The door of the tomb is open: Participatory action research to assess the impact of strengthened community capacity on maternal health care in rural Mali

This participatory action-research project addressed the hypothesis that strengthened community and women's capacity for self-development will lead to action to address maternal health problems and the prevention of maternal morbidity and mortality in Mali. Research objectives were: (1) to undertake a comparative cross-sectional study of the association of community capacity with improved maternal health in rural areas of Sanando, Mali, where capacity building interventions have taken place in some villages but not in others. (2) to describe women's maternal health status, access to and use of maternal health services given their residence in program or comparison communities.^ The participatory action research project was an integrated qualitative and quantitative study using participatory rural appraisal exercises, semi-structured group interviews and a cross-sectional survey.^ Factors related to community capacity for self-development were identified: community harmony; an understanding of the benefits of self-development; dynamic leadership; and a structure to implement collective activities.^ A distinct difference between the program and comparison villages was the commitment to train and support traditional birth attendants (TBAs). The TBAs in the program villages work in the context of the wider, integrated self-development program and, 10 years after their initial training, the TBAs continue to practice.^ Many women experience labor and childbirth alone or are attended by an untrained relative in both program and comparison villages. Nevertheless a significant change is apparent, with more women in program villages than in comparison villages being assisted by the TBAs. The delivery practices of the TBAs reveal the positive impact of their training in the "three cleans" (clean hands of the assistant, clean delivery surface and clean cord-cutting). The findings of this study indicate a significant level of unmet need for child spacing methods in all villages.^ The training and support of TBAs in the program villages yielded significant improvements in their delivery practices, and resulting outcomes for women and infants. However, potential exists for further community action. Capacities for self-development have not yet been directed toward an action plan encompassing other Safe Motherhood interventions, including access to family planning services and emergency obstetric care services. ^

Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers

BACKGROUND AND PURPOSE Inverse relationship between onset-to-door time (ODT) and door-to-needle time (DNT) in stroke thrombolysis was reported from various registries. We analyzed this relationship and other determinants of DNT in dedicated stroke centers. METHODS Prospectively collected data of consecutive ischemic stroke patients from 10 centers who received IV thrombolysis within 4.5 hours from symptom onset were merged (n=7106). DNT was analyzed as a function of demographic and prehospital variables using regression analyses, and change over time was considered. RESULTS In 6348 eligible patients with known treatment delays, median DNT was 42 minutes and kept decreasing steeply every year (P<0.001). Median DNT of 55 minutes was observed in patients with ODT ≤30 minutes, whereas it declined for patients presenting within the last 30 minutes of the 3-hour time window (median, 33 minutes) and of the 4.5-hour time window (20 minutes). For ODT within the first 30 minutes of the extended time window (181-210 minutes), DNT increased to 42 minutes. DNT was stable for ODT for 30 to 150 minutes (40-45 minutes). We found a weak inverse overall correlation between ODT and DNT (R(2)=-0.12; P<0.001), but it was strong in patients treated between 3 and 4.5 hours (R(2)=-0.75; P<0.001). ODT was independently inversely associated with DNT (P<0.001) in regression analysis. Octogenarians and women tended to have longer DNT. CONCLUSIONS DNT was decreasing steeply over the last years in dedicated stroke centers; however, significant oscillations of in-hospital treatment delays occurred at both ends of the time window. This suggests that further improvements can be achieved, particularly in the elderly.

Eenige blikken in de negentiende aflevering van het "Beredeneerd Hebr. - en Chald. - Nederl. - Woordenboek bewerkt naar de Grammaticale en Lexicale Werken von Fürst, Landau, Gesenius, Vater en anderen, door I. Waterman"

Philip Elte

Catalogus der tentoonstelling in het Portugeesch Israelietisch Seminarium "Ets Haim" te Amsterdam : ter herinnering aan het driehonderd-jarig jubileum van het eerste door Menassah Ben Israel te Amsterdam gedrukte Hebreeuuwsche boek

samengesteld da J. S. Da Silva Rosa

Droeve Traenen, Wtgestort door de zwaer-verfolgde Duytsche Maegd : Over de beklagelijcke, schaderijcke ende ontijdige Dood des onvergelijckelijcken ... Coningh von Svveden Gustavus Adolphus ... ; Den 16 November, 1632

Klagelied der "deutschen Magd" auf den Tod Gustav Adolfs II.

Daniel Veth's reizen in Angola, voorafgegaan door eene schets van zin leven

bewerkt door P. J. Veth en Joh. F. Snelleman

De Europische Insecten : Naauwkeurig onderzogt, na't leven geschildert, en in print gebragt door Maria Sibilla Merian; Met een korte Beschryving, waar in door haar gehandelt word van der Rupsen begin, Voedzel en wonderbare Verandering; En Ook Vertoont Word De Oorspronk, Spys en Gestalt-verwisseling, de Tyd, Plaats en Eigenschappen der Rupzen, Uiltjes, Vliegen en andere diergelyke bloedeloose Beesjes; Hier Is Nog Bygevoegt Een naauwkeurige Beschryving van de Planten, in dit Werk voorkomende; ... In't Frans beschreven door J. Marret, Medicinæ Doctor, En door een voornaam Liefhebber in't Nederduits vertaalt

Die Illustrationen sind Kupferstiche

The Open Door Mission: Measuring and predicting outcomes of one community-based substance abuse treatment program

The objectives of this study were to identify and measure the average outcomes of the Open Door Mission's nine-month community-based substance abuse treatment program, identify predictors of successful outcomes, and make recommendations to the Open Door Mission for improving its treatment program.^ The Mission's program is exclusive to adult men who have limited financial resources: most of which were homeless or dependent on parents or other family members for basic living needs. Many, but not all, of these men are either chemically dependent or have a history of substance abuse.^ This study tracked a cohort of the Mission's graduates throughout this one-year study and identified various indicators of success at short-term intervals, which may be predictive of longer-term outcomes. We tracked various levels of 12-step program involvement, as well as other social and spiritual activities, such as church affiliation and recovery support.^ Twenty-four of the 66 subjects, or 36% met the Mission's requirements for success. Specific to this success criteria; Fifty-four, or 82% reported affiliation with a home church; Twenty-six, or 39% reported full-time employment; Sixty-one, or 92% did not report or were not identified as having any post-treatment arrests or incarceration, and; Forty, or 61% reported continuous abstinence from both drugs and alcohol.^ Five research-based hypotheses were developed and tested. The primary analysis tool was the web-based non-parametric dependency modeling tool, B-Course, which revealed some strong associations with certain variables, and helped the researchers generate and test several data-driven hypotheses. Full-time employment is the greatest predictor of abstinence: 95% of those who reported full time employment also reported continuous post-treatment abstinence, while 50% of those working part-time were abstinent and 29% of those with no employment were abstinent. Working with a 12-step sponsor, attending aftercare, and service with others were identified as predictors of abstinence.^ This study demonstrates that associations with abstinence and the ODM success criteria are not simply based on one social or behavioral factor. Rather, these relationships are interdependent, and show that abstinence is achieved and maintained through a combination of several 12-step recovery activities. This study used a simple assessment methodology, which demonstrated strong associations across variables and outcomes, which have practical applicability to the Open Door Mission for improving its treatment program. By leveraging the predictive capability of the various success determination methodologies discussed and developed throughout this study, we can identify accurate outcomes with both validity and reliability. This assessment instrument can also be used as an intervention that, if operationalized to the Mission’s clients during the primary treatment program, may measurably improve the effectiveness and outcomes of the Open Door Mission.^

Safety door for the unloading mechanism of self-unloading wagons

A safety door for the discharge opening of a selfunloading wagon is disclosed herein. The wagon includes a material receiving box having a first conveyor therein for conveying the material towards one end thereof. A cross conveyor is mounted at the one end of the box for conveying the material outwardly from the box through the lower end of a discharge opening formed in the side of the box. A material beater means is rotatably mounted in the box above the cross conveyor. The safety door extends across the discharge opening to prevent the operator from reaching inwardly through the discharge opening. The safety door is self-closing and is opened by the material being discharged outwardly through the discharge opening.

Snelheid extra selected sinaazappelen [ [Material gráfico]: eet fruit : speciaal gepakt door : N.V. "Solbandera", Alcira, Spanje.

Tit. en la etiqueta:"Geen alcohol / bij snelverkeer / Snelheid / extra selected sinaasappelen / eet fruit / speciaal gepakt door / N.V. "Solabandera", Alcira, Spanje"

Nuchterheid [ [Material gráfico]: extra superior sinaasappelen : special gepakt door ... : N. V. Solbandera Alcira Spanje.

Tit. en la etiqueta: "Niet drinken / niet schenken / nuchterheid / extra superior sinaasappelen / special Gepakt door / bij dorst / dit fruit gedenken / N.V. Solbandera Alcira, Spanje"

Levensschets van sulthan Ibrahiem, vorst van Eirakh: uit het Arabisch in het Maleisch vertaald door eenen Maleischen schriftgeleerden

en uit het Maleisch in het Nederduitsch overgebracht door Philippus Pieter Roorda van Eijsinga.