bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple sclerosis in New Zealand Māori
Authors: Pearson John F , Alla Sridhar , Clarke Glynnis , Taylor Bruce V , Miller David H , Richardson Ann , Mason Deborah F
Published: May 2014

The prevalence of MS in New Zealand in 2006 was 73.2 (age standardized per 100,000) while for those with indigenous Māori ancestry it was 3.6 times lower at 20.6. Earlier regional surveys (1968–2001) all reported much lower, or zero, prevalence for Māori than European. There was no evidence for differences in MS between those with and without Māori ancestry in either clinical features or latitude, confirming that Māori ancestry does not produce the reported increase in prevalence with latitude. It is likely that prevalence is increasing in low risk Māori; however, MS prognosis is independent of Māori ancestry.
Imagining new dialogues about human rights: The implications of Charles Taylor’s theory of recognition for global feminism
Authors: Mookherjee Monica
Published: May 2014

This article explores the implications of Charles Taylor’s politics of recognition for a global feminist theory. The main contention is that Taylor’s thought implies an innovative dialogue about human rights that assists a flexible understanding of diverse women’s needs. This central claim is developed, however unexpectedly, by focusing on the controversial practice of footbinding. Prevalent in imperial China, this debilitating convention was supported by values that contrast markedly with those of the modern West. The case thus confronts global feminists with the serious issue of comprehending sympathetically the lived concerns of diverse human beings, while reacting critically to the oppression that they may experience. A creative reading of Taylor’s theory here yields, I argue, commitments to two normative claims that I call ‘narrativity’ and ‘instability’. Together, these claims promise not a static form of recognition based on uncontroversial rights to autonomy or bodily integrity but an imaginative dialogue which is sensitive to cultural differences in the interpretation of human needs and critical of culturally diverse forms of oppression. The critique of footbinding implied by Taylor’s thought is finally developed through comparison with contemporary cosmetic surgeries in the West. The study reveals a feminist politics of recognition attuned to subaltern struggles over the meaning of human rights and of women as active participants in this vital, ongoing work.
Patterns of Employee Relations Governance in a Large British Multinational Food Retailer: An Unusual Case of a Longstanding Partnership?
Authors: Geppert Mike , Williams Karen , Wortmann Michael
Published: May 2014

This article investigates an example of variance from the Varieties of Capitalism literature in the case of a longstanding partnership between a major British food retail multinational company and the Union of Shop, Distributive and Allied Workers (USDAW). We argue that it can be seen as a corporate attempt to institutionalize conflict and engage the energies of the employees in achieving corporate goals in a situation of high union membership density and recognition in the UK retail industry. The findings underline the importance of sectoral diversity within national capitalist economies in the context of increased internationalization and the significant role still played by labour even in a liberal market economy such as the UK.
Growing with Global Production Sharing: The Tale of Penang Export Hub, Malaysia
Authors: Athukorala Prema-Chandra
Published: May 2014

This article seeks to broaden our understanding of the phenomenon of global production sharing and to explore policy options for developing countries for engaging effectively in production networks, through a case study on the export production hub in the State of Penang, Malaysia. The findings uphold Penang as a unique example of marrying development strategy with emerging opportunities for global production sharing. The state government of Penang has not only attracted major multinational enterprises in the global electronics industry but also helped them become deeply rooted in the economy through a well-designed investment promotion and development strategy.
Generalizations of Hölder inequality and some related results on time scales
Authors: Chen Guang-Sheng , Huang Feng-Li , Liao Li-Fang
Published: May 2014

In this paper, we establish some generalizations and refinements of the Hölder inequality on time scales via the diamond-α dynamic integral, which is defined as a linear combination of the delta and nabla integrals. Some related inequalities are also considered.

MSC:26D15.
Investigation of the stabilization of verdigris-containing rag paper by wet chemical treatments
Authors: Ahn Kyujin , Hartl Andreas , Hofmann Christa , Henniges Ute , Potthast Antje
Published: May 2014

Copper pigments promote the deterioration of paper objects; hence, it has been problematic to paper conservation since many valuable historical manuscripts contain copper green pigments. In particular, verdigris yields relatively mobile copper ions that can cause a higher risk of degradation depending on the relative humidity of the storage conditions. Although several research studies have demonstrated potential chemicals to slow down the degradation of the paper with copper ions or copper pigments, passive treatments such as mechanical reinforcement or environmental controls are still preferred since wet chemical treatments need to be further investigated.

In the present study, various wet chemical treatments of rag paper with verdigris are tested with consideration for the practical situations of application as well as the sample conditions. GPC-Fluorescence-MALLS system after fluorescence labeling of carbonyl groups of cellulose was employed to evaluate the inhibition of both, hydrolysis and oxidation of cellulose after treatments. Samples were prepared to simulate a partially soluble verdigris pigment bound in gum arabic on gelatin-sized rag paper.

With the given sample conditions, beneficial effects from deacidification was rather limited despite the use of a mixture of water and ethanol as a co-solvent. In contrast, treatments with tetrabutylammonium bromide in ethanol or 1H-benzotriazol in ethanol showed significant stabilization of the samples. For both cases, hydrolytic degradation and oxidation of cellulose were retarded significantly when brushing application on verso was employed. Testing various conditions of the solutions and two different application methods led to the conclusion that the outcome of the solution treatment depends on not only the chemical, but also how it is applied.
Historical Regional Variation in Census Occupation Terms
Authors: Urbatsch Robert
Published: May 2014

Censuses offer bountiful but underexploited sources for studies of linguistic usage, especially with their detailed geographic and demographic information about respondents. To demonstrate potential uses of census data, this study explores the regional variation in 1880 U.S. Census respondents when referring to establishments serving alcoholic beverages and to those establishments’ employees. The analysis shows distinct regional patterns of using barkeeper rather than bartender (more common in the South), of referring to a workplace as a tavern (overwhelmingly a Middle Atlantic phenomenon), and of speaking of attending bar rather than tending or keeping it (also concentrated in the Middle Atlantic).
Ontogenetic investigation of underwater hearing capabilities of loggerhead sea turtles (Caretta caretta) using a dual testing approach
Authors: Lavender Ashley L. , Bartol Soraya M. , Bartol Ian K.
Published: May 2014

Sea turtles reside in different acoustic environments with each life history stage and may have different hearing capacity throughout ontogeny. For this study, two independent yet complementary techniques for hearing assessment, i.e., behavioral and electrophysiological audiometry, were employed to (1) measure hearing in post-hatchling and juvenile loggerhead sea turtles Caretta caretta (19-62 cm straight carapace length) to determine whether these migratory turtles exhibit an ontogenetic shift in underwater auditory detection and (2) evaluate whether hearing frequency range and threshold sensitivity are consistent in behavioral and electrophysiological tests. Behavioral trials first required training turtles to respond to known frequencies, a multi-stage, time-intensive process, and then recording their behavior when they were presented with sound stimuli from an underwater speaker using a two-response forced-choice paradigm. Electrophysiological experiments involved submerging restrained, fully conscious turtles just below the air-water interface and recording auditory evoked potentials (AEPs) when sound stimuli were presented using an underwater speaker. No significant differences in behavior-derived auditory thresholds or AEP-derived auditory thresholds were detected between post-hatchling and juvenile sea turtles. While hearing frequency range (50-1000/1100 Hz) and highest sensitivity (100-400 Hz) were consistent in audiograms pooled by size class for both behavior and AEP experiments, both post-hatchlings and juveniles had significantly higher AEP-derived than behavior-derived auditory thresholds, indicating that behavioral tests are a more sensitive testing approach. The results from this study suggest that post-hatchling and juvenile loggerhead sea turtles are low frequency specialists, exhibiting little differences in threshold sensitivity and frequency bandwidth despite residence in acoustically distinct environments throughout ontogeny.
A central role for the primary microRNA stem in guiding the position and efficiency of Drosha processing of a viral pri-miRNA
Authors: Burke James M. , Kelenis Demetra P. , Kincaid Rodney P. , Sullivan Christopher S.
Published: May 2014

Processing of primary microRNA (pri-miRNA) stem–loops by the Drosha–DGCR8 complex is the initial step in miRNA maturation and crucial for miRNA function. Nonetheless, the underlying mechanism that determines the Drosha cleavage site of pri-miRNAs has remained unclear. Two prevalent but seemingly conflicting models propose that Drosha–DGCR8 anchors to and directs cleavage a fixed distance from either the basal single-stranded (ssRNA) or the terminal loop. However, recent studies suggest that the basal ssRNA and/or the terminal loop may influence the Drosha cleavage site dependent upon the sequence/structure of individual pri-miRNAs. Here, using a panel of closely related pri-miRNA variants, we further examine the role of pri-miRNA structures on Drosha cleavage site selection in cells. Our data reveal that both the basal ssRNA and terminal loop influence the Drosha cleavage site within three pri-miRNAs, the Simian Virus 40 (SV40) pri-miRNA, pri-miR-30a, and pri-miR-16. In addition to the flanking ssRNA regions, we show that an internal loop within the SV40 pri-miRNA stem strongly influences Drosha cleavage position and efficiency. We further demonstrate that the positions of the internal loop, basal ssRNA, and the terminal loop of the SV40 pri-miRNA cooperatively coordinate Drosha cleavage position and efficiency. Based on these observations, we propose that the pri-miRNA stem, defined by internal and flanking structural elements, guides the binding position of Drosha–DGCR8, which consequently determines the cleavage site. This study provides mechanistic insight into pri-miRNA processing in cells that has numerous biological implications and will assist in refining Drosha-dependent shRNA design.
Model of Running Online Professional Learning Based on Competency-Building Approach
Authors: ��������  , Batyreva Svetlana
Published: May 2014

The model designed to run online learning courses of professional development is presented. Online mode of professional development is of special essence

as it is meant that course participants could immediately test and put to practice up-to-date professional knowledge, got in the process of online

learning.

The original model is elaborated using competency-building, system-and-activity-based approach, conducive to nurturing learners� subject position.

The mentioned training module provides for stage-by-stage learning process and assumes, that learners individually deal with and interact with online

support and tutorial follow-up.

The primary purpose of the model is to get teaching staff well prepared for evaluation activities in the context of implementing Federal State Educational

Standard (FSES), which implies, that primary school teachers should develop evaluation competency. Modules, appearing in the program, if considered

in the aggregate, correspond to the structure of training activity, which is of essence when implementing FSES.
Didactic Functions, Capacities and Features of Electronic Educational Resources
Authors: ��������  , Suvorova T.
Published: May 2014

The paper addresses several starting suppositions and principles to be taken in consideration when designing electronic educational resources (EER)

and integrating thereof in the educational process. Some of the most common approaches to interpreting the notions of EER didactic functions, capacities

and features are analyzed. In the light of up-to-date goals of education the author highlights three didactic functions of EER: to extend (enrich) the

educational content; to introduce new kinds of educational activities and to improve traditional educational activities performance; to personalize the

educational process itself. Given the mentioned didactic functions, structural composition of EER didactic capacities and features have been augmented.

The case study is presented to exemplify interrelation of EER didactic functions, capacities and features with the goals of educational activities, kinds of

educational activities, and atomic actions, aimed at meeting educational goals.
Using Analytic System of Moscow Register of Education Quality as a Powerful Tool of Managerial Activities Within the Educational Complex
Authors: ����������  , Kurchatkina Irina
Published: May 2014

Large-scale educational institutions produce additional resources for educational environment development, for enriching range of educational services,

and are especially conducive to enhancing capacities of personality-oriented learning, nurturing competencies, necessary for informed choice of

profession, and for better perspectives of education in general. However, this generate a new set of risks � mainly of psychological nature � typical

to the situation, when diverse teams of teaching staff and students have to merge, as well as risks of managerial origin, as a result of new set of tasks

come around and renovation of the organizational mission. We assume that each educational institution to be integrated in the educational complex, is

unique. And we believe that each item of best practices must be preserved and at the same time developed at the new level through setting and meeting

new objectives and implementing up-to-date projects. And all the necessary resources and opportunities for this are available.
System of Education Quality Assessment as Оne of the FGOS Implementation Tools
Authors: Сиротин  , Sirotin Vladimir
Published: May 2014

The paper discusses how to incorporate the system of education quality assessment in the educational process to meet one of the essential requirements

for successful implementing the Federal State Educational Standards (FGOS) in the context of recently enacted laws on education.
Red Eléctrica de España Uses Integer Programming for Annual Salary Revisions
Authors: Mahou Ángel , García-Sánchez Álvaro , Ortega-Mier Miguel , Romero Ana Moreno
Published: May 2014

In this paper, we present a mixed-integer linear programming model for determining salary-revision matrices for an organization based on that organization’s general strategies. The solution obtained from this model consists of salary increases for each employee; these increases consider the employee’s professional performance, salary level relative to peers within the organization, and professional group. In addition to budget constraints, we modeled other elements typical of compensation systems, such as equity and justice. Red Eléctrica de España (REE), the transmission agent and operator of the Spanish electricity system, used the model to revise its 2010 and 2011 salary policies, and achieved results that were aligned with the company strategy. REE incorporated the model into the salary management module within its information system, and plans to continue to use the model in revisions of the module.
GREEK-ALBANIAN DICTIONARIES PUBLISHED IN THE 1990s AND LATER
Authors: Ksera Kostando
Published: May 2014

In the last century, the compilation of bilingual Greek-Albanian and Albanian-Greek dictionaries did not experience any significant development, despite the fact that educational, scientific and cultural needs for these kinds of dictionaries demanded addressing. It is a fact that for 100 plus years the Greek-Albanian and Albanian-Greek dictionaries can be counted on the fingers on one’s hand. This is something inexcusable even though politics has had a negative influence for decades. The situation changed for the better after the 90s, where we have the compilation and publication of three Greek-Albanian dictionaries: The Greek-Albanian dictionary of Niko Gjini published in 1993, The Greek-Albanian dictionary of Kostandin Papafili published in 1997 and The Greek-Albanian dictionary of Hysen Sinani published in 2001. In this article we will talk about the characteristic features of these three dictionaries.
Strategic directions for strengthening nursing and midwifery services
Authors: Phiri Margaret Loma
Published: May 2014

In May 2001, the World Health Assembly (WHA) adopted a resolution requesting the Director General rapidly to prepare the plan of action for strengthening nursing and midwifery services 2002–2008, known as strategic directions in support of WHA resolution 54.12 on strengthening nursing and midwifery (SDNM).

The main purpose of the SDNM is to support efforts to scale up national health systems' capacity in order to meet health goals set by member states in priority areas, including: HIV/AIDS; maternal and infant health; tuberculosis; malaria; adolescent health; mental health; and chronic illnesses. The SDNM will also contribute to the achievement of WHO strategic directions which are: reducing excess mortality, morbidity and disability in populations; promoting healthy life styles and reducing risk factors; developing health systems that equitably improve health outcomes; and framing enabling policies.

The purpose of this article is to provide an overview of the SDNM, progress made in their implementation and the developed regional guidelines to accelerate action at country level.
Do nurses make the best midwives?
Authors: King Laetitia , Sherratt Della
Published: May 2014

Millions of people throughout the developing world are dying due to lack of access to health care services or professional health care workers. As indicated in the 2006 World Health Report (WHO, 2006) it is estimated that worldwide, there is a shortage of 4.3 million doctors, nurses, health managers and other health care workers. As a result, over 2 billion people have no access to health care. Numerous Declarations and expressions of commitment to address the issue have been developed, and yet this situation remains critical.
Satisfaction ratings of obstetric ultrasound: a validation study
Authors: Ugwu AC , Idigo FU , Anakwue AC , Nwogu UB , Egwu OA
Published: May 2014

Researchers studying patient satisfaction have reported several factors affecting patient satisfaction in the West. These factors, to the best of knowledge, have not been validated in Nigeria. This study validated some of the factors in patient satisfaction rating in this population. Ninety-two patients were reviewed in four ultrasound service providing centres/institutions. Five variables which could be influenced by the ultrasound practitioner were tested. Tests were two-tailed and deemed to be significant at P<0.05. None of these variables showed significant correlation with satisfaction rating among patients with previous experience of obstetric ultrasound procedure. Among those that had no previous experience of the ultrasound procedure, explanation, privacy and comfort showed significant correlations with the satisfaction rating. Patients’ perceptions of comfort on the table was found to be most critical in predicting satisfaction, followed by explanation. In this environment first experience patients are more sensitive to satisfaction indices and should be preferentially treated.
The modified WHO partograph: do we need a latent phase?
Authors: Kwast Barbara E. , Poovan Pia , Vera Edita , Kohls Elaine
Published: May 2014

The objective was to study the frequency and mode of delivery of women admitted in the latent and active phase of labour in St. Luke's Catholic Hospital in Wolisso, Southwest Shoa Zone, Oromia Regional State, Ethiopia. It was a descriptive, retrospective design. Admission phases of labour and mode of delivery were collected for seven months.

The modified World Health Organization (WHO) partograph was introduced in Wolisso in January 2007. Analysis of mode of delivery of women admitted in the latent and active phase, showed that women admitted in the latent phase had more operative (both abdominal and vaginal) deliveries as labour progressed to the right of the alert line in active phase compared to women admitted in the active phase of labour. Partographs were generally plotted very well, with 86% of those eligible for partography available for analysis. Application of the management protocol needs to improve as the average monthly C/S rate is 22.5% and augmentation of labour is rarely applied. It is recommended that a management protocol for women admitted in the latent phase is formulated and applied. Space for these women needs to be organized closer to the labour ward for regular observation in the latent phase and earlier diagnosis of the onset of the active phase of labour. Considering the mean number of 5.857 hours until the active phase was diagnosed, re-introduction of the latent phase on the WHO partograph remains a controversial subject. However, development of, and adherence to, a management protocol for these women is strongly recommended. One-third of the women were admitted in the second stage of labour which means that frequency of partograph use should not be used as a quality of care indicator in management information systems but criterion-based audits would definitely improve management of labour.
Japan struggles to maintain its population
Authors: Daniel Lincia
Published: May 2014

The number of births in Japan has recently declined because of a sharp drop in women in their twenties giving birth and an unstable global economy, as well as a reduced number of women of childbearing age.
Teenage mothers in Kenya: seduced, coerced and at risk of HIV
Authors: Omoni Grace M
Published: May 2014

The HIV/AIDS epidemic is affecting the sub-Saharan Africa more severely than other parts of the world, with 60% of global AIDS cases occurring in Africa. This article explores predisposing factors for teenage pregnancy which have implications for the spread of HIV/AIDS and STIs among adolescents in Kenya. In a recent study in one district, four factors were found to be prominent in predisposing teenage pregnancy: having multiple partners, sex for money, seduction by teachers, and coercion by friends and relatives. In-depth interviews of a sub-group of the subjects revealed some issues that are of great concern in the context of the current efforts to combat the HIV/AIDS pandemic. Attention so far has been on creating awareness but risk behaviours in adolescents are common, with the attendant dangers of unintended pregnancy, HIV/AIDS and other STIs. This article seeks to highlight some of the factors that affect risky behaviours even in fully aware teenagers. It highlights a need for specific interventions beyond awareness creation.
Sexual violence against women in a South African rural community
Authors: Akinsola Henry Abayomi , Ramakuela Nditsheni Janette
Published: May 2014

This study seeks to explore the factors that promote and sustain sexual violence against women in Vhembe district, Limpopo province, South Africa. The design of the study is qualitative and the instrument for data collection was an interview guide which contained an open-ended question. Seventeen health practitioners working in various health facilities and communities in Vhembe district, Limpopo Province, South Africa gave written answers to the question. Data collected were analysed descriptively in themes using the Tesch method (Creswell, 1994). Several socio-economic, cultural, political and psychological factors were identified by the respondents both as predictors and risk factors for sexual violence in the study setting. The study shows that sexual violence in South Africa is a serious social and public health issue and therefore the problem should be perceived and analysed broadly for long-term preventive measures to be developed.
Women in Ireland drink the most alcohol in pregnancy
Authors: Bainbridge Jane
Published: May 2014

In a Dublin study involving 43 818 Irish women, 7.9% of pregnant women were found to drink nine or ten units of alcohol per week, showing a lack of awareness of the dangerous effects of alcohol on the unborn baby.
Low uptake of postnatal care services in Swaziland
Authors: Ziyane Isabella S. , Thwala Makhosazana
Published: May 2014

A survey was undertaken in two maternity centers in Swaziland to identify factors associated with low use of postnatal care services during early pueperium. A quantitative descriptive nonexperimental study design with purposive sampling was used. Fifty recuperating clients who visited public postnatal care services participated in a face-to-face interviews. The study reported that the main factor responsible for low uptake of early postnatal care services was socio-cultural. Other deterrents were personal, economic and health service factors. Recommendations were made to policy makers, midwifery training institutions and health-care institutions regarding the provision of quality, equitable, culturally acceptable postnatal care services to all mothers.
Factors contributing to poor use of postnatal care services in clinics
Authors: Mabuza Eunice Mkhetsile , Tagutanazvo Oslinah Buru , Mngadi Patricia Thuli , Dlamini Mirriam
Published: May 2014

The aim of postnatal care is to promote and improve the health of all women and their infants following childbirth. The purpose of the study was to identify the factors that contribute to low use of postnatal care services by women. A quantitative, exploratory and descriptive research design was used in the study. Data were collected from women and midwives through structured interviews and self-administered questionnaires. Purposive sampling was used. Data was analysed through descriptive statistics. Responses to open-ended questions were categorized, coded and analyzed based on themes and sub-themes. The results indicated that most of the respondents were discharged within 24 hours following childbirth; the majority stayed far away from health facilities and postnatal care that was mainly provided for children. Inadequate training for the midwives on postnatal care and lack of knowledge about the importance of attending postnatal clinic among the clients were reported.
Predictive factors for uptake of post-abortion care in western Kenya
Authors: Onyango Monica Adhiambo , Oguttu Monica , Barger Mary
Published: May 2014

The objective of this study was to establish factors associated with the receipt of post-abortion contraceptive counselling and uptake at private health facilities in western Kenya. A crosssectional study was conducted at 25 private health facilities from July 2004–October 2004. A total of 403 women were interviewed following post-abortion care (PAC) via manual vacuum aspiration (MVA). Nurse-midwives provided the majority of PAC (55%). Only 44% of women received contraceptive counselling and 31% adopted a method. The strongest predictor for receipt of counselling was obtaining PAC at a low MVA volume facility (odds ratio 5.63). Women who received contraceptive counselling, and those who had an unplanned pregnancy, were three times more likely to adopt a method. Uptake of a method was also influenced by counselling time. Busy facilities in western Kenya should consider training staff specifically for post-abortion contraceptive counselling to increase uptake following PAC.
Inferential analysis: Powerful storytelling
Authors: Delaney Laura
Published: May 2014

A lot of health research is based on the inferential analysis of data. In contrast to descriptive analysis, which describes the sample group, inferential analysis takes the description of the sample group to another level by using the sample data to draw conclusions about the population from which the sample was selected. The sample group must be selected randomly from the population in order to draw conclusions about the population. Undertaking inferential analysis with sample data is a powerful way to tell a story about the population.
Perceived cervical cancer risk, knowledge and preventive practices
Authors: Muliira Joshua Kanaabi , Kisaakye Esther , Kizza Irene Betty , Suubi Rhoda Racheal
Published: May 2014

Cervical cancer (CACX) represents the largest percentage of female malignancies in Uganda and it is mostly diagnosed late. This study describes CACX knowledge, perceived risk and preventive practices of female university students in Uganda. Stratified systematic sampling technique was used to get a sample of 323 participants from a public university in Uganda. Results from the 323 participants (mean age 21.28 years, standard deviation 1.64 years) show that the majority (79%) perceived their CACX risk as low. Participants had poor CACX-related knowledge as indicated by a lack of knowledge about causes (62%), signs (72%) and screening methods (61–85%). Participants also had poor CACX preventive practices, indicated by reports of unprotected sex (80%), multiple sexual partners (64%) and no Pap smears (96%) or gynaecological examinations (71%). A significant relationship was found between perceived risk and preventive practices (P ≤ 0.01) and between perceived risk and knowledge (P ≤ 0.05). This study reinforces the need for scaling up CACX health education among groups of women at high risk of preventable gynaecological cancers.
Why are pregnant women and newborns still dying in rural Ethiopia?
Authors: Ghosh Biku , Solomon Fitsum , Gobeze Aberra A , Phillips Robyn , East Melrose
Published: May 2014

Background and aims:

Maternal and newborn mortality in most sub-Saharan African countries, such as in Ethiopia, remains unacceptably high; the maternal mortality rate is 470 per 100 000 live births. This study aimed to establish why maternal and newborn mortality remains so high in rural Ethiopia.

Methods:

For a consecutive period of 3 weeks all pregnant women requiring emergency obstetric surgery at a rural district hospital in Ethiopia were surveyed. Patients already admitted in the hospital and/or waiting planned or urgent caesarean sections were excluded from this study. To establish the main bottle neck areas of concern to reduce maternal and/or neonatal mortality, a survey of woman's journey from home to operating table was carried out in a district hospital in Ethiopia. Thirty-six pregnant women who required emergency obstetric operations due to serious complications in pregnancy were included in the study.

Results:

The most common obstetric problems observed were obstructed labour (80%), eclampsia, antepartum and postpartum haemorrhage. The average time taken from the decision to transfer and arrival at a hospital was 5.5 hours. Two mothers and 26 babies did not survive; 3 women developed vesico-vaginal fistula. Of the 36 women, 9 had hysterectomy for ruptured uteruses. The average costs to the family for transport and for hospital treatment were US$63—the average annual family income in Ethiopia is only around US$180.

Conclusion:

Complications in pregnancy in rural Ethiopia lead to poor outcomes. The major causes of these are failure to diagnose complications early due to the lack of appropriate healthcare available locally and when diagnosed, in the delay of transfer to hospital for intervention.
Transdisciplinary collaborative training: A midwifery need
Authors: James Sindiwe , Mabenge Mfundo , Rala Ntombana
Published: May 2014

In 2000, the United Nations Development Programme (UNDP) set out are eight international development goals—Millennium Development Goals (MDGs)—that all 193 United Nations (UN) member states and at least 23 international organisations have agreed to achieve by 2015. MDG 4 and 5 are concerned with reducing child mortality rates, and improving maternal health, respectively ( UNDP, 2012 ). Midwives are expected to provide the best level of care for women and babies and are held responsible for doing so. Thus special attention to the training of midwives, like that of other nursing professionals, is of crucial importance for improving maternal and child health. South Africa is currently facing a challenge in achieving MDG 4 by 2015 and for that reason extensive interventions are needed to assist the midwives and midwifery health authorities towards the MDG target. Midwifery training has to be strengthened in South Africa to enhance competency and independency of midwives especially with the adoption of the concept of the midwifery obstetric units. Assessments and interventions of midwives should not only be theoretically-based but also skill-based. Thus, this article proposes a collaborative training of midwives. Indeed collaboration in the training of doctors/obstetricians and midwives will benefit the much-needed improved midwifery skills; and, in the long run, reduce the rate of perinatal and maternal mortalities. A pilot project of this type of collaborative training has shown that both professions appreciate each other's knowledge, experience and skills, are willing to learn from each other's experience and knowledge, and are willingly accepting each other as team members.
Poor pregnancy outcomes in public health facilities in Kenya
Authors: Cheptum Joyce Jebet , Oyore John Paul , Okello Agina Bonaventure Michael
Published: May 2014

Background:

Addressing poor pregnancy and childbirth outcomes such as still births, pre-term births and neonatal deaths have continued to be a major global challenge. Nations and organisations have invested much effort and resources to promote safe pregnancy and childbirth.

Objective:

To identify factors contributing to adverse pregnancy outcomes among women seeking care in public health facilities in the Keiyo district of Kenya.

Methods:

A descriptive cross-sectional design was used employing both quantitative and qualitative methods. Three hundred and eighty four women of reproductive age (15–49 years) attending public health facilities for Maternal and Child Health/Family Planning (MCH/FP) were interviewed.

Results:

There are several factors which cause adverse pregnancy outcomes. Socioeconomic and demographic factors that were associated with poor pregnancy outcomes include low education level, lack of formal employment and multiparity. Other factors included pre-term birth, preexisting medical conditions, illnesses during pregnancy and obstetric emergencies. The lengthy referral pattern also was a contributory factor.

Conclusions:

There are several factors that contribute to poor pregnancy outcomes. Social mobilisation of the community on reproductive health issues should be done through health education to enhance proper basic obstetric care and emergency obstetric care. Health facilities should be well staffed and well equipped in order to avoid poor pregnancy outcomes, which may occur as a result of delays owing to lack of staff or equipment. There should be a well defined referral system to enable timely referrals.
Factors Hindering Breastfeeding Practices Among Mothers in Rural Tanzania
Authors: Chuwa Mary , Mgaya Benedicta Benedict
Published: May 2014

Exclusive breastfeeding practices for infants and young children worldwide are not optimal. More than seven million children under the age of 5 die each year in sub-Saharan Africa and Asia due to poor breastfeeding practices ( Quinn et al, 2004 ). This study determines factors hindering exclusive breastfeeding (EBF) practice among mothers of infants aged 0–6 months attending the Reproductive and Child Health (RCH) clinic at Peramiho Mission Hospital, Ruvuma division, Songea Rural district in Tanzania. A descriptive cross-sectional study employed quantitative design through the use of structured questionnaires. A total of 92 respondents were interviewed. The respondents were mothers of infants aged 0–6 months. Convenient non-random sampling was used, which means all mothers with infants in the age group who were present at the time of data collection were included. Data was analysed using the Epi–Info 6 version, statistical package. It was discovered that around one-third of respondents were peasants who need to work hard and engage in various economic and domestic activities soon after delivery, thus lacking enough time for cooking and caring for their young ones. Furthermore this study revealed that educational level had a bearing on knowledge about exclusive breastfeeding as the majority (57%) of respondents with primary education had inadequate knowledge about exclusive breastfeeding—although this was not statistically significant. Also, 22% of the respondents reported having exclusively breastfed their infants for six months. However, findings from the current study show that a significant number of respondents had some cultural beliefs which hinder exclusive breastfeeding. Exclusive breastfeeding is still rarely practised in the area of study as more than half of infants are supplemented early and the majority of mothers have inadequate knowledge on exclusive breastfeeding. To promote breastfeeding, education and campaigning on the importance of continued breastfeeding should be provided to the general public, particularly to health workers in maternity units.
Community social support roles of trained traditional birth attendants in Chongwe district, Zambia
Authors: Chanda Dorothy Chinwendu , Siziya Seter , Baboo Kumar Sridutt , Mweemba Oliver
Published: May 2014

Although traditional birth attendants (TBAs) play key roles in providing maternal health care in many low-resource countries, there are few studies that describe the actual roles and practices of TBAs in their local communities. In addition, there remains controversy about the impact of TBAs on the reduction of maternal and infant morbidity and mortality. This paper presents the results of focus group discussions that were conducted in the Chongwe district in the Lusaka Province of Zambia. It describes the roles of trained (t)TBAs in the district. Method: The researcher used an interview guide to conduct five focus group discussions with 28 tTBAs, four mothers, two midwives, two nurses, and one village leader. The study participants were recruited using a convenience sampling approach, from four district health facilities. The focus group discussions were conducted in English, tape-recorded and then transcribed. The data were analysed using the qualitative content analysis method. Results: The main theme identified as describing the role of the tTBA was community social support. This theme was further divided into three categories: providing safe motherhood services, counselling, and health education. Each of these categories also included sub-categories. These findings do not present a view of the general population since it was conducted in only one out of 73 districts in Zambia. Conclusions: The findings from this study recommend the continued training, monitoring, evaluating and documenting of the impact of the TBAs' practices using the modified Ministry of Health TBA training curriculum and the monitoring tool during supervisions. The documentation of their impact would inform evidence-based policy formulation. The influential leaders should sustain their practice by using rural folks' wealth–ranking approach. Generally, tTBAs are likened to ‘spare wheels of cars’ which need to be ready for use in emergency situations when a tyre fails. Chongwe district should form an association to advocate for tTBAs' sustainability.
Challenges in caring for people with long-term conditions
Authors: Margereson Carl
Published: May 2014

Carl Margereson discusses the challenges facing society and cardiac nurses in caring for patients with long-term conditions.
Better together: Providing palliative care in heart failure
Authors: Pattenden Jill
Published: May 2014

Jill Pattenden argues the case for specialized palliative care in heart failure and tells us about the new initiative of the British Heart Foundation and Marie Curie Cancer Nurses to fulfill this need.
Happy Christmas
Authors: Johnson Kate
Published: May 2014

Every year the references to Christmas and Christmas items seem to appear in the media and shops earlier, often coinciding with the end of the summer. The effect this has on me is that I become so conditioned to it that, by the time December arrives, it always seems to take me by surprise and I end up in a panic about all the things I haven’t done. I’m sure there are many people who can relate to this.
Heart disease and erectile dysfunction: Management at a nurse-led clinic
Authors: Steggall Martin J , Butler Jane , Coals Sally , Chinegwundoh Francis I
Published: May 2014

Background: Erectile dysfunction has an estimated prevalence of 10% in all sexually active men. Aetiological features include neurovascular disease and psychological distress. The authors’ clinical impression was that men with hear t disease were not offered any intervention for erectile dysfunction at all whereas men with prostate disease were.

Aim: To per form a retrospective analysis of men who had sought treatment for erectile dysfunction at the east London nurse-led sexual dysfunction clinic in the last 22 months.

Methods: A retrospective comparative analysis was made of the time it took different groups of men to seek treatment. The authors identified 96 patients who met the inclusion criteria for a diagnosis of erectile dysfunction. A search of all clinical notes of men seen in the erectile dysfunction clinic was conducted by hand.

Main outcome measure: Demographic and clinical data were collected from the clinical notes. The source of referrer, previous treatment and reasons for delay in seeking treatment were identified. The data were compared with men presenting to the same clinic but with a history of prostate cancer treatment only.

Results: The mean age of men attending the clinic for advice was 62.2 years and 61% of patients with cardiac disease and 5% with prostatic disease had not tried any treatment for erectile dysfunction. After referral and assessment only 12% declined active therapy for erectile dysfunction.

Conclusions: On average men who attend the clinic for advice had not had successful sexual activity for about 41.7 months. The reasons cited for delay in seeking help were embarrassment and because the subject was not brought up by health professionals. The authors believe that the subject of erectile dysfunction should be broached with patients, and referral pathways should be developed to facilitate an improvement in sexual function.
Chest drains: A practical guide
Authors: Thorn Michelle
Published: May 2014

Michelle Thorn discusses the indications for and principles of chest drain management
An analysis tool for 12-lead ECG interpretation
Authors: Gregory Joanne
Published: May 2014

Joanne Gregory introduces a systematic analysis tool which can be used as an aid to ECG interpretation.The tool consists of six steps, which are each explored in detail.
Diagnosing and treating Brugada syndrome
Authors: Firman Eileen
Published: May 2014

The inclusion of Chapter 8 in the Coronary Heart Disease: National Service Framework for Coronary Heart Disease: Modern Standards and Service Models (DH, 2005) has highlighted conditions that cause sudden death in young people. Brugada syndrome is an inherited genetic condition involving the cardiac sodium channels and the clinical presentation, ECG abnormalities and treatment are discussed in this article.

Progress in the field of molecular genetics and the mapping of the SCN5A gene has resulted in the potential for genetic testing not only to help in diagnosis of an affected patient or deceased relative, but in predictive testing of family members. The psychological impact of the disease on families and the role of the nurse are also explored.
Cardiothoracic surgery
Authors: Johnson Kate
Published: May 2014

While many cardiac textbooks will usually have a section on coronary artery bypass grafts and heart valve surgery, there are fewer available that also cover other types of cardiac surgery and thoracic surgery.
Resuscitation guidelines 2005: Translating evidence into practice and its impact on care
Authors: Bullock Ian
Published: May 2014

Evidence-based health care is fundamental to both practice innovation and improvement in the quality of patient outcomes. The publication of the guidelines from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations is another important step forward for the critical care community. They are able to target improvements in health technologies and improve knowledge development underpinning clinical practice crucial in the prevention of premature death related to cardiac arrest. This article focuses on changes to previous guidelines in resuscitation practice, providing the rationale for changes and illustrating how the consensus process creates clinician confidence when implementing recommendations into practice. Translating evidence into every day practice remains challenging. The extensive national training programmes of the Resuscitation Council (UK) and the Advanced Life Support Group in basic, immediate and advanced life support provide an ideal tool that facilitates the use of best evidence, thus leading to improvements in patient outcome and care.
Becoming a BHF nurse project manager
Authors: May Susie
Published: May 2014

Susie May describes her role with the British Heart Foundation’s nurse project which funds and supports nurse specialists
Cardiac troponins T and I: Biochemical markers in diagnosing myocardial infarction
Authors: Collinson Paul
Published: May 2014

The cardiac troponins T (cTnT) and I (cTnI) can be measured by immunoassay systems and provide key biochemical information in patients with an acute coronary syndrome. Cardiac troponins are released only after cardiac damage has occurred and are sensitive and specific for myonecrosis. In this article, the clinical role of troponin measurement is illustrated in the diagnosis and management of three categories of patients: those in whom ST segment elevation is shown on the ECG; those with possible acute coronary syndrome at high risk of non-ST elevation acute myocardial infarction; and those with low risk/possible acute coronary syndrome. However, both cTnT and cTnI values can be raised in disorders resulting from causes other than myocardial infarction, for example, in renal failure and after percutaneous coronary intervention. These situations are discussed.