Caesarean section rate as a process indicator of safe motherhood programmes: the case of Midlands Province

A CAJM article on safe motherhood in Zimbabwe.More than 10 years after the launch of the Safe Motherhood Initiative in 1987 in Kenya, many African countries still experience high levels of maternal mortality. Although this is recognized by most stakeholders in the field of reproductive health, it is difficult to give an exact figure to express the seriousness of the problem. The magnitude of maternal mortality is unknown, although various figures are circulating. The range of the maternal mortality figures reflects the variety of methods used to measure maternal mortality : vital statistics, hospital statistics or population based surveys

PRISMA database machine: A distributed, main-memory approach

The PRISMA project is a large-scale research effort in the design and implementation of a highly parallel machine for data and knowledge processing. The PRISMA database machine is a distributed, main-memory database management system implemented in an object-oriented language that runs on top of a multi-computer system. A prototype that is envisioned consists of 64 processing elements

Event Stream Processing with Multiple Threads

Current runtime verification tools seldom make use of multi-threading to speed up the evaluation of a property on a large event trace. In this paper, we present an extension to the BeepBeep 3 event stream engine that allows the use of multiple threads during the evaluation of a query. Various parallelization strategies are presented and described on simple examples. The implementation of these strategies is then evaluated empirically on a sample of problems. Compared to the previous, single-threaded version of the BeepBeep engine, the allocation of just a few threads to specific portions of a query provides dramatic improvement in terms of running time

Susceptibility of a series of routine sputum samples for antituberculosis chemotherapy in Gweru, Zimbabwe

CITATION: Apers, L. M. & Chihota, V. 2004. Susceptibility of a series of routine sputum samples for antituberculosis chemotherapy in Gweru, Zimbabwe. South African Medical Journal, 94(4):282.The original publication is available at http://www.samj.org.zaResistance of Mycobacterium tuberculosis to the commonly used antibiotics in national tuberculosis programmes (NTPs) is a growing concern in many parts of the world.1 Nevertheless there is much anecdotal, but little published, evidence that drug resistance is becoming an important barrier to effective TB control.2 In Zimbabwe the only routine source of data on drug resistance that is going further than individual case management is that of the national TB reference laboratory. This institute is performing routine drug susceptibility testing on sputum samples for the whole country. According to the NTBP guidelines, this test is only done on specific indications, i.c. when a sputum-positive patient has not converted to negative after 2 months of intensive antituberculosis chemotherapy.Publisher’s versio

A Single-Center Comparison of Extended and Restricted THROMBOPROPHYLAXIS with LMWH after Metabolic Surgery

IntroductionMorbid obesity is an important risk factor for developing a venous thromboembolic events (VTE) after surgery. Fast-track protocols in metabolic surgery can lower the risk of VTE in the postoperative period by reducing the immobilization period. Administration of thromboprophylaxis can be a burden for patients. This study aims to compare extended to restricted thromboprophylaxis with low molecular weight heparin (LMWH) for patients undergoing metabolic surgery.MethodsIn this single center retrospective cohort study, data was collected from patients undergoing a primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2014 and 2018. Patients operated in 2014-2017 received thromboprophylaxis for two weeks. In 2018, patients only received thromboprophylaxis during hospital admission. Patients already using anticoagulants were analyzed as a separate subgroup. The primary outcome measure was the rate of clinically significant VTEs within three months. Secondary outcome measures were postoperative hemorrhage and reoperations for hemorrhage.Results3666 Patients underwent a primary RYGB or SG following the fast-track protocol. In total, two patients in the 2014-2017 cohort were diagnosed with VTE versus zero patients in the 2018 cohort. In the historic group, 34/2599 (1.3%) hemorrhages occurred and in the recent cohort 8/720 (1.1%). Postoperative hemorrhage rates did not differ between the two cohorts (multivariable analysis, p=0.475). In the subgroup of patients using anticoagulants, 21/347(6.1%) patients developed a postoperative hemorrhage. Anticoagulant use was a significant predictor of postoperative hemorrhage (

Low-pressure pneumoperitoneum with deep neuromuscular blockade in metabolic surgery to reduce postoperative pain:a randomized pilot trial

Background For metabolic laparoscopic surgery, higher pressures up to 20 mmHg are often used to create a surgical field of sufficient quality. This randomized pilot study aimed to determine the feasibility, safety and tolerability of low intraabdominal pressure (IAP) and deep neuromuscular blockade (NMB) to reduce postoperative pain. Methods In a teaching hospital in the Netherlands, 62 patients eligible for a laparoscopic Roux-en-Y gastric bypass (LRYGB) were randomized into one of four groups in a 2 x 2 factorial design: deep/moderate NMB and standard (20 mmHg)/low IAP (12 mmHg). Patient and surgical team were blinded. Primary outcome measure was the surgical field quality, scored on the Leiden-Surgical Rating Scale (L-SRS). Secondary outcome measures were (serious) adverse events, duration of surgery and postoperative pain. Results 62 patients were included. L-SRS was good or perfect in all patients that were operated under standard IAP with deep or moderate NMB. In 40% of patients with low IAP and deep NMB, an increase in IAP was needed to improve surgical overview. In patients with low IAP and moderate NMB, IAP was increased to improve surgical overview in 40%, and in 75% of these cases a deep NMB was requested to further improve the surgical overview. Median duration of surgery was 38 min (IQR34-40 min) in the group with standard IAP and moderate NMB and 52 min (IQR46-55 min) in the group with low IAP and deep NMB. Conclusions The combination of moderate NMB and low IAP can create insufficient surgical overview. Larger trials are needed to corroborate the findings of this study. Trial registration: Dutch Trial Register: Trial NL7050, registered 28 May 2018.

On analog quantum algorithms for the mixing of Markov chains

The problem of sampling from the stationary distribution of a Markov chain finds widespread applications in a variety of fields. The time required for a Markov chain to converge to its stationary distribution is known as the classical mixing time. In this article, we deal with analog quantum algorithms for mixing. First, we provide an analog quantum algorithm that given a Markov chain, allows us to sample from its stationary distribution in a time that scales as the sum of the square root of the classical mixing time and the square root of the classical hitting time. Our algorithm makes use of the framework of interpolated quantum walks and relies on Hamiltonian evolution in conjunction with von Neumann measurements. There also exists a different notion for quantum mixing: the problem of sampling from the limiting distribution of quantum walks, defined in a time-averaged sense. In this scenario, the quantum mixing time is defined as the time required to sample from a distribution that is close to this limiting distribution. Recently we provided an upper bound on the quantum mixing time for Erd\"os-Renyi random graphs [Phys. Rev. Lett. 124, 050501 (2020)]. Here, we also extend and expand upon our findings therein. Namely, we provide an intuitive understanding of the state-of-the-art random matrix theory tools used to derive our results. In particular, for our analysis we require information about macroscopic, mesoscopic and microscopic statistics of eigenvalues of random matrices which we highlight here. Furthermore, we provide numerical simulations that corroborate our analytical findings and extend this notion of mixing from simple graphs to any ergodic, reversible, Markov chain.Comment: The section concerning time-averaged mixing (Sec VIII) has been updated: Now contains numerical plots and an intuitive discussion on the random matrix theory results used to derive the results of arXiv:2001.0630

The Wellesley News (01-19-1933)

https://repository.wellesley.edu/news/1936/thumbnail.jp

Reducing complication rates and hospital readmissions while revising the enhanced recovery after bariatric surgery (ERABS) protocol

Background: To optimize the postoperative phase following bariatric surgery, the enhanced recovery after bariatric surgery pathway (ERABS) has been developed. The aim of ERABS is to create a care path that is as safe, efficient and patient-friendly as possible. Continuous evaluation and optimization of ERABS are important to ensure a safe treatment path and may result in better outcomes. The objective of this study was to compare the clinical outcomes of patients undergoing bariatric surgery over 2014–2017, during which the ERABS protocol was continuously evaluated and optimized. Methods: This is a retrospective cohort study. Data were collected from patients undergoing a primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2014 and December 2017. Outcomes were early complications, unplanned hospital revisits, readmissions, duration of surgery and length of hospital stay. Results: 2889 patients underwent a primary bariatric procedure in a single center. There was a significant decrease in minor complications over the years from 7.0 to 1.9% (p < 0.001). Hospital revisit rates decreased after 2015 (p < 0.001). Readmission rates decreased over time (p < 0.001). The mean duration of surgery decreased from 52 (in 2014) to 41 (in 2017) minutes (p < 0.001). Median length of hospital stay decreased from 1.8 to 1.5 days in 2015 (p = 0.002) and remained stable since. Conclusion: An improvement of the ERABS protocol was associated with a decrease in minor complication rates, number of unplanned hospital revisits and readmission rates after primary bariatric procedures