BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitat...BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or nonimplementation of unplanned extubation prevention interventions.To effectively identify and manage the risk of unplanned extubation,a comprehensive and universal unplanned extubation risk assessment tool is needed.AIM To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.METHODS This was a retrospective validation study.In this study,medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China.For patients with tubes during hospitalization,the following information was extracted from the hospital information system:age,sex,admission mode,education,marital status,number of tubes,discharge mode,unplanned extubation occurrence,and the Huaxi Unplanned Extubation Risk Assessment Scale(HUERAS)score.Only inpatients were included,and those with indwelling needles were excluded.The best cut-off value and the area under the curve(AUC)of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.RESULTS A total of 76033 inpatients with indwelling tubes were included in this study,and 26 unplanned extubations occurred.The patients’HUERAS scores were between 11 and 30,with an average score of 17.25±3.73.The scores of patients with or without unplanned extubation were 22.85±3.28 and 17.25±3.73,respectively(P<0.001).The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843.The best cut-off value was 21,and there were 14135 patients with a high risk of unplanned extubation,accounting for 18.59%.The Cronbach’sα,sensitivity,specificity,positive predictive value,and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815,84.62%,81.43%,0.16%,and 99.99%,respectively.The AUC of HUERAS was 0.851(95%CI:0.783-0.919,P<0.001).CONCLUSION The HUERAS has good reliability and predictive validity.It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.展开更多
Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases wit...Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.展开更多
Introduction: Performance monitoring and performance improvement (PI) are increasingly important. Little is known regarding unplanned re-admission (UPR) in trauma patients. This study characterizes UPRs at one institu...Introduction: Performance monitoring and performance improvement (PI) are increasingly important. Little is known regarding unplanned re-admission (UPR) in trauma patients. This study characterizes UPRs at one institution. Methods: Retrospective descriptive review of UPR to a Level I Trauma Center Information was obtained on: initial trauma diagnoses, diagnosis precipitating UPR, discharge interval, treatment rendered and length of stay (LOS) during both encounters, and PI committee judgments. Characteristics of UPR patients were determined and compared to those of all discharged patients. Descriptive statistics were applied. Results: Over 2.5 years there were 2827 discharges and 58 UPR(2%). The majority of original diagnoses were related to blunt trauma and head injuries. UPR occurred at a median of 3 days, with 54% re-admitted to the trauma service. Operative rate for UPR patients during the initial admission was 48% with 28%requiring operation on the UPR. Headache and wound issues were responsible for 42% of UPR. Diagnosis precipitating UPR was primarily related to post-operative complications in 26% of all UPR and 57% of those undergoing operation on the initial admission. Median LOS for UPR was 3days with ICU care being required by 13%. Of all UPRs,33% were attributable to opportunities for improved care (OFI) during the first admission. Identified OFIs were related to errors in technique (53%), errors in judgment (27%), and system issues (20%). Of UPR without OFI, 87% were related to disease and13% systems issues. Conclusion: UPR at a Level I trauma center is rare, occurs shortly after discharge, is brief in duration and usually related to postoperative wound issues or headache. Post operative patients seem at greater risk for UPR. While most UPR are considered non-preventable, attention to discharge instructions,patient education, resident education and supervisionand outpatient support, may obviate a number of preventable UPRs.展开更多
Unplanned pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pre...Unplanned pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy with adverse effects. And the aim of this study is to establish the level of effect of the unplanned pregnancy in women college in Wadajir district. This study used a cross-sectional study design. And the aim of this study is to establish the level of effect of the unplanned pregnancy on women college in Wadajir district. This study was being used cross sectional study design. This research had undertaken Wadajir district in Banadir region Mogadishu-Somalia. The sample size was 60 participating in the data collection phase from 1-30 Jun 2020. This study used primary data. This was collected from respondents in the area of study. Data was collected using a pre-cod structured questionnaire for the survey. Data showed that: 39 (65%) of the respondents answered yes that lack of education caused most unplanned pregnancy, 40 (66%) said that low-income countries are the risk factor of unplanned pregnancy, 47 (78%) of the respondents answered family planning is most common preventive for unplanned pregnancy, and 0 (67%) said that school dropout is the most compilation of unplanned pregnancy. Based on the findings of this research, the knowledge of the majority of respondents about unplanned pregnancy among women college replied yes, and they also replied that the most cause of unplanned pregnancy among women college is lack of education.展开更多
A grid connected microgrid connects to the grid at a point of common coupling. Due to the great inertia of the grid which accelerates and decelerates the generator when its frequency tends to deviate, the grid connect...A grid connected microgrid connects to the grid at a point of common coupling. Due to the great inertia of the grid which accelerates and decelerates the generator when its frequency tends to deviate, the grid connected microgrid operates at a frequency of the infinity bus. Frequency instability is one of the major challenges facing the grid connected microgrid during islanding. The power demand variation causes the variation in rotor speed, resulting to frequency deviation. Frequency can be brought back to standard by varying the power generation to match with the varying load. The performance of the frequency stability control system at Mwenga hydroelectric microgrid has been studied. Through site visitation, the power demand and generation status data were collected and analysed for model preparation. The results of the study indicate that, during islanding, the Mwenga rural electrification project is observed to be subjected to power imbalance which leads to frequency instability. Although the frequency control system tries to keep the system at a nominal frequency by maintaining the continuous balance between generation and varying load demand, however the system still operates with large magnitude of overshoot, undershoot and longer settling time.展开更多
Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method wa...Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method was used to analyze the causes,identify the actual causes of unplanned out-of-control,take corresponding measures,formulate corresponding countermeasures,implement standardized management,and carry out continuous improvement.Results:Following the implementation of quality control circle activities,the rate of unplanned extubation of venous access in perioperative patients decreased from 27.35%before improvement to 3.42%after improvement.Conclusion:The use of quality control circle activities in the safety management of venous access in perioperative patients is conducive to reducing the rate of unplanned extubation of venous access in perioperative patients.展开更多
Objective:To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.Methods:We used data from the Nationwide Inpatient Sample to co...Objective:To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.Methods:We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to 2011.Multivariable logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care,palliative care,and in-hospital mortality.Temporal trends in outcomes were characterized with use of joinpoint regression.Results:There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic cancer.During their inpatient stay,5.8%of patients received palliative care,and among those discharged alive,12.2%were referred to hospice care.The rate of inpatient palliative care increased from 2.3%to 13.6%,the rate of discharge to hospice care increased from 4.1%to 15.6%,and the in-hospital mortality rate decreased from more than 14.0%to 9.8%.These patterns were consistent across cancer subtypes,and were most pronounced among patients with extreme risk of mortality.Conclusion:Despite increases in the provision of comfort-oriented care to patients with meta-static cancer,few receive such services.We recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.展开更多
Steeply dipping,vein and tabular orebodies are traditionally extracted with longitudinal retreat mining methods such as Eureka and Avoca in a bottom-up sequence with delayed backfill.To increase productivity,sill pill...Steeply dipping,vein and tabular orebodies are traditionally extracted with longitudinal retreat mining methods such as Eureka and Avoca in a bottom-up sequence with delayed backfill.To increase productivity,sill pillars in the orebody are used to separate mining zones thus allowing production to take place simultaneously in two or more zones.While such mining methods are productive,they may be accompanied with high volumes of hanging wall overbreak causing significant unplanned ore dilution.In this work,it is shown through a mine design case study of a narrow vein deposit that a sill pillar could also play a significant role in limiting hanging wall overbreak.To demonstrate the role of sill pillar,a novel numerical modelling scheme is proposed to account for progressive stope wall overbreak.A numerical modelling approach of element death and rebirth is developed to allow for the detected stope overbreak to be immediately removed and replaced with backfill material before upper-level stope extraction.It is further shown that the average overbreak volume could be reduced by as much as 33%when the sill pillar is strategically placed in the lower half of a mine plan.展开更多
Introduction: As far as adult and married women were concerned, when they occurred to “unplanned pregnancy”, they felt so surprised and concussive all the time. Besides, the unplanned pregnancy also affects the othe...Introduction: As far as adult and married women were concerned, when they occurred to “unplanned pregnancy”, they felt so surprised and concussive all the time. Besides, the unplanned pregnancy also affects the other members in the family system. Therefore, when married women have to face the choice: “birth” or “abortion”, they’ll consider lots of thoughts and different decision criteria and decision pattern under various influences on physician, mind, mental and society. The purpose of this study was to investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. Methods: The study uses the method—“Ethnographic Decision Tree Modeling” [1] to build model of the decision criteria and decision patterns involved when adult married women make a decision about their unplanned pregnancy. There are three process in the research method: “Pilot Study”—interview two groups, every group distinct 4 married adult women with unplanned pregnancies, which decide whether to terminate or continue an unplanned pregnancy, what is the items of decision characters affect to the choice: “birth” or “abortion”. “Building of the Model”, displays the importance in proper order of those items and build the modeling with these two groups of women. “Testing of the Model”: investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. The study interviewed 34 married adult women with 43 unplanned pregnancies totally. Results: The result of the study finds out 12 items of decision characters, including planning to get pregnant or not, stability of feelings for married partner, the points of view on life, was affected by mother, mother-in-law, an husband’s emphasis on male, the meanings of children, the financial burden, the plan an assignment of career and time, the past pregnant experiences, the status of raising children, the health of parents and fetus, the effect of living environment, and social and cultural vision. Besides, there are four decision patterns of married adult women with unplanned pregnancy are “receiving abortion positively”;“giving birth as long as getting pregnancy naturally”;“ the minds are hesitative and changeable”, and “being forced by important others.” Conclusion: By setting the decision model tree, we found several decision criteria and patterns, and possible modes actions to be taken, could offer to see the adult married women’s decision-making and struggles in mind about unplanned pregnancy.展开更多
Purpose: The purpose of this review was to identify evidence about determinants of male engagement in family planning. Methods: An integrative review was used to assess the determinants of male engagement in family pl...Purpose: The purpose of this review was to identify evidence about determinants of male engagement in family planning. Methods: An integrative review was used to assess the determinants of male engagement in family planning. Data search was between 2014 and 2019 using Google Scholar, Scopus, Web of Science, Science Direct, Pub Med, Medline, CINAHL, EBSCO, Cochrane, and EBSCO host. A total of 14 articles met the eligibility criteria. Results: The fourteen reviewed articles were adopted with mixed method designs, randomized controlled trial, quazi-experimental, and survey. Themes were: determinant of male engagement in family planning, women perception of male enrolment in family planning, and methods to enhance male use of family planning. Conclusion: Religion, large family size, culture, fear of side effect, access and exposure to information, attitudes, norms and self-efficacy and interaction with a health care provider are determinants of male involvement in family planning use. Interventional programs by health care providers and intensive education to men will positively increase prevalence of family planning use. It’s recommended to involve religious leaders in education. Implication: More attention is needed at community and governmental level to identify strategies to promote gender equity, shared decision making, shared responsibility and positive participation of men, empowering women, and to increase effectiveness of male participation.展开更多
<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive a...<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. <strong>Methods: </strong>We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. <strong>Results: </strong>Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. <strong>Conclusions:</strong> Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.展开更多
and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The mate...and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.展开更多
基金Supported by West China Nursing Discipline Development Special Fund Project,Sichuan University,No.HXHL19059。
文摘BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or nonimplementation of unplanned extubation prevention interventions.To effectively identify and manage the risk of unplanned extubation,a comprehensive and universal unplanned extubation risk assessment tool is needed.AIM To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.METHODS This was a retrospective validation study.In this study,medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China.For patients with tubes during hospitalization,the following information was extracted from the hospital information system:age,sex,admission mode,education,marital status,number of tubes,discharge mode,unplanned extubation occurrence,and the Huaxi Unplanned Extubation Risk Assessment Scale(HUERAS)score.Only inpatients were included,and those with indwelling needles were excluded.The best cut-off value and the area under the curve(AUC)of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.RESULTS A total of 76033 inpatients with indwelling tubes were included in this study,and 26 unplanned extubations occurred.The patients’HUERAS scores were between 11 and 30,with an average score of 17.25±3.73.The scores of patients with or without unplanned extubation were 22.85±3.28 and 17.25±3.73,respectively(P<0.001).The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843.The best cut-off value was 21,and there were 14135 patients with a high risk of unplanned extubation,accounting for 18.59%.The Cronbach’sα,sensitivity,specificity,positive predictive value,and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815,84.62%,81.43%,0.16%,and 99.99%,respectively.The AUC of HUERAS was 0.851(95%CI:0.783-0.919,P<0.001).CONCLUSION The HUERAS has good reliability and predictive validity.It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.
基金National Natural Science Foundation of China No. 81770365National Key Research and Development Program of China No. 2016YFC1301301Beijing United Heart Foundation No. BJUHFCSOARF201901-19。
文摘Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.
文摘Introduction: Performance monitoring and performance improvement (PI) are increasingly important. Little is known regarding unplanned re-admission (UPR) in trauma patients. This study characterizes UPRs at one institution. Methods: Retrospective descriptive review of UPR to a Level I Trauma Center Information was obtained on: initial trauma diagnoses, diagnosis precipitating UPR, discharge interval, treatment rendered and length of stay (LOS) during both encounters, and PI committee judgments. Characteristics of UPR patients were determined and compared to those of all discharged patients. Descriptive statistics were applied. Results: Over 2.5 years there were 2827 discharges and 58 UPR(2%). The majority of original diagnoses were related to blunt trauma and head injuries. UPR occurred at a median of 3 days, with 54% re-admitted to the trauma service. Operative rate for UPR patients during the initial admission was 48% with 28%requiring operation on the UPR. Headache and wound issues were responsible for 42% of UPR. Diagnosis precipitating UPR was primarily related to post-operative complications in 26% of all UPR and 57% of those undergoing operation on the initial admission. Median LOS for UPR was 3days with ICU care being required by 13%. Of all UPRs,33% were attributable to opportunities for improved care (OFI) during the first admission. Identified OFIs were related to errors in technique (53%), errors in judgment (27%), and system issues (20%). Of UPR without OFI, 87% were related to disease and13% systems issues. Conclusion: UPR at a Level I trauma center is rare, occurs shortly after discharge, is brief in duration and usually related to postoperative wound issues or headache. Post operative patients seem at greater risk for UPR. While most UPR are considered non-preventable, attention to discharge instructions,patient education, resident education and supervisionand outpatient support, may obviate a number of preventable UPRs.
文摘Unplanned pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy with adverse effects. And the aim of this study is to establish the level of effect of the unplanned pregnancy in women college in Wadajir district. This study used a cross-sectional study design. And the aim of this study is to establish the level of effect of the unplanned pregnancy on women college in Wadajir district. This study was being used cross sectional study design. This research had undertaken Wadajir district in Banadir region Mogadishu-Somalia. The sample size was 60 participating in the data collection phase from 1-30 Jun 2020. This study used primary data. This was collected from respondents in the area of study. Data was collected using a pre-cod structured questionnaire for the survey. Data showed that: 39 (65%) of the respondents answered yes that lack of education caused most unplanned pregnancy, 40 (66%) said that low-income countries are the risk factor of unplanned pregnancy, 47 (78%) of the respondents answered family planning is most common preventive for unplanned pregnancy, and 0 (67%) said that school dropout is the most compilation of unplanned pregnancy. Based on the findings of this research, the knowledge of the majority of respondents about unplanned pregnancy among women college replied yes, and they also replied that the most cause of unplanned pregnancy among women college is lack of education.
文摘A grid connected microgrid connects to the grid at a point of common coupling. Due to the great inertia of the grid which accelerates and decelerates the generator when its frequency tends to deviate, the grid connected microgrid operates at a frequency of the infinity bus. Frequency instability is one of the major challenges facing the grid connected microgrid during islanding. The power demand variation causes the variation in rotor speed, resulting to frequency deviation. Frequency can be brought back to standard by varying the power generation to match with the varying load. The performance of the frequency stability control system at Mwenga hydroelectric microgrid has been studied. Through site visitation, the power demand and generation status data were collected and analysed for model preparation. The results of the study indicate that, during islanding, the Mwenga rural electrification project is observed to be subjected to power imbalance which leads to frequency instability. Although the frequency control system tries to keep the system at a nominal frequency by maintaining the continuous balance between generation and varying load demand, however the system still operates with large magnitude of overshoot, undershoot and longer settling time.
文摘Objective:To investigate the application effect of quality control circle activities in reducing the rate of unplanned extubation of venous access in perioperative patients.Methods:The quality control circle method was used to analyze the causes,identify the actual causes of unplanned out-of-control,take corresponding measures,formulate corresponding countermeasures,implement standardized management,and carry out continuous improvement.Results:Following the implementation of quality control circle activities,the rate of unplanned extubation of venous access in perioperative patients decreased from 27.35%before improvement to 3.42%after improvement.Conclusion:The use of quality control circle activities in the safety management of venous access in perioperative patients is conducive to reducing the rate of unplanned extubation of venous access in perioperative patients.
文摘Objective:To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United States.Methods:We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to 2011.Multivariable logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care,palliative care,and in-hospital mortality.Temporal trends in outcomes were characterized with use of joinpoint regression.Results:There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic cancer.During their inpatient stay,5.8%of patients received palliative care,and among those discharged alive,12.2%were referred to hospice care.The rate of inpatient palliative care increased from 2.3%to 13.6%,the rate of discharge to hospice care increased from 4.1%to 15.6%,and the in-hospital mortality rate decreased from more than 14.0%to 9.8%.These patterns were consistent across cancer subtypes,and were most pronounced among patients with extreme risk of mortality.Conclusion:Despite increases in the provision of comfort-oriented care to patients with meta-static cancer,few receive such services.We recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.
基金financially supported by the Natural Science and Engineering Research Council(NSERC)-Discovery Grants Program。
文摘Steeply dipping,vein and tabular orebodies are traditionally extracted with longitudinal retreat mining methods such as Eureka and Avoca in a bottom-up sequence with delayed backfill.To increase productivity,sill pillars in the orebody are used to separate mining zones thus allowing production to take place simultaneously in two or more zones.While such mining methods are productive,they may be accompanied with high volumes of hanging wall overbreak causing significant unplanned ore dilution.In this work,it is shown through a mine design case study of a narrow vein deposit that a sill pillar could also play a significant role in limiting hanging wall overbreak.To demonstrate the role of sill pillar,a novel numerical modelling scheme is proposed to account for progressive stope wall overbreak.A numerical modelling approach of element death and rebirth is developed to allow for the detected stope overbreak to be immediately removed and replaced with backfill material before upper-level stope extraction.It is further shown that the average overbreak volume could be reduced by as much as 33%when the sill pillar is strategically placed in the lower half of a mine plan.
文摘Introduction: As far as adult and married women were concerned, when they occurred to “unplanned pregnancy”, they felt so surprised and concussive all the time. Besides, the unplanned pregnancy also affects the other members in the family system. Therefore, when married women have to face the choice: “birth” or “abortion”, they’ll consider lots of thoughts and different decision criteria and decision pattern under various influences on physician, mind, mental and society. The purpose of this study was to investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. Methods: The study uses the method—“Ethnographic Decision Tree Modeling” [1] to build model of the decision criteria and decision patterns involved when adult married women make a decision about their unplanned pregnancy. There are three process in the research method: “Pilot Study”—interview two groups, every group distinct 4 married adult women with unplanned pregnancies, which decide whether to terminate or continue an unplanned pregnancy, what is the items of decision characters affect to the choice: “birth” or “abortion”. “Building of the Model”, displays the importance in proper order of those items and build the modeling with these two groups of women. “Testing of the Model”: investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. The study interviewed 34 married adult women with 43 unplanned pregnancies totally. Results: The result of the study finds out 12 items of decision characters, including planning to get pregnant or not, stability of feelings for married partner, the points of view on life, was affected by mother, mother-in-law, an husband’s emphasis on male, the meanings of children, the financial burden, the plan an assignment of career and time, the past pregnant experiences, the status of raising children, the health of parents and fetus, the effect of living environment, and social and cultural vision. Besides, there are four decision patterns of married adult women with unplanned pregnancy are “receiving abortion positively”;“giving birth as long as getting pregnancy naturally”;“ the minds are hesitative and changeable”, and “being forced by important others.” Conclusion: By setting the decision model tree, we found several decision criteria and patterns, and possible modes actions to be taken, could offer to see the adult married women’s decision-making and struggles in mind about unplanned pregnancy.
文摘Purpose: The purpose of this review was to identify evidence about determinants of male engagement in family planning. Methods: An integrative review was used to assess the determinants of male engagement in family planning. Data search was between 2014 and 2019 using Google Scholar, Scopus, Web of Science, Science Direct, Pub Med, Medline, CINAHL, EBSCO, Cochrane, and EBSCO host. A total of 14 articles met the eligibility criteria. Results: The fourteen reviewed articles were adopted with mixed method designs, randomized controlled trial, quazi-experimental, and survey. Themes were: determinant of male engagement in family planning, women perception of male enrolment in family planning, and methods to enhance male use of family planning. Conclusion: Religion, large family size, culture, fear of side effect, access and exposure to information, attitudes, norms and self-efficacy and interaction with a health care provider are determinants of male involvement in family planning use. Interventional programs by health care providers and intensive education to men will positively increase prevalence of family planning use. It’s recommended to involve religious leaders in education. Implication: More attention is needed at community and governmental level to identify strategies to promote gender equity, shared decision making, shared responsibility and positive participation of men, empowering women, and to increase effectiveness of male participation.
文摘<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. <strong>Methods: </strong>We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. <strong>Results: </strong>Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. <strong>Conclusions:</strong> Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.
文摘and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.
