Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

Research on the Application of Cold Energy of Largescale Lng-Powered Container Ships to Refrigerated Containers

With the aim of considering the problem of excess fuel cold energy and excessive power consumption of refrigerated containers on large LNG-powered container ships, a new utilisation method using LNG-fuelled cold energy to cool refrigerated containers in cargo holds is proposed in this study, and the main structure of the cold storage in the method is modelled in three dimensions. Then, combined with the different conditions, 15 different combination schemes of high temperature cold storage and low temperature cold storage are designed to utilise the cold energy of LNG fuel, the exergy efficiency and cold energy utilisation rate calculation model of the system is established. The simulation tool ‘Aspen HYSYS’ is used to simulate and calculate the exergy efficiency and cold energy utilisation rate of the system under 15 combinations, verifying the feasibility of the scheme. According to the characteristics of such a ship’s cross-seasonal navigation routes and the number of refrigerated containers loaded in different ports, the combination schemes of the number of low-temperature cold storage and high-temperature cold storage are selected. Thus, the average exergy efficiency and cold energy utilisation rate of the whole line is obtained, which proves that LNG-powered container ships could effectively utilise the cold energy of LNG. By calculating the total electric energy consumed by refrigerated containers on the whole sailing route, before and after the adoption of the LNG cold energy method, it is found that the adoption of this new method can promote the realisation of energy saving and emission reduction of ships.

Effect of Monthly Evaluations on Irrational Rates of Antimicrobial Drug Prescription in Outpatient and Emergency Departments

Reduction of the excessive rate of antibiotic prescription is needed to curb antibiotic resistance. This retrospective study was conducted to verify whether monthly evaluations of antibiotic prescriptions could improve clinical antibiotic use in outpatient and emergency departments. Every month, from July 2016 to June 2019, 25% of the antibacterial prescriptions from the outpatient and emergency departments in our hospital were randomly selected. The hospital formed an evaluation team that conducted preliminary evaluations of these prescriptions and an expert team that re-evaluated any problematic prescriptions. We analysed the irrational prescription rate, proportion of antibiotic use, and consistency between the evaluation and expert teams. At the end of the evaluation period, the utilisation rate of single antibiotics in the outpatient and emergency departments increased, the irrational prescription rate decreased, and the proportion of sold antibiotics gradually decreased. In addition, the consistency of prescription evaluation results between the evaluation and expert groups increased over time. In conclusion, monthly evaluation of antibiotic prescriptions is an effective management tool for the rational use of antibiotics in clinical practice and plays an important role in safe clinical drug use.

Novel Propagation Strategy of Saccharomyces cerevisiae for Enhanced Xylose Metabolism during Fermentation on Softwood Hydrolysate

An economically viable production of second-generation bioethanol by recombinant xylose-fermenting Saccharomyces cerevisiae requires higher xylose fermentation rates and improved glucose–xylose co-consumption. Moreover, xylose-fermenting S. cerevisiae recognises xylose as a non-fermentable rather than a fermentable carbon source, which might partly explain why xylose is not fermented into ethanol as efficiently as glucose. This study proposes propagating S. cerevisiae on non-fermentable carbon sources to enhance xylose metabolism during fermentation. When compared to yeast grown on sucrose, cells propagated on a mix of ethanol and glycerol in shake flasks showed up to 50% higher xylose utilisation rate (in a defined xylose medium) and a double maximum fermentation rate, together with an improved C5/C6 co-consumption (on an industrial softwood hydrolysate). Based on these results, an automated propagation protocol was developed, using a fed-batch approach and the respiratory quotient to guide the ethanol and glycerol-containing feed. This successfully produced 71.29 ± 0.91 g/L yeast with an average productivity of 1.03 ± 0.05 g/L/h. These empirical findings provide the basis for the design of a simple, yet effective yeast production strategy to be used in the second-generation bioethanol industry for increased fermentation efficiency.

Optimisation of the amount of nitrogen enhances quality and yield of pepper

The goals of this study were to explore the characteristics of nitrogen (N) absorption and utilisation of chilli peppers (Capsicum annuum L.), improve the utilisation rate of nitrogen, and provide a theoretical basis for scientific fertilisation. In this experiment, pepper cv. Huoyanjiaowang was used as the material, and potted sand cultures and field randomised block experiments were conducted to study the effects of fertilisation of different forms of nitrogen on the photosynthetic characteristics, chlorophyll, nitrate nitrogen, alkaline nitrogen, capsaicin, dihydrocapsaicin and yield. In the pot experiment, the nitrogen application rates were 0, 10, 100, 320 and 600 mg/L, a level of nitrogen of 100 mg/L significantly inhibited the growth of pepper. With the increase in the application of nitrogen, the photosynthetic capacity gradually decreased, and 10 mg/L was the optimal nitrogen level. Under 0 and 10 mg N/L nitrogen levels in the field experiment, the content of chlorophyll of this group was significantly lower than those of other treatment groups, indicating that the plot lacked nitrogen. With the increase in the level of application of nitrogen, the contents of nitrate nitrogen and alkaline hydrolysis nitrogen in the soil increased. The yield of 153.18 kg/ha and 230 kg/ha nitrogen treatments was relatively high. Therefore, among the five nitrogen treatment levels, treatment with 153.18–230 kg N/ha was the most effective at stimulating the growth and yield of pepper.

Effective Tax Rate Time Trends and its Determinants: Insight From The Corporate Taxpayer Utilising Reinvestment Allowance In Malaysia

This study aims to provide evidence on the trend in corporate tax revenue from the application of time-trend analysis of effective tax rate (ETR) amongst corporate taxpayers in Malaysia who claimed reinvestment allowance (RA) over a decade between 2007 and 2016. This study chose these observation periods because the Malaysian corporate STR has been found to have gradually reduced from 27 per cent to 24 per cent between 2007 to 2016, whereby these changes somehow impacted the tax revenue. Taxpayers who used RA for tax planning pay low taxes over time, determined through tax return data. Then, the study intended to examine the relationships between certain tax attributes, namely, company's profitability (ROA), the reinvestment allowance utilisation rate (RAUTI), type of corporate taxpayers (TPP), the book-tax gap (BTG) and how they associate to the trend in ETR. Reinvestment Allowance (RA) is renowned for being a corporate tax incentive in Malaysia to encourage investments in qualified projects through a tax deduction. An incentivised firm that pays low tax may not be engaging in fraudulent management, as generally assumed. However, it could have been due to tax avoidance strategies that can be observed through reduced or lowered effective tax rate (ETR) across ten years. Keywords: Effective Tax Rates, Tax Avoidance, Reinvestment Allowance, Tax Incentive, Taxation.

Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

Background Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities’ suggestions to improve the services. No study has assessed this in Ethiopia previously. Methods An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases’ diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. Result A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18–0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08–0.09). Children in the age group of 5–14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21–0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09–4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals’ skill and attitudes, and improving affordability and physical accessibility of the services. Conclusion The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

Effectiveness of Model Based Training on Competence Regarding Intra Uterine Contraceptive Device (IUCD) Insertion among Nursing Students at Selected Nursing College

Background of the study: Intrauterine contraceptive devices IUCD are a safe and cost-effective contraceptive method. Despite this, the utilisation rate for IUCDs is relatively low in many countries. Provision of training regarding IUCDs to nurses, is one approach to overcome some of the barriers that may prevent wider uptake of IUCDs. Objectives: To assess the competence of nursing students regarding IUCD insertion. To evaluate the effectiveness of model based training on competence regarding IUCD insertion among nursing students and to find out an association between pre test competence scores of nursing students with their selected socio demographic variables. Methodology: An evaluative study was conducted among 30 final year B.Sc Nursing students of KLES’ Institute of Nursing Sciences, Hubballi. The research design used for the study was Pre-experimental; one group pre-test, post-test design. OSCE based checklist of interval IUCD insertion procedure was used for obtaining the level of competence. Results: The study results revealed that majority of the subjects 20 (66.7%) were females and 14 (46.6%) had previous knowledge regarding IUCD insertion. With respect to competence scores, majority of the subjects in pre-test 24 (80%) had unsatisfactory competence, 6 (20%) had satisfactory competence. In post-test 25 (83.33%) had satisfactory competence, 05 (16.66%) had unsatisfactory competence. After model based training on competence regarding interval IUCD insertion, there was a significant gain in competence i.e 41.4%. The calculated paired ‘t’ value (tcal = 24.44*) was greater than the tabulated value (ttab = 2.045). This indicates that the gain in competence score was statistically significant at 0.05 level of significance. Conclusion: The study concludes that model based training on competence regarding interval IUCD insertion was effective in upgrading the skills of final year B.Sc nursing students. Hence, it is recommended to re-address & improve pre-service nursing education pertaining to the family planning services. Key words: IUCD, competence, OSCE, nursing students, model based training.

P–731 Correlation between fertility rate, utilisation of ART and gross domestic product across Europe

Study question Are there any correlations between a country’s wealth determined by GDP per capita and its total fertility rate (TFR) and utilisation of ART in Europe? Summary answer There is strong correlation across Europe between GDP and utilisation of ART. This correlation does not exist when only investigating the European Economic Area (EEA) What is known already The number of documented ART cycles has increased significantly from 203,893 cycles in 1997 (first European report) to 918,159 in 2016. During the same period, growth was observed in European GDP and, to a lesser extent, TFR following a significant and prolonged decline. Global data suggest that utilisation rate is higher in developed countries, speculated to be due to either generous reimbursement systems or higher affordability for patients paying out of pocket. This study analysed for the first time the relationships between national GDP, TFR and utilisation in Europe both as a whole, and specifically the more affluent EEA Study design, size, duration This study was an analysis of publicly available primary international reports: total cycles in the European IVF-monitoring Consortium (EIM) and TFR, GDP and population size from the World Bank indicators (https://data.worldbank.org/indicator). The period studied ranged from the first EIM report for 1997 (published in 1999) to the 20th report for 2016 (published in 2020). Participants/materials, setting, methods TFR was described as births per women (BPW) and country wealth was presented as GDP per capita in US Dollars. Utilisation rate was defined as the total national number of cycles (fresh IVF and ICSI, and frozen embryo transfer) divided per population, and presented as cycles per million (CPM). When utilisation was not reported, total cycles were projected by proportional calculation. Pearson Correlations were calculated using Sigmaplot for utilisation, GDP and TFR in 2016 Main results and the role of chance Forty countries were included in the EIM report for 2016, of which 18 reported in full. The median utilisation rate was 1280 CPM (range 162 - 3,156) and median TFR was 1.6 BPW (range 1.26 - 2.73); only one country, Kazakhstan, had a TFR above the natural fertility replacement level of 2.1 BPW. Mean GDP was $31604 per capita (range $10,610 - $110,650). There was no correlation between TFR and utilisation or between TFR and GDP, however there was a significant positive correlation between GDP and CPM (correlation coefficient = 0.428; P = 0.00661). Compared to Europe as a whole, analysis of only the EEA countries – EU member states plus Norway, Iceland, and Switzerland – revealed a similar median TFR (1.59), but a 27% increase in the utilisation rate to 1629 CPM (range: 317 – 3157) and 24% rise in GDP per capita to $39,300 (range: $19,885- $110,650). For the EEA, no significant correlations were observed, including between GDP and utilisation (correlation coefficient = 0.131; P = 0.507). Additionally, there was no significant correlation between TFR and GDP in the EU for the period of 1997 – 2016. Limitations, reasons for caution The data is a snapshot of a single year, but we observed similar outcomes in previous years. Projection calculation of utilisation in partially reporting countries may cause bias, however, with a reporting level of 92% (1347 of 1467 clinics), this bias is probably very limited. Wider implications of the findings: Findings of this study confirm that there are strong disparities in the availability of ART even in Europe. This difference does not exist in the more affluent countries in Europe suggesting that the reason for lower utilisation in lower-income countries being reduced affordability. Trial registration number NA