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.

先天性动脉导管未闭致病基因MESP2新突变的发现与功能分析

目的:研究先天性动脉导管未闭(PDA)致病基因MESP2新突变。方法:选取2016年2月至2019年11月同济大学医学院附属同济医院儿科208例先天性心脏病(CHD)患儿和232名无CHD儿童,收集其血液标本及临床数据。常规纯化基因组DNA,测序分析转录因子基因MESP2以发现新的致病突变。克隆野生型MESP2基因并构建其真核表达质粒,通过定位诱变产生突变型MESP2表达质粒,转染HEK 293T细胞,通过报告基因分析揭示突变体的功能特性。结果:1例散发性先天性动脉导管未闭(PDA)患者检测出1个MESP2基因新突变,即NM_001039958.2:c.268G>T(p.Glu90*)突变。该突变不存在于对照组和其他CHD儿童中。报告基因分析显示突变型MESP2对靶基因NKX2.5的转录激活功能丧失。结论:MESP2基因缺陷可能是部分先天性PDA的分子病因,为先天性PDA的防治提供了新的分子靶标。

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.

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).

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.

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.

一种多用户频谱分配优化模型建立与求解

为解决多区域多用户在通信过程中的频谱最优分配与激励问题,本文首先在考虑多个通信运营商及多个小区用户的情况下,通过区块链理论对不同小区不同用户的频谱分配问题进行分析建模,并建立频谱最优分配优化模型;其次,针对优化模型的约束条件,通过引入拉格朗日及二分法理论对其进行求解,进而得出不同小区用户人数与频谱分配之间的数学关系;最后,通过仿真证明了容纳小区人数与频谱持有量近似地呈线性关系,且基站功率越大,近似直线的斜率越大。当基站的持有频谱量较少时,提高功率对可容纳人数的增加影响较小,随着频谱量的增加,提高基站功率,可容纳人数随之近似线性增加。

论网络服务提供者对侵权通知的审查义务

“通知-删除”规则在我国网络侵权治理中发挥着重要作用,随着网络侵权形势日趋复杂,亟须确立网络服务提供者对侵权通知的审查义务以应对频发的错误通知。对比分析不同法域“通知-删除”规则的差异,尊重网络服务提供者对侵权通知进行审查的事实,从法解释论视角,明确网络服务提供者对侵权通知的审查义务。我国法语境下的“通知-删除”规则应为归责规范,适用过错责任原则,网络服务提供者的审查义务是其注意义务的组成部分。确定网络服务提供者对侵权通知审查义务的内容应当同步考量权利人的维权成本和网络服务提供者的审查负担,以“盖然性优势”为标准对通知的不同要素进行审查,是网络服务提供者对侵权通知的审查义务的一般性内容。针对不同类型权利的权属证据和侵权证据,网络服务提供者的审查逻辑和判断标准可进行适当调整。

考虑不确定性的综合能源供应商日前优化运行策略

综合能源供应商作为多能源供应主体,可以参与市场化交易。为探索综合能源供应商在电力市场环境下新的盈利点,构建了考虑需求响应的多主体互动机制,并充分考虑光伏出力、多元用能需求、市场电价以及需求响应资源潜力的不确定性,采用区间优化方法构建了表征综合能源供应商日前运行优化问题的混合整数线性规划模型,得到综合能源供应商的购能、设备运行以及需求响应资源调用等策略。算例验证结果表明,需求响应机制可以有效降低购电成本,增加综合能源供应商的运行收益。

论短视频版权侵权行为中平台责任的认定

长视频版权方与短视频平台之间的矛盾是愈演愈烈的长短视频之争中需要首先解决的问题,短视频版权侵权行为中平台责任的认定亟须得到明确。合理使用情形的排除是平台担责的前提,重点是对“适当引用”条款的理解,应通过非实质性引用和比例原则检验引用是否适当。避风港规则是判断平台是否被归责的标准,红旗原则是排除避风港规则适用的例外。平台对用户上传内容的实质审查义务取决于平台对内容的版权性接触事实或接触可能,但平台对内容的合规审查义务并不必然触发其对内容版权合法性的审查义务。提供网络服务的类型是平台担责的基础,平台身份越靠近网络中介服务提供者,越有可能通过避风港规则免责;反之,平台身份越靠近网络内容提供者,越难以通过避风港规则免责。

考虑动态定价和碳交易的多园区综合能源服务商低碳合作优化策略

为解决多园区综合能源服务商参与综合能源市场和碳交易市场带来的利益分配和动态定价问题,该文提出一种新的多园区服务商合作交易框架。首先,设计阶梯式碳交易下多园区综合能源服务商合作运行交易机制,针对区域零售市场制定动态价格,以指导各园区服务商购能行为;其次,在新型电力系统的逐步构建下,根据新能源占比变化,完善碳配额与碳排放模型,并通过市场下阶梯式碳交易机制约束各园区的碳排放;最后,建立多园区服务商纳什议价模型,将所建模型分解为联盟成本最小化与电热交易支付谈判子问题,通过算例验证所提模型和方法能提高各园区参与联盟主动性,并有效降低各园区碳排放和总运行成本。

基于AHP和ANSYS的养老院共享轮椅设计与研究

文章旨在研究养老院的轮椅设施使用现状,并提出养老院共享轮椅的方案,鼓励老人们走出房间,与其他老人交流和建立社交关系,提高养老生活质量。运用层次分析法得到具体需求权重,进行养老院共享轮椅设计,通过ANSYS有限元分析验证该轮椅的结构安全性。完成养老院共享轮椅的模型及系统设计。集成AHP层次分析法和ANSYS分析的轮椅创新设计流程,分析求解得到该轮椅主要承重结构可靠,确保老人使用安全,实现养老院内健康安心养老。

考虑碳排放分摊的综合能源服务商交易策略

为寻求在满足用户用能需求的同时降低系统碳排放的有效途径,提出了一种考虑碳排放分摊的多综合能源服务商能源交易策略。基于网络流模型实现碳流追踪并联合Shapley理论建立了综合能源服务商碳排放成本计算模型。应用Nash议价理论构建了多综合能源服务商合作博弈运行模型,将综合能源服务商碳排放成本引入优化目标函数,并利用分布式算法求解最优能源交易量和交易费用。基于由修改的IEEE 39节点电网和12节点气网构成的多综合能源服务商系统进行仿真分析,验证了所提模型和方法的有效性。

父母为子女购房出资纠纷的解决路径探析

针对因父母为子女婚后购房出资作为夫妻共有财产而可能产生的利益失衡问题,司法实务中主要有“出资不明视为借贷”“无赠与双方意思视为确定归一方”以及“出资不明为共有但离婚时酌情考虑出资”等变通解决路径。多种路径可以解决个案利益失衡问题,但也导致了此类纠纷法律定性和法律适用的混乱状态。比较而言,“视为借贷”与出资行为的真实意思不符;“无赠与双方意思视为确定归一方”与立法本意存在偏差。现行法下更为合理的解决路径应是:在遵循“未指明一方即归于共有”规则的前提下,引入“公平分割”理念,在离婚财产分割时考虑财产来源以保护出资方的利益。

通用人工智能提供者内容审查注意义务的证成

通用人工智能可自发或受用户操控被动生成有害信息,它的提供者作为新型的网络内容提供者,负有数字内容“守门人”职责,同时负有网络空间的安全保护义务,应承担内容审查的注意义务,从而预防有害信息的侵权风险。“以数据为中心”的内容生产方式和算法黑箱效应降低了通用人工智能提供者对内容的管控力,导致对生成内容的普遍审查难以被实现。应针对有害信息,结合内容生产场景、提供者风险预见能力差异化构建内容审查的注意义务。该注意义务以技术性审查为标准,提供者采取符合技术特点的内容审查机制,便应当认定履行了相关义务。

全民健身公共服务多元协同供给的演化博弈分析与实施路径研究

落实全民健身公共服务多元协同供给,是“十四五”时期深入实施全民健身国家战略的迫切要求,是全面建设社会主义现代化国家的应然选择。借助公共产品理论、协同学理论和演化博弈理论,构建以政府、市场和社会组织三方为参与主体的全民健身公共服务多元协同供给演化博弈模型,分析三方主体的演化策略选择,并分别就三方主体的初始意愿、激励成本、补贴力度和处罚力度对演化策略的影响程度进行数值仿真。分析认为,通过提高初始意愿,控制激励成本,对市场和社会组织进行适度补贴并合理规制,能够有效实现全民健身公共服务多元协同供给。以供给全过程为逻辑理路,提出重构供给主体的权责关系、丰富供给内容的差序格局、健全供给系统的监督反馈机制等全民健身公共服务多元协同供给实施路径。

照顾者共同决策家庭营养支持对食管癌术后患者营养状况、心理状况及生活质量的影响

目的 研究照顾者共同决策家庭营养支持对食管癌患者手术后生活质量、营养状况以及心理状况的影响。方法 选取2019年7月至2022年9月收治的行食管癌手术治疗患者86例,依据据信封法将患者分为对照组和观察组44例,对照组术后予以常规法治疗,观察组在对照组基础上给予照顾者共同决策家庭营养支持。比较2组术后恢复情况、并发症发生情况及干预前后睡眠情况、营养指标、生活质量、心理情况。结果 2组术后首次肛门排气时间、肠鸣音恢复时间以及首次排便时间比较,差异无统计学意义P>0.05;2组干预前血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数量表(PSQI)评分、焦虑自评量表(SAS)、角色功能、躯体功能、社会功能以及情绪功能评分比较,差异无统计学意义(P>0.05)。观察组首次进食时间短于对照组(P<0.05),干预后2组PA、ALB、Hb、TRF、角色功能、情绪功能、躯体功能以及社会功能评分比术前上升且术后观察组高于对照组(P<0.05),干预后2组SAS、SDS、PSQI评分较干预前下降且观察组降低幅度大于对照组(P<0.05),观察组并发症总发生率低于对照组(P<0.05)。结论 食管癌患者手术后进行照顾者共同决策家庭营养支持,营养状况改善明显,心理状况、生活质量显著提高,值得在临床上推广使用。

考虑碳排放的新能源电网电力交易动态定价方法

随着“双碳”目标的持续推进,传统的电力交易体系面临新的挑战。为促进实现碳交易与电力交易市场的衔接,文章在考虑区域碳排放的基础上提出了一种基于电网需求侧响应的电能定价方法。首先,考虑碳减排激励及可控负荷参与调峰响应的经济补偿,建立考虑碳排放及调峰成本的负荷调动成本模型;然后,基于博弈思想,将需求侧储能装置及可控负荷作为灵活性资源,制定了需求侧参与的电能定价体系,并构建了1-K型Stackelberg主从博弈决策模型;最后,针对定价问题的非线性特点,采用遗传算法的逆向归纳法对模型进行求解,并进行了实例验证。仿真结果表明,文章提出的考虑区域碳排放的新能源电网电能定价方法能够促进电力系统的最优运营,可实现新型配电网效率、效益双提升。

多主体博弈下基于改进灰狼算法的综合能源服务商优化运行策略

为促进新能源消纳和满足不同负荷需求,本文提出了多主体博弈下的综合能源服务商优化运行策略。通过分析不同主体的交互及利益关系,建立综合能源服务商与分布式发电商、负荷用户的主从博弈双层优化模型,上层综合能源服务商通过售能价格激励下层负荷用户调整用能需求,并以高于新能源上网电价的购电价格激励下层分布式发电商进行售电量调整。针对模型的高维、非线性特征,通过引入差分进化和精英保留策略加速灰狼算法的全局搜索能力和收敛性。仿真结果表明所建模型在兼顾不同主体利益的同时,降低了系统的碳排放量,所提优化求解方法快速高效。

面向区域多主体平衡的独立平衡服务商运营双层优化研究

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