Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Background: The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care. Methods: Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics. Results: Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%). Conclusions: Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority

The role of Bacillus cereus in the sweet-curdling defect of fluid milk

The recent increase in number of isolations of psychrotrophic bacilli and the sweet curd formation in fluid milk have created the need for more information as to the role of Bacillus cereus. The purpose of this study was to determine the influence of the current trends in the dairy industry towards higher pasteurization temperatures and extended storage times on activation and germination of psychrotrophic Bacillus cereus, as well as the determination of stimulatory influence of the growth of the common Pseudomonas organisms in raw milk on these activated spores. Twenty-eight percent of commercially pasteurized milk samples procured from various plants throughout Tennessee exhibited the sweet-curdling defect on refrigerated storage within 10 days. This defect was observed many times at the bottom but sometimes throughout the carton of milk. Psychrotrophic Bacillus cereus was isolated as a causative organism from these sweet-curdled milk samples. The isolates differed from the type culture organism only with regard to their ability to grow and bring about sweet curd formation in skimmilk at refrigeration temperature, These isolates of psychrotrophic bacilli even though possessing the same cultural and biochemical characteristics, exhibited marked difference in their response to various heat-activation temperatures as well as the initial excessive growth of Pseudomonas species in raw skimmilk. Spores of the three isolates exhibited greater activity after activation at 80 C for 15 seconds, which happens to be the higher pasteurization temperature currently used by many dairy plants, than the standard pasteurization at 71.5 C for 15 seconds. The sweet curd formation was invariably noticed within 10 hours of incubation at 35 C and was always associated with exponential growth of the bacilli with counts ranging from 40 million to more than 60 million. The two common Pseudomonas species, Pseudomonas fluorescens and Pseudomonas fragi, were isolated from the stored samples of fluid milk for this study. Excessive growth of these Pseudomonas species in the raw skimmilk prior to processing had a stimulatory effect on psychrotrophic Bacillus cereus isolates in combination with heat-activation. Two of three isolates of Bacillus cereus provided statistical evidence of the stimulatory effect due to growth of these Pseudomonas organisms especially when the spores of psychrotrophic bacilli were activated at 80 C for 15 seconds

Study of vortex generators on Francis turbine runner for variable speed operation

In the present context, the use of energy from renewable sources is evermore growing to meet the goal of being carbon neutral and reduce the impact on climate change. The development and installation of intermittent renewable sources like wind and solar is boosted all around the world. As the name suggests, these energy sources cannot sustain the demand-supply curves due to their dependence on natural phenomena. So, hydropower must be used to regulate this flow of energy and bring stability to the grid. To accomplish such a task, hydropower plants must grow through abnormal operating procedures that can inflict severe consequences on their performance and structural stability. Several noble ideas have been pitched in and researched on in the recent decade to limit and avoid these scenarios. In case of most popular hydraulic turbine like Francis, the concept of variable speed operation has been introduced which can counter some of the complications brought by off-design conditions. However, the design and implementation of Francis runner with variable speed capability requires intensive research works and financial investment. As identified, from many recent investigations in off-design operations of Francis turbine, the main problem is separation of flow on runner blades at the inlet. The flow separation has been dealt effectively in other fields like aerodynamics and marine hydrodynamics with the use of vortex generators, which are simple passive devices attached on the working surfaces. These passive devices have proven to be very effective even in conditions with adverse pressure gradients. So, this research mainly focused on exploring the possibility of use of these devices on Francis runner blades with analytical, numerical and experimental methods. The vortex generators mainly function by drawing energy from mainstream flow and passing it on to the boundary layer which eventually help to sustain optimal flow under adverse operating conditions. These devices can enhance wall shear stress at boundary layers and turbulence kinetic energy in the flow which has been presented in Paper II. The efficiency and power output in the turbine have been significantly improved at offdesign conditions as well which has been presented in Paper I and Paper III. The performance of vortex generators depends heavily on the size, shape and design which should be thoroughly analyzed and curated properly which has been accomplished in this study. However, the procedures followed in this study have some shortcomings and should be avoided for the future research. The numerical results show a bit of over prediction on the improvement of performance as contrary to the experimental results. So, the turbulence models, boundary conditions and analysis settings should be chosen with utmost caution to have results within acceptable levels of uncertainty. The use of vortex generators on the runner blades in the experimental analysis resulted in vortex generators falling off during the analysis which resulted some offsets in the expected outcomes. Therefore, it recommended to select adhesives with good durability in the dry as well wet conditions and extensive preliminary stress tests should be conducted so prolonged experimental analysis can be conducted. Overall, the study is an excellent step towards improving performance of Francis turbine at the off-design conditions and with some technical adjustment, the technology can be implemented on prototypes as well

Predictions of thermal behavior of power electronics components with neural networks

In electric vehicles, inverters convert Direct current (DC) to Alternating current (AC) for the motor driving operation. Overheating during high-demand driving can shorten the lifespan and cause failures in the system; therefore, to address this issue, various models evaluate the thermal behavior of inverter components. The lifespan evaluation of the inverter components’ temperature is currently calculated using thermal Foster networks. This data is used for the design of components and tests. However, thermal Foster networks are inadequate for accurately mapping interactions between components. A step function is used to train these networks, making it difficult to determine real component loads and explicitly failing to train for correct thermal decay behavior. Errors in predicting temperature data can result in design flaws and inaccurate validation, which can potentially lead to quality issues in the field or increased validation costs. While node models would be a more effective solution, however fitting temperature data is too complex. Alternatively, 3D models offer the highest accuracy, but they are too slow for practical use in lifespan temperature prediction. To solve the problem, we plan to use deep learning, especially a Nonlinear Autoregressive network with Exogenous Inputs (NARX) which is a subclass of Recurrent Neural Networks. RNNs are ideal for time-series data and sequential problems, which makes them perfect for predicting the thermal behavior of inverter components in electric vehicles. Deep learning’s ability to learn from data can address various environmental conditions, offering innovative thermal modeling and reliability solutions. The primary goal is to create a deep learning model that quickly and accurately predicts the thermal behavior of inverter components in electric vehicles, provides optimizing designs for customer use cases, and ensures better quality with a reduction in costs

Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program

Background: Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes. Methods and Findings A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes. Conclusions: Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.

Study of cases of rupture uterus in a tertiary institute and its maternal and perinatal outcome

Background: Uterine rupture is undoubtedly one of the most tragic events that can occur in a women’s life and tragedy becomes more grim when she is young. In India, in advanced cities the incidence of rupture preceded by obstructed labour is decreasing, in rural parts where there is inadequate care, lack of communication and transport, home deliveries by untrained dais incidence of rupture uterus is still high. So, the study is to evaluate the etiological factors, incidence, management modalities and maternal and perinatal outcome.Methods: A prospective cross-sectional study of 46 cases of rupture uterus and maternal and Perinatal outcome, in the department of Obstetrics and Gynecology in government tertiary reference center.Results: Overall incidence of uterine rupture is 1 in 924. Out of 46 cases 07 (15.22%) were booked, and 39 (84.78%) were referred patients. The 20-30 years age group is the most vulnerable age group. Out of 44 rupture uterus during labor, 13 (22.72%) were spontaneous of intact uterus and 31(70.45%) were in scarred uterus. Subtotal abdominal hysterectomy was commonest modality of treatment used (28 out of 46 cases), followed by suturing of tear. There were 5 maternal deaths out of 46 patients, giving maternal mortality rate of 13.51%. Perinatal mortality rate still on higher side was 76.08%.Conclusions: Most cases of rupture uterus are preventable with good antenatal and intra-partum care. Our study shows that there has been a decline in the overall morbidity in cases of rupture uterus and so also the mortality rate (decreased from 24.3 to 13.51%)

PSYCHOSOCIAL FACTORS AS RISK FACTOR IN SUICIDAL POISONING: A CROSS-SECTIONAL STUDY

  Objective: Suicide is known to be a phenomenon in low-, middle-, and high-income countries and occurs in all sociodemographic groups. It ranges from acute to fatal lethal attempts which occur in the context of a social crisis. Deliberate self-poisoning for suicide is a growing public health concern with frequent emergency department admissions. An epidemiological surveillance is essential for every region to understand the pattern, underlying psychological factors, and the scope of preventive measures.Methods: The 2-year retrospective study describes the epidemiology and influencing factors of suicides by self-poisoning in patients admitted to a Government Hospital and a Teaching Hospital in Pune, Maharashtra, from January 1, 2014 to December 31, 2015.Result: Out of 1010 poisoning cases reported, 539 were suicidal self-poisoning. Significantly males more than females were brought to the hospitals due to deliberate self-poisoning (1:0.86, χ2=38.05; p&lt;0.001). The age group most recorded was 20-35 years (67.7%). Psychosocial factors were associated with increased risk of suicidal self-poisoning attempts (risk ratio 4.76, 95% confidence interval 4.07-5.57; p&lt;0.001). Psychosocial factors were interpersonal conflict (52.4%), stress (30.4), dissatisfaction in life (6%), and alcoholism or mental disorders (11.1%). Household and agricultural products (71.8%) were the popular choices of the toxic agent in self-poisoning with phenols (20%) being the most common. 19 cases (3.5%) were severe, out of which 15 cases lead to death (2.8% mortality).Conclusion: There is an urgent need to develop and implement preventative and treatment strategies for high-risk groups attempting suicide by self-poisoning

Effect of Inorganic, Organic Nutrient Sources and Bio-Fertilizers on Growth Attributes, Biomass at Flowering and Nodule Weight of Phaseolus vulgaris (Rajma)

It is essential to adopt new techniques and management practices as integrated nutrient management. The combined use of organic, inorganic manures and bio-fertilizer not only increases the crop yield but also improves the physical, Chemical and biological properties of soil. As enhance these properties, we can enhance the growth rate at flowering and nodule weight of plant, Phaseolus vulgaris. It did positive impact on quality and yield of Rajama. To study this, nine treatments, three replications, RBD design and Dibbling sowing method was adopted. The growth and yield attributes i.e. height, number of branches plant-1, Number of pods plant-1, number of grains pod-1 were recorded highest when only inorganic fertilizers @ 150% RDF was applied and these plant characters were recorded lowest when only vermicompost was applied.&nbsp; Biomass production at flowering, grain and straw yield were highest due to application of 150% RDF of NPK through inorganic fertilizers.&nbsp; The lowest biomass production at flowering was recorded where 2.5 t vermicompost at sowing and 50 % N through urea at flowering were applied. The lowest grain yield and straw yield was recorded when only vermicompost @ 5 tonnes ha-1 was applied.&nbsp; Fresh weights of nodules were negligible

CMOS Active Pixel Sensors for Digital Cameras: Current State-of-the-Art

Image sensors play a vital role in many image sensing and capture applications. Among the various types of image sensors, complementary metal oxide semiconductor (CMOS) based active pixel sensors (APS), which are characterized by reduced pixel size, give fast readouts and reduced noise. APS are used in many applications such as mobile cameras, digital cameras, Webcams, and many consumer, commercial and scientific applications. With these developments and applications, CMOS APS designs are challenging the old and mature technology of charged couple device (CCD) sensors. With the continuous improvements of APS architecture, pixel designs, along with the development of nanometer CMOS fabrications technologies, APS are optimized for optical sensing. In addition, APS offers very low-power and low-voltage operations and is suitable for monolithic integration, thus allowing manufacturers to integrate more functionality on the array and building low-cost camera-on-a-chip. In this thesis, I explore the current state-of-the-art of CMOS APS by examining various types of APS. I show design and simulation results of one of the most commonly used APS in consumer applications, i.e. photodiode based APS. We also present an approach for technology scaling of the devices in photodiode APS to present CMOS technologies. Finally, I present the most modern CMOS APS technologies by reviewing different design models. The design of the photodiode APS is implemented using commercial CAD tools