Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey

Background: Partograph is an effective, but underutilized tool for monitoring labour. This study examined the influence of hospital policy on the knowledge, attitude, practice and skills of doctors towards partograph plotting.Methods: A cross-sectional survey among doctors posted in labour rooms of tertiary care public teaching hospitals of India was carried out, using self-administered questionnaire to assess knowledge, attitude and practice; and labour case scenarios were provided to assess partograph plotting skills. Chi-square test or Fisher’s exact test were employed to test the significance of association between knowledge, attitude, practice and skills of 150 doctors working in hospitals with (n=3) and without (n=2) policy of routine partograph plotting.Results: The majority of doctors in both groups had correct knowledge about different partograph components. However, doctors working in hospitals with a policy of partograph use, demonstrated significantly better skills using case scenarios for plotting partographs (p<0.01), and a positive attitude towards plotting partograph and its use as a decision support tool (p=0.000) as compared to doctors working in hospitals without a routine partograph plotting policy.Conclusions: Hospital policy of routine partograph plotting may positively influence utilization of partograph in tertiary care public hospitals in India

Knowledge, perception and practice towards oxytocin stability and quality: A qualitative study of stakeholders in three resource-limited countries

Background: Oxytocin is the gold standard drug for the prevention of postpartum haemorrhage, but limitations in cold chain systems in resource-constrained settings can severely compromise the quality of oxytocin product available in these environments. This study investigated the perspectives and practices of stakeholders in low and lower-middle income countries towards oxytocin, its storage requirements and associated barriers, and the quality of product available. Methods: Qualitative inquiries were undertaken in Ethiopia, India and Myanmar, where data was collected through Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs). A total of 12 FGDs and 106 IDIs were conducted with 158 healthcare providers (pharmacists, midwives, nurses, doctors and obstetricians) and 40 key informants (supply chain experts, program managers and policy-makers). Direct observations of oxytocin storage practices and cold chain resources were conducted at 51 healthcare facilities. Verbatim transcripts of FGDs and IDIs were translated to English and analysed according to a thematic content analysis framework. Findings: Stakeholder awareness of oxytocin heat sensitivity and the requirement for cold storage of the drug was widespread in Ethiopia but more limited in Myanmar and India. A consistent finding across all study regions was the significant barriers to maintaining a consistent cold chain, with the lack of refrigeration facilities and unreliability of electricity cited as major challenges. Perceptions of compromised oxytocin quality were expressed by some stakeholders in each country. Conclusion: Knowledge of the heat sensitivity of oxytocin and the potential impacts of inconsistent cold storage on product quality is not widespread amongst healthcare providers, policy makers and supply chain experts in Myanmar, Ethiopia and India. Targeted training and advocacy messages are warranted to emphasise the importance of cold storage to maintain oxytocin quality

Use of Hydrothermal Carbonization and Cold Atmospheric Plasma for Surface Modification of Brewer’s Spent Grain and Activated Carbon

This paper presents results that show the effect of hydrothermal carbonization and subsequent cold plasma jet treatment with helium and argon on the structure and sorption properties of a material—spent brewery grain. Treatment of activated carbon, with a cold atmospheric plasma jet, was used comparatively. The effect of activation on the pore structure of the materials was carried out by the volumetric method at low pressure (N2, 77 K). The specific surface area as well as the total pore volume, average pore size, and pore size distribution were determined using different theoretical models. A high improvement in the sorption capacity parameter was obtained for hydrochars after cold atmospheric plasma jet treatment with an increase of 7.5 times (using He) and 11.6 times (using Ar) compared with hydrochars before cold atmospheric plasma jet treatment. The increase in specific surface area was five-fold (He) and fifteen-fold (Ar). For activated carbon, such a large change was not obtained after plasma activation. Regardless of the gas used, the increase in structural parameter values was 1.1–1.3

Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India.

BACKGROUND: Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices. METHODS: We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers. RESULTS: Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coach was present (range: -1% to 62%). CONCLUSION: Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings

Far-Ultraviolet to Near-Infrared Observations of SN 2023ixf: A high energy explosion engulfed in complex circumstellar material

We present early-phase panchromatic photometric and spectroscopic coverage spanning far-ultraviolet (FUV) to the near-infrared (NIR) regime of the nearest hydrogen-rich core-collapse supernova in the last 25 years, SN~2023ixf. We observe early `flash' features in the optical spectra due to a confined dense circumstellar material (CSM). We observe high-ionization absorption lines Fe II, Mg II in the ultraviolet spectra from very early on. We also observe a multi-peaked emission profile of H-alpha in the spectrum beginning ~16 d, which indicates ongoing interaction of the SN ejecta with a pre-existing shell-shaped CSM having an inner radius of ~ 75 AU and an outer radius of ~140 AU. The shell-shaped CSM is likely a result of enhanced mass loss ~ 35 - 65 years before the explosion assuming a standard Red-Supergiant wind. Spectral modeling of the FUV, NUV, and the optical spectra during 9-12 d, using the radiative transfer spectrum synthesis code TARDIS indicates that the supernova ejecta could be well represented by a progenitor elemental composition greater than solar abundances. Based on early light curve models of Type II SNe, we infer that the nearby dense CSM confined to ~7+-3e14~cm(~45 AU) is a result of enhanced mass loss ~1e-(3.0+-0.5) Msol/yr two decades before the explosion.Comment: Submitted to AAS Journals, 4 figures, 2 table

Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption

<p>Abstract</p> <p>Background</p> <p>The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or <it>paan masala </it>on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, <it>paan masala </it>and tobacco chewing on the donor site morbidity has been documented.</p> <p>Methods</p> <p>Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.</p> <p>Results</p> <p>Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.</p> <p>Conclusion</p> <p>Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.</p

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians

Local structural changes in paramagnetic and charge ordered phases of Sm0.2Pr0.3Sr0.5MnO3: An EXAFS Study

Sm{0.5-x}Pr{x}Sr{0.5}MnO{3} exhibits variety of ground states as x is varied from 0 to 0.5. At an intermediate doping of x = 0.3 a charge-ordered CE type antiferromagnetic insulating (AFI) ground state is seen. The transition to this ground state is from a paramagnetic insulating (PMI) phase through a ferromagnetic metallic phase (FMM). Local structures in PMI and AFI phases of x = 0.3 sample have been investigated using Pr K-edge and Sm K-edge Extended X-ray Absorption Fine Structure (EXAFS). It can be seen that the tilting and rotation of the MnO6 octahedra about the b-axis are responsible for the charge ordered CE-type antiferromagnetic ground state at low temperatures. In addition a shift in the position of the rare earth ion along the c-axis has to be considered to account for observed distribution of bond distances around the rare earth ion