Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Psychologically-Based and Content-Oriented Experience in Entertainment Virtual Environments

In daily life, rich experiences evolve in every environmental and social interaction. Because experience has a strong impact on how people behave, scholars in different fields are interested in understanding what constitutes an experience. Yet even if interest in conscious experience is on the increase, there is no consensus on how such experience should be studied. Whatever approach is taken, the subjective and psychologically multidimensional nature of experience should be respected. This study endeavours to understand and evaluate conscious experiences. First I intro-duce a theoretical approach to psychologically-based and content-oriented experience. In the experiential cycle presented here, classical psychology and orienting-environmental content are connected. This generic approach is applicable to any human-environment interaction. Here I apply the approach to entertainment virtual environments (VEs) such as digital games and develop a framework with the potential for studying experiences in VEs. The development of the methodological framework included subjective and objective data from experiences in the Cave Automatic Virtual Environment (CAVE) and with numerous digital games (N=2,414). The final framework consisted of fifteen factor-analytically formed subcomponents of the sense of presence, involvement and flow. Together, these show the multidimensional experiential profile of VEs. The results present general experiential laws of VEs and show that the interface of a VE is related to (physical) presence, which psychologically means attention, perception and the cognitively evaluated realness and spatiality of the VE. The narrative of the VE elicits (social) presence and involvement and affects emotional outcomes. Psychologically, these outcomes are related to social cognition, motivation and emotion. The mechanics of a VE affect the cognitive evaluations and emotional outcomes related to flow. In addition, at the very least, user background, prior experience and use context affect the experiential variation. VEs are part of many peoples lives and many different outcomes are related to them, such as enjoyment, learning and addiction, depending on who is making the evalua-tion. This makes VEs societally important and psychologically fruitful to study. The approach and framework presented here contribute to our understanding of experiences in general and VEs in particular. The research can provide VE developers with a state-of-the art method (www.eveqgp.fi) that can be utilized whenever new product and service concepts are designed, prototyped and tested.

Characterization of oxygen free radicals generated during vanadate-stimulated NADH oxidation

The oxidation of NADH and accompanying reduction of oxygen to H2O2 stimulated by polyvanadate was markedly inhibited by SOD and cytochrome c. The presence of decavanadate, the polymeric form, is necessary for obtaining the microsomal enzyme-catalyzed activity. The accompanying activity of reduction of cytochrome c was found to be SOD-insensitive and therefore does not represent superoxide formation. The reduction of cytochrome c by vanadyl sulfate was also SOD-insensitive. In the presence of H2O2 all the forms of vanadate were able to oxidize reduced cytochrome c, which was sensitive to mannitol, tris and also catalase, indicating H202-dependent generation of hydroxyl radicals. Using ESR and spin trapping technique only hydroxyl radicals, but not superoxide anion radicals, were detected during polyvanadate-dependent NADH oxidation.

On infinitesimal σ-fields generated by random processes

It is proved that the infinitesimal look-ahead and look-back σ-fields of a random process disagree at atmost countably many time instants.

Modelling, simulation, and graphical user interface for industrial gas carburising process

A mathematical model has been developed for the gas carburising (diffusion) process using finite volume method. The computer simulation has been carried out for an industrial gas carburising process. The model's predictions are in good agreement with industrial experimental data and with data collected from the literature. A study of various mass transfer and diffusion coefficients has been carried out in order to suggest which correlations should be used for the gas carburising process. The model has been interfaced in a Windows environment using a graphical user interface. In this way, the model is extremely user friendly. The sensitivity analysis of various parameters such as initial carbon concentration in the specimen, carbon potential of the atmosphere, temperature of the process, etc. has been carried out using the model.

Aromatic, microporous polymer networks with high surface area generated in Friedel-Crafts-type polycondensations

A series of novel, microporous polymer networks (MPNs) have been generated in a simple, acid catalysed Friedel-Crafts-type self-condensation of A(2)B(2)- and A(2)B(4)-type fluorenone monomers. Two A2B4-type monomers with 2,7-bis(N, N-diphenylamino) A or 2,7-bis [4-(N, N-diphenylamino) phenyl] D substitution of the fluorenone cores lead to MPNs with high S(BET) surface areas of up to 1400 m(2) g(-1). Two MPNs made of binary monomer mixtures showed the highest Brunauer-Emmett-Teller (BET) surface areas S(BET) of our series (SBET of up to 1800 m(2) g(-1)) after washing the powdery samples with supercritical carbon dioxide. Total pore volumes of up to 1.6 cm(3) g(-1) have been detected. It is observed that the substitution pattern of the monomers is strongly influencing the resulting physicochemical properties of the microporous polymer networks (MPNs).

Relationship Between Physical Structure and Tribology of Single Soot Particles Generated by Burning Ethylene

Ethylene gas is burnt and the soot generated is sampled thermophoretically at different heights along the flame axis starting from a region close to the root of the flame. The morphology and crystallinity of the particle are recorded using high resolution transmission electron microscopes. The hardness of a single particle is measured using a nanoindenter. The frictional resistance and material removal of a particle are measured using an atomic force microscope. The particles present in the mid-flame region are found to have a crystalline shell. The ones at the flame root are found to be highly disordered and the ones at the flame tip and above have randomly distributed pockets of short range order. The physical state of a particle is found to relate, but not very strongly, with the mechanical and tribological properties of the particles.

Setting up Multilingual Information Repository: A case Study with EPrints.org Software

Today 80 % of the content on the Web is in English, which is spoken by only 8% of the World population and 5% of Indian population. There is wealth of useful content in the various languages of the world other than English, which can be made available on the Internet. But, to date, for various reasons most of it is not yet available on the Internet. India itself has 18 officially recognized languages and scores of dialects. Although the medium of instruction for most of the higher education and research in India is English, substantial amount of literature by way of novels, textbooks, scholarly information are being generated in the other languages in the country. Many of the e-governance initiatives are in the respective state languages. In the past, support for different languages by the operating systems and the software packages were not very encouraging. However, with the advent of Unicode technology, operating systems and software packages are supporting almost all the major languages of the world that have scripts. In the work reported in this paper, we have explained the configuration changes that are needed for Eprints.org software to store multilingual content and to create a multilingual user interface.

Virtually cool ternary content addressable memory

Fast content addressable data access mechanisms have compelling applications in today's systems. Many of these exploit the powerful wildcard matching capabilities provided by ternary content addressable memories. For example, TCAM based implementations of important algorithms in data mining been developed in recent years; these achieve an an order of magnitude speedup over prevalent techniques. However, large hardware TCAMs are still prohibitively expensive in terms of power consumption and cost per bit. This has been a barrier to extending their exploitation beyond niche and special purpose systems. We propose an approach to overcome this barrier by extending the traditional virtual memory hierarchy to scale up the user visible capacity of TCAMs while mitigating the power consumption overhead. By exploiting the notion of content locality (as opposed to spatial locality), we devise a novel combination of software and hardware techniques to provide an abstraction of a large virtual ternary content addressable space. In the long run, such abstractions enable applications to disassociate considerations of spatial locality and contiguity from the way data is referenced. If successful, ideas for making content addressability a first class abstraction in computing systems can open up a radical shift in the way applications are optimized for memory locality, just as storage class memories are soon expected to shift away from the way in which applications are typically optimized for disk access locality.

A non-isothiocyanate route to synthesize trisubstituted thioureas of arylamines using in situ generated dithiocarbamates

A novel, user-friendly, and convenient method for the synthesis of trisubstituted thioureas of arylamines is presented, for the first time, using in situ generated dithiocarbamates of secondary amines. This strategy provides an excellent opportunity to access thioureas containing primary aryl amines. A non-isothiocyanate route to obtain thioureas is the advantage of this strategy, which may provide a useful route to synthesize a variety of biologically active derivatives of thioureas.

NrichD database: sequence databases enriched with computationally designed protein-like sequences aid in remote homology detection

NrichD content content-type=''no-hyphen'' xlink:type=''simple''>( ext-link-type=''uri'' xlink:href=''http://proline.biochem.iisc.ernet.in/NRICHD/'' xlink:type=''simple''>http://proline.biochem.iisc.ernet.in/NRICHD/)< /named-content> is a database of computationally designed protein-like sequences, augmented into natural sequence databases that can perform hops in protein sequence space to assist in the detection of remote relationships. Establishing protein relationships in the absence of structural evidence or natural `intermediately related sequences' is a challenging task. Recently, we have demonstrated that the computational design of artificial intermediary sequences/linkers is an effective approach to fill naturally occurring voids in protein sequence space. Through a large-scale assessment we have demonstrated that such sequences can be plugged into commonly employed search databases to improve the performance of routinely used sequence search methods in detecting remote relationships. Since it is anticipated that such data sets will be employed to establish protein relationships, two databases that have already captured these relationships at the structural and functional domain level, namely, the SCOP database and the Pfam database, have been `enriched' with these artificial intermediary sequences. NrichD database currently contains 3 611 010 artificial sequences that have been generated between 27 882 pairs of families from 374 SCOP folds. The data sets are freely available for download. Additional features include the design of artificial sequences between any two protein families of interest to the user.

Thermoelectric properties of Pb0.75-xMnxSn0.25Te alloys with variable manganese content

Lead tin telluride is one of the well-established thermoelectric materials in the temperature range 350-750 K. In the present study, Pb0.75-xMnxSn0.25Te1.00 alloys with variable manganese (Mn) content were prepared by solid state synthesis and the thermoelectric properties were studied. X-ray diffraction, (XRD) showed that the samples followed Vegard's law, indicating solid solution formation and substitution of Mn at the Pb site. Scanning Electron Microscopy (SEM) showed that the grain sizes varied from <1 mu m to more than 10 mu m and MnTe rich phase was present for higher Mn content. Seebeck coefficient, electrical resistivity and thermal conductivity were measured from room temperature to 720 K. At 300 K, large Seebeck values were obtained, possibly due to increased effective mass on Mn substitution and low carrier concentration of the samples. At higher temperatures, transition from n-type to p-type indicated the presence of thermally generated carriers. Temperature dependent electrical resistivity showed the transition from degenerate to non-degenerate behavior. For thermal conductivity, low values (similar to 1 W/m-K at 300 K) were obtained. At higher temperatures bipolar conduction was observed, in agreement with the Seebeck and resistivity data. Due to low power factor, the maximum thermoelectric figure of merit (zT) was limited to 0.23 at 329 K for the sample with lowest Mn content (x=0.03). (C) 2015 Elsevier Ltd. All rights reserved.

Enriching the content provided by cultural catalogues with data from institutional repositories

[EN] This paper is an outcome of the ERASMUS IP program called TOPCART, there are more information about this project that can be accessed from the following item:

Properties of convergence of a class of iterative processes generated by sequences of self-mappings with applications to switched dynamic systems

This article investigates the convergence properties of iterative processes involving sequences of self-mappings of metric or Banach spaces. Such sequences are built from a set of primary self-mappings which are either expansive or non-expansive self-mappings and some of the non-expansive ones can be contractive including the case of strict contractions. The sequences are built subject to switching laws which select each active self-mapping on a certain activation interval in such a way that essential properties of boundedness and convergence of distances and iterated sequences are guaranteed. Applications to the important problem of stability of dynamic switched systems are also given.

Improving Content Delivery Efficiency through Multi-Layer Mobile Edge Adaptation

This paper presents a novel architecture for optimizing the HTTP-based multimedia delivery in multi-user mobile networks. This proposal combines the usual client-driven dynamic adaptation scheme DASH-3GPP with network-assisted adaptation capabilities, in order to maximize the overall Quality of Experience. The foundation of this combined adaptation scheme is based on two state of the art technologies. On one hand, adaptive HTTP streaming with multi-layer encoding allows efficient media delivery and improves the experienced media quality in highly dynamic channels. Additionally, it enables the possibility to implement network-level adaptations for better coping with multi-user scenarios. On the other hand, mobile edge computing facilitates the deployment of mobile services close to the user. This approach brings new possibilities in modern and future mobile networks, such as close to zero delays and awareness of the radio status. The proposal in this paper introduces a novel element, denoted as Mobile Edge-DASH Adaptation Function, which combines all these advantages to support efficient media delivery in mobile multi-user scenarios. Furthermore, we evaluate the performance enhancements of this content- and user context-aware scheme through simulations of a mobile multimedia scenario.