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Abstract Background In a post-2015 development agenda, achieving Universal Health Coverage (UHC) for women and newborns will require a fit-for-purpose and fit-to-practice sexual, reproductive, maternal, adolescent and newborn health (SRMNAH) workforce. The aim of this paper is to explore barriers, challenges and solutions to the availability, accessibility, acceptability and quality (AAAQ) of SRMNAH services and workforce. Methods The State of the World’s Midwifery report 2014 used a broad definition of midwifery (“the health services and health workforce needed to support and care for women and newborns”) and provided information about a wide range of SRMNAH workers, including doctors, midwives, nurses and auxiliaries. As part of the data collection, 36 out of the 73 participating low- and middle-income countries conducted a one-day workshop, involving a range of different stakeholders. Participants were asked to discuss barriers to the AAAQ of SRMNAH workers, and to suggest strategies for overcoming the identified barriers. The workshop was facilitated using a discussion guide, and a rapporteur took detailed notes. A content analysis was undertaken using N-Vivo software and the AAAQ model as a framework. Results Across the 36 countries, about 800 participants attended a workshop. The identified barriers to AAAQ of SRMNAH workers included: insufficient size of the workforce and inequity in its distribution, lack of transportation, user fees and out of pocket payments. In some countries, respondents felt that women mistrusted the workforce, and particularly midwives, due to cultural differences, or disrespectful behaviour towards service users. Quality of care was undermined by a lack of supplies/equipment and inadequate regulation. Against these, countries identified a set of solutions including adequate workforce planning supported by a fast and equitable deployment system, aligned with the principles of UHC. Acceptability and quality could be improved with the provision of respectful care as well as strategies to improve education and regulation. Conclusions The number and scale of the barriers still needing to be addressed in these 36 countries was significant. Adequate planning and policies to support the development of the SRMNAH workforce and its equitable distribution are a priority. Enabling strategies need to be put in place to improve the status and recognition of midwives, whose role is often undervalued.

Background: Many countries are responding to the global shortage of midwives by increasing the student intake to their midwifery schools. At the same time, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. Methods of assuring quality of education include accreditation schemes, but capacity to implement such schemes is weak in many countries. Objective: This paper describes the process of developing and pilot testing the International Confederation of Midwives’ Midwifery Education Accreditation Programme (ICM MEAP), based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns. Methods: A review of relevant global, regional and national standards and tools informed the development of a set of assessment criteria (which was validated during an international consultation exercise) and a process for applying these criteria to midwifery schools. The process was pilot tested in two countries: Comoros and Trinidad and Tobago. Results: The assessment criteria and accreditation process were found to be appropriate in both country contexts, but both were refined after the pilot to make them more user-friendly. Conclusion: The ICM MEAP has the potential to contribute to improving health outcomes for women and newborns by building institutional capacity for the provision of high-quality midwifery education and thus improved quality of midwifery care, via improved accountability for the quality of midwifery education.

Globally, the burden of deaths and illness is still unacceptably high at the day of birth. Annually, approximately 300.000 women die related to childbirth, 2.7 million babies die within their first month of life, and 2.6 million babies are stillborn. Many of these fatalities could be avoided by basic, but prompt care, if birth attendants around the world had the necessary skills and competencies to manage life-threatening complications around the time of birth. Thus, the innovative Helping Babies Survive (HBS) and Helping Mothers Survive (HMS) programs emerged to meet the need for more practical, low-cost, and low-tech simulation-based training. This paper provides users of HBS and HMS programs a 10-point list of key implementation steps to create sustained impact, leading to increased survival of mothers and babies. The list evolved through an Utstein consensus process, involving a broad spectrum of international experts within the field, and can be used as a means to guide processes in low-resourced countries. Successful implementation of HBS and HMS training programs require country-led commitment, readiness, and follow-up to create local accountability and ownership. Each country has to identify its own gaps and define realistic service delivery standards and patient outcome goals depending on available financial resources for dissemination and sustainment.

Globally, the burden of deaths and illness is still unacceptably high at the day of birth. Annually, approximately 300.000 women die related to childbirth, 2.7 million babies die within their first month of life, and 2.6 million babies are stillborn. Many of these fatalities could be avoided by basic, but prompt care, if birth attendants around the world had the necessary skills and competencies to manage life-threatening complications around the time of birth. Thus, the innovative Helping Babies Survive (HBS) and Helping Mothers Survive (HMS) programs emerged to meet the need for more practical, low-cost, and low-tech simulation-based training. This paper provides users of HBS and HMS programs a 10-point list of key implementation steps to create sustained impact, leading to increased survival of mothers and babies. The list evolved through an Utstein consensus process, involving a broad spectrum of international experts within the field, and can be used as a means to guide processes in low-resourced countries. Successful implementation of HBS and HMS training programs require country-led commitment, readiness, and follow-up to create local accountability and ownership. Each country has to identify its own gaps and define realistic service delivery standards and patient outcome goals depending on available financial resources for dissemination and sustainment. [ABSTRACT FROM AUTHOR]

Background: Education, regulation and association (ERA) are the supporting pillars of an enabling environment for midwives to provide quality care. This study explores these three pillars in the 73 low- and middle-income countries who participated in the State of the World's Midwifery (SoWMy) 2014 report. It also examines the progress made since the previous report in 2011.Methods: A self-completion questionnaire collected quantitative and qualitative data on ERA characteristics and organisation in the 73 countries. The countries were grouped according to World Health Organization (WHO) regions. A descriptive analysis was conducted.Results: In 82% of the participating countries, the minimum education level requirement to start midwifery training was grade 12 or above. The average length of training was higher for direct-entry programmes at 3.1 years than for post-nursing/healthcare provider programmes at 1.9 years. The median number of supervised births that must be conducted before graduation was 33 (range 0 to 240). Fewer than half of the countries had legislation recognising midwifery as an independent profession. This legislation was particularly lacking in the Western Pacific and South-East Asia regions. In most (90%) of the participating countries, governments were reported to have a regulatory role, but some reported challenges to the role being performed effectively. Professional associations were widely available to midwives in all regions although not all were exclusive to midwives.Conclusions: Compared with the 2011 SoWMy report, there is evidence of increasing effort in low- and middle-income countries to improve midwifery education, to strengthen the profession and to follow international ERA standards and guidelines. However, not all elements are being implemented equally; some variability persists between and within regions. The education pillar showed more systematic improvement in the type of programme and length of training. The reinforcement of regulation through the development of legislation for midwifery, a recognised definition and the strengthening of midwives' associations would benefit the development of other ERA elements and the profession generally. [ABSTRACT FROM AUTHOR]

The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality. [ABSTRACT FROM AUTHOR]

The June 2013 flood in the Upper Danube basin was one of the largest floods in the past two centuries. An atmospheric blocking situation produced precipitation exceeding 300mm over four days at the northern rim of the Alps. The high precipitation along with high antecedent soil moisture gave rise to extreme flood discharges in a number of tributaries including the Tiroler Ache, Saalach, Salzach and Inn. Runoff coefficients ranged from 0.2 in the Bavarian lowlands to 0.6 in the Alpine areas in Austria. Snowfall at high altitudes (above about 1600ma.s.l.) reduced the runoff volume produced. Precipitation was distributed over two blocks separated by a few hours which resulted in a single peak, long duration flood wave at the Inn and Danube. At the confluence of the Bavarian Danube and the Inn, the small time lag between the two flood waves exacerbated the downstream flood at the Danube. Because of the long duration and less inundation, there was less flood peak attenuation along the Austrian Danube reach than for the August 2002 flood. Maximum flood discharges of the Danube at Vienna were about 11 000 m³ s-1, as compared to 10 300, 9600 and 10 500 m³ s-1 in 2002, 1954 and 1899, respectively. This paper reviews the meteorological and hydrological characteristics of the event as compared to the 2002, 1954 and 1899 floods, and discusses the implications for hydrological research and flood risk management. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the snow routine of a semi-distributed conceptual water balance model calibrated to streamflow data alone. The model is used for operational flood forecasting in 57 catchments in Austria and southern Germany with elevations ranging 200-3,800 m a.s.I. We compared snow water equivalents (SWE) simulated by the hydrologic model with snow covered area (SCA) derived from a combined product of MODIS (version 5) Terra and Aqua satellite data for the period 2003-200:2 using efficiency measures and a spatial analysis. In the comparison, thresholds for percent catchment snow cover and a cut-off water equivalent need to be chosen with care as they affect the snow model efficiency. Results indicate that the model has a tendency to underestimate snow cover in prealpine areas and forested areas while it performs better in alpine catchments and open land. The spatial analysis shows that for 88% of the analysed model area snow cover is modelled correctly on more than 80% of the days. The space borne snow cover data proved to be very useful for evaluating the snow model. We therefore suggest that the snow data will be similarly useful for data assimilation in real time flood forecasting. [ABSTRACT FROM AUTHOR]

Flood forecasts are generally associated with errors, which can be attributed to uncertainties in the meteorological forecasts and the hydrologie simulations, and ensemble spreads are usually considered capable of representing them. To quantify these two components of the total forecast errors and to compare these to ensemble spreads, an extended data set is used. Four years of operational flood forecasts at hourly time step with lead times up to 48 h are evaluated for 43 catchments in Austria and Germany. Catchment sizes range from 70 to 25,600 km², elevations from 200 to 3800 m, and mean annual precipitation from 700 to 2000 mm. A combination of ECMWF and ALADIN ensemble forecasts are used as input in a semidistributed conceptual water balance model on an hourly time step. The results indicate that, for short lead times, the ratio of hydrological simulation error to precipitation forecast error is 1.2 to 2.7 with increasing catchment size from 100 to 10,000 km². For long lead times the ratio of hydrological simulation error to precipitation forecast error decreases from 1.1 to 0.9 with increasing catchment size. Clear scaling relationships of the forecast error components with catchment area are found. A similar scaling is also found for ensemble spreads, which are shown to represent quantitatively the total forecast error when forecasting floods. [ABSTRACT FROM AUTHOR]

This paper reports on experience with developing the flood forecasting model for the Upper Danube basin and its operational use since 2006. The model system consists of hydrological and hydrodynamic components, and involves precipitation forecasts. The model parameters were estimated based on the dominant processes concept. Runoff data are assimilated in real time to update modelled soil moisture. An analysis of the model performance indicates 88% of the snow cover in the basin to be modelled correctly on more than 80% of the days. Runoff forecasting errors decrease with catchment area and increase with forecast lead time. The forecast ensemble spread is shown to be a meaningful indicator of the forecast uncertainty. During the 2013 flood, there was a tendency for the precipitation forecasts to underestimate event precipitation and for the runoff model to overestimate runoff generation which resulted in, overall, rather accurate runoff forecasts. It is suggested that the human forecaster plays an essential role in interpreting the model results and, if needed, adjusting them before issuing the forecasts to the general public.

Background: In a post-2015 development agenda, achieving Universal Health Coverage (UHC) for women and newborns will require a fit-for-purpose and fit-to-practice sexual, reproductive, maternal, adolescent and newborn health (SRMNAH) workforce. The aim of this paper is to explore barriers, challenges and solutions to the availability, accessibility, acceptability and quality (AAAQ) of SRMNAH services and workforce.Methods: The State of the World's Midwifery report 2014 used a broad definition of midwifery ("the health services and health workforce needed to support and care for women and newborns") and provided information about a wide range of SRMNAH workers, including doctors, midwives, nurses and auxiliaries. As part of the data collection, 36 out of the 73 participating low- and middle-income countries conducted a one-day workshop, involving a range of different stakeholders. Participants were asked to discuss barriers to the AAAQ of SRMNAH workers, and to suggest strategies for overcoming the identified barriers. The workshop was facilitated using a discussion guide, and a rapporteur took detailed notes. A content analysis was undertaken using N-Vivo software and the AAAQ model as a framework.Results: Across the 36 countries, about 800 participants attended a workshop. The identified barriers to AAAQ of SRMNAH workers included: insufficient size of the workforce and inequity in its distribution, lack of transportation, user fees and out of pocket payments. In some countries, respondents felt that women mistrusted the workforce, and particularly midwives, due to cultural differences, or disrespectful behaviour towards service users. Quality of care was undermined by a lack of supplies/equipment and inadequate regulation. Against these, countries identified a set of solutions including adequate workforce planning supported by a fast and equitable deployment system, aligned with the principles of UHC. Acceptability and quality could be improved with the provision of respectful care as well as strategies to improve education and regulation.Conclusions: The number and scale of the barriers still needing to be addressed in these 36 countries was significant. Adequate planning and policies to support the development of the SRMNAH workforce and its equitable distribution are a priority. Enabling strategies need to be put in place to improve the status and recognition of midwives, whose role is often undervalued. [ABSTRACT FROM AUTHOR]

Provides information on the celebration of the International Day of the Midwife (IDM) in 2005. Background on the Campaign for Normal Birth promotion of the Royal College of Midwives; Issuance of an IDM press release by the American College of Nurse-Midwives; Formation of an organization called For Love of Women.

Studies the effect of allogeneic peripheral stem cell transplantation in a patient with job syndrome of hyperimmunoglobulinemia E and recurrent infections. Description of research methodology used; Examination of the patient's medical history; Details on the diagnosis of job syndrome; Medical treatment given to the patient.

Background: Volume-reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out-of-group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD-A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue., Study Design and Methods: This report compares corrected count increments (CCIs) from full-volume and ACD-A acidified volume-reduced human platelets in a retrospective study at a single hospital and in a mouse model., Results: At a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20-month study period. Among all patients, the expected 4-h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full-volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD-acidified volume-reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24-h mean CCI: 6.3 (95% CI: 5.5-7.0) with full-volume platelet, 4.7 (95% CI: 3.6-6.0) with ACD-acidified volume-reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4- and 24-h predicted CCIs, showing lower CCIs in ACD-acidified volume-reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count-adjusted, volume-reduced platelets was significantly lower in mice, suggesting a procedure-related defect., Discussion: ACD-A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4-h and 24-h platelet increments., (© 2024 AABB.)

Purpose: Utilization of technology-assisted workflow (TAWF) systems has gained popularity in the sterile compounding setting. This study was designed to evaluate whether safety and efficiency could be seen when preparing oral controlled substance doses gravimetrically vs volumetrically., Methods: This 2-phase observational study combined manual data collection with automated logs generated by a single TAWF. During phase I, oral controlled substance solutions were prepared volumetrically. In phase II, the same subset of medications was to be prepared gravimetrically via the same TAWF. Findings from phases I and II were compared against each another to determine safety, efficiency, and documentation differences between the volumetric and gravimetric workflows., Results: Thirteen different medications were evaluated during phase I (1,495 preparations) and phase II (1,781 preparations) of this study. Mean compounding time (min:sec) increased in phase II when compared to phase I (1:49 vs 1:28; P < 0.01), with the deviation detection rate also increasing (7.9% vs 4.7%; P < 0.01). Despite a target in phase II of utilizing gravimetric analysis for more than 80% of preparations, only 45.5% (811 preparations) were prepared with this workflow, as adoption challenges and dose size limitations prevented compliance. Doses that were prepared gravimetrically had a mean accuracy rate of 100.6% (the mean achieved dose was 0.6% higher than the mean prescribed dose) and a rejection rate of 0.99% (compared to the phase I rejection rate of 1.07%; P = 0.67)., Conclusion: The gravimetric workflow provided accuracy and additional safety checks when compared to the volumetric alternative, all while providing users with greater access to data. Health systems should consider staffing, product sourcing, patient populations, and medication safety when determining the balance between volumetric and gravimetric workflows., (© American Society of Health-System Pharmacists 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)