Helping rural women in Pakistan to prevent postpartum hemorrhage: A quasi experimental study

BACKGROUND: According to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home. METHODS: A quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants. RESULTS: Out of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future. CONCLUSIONS: Self-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be considered

A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators

Objective: To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. Method: An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists. Results: Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients. Conclusions: The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings

SYNTHESIS OF AMINO ACID BASED SCHIFF BASE AND ITS COMPLEXES AS MICROBIAL GROWTH INHIBITORS

ABSTRACT The amino acid ligand [(1-(5-chloro-2-hydroxyphenyl)ethanone-(S)-alpha-amino-4-hydroxybenzenepropanoic acid] was prepared by the reaction of [(1-(5-chloro-2-hydroxyphenyl)ethanone] with (S)-alpha-amino-4-hydroxybenzenepropanoic acid under reflux in methanol. The complexes of this ligand have been prepared using metal acetates of Mn(II), Co(II), Ni(II), Cr(III), Cu(II), Zn(II) and Cd(II) under reflux in methanol. The products were found to be crystalline solid. The ligand is characterized by analytical, FT-IR, thermogravimetric analysis, proton NMR spectral data while complexes have been characterized by analytical, FT-IR, thermogravimetric analysis, diffused reflectance and magnetic susceptibility measurements. The compounds were screened for antibacterial activity against some clinically important bacteria, such as E. coli, S. typhy, S. aureus, P. aeruginosa and K. pneumonie by using nutrient agar medium and antifungal activity against C. albicans and A. niger species by using potato dextrose agar medium

Construction of Linear Codes from the Unit Graph G(Zn)G(\mathbb{Z}_{n})

In this paper, we consider the unit graph $G(\mathbb{Z}_{n})$, where $n=p_{1}^{n_{1}} \text{ or } p_{1}^{n_{1}}p_{2}^{n_{2}} \text{ or } p_{1}^{n_{1}}p_{2}^{n_{2}}p_{3}^{n_{3}}$ and $p_{1}, p_{2}, p_{3}$ are distinct primes. For any prime $q$, we construct $q$-ary linear codes from the incidence matrix of the unit graph $G(\mathbb{Z}_{n})$ with their parameters. We also prove that the dual of the constructed codes have minimum distance either 3 or 4. Lastly, we stated two conjectures on diameter of unit graph $G(\mathbb{Z}_{n})$ and linear codes constructed from the incidence matrix of the unit graph $G(\mathbb{Z}_{n})$ for any integer $n$

Relative effects of sensory modalities and importance of fatty acid sensitivity on fat perception in a real food model

Fat can be perceived through mouthfeel, odour and taste, but the influence of these modalities on fat perception remains undefined. Fatty acids are stimuli. Individual’s sensitivity to fatty acids varies. Studies show association between fatty acid sensitivity, dietary intake and BMI, but results are conflicting. Therefore, this study examined this association, and the effects of modalities on fat perception. Two sub-studies conducted. In Study 1 (n=46), fat intensity was assessed by milk/cream mixtures varying by five fat levels. Fat intensity was rated under four conditions: mouthfeel-odour masked, mouthfeel masked, odour masking and no masking. Mouthfeel masking was achieved using thickener and paraffin, odour masking using nose-clips. Fatty acid sensitivity was measured by 3-AFC-staircase method using milk containing oleic acid (0.31-31.4mM). In Study 2 (n=51), more fat levels were added in fat intensity rating. A 2-AFC discrimination test was used to confirm whether fat levels could be distinguished. In the sensitivity test, a wider range of oleic acid was included. Fat intensity was rated higher without nose-clips (p<0.0001), implying that odour increased fat perception. Samples with mouthfeel-masked were rated higher, showing that increased viscosity and lubricity enhanced fat perception (p<0.0001). Participants could distinguish fat levels based on “taste” in rating tests and 2-AFC-tests. Participants were divided into high/medium/low-sensitivity groups. No significant difference found in fat intensity between groups, however, high-sensitivity group discriminated more fat levels. No association between sensitivity groups, nutrient intake or BMI found

A new approach to construct minimal linear codes over F3\mathbb{F}_{3}

In this article, we present two new approaches to construct minimal linear codes of dimension $n+1$ over $\mathbb{F}_{3}$ using characteristic and ternary functions. We also obtain the weight distributions of these constructed minimal linear codes. We further show that a specific class of these codes violates Ashikhmin-Barg condition

Attitudes and Perceptions of Healthcare Providers towards Clinical Pharmacy Services at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Purpose: To evaluate the attitudes and perceptions of health care providers towards clinical pharmacy services at King Khalid University Hospital Riyadh Saudi ArabiaMethod: A cross-sectional survey of healthcare providers was conducted in King Khalid University Hospital, Riyadh, Saudi Arabia from September to November 2013. A self-administered questionnaire was delivered to health care professionals (HCPs) who included physicians, pharmacists and nurses.Results: The response rate was 78 % (457/600). The majority of the respondents (92.4 %) knew that the clinical pharmacist is an integral part of the medical team while 86.5 % of the participants expressed confidence in the ability of clinical pharmacists to improve the quality of patient care through their practice. Despite the relative lack of awareness of the increasing interest in clinical pharmacy practice (59.6 % were not aware of such a trend), pharmacists were less appreciative (p &lt; 0.05) of the positive role of clinical  pharmacists in direct patient care compared to both physicians and nurses (67.4, 74.3 and 72.3 %, respectively).Conclusion: The findings of this study reveal that health care professionals HCPs have positive attitude towards the role of the clinical pharmacist in the health care setting studied. However, there is a need for Saudi hospitals to adopt full clinical pharmacy service including drug monitoring, drug information and pharmacotherapy for enhanced health care.Keywords: Saudi Arabia, Clinical pharmacy services, Healthcare professionals, Attitude, Patient car

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia