Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya.

BACKGROUND: In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. METHODS: This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2-6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. RESULTS: Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others' perspectives on delivery location and lack of aides/escorts. CONCLUSIONS: Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women's preferences.

Discovery and Contribution of Nontypeable Haemophilus influenzae NTHI1441 to Human Respiratory Epithelial Cell Invasion.

Nontypeable Haemophilus influenzae (NTHi) is the primary cause of bacterially induced acute exacerbations of chronic obstructive pulmonary disease (COPD). NTHi adheres to and invades host respiratory epithelial cells as a means to persist in the lower airways of adults with COPD. Therefore, we mined the genomes of NTHi strains isolated from the airways of adults with COPD to identify novel proteins to investigate their role in adherence and invasion of human respiratory epithelial cells. An isogenic knockout mutant of the open reading frame NTHI1441 showed a 76.6% ± 5.5% reduction in invasion of human bronchial and alveolar epithelial cells at 1, 3, and 6 h postinfection. Decreased invasion of the NTHI1441 mutant was independent of either intracellular survival or adherence to cells. NTHI1441 is conserved among NTHi genomes. Results of whole-bacterial-cell enzyme-linked immunosorbent assay (ELISA) and flow cytometry experiments identified that NTHI1441 has epitopes expressed on the bacterial cell surface. Adults with COPD develop increased serum IgG against NTHI1441 after experiencing an exacerbation with NTHi. This study reveals NTHI1441 as a novel NTHi virulence factor expressed during infection of the COPD lower airways that contributes to invasion of host respiratory epithelial cells. The role in host cell invasion, conservation among strains, and expression of surface-exposed epitopes suggest that NTHI1441 is a potential target for preventative and therapeutic interventions for disease caused by NTHi.

Equinodermos (Echinodermata) de las aguas mexiacanas del Golfo de México / Echinoderms (Echinodermata) from the Mexican waters of the Gulf of Mexico

We present a systematic list of the echinoderms from Gulf of Mexico's Mexican waters based on specimens of the Colecci6n Nacional de Equinodermos, Instituto de Ciencias del Mar y Limnologia, Universidad Nacional Aut6noma de México and the National Museum of Natural History, Smithsonian Institution, Washington, D.C. This list reveals an important echinoderm biodiversity present in the Gulf of Mexico, where five of the six echinoderm classes are represented. A total of 209 echinoderm species is recorded, distributed in 129 genera, 63 families and 25 orders. 31 new records for the Gulf of Mexico are presented: Asteroidea (16), Ophiuroidea (nine), Echinoidea (one) and Holothuroidea (five).

Equinodermos (Echinodermata) del Caribe Mexicano / Echinoderms (Echinodermata) of the Mexican Caribbean

A systematic list of the echinoderms of the Mexican Caribbean based on museum specimens of the Colección Nacional de Equinodermos, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México and the National Museum of Natural History, Smithsonian Institution, Washington, D.C. is presented. This list reveals an important echinoderm biodiversity in the Mexican Caribbean, where five of the six echinoderm classes are represented. A total of 178 echinoderm species is recorded, distributed in 113 genera, 51 families and 22 orders. 30 new records for the Mexican Caribbean are presents: Crínoidea (three), Asteroidea (two), Ophiuroidea (eleven), Echinoidea (one), Holothuroidea (thirteen).

Equinodermos (Echinodermata) del Golfo de California, México / Echinoderms (Echinodermata) from the Gulf of California, Mexico

A systematic list of the echinoderms of the Gulf of California, based on museum specimens of the Colección Nacional de Equinodermos, Instituto de Ciencias del Mar y Limnologia, Universidad Nacional Autónoma de México and the National Museum of Natural History, Smithsonian Institution, Washington, D.C. is presented. A total of 193 echinoderm species is recorded, distributed in 108 genera, 51 families and 19 orders. 12 new records for the Gulf of California are presented: Asteroidea (four), Ophiuroidea (three) and Holothuroidea (five).

Just a spoonful of humanities makes the medicine go down: introducing literature into a family medicine clerkship.

BACKGROUND: This project introduced medicine-related poetry and prose to a Year 3 family medicine clerkship with the purpose of determining students' perception of the usefulness of such materials to enhance empathy, improve patient management, and reduce stress. Although humanities are represented in the curricula of many medical schools, we need more information on how best to incorporate them during the clinical years. METHOD: In 2000, we used a needs assessment survey to identify learner perceptions of medical humanities. Using this information, in 2001-03 we developed and implemented a humanities-based curriculum consisting of readings linked to clinical vignettes, comments about humanities reading in required clinical Subjective, Objective, Assessment, Plan (SOAP) notes, and either station-specific or general poetry accompanying student end-of-clerkship objective structured clinical examinations. We collected both quantitative and qualitative data assessing student reactions and examined the data using non-parametric statistics and content analysis, respectively. RESULTS: Students showed moderate interest in incorporating humanities in medical education as a way of enhancing empathy, improving understanding and reducing frustration. Assessment of the clerkship humanities curriculum suggested a positive influence on students in terms of empathy for the patient's perspective, and a lesser, but still positive, impact on patient management. DISCUSSION: Responses from this group of learners suggest that there is receptivity toward introducing medical humanities into family medicine curricular venues and that such effort can have a generally positive effect on learner empathy, awareness and understanding toward patients and doctors.