This report illustrates how the Government of Mongolia responded to a rapid surge of COVID-19 cases during 2021 and took urgent actions to minimize preventable mortality. The analytical framework on ...efficient ICU bed management through a systems approach would be useful in similar settings.
Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by ...caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth.
We describe the first infant born to a woman with COVID‐19 in Vietnam, by Caesarean section at 36 weeks and 5 days of gestation. The mother and baby remained together during their hospital stay and ...prolonged skin‐to‐skin contact and early and exclusive breastfeeding were achieved. This was in line with the World Health Organization's Early Essential Newborn Care (EENC) recommendations, the national Vietnamese standard of care since 2014. The baby remained virus‐free throughout the 34‐day postpartum follow‐up.
Conclusion
The EENC approach can still be used with mothers who have COVID‐19 if effective infection control measures are applied.
In China, the rates of early initiation and exclusive breastfeeding are low. The high cesarean delivery rates further contribute to low breastfeeding outcomes. Skin-to-skin contact, a key component ...of early essential newborn care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to a randomized control trial.
This study aimed to determine the association of the duration of skin-to-skin contact after cesarean delivery with breastfeeding outcomes and maternal and neonatal health outcomes in China.
This was a multicentric randomized controlled trial that was conducted at 4 hospitals in China. A total of 720 participants at ≥37 gestational weeks with a singleton pregnancy and who received an elective cesarean delivery with epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at a ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2), and 3 (G3) received 30, 60, and 90 minutes of skin-to-skin contact immediately after the cesarean delivery, respectively.
Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in the control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2, and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71%, and 72%, respectively, compared with 22% in the control group (P<.001). The exclusive breastfeeding rate at discharge was 69%, 62%, and 71%, respectively, compared with 57% in the control group (P=.003). Early essential newborn care practices were associated with a reduction in postpartum blood loss and neonatal intensive care unit or neonatal ward admission (P<.001; P=.022) .
Our findings highlight that prolonged skin-to-skin contact after a cesarean delivery was associated with higher initiation and exclusive breastfeeding at discharge rates. It also found associations with reduced postpartum blood loss and neonatal intensive care unit or neonatal ward admission.
Water, sanitation and hygiene (WASH) services are critical to providing quality maternal and neonatal care in health facilities. This study aimed to investigate availability of WASH policies, ...standards, and services for childbirth and newborn care in hospitals in East Asia and the Pacific.
Descriptive analysis of survey data and observations of water, sanitation and hygiene services in maternity and neonatal care rooms and of deliveries in 147 hospitals in Cambodia, Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Philippines, Solomon Islands, and Viet Nam. The main outcome measures were availability of national policies and standards; availability of water, sanitation, and hygiene services in maternity rooms and neonatal care units; and practice of hygiene at childbirth.
Four of eight countries had national WASH policies and four had standards for health facilities. Seventy-seven percent of hospitals had a sink with water and soap or alcohol hand rub in delivery rooms, 78% in neonatal care rooms and 43% in postnatal care rooms. Only 45% of hospitals had clean sinks with water, soap and hand drying methods in the delivery room, 37% in neonatal care units and 10% in postnatal care rooms. Flush toilets were available in or next to delivery rooms and neonatal care units in 53% of 15 hospitals with data. Countries with WASH standards had a higher proportion of hospitals with water and hand hygiene services. Appropriate hygiene was practiced by health workers in 66% of 388 deliveries observed, and more likely in delivery rooms with a sink, water and soap.
Coverage of WASH services for maternal and newborn care must be improved to reduce risks of maternal and newborn morbidity and mortality.
Kurt Gödel argues in “Russell’s Mathematical Logic” that on the assumption that, contrary to Russell, definite descriptions are terms, it follows given only several “apparently obvious axioms” that ...“all true sentences have the same signification (as well as all false ones).” Stephen Neale has written that this argument, and others by Church, Davidson, and Quine to similar conclusions, are of considerable philosophical interest. Graham Oppy, responding to this opinion, says they are of minimal interest. Falling between these is my opinion that implications of these arguments for propositions and facts are of moderate philosophical interest, and that these arguments provide occasions for reflection of possible interest on fine lines of several theories of definite descriptions and class–abstractions.
Money Pumps Sobel, Jordan Howard
Philosophy of science,
06/2001, Letnik:
68, Številka:
2
Journal Article
Recenzirano
After maintaining in (Sobel 1997) that certain cyclical preferences can be reasonable, the following questions were tabled: “in what circumstances and under what assumptions … these … preferences of ...George's would turn him into a ”money pump,” and in what circumstances and under what assumptions they would not do that.” (47) Two pumps afford answers. George, who is sufficiently reasonable and well-informed to use backward induction, has, for this reason, nothing to fear from the first pump, but the second, of a nonstandard design by Wlodek Rabinowicz, ruins him just because he is subject to the constraints of backward induction. Could he be helped by extending his options from actions in a single round, to
courses
of actions starting in that round? Possibly not. He would be safe if he were capable of
resolute
choices of couses of action. Even so, he is in trouble through no
fault
of his, if, as I think, not having that capacity, though a misfortune, is not a fault.
A Natural Ceramic/Polymer Layered Composite Sobel, Howard L.; Williams, Wendell S.
Journal of the American Ceramic Society,
July 1997, Letnik:
80, Številka:
7
Journal Article, Conference Proceeding
Recenzirano
The examination of natural materials at the microscopic and microchemical level from a materials science perspective can occasionally suggest advances in modern materials engineering. The present ...paper reports on such a case: an analytical study of the detailed structure and composition of sea urchin teeth.
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