The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

Le rôle du sublime dans le système critique kantien

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Spaces of Visibility for the Migrants of Lampedusa: The Counter Narrative of the Aesthetic Discourse

Political, legal, and media discourse around ‘boat-migrants’ arriving in Lampedusa share a tendency to focus on an unnamed and anonymous mass of people in order to build and sustain a Border Spectacle revolving around immigration to Italy. In this context, where very little space is usually left to individual migrant voices, this article challenges this common understanding of immigration to Lampedusa by showing a different side of the story, a story told by the real actors of the Mediterranean passage, the migrants themselves, who, by relying on the realm of aesthetics, have managed to gain visibility and to become ‘subjects of power.’

Non-Verbal Categories. Analysis of an Galician Oral Narrative

Based on the concept of the triple basic structure of human communication by Poyatos (1994a, 1994b) and on the analytical and theoretical implications that derive from this, the present paper conceives the human communication as an indivisible whole in which verbal communication can not be separated from body behavior. This paper analyzes nonverbal categories used in oral communication. The corpus consists of an oral narration in Galician from which we highlighted certain kinemes (minimum units of body movement with meaning) by using the model proposed by Bouvet (2001), in order to explain the non-verbal categories with examples taken from said recordings.

Splitting monoidal stable model categories

If C is a stable model category with a monoidal product then the set of homotopy classes of self-maps of the unit forms a commutative ring, [S,S]C. An idempotent e of this ring will split the homotopy category: [X,Y]C≅e[X,Y]C⊕(1−e)[X,Y]C. We prove that provided the localised model structures exist, this splitting of the homotopy category comes from a splitting of the model category, that is, C is Quillen equivalent to LeSC×L(1−e)SC and [X,Y]LeSC≅e[X,Y]C. This Quillen equivalence is strong monoidal and is symmetric when the monoidal product of C is.

Cooperative Mapping and Exploration using Counter-rotational Potential Fields

This paper presents a novel technique for mapping and exploration using cooperating autonomous underwater vehicles. Rather than using the typical lawnmower sweep pattern to search an entire area, the proposed navigational plan involves guiding the formation directly towards each object of interest in turn, before arriving at a final goal position. This is achieved by the use of traditional artificial potential fields alongside counter-rotational potential fields. These clockwise and counter-clockwise fields are employed simultaneously by vehicles to ensure that the entire object is scanned rather than simply avoided as is the case with traditional collision avoidance techniques. The proposed methodology allows a formation to have fluid-like motion whilst a separation distance between cooperating agents (free of angular constraints) is maintained with a greater degree of flexibility than traditional formation control approaches. Owing to its nature, this technique is suited for applications such as exploration, mapping and underwater inspection to name a few. Simulation results demonstrate the efficacy of the proposed approach.

The Influence of Informational and Emotional Advertising Appeals on Advertising Effectiveness – Consumers’ Perspective on the Over-the-Counter Product Advertisements in Finland

Consumers face enormous amounts of promotional messages daily whereas the pharmaceutical companies among other industries spend considerable time and money developing effective advertising strategies. There are multiple possible ways to appeal the target customer in order to increase the effectiveness of the advertisement. In spite of the various possibilities to categorize persuasive communication, the informational and the emotional appeals are the typical approaches. This study assesses the influence of the informational and emotional advertising appeals on the advertising effectiveness in the context of OTCs in Finland. The research method applied in this study is a quantitative survey. The data consists of 461 responses from the target population of 18–80 years old Finnish speaking consumers. The results from the marketing research indicate that the positive correlations of the emotional appeals are much stronger than the positive correlations of the informational appeals relating to the advertising effectiveness. However, on average the Finnish consumers experience the OTC advertisements relying on the informational appeals more effective than the OTC advertisements relying on the emotional appeals. Furthermore, within emotional appeals there is a much greater variety in the experienced advertising effectiveness not providing as stabile and consistent experienced advertising effectiveness compared to the informational appeals. Thus, the OTC advertisement relying more on the emotional appeals are much more risky in terms of advertising effectiveness. There are also differences with the experienced advertising effectiveness between the Finnish consumer groups and the information can be utilised when designing tailored OTC advertisements. The Finnish men consider humorous advertisements more effective than the Finnish women. In addition, the people living outside Uusimaa Region experience higher advertising effectiveness with the advertisements relying more on the informational advertisements compared to the people living in Uusimaa Region. In similar vein, the people with lower education experience higher advertising effectiveness with the advertisements relying more on the informational advertisements compared to the people with high education. Additionally, the older generation perceive an OTC advertisement with a middle-aged celebrity more effective than the younger consumers

Categories, Allegories, and Circuit Design

Languages based upon binary relations offer an appealing setting for constructing programs from specifications. For example, working with relations rather than functions allows specifications to be more abstract (for example, many programs have a natural specification using the converse operator on relations), and affords a natural treatment of non-determinism in specifications. In this paper we present a novel pictorial interpretation of relational terms as simple pictures of circuits, and a soundness/completeness result that allows relational equations to be proved by pictorial reasoning.

Minimizar o sobrecusto da redução da capacidade de interligação com recurso ao counter-trading

Dissertação para obtenção do grau de Mestre em Engenharia Electrotécnica Ramo de energia

2-categories and cyclic homology

The topic of this thesis is the application of distributive laws between comonads to the theory of cyclic homology. The work herein is based on the three papers 'Cyclic homology arising from adjunctions', 'Factorisations of distributive laws', and 'Hochschild homology, lax codescent,and duplicial structure', to which the current author has contributed. Explicitly, our main aims are: 1) To study how the cyclic homology of associative algebras and of Hopf algebras in the original sense of Connes and Moscovici arises from a distributive law, and to clarify the role of different notions of bimonad in this generalisation. 2) To extend the procedure of twisting the cyclic homology of a unital associative algebra to any duplicial object defined by a distributive law. 3) To study the universality of Bohm and Stefan’s approach to constructing duplicial objects, which we do in terms of a 2-categorical generalisation of Hochschild (co)homology. 4) To characterise those categories whose nerve admits a duplicial structure.

Subject categories used in Nuclear science abstracts, 1967-1975 /

"TID-26500/R1. Distribution category: UC-2."

Diketonylpyridinium cations as a support of new ionic liquid crystals and ion-conductive materials: analysis of counter-ion effects

Ionic liquid crystals (ILCs) allow the combination of the high ionic conductivity of ionic liquids (ILs) with the supramolecular organization of liquid crystals (LCs). ILCs salts were obtained by the assembly of long-chained diketonylpyridinium cations of the type [HOO^(R(n)pyH)] + and BF_(4)^(-) , ReO_(4)^(-), NO_(3)^(-), CF_(3)SO_(3)^(-), CuCl_(4)^(2-) counter-ions. We have studied the thermal behavior of five series of compounds by differential scanning calorimetry (DSC) and hot stage polarized light optical microscopy (POM). All materials show thermotropic mesomorphism as well as crystalline polymorphism. X-ray diffraction of the [HOO^(R(12)pyH)][ReO_(4)] crystal reveals a layered structure with alternating polar and apolar sublayers. The mesophases also exhibit a lamellar arrangement detected by variable temperature powder X-ray diffraction. The CuCl_(4)^(2-) salts exhibit the best LC properties followed by the ReO_(4)^(-) ones due to low melting temperature and wide range of existence. The conductivity was probed for the mesophases in one species each from the ReO_(4)^(-) , and CuCl_(4)^(2-) families, and for the solid phase in one of the non-mesomorphic Cl^(-) salts. The highest ionic conductivity was found for the smectic mesophase of the ReO_(4)^(-) containing salt, whereas the solid phases of all salts were dominated by electronic contributions. The ionic conductivity may be favored by the mesophase lamellar structure.