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.

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.

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.

Design, modelling, simulation and integration of cyber physical systems: methods and applications

The main drivers for the development and evolution of Cyber Physical Systems (CPS) are the reduction of development costs and time along with the enhancement of the designed products. The aim of this survey paper is to provide an overview of different types of system and the associated transition process from mechatronics to CPS and cloud-based (IoT) systems. It will further consider the requirement that methodologies for CPS-design should be part of a multi-disciplinary development process within which designers should focus not only on the separate physical and computational components, but also on their integration and interaction. Challenges related to CPS-design are therefore considered in the paper from the perspectives of the physical processes, computation and integration respectively. Illustrative case studies are selected from different system levels starting with the description of the overlaying concept of Cyber Physical Production Systems (CPPSs). The analysis and evaluation of the specific properties of a sub-system using a condition monitoring system, important for the maintenance purposes, is then given for a wind turbine.

Optimization of aeroponic technology for future integration in quality potato seed production systems in tropical environments

Virus and soil borne pathogens negatively impact on the production of potatoes in tropical highland and sub-tropical environments, limiting supply of an increasingly popular and important vegetable in these regions. It is common for latent disease infected seed tubers or field grown cuttings to be used as potato planting material. We utilised an International Potato Centre technique, using aeroponic technology, to produce low cost mini-tubers in tropical areas. The system has been optimised for increased effectiveness in tropical areas. High numbers of seed tubers of cultivar Sebago (630) and Nicola per m2 (>900) were obtained in the first generation, and the system is capable of producing five crops of standard cultivars in every two years. Initial results indicate that quality seed could be produced by nurseries and farmers, therefore contributing to the minimisation of soil borne diseases in an integrated management plan. This technology reduces seed production costs, benefiting seed and potato growers. © ISHS.

Advances in integration of photovoltaic power and energy production in practical systems

This thesis presents advances in integration of photovoltaic (PV) power and energy in practical systems, such as existing power plants in buildings or directly integrated in the public electrical grid. It starts by providing an analyze of the current state of PV power and some of its limitations. The work done in this thesis begins by providing a model to compute mutual shading in large PV plants, and after provides a study of the integration of a PV plant in a biogas power plant. The remainder sections focus on the work done for project PVCROPS, which consisted on the construction and operation of two prototypes composed of a PV system and a novel battery connected to a building and to the public electrical grid. These prototypes were then used to test energy management strategies and validate the suitability of the two advanced batteries (a lithium-ion battery and a vanadium redox ow battery) for households (BIPV) and PV plants. This thesis is divided in 7 chapters: Chapter 1 provides an introduction to explain and develop the main research questions studied for this thesis; Chapter 2 presents the development of a ray-tracing model to compute shading in large PV elds (with or without trackers); Chapter 3 shows the simulation of hybridizing a biogas plant with a PV plant, using biogas as energy storage; Chapters 4 and 5 present the construction, programming, and initial operation of both prototypes (Chapter 4), EMS testing oriented to BIPV systems (Chapter 5). Finally, Chapters 6 provides some future lines of investigation that can follow this thesis, and Chapter 7 shows a synopsis of the main conclusions of this work; Resumo: Avanços na integracão de potência fotovoltaica e producão de energia em sistemas práticos Esta tese apresenta avanços na integração de potência e energia fotovoltaica (PV) em sistemas práticos, tais como centrais existentes ou a rede eléctrica pública. Come ça por analisar o estado corrente do fotovoltaico no mundo e aborda algumas das suas limitações. O trabalho feito para esta tese de doutoramento começou pelo desenvolvimento de um modelo para calcular os sombreamentos que ocorrem em grandes campos fotovoltaicos, e depois apresenta um estudo sobre a integração um sistema fotovoltaico em uma central eléctrica a bióg as. As ultimas secções da tese focam-se no trabalho feito para o projecto PVCROPS, que consistiu na construção e operação de dois demonstratores, cada um formado por um sistema fotovoltaico e bateria conectados a um edíficio e a rede eléctrica pública. Estes protótipos foram posteriormente utilizados para testar estratégias de gestão de energia (EMS) e para validar a operação de duas baterias avançadas (bateria de Iões de Li tio e bateria de Fluxo Redox de Van adio) e a sua utiliza ção para habitações e centrais PV. A tese está dividida em 7 capitulos: O capitulo 1 apresenta uma introdução para explicar e desenvolver as principais questões que foram investigadas nesta tese; O capitulo 2 mostra o desenvolvimento de um modelo baseado em traçados de raios para calcular sombreamentos mútuos em grandes centrais PV (com e sem seguidores); O capitulo 3 mostra a simulação da hibridização de uma central electrica a biogas com uma central PV, e utilizando o biógas como armazenamento de energia. Os capitulos 4 e 5 apresentam a construção, programação e operação inicial dos dois demonstradores (Capitúlo 4), o teste de EMS orientadas para sistemas PV em habitações (Capítulo 5). Finalmente, o capítulo 6 sugere algumas futuras linhas de investigação que poderão seguir esta tese, e o Capítulo 7 faz uma sinopse das principais conclusões deste trabalho.

AgroDB - integration of database management systems with crop models.

2016

Integration of heterogeneous data sources and automated reasoning in healthcare and domotic IoT systems

In recent years, IoT technology has radically transformed many crucial industrial and service sectors such as healthcare. The multi-facets heterogeneity of the devices and the collected information provides important opportunities to develop innovative systems and services. However, the ubiquitous presence of data silos and the poor semantic interoperability in the IoT landscape constitute a significant obstacle in the pursuit of this goal. Moreover, achieving actionable knowledge from the collected data requires IoT information sources to be analysed using appropriate artificial intelligence techniques such as automated reasoning. In this thesis work, Semantic Web technologies have been investigated as an approach to address both the data integration and reasoning aspect in modern IoT systems. In particular, the contributions presented in this thesis are the following: (1) the IoT Fitness Ontology, an OWL ontology that has been developed in order to overcome the issue of data silos and enable semantic interoperability in the IoT fitness domain; (2) a Linked Open Data web portal for collecting and sharing IoT health datasets with the research community; (3) a novel methodology for embedding knowledge in rule-defined IoT smart home scenarios; and (4) a knowledge-based IoT home automation system that supports a seamless integration of heterogeneous devices and data sources.

Power flow forecasting and smart charging for electric vehicle charging systems with photovoltaic integration

An essential role in the global energy transition is attributed to Electric Vehicles (EVs) the energy for EV traction can be generated by renewable energy sources (RES), also at a local level through distributed power plants, such as photovoltaic (PV) systems. However, EV integration with electrical systems might not be straightforward. The intermittent RES, combined with the high and uncontrolled aggregate EV charging, require an evolution toward new planning and paradigms of energy systems. In this context, this work aims to provide a practical solution for EV charging integration in electrical systems with RES. A method for predicting the power required by an EV fleet at the charging hub (CH) is developed in this thesis. The proposed forecasting method considers the main parameters on which charging demand depends. The results of the EV charging forecasting method are deeply analyzed under different scenarios. To reduce the EV load intermittency, methods for managing the charging power of EVs are proposed. The main target was to provide Charging Management Systems (CMS) that modulate EV charging to optimize specific performance indicators such as system self-consumption, peak load reduction, and PV exploitation. Controlling the EV charging power to achieve specific optimization goals is also known as Smart Charging (SC). The proposed techniques are applied to real-world scenarios demonstrating performance improvements in using SC strategies. A viable alternative to maximize integration with intermittent RES generation is the integration of energy storage. Battery Energy Storage Systems (BESS) may be a buffer between peak load and RES production. A sizing algorithm for PV+BESS integration in EV charging hubs is provided. The sizing optimization aims to optimize the system's energy and economic performance. The results provide an overview of the optimal size that the PV+BESS plant should have to improve whole system performance in different scenarios.

Integration of ROS for the control of industrial robotic systems in a proprietary environment

The paper deals with the integration of ROS, in the proprietary environment of the Marchesini Group company, for the control of industrial robotic systems. The basic tools of this open-source software are deeply studied to model a full proprietary Pick and Place manipulator inside it, and to develop custom ROS nodes to calculate trajectories; speaking of which, the URDF format is the standard to represent robots in ROS and the motion planning framework MoveIt offers user-friendly high-level methods. The communication between ROS and the Marchesini control architecture is established using the OPC UA standard; the tasks computed are transmitted offline to the PLC, supervisor controller of the physical robot, because the performances of the protocol don’t allow any kind of active control by ROS. Once the data are completely stored at the Marchesini side, the industrial PC makes the real robot execute a trajectory computed by MoveIt, so that it replicates the behaviour of the simulated manipulator in Rviz. Multiple experiments are performed to evaluate in detail the potential of ROS in the planning of movements for the company proprietary robots. The project ends with a small study regarding the use of ROS as a simulation platform. First, it is necessary to understand how a robotic application of the company can be reproduced in the Gazebo real world simulator. Then, a ROS node extracts information and examines the simulated robot behaviour, through the subscription to specific topics.

Justified Fault-Ride-Through Requirements for Wind Turbines in Power Systems

In this paper, a novel adaptive strategy to obtain technically justified fault-ride-through requirements for wind turbines (WTs) is proposed. The main objective is to promote an effective integration of wind turbines into power systems with still low penetration levels of wind power based on technical and economical considerations. The level of requirement imposed by the strategy is increased stepwise over time, depending on system characteristics and on wind power penetration level. The idea behind is to introduce stringent requirements only when they are technically needed for a reliable and secure power system operation. Voltage stability support and fault-ride-through requirements are considered in the strategy. Simulations are based on the Chilean transmission network, a midsize isolated power system with still low penetration levels of wind power. Simulations include fixed speed induction generators and doubly fed induction generators. The effects on power system stability of the wind power injections, integrated into the network by adopting the adaptive strategy, are compared with the effects that have the same installed capacity of wind power but only considering WTs able to fulfill stringent requirements (fault-ride-through capability and support voltage stability). Based on simulations and international experience, technically justified requirements for the Chilean case are proposed.

Digital control and integration of a 192 MW wind farm with doubly fed induction generator into the Brazilian power system

This paper reports on design of digital control for wind turbines and its relation to the quality of power fed into the Brazilian grid on connecting to it a 192 MW wind farm equipped with doubly fed induction generators. PWM converters are deployed as vector controlled regulated current voltage sources for their rotors, for independent control of both active and reactive power of those generators. Both speed control and active power control strategies are analyzed, in the search for maximum efficiency of conversion of wind kinetic energy into electric power and enhanced quality of delivered power. (C) 2009 Elsevier B.V. All rights reserved.

Robust integration of real time optimization with linear model predictive control

Here, we study the stable integration of real time optimization (RTO) with model predictive control (MPC) in a three layer structure. The intermediate layer is a quadratic programming whose objective is to compute reachable targets to the MPC layer that lie at the minimum distance to the optimum set points that are produced by the RTO layer. The lower layer is an infinite horizon MPC with guaranteed stability with additional constraints that force the feasibility and convergence of the target calculation layer. It is also considered the case in which there is polytopic uncertainty in the steady state model considered in the target calculation. The dynamic part of the MPC model is also considered unknown but it is assumed to be represented by one of the models of a discrete set of models. The efficiency of the methods presented here is illustrated with the simulation of a low order system. (C) 2010 Elsevier Ltd. All rights reserved.

Distributed power control algorithm for multiple access systems based on Verhulst model

In this paper the continuous Verhulst dynamic model is used to synthesize a new distributed power control algorithm (DPCA) for use in direct sequence code division multiple access (DS-CDMA) systems. The Verhulst model was initially designed to describe the population growth of biological species under food and physical space restrictions. The discretization of the corresponding differential equation is accomplished via the Euler numeric integration (ENI) method. Analytical convergence conditions for the proposed DPCA are also established. Several properties of the proposed recursive algorithm, such as Euclidean distance from optimum vector after convergence, convergence speed, normalized mean squared error (NSE), average power consumption per user, performance under dynamics channels, and implementation complexity aspects, are analyzed through simulations. The simulation results are compared with two other DPCAs: the classic algorithm derived by Foschini and Miljanic and the sigmoidal of Uykan and Koivo. Under estimated errors conditions, the proposed DPCA exhibits smaller discrepancy from the optimum power vector solution and better convergence (under fixed and adaptive convergence factor) than the classic and sigmoidal DPCAs. (C) 2010 Elsevier GmbH. All rights reserved.

Emulsified systems based on glyceryl monostearate and potassium cetyl phosphate: Scale-up and characterization of physical properties

introducing a pharmaceutical product on the market involves several stages of research. The scale-up stage comprises the integration of previous phases of development and their integration. This phase is extremely important since many process limitations which do not appear on the small scale become significant on the transposition to a large one. Since scientific literature presents only a few reports about the characterization of emulsified systems involving their scaling-up, this research work aimed at evaluating physical properties of non-ionic and anionic emulsions during their manufacturing phases: laboratory stage and scale-up. Prototype non-ionic (glyceryl monostearate) and anionic (potassium cetyl phosphate) emulsified systems had the physical properties by the determination of the droplet size (D[4,3 1, mu m) and rheology profile. Transposition occurred from a batch of 500-50,000 g. Semi-industrial manufacturing involved distinct conditions: intensity of agitation and homogenization. Comparing the non-ionic and anionic systems, it was observed that anionic emulsifiers generated systems with smaller droplet size and higher viscosity in laboratory scale. Besides that, for the concentrations tested, augmentation of the glyceryl monostearate emulsifier content provided formulations with better physical characteristics. For systems with potassium cetyl phosphate, droplet size increased with the elevation of the emulsifier concentration, suggesting inadequate stability. The scale-up provoked more significant alterations on the rheological profile and droplet size on the anionic systems than the non-ionic. (C) 2008 Elsevier B.V. All rights reserved.