Perinatal mortality and quality of care at the National Institute of Perinatology: A 3-year analysis

Quality of medical care has been indirectly assessed through the collection of negative outcomes. A preventable death is one that could have been avoided if optimum care had been offered. The general objective of the present project was to analyze the perinatal mortality at the National Institute of Perinatology (located in Mexico City) by social, biological and some available components of quality of care such as avoidability, provider responsibility, and structure and process deficiencies in the delivery of medical care. A Perinatal Mortality Committee data base was utilized. The study population consisted of all singleton perinatal deaths occurring between January 1, 1988 and June 30, 1991 (n = 522). A proportionate study was designed.^ The population studied mostly corresponded to married young adult mothers, who were residents of urban areas, with an educational level of junior high school or more, two to three pregnancies, and intermediate prenatal care. The mean gestational age at birth was 33.4 $\pm$ 3.9 completed weeks and the mean birthweight at birth was 1,791.9 $\pm$ 853.1 grams.^ Thirty-five percent of perinatal deaths were categorized as avoidable. Postnatal infection and premature rupture of membranes were the most frequent primary causes of avoidable perinatal death. The avoidable perinatal mortality rate was 8.7 per 1000 and significantly declined during the study period (p $<$.05). Preventable perinatal mortality aggregated data suggested that at least part of the mortality decline for amenable conditions was due to better medical care.^ Structure deficiencies were present in 35% of avoidable deaths and process deficiencies were present in 79%. Structure deficiencies remained constant over time. Process deficiencies consisted of diagnosis failures (45.8%) and treatment failures (87.3%), they also remained constant through the years. Party responsibility was as follows: Obstetric (35.4%), pediatric (41.4%), institutional (26.5%), and patient (6.6%). Obstetric responsibility significantly increased during the study period (p $<$.05). Pediatric responsibility declined only for newborns less than 1500 g (p $<$.05). Institutional responsibility remained constant.^ Process deficiencies increased the risk for an avoidable death eightfold (confidence interval 1.7-41.4, p $<$.01) and provider responsibility ninety-fivefold (confidence interval 14.8-612.1, p $<$.001), after adjustment for several confounding variables. Perinatal mortality due to prematurity, barotrauma and nosocomial infection, was highly preventable, but not that due to transpartum asphyxia. Once specific deficiencies in the quality of care have been identified, quality assurance actions should begin. ^

AMS 14C and 230Th/U dates determined on 24 coral species from the Gulf of Cádiz

This paper presents the first compilation of information on the spatial distribution of scleractinian cold-water corals in the Gulf of Cádiz based on literature research and own observations (video footage, sediment samples). Scleractinian cold-water corals are widely distributed along the Spanish and Moroccan margins in the Gulf of Cádiz, where they are mainly associated with mud volcanoes, diapiric ridges, steep fault escarpments, and coral mounds. Dendrophyllia cornigera, Dendrophyllia alternata, Eguchipsammia cornucopia, Madrepora oculata and Lophelia pertusa are the most abundant reef-forming species. Today, they are almost solely present as isolated patches of fossil coral and coral rubble. The absence of living scleractinian corals is likely related to a reduced food supply caused by low productivity and diminished tidal effects. In contrast, during the past 48 kyr scleractinian corals were abundant in the Gulf of Cádiz, although their occurrence demonstrates no relationship with main climatic or oceanographic changes. Nevertheless, there exists a conspicuous relationship when the main species are considered separately. Dendrophylliids are associated with periods of relatively stable and warm conditions. The occurrence of L. pertusa mainly clusters within the last glacial when bottom current strength in the Gulf of Cádiz was enhanced and long-term stable conditions existed in terms of temperature. Madrepora oculata shows a higher tolerance to abrupt environmental changes.

Formless as Water, Flaming as a Fire-Some observations on the Theory and Practice of Self-Determination

The concept of national self-determination is a highly contested concept from very outset. It is partly due to its dual parentage, namely nationalism and liberalism. Prior to 1945 it was only a political concept without legal binding. With the incorporation of the principle in the UN Charter it was universalized and legalized. However, there were two competing interpretations at the UN based on de-colonization and representative government. How to define self and what really determined remain highly controversial. How to reconcile the international norm of sovereignty of state and self determination of people became more complex problem with the tide of secessionist movements based on ethno-nationalism. The concept of internal self-determination came as a compromise; but it is also very vague and harbors a wide range of interpretations.

Perspectives on the design and use of direct alcohol fuel cells fed by alcohol blends

The fast-growing power demand by portable electronic devices has promoted the increase of global production of portable PEM fuel cell, a quarter of them consist of direct methanol fuel cell (DMFC) units. These present the advantage of being fuelled directly with a liquid fuel, as well as direct ethanol fuel cells (DEFC) do.

Considerations on the trade and finances of this Kingdom, and on the measures of Administration with respect to those great national objects since the conclusion of the peace [Texto impreso]

Autor tomado de la Britsh Library

An experimental test for lineage-specific position effects on alcohol dehydrogenase (Adh) genes in Drosophila

Independent transgene insertions differ in expression based on their location in the genome; these position effects are of interest because they reflect the influence of genome organization on gene regulation. Position effects also represent potentially insurmountable obstacles to the rigorous functional comparison of homologous genes from different species because (i) quantitative variation in expression of each gene across genomic positions (generalized position effects, or GPEs) may overwhelm differences between the genes of interest, or (ii) divergent genes may be differentially sensitive to position effects, reflecting unique interactions between each gene and its genomic milieu (lineage-specific position effects, or LSPEs). We have investigated both types of position-effect variation by applying our method of transgene coplacement, which allows comparisons of transgenes in the same position in the genome of Drosophila melanogaster. Here we report an experimental test for LSPE in Drosophila. The alcohol dehydrogenase (Adh) genes of D. melanogaster and Drosophila affinidisjuncta differ in both tissue distribution and amounts of ADH activity. Despite this striking regulatory divergence, we found a very high correlation in overall ADH activity between the genes of the two species when placed in the same genomic position as assayed in otherwise Adh-null adults and larvae. These results argue against the influence of LSPE for these sequences, although the effects of GPE are significant. Our new findings validate the coplacement approach and show that it greatly magnifies the power to detect differences in expression between transgenes. Transgene coplacement thus dramatically extends the range of functional and evolutionary questions that can be addressed by transgenic technology.

The Impacts of National Culture on Safety Culture in the Global Oil and Gas Industry

Safety culture is one of the most-studied subjects in the safety literature today, although no agreement exists on exactly what it means. Most safety culture research has been conducted in high-hazard industries such as nuclear power, aviation, and offshore oil and gas production. Only limited research has investigated links between safety culture and the prevailing national culture. This paper proposes that efforts to build safety culture and improve safety performance in the global oil and gas industry will be enhanced if the safety culture maturity and the prevailing national culture are assessed and a location-specific plan is developed based on these factors. A model plan to improve safety performance for one multinational oil and gas company is presented.