Calculation of costs of pregnancy- and puerperium-related care: Experience from a hospital in a low-income country

Calculation of costs of different medical and surgical services has numerous uses, which include monitor-ing the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost alloca-tion was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services

Carrier generation using a dual-frequency distributed feedback waveguide laser for phased array antenna (PAA)

Background: Carrier generation based on optical heterodyning techniques where a beat signal is generated from the mixing of two light sources can be interesting solution due to ease on tunability. The free running heterodyning scheme benefits with a very wide tuning capability and the generated carrier can be freely adjusted. However, the drawbacks come in the form of frequency stability. Heterodyning of two optical frequencies coming from a single laser cavity has shown its potential on improvement of frequency stability. Methods: The impact of the laser parameters (i.e., optical power and linewidth) on the quality of the generated carrier (i.e., phase/frequency stability and carrier-to-noise ratio) is analyzed for a 25×64 elements PAA system. An optically generated carrier signal using a dual-frequency distributed feedback waveguide laser in ytterbium doped aluminum oxide (Al2O3:Yb3+) is analyzed and experimentally demonstrated in this paper. The carrier signal is used for downconversion of the signal received from a phased array antenna (PAA) of a DVB-S (Digital Video Broadcasting-Satellite) system. Results: An optical frequency locked loop (OFLL) to stabilize the generated carrier is implemented which results in a microwave frequency at ∼14 GHz with a phase noise of -75 dBc/Hz at 1 MHz offset from the center frequency and gives a loop settling time of 12 μs. By using the proposed OFLL, the long term and the short term frequency stability of the generated carrier has an Allan deviation of more than 1×10−10 for an averaging time of 1000 s and a standard deviation of 39.4 kHz, respectively. The lasers linewidth should be in the order of tens of Hz, with a maximum relative intensity noise (RIN) of -107 dB/Hz and a minimum optical power of 0.94 mW. Conclusions: The optical carrier generation by OFLL using a DFL to comply with the requirements of the standard carrier used in commercial LNBs has been investigated. The detailed analysis of the OFLL scheme is presented. Specifications requirement on carrier power, linewidth and relative intensity noise of the optically generated carrier have been addressed. The optical carrier generation is experimentally demonstrated and the requirements on CNR have been determined by measuring the noise floor and the optical carrier power. The measured values are compared with the calculated values and found to be very close

Carrier generation using a dual-frequency distributed feedback waveguide laser for phased array antenna (PAA)

Abstract Background Carrier generation based on optical heterodyning techniques where a beat signal is generated from the mixing of two light sources can be interesting solution due to ease on tunability. The free running heterodyning scheme benefits with a very wide tuning capability and the generated carrier can be freely adjusted. However, the drawbacks come in the form of frequency stability. Heterodyning of two optical frequencies coming from a single laser cavity has shown its potential on improvement of frequency stability. Methods The impact of the laser parameters (i.e., optical power and linewidth) on the quality of the generated carrier (i.e., phase/frequency stability and carrier-to-noise ratio) is analyzed for a 25×64 elements PAA system. An optically generated carrier signal using a dual-frequency distributed feedback waveguide laser in ytterbium doped aluminum oxide (Al2O3:Yb3+) is analyzed and experimentally demonstrated in this paper. The carrier signal is used for downconversion of the signal received from a phased array antenna (PAA) of a DVB-S (Digital Video Broadcasting-Satellite) system. Results An optical frequency locked loop (OFLL) to stabilize the generated carrier is implemented which results in a microwave frequency at ∼14 GHz with a phase noise of -75 dBc/Hz at 1 MHz offset from the center frequency and gives a loop settling time of 12 μs. By using the proposed OFLL, the long term and the short term frequency stability of the generated carrier has an Allan deviation of more than 1×10−10 for an averaging time of 1000 s and a standard deviation of 39.4 kHz, respectively. The lasers linewidth should be in the order of tens of Hz, with a maximum relative intensity noise (RIN) of -107 dB/Hz and a minimum optical power of 0.94 mW. Conclusions The optical carrier generation by OFLL using a DFL to comply with the requirements of the standard carrier used in commercial LNBs has been investigated. The detailed analysis of the OFLL scheme is presented. Specifications requirement on carrier power, linewidth and relative intensity noise of the optically generated carrier have been addressed. The optical carrier generation is experimentally demonstrated and the requirements on CNR have been determined by measuring the noise floor and the optical carrier power. The measured values are compared with the calculated values and found to be very close

Carrier generation using a dual-frequency distributed feedback waveguide laser for phased array antenna (PAA)

Background: Carrier generation based on optical heterodyning techniques where a beat signal is generated from the mixing of two light sources can be interesting solution due to ease on tunability. The free running heterodyning scheme benefits with a very wide tuning capability and the generated carrier can be freely adjusted. However, the drawbacks come in the form of frequency stability. Heterodyning of two optical frequencies coming from a single laser cavity has shown its potential on improvement of frequency stability. Methods: The impact of the laser parameters (i.e., optical power and linewidth) on the quality of the generated carrier (i.e., phase/frequency stability and carrier-to-noise ratio) is analyzed for a 25×64 elements PAA system. An optically generated carrier signal using a dual-frequency distributed feedback waveguide laser in ytterbium doped aluminum oxide (Al2O3:Yb3+) is analyzed and experimentally demonstrated in this paper. The carrier signal is used for downconversion of the signal received from a phased array antenna (PAA) of a DVB-S (Digital Video Broadcasting-Satellite) system. Results: An optical frequency locked loop (OFLL) to stabilize the generated carrier is implemented which results in a microwave frequency at ∼14 GHz with a phase noise of -75 dBc/Hz at 1 MHz offset from the center frequency and gives a loop settling time of 12 μs. By using the proposed OFLL, the long term and the short term frequency stability of the generated carrier has an Allan deviation of more than 1×10−10 for an averaging time of 1000 s and a standard deviation of 39.4 kHz, respectively. The lasers linewidth should be in the order of tens of Hz, with a maximum relative intensity noise (RIN) of -107 dB/Hz and a minimum optical power of 0.94 mW. Conclusions: The optical carrier generation by OFLL using a DFL to comply with the requirements of the standard carrier used in commercial LNBs has been investigated. The detailed analysis of the OFLL scheme is presented. Specifications requirement on carrier power, linewidth and relative intensity noise of the optically generated carrier have been addressed. The optical carrier generation is experimentally demonstrated and the requirements on CNR have been determined by measuring the noise floor and the optical carrier power. The measured values are compared with the calculated values and found to be very close

Reasons for performing a caesarean section in public hospitals in rural Bangladesh

Background It is estimated that 18.5 million Caesarean Sections (CS) are conducted annually worldwide and about one-third of them are done without medical indications and described as “unnecessary”. Although developed countries account for most of the rise in the trend of unnecessary CS, more studies report a similar trend in developing countries, putting a strain on existing but limited healthcare resources, jeopardizing families' financial security and presenting a barrier to equitable universal coverage. We examined indications for CS in public hospitals of one district in Bangladesh and explored factors influencing decision to perform the procedure. Methods Retrospective review of case notes of 530 women who had CS in 5 public hospitals in Thakurgaon District of Bangladesh. Key Informant Interviews (KII) with 18 service providers to explore factors associated with the decision to perform a CS. Results The commonest recorded indications for CS were: previous CS (29.4%), fetal distress (15.7%), cephalo-pelvic disproportion (10.2%), prolonged obstructed labor (8.3%) and post-term dates (7.0%). The majority (68%) of CS were performed as emergency; mainly during daytime working hours. Previous CS and “post-term dates” were common indications for elective CS with “post dates” – the commonest indication for CS in primiparous women. 16.0% of all CS were conducted for cases where alternative forms of care might have been more appropriate. Providers reported not using protocols and evidence based guidelines even though these are available. Pressure from patients and relatives to deliver by CS strongly influenced decision making. External agents from private hospitals receive a financial reward for every CS performed and are present in public hospitals to “lobby” for CS. Conclusion Factors other than evidence based practice or the presence of a clear medical indication influence providers’ decision to perform both elective and emergency CS in public hospitals in Bangladesh