Impact of the WHO Safe Childbirth Checklist on safety culture among health workers: A randomized controlled trial in Aceh, Indonesia

The World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control facilities). We introduced the SCC in combination with a medium intensity coaching in health facilities which already offered at minimum basic emergency obstetric and newborn care (BEMonC). We assess the effects of using the SCC on 14 outcome variables measuring self-perceived information access, information transmission, frequency of errors, workload and access to resources at the facility level. We apply Ordinary Least Square regressions to identify an Intention to Treat Effect (ITT) and Instrumental Variable regressions to determine a Complier Average Causal Effect (CACE). The results suggest that the treatment significantly improved self-assessed attitudes regarding the probability of calling attention to problems with patient care (ITT 0.6945 standard deviations) and the frequency of errors in times of excessive workload (ITT -0.6318 standard deviations). Moreover, self-assessed resource access increased (ITT 0.6150 standard deviations). The other eleven outcomes were unaffected. The findings suggest that checklists can contribute to an improvement in some dimensions of safety culture among health workers. However, the complier analysis also highlights that achieving adherence remains a key challenge to make checklists effective.

Inertial active ratchet: Simulation versus theory

We present the inertial active dynamics of an Ornstein-Uhlenbeck particle in a piecewise sawtooth ratchet potential. Using the Langevin simulation and matrix continued fraction method (MCFM), the particle transport, steady-state diffusion, and coherence in transport are investigated in different parameter regimes of the model. Spatial asymmetry is found to be a key criterion for the possibility of directed transport in the ratchet. The MCFM results for net particle current of overdamped dynamics of the particle agree well with the simulation results. The simulated particle trajectories for the inertial dynamics and the corresponding position and velocity distribution functions reveal that the system passes through an activity-induced transition in the transport from the running phase to the locked phase of the dynamics. This is further corroborated by the mean square displacement (MSD) calculations, where the MSD gets suppressed with increase in the persistent duration of activity or self-propulsion in the medium and finally approaches zero for a very large value of self propulsion time. The nonmonotonic behavior of the particle current and Péclet number with self-propulsion time confirms that the particle transport and its coherence can be enhanced or reduced by fine tuning the persistent duration of activity. Moreover, for intermediate ranges of self-propulsion time as well as mass of the particle, even though the particle current shows a pronounced unusual maximum with mass, there is no enhancement in the Péclet number, instead the Péclet number decreases with mass, confirming the degradation of coherence in transport.

Inertial active Ornstein-Uhlenbeck particle in the presence of a magnetic field

We consider an inertial active Ornstein-Uhlenbeck particle in an athermal bath. The particle is charged, constrained to move in a two-dimensional harmonic trap, and a magnetic field is applied perpendicular to the plane of motion. The steady-state correlations and the mean-square displacement are studied when the particle is confined as well as when it is set free from the trap. With the help of both numerical simulation and analytical calculations, we observe that inertia plays a crucial role in the dynamics in the presence of a magnetic field. In a highly viscous medium where the inertial effects are negligible, the magnetic field has no influence on the correlated behavior of position as well as velocity. In the time asymptotic limit, the overall displacement of the confined harmonic particle gets enhanced by the presence of a magnetic field and saturates for a stronger magnetic field. On the other hand, when the particle is set free, the overall displacement gets suppressed and approaches zero when the strength of the field is very high. Interestingly, it is seen that in the time asymptotic limit, the confined harmonic particle behaves like a passive particle and becomes independent of the activity, especially in the presence of a very strong magnetic field. Similarly, for a free particle the mean-square displacement in the long time limit becomes independent of activity even for a longer persistence of noise cor- relation in the dynamics.

Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia: A Cluster-Randomized Clinical Trial

Importance

To address major causes of perinatal and maternal mortality, the World Health Organization developed the Safe Childbirth Checklist (SCC), which to our knowledge has been rigorously evaluated only in combination with high-intensity coaching.

Objective

To evaluate the effect of the SCC with medium-intensity coaching on health care workers' performance of essential birth practices.

Design, Setting, and Participants

This cluster randomized clinical trial without blinding included 32 hospitals and community health centers in the province of Aceh, Indonesia (a medium-resource setting) that met the criterion of providing at least basic emergency obstetric and newborn care. Baseline data were collected from August to October 2016, and outcomes were measured from March to April 2017. Data were analyzed from January 2020 to October 2021.

Interventions

After applying an optimization method, facilities were randomly assigned to the treatment or control group (16 facilities each). The SCC with 11 coaching visits was implemented during a 6-month period.

Main Outcomes and Measures

For the primary outcome, clinical observers documented whether 36 essential birth practices were applied at treatment and control facilities at 1 or more of 4 pause points during the birthing process (admission to the hospital, just before pushing or cesarean delivery, soon after birth, and before hospital discharge). Probability models for binary outcome measures were estimated using ordinary least-squares regressions, complemented by Firth logit and complier average causal effect estimations.

Results

Among the 32 facilities that participated in the trial, a significant increase of up to 41 percentage points was observed in the application of 5 of 36 essential birth practices in the 16 treatment facilities compared with the 16 control facilities, including communication of danger signs at admission (treatment: 136 of 155 births [88%]; control: 79 of 107 births [74%]), measurement of neonatal temperature (treatment: 9 of 31 births [29%]; control: 1 of 20 births [5%]), newborn feeding checks (treatment: 22 of 34 births [65%]; control: 5 of 21 births [24%]), and the rate of communication of danger signs to mothers and birth companions verbally (treatment: 30 of 36 births [83%]; control: 14 of 22 births [64%]) and in a written format (treatment: 3 of 24 births [13%]; control: 0 of 16 births [0%]).

Conclusions and Relevance

In this cluster randomized clinical trial, health facilities that implemented the SCC with medium-intensity coaching had an increased rate of application for 5 of 36 essential birth practices compared with the control facilities. Medium-intensity coaching may not be sufficient to increase uptake of the SCC to a satisfying extent, but it may be worthwhile to assess a redesigned coaching approach prompting long-term behavioral change and, therefore, effectiveness.

Trial Registration

isrctn.org Identifier: ISRCTN11041580.

Orbital magnetism of an active particle in viscoelastic suspension

We consider an active (self-propelling) particle in a viscoelastic fluid. The particle is charged and constrained to move in a two-dimensional harmonic trap. Its dynamics is coupled to a constant magnetic field applied perpendicular to its plane of motion via Lorentz force. Due to the finite activity, the generalized fluctuation-dissipation relation (GFDR) breaks down, driving the system away from equilibrium. While breaking GFDR, we have shown that the system can have finite classical orbital magnetism only when the dynamics of the system contains finite inertia. The orbital magnetic moment has been calculated exactly. Remarkably, we find that when the elastic dissipation timescale of the medium is larger (smaller) than the persistence timescale of the self-propelling particle, it is diamagnetic (paramagnetic). Therefore, for a given strength of the magnetic field, the system undergoes a transition from diamagnetic to paramagnetic state (and vice versa) simply by tuning the timescales of underlying physical processes, such as active fluctuations and viscoelastic dissipation. Interestingly, we also find that the magnetic moment, which vanishes at equilibrium, behaves nonmonotonically with respect to increasing persistence of self-propulsion, which drives the system out of equilibrium.

COVID-19 lockdown: Effects on selected volatile organic compound (VOC) emissions over the major Indian metro cities

Due to the COVID-19 pandemic, many countries across the world, including India, have imposed nationwide lockdowns to contain the spread of the virus. Many studies reported that the air quality had improved much due to the lockdown. This study examines the variation of Volatile Organic Compounds (VOCs) over the Indian metropolitan cities during the lockdown period by using ground-based and satellite observations. Ground-based BTEX (Benzene, Toluene, Ethylbenzene, and Xylenes) measurements from various metropolitan cities have shown a drastic drop of about 82% in the first phase of lockdown when compared with the pre-lockdown period. Whereas the spatial distribution of formaldehyde (HCHO), obtained from the TROPOspheric Monitoring Instrument (TROPOMI) onboard Sentinal-5P satellite, did not show any significant variation due to COVID-19 lockdown, indicating the major source of HCHO is biogenic or pyrogenic. The BTEX ratios were evaluated for a better understanding of the source and photochemical age of the air samples. The ozone forming potential of BTEX in all locations was found reduced; however, the corresponding decrease in ozone concentrations was not observed. The increase in ozone concentrations during the same period indicates alternative sources contributing to ozone formation.

Ulcerative Colitis in Hemophilia A Patient: Case Report

Introduction:

Ulcerative colitis (UC) is a chronic inflammatory disease that affects colon while the incidence is increasing worldwide. The pathogenesis of the disease is complex and involves multi factors such genetic predisposition, defects in epithelial barrier and immune response as well as environmental factors. Combination UC with Hemophilia A, a hereditary hemorrhagic disorder, is very rare but can lead massive rectal bleeding that will be fatal for the patients.

Aim:

The case report present a case of a man with hemophilia A with rectal bleeding and recently diagnosed with ulcerative colitis.

Case Report:

A 52 years old man presented with massive rectal bleeding since 3 days before admitted to hospital. The patient reported recurrent rectal bleeding for years but never continue for more than a week. He was previously diagnosed with hemophilia A since 34 years ago with factor VIII between 5 to 8 percent and receive recombinant human factor VIII routinely. Colonoscopy examination showed redness and ulcer along colon descendent and was confirmed for ulcerative colitis with histopathology analysis. The patient showed clinical improvement after administered with sulfasalazine and tranexamide acid.

Conclusion:

UC can cause fatal bleeding in patient with hemophilia A therefore early diagnosis of UC altogether with UC flare prevention, continuing FVII infusion and anti-hemorrhagic administration are the most important strategy in management UC in hemophilia A patient.

Healthcare providers' perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study

OBJECTIVES

Our study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia.

DESIGN

With a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility.

SETTING

In three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered.

PARTICIPANTS

Across the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys.

PRIMARY AND SECONDARY OUTCOME MEASURES

The first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district.

RESULTS

Overall, mothers'/families' consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities.

CONCLUSIONS

The largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.

IL-6 is required for protective immune responses against early filarial infection

IL-6 has a wide range of biological activities that includes anti- and pro-inflammatory aspects. In this study, we investigated the role of IL-6 in immune responses to the rodent filarial nematode Litomosoides sigmodontis, a model for human filarial infections. IL-6^-/- mice had a significantly increased worm burden after natural infection compared with wild type controls at early time points p.i. Given that the worm burden in IL-6^-/- mice was already increased at the time point the infective larvae reached the pleural cavity, immune responses that may facilitate the migration from the site of infection (skin) via the lymphatics to the pleural cavity were analysed. Increased vascular permeability may facilitate larval migration, but blocking of histamine receptors had no effect on worm burden and vascular permeability was similar between IL-6^-/- mice and wild type controls. In contrast, blocking mast cell degranulation reduced the worm burden in IL-6^-/- mice partially, suggesting that release of mast cell-derived mediators improves larval migration to some degree. Protective immune responses within the skin were involved, as bypassing the skin barrier by inoculating infective L3s subcutaneously resulted in a comparable worm recovery in both mouse strains. Analysis of the cellular composition by flow cytometry and PCR array in the skin after exposure to filarial extract or L3s, respectively, indicate that the absence of IL-6 results in a delayed recruitment of neutrophils and macrophages to the site of initial infection. These results demonstrate that IL-6 is essentially involved in protective immune responses within the skin that impair migration of infective L3s.

Eotaxin-1 is involved in parasite clearance during chronic filarial infection

Eosinophil migration as key feature of helminth infection is increased during infection with filarial nematodes. In a mouse model of filariasis, we investigated the role of the eosinophil-attracting chemokine Eotaxin-1 on disease outcome. BALB/c and Eotaxin-1(-/-) mice were infected with the rodent filaria Litomosoides sigmodontis, and parasitic parameters, cellular migration to the site of infection, and cellular responsiveness were investigated. We found increased parasite survival but unaffected eosinophil migration to the site of infection in Eotaxin-1(-/-) mice. Expression of CD80 and CD86 was reduced on eosinophils from Eotaxin-1(-/-) mice after in vitro TLR2 stimulation and exposure to filarial antigen, respectively, suggesting a potential reduced activation state of eosinophils in Eotaxin-1 deficient mice. We further demonstrated that macrophages from Eotaxin-1(-/-) mice produce decreased amounts of IL-6 in vitro, a cytokine found to be associated with parasite containment, suggesting possible mechanisms by which Eotaxin-1 regulates activation of inflammatory cells and thus parasite survival.

Genetic diversity of rice tungro spherical virus in tungro-endemic provinces of the Philippines and Indonesia

The two adjacent genes of coat protein 1 and 2 of rice tungro spherical virus (RTSV) were amplified from total RNA extracts of serologically indistinguishable field isolates from the Philippines and Indonesia, using reverse transcriptase polymerase chain reaction (RT-PCR). Digestion with HindIII and BstYI restriction endonucleases differentiated the amplified DNA products into eight distinct coat protein genotypes. These genotypes were then used as indicators of virus diversity in the field. Inter- and intra-site diversities were determined over three cropping seasons. At each of the sites surveyed, one or two main genotypes prevailed together with other related minor or mixed genotypes that did not replace the main genotype over the sampling time. The cluster of genotypes found at the Philippines sites was significantly different from the one at the Indonesia sites, suggesting geographic isolation for virus populations. Phylogenetic studies based on the nucleotide sequences of 38 selected isolates confirm the spatial distribution of RTSV virus populations but show that gene flow may occur between populations. Under the present conditions, rice varieties do not seem to exert selective pressure on the virus populations. Based on the selective constraints in the coat protein amino acid sequences and the virus genetic composition per site, a negative selection model followed by random-sampling events due to vector transmissions is proposed to explain the inter-site diversity observed.

International Congress of Chemotherapy--21st meeting. 4-7 July 1999, Birmingham, UK

Held every two years, the International Congress of Chemotherapy (ICC) represents one of the most important scientific meetings focusing on antimicrobial and anticancer research as well as therapeutics. The chairman of the scientific committee of the congress, Richard Wise (Professor in Clinical Microbiology, Birmingham University, UK) described the meeting as a timely opportunity to review and discuss the challenges and advances in the diagnosis, treatment and prevention of infection. 3300 Delegates from 78 countries were in attendance.

World pharmaceuticals--Financial Times tenth annual conference. 22-23 April 1999, London, UK

This two-day conference was organized by The Financial Times, in association with PriceWaterhouseCoopers LLP. The general theme of the event was the state of the healthcare industry, past, present and future. The main areas covered included addressing the challenges of the 1990s, anticipating the challenges of the next decade, the changing shape of global marketing, IT in healthcare, consolidation challenges, shareholder expectations, and new strategies and technologies for growth sustenance within the industry. Key speakers within the industry addressed these issues to an audience of approximately 200 healthcare business executives. The first day was chaired by Mr Robert Cawthorn (Chairman Emeritus, Rhone-Poulenc Rorer Inc) and the second by Professor Trevor Jones (Director General, Association of the British Pharmaceutical Industry).

INFOTECHpharma '99--the information revolution in the pharmaceutical industry. 28-29 January 1999, London, UK

This meeting bought together 180 directors and heads of research spanning all disciplines of the pharmaceutical industry. With the backdrop of increasing globalization, the major theme of the conference was concerned with the necessary improvement of pharmaceutical development processes. The role of new and emerging technologies in the increasing number of new leads generated, and the necessary information and knowledge management that this entails was examined from the perspective of R and D process improvement. Identifying superior clinical candidates using predictive ADME parameters, thereby avoiding costly screening processes, was addressed, while at the post-launch stage of the process the use of IT and www technology and how these can be effectively integrated into the business process to enhance productivity was reviewed.

Sustaining growth and profitability--The Economist fifth annual pharmaceuticals conference. 12-13 November 1998, London, UK

This two-day conference, organized by The Economist, focused on R and D productivity, strategic and innovative methodologies, M and A activities and knowledge management within the pharmaceutical industry. Key speakers within the industry addressed these issues to an audience of approximately 100 healthcare business executives. The first day was chaired by Barrie Haigh (Quintiles Translational Corp) and the second day by Tobias Rooney (Gemini Consulting).