Successful combined spinal–Epidural anesthesia for a case of scleroderma for amputation

This research has two objectives. The first objective is to explore the use of the modeling tool called "latent structural equations" (structural equations with latent variables) in the general field of travel behavior analysis and the more specific field of dynamic analysis of travel behavior. The second objective is to apply a latent structural equation model in order to determine the causal relationships between income, car ownership, and mobility.Many transportation researchers might be unfamiliar with latent structural equation modeling, which is also known as "latent structural analysis," "causal analysis," and "soft modeling." However, most researchers will be quite familiar with techniques that are special cases of latent structural equations: e.g., conventional multiple regression and simultaneous equations, path analysis, and (confirmatory) factor analysis. Furthermore, recent advances in estimation techniques have made it possible to incorporate discrete choice variables and other non-normal variables in structural equations models. Thus, probit choice models (binomial, ordered, and multinomial) can be incorporated within the general model framework.The empirical analysis reported here involves dynamic travel demand data from the Dutch National Mobility Panel for the three years 1984 through 1986. All variables in the model, with the exception of income level in the first year, are endogenous: income is treated as an ordinal (four category) variable; car ownership is treated as either an ordinal (ordered probit) or a categorical (multinomial probit) choice variable; and mobility, in terms of car trips and public transport trips, is treated as two censored (tobit) continuous variables. The model fits the data well, but only scratches the surface of the potential of latent structural equation modeling with panel data. Some possible extensions are outlined.The methodological discussion is not intended as a comprehensive overview of structural equation modeling with latent variables. Rather, the aim is to explore the technique in comparison to conventional methods of travel behavior analysis. Many extensive overviews are available, due to the popularity of the technique in the fields of sociology and psychology, and more recently in marketing research. The technique as described here has been in use since the early 1970s, but, because of recent rapid developments, current overviews are more relevant to transportation researchers. Such overviews are provided by Bentler (1980), Bentler and Weeks (1985), Fornell and Larcker (1981), Hayduk (1987), and Joreskog and Wold (1982), among others. In particular, Hayduk (1897) provides an extensive bibliography. Historical developments are reviewed in Bentler (1986) and Bielby and Hauser (1977).The author is aware of three computer programs for latent structural equation modeling: LISREL (Joreskog and Sorbom, 1984; 1987), EQS (Bentler, 1985), and LISCOMP (Muthen, 1987). Each program is based on a different approach to estimation and testing and each has its advantages and disadvantages. The three approaches are briefly reviewed in Section 6 on estimation methods. The application results presented here were obtained using the LISCOMP program. It is also possible to replicate the approaches of these programs by implementing several separate estimation procedures (e.g., maximum likelihood estimations of probit models and tobit models, and generalized least square and maximum likelihood estimations of siumultaneous equations) in sequential and recursive order, but this is inefficient in view of the available comprehensive packages

Choice of contraceptive methods in public and private facilities in rural India

Background: Client-centric quality of care (QoC) in family planning (FP) services are imperative for contraceptive method adoption and continuation. Less is known about the choice of contraceptive method in India beyond responses to the three common questions regarding method information, asked in demographic and health surveys. This study argues for appropriate measurement of method choice and assesses its levels and correlates in rural India. Methods: A cross-sectional study was conducted with new acceptors of family planning method (N = 454) recruited from public and private health facilities in rural Bihar and Uttar Pradesh, the two most populous states in India. The key quality of care indicator ‘method choice’ was assessed using four key questions from client-provider interactions that help in making a choice about a particular method: (1) whether the provider asked the client about their preferred method, (2) whether the provider told the client about at least one additional method, (3) whether the client received information without any single method being promoted by the provider, and (4) client’s perception about receipt of method choice. The definition of method choice in this study included women who responded “yes” to all four questions in the survey. The relationship between contraceptive communication and receipt of method choice was assessed using logistic regression analyses, after adjusting for socio-demographic characteristics of the respondents. Results: Although 62% of clients responded to a global question and reported that they received the method of their choice, only 28% received it based on responses about client-provider interactions. Receipt of the information on side-effects of the selected method (Adjusted Odds Ratio [AOR]: 7.4, 95% Confidence Interval [CI]: 3.96–13.86) and facility readiness to provide a range of contraceptive choice (AOR: 2.67, 95% CI: 1.48–4.83) were significantly associated with receipt of method choice. Conclusions: Findings demonstrated that women’s choice of contraceptive could be improved in rural India if providers give full information prior to and during the acceptance of a method and if facilities are equipped to provide a range of choice of contraceptive methods

Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India

Background: In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India’s guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country’s primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method: The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result: Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider’s adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. Conclusion: The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention