Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Light-Weighted Decision Support Framework for Selecting Cloud Service Providers

Multi-criteria decision making(MCDM)is a technique used to achieve better outcomes for some complex business-related problems,whereby the selection of the best alternative can be made in as many cases as possible.This paper proposes a model,the multi-criteria decision support method,that allows both service providers and consumers to maximize their profits while preserving the best matching process for resource allocation and task scheduling.The increasing number of service providers with different service provision capabilities creates an issue for consumers seeking to select the best service provider.Each consumer seeks a service provider based on various preferences,such as price,service quality,and time to complete the tasks.In the literature,the problem is viewed from different perspectives,such as investigating how to enhance task scheduling and the resource allocation process,improve consumers’trust,and deal with network problems.This paper offers a novel model that considers the preferences of both service providers and consumers to find the best available service provider for each consumer.First,the model adopts the best-worst method(BWM)to gather and prioritize tasks based on consumers’and service providers’preferences.Then,the model calculates and matches similarities between the sets of tasks from the consumer’s side with the sets of tasks from the provider’s side to select the best service provider for each consumer using the two proposed algorithms.The complexity of the two algorithms is found to be O(n3).

Rationale of a Cross Sectional Descriptive Study on Knowledge and Practices of Healthcare Providers on Postpartum Hemorrhage Management in Kinshasa, the Democratic Republic of the Congo

Background: Healthcare Providers’ knowledge and practice of postpartum hemorrhage (PPH) management are essential to reduce maternal morbidity and mortality. PPH is a public health problem due to the high maternal mortality (MM) associated with it worldwide (25%). Improving the quality of PPH management is a major challenge in low-income countries where, despite the progress made in its management, PPH remains a major contributor to maternal morbidity and mortality. Objective: We will evaluate the level of knowledge and practices of providers in the PPH management in Kinshasa in the Democratic Republic of the Congo (DRC). Methods: This study will be descriptive and cross-sectional. The minimum sample size will be 86. Our study population will consist of delivery room care providers. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparisons of means between groups will be made using Student’s t-test and Pearson’s chi-square test. The test will be statistically significant for a p value 0.05. Data will be collected and processed anonymously and confidentially. Conclusion: Improving quality of care must be a priority in obstetrics. This evaluation requires us to determine the level of knowledge and practices of providers in the PPH management in Kinshasa.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

Examining Knowledge Decay in the Anesthesia Provider—An Integrative Review

Background: Knowledge decay can be present in a lot of different careers but it is especially important when affecting the anesthesia provider. Knowledge decay can lead to skill decay. Therefore, it leads to worse patient outcomes. It is important to know how knowledge decay occurs and to know how to prevent it. Purpose: The purpose of this review was to explore the contributing factors of knowledge decay while also examining how different learning activities can be used to prevent it from occurring. Methods: A systematic literature search was performed in PubMed, Cochrane databases, and Embase. The American Association of Nurse Anesthesiology website was also examined. Findings: Knowledge decay usually occurs when either the anesthesia provider is in a new area of practice or when the provider has had a significant amount of time pass since the latest implementation of an anesthesia skill. The type of activity shown to best combat knowledge decay is the use of a simulation-based learning activity. Classroom learning can also help combat knowledge decay, but not to the same extent. Conclusions: The most significant way to prevent knowledge decay in the anesthesia provider is to implement simulation-based learning activities, as well as keep anesthesia providers comfortable with the skills that they practice.

Making Sense of Anything thru Analytics: Employees Provident Fund (EPF)

Employees Provident Fund (EPF) has always been a hot topic, from the previous Government permitted “withdrawals” during the pandemic to the present Government disallowing further withdrawals (afraid it would lead to a financial crisis) and allowing emergency loans through an EPF collateral agreement. The latter used median studies to “contribute” MYR 500 to EPF members with less than RM 10,000 in their accounts. Baffled/bewildered by the current Government’s generosity and highlighted in this paper, I used Monte Carlo simulation, a method used by analysts when determining the size of a client’s portfolio to support their desired retirement lifestyle, to establish a reference-type table displaying ideal savings when reaching 50. The Government could use the table mentioned above to give more meaningful contributions to EPF members, apart from EPF active and inactive members, knowing where they stand concerning their current EPF savings.

Providence夜用型支具治疗青少年特发性脊柱侧凸的效果分析

目的评价Providence夜用型支具治疗青少年特发性脊柱侧凸(AIS)的临床效果。方法选取采用Providence夜用型支具治疗的19例AIS女性患者为P组,采用Boston全天佩戴型支具治疗19例的AIS患者为B组,随访18个月,每6个月复查1次,去除支具摄站立位全脊柱正侧位X线片。结果 P组治疗前后Cobb角分别为(29.8±4.1)°和(18.5±2.1)°,B组治疗前后Cobb角分别为(30.5±4.0)°和(20.1±2.3)°,两组治疗前后的Cobb角比较差异有统计学意义(P<0.05)。P组与B组的矫正率分别为37.9%和34.1%,两组比较差异无统计学意义(P>0.05)。P组的依从性、合并症、心理状况和社会适应情况均优于B组。结论 Providence夜用型支具治疗Cobb角<35°的腰段、胸腰段的AIS可取得满意效果,依从性好,正确的临床应用能有效避免手术治疗。

基于语料库的英语同义词搭配特征研究——以supply和provide为例

以Sketch Engine(SkE)软件为工具,基于语料库的英语同义词搭配特征研究发现,英语中的同义词虽然基本语义相同或相近,但在类联接模式、典型搭配词及语义韵等方面存在差异。英语词汇教学可借助语料库,在比较中紧密联系词汇的搭配特征,以帮助学习者更快、更准地习得并输出地道、流利的英语。

品质 从服务做起——iCan Provider Suite打造新服务

今天,将任务关键型服务及应用进行外包的呼声已经越来越高。当iCan SP推出的ican Provider Suite今年6月在国外发布、9月在国内全面发布以来,业界对此服务管理解决方案并没有太多的认识。在同CA公司亚洲区资深副总裁段践冰的交谈中,终于能从中一窥iCan Provider Suite方案的端倪。这套服务管理解决方案提出了一个全新的理念,它致力于提升服务商和IT部门的竞争力,而且也把无形的服务透明化、具体化了。

A Study on the Multi-Task Incentive Mechanism for the Service Provider

Both conflict and asymmetric information exist betweenthe telecom operators and the service provider,and result in illegal behaviors of the service provider.The relationship between the telecom operators andthe service provider is classical multi-task principalagentrelationship. The multi-task incentive for theservice provider is considered in the design of theprincipal-agent incentive contract, and it is necessaryto add the multi-task incentive to the serviceproviders through the analysis of the risk costs andthe agency costs of this problem.

Gallium oxide: promise to provide more efficient life

Despite being the long-time mainstream semiconductor for both logic and power devices, Silicon is now facing its dilemma and limitation of scalability and material potential.Especially for power devices, people are demanding escalating efficiency with higher blocking voltage while its power consumption and heat generation are less. Constrained by its narrow bandgap of 1.14 eV, Silicon only has a critical breakdown field(E_c) of 0.3 MV/cm, yielding a Baliga figureof-merit(BFOM = ε×μ× E_c^3) of unity when normalized to itself. It is hence required that the dominating factor E_c should be as high as possible such that the BFOM will be hundreds or even thousands of times when compared to Silicon so as to minimize the conduction loss. Beta-Gallium Oxide(β-Ga_2O_3) with decent μ of 250 cm2/Vs, ultra-wide bandgap of4.8 eV and high critical E_c of 8 MV/cm, yielding a superior high BFOM of more than 3000. Therefore, system made withβ-Ga_2O_3 can be thinner, lighter and capable of handling more power than the one with Silicon. In addition, low-cost and large size substrate through melt-grown method endows β-Ga_2O_3 more potentials as cost-effective power devices. After resolving the low thermal conductivity issue,unipolar devices made with ultra-wide bandgap β-Ga_2O_3 are promised to make power transition and our life more efficient.

Perception of Adolescents on the Attitudes of Providers on Their Access and Use of Reproductive Health Services in Delta State, Nigeria

This paper examines the perception of adolescents on the attitudes of providers on their access and use of reproductive health services (ARHS) in Delta State, Nigeria, with a view of assessing the impact of providers’ attitude on the use of adolescents’ reproductive health services in Delta State. The study adopted a survey design to collect primary data using questionnaires and focus group discussions (FGDs) from adolescents in a sample of schools. A sample size of 1500 respondents was taken from 12 schools in six Local Government Areas in three Senatorial Districts in Delta State, Nigeria. The locations of the schools were such that six each were in rural and urban communities respectively. The result from the study was that unfriendly attitudes of providers which keep adolescents waiting, inadequate duration of consultations, judgmental attitudes of some providers, lack of satisfactory services provision and lack of confidentiality will put off adolescents from accessing and using adolescents’ reproductive health services irrespective of their sex, age, class, religion, residence, ethnic group, parents’ education or income levels. The paper concludes that medical personnel take all these issues very seriously when dealing with adolescents to enhance access and use adolescents’ reproductive health services in Delta State and indeed Nigeria.

Assessment of the Contributions of Private Provider Engagement in Tuberculosis Case Finding and Notification in South West Nigeria

Introduction: Tuberculosis is one of the leading causes of mortalities attributable to an infectious disease. In a private sector-driven health system such as Nigeria, the private health providers are very important stakeholders in tuberculosis diagnosis and management. Unfortunately, there are few data on the level of contribution of these private health providers to the case finding and notification of tuberculosis in Nigeria. Consequently, this study assessed the contribution of the private providers to the diagnosis and treatment of tuberculosis under the Global Fund Private Public Mix New Funding Model (2nd phase) grant (GF PPM NFM2) in the four implementing states of south west Nigeria. Materials and Methods: This is a retrospective, cross-sectional analysis of the NFM2 programme implementation data collected between January 1, 2019 and December 31, 2020. Data was extracted from the routine registers such as the presumptive TB registers;treatment register of the private health facilities engaged for PPM activities between 2019 and 2020. The data was entered and analyzed using Microsoft excel package. The variables were summarized using appropriate charts and table. Results: Concerning the percentage contribution of the Global Fund Private Public Mix (GF PPM) grant to the total state TB case notification, majority of the implementing states show some progressive rise in the contribution of GF PPM to State TB case notification as the grant implementation progressed. Furthermore, at the initial period of the grant implementation, the health facilities seemed to have generated majority of the cases. However, as the grant implementation progressed, the PPMVs were responsible for the diagnosis of majority of the cases. Conclusion: As the grant progressed, there was a progressive increase in the number of presumptive TB cases as well as in the number of notified cases of tuberculosis attributable to private provider engagement.

“Man Shall Find Grace”: A Biblical Reading of the “Eternal Providence” in Milton's Paradise Los

John Milton introduces the Biblical world into literature. Some modern critics think that in Paradise Lost, Milton makes Satan a hero while God a tyrant, yet, adopting the original Biblical perception, the reader will see the "Eternal Providence" of God and will agree that Milton has succeeded in justifying God as a Father Who says "Man Shall Find Grace". A Biblical reading of this epic will be done by focusing on its detail contents.

Fano Resonances Can Provide Two Criteria to Distinguish Majorana Bound States from Other Candidates in Experiments

There are still debates on whether the observed zero energy peak in the experiment by Stevan et al. [Science 346 （2014） 602] reveals the existence of the long pursued Ala.jorana bound states （MBSs）. We propose that, by mounting two scanning tunneling microscopic tips on top of the topological superconducting chain and measuring the transmission spectrum between these two metallic tips, there are two kinds of characteristics on the spectrum that are caused by A.IBSs uniquely： One is symmetric peaks with respect to zero energy and the other is 4~r period caused by a nearby dosephson junction. The former refers to the fact that MBSs are eomposited by Alajorana fermions which distributed in the particle and hole subspaees equally. The latter is based on the well known 4w period of Josephson effect in topological superconductor. We think that such two characteristics can be used as criteria to distinguish MBSs from other candidates, such as impurities, Kondo effect and traditional Andreev bound states.

Knowledge of coronavirus disease 2019(COVID-19) among healthcare providers: A cross-sectional study in Indonesia

Objective:To assess healthcare workers’knowledge of novel coronavirus disease 2019(COVID-19)in the early phase of the outbreak in Indonesia.Methods:A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25,2020.Healthcare workers’knowledge on COVID-19 was assessed,and demographic data,workplace characteristics,and medical professional characteristics as well as the current local situation of COVID-19 were collected.To characterize determinants associated with knowledge,a logistic regression analysis was employed.Results:Out of 288 healthcare workers who completed the interview-assisted questionnaire,149(51.7%)respondents had a good knowledge.Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors:adjusted odds ratio(aO R):0.38;95%CI:0.20-0.72 and aO R:0.31;95%CI:0.13-0.73,respectively.Compared to healthcare workers who had medical practice experience less than 5 years,those who had worked for more than 10 years had lower knowledge(a OR:0.43;95%CI:0.20-0.90).Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room(aO R:14.33;95%CI:3.67-55.88).Conclusions:The knowledge of COVID-19 among surveyed healthcare workers was relatively low.The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.

Catalytic Desulfurization of n-Butyl-sulfide over HZSM-5 Zeolite in the Presence of a Hydrogen Provider

The catalytic desulfurization of a model organic sulfurous compound n-butyl-sulfide in a fixed bed microreactor is studied in the presence of catalyst and a hydrogen provider. The experimental results show that the appropriate reaction conditions are： a mixed catalyst of HZSM-5 zeolite and Co-Mo/Al2O3-TiO2, a reaction temperature of 300℃, atmosphere pressure, a feed speed of 50 mL/h and a mass hourly space velocity of 3.0 h^-1 A higher catalytic property and desulfurization efficiency of the mixed catalyst of HZSM-5 zeolite and Co-Mo/Al2O3-TiO2 is achieved. The adsorption and desulfurization efficiency of the FCC gasoline from Shenghua Refinery, which is affiliated to China University of Petroleum （East China）, is 53.0 %.

Intracellular sorting pathways of the amyloid precursor protein provide novel neuroprotective strategies

Alzheimer＇s disease（AD）is the most common cause of senile dementia.It is characterized by the formation of plaques mainly composed of the amyloid-beta peptide（Aβ）.Diverse lines of evidence support the notion that accumulation of Aβis a primary cause of AD pathogenesis（Huang and Mucke,2012）.Amyloid precusor protein（APP）processing is dependent on its subcelluar trafficking pathway：Aβis derived from APP by proteolyric processing.

Tax Cuts and Fee Reduction Will Provide More Policy Bonuses

'This year we will put more efforts in to tax cuts and fee reductions, to lower the VAT rate and contribution rate for basic retirement insurance. The surplus will amount to RMB 2 trillion,'Premier Li Keqiang said at the press conference during the Two Sessions.He also commented that all types of enterprises will benefit from the tax cuts and fee reductions policies and it will have a very high efficiency as the benefits will be delivered directly to market entities. The VAT cuts took effect from April 1 and pension insurance rate will be lower starting from May 1.

The Relationship between Size and Performance of Palestinian Water Service Providers

Studies investigating the relationship between size and performance of water service providers are abundant. Yet, this relationship has not been fully addressed in Palestinian water sector, particularly, after the issuance of water law 2014 which calls for merging water providers into large regional utilities. This research evaluates the significant effect of the size of Palestinian water service providers on non-revenue water, staff productivity, collection efficiency, average consumption, average price, operating and maintenance cost, working ratio, and gross profit. The multivariate analysis shows that there are significant differences in working ratio, non-revenue water, staff productivity, average price, and gross profit based on the size. On the other side, no significant differences have been found in average daily consumption, operating and maintenance cost per unit, and collection efficiency based on those providers’ size. The small service providers perform better in non-revenue water, staff productivity, and collection efficiency;wherein, large service providers are more profitable than small service providers. Implications of these findings by conducting further studies will add the value for better merging of the Palestinian water providers and the reforming process.