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.

State of play: review of environmental policy integration literature. Research series paper no. 7

A report for the National Economic and Social Council (NESC), prepared by the Cleaner Production Promotion Unit, UCC offering an up-to-date review of the Environmental Policy Integration literature in both academic and policy debates. The report provides an overview of the theory and conceptual development; methodologies outlined and presents examples of current applications in policy across Europe and internationally.

The Causal Links between FDI and Economic Growth in Developing Countries: A Case Study of the Republic of Rwanda

The study examines the short-run and long-run causality running from real economic growth to real foreign direct investment inflows (RFDI). Other variables such as education (involving combination of primary, secondary and tertiary enrolment as a proxy to education), real development finance, unskilled labour, to real RFDI inflows are included in the study. The time series data covering the period of 1983 -2013 are examined. First, I applied Augmented Dicky-Fuller (ADF) technique to test for unit root in variables. Findings shows all variables integrated of order one [I(1)]. Thereafter, Johansen Co-integration Test (JCT) was conducted to establish the relationship among variables. Both trace and maximum Eigen value at 5% level of significance indicate 3 co-integrated equations. Vector error correction method (VECM) was applied to capture short and long-run causality running from education, economic growth, real development finance, and unskilled labour to real foreign direct investment inflows in the Republic of Rwanda. Findings shows no short-run causality running from education, real development finance, real GDP and unskilled labour to real FDI inflows, however there were existence of long-run causality. This can be interpreted that, in the short-run; education, development finance, finance and economic growth does not influence inflows of foreign direct investment in Rwanda; but it does in long-run. From the policy perspective, the Republic of Rwanda should focus more on long term goal of investing in education to improve human capital, undertake policy reforms that promotes economic growth, in addition to promoting good governance to attract development finance – especially from Nordics countries (particularly Norway and Denmark).

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.

Immigration in Spain: Integration with Feet of Clay?

The aim of the paper is to analyze the impact of the economic crisis on the integration of the immigrant population in Spain. The Spanish case is singular because during the years of intense immigration achieved a remarkable degree of socio-cultural integration. The paper argues that such integration it has been the result of the confluence of exceptional factors rather than the result of the policy making. From a mixed methodology approach, it shows that, during the period of expansion, two factors of the immigration contribute to their coexistence with native population: finding job and access to public services. But the economic crisis, with its impact in terms of job losses and austerity policies, expose the weaknesses of the Spanish model of integration.

The economic activities and functional organization of the Asturias coast

This paper proposes a methodology for analyze coastal territories focused on the functional analysis. It establishes analysis and diagnosis procedures for the activities of a coastal territory, and organizes its monitoring during time, allowing a consistent definition for the coastal territories as engines spaces or integrated spaces

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 between the London and New York Stock Exchanges, 1825-1925

The integration between the London and New York Stock Exchanges is analyzed during the era when they were still developing as asset markets. The domestic securities on both exchanges showed little sustained integration, even when controlling for the different characteristics of stocks, implying that the pricing of securities in the US and UK were still being driven by local factors. However, there was considerable integration between New York and those listings on London which operated internationally. These results place a limit on the view that pre-World War I was the first era of globalization in terms of capital markets, and suggest that the listing of foreign securities may be one of the primary mechanisms driving asset market integration.

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.

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.

Essays on cultural and institutional dynamics in economic development using spatial analysis

This thesis seeks to research patterns of economic growth and development from a number of perspectives often resonated in the growth literature. By addressing themes about history, geography, institutions and culture the thesis is able to bring to bear a wide range of inter-related literatures and methodologies within a single content. Additionally, by targeting different administrative levels in its research design and approach, this thesis is also able to provide a comprehensive treatment of the economic growth dilemma from both cross-national and sub-national perspectives. The three chapters herein discuss economic development from two broad dimensions. The first of these chapters takes on the economic growth inquiry by attempting to incorporate cultural geography within a cross-country formal spatial econometric growth framework. By introducing the global cultural dynamics of languages and ethnic groups as spatial network mechanisms, this chapter is able to distinguish economic growth effects accruing from own-country productive efforts from those accruing from interconnections within a global productive network chain. From this, discussions and deductions about the implications for both developed and developing countries are made as regards potentials for gains and losses from such types and levels of productive integration. The second and third chapters take a different spin to the economic development inquiry. They both focus on economic activity in Africa, tackling the relevant issues from a geo-intersected dimension involving historic regional tribal homelands and modern national and subnational administrative territories. The second chapter specifically focuses on attempting to adopt historical channels to investigate the connection between national institutional quality and economic development in demarcated tribal homelands at the fringes of national African borders. The third chapter on the other hand focuses on looking closer at the effects of demarcations on economic activity. It particularly probes how different kinds of demarcation warranted by two different but very relevant classes of politico-economic players have affected economic activity quite distinguishably within the resulting subnational regions in Africa.

Establishing continental sovereignty in Africa: risk and opportunity in financial integration - lessons for Africa from a legal perspective

This thesis identifies and defines the new African sovereignty. It establishes a modern sovereignty in Africa hatched from the changing nature of sovereignty in which countries come together at various levels or grades of partial surrender of national sovereignty in order to work closer together for their mutual advantage and benefit. To this end, the narrative zooms in on the central issues within the realms of money matters whereby a new model of monetary sovereignty and monetary solutions is designed in an attempt to ease the recurring tensions and challenges of modern national sovereignty in the continent of Africa. As such, this discussion will offer a historical journey through the constitution of sovereignty, to the birth of the nation state and international public law. It develops the theory of the changing nature of sovereignty within the modern state and opens new lines of inquiry for Africa. In this regard, it draws from juxtaposing and mixing elements of regional and global financial integration as well as retaining national financial sovereignty features to form this new design which I dub continental sovereignty. At its core, the thesis will deal with the legal aspects that stem from the co-mingling of legal systems of nation states and communities at the regional and global levels within the context of financial integration. The argument is that the rule of law remains sacrosanct in monetary management. Effective financial integration is the result of properly structured and managed legal frameworks with robust laws and institutions whether at a national, regional or global level. However, the thesis reveals that in order to avoid undermining the progress of Africa’s financial integration project, any solution for Africa must be immersed within a broader global solution where development issues are addressed and resolved and Africa can form a more central part in all relevant international discussion fora. The work will expound these issues by applying them within a regional and global context, with the state of affairs in Africa forming the nucleus. This application consequently presents the six key themes of the thesis which will be considered therein. They are: a.) regional advantage: which exploits the possibilities of deeper and further financial integration between smaller communal arrangements; b.) regional risk and exposure: the extent to which this deeper form of financial integration can spiral out of control if effected too quickly and too ambitiously; c.) global advantage: which considers the merits of global financial integration and the influence exerted by financial laws on the global financial architecture; d.) global risk and exposure: which considers the challenges of global financial integration especially within the background of the Global Financial Crisis 2007-2008; e.) African challenge: which considers the extent to which this analysis impacts the African economic and financial integration agenda; and f.) development challenge: which examines the extent to which global development issues impact the African solution (continental sovereignty) and the need for any solution for the continent to be roped into a broader global solution within which Africa can form an important part. Even though the thesis requests an optimistic undertone on the progress made so far, it unearths the African problem of multiple national sovereignty and multiple overlapping regional sovereignty constituted as the ‘spaghetti bowl’ dilemma. As such, the unique contribution to knowledge on financial integration in Africa can be echoed in these words: Africa‘s financial integration agenda has had little success in authenticating a systematic and dependable legal framework for monetary management. Efforts made have been incomplete, substandard, and not carefully followed through particularly reflected in the impuissant nature of the judicial enforcement mechanisms. Thus, the thesis argues that, any meaningful answer to the problems dogging the continent is inter alia deeply entrenched within a new form of cooperative monetary sovereignty. In other words, the thesis does not prescribe the creation of new laws; rather it advocates the effective enforcement of existing laws.

REFUGEES AND RESETTLEMENT: A QUALITATIVE ANALYSIS OF REFUGEE INTEGRATION THROUGH SOCIAL & SUPPORT SERVICES

This dissertation studies refugee resettlement in the United States utilizing the Integration Indicator’s framework developed by Ager and Strang for the U.S. context. The study highlights the U.S. refugee admissions program and the policies in the states of Maryland and Massachusetts while analyzing the service delivery models and its effects on refugee integration in these locations. Though immigration policy and funding for refugee services are primarily the domain of the federal government, funds are allocated through and services are delivered at the state level. The Office of Refugee Resettlement (ORR), which operates under the Department of Health and Human Services, was established after the Refugee Act of 1980 to deliver assistance to displaced persons. The ORR provides funds to individual states primarily through The Refugee Social Service and Targeted Assistance Formula Grant programs. Since the inauguration of the ORR three primary models of refugee integration through service delivery have emerged. Two of the models include the publicly/privately administered programs, where resources are allocated to the state in conjunction with private voluntary agencies; and the Wilson/Fish Alternative programs, where states sub-contract all elements of the resettlement program to voluntary agencies and private organizations —in which they can cease all state level participation and voluntary agencies or private organizations contract directly from the ORR in order for all states to deliver refugee services where the live. The specific goals of this program are early employment and economic self-sufficiency. This project utilizes US Census, state, and ORR data in conjunction with interviews of refugee resettlement practitioners involved in the service delivery and refugees. The findings show that delivery models emphasizing job training, English instruction courses, institutional collaboration, and monetary assistance, increases refugee acclimation and adaptation, providing insight into their potential for integration into the United States.

Integration of Social Concerns in Collaborative Logistics and Transportation Networks

Part 21: Mobility and Logistics

Does Final Energy Demand in Portugal Exhibit Long Memory? A Fractional Integration Analysis

In this paper, we measure the degree of fractional integration in final energy demand in Portugal using an ARFIMA model with and without adjustments for seasonality. We consider aggregate energy demand as well as final demand for petroleum, electricity, coal, and natural gas. Our findings suggest the presence of long memory in all of the components of energy demand. All fractional-difference parameters are positive and lower than 0.5 indicating that the series are stationary, although with mean reversion patterns slower than in the typical short-run processes. These results have important implications for the design of energy policies. As a result of the long-memory in final energy demand, the effects of temporary policy shocks will tend to disappear slowly. This means that even transitory shocks have long lasting effects. Given the temporary nature of these effects, however, permanent effects on final energy demand require permanent policies. This is unlike what would be suggested by the more standard, but much more limited, unit root approach, which would incorrectly indicate that even transitory policies would have permanent effects