Cesarean Section Surgical Site Infections in Sub-Saharan Africa: A Multi-Country Study from Medecins Sans Frontieres

Background: Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs. Methods: This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone. Women undergoing from August 1 2010 to January 31 2011 were included. CS post-operative SSI data were prospectively collected. Logistic regression was used to model SSI risk factors. Findings: In total, 1,276 women underwent CS. The incidence of SSI was 7.3 % (range 1.7–10.4 %). 93 % of SSI were superficial. The median length of stay of women without SSI was 7 days (range 3–63 days) compared to 21 days (range 5–51 days) in those with SSI (p < 0.001). In multivariate analysis, younger age, premature rupture of the membranes, and neonatal death were associated with an increased risk of SSI, while antenatal hemorrhage and the Lubutu, DRC project site were associated with a lower risk of developing an SSI. Conclusions: This study demonstrates that surgery can be performed with a low incidence of SSI, a proxy for surgical safety, in sub-Saharan Africa. Protocols such as perioperative antibiotics and basic infrastructure such as clean water and sterilization can be achieved. Simple data collection tools will assist policymakers with monitoring and evaluation as well as quality control assurance of surgical programs in low and middle income countries

An Assessment Of Patterns Of Coauthorship For Academic Accountants Within Premier Journals Edited Outside The U.S.: Evidence From 1995 - 2009

Research inaccounting indicates that accounting faculty publish less in their elitejournals than marketing, management, and finance faculty publish in theirrespective elite journals (Swanson, 2004). This paper investigates co-authorshipratios for twelve premier non-U.S. edited accounting and finance journals overthe fifteen year period from 1995 to 2009. Our results suggest that for the years considered, the aggregate co-authorshipratio for non-U.S. premier accounting journals has increased significantly.Also our findings indicate that the financial accounting specialization has thehighest level of co-authorship. Additionally, the co-authorship ratio for Top25 non-U.S. universities is not significantly different than that of lowerranked non-U.S. academic institutions. We also observe that co-authorship among non-U.S. researchers is lowerthan that of U.S. researchers. The findings of this study indicate that trendsof increasing co-authorship among non-U.S. premier accounting journals areconsistent with those of U.S. premier accounting journals

The Economic Impact on Leisure Activities

This study explores the influence of the economic recession on leisure activities because economic impact is a significant factor that can change people’s travel decisions. A methodology, Ridit analysis, is applied in this study, and it adopts cumulative probability scores instead of ordinal scores. Results show that current economic crisis has had an impact on people’s ability to take time away from work

Examining the relationships between perceived value, service quality, satisfaction, and willingness to revisit a theme park

The purpose of the study is to examine the relationships between satisfaction, perceived value, and quality in their prediction of revisiting intention. Furthermore, this study applies Cronin’s (2000) research model to test the relationships, and a structural model (SEM) is used to examine the hypothesized relationships. The results show that service quality has a direct effect on perceived value and satisfaction, perceived value has direct effect on satisfaction, and satisfaction has strong relation to visitors’ willingness to revisit theme parks

Concert recording 2018-04-13

[Track 1]. Trio for piano, oboe, and horn, op. 188. I. Allegro moderato [Track 2]. II. Scherzo [Track 3]. III. Adagio [Track 4]. IV. Finale. Allegro ma non troppo / Carl Reinecke -- [Track 5]. Contrasts for clarinet, violin and piano, Sz. 111. I. Verbunkos (Recruiting dance) / Béla Bartók -- [Track 6]. InChaSon for violin, piano and tumbadoras. I. Intro [Track 7]. II. Cha cha cha [Track 8]. III. Son / Fernando Valencia -- [Track 9]. Sextet for piano and flute, oboe, clarinet, bassoon and horn, op. 100. I. Allegro vivace [Track 10]. II. Divertimento andantino [Track 11]. III. Finale, prestissimo / Francis Poulenc

Patients educating health care providers on Lynch syndrome

Objective: Lynch syndrome (LS) patients are at an elevated risk for early-onset cancers, including endometrial and colorectal (CRC). Prior research has shown a deficit in provider knowledge of LS, which may affect patient satisfaction and adherence to recommended screening and surveillance regimens. Studies suggest patients with LS may educate providers perceived as lacking LS knowledge; however, little is known about these interactions. The goal of this study is to assess patient-reported outcomes from clinical interactions where LS patients educate their providers. Methods: Participants (n=55) were asked to complete an in-depth telephone interview. Results: Out of 55 participants, approximately two-thirds (n=37) reported engaging in educational interactions. Participants reported feeling satisfied with the provider response in over half of the reported educational interactions (n=24). Participants reported changes in their patient-provider relationship ranging from improvements in their relationship to termination of services. Conclusion: Patients with LS report educating providers on their diagnosis as well as their screening and surveillance requirements. Patient-reported outcomes of these educational interactions vary based on the provider’s response to the interaction. Providers should be open and receptive to these educational interactions and follow-up on the discussion to improve patient satisfaction

Aerosol Lidar and MODIS Satellite Comparisons for Future Aerosol Loading Forecast

Knowledge of the concentration and distribution of atmospheric aerosols using both airborne lidar and satellite instruments is a field of active research. An aircraft based aerosol lidar has been used to study the distribution of atmospheric aerosols in the California Central Valley and eastern US coast. Concurrently, satellite aerosol retrievals, from the MODIS (Moderate Resolution Imaging Spectroradiometer) instrument aboard the Terra and Aqua satellites, were take over the Central Valley. The MODIS Level 2 aerosol data product provides retrieved ambient aerosol optical properties (e.g., optical depth (AOD) and size distribution) globally over ocean and land at a spatial resolution of 10 km. The Central Valley topography was overlaid with MODIS AOD (5x5 sq km resolution) and the aerosol scattering vertical profiles from a lidar flight. Backward air parcel trajectories for the lidar data show that air from the Pacific and northern part of the Central Valley converge confining the aerosols to the lower valley region and below the mixed layer. Below an altitude of 1 km, the lidar aerosol and MODIS AOD exhibit good agreement. Both data sets indicate a high presence of aerosols near Bakersfield and the Tehachapi Mountains. These and other results to be presented indicate that the majority of the aerosols are below the mixed layer such that the MODIS AOD should correspond well with surface measurements. Lidar measurements will help interpret satellite AOD retrievals so that one day they can be used on a routine basis for prediction of boundary layer aerosol pollution events

Prevalence of Trachoma in Benishangul Gumuz Region, Ethiopia: Results of Seven Population-Based Surveys from the Global Trachoma Mapping Project.

PURPOSE: Trachoma is a major cause of blindness in Ethiopia, and targeted for elimination as a public health problem by the year 2020. Prevalence data are needed to plan interventions. We set out to estimate the prevalence of trachoma in each evaluation unit of grouped districts ("woredas") in Benishangul Gumuz region, Ethiopia. METHODS: We conducted seven cross-sectional community-based surveys, covering 20 woredas, between December 2013 and January 2014, as part of the Global Trachoma Mapping Project (GTMP). The standardized GTMP training package and methodologies were used. RESULTS: A total of 5828 households and 21,919 individuals were enumerated in the surveys. 19,583 people (89.3%) were present when survey teams visited. A total of 19,530 (99.7%) consented to examination, 11,063 (56.6%) of whom were female. The region-wide age- and sex-adjusted trichiasis prevalence in adults aged ≥15 years was 1.3%. Two evaluation units covering four woredas (Pawe, Mandura, Bulen and Dibate) with a combined rural population of 166,959 require implementation of the A, F and E components of the SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvement) for at least three years before re-survey, and intervention planning should begin for these woredas as soon as possible. CONCLUSION: Both active trachoma and trichiasis are public health problems in Benishangul Gumuz, which needs implementation of the full SAFE strategy

Prognosticating for adult patients with advanced incurable cancer : a needed oncologist skill

Introduction: Prognostication is the process of making predictions about future health outcomes, usually about predicting length of survival. Patients with advanced cancer frequently express a desire for prognostic information [1]. However, simply being told that one is “terminal” or “incurable” does not usually provide sufficient information for patients or families to make detailed plans for the future [1, 2]. Even if patients do not wish to know exact timescales, they may want to have prognostic information to inform treatment discussions, undertake advance care planning, or help with decision-making [3, 4]. Clinicians commonly find it difficult to make these predictions and to discuss them with patients and relatives, leading to unmet information needs [5, 6]. Communication in this area is complex and requires skill and experience, particularly in finding the balance between conveying useful information about expected timeframes, while also explaining the inherent uncertainty in such predictions. Advanced communication skills should therefore be considered an essential element in the process of prognostication [7]. The prognosis of an individual patient is liable to change over time and to be influenced by biological, clinical, and social factors beyond diagnosis and stage of disease [8, 9]. Therefore, it is important for oncologists to develop and maintain skills in predicting survival even when the disease has become incurable and disease-directed treatment options are limited or non-existent. This is distinct from the more common practice of staging cancers to derive median survival estimates at diagnosis or the use of prognostic markers to predict response to treatment. A prognostic estimate can be formulated using a clinician’s experience and knowledge to make a judgement; this is known as a clinical prediction of survival. Although widely used, there are concerns about the subjective nature of this approach, which makes it difficult to reproduce and teach. Also, subjective judgements tend to be inaccurate and over-optimistic [10, 11••, 12]. Therefore, more “objective” scales and tools have been developed to support clinical predictions [13, 14••]. The aim of this paper is to evaluate the recent literature on prognostication for patients with advanced cancer and to suggest ways in which physicians can improve their own clinical practice in formulating and communicating prognostic estimates