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| 7. |
- Rees, CA, et al.
(författare)
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Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries
- 2022
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2–59 months at risk of hospitalised pneumonia-related mortality across various settings.MethodsWe used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool.ResultsA total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84).ConclusionsThe PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality.
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| 10. |
- Hossain, Aniqa T., et al.
(författare)
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Measuring coverage and quality of supportive care for inpatient neonatal infections : EN-BIRTH multi-country validation study
- 2022
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Ingår i: Journal of Global Health. - : International Global Health Society. - 2047-2978 .- 2047-2986. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: An estimated 7 million episodes of severe newborn infections occur annually worldwide, with half a million newborn deaths, most oc-curring in low-and middle-income countries. Whilst injectable antibiotics are necessary to treat the infection, supportive care is also crucial in ending preventable mortality and morbidity. This study uses multi-country data to assess gaps in coverage, quality, and documentation of supportive care, considering implications for measurement.Methods: The EN-BIRTH study was conducted in five hospitals in Bangla-desh, Nepal, and Tanzania (July 2017-July 2018). Newborns with an ad-mission diagnosis of clinically-defined infection (sepsis, meningitis, and/or pneumonia) were included. Researchers extracted data from inpatient case notes and interviews with women (usually the mothers) as the primary fam-ily caretakers after discharge. The interviews were conducted using a struc-tured survey questionnaire. We used descriptive statistics to report coverage of newborn supportive care components such as oxygen use, photothera-py, and appropriate feeding, and we assessed the validity of measurement through survey-reports using a random-effects model to generate pooled estimates. In this study, key supportive care components were assessment and correction of hypoxaemia, hyperbilirubinemia, and hypoglycaemia.Results: Among 1015 neonates who met the inclusion criteria, 89% had an admission clinical diagnosis of sepsis. Major gaps in documentation and care practices related to supportive care varied substantially across the par-ticipating hospitals. The pooled sensitivity was low for the survey-reported oxygen use (47%; 95% confidence interval (CI) = 30%-64%) and moderate for phototherapy (60%; 95% CI = 44%-75%). The pooled specificity was high for both the survey-reported oxygen use (85%; 95% CI = 80%-89%) and phototherapy (91%; 95% CI = 82%-97%).Conclusions: The women's reports during the exit survey consistently un-derestimated the coverage of supportive care components for managing infection. We have observed high variability in the inpatient documents across facilities. A standardised ward register for inpatient small and sick newborn care may capture selected supportive care data. However, tracking the detailed care will require standardised individual-level data sets linked to newborn case notes. We recommend investments in assessing the im-plementation aspects of a standardised inpatient register in resource-poor settings.
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| 11. |
- Hossain, Aniqa T, et al.
(författare)
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Measuring coverage and quality of supportive care for inpatient neonatal infections: EN-BIRTH multi-country validation study.
- 2022
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Ingår i: Journal of global health. - : International Global Health Society. - 2047-2986 .- 2047-2978. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- An estimated 7 million episodes of severe newborn infections occur annually worldwide, with half a million newborn deaths, most occurring in low- and middle-income countries. Whilst injectable antibiotics are necessary to treat the infection, supportive care is also crucial in ending preventable mortality and morbidity. This study uses multi-country data to assess gaps in coverage, quality, and documentation of supportive care, considering implications for measurement.The EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Newborns with an admission diagnosis of clinically-defined infection (sepsis, meningitis, and/or pneumonia) were included. Researchers extracted data from inpatient case notes and interviews with women (usually the mothers) as the primary family caretakers after discharge. The interviews were conducted using a structured survey questionnaire. We used descriptive statistics to report coverage of newborn supportive care components such as oxygen use, phototherapy, and appropriate feeding, and we assessed the validity of measurement through survey-reports using a random-effects model to generate pooled estimates. In this study, key supportive care components were assessment and correction of hypoxaemia, hyperbilirubinemia, and hypoglycaemia.Among 1015 neonates who met the inclusion criteria, 89% had an admission clinical diagnosis of sepsis. Major gaps in documentation and care practices related to supportive care varied substantially across the participating hospitals. The pooled sensitivity was low for the survey-reported oxygen use (47%; 95% confidence interval (CI) = 30%-64%) and moderate for phototherapy (60%; 95% CI = 44%-75%). The pooled specificity was high for both the survey-reported oxygen use (85%; 95% CI = 80%-89%) and phototherapy (91%; 95% CI = 82%-97%).The women's reports during the exit survey consistently underestimated the coverage of supportive care components for managing infection. We have observed high variability in the inpatient documents across facilities. A standardised ward register for inpatient small and sick newborn care may capture selected supportive care data. However, tracking the detailed care will require standardised individual-level data sets linked to newborn case notes. We recommend investments in assessing the implementation aspects of a standardised inpatient register in resource-poor settings.
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| 12. |
- Khan, A., et al.
(författare)
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A comprehensive review of the methane decomposition using a gliding arc discharge reactor for hydrogen generation
- 2023
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Ingår i: Journal of the Energy Institute. - : Elsevier. - 1743-9671 .- 1746-0220. ; 109
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Tidskriftsartikel (refereegranskat)abstract
- The use of fossil fuels has caused an ongoing increase in greenhouse gases (GHGs), which have a negative impact on both the environment and human health. The world requires an alternative green sustainable fuel that can solve these problems. Hydrogen (H2) can be considered as an alternative green energy source as it has zero carbon emissions. Methane (CH4) decomposition is a potential technique to produce H2 fuel. Gliding arc discharge (GAD) reactors have gained significant attention to produce H2 from the decomposition of CH4. This review focuses on the application of GAD reactors for CH4 conversion. The effects of different parameters, such as operation conditions, additives, geometric configuration, and catalysts, on the performance of the GAD reactor, are discussed in this review. © 2023 Energy Institute
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| 17. |
- Qazi, S. Junaid S., et al.
(författare)
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Alignment of Dispersions of Plate-Like Colloidal Particles of Ni(OH)(2) Induced by Elongational Flow
- 2011
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Ingår i: Journal of Physical Chemistry B. - : American Chemical Society (ACS). - 1520-6106 .- 1520-5207. ; 115:13, s. 3271-3280
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Tidskriftsartikel (refereegranskat)abstract
- Small-angle neutron scattering, SANS, has been used to study the alignment of a sterically stabilized colloidal dispersion of nickel hydroxide induced by elongational flow. Two different concentrations, 20 and 23 wt %, of well-defined hexagonal platelets have been studied. Significant anisotropy in the scattering patterns has been observed for the higher concentration dispersion that increases with increasing elongational strain rate. The effect of pipe flow (shear flow) on the orientational ordering at the inlets is also described. Near the outlets there is also a shear stress and this tends to increase the alignment. The orientational distribution of the particles under flow is described in terms of an order parameter calculated with respect to an individual director for each scattering pattern. The experimental measurements are supported by comparison with computer simulations which help to explain the effects of local velocity on the alignment induced by elongational flow. A slight decrease in the observed alignment was found after continuous flow for approximately 30 min and possible reasons are discussed.
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| 18. |
- Qazi, S. Junaid S., et al.
(författare)
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Alignment of Plate-Like Particles in a Colloidal Dispersion under Flow in a Uniform Pipe Studied by High-Energy X-ray Diffraction
- 2010
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Ingår i: Langmuir. - : American Chemical Society (ACS). - 0743-7463 .- 1520-5827. ; 26:24, s. 18701-18709
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Tidskriftsartikel (refereegranskat)abstract
- High-energy angle-dispersive X-ray diffraction has been used to study the alignment of colloidal suspension of kaolinite particles in water as they flow along a pipe. X-rays with energies above 25 keV have a major advantage, as they can penetrate through thick samples and walls of containers and permit investigation of samples under realistic flow conditions. As an example of the method, flow through a circular cross-section pipe with an internal diameter of 5 mm has been studied: this is typical of industrial applications. The angular distribution of intensities of peaks in the diffraction pattern as a function of the location of the pipe in the X-ray beam provides information about the alignment of particles under flow. Order parameters have been calculated to describe the alignment and direction of orientation. It is observed that the particles align in the direction of flow with their flat faces parallel to the flow. The experimental results are compared with the calculations of the local strain rate that help to explain the onset of alignment of the particles.
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| 19. |
- Qazi, S. Junaid S., et al.
(författare)
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Dispersions of plate-like colloidal particles : Cubatic order?
- 2010
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Ingår i: Journal of Colloid and Interface Science. - : Elsevier BV. - 0021-9797 .- 1095-7103. ; 348:1, s. 80-84
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Tidskriftsartikel (refereegranskat)abstract
- Experimental evidence for the existence of 'cubatic' order in a colloidal dispersion of plate-like particles is presented. In a 'cubatic' phase, disk-like particles self-assemble with domains of a few parallel plates and the director tends to be orthogonal in adjacent domains. This phase has been predicted previously by computer simulation. The domains are approximately equiaxial and are predicted to exist only within a limited range of aspect ratios and volume fractions. This locally ordered structure cannot be identified readily using scattering techniques, since the patterns are expected to be similar to those of isotropic liquid phases. For this reason, we have used a real-space technique of cryo-transmission electron microscopy that directly probes such locally ordered structures to study dispersions of nickel hydroxide particles. Polydispersity of particle size is expected to require some local tilting in order to include larger particles in a dense structure and this is discussed with respect to the concentration range for which cubatic order is observed. This new structure offers the possibility of novel materials that could be prepared by self-assembly and have applications in a wide range of fields.
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| 20. |
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| 21. |
- Qazi, S. Junaid S.
(författare)
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Flow of Colloidal Mesophases
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation presents new work and results in the flow of complex fluids and experimental methodologies for their investigation. Plate-like colloidal particles of kaolinite and nickel hydroxide are studied. A study of lamellar fragments and their mixture with the nickel hydroxide particles is also presented. The lamellar fragments are self-assembled structures of surfactant molecules that approximate disks. Particles are seen to align with their large faces parallel to the flow direction under shear and elongational strains. Order parameters have been calculated to quantify the extent of preferential alignment and direction of orientation. The experimental data are supported by comparisons with finite-element fluid mechanics calculations that provide estimates of the flow patterns and the strain rates. Elongational strain rates in the range of 5 − 20 s−1 are required to induce a high degree of alignment with the various sizes of the particles whereas about two to three order of magnitude higher shear strain rates are required. The combination of both elongational and shear strain is an effective means to provide a uniform alignment. Comparison of the Peclet numbers calculated for both the shear and elongational flow are presented and this explains that alignment occurs when the energy per particle of the strain is larger than the thermal energy. Mixtures have shown complex behavior: significant changes in the structure are observed that are not seen to the same extent in samples at rest. X-ray diffraction and small-angle neutron scattering techniques are used to characterize the samples and determine the structure in flowing systems. Laboratory X-ray diffraction can be used to characterize dispersed samples. The combination of dynamic light scattering and X-ray diffraction was used to estimate the thickness of the stabilizing layers of the polymer on the colloidal particles. Scattering of synchrotron radiation and neutrons are powerful complementary techniques to provide information about flow and the potential to apply them to systems that are beyond the scope of simple simulations has been demonstrated.
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| 23. |
- Qazi, S. Junaid S., et al.
(författare)
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Impact of Ni(OH)(2) Platelike Particles on Lamellar Surfactant Mesophases and the Orientation of Their Mixtures under Elongational Flow
- 2011
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Ingår i: Journal of Physical Chemistry B. - : American Chemical Society (ACS). - 1520-6106 .- 1520-5207. ; 115:35, s. 10413-10424
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Tidskriftsartikel (refereegranskat)abstract
- This article describes the behavior under elongational flow of mixtures of lamellar fragments and platelike colloidal particles. Mixtures of a dialkyl chain cationic surfactant, DHTAC (15 wt %), and the nonionic surfactant Brij 97 (0.5 wt %) form dispersions of lamellar phase fragments, and these were studied in the presence of smaller platelike colloidal particles of Ni(OH)(2) stabilized with sodium polyacrylate. Small-angle neutron scattering was used to follow the changes in the lamellar phase fragments in the mixture under elongational flow. The addition of a small fraction of the Ni(OH)(2) dispersion resulted in significantly increased viscosity and reduced the structure and size of the lamellar fragments, and this effect was further enhanced because of the flow induced alignment. The behavior of the mixture under elongational flow is described, and the induced orientation is discussed in terms of order parameters at the different positions using spatially resolved small-angle scattering. The effect of flow rate on the orientational alignment in the mixture is also described.
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| 24. |
- Qazi, S. Junaid S., et al.
(författare)
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Orientation of a Dispersion of Kaolinite Flowing in a Jet
- 2012
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Ingår i: Langmuir. - : American Chemical Society (ACS). - 0743-7463 .- 1520-5827. ; 28:8, s. 3704-3713
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Tidskriftsartikel (refereegranskat)abstract
- Orientational alignment in a dilute dispersion of kaolinite particles has been investigated in a flow pattern that combines both shear and elongational stress, namely flow at a jet created by a 2 mm diameter nozzle inserted in a 6 mm diameter pipe. Spatially-resolved X-ray diffraction with synchrotron radiation permits detailed maps of the alignment to be deduced and compared with fluid mechanics calculations of the flow. The angular distribution of diffracted intensity from a given position in the pipe provides information about the orientation distribution of the particles. This is quantified and presented in terms of order parameters. The cone-shaped nozzle provides a jet of liquid giving a high degree of alignment of the particles that is uniform along lines across the conical section and constant in the small straight-sided region at the exit of the nozzle. The vortex motion that arises from the flow with a modest Reynolds number could be determined as well as the tendency for some particles to align with their large faces perpendicular to the overall flow direction at the flat surface of the nozzle outlet.
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| 25. |
- Qazi, S. Junaid S., et al.
(författare)
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Self-Assembled Structures of Disc-Like Colloidal Particles
- 2011
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Ingår i: Trends in colloid andinterface science XXIV. - Berlin, Heidelberg : Springer. - 9783642190377 ; , s. 61-65
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Konferensbidrag (refereegranskat)abstract
- Self-assembly is an important phenomenon that leads to formation of interesting and novel structures in colloidal dispersions. We present experimental evidence for the existence of a ‘cubatic’ phase in a colloidal dispersion of disc-like particles of nickel hydroxide colloidal dispersions. In this structure, disc-like particles self-assemble as domains of a few parallel discs and the orientation tends to be orthogonal in adjacent domains. This phase has been predicted previously by computer simulations. The domains are approximately equiaxial and are predicted to exist only within a limited range of aspect ratios and volume fractions. We have used the real space technique of cryo-transmission electron microscopy in our studies as this locally ordered structure could not be identified readily using scattering techniques, since the patterns are expected to be similar to those of isotropic liquid phases.
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| 26. |
- Qazi, S. Junaid S., et al.
(författare)
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Use of wide-angle X-ray diffraction to measure shape and size of dispersed colloidal particles
- 2009
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Ingår i: Journal of Colloid and Interface Science. - : Elsevier BV. - 0021-9797 .- 1095-7103. ; 338:1, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- Laboratory X-ray diffraction is used to investigate the size and shape of dispersed plate-like and spherical colloidal particles. Analysis of the wide-angle diffraction data provides information about the size and shape of crystals from the width of the Bragg peaks according to the Debye-Scherrer formula. The measurements, data analysis, and evaluation are discussed. It is shown that X-ray diffraction with conventional laboratory equipment on dispersed particles is feasible as a tool to determine both particle size and shape. Data for two samples - gold colloids and nickel (II) hydroxide particles are presented. The advantages and limitations of the method are discussed. X-ray diffraction measurements that are made in combination with dynamic light scattering can be used to estimate the thickness of stabilizing layers of polymers. (C) 2009 Elsevier Inc. All rights reserved.
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| 27. |
- Ratajczak-Tretel, B., et al.
(författare)
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Atrial fibrillation in cryptogenic stroke and TIA patients in the nordic atrial fibrillation and stroke The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study : Main results
- 2023
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Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 8:1, s. 148-156
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension (p = 0.045) and dyslipidaemia (p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%. Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.
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| 28. |
- Ratajczak-Tretel, B, et al.
(författare)
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Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke : results from the NOR-FIB Study
- 2023
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Ingår i: Journal of Neurology. - 1432-1459. ; 270:8, s. 4049-4059
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study.METHOD: The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA 2DS 2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. RESULTS: In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7.CONCLUSION: Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.
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| 29. |
- Ratajczak-Tretel, B, et al.
(författare)
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Underlying causes of cryptogenic stroke and TIA in the nordic atrial fibrillation and stroke (NOR-FIB) study : the importance of comprehensive clinical evaluation
- 2023
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management.METHODS: Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis.RESULTS: After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger (p < 0.001), had lower CHA 2DS 2-VASc score (p < 0.001) on admission, and lower NIHSS score (p = 0.031) and mRS (p = 0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic (p = 0.014), while dyslipidaemia was less prevalent (p = 0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, (p = 0.091). CONCLUSION: Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal.TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23.
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| 31. |
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| 32. |
- Day, Louise T., et al.
(författare)
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"Every Newborn-BIRTH" protocol : observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania
- 2019
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Ingår i: Journal of Global Health. - : International Global Health Society. - 2047-2978 .- 2047-2986. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels.Methods: EN-BIRTH is an observational study including >20000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses.Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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| 33. |
- Day, Louise T, et al.
(författare)
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"Every Newborn-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania.
- 2019
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Ingår i: Journal of global health. - : International Global Health Society. - 2047-2986 .- 2047-2978. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels.EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses.To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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| 34. |
- Day, Louise Tina, et al.
(författare)
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Labour and delivery ward register data availability, quality, and utility - Every Newborn - birth indicators research tracking in hospitals (EN-BIRTH) study baseline analysis in three countries.
- 2020
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study.We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data.Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates.Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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- Graham, HR, et al.
(författare)
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Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria
- 2022
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 7:8
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Tidskriftsartikel (refereegranskat)abstract
- Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme.MethodsProspective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January–March 2021), summary admission data (January 2018–December 2020), programme cost data. Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support. Primary outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO2 <90%) children who received oxygen. Comparison across three time periods: preintervention (2014–2015), intervention (2016–2017) and follow-up (2018–2020) using mixed-effects logistic regression. Calculated cost-effectiveness of the intervention on child pneumonia mortality using programme costs, recorded deaths and estimated counterfactual deaths using effectiveness estimates from our effectiveness study. Reported cost-effectiveness over the original 2-year intervention period (2016–2017) and extrapolated over 5 years (2016–2020).ResultsPulse oximetry coverage for neonates and children remained high during follow-up (83% and 81%) compared with full oxygen system period (94% and 92%) and preintervention (3.9% and 2.9%). Oxygen coverage for hypoxaemic neonates/children was similarly high (94%/88%) compared with full oxygen system period (90%/82%). Functional oxygen sources were present in 11/12 (92%) paediatric areas and all (8/8) neonatal areas; three-quarters (15/20) of wards had a functional oximeter. Of 32 concentrators deployed, 23/32 (72%) passed technical testing and usage was high (median 10 797 hours). Estimated 5-year cost-effectiveness US$86 per patient treated, $2694–4382 per life saved and $82–125 per disability-adjusted life year-averted. We identified practical issues for hospitals and Ministries of Health wishing to adapt and scale up pulse oximetry and oxygen.ConclusionHospital-level improvements to oxygen and pulse oximetry systems in Nigerian hospitals have been sustained over the medium-term and are a highly cost-effective child pneumonia intervention.
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- King, C, et al.
(författare)
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Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi
- 2020
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Ingår i: Gates open research. - : F1000 Research Ltd. - 2572-4754. ; 4, s. 178-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as ‘acute respiratory infection’ using InterVA-4. Data were extracted from free-text narratives based on domains in the ‘Pathways to Survival’ framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.
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- Scherfer, Christoph, et al.
(författare)
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The Toll immune-regulated Drosophila protein Fondue is involved in hemolymph clotting and puparium formation
- 2006
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Ingår i: Developmental Biology. - : Elsevier BV. - 0012-1606 .- 1095-564X. ; 295, s. 156-163
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Tidskriftsartikel (refereegranskat)abstract
- Clotting is critical in limiting hemolymph loss and initiating wound healing in insects as in vertebrates. It is also an important immune defense, quickly forming a secondary barrier to infection, immobilizing bacteria and thereby promoting their killing. However, hemolymph clotting is one of the least understood immune responses in insects. Here, we characterize fondue (fon; CG15825), an immune-responsive gene of Drosophila melanogaster that encodes an abundant hemolymph protein containing multiple repeat blocks. After knockdown of fon by RNAi, bead aggregation activity of larval hemolymph is strongly reduced, and wound closure is affected. Jon is thus the second Drosophila gene after hemolectin (hml), for which a knockdown causes a clotting phenotype. In contrast to hml-RNAi larvae, clot fibers are still observed in samples from fon-RNAi larvae. However, clot fibers from fon-RNAi larvae are more ductile and longer than in wt hemolymph samples, indicating that Fondue might be involved in cross-linking of fiber proteins. In addition, fon-RNAi larvae exhibit melanotic tumors and constitutive expression of the antifungal peptide gene Drosomycin (Drs), while fon-RNAi pupae display an aberrant pupal phenotype. Altogether, our studies indicate that Fondue is a major hemolymph protein required for efficient clotting in Drosophila.
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