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Background: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh Methods: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Findings: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04–5.38, p < .001 and in phase 2: 15.20 CI: 6.36–36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother’s education, husband’s education, and fetal sex Conclusion: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh. Trial registration: ClinicalTrials.gov . [ABSTRACT FROM AUTHOR]

The safety of highly aggregated tourist crowds is a challenging and important issue. This paper not only provided a comprehensive analysis of the accidents of highly aggregated tourist crowds but also determined the occurrence mechanism and coping paths. Based on the analysis of multiple cases, we found that the variable status of highly aggregated tourist crowds was the result of the interaction of three main elements: multisource pressure, state mutations and management responses. A series of factors interact and result in accidents, and the lack of a management response or a low-quality management response is the root cause of such accidents. A high-quality management response is a basic safety precaution for highly aggregated tourist crowds. Therefore, forming a virtuous circle of multisource pressure, state mutations and management responses is an effective path for coping with accidents. [ABSTRACT FROM AUTHOR]

This paper discusses the necessity of proposing an epistemological approach that focuses on both essential and empirical features of culture. Phenomenology, as we find in Edmund Husserl, is introduced as the main methodology enabling us to establish invariant or essential principles of human culture. We explain how phenomenology analyzes consciousness and its structures, showing a different approach from empirical studies of culture, such as cultural anthropology. Despite these epistemological divergencies, we argue that phenomenology and anthropology should collaborate, and we illustrate this through an analysis of particular Jewish rituals, as an instance of anthropological descriptions and phenomenological analysis. In the first part of the paper, we provide a brief introduction to phenomenology, by outlining the most important concepts to understand this methodology, such as intentionality, constitution, and experiential layers. In the second part, we will use the previous essential analysis of culture as guidelines to analyze a concrete culture, like Judaism, with a focus on specific rituals. While analyzing Judaism unavoidably requires empirical observations in their various forms, phenomenology provides us with a method through which enucleating universal principles underlying contextual and historical elements, which need to be considered as invariant in each human group. [ABSTRACT FROM AUTHOR]

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