patients admitted to the service for management of snakebite were included.Results. The offending snake is rarely identified, and the syndromic approach is now the mainstay of management. Most envenomations seen during the study period were cytotoxic, presenting with painful progressive swelling (PPS). We did not see any purely neurotoxic or haemotoxic envenomations. Antivenom is required for a subset of patients. The indications are essentially PPS that increases by >15 cm over an hour, PPS up to the elbow or knee after 4 hours, PPS of the whole limb after 8 hours, threatened airway, shortness of breath, associated clotting abnormalities and compartment syndrome. If no symptoms have manifested within 1 hour of a snakebite, clinically significant envenomation is unlikely to have occurred. Antivenom is associated with a high rate of anaphylaxis and should only be administered when absolutely indicated, preferably in a high-care setting under continuous monitoring. The need for surgery is less well defined. Urgent surgery is indicated for compartment syndrome of the limb, which is a potentially life- and limb-threatening condition. Its diagnosis is usually made clinically, but this is difficult in snakebites. Morbidity and cost increase dramatically once fasciotomy is required, as evidenced by much longer hospital stay. There is frequently a degree of cross-over between cytotoxicity and haemotoxicity in envenomations that require fasciotomy, which means that fasciotomy may result in catastrophic bleeding and should be preceded by the administration of antivenom, especially in patients with a low platelet count or a high international normalised ratio. Physiological and biochemical markers are unhelpful in assessing the need for fasciotomy. Objective methods include measurement of compartment pressures and ultrasound.Conclusion. The syndromic management of snakebite is effective and safe. There is a high incidence of anaphylactic reactions to antivenom, and its administration must be closely supervised. In our area we overwhelmingly see cytotoxic snakebites with PPS. Surgery is often needed, and we need to refine our algorithms in terms of deciding on surgery