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.

Perspectives of Teachers Regarding the Integration of Mathematics and Science at the Secondary School Level

The integration of mathematics and science in secondary schools in the 21st century continues to be an important topic of practice and research. The purpose of my research study, which builds on studies by Frykholm and Glasson (2005) and Berlin and White (2010), is to explore the potential constraints and benefits of integrating mathematics and science in Ontario secondary schools based on the perspectives of in-service and pre-service teachers with various math and/or science backgrounds. A qualitative and quantitative research design with an exploratory approach was used. The qualitative data was collected from a sample of 12 in-service teachers with various math and/or science backgrounds recruited from two school boards in Eastern Ontario. The quantitative and some qualitative data was collected from a sample of 81 pre-service teachers from the Queen’s University Bachelor of Education (B.Ed) program. Semi-structured interviews were conducted with the in-service teachers while a survey and a focus group was conducted with the pre-service teachers. Once the data was collected, the qualitative data were abductively analyzed. For the quantitative data, descriptive and inferential statistics (one-way ANOVAs and Pearson Chi Square analyses) were calculated to examine perspectives of teachers regardless of teaching background and to compare groups of teachers based on teaching background. The findings of this study suggest that in-service and pre-service teachers have a positive attitude towards the integration of math and science and view it as valuable to student learning and success. The pre-service teachers viewed the integration as easy and did not express concerns to this integration. On the other hand, the in-service teachers highlighted concerns and challenges such as resources, scheduling, and time constraints. My results illustrate when teachers perceive it is valuable to integrate math and science and which aspects of the classroom benefit best from the integration. Furthermore, the results highlight barriers and possible solutions to better the integration of math and science. In addition to the benefits and constraints of integration, my results illustrate why some teachers may opt out of integrating math and science and the different strategies teachers have incorporated to integrate math and science in their classroom.

A Minor Change?: A Case Study of Carleton Place's Integration of Minor Variance Procedures into Ontario's Development Permit System

The Development Permit System has been introduce with minimal directives for establishing a decision making process. This is in opposition to the long established process for minor variances and suggests that the Development Permit System does not necessarily incorporate all of Ontario’s fundamental planning principles. From this concept, the study aimed to identify how minor variances are incorporated into the Development Permit System. In order to examine this topic, the research was based around the following research questions: • How are ‘minor variance’ applications processed within the DPS? • To what extent do the four tests of a minor variance influence the outcomes of lower level applications in the DPS approval process? A case study approach was used for this research. The single-case design employed both qualitative and quantitative research methods including a review of academic literature, court cases, and official documents, as well as a content analysis of Class 1, 1A, and 2 Development Permit application files from the Town of Carleton Place that were decided between 2011 and 2015. Upon the completion of the content analysis, it was found that minor variance issues were most commonly assigned to Class 1 applications. Planning staff generally met approval timelines and embraced their delegated approval authority, readily attaching conditions to applications in order to mitigate off-site impacts. While staff met the regulatory requirements of the DPS, ‘minor variance’ applications were largely decided on impact alone, demonstrating that the principles established by the four tests, the defining quality of the minor variance approval process, had not transferred to the Development Permit System. Alternatively, there was some evidence that the development community has not fully adjusted to the requirements of the new approvals process, as some applications were supported using a rationale containing the four tests. Subsequently, a set of four recommendations were offered which reflect the main themes established by the findings. The first two recommendations are directed towards the Province, the third to municipalities and the fourth to developers and planning consultants: 1) Amend Ontario Regulation 608/06 so that provisions under Section 4(3)(e) fall under Section 4(2). 2) Change the rhetoric from “combining elements of minor variances” to “replacing minor variances”. 3) Establish clear evaluation criteria. 4) Understand the evaluative criteria of the municipality in which you are working.

The capacities of institutions for the integration of ecosystem services in coastal strategic planning: The case of Jiaozhou Bay

This paper explains how the practice of integrating ecosystem-service thinking (i.e., ecological benefits for human beings) and institutions (i.e., organisations, policy rules) is essential for coastal spatial planning. Adopting an integrated perspective on ecosystem services (ESs) both helps understand a wide range of possible services and, at the same time, attune institution to local resource patterns. The objective of this paper is to identify the extent to which ESs are integrated in a specific coastal strategic planning case. A subsequent objective is to understand whether institutions are capable of managing ESs in terms of uncovering institutional strengths and weaknesses that may exist in taking ESs into account in existing institutional practices. These two questions are addressed through the application of a content analysis method and a multi-level analysis framework on formal institutions. Jiaozhou Bay in China is used as an illustrative case. The results show that some ESs have been implicitly acknowledged, but by no means the whole range. This partial ES implementation could result from any of four institutional weaknesses in the strategic plans of Jiaozhou Bay, namely a dominant market oriented interest, fragmented institutional structures for managing ESs, limited ES assessment, and a lack of integrated reflection of the social value of ESs in decision-making. Finally, generalizations of multi-level institutional settings on ES integration, such as an inter-organisational fragmentation and a limited use of ES assessment in operation, are made together with other international case studies. Meanwhile, the comparison highlights the influences of extensive market-oriented incentives and governments' exclusive responsibilities on ES governance in the Chinese context.

Measuring the Diversity and the Integration of Film Production in Mercosur: A Social Network Analysis

Based on an original and comprehensive database of all feature fiction films produced in Mercosur between 2004 and 2012, the paper analyses whether the Mercosur film industry has evolved towards an integrated and culturally more diverse market. It provides a summary of policy opportunities in terms of integration and diversity, emphasizing the limiter role played by regional policies. It then shows that although the Mercosur film industry remains rather disintegrated, it tends to become more integrated and culturally more diverse. From a methodological point of view, the combination of Social Network Analysis and the Stirling Model opens up interesting research tracks to analyse creative industries in terms of their market integration and their cultural diversity.

On the integration of Argentinian activist art at exhibition venues

This article examines the institutional integration of activist art in the aftermath of the 2001 economic crisis in Argentina. Following this aim, we begin with a description of the most significant new groups of activist art in the City of Buenos Aires. Then, we elaborate the position these new groups take up in the field with respect to their dispute with the “light art” from the 90s, and in relation to the mutual accusations over the “trend” of political art. Finally, we analyse the reception of these groups of activist art in art exhibitions in the City of Buenos Aires and abroad, and we reflect upon the institutionalization of these specific and situated aesthetic and political practices.

Integration of cad/ tool path data for 5-axis step-nc machining of free form / irrregular contoured surfaces

This research paper presents the work on feature recognition, tool path data generation and integration with STEP-NC (AP-238 format) for features having Free form / Irregular Contoured Surface(s) (FICS). Initially, the FICS features are modelled / imported in UG CAD package and a closeness index is generated. This is done by comparing the FICS features with basic B-Splines / Bezier curves / surfaces. Then blending functions are caculated by adopting convolution theorem. Based on the blending functions, contour offsett tool paths are generated and simulated for 5 axis milling environment. Finally, the tool path (CL) data is integrated with STEP-NC (AP-238) format. The tool path algorithm and STEP- NC data is tested with various industrial parts through an automated UFUNC plugin.

Integration of global SNP-based mapping and expression arrays reveals key regions, mechanisms, and genes important in the pathogenesis of multiple myeloma.

Multiple myeloma is characterized by genomic alterations frequently involving gains and losses of chromosomes. Single nucleotide polymorphism (SNP)-based mapping arrays allow the identification of copy number changes at the sub-megabase level and the identification of loss of heterozygosity (LOH) due to monosomy and uniparental disomy (UPD). We have found that SNP-based mapping array data and fluorescence in situ hybridization (FISH) copy number data correlated well, making the technique robust as a tool to investigate myeloma genomics. The most frequently identified alterations are located at 1p, 1q, 6q, 8p, 13, and 16q. LOH is found in these large regions and also in smaller regions throughout the genome with a median size of 1 Mb. We have identified that UPD is prevalent in myeloma and occurs through a number of mechanisms including mitotic nondisjunction and mitotic recombination. For the first time in myeloma, integration of mapping and expression data has allowed us to reduce the complexity of standard gene expression data and identify candidate genes important in both the transition from normal to monoclonal gammopathy of unknown significance (MGUS) to myeloma and in different subgroups within myeloma. We have documented these genes, providing a focus for further studies to identify and characterize those that are key in the pathogenesis of myeloma.

Development of sustainable, innovative and energy-efficient concrete, based on the integration of all-waste materials: SUS-CON panels for building applications

The building sector requires the worldwide production of 4 billion tonnes of cement annually, consuming more than 40% of global energy and accounting for about 8% of the total CO2 emissions. The SUS-CON project aimed at integrating waste materials in the production cycle of concrete, for both ready-mixed and pre-cast applications, resulting in an innovative light-weight, ecocompatible and cost-effective construction material, made by all-waste materials and characterized by enhanced thermal insulation performance and low embodied energy and CO2. Alkali activated “cementless” binders, which have recently emerged as eco-friendly construction materials, were used in conjunction with lightweight recycled aggregates to produce sustainable concrete for a range of applications. This paper presents some results from the development of a concrete made with a geopolymeric binder (alkali activated fly ash) and aggregate from recycled mixed plastic. Mix optimisation was achieved through an extensive investigation on production parameters for binder and aggregate. The mix recipe was developed for achieving the required fresh and hardened properties. The optimised mix gave compressive strength of about 7 MPa, flexural strength of about 1.3 MPa and a thermal conductivity of 0.34 W/mK. Fresh and hardened properties were deemed suitable for the industrial production of precast products. Precast panels were designed and produced for the construction of demonstration buildings. Mock-ups of about 2.5 x 2.5 x 2.5 m were built at a demo park in Spain both with SUS-CON and Portland cement concrete, monitoring internal and external temperatures. Field results indicate that the SUS-CON mock-ups have better insulation. During the warmest period of the day, the measured temperature in the SUS-CON mock-ups was lower.

Sustainable solutions for the construction sector: integration of secondary raw materials in the production cycle of concrete

The construction industry is one of the largest consumers of raw materials and energy and one of the highest contributor to green-houses gases emissions. In order to become more sustainable it needs to reduce the use of both raw materials and energy, thus lim-iting its environmental impact. Developing novel technologies to integrate secondary raw materials (i.e. lightweight recycled aggre-gates and alkali activated “cementless” binders - geopolymers) in the production cycle of concrete is an all-inclusive solution to im-prove both sustainability and cost-efficiency of construction industry. SUS-CON “SUStainable, Innovative and Energy-Efficiency CONcrete, based on the integration of all-waste materials” is an European project (duration 2012-2015), which aim was the inte-gration of secondary raw materials in the production cycle of concrete, thus resulting in innovative, sustainable and cost-effective building solutions. This paper presents the main outcomes related to the successful scaling-up of SUS-CON concrete solutions in traditional production plants. Two European industrial concrete producers have been involved, to design and produce both pre-cast components (blocks and panels) and ready-mixed concrete. Recycled polyurethane foams and mixed plastics were used as aggre-gates, PFA (Pulverized Fuel Ash, a by-product of coal fuelled power plants) and GGBS (Ground Granulated Blast furnace Slag, a by-product of iron and steel industries) as binders. Eventually, the installation of SUS-CON concrete solutions on real buildings has been demonstrated, with the construction of three mock-ups located in Europe (Spain, Turkey and Romania)

Model based integration of management systems (MSs) – case study

Abstract Purpose – The purpose of this paper is to present a case study regarding the deployment of a previously developed model for the integration of management systems (MSs). The case study is developed at a manufacturing site of an international enterprise. The implementation of this model in a real business environment is aimed at assessing its feasibility. Design/methodology/approach – The presented case study takes into account different management systems standards (MSSs) progressively implemented, along the years, independently. The implementation of the model was supported by the results obtained from an investigation performed according to a structured diagnosis that was conducted to collect information related to the organizational situation of the enterprise. Findings – The main findings are as follows: a robust integrated management system (IMS), objectively more lean, structured and manageable was found to be feasible; this study provided an holistic view of the enterprise’s global management; clarifications of job descriptions and boundaries of action and responsibilities were achieved; greater efficiency in the use of resources was attained; more coordinated management of the three pillars of sustainability – environmental, economic and social, as well as risks, providing confidence and added value to the company and interested parties was achieved. Originality/value – This case study is pioneering in Portugal in respect to the implementation, at the level of an industrial organization, of the model previously developed for the integration of individualized MSs. The case study provides new insights regarding the implementation of IMSs including the rationalization of several resources and elimination of several types of organizational waste leveraging gains of efficiency. Due to its intrinsic characteristics, the model is able to support, progressively, new or revised MSSs according to the principles of annex SL (normative) – proposals for MSSs – of the International Organization for Standardization and the International Electrotechnical Commission, that the industrial organization can adopt beyond the current ones.

Analysis of Ultrasonic Techniques for the Characterization of Microfiltration Polymeric Membranes

The use of polymeric membranes is extremely important in several industries such as nuclear, biotechnology, chemical and pharmaceutical. In the nuclear area, for instance, systems based on membrane separation technologies are currently being used in the treatment of radioactive liquid effluent, and new technologies using membranes are being developed at a great rate. The knowledge of the physical characteristics of these membranes, such as, pore size and the pore size distribution, is very important to the membranes separation processes. Only after these characteristics are known is it possible to determine the type and to choose a particular membrane for a specific application. In this work, two ultrasonic non destructive techniques were used to determine the porosity of membranes: pulse echo and transmission. A 25 MHz immersion transducer was used. Ultrasonic signals were acquired, for both techniques, after the ultrasonic waves passed through a microfiltration polymeric membrane of pore size of 0.45 μm and thickness of 180 μm. After the emitted ultrasonic signal crossed the membrane, the received signal brought several information on the influence of the membrane porosity in the standard signal of the ultrasonic wave. The ultrasonic signals were acquired in the time domain and changed to the frequency domain by application of the Fourier Fast Transform (FFT), thus generating the material frequency spectrum. For the pulse echo technique, the ultrasonic spectrum frequency changed after the ultrasonic wave crossed the membrane. With the transmission technique there was only a displacement of the ultrasonic signal at the time domain.

Automated generic integration of flight logbook data into aircraft maintenance systems

The automated transfer of flight logbook information from aircrafts into aircraft maintenance systems leads to reduced ground and maintenance time and is thus desirable from an economical point of view. Until recently, flight logbooks have not been managed electronically in aircrafts or at least the data transfer from aircraft to ground maintenance system has been executed manually. Latest aircraft types such as the Airbus A380 or the Boeing 787 do support an electronic logbook and thus make an automated transfer possible. A generic flight logbook transfer system must deal with different data formats on the input side – due to different aircraft makes and models – as well as different, distributed aircraft maintenance systems for different airlines as aircraft operators. This article contributes the concept and top level distributed system architecture of such a generic system for automated flight log data transfer. It has been developed within a joint industry and applied research project. The architecture has already been successfully evaluated in a prototypical implementation.