Childbirth in Palestine

Objective: This study describes staffing, caseloads and reported routine practices for normal childbirth in Palestinian West Bank (WB) governmental maternity facilities and compares these practices with evidence-based care. Methods: Data on routine childbirth practices in all eight governmental hospitals were obtained through interviews with head obstetricians and midwives. Data on staffing and monthly number of births were collected by phone or personal interview from all 37 WB hospitals. Results: Forty-eight percent of WB deliveries took place in crowded and understaffed governmental hospitals. Reported practices were not consistently in line with evidence-based care. Lack of knowledge and structural barriers were reasons for this gap. Conclusion: The implications of limiting unnecessary interventions in the normal birth process are particularly important in a context of limited access and scarce resources. More skilled birth attendants and a universal commitment to effective care are neede

Building the infrastructure, modeling the nation: the case of birth in Palestine

This article explores the intersection between the professional politics of medicine and national politics during the second Palestinian uprising, which erupted in 2000. Through an analysis of stories about childbirth from actors in the birth process—obstetricians, midwives and birth mothers—it examines two overlapping movements that contributed to building the public health infrastructure, the movement of sumud or steadfastness (1967–87) and the popular health movement (1978–94), as well as their contemporary afterlife. Finally, it deals with relations between medicine and governance through an analysis of the interpenetration of medical and political authority. The birth stories bring to light two contrasting visions of a nation in the context of restrictions on mobility and a ground chopped up by checkpoints. The quasi-postcolonial condition of Palestine as popular construct, institutional protostate organism, and the lived experience of its experts and of its gendered subjects underlie the ethnographic account

Birth at the Checkpoint, the Home or the Hospital? Adapting to the Changing Reality in Palestine

Women have the right to feel safe during childbirth and to choose the place where they want to give birth. This certainly has not been the case for Palestinian women living under occupation in the past two years. The emergency situation has changed the parameters of maternity care. In the previous decade, the trend had been toward a decrease in home births, with ninety per cent of pregnant women in the West Bank giving birth in maternity facilities in 1999. Recently, however, the frequent and severe closures, the extended curfews, and the unpredictable emergency situation has led to a considerable increase in childbirth at home or in doctors’ clinics. During these periods of siege, midwives (both formally trained ones and the dayas or traditional birth attendants), physicians, and even family members were called upon to be birth attendants. Birthing women have shown strength and courage despite the atmosphere of fear linked to the siege and the periodic inability to reach the hospital in case of emergency. Midwives have calmed many anxious pregnant women, reassuring them that they will accompany them throughout the birth and give them the necessary encouragement and support that they need to give birth successfully, in spite of the obstacles. Some health professionals, unaccustomed to birth outside of the hospital, had to overcome their own anxieties in order to assist pregnant women and deal with the complications in the community. Many of the births resulted in healthy babies. However, some of the cases ended in tragedy with the death of the infant and in rare cases with maternal death, when the laboring woman was delayed at the checkpoin

Childbirth in Palestine: Reported Practices and Evidence-based Guidlines

This study has identified a gap between reported practices and evidence-based care for normal childbirth in WB maternity facilities. Promoting normal birth and avoiding over-medicalization of the birth process with excessive interventions are particularly important in a situation of conflict and scarce resources. Normal births without unnecessary technical interventions are relatively inexpensive and are less likely to lead to iatrogenic complications, particularly when access to higher levels of care is limited. Using only those practices in routine childbirth care that have been shown to be beneficial and avoiding those that are harmful would improve the quality of care for normal labor and birth. In addition, there is an imbalance in the availability of skilled birth attendants in maternity facilities across the sectors. Given the importance of the governmental sector in the provision of childbirth care to the many pregnant women who cannot afford private services and the significant number of high-risk referral cases, there is an urgent need to improve the quality of care and sustainability of these services. A sufficient number of skilled birth attendants with appropriate attitudes, skills and time to support normal labor and birth are needed for safe childbirth in maternity facilities

Development and application of a microarray meter tool to optimize microarray experiments

<p>Abstract</p> <p>Background</p> <p>Successful microarray experimentation requires a complex interplay between the slide chemistry, the printing pins, the nucleic acid probes and targets, and the hybridization milieu. Optimization of these parameters and a careful evaluation of emerging slide chemistries are a prerequisite to any large scale array fabrication effort. We have developed a 'microarray meter' tool which assesses the inherent variations associated with microarray measurement prior to embarking on large scale projects.</p> <p>Findings</p> <p>The microarray meter consists of nucleic acid targets (reference and dynamic range control) and probe components. Different plate designs containing identical probe material were formulated to accommodate different robotic and pin designs. We examined the variability in probe quality and quantity (as judged by the amount of DNA printed and remaining post-hybridization) using three robots equipped with capillary printing pins.</p> <p>Discussion</p> <p>The generation of microarray data with minimal variation requires consistent quality control of the (DNA microarray) manufacturing and experimental processes. Spot reproducibility is a measure primarily of the variations associated with printing. The microarray meter assesses array quality by measuring the DNA content for every feature. It provides a post-hybridization analysis of array quality by scoring probe performance using three metrics, a) a measure of variability in the signal intensities, b) a measure of the signal dynamic range and c) a measure of variability of the spot morphologies.</p

A cross sectional study of maternal ‘near-miss’ cases in major public hospitals in Egypt, Lebanon, Palestine and Syria

The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and SyriaWHO Alliance grant (Implementation Research Protocol ID A65770)

Prognostic Markers of DNA Methylation and Next-Generation Sequencing in Progressive Glioblastoma from the EORTC-26101 Trial

PURPOSE: The EORTC-26101 study was a randomized phase II and III clinical trial of bevacizumab in combination with lomustine versus lomustine alone in progressive glioblastoma. Other than for progression-free survival (PFS), there was no benefit from addition of bevacizumab for overall survival (OS). However, molecular data allow for the rare opportunity to assess prognostic biomarkers from primary surgery for their impact in progressive glioblastoma. EXPERIMENTAL DESIGN: We analyzed DNA methylation array data and panel sequencing from 170 genes of 380 tumor samples of the EORTC-26101 study. These patients were comparable with the overall study cohort in regard to baseline characteristics, study treatment, and survival.RESULTS: Of patients' samples, 295/380 (78%) were classified into one of the main glioblastoma groups, receptor tyrosine kinase (RTK)1, RTK2 and mesenchymal. There were 10 patients (2.6%) with isocitrate dehydrogenase mutant tumors in the biomarker cohort. Patients with RTK1 and RTK2 classified tumors had lower median OS compared with mesenchymal (7.6 vs. 9.2 vs. 10.5 months). O6-methylguanine DNA-methyltransferase (MGMT) promoter methylation was prognostic for PFS and OS. Neurofibromin (NF)1 mutations were predictive of response to bevacizumab treatment.CONCLUSIONS: Thorough molecular classification is important for brain tumor clinical trial inclusion and evaluation. MGMT promoter methylation and RTK1 classifier assignment were prognostic in progressive glioblastoma. NF1 mutation may be a predictive biomarker for bevacizumab treatment.</p

Quantifying interactions between accommodation and vergence in a binocularly normal population

AbstractStimulation of the accommodation system results in a response in the vergence system via accommodative vergence cross-link interactions, and stimulation of the vergence system results in an accommodation response via vergence accommodation cross-link interactions. Cross-link interactions are necessary in order to ensure simultaneous responses in the accommodation and vergence systems. The crosslink interactions are represented most comprehensively by the response AC/A (accommodative vergence) and CA/C (vergence accommodation) ratios, although the stimulus AC/A ratio is measured clinically, and the stimulus CA/C ratio is seldom measured in clinical practice. The present study aims to quantify both stimulus and response AC/A and CA/C ratios in a binocularly normal population, and determine the relationship between them. 25 Subjects (mean±SD age 21.0±1.9years) were recruited from the university population. A significant linear relationship was found between the stimulus and response ratios, for both AC/A (r2=0.96, p<0.001) and CA/C ratios (r2=0.40, p<0.05). Good agreement was found between the stimulus and response AC/A ratios (95% CI −0.06 to 0.24MA/D). Stimulus and response CA/C ratios are linearly related. Stimulus CA/C ratios were higher than response ratios at low values, and lower than response ratios at high values (95% CI −0.46 to 0.42D/MA). Agreement between stimulus and response CA/C ratios is poorer than that found for AC/A ratios due to increased variability in vergence responses when viewing the Gaussian blurred target. This study has shown that more work is needed to refine the methodology of CA/C ratio measurement

Safety Assessment of Graphene-Based Materials: Focus on Human Health and the Environment

Graphene and its derivatives are heralded as 'miracle' materials with manifold applications in different sectors of society from electronics to energy storage to medicine. The increasing exploitation of graphene-based materials (GBMs) necessitates a comprehensive evaluation of the potential impact of these materials on human health and the environment. Here we discuss synthesis and characterization of GBMs as well as human and environmental hazard assessment of GBMs using in vitro and in vivo model systems with the aim to understand the properties that underlie the biological effects of these materials; not all GBMs are alike, and it is essential that we disentangle the structure-activity relationships for this class of materials

Analysis of Endocrine Disruption in Southern California Coastal Fish Using an Aquatic Multispecies Microarray

BackgroundEndocrine disruptors include plasticizers, pesticides, detergents, and pharmaceuticals. Turbot and other flatfish are used to characterize the presence of chemicals in the marine environment. Unfortunately, there are relatively few genes of turbot and other flatfish in GenBank, which limits the use of molecular tools such as microarrays and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) to study disruption of endocrine responses in sentinel fish captured by regulatory agencies.ObjectivesWe fabricated a multigene cross-species microarray as a diagnostic tool to screen the effects of environmental chemicals in fish, for which there is minimal genomic information. The array included genes that are involved in the actions of adrenal and sex steroids, thyroid hormone, and xenobiotic responses. This microarray will provide a sensitive tool for screening for the presence of chemicals with adverse effects on endocrine responses in coastal fish species.MethodsWe used a custom multispecies microarray to study gene expression in wild hornyhead turbot (Pleuronichthys verticalis) collected from polluted and clean coastal waters and in laboratory male zebrafish (Danio rerio) after exposure to estradiol and 4-nonylphenol. We measured gene-specific expression in turbot liver by qRT-PCR and correlated it to microarray data.ResultsMicroarray and qRT-PCR analyses of livers from turbot collected from polluted areas revealed altered gene expression profiles compared with those from nonaffected areas.ConclusionsThe agreement between the array data and qRT-PCR analyses validates this multispecies microarray. The microarray measurement of gene expression in zebrafish, which are phylogenetically distant from turbot, indicates that this multispecies microarray will be useful for measuring endocrine responses in other fish