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Converting the Rehoboth Beach Convention Center into a first-class auction venue and then transforming it again into a high-energy dance club, all within the space of a single weekend, takes enormous energy, resources, commitment, and dedication.
Fortunately, that heart in the center of the CAMP Rehoboth logo isn’t just a graphic. The love supporters feel for the organization and its goals clearly figures into Sundance. Team captains for the event recently provided a rare, behind-the-scenes view of what it takes to pull off the two-day event, which will be held Saturday-Sunday, Aug. 30-31.
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Volunteers are organized into teams, and team captains each have their own crew of helpers and specific areas of responsibility. For many, Sundance is more than just a fundraiser. “The thing that is most amazing is that we have had some of the same hosts, supporters, auction donors, and volunteers since the inception of Sundance,” says Charlie Lee, who started his involvement with Sundance by volunteering to pick up auction items and is now responsible for generating the massive database used for, among other things, producing the more than 600 thank-you letters needed to acknowledge all the people, businesses, and organizations that contribute to the event each year. “Sundance is the ultimate CAMP benefit that brings everyone together,” he says.
Jane Blue, who manages the food for Sundance with the help of Steve Elkins (one of the event’s founders) adds, “To me, Sundance means camaraderie. It seems like our whole community comes together for a week of summer fun and laughs. It has always been my favorite CAMP event. It really pumps my adrenaline.”
Karl Zoric, Mark Pipkin, Michael Fetchko, and Keith Petrack are known as the beach team ticket sales captains. They gather each year on Poodle Beach under a big white tent the last two weekends in August to promote Sundance and sell tickets. In addition, they sell tickets in the CAMP Courtyard and even work the streets of D.C. to gather donations large and small for the auction.
“The highlight for all of us as team captains is participating in the live auction and being part of ‘Team Vanna’ with Sandra Skidmore as our lead, showcasing the auction items on stage,” says Zoric. “Being a Sundance team captain is our way of giving back to CAMP Rehoboth and the important work they do to support our community,” adds Pipkin.
Another key part of the event involves setting the scene for fun. Cathin Bishop is one of the décor captains. “I work with Murray and the other captains to bring his vision to reality,” she says. “Sometimes, it can be more engineering and construction than décor, but we figure it out. I love the way we work together. Some of us may not see one another all year, but we fall right into sync with each other and the process just purrs.”
An essential part of Sundance Weekend is the silent auction, when the Rehoboth Beach Convention Center is filled with hundreds of incredible gift items, vacation packages, dining opportunities, pieces of fine art, and one-of-a-kind experiences donated by the many generous businesses and individuals of the Rehoboth/Lewes area and beyond. Bob Hoffer and Max Dick direct this effort, which involves calling upon area businesses and organizations to ask what they might be able to contribute, picking up the donations, and delivering them to CAMP headquarters, where they must be organized, labeled, and prepared for display.
Murray Archibald, event cofounder, can’t help being a little dazzled himself, at both the generosity of the volunteers and the continued growth and success of the event. “As the producers of Sundance for 27 years, Steve and I are always deeply moved by the incredible commitment that our team captains and their crews bring to the event. Many of them have been doing this for years - some for decades! They are our Sundance family, and there’s always room for more!”
Sundance raises much-needed funds for CAMP Rehoboth, an organization that operates a full-service community center; offers a variety of activities, cultural events, service projects, and educational programs; and advocates for a community of inclusion in Rehoboth Beach. Individuals and organizations can be a part of the event through ticket purchases or sponsorships, which start at just $100. All proceeds from the event benefit CAMP Rehoboth, a 501c3 nonprofit corporation, and support the activities and programs it provides to the Rehoboth community. For more information, go to camprehoboth.com.


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Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre–Post Interventional Study
Received 29 July 2020
Accepted for publication 25 September 2020
Published 13 October 2020 Volume 2020:12 Pages 835—847
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Everett Magann
Habtamu Mihret,1 Asmamaw Atnafu,2 Tsegaye Gebremedhin,2 Endalkachew Dellie2
1Injibara General Hospital, Awi Zone administration, Amhara National Regional State, Injibara, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Correspondence: Endalkachew Dellie
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar Po. Box 196, University of Gondar, Gondar, Ethiopia
Email [email protected]
Introduction: Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia.
Materials and Methods: A pre–post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of < 0.05 and a mean difference with 95% CI was used to test the significance of the interventions.
Results: The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55– 0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline.
Conclusion: Respectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in‐service training of healthcare workers may indorse the practice of respectful maternal care.
Keywords: disrespect, abuse, pregnancy, delivery, intervention, Ethiopia
Disrespect and abuse during pregnancy and childbirth at the health facilities are documented as a global problem, but worse in low-income countries such as Ethiopia.1–4 Such disrespect and abuse not only violate women’s rights to compassionate and respectful maternity care, but it can also threaten women’s rights to life, health, bodily integrity, and freedom from discrimination.4–7 It is one of the most important barriers to maternal service utilization, quality of care problems, and often a violation of women ‘s human rights.8–10 However, it received less attention as compared to other more commonly recognized barriers such as access and financial obstacles of maternal care during childbirth.11
Disrespect and abuse (D&A) during childbirth determine the quality of maternal care and it is one of the indicators of a violation of women’s basic human rights.8,12 It includes both the behavior of healthcare providers and structural deficiencies from human rights standards of good quality care or recommended professional practices.13 Scholars classify facility-based D&A into seven categories: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care, and detention in facilities.6
Although much has been done to ensure access to health services, in Ethiopia a lack of quality services and low utilization of maternal health service continues to be a challenge.14–17 Every year. One of 52 mothers has a chance to die from pregnancy and childbirth related problems.18 Delays in seeking care, delays in transport to facilities and delay in providing services inside facilities contribute for these maternal deaths.19,20 Although the direct maternal services are offered free of charge, a limited number of skilled staff, inadequate essential drugs and supplies to health facilities and disrespect or humiliation of women by healthcare providers after reaching health facilities also hinder the use of maternal care.21–23
In Africa, the prevalence of D&A ranges from 13.9% in Malawi24 to 98% in Nigeria.25 Similarly, studies in different parts of Ethiopia on the issue reported a high prevalence, ranging from 36–98.9%.2,26–30
Disrespect and abuse are universal maternal health care utilization problems. However, it is unspoken that has been attributed to courtesy bias where women do not tend to report D&A while still in the health facility.31 In some cases, policymakers, program managers, and care providers are unaware of the disrespect and abuse experienced in their settings or the settings they are responsible for. In other cases, the people entrusted with women’s care and their newborns may recognize a need for respectful maternal care (RMC) but may feel ill-equipped to address the need.11 The lack of legal and ethical foundations to address D&A, lack of leadership in this area, lack of standards and accountability, provider prejudice due to lack of training and resources, and normalizing disrespect and abuse may contribute to this experience.6,32
The provision of compassionate and respectful maternity care during pregnancy and childbirth has become one of the key components of improving the quality of maternity service,31 to reduce maternal mortality and morbidity and to meet the Sustainable Development Goals (SDGs) of reducing maternal mortality ratio (MMR) to 70 per 100,000 live births.33,34 There are however rare interventional studies in Ethiopia on how to reduce disrespect and abuse. Hence, this study aimed at improving respectful maternal care through simple interventions. The information generated from this study will provide managers to design appropriate strategies to address women’s disrespect and abuse during Antenatal Care (ANC) and delivery services.
Materials and Methods
Study Design and Setting
A pre–post interventional mixed-method (quantitative and qualitative) design was conducted at Injibara general hospital, to reduce D&A during pregnancy and childbirth from November 1, 2018 to May 20, 2019.
Injibara general hospital is located in northwest Ethiopia, which is 144 and 450 kilometers far from Bahirdar (the capital city of Amhara National Regional State) and Addis Ababa, respectively. The hospital provides outpatient, inpatient, adult and neonatal intensive care unit, surgery and other diagnostic and laboratory services for around 1.2 million catchment population in Awi zonal administrative. It has a total of three hundred four health workforces and serves as a referral site for 107 private health facilities, four primary hospitals, forty-four health centers and 185 health posts. Mothers who came for antenatal care follow up and delivery services from November 1 to 10, 2018 for pre-intervention and from May 1 to 10, 2019 for post-intervention at Injibara general hospital were included in the study. The interventions were provided from December 11, 2018, to April 30, 2019. Pregnant and labouring mothers who could not communicate and unconscious of being interviewed were excluded from the exit interview.
Root Causes Analysis and Selection of Interventions
The identification and selection of root causes and interventions to reduce D&A during antenatal care and delivery services at the hospital were undertaken through a participatory approach of a multidisciplinary team. The multidisciplinary team consisted of the senior hospital management team, midwifery department coordinator, ANC focal person, gynecologists, hospital quality officer, plan and program officer, health management information system (HMIS) officer.
Initially, structured group discussions and interviews were conducted with senior midwiferies, gynecologists and a quality assurance officer. Observation was also made in the labour-delivery and ANC clinics, and empirical evidence reviewed. The fishbone diagram was then used as a method of root cause analysis to extract the possible root causes of D&A of pregnant and labouring mothers at the point of care.35 We use the fish-bone diagram as a root cause analysis tool because it is more suitable to identify multiple root causes of problems with different themes/perspectives at the same time.35 Then in our interventional study, the possible root causes of poor respectful maternal care were thematized under people (Knowledge, skills, feedback, motivation, support …), policy and procedure (guidelines, rules, regulations …), Medical equipment and supply (eg delivery coach, ultrasound, …), and environment (internal and external) related factors.
Accordingly, poor monitoring and evaluation systems, poor knowledge and skill of staff towards respectful care and poor provider motivation were identified as possible root causes related to people. Under the medical equipment and supply related theme, the absence of some required medical equipment (eg ultrasound, blood pressure apparatus, delivery coach …) and absence of certain essential drugs and supplies for the provision of maternal health services were identified as possible root causes. Whereas, the policy and procedure-related root causes were unavailabilities of written policies that describe the responsibilities of healthcare providers in the respectful maternal care process, absence of written professional code of conduct and ethics for health care providers at the labour wards and ANC clinic, a poor system for reporting illegal, incompetent or impaired practices. Moreover, poor infrastructure, poor working environment and poor support from the regional health bureau were the identified environment-related possible root-causes for low respectful maternal care at Ingibara general hospital.
Subsequently, identification and selection of proposed interventions were made that might address those identified root causes, and the proposed intervention was prioritized by evaluation criteria. The criteria used were: effectiveness/impact (how much will it decrease the problem), time (how long will it take to work), feasibility (is there capacity/stakeholder support/will the culture accept it), and cost (how expensive is the intervention to carry out).36,37 These criteria were chosen to prioritize the interventions because they were the most suitable criteria as it provides a structured approach for comparison and selection of best interventions that help to overcome the stated problem.36 Each criterion was measured by using a five-point Likert scale (from one to five) and the highest scores were considered as the best intervention to reduce D&A during pregnancy and childbirth. The overall interventions were presented and well-defined using the logical framework matrix (Table 1).
Table 1 Log Frame Matrix for Reducing Disrespectful and Abuse of Maternal Care Among Labouring and ANC Follow-Up Mothers at Injibara General Hospital, Northwest Ethiopia, May 2019
After that, training to healthcare providers on Compassionate Respectful and Caring (CRC) with strong attention to respectful maternal care to improve the knowledge and practice of staff towards respectful care was chosen as the primary intervention. Preparation of written guidelines and protocols describing the responsibilities of healthcare providers in the respectful maternal care process was chosen as a secondary intervention. Improving facility infrastructure (eg establishing waiting room for pregnant and labouring mothers, family member/support person, avail screens or curtain to maintain privacy and sufficient space to walk around, bathroom and toilet with a door that is accessible and has a handwashing sink with soap and water for both labouring and pregnant mothers); availing all the required equipment, essential drugs, and supplies for maternal health service provision; establishing regular monitoring and evaluation practice through supportive supervision and mentoring and recognizing for good performance employees were the other subsequent intervention chosen to improve RMC at Ingibara general hospital.
A total of one hundred thirty-three health care providers and supervisors (midwives, case managers, coordinators, porters, medical record unit coordinators and liaison officers) working in the hospital had undergone a five-day training in collaboration with the University of Gondar and Amhara National Regional State Health Bureau, including modules on patient-centered care; respectful maternal care, planning, monitoring, and implementation of CRC; client-provider interaction; facilitation of patients’ and families’ participation in decisions and care; and communication with teams and health care ethics.
The hospital established one waiting room with eight beds equipped with mattresses, a television, private bathroom, toilet, and maternal reception room with food services for those mothers who came for delivery by integrating it with the hospital’s inpatient department.
Furthermore, a sufficient number of screens or curtains were availed to maintain the privacy of mothers during service provision. Written guidelines and protocols describing the responsibilities of nursing/midwifery for the nursing/midwifery process including the admission assessment, planning, implementation and evaluation of nursing/midwifery care were prepared by the senior midwiferies and the quality assurance team and approved by the senior management body of the hospital. Moreover, all essential drugs and supplies for the provision of maternal health services were satisfied; the monitoring and evaluation system through supportive supervision and mentorship were established. At the same time, a protocol for recognizing high-performing employees was developed by the hospital human resource management team in collaboration with the quality assurance team. All these interventions were worked-out with the involvement and promises of the healthcare providers.
Regarding supportive supervision and mentoring activities, supervisors conduct monitoring and evaluation activities every two weeks using specially designed mentorship checklists developed by the quality assurance team in collaboration with the labour and delivery department of the hospital. In the six months intervention period from December to May 2019, they missed only one supervision and mentorship. The mentorship tool had a structured questionnaire on the RMC practice and a request box for feedback. The supervisors interviewed six mothers from the labour ward and three mothers from the ANC follow-up clinic. Then a discussion was held with the project investigator, the quality assurance team and healthcare providers working at both service points about the findings of mentorship and pursue suggestions for future improvements in RMC.
Primary Outcomes (Process Measures)
The availability of written policies, protocols and monitoring and evaluation guidelines for improving RMC practice, the number of trained healthcare providers and supervisors, number of stockout report on essential drugs and supplies for the provision of maternal healthcare services, the availability of separate waiting rooms for labouring and ANC follow-up clients, availability of screens or curtain in sufficient number, the number of supportive supervisions and mentorship conducted, availability of mentorship written feedbacks provided to delivery and ANC follow-up service units, number of recognized high performer employees in each month by the end of May 2019 were the process measures.
Secondary Outcomes (Outcome Measures)
The proportion of disrespect and abuse among pregnant and labouring mothers was the outcome measure.
Variables and Measurements
Disrespect and Abuse
Was defined as any form of inhumane treatment or uncaring behavior toward a woman during labour and delivery that is related to any of the seven categories of mistreatment listed as physical abuse, non-consented care, non-confidential care, non-dignified care, abandonment, or denial of care, discrimination and detention in facilities. It is measured by a total of 24 questions with dichotomous (Yes/No) response adapted from a landscape analysis by Bowser and Hill to explore evidence for disrespect and abuse in facility-based childbirth.6 If a woman responded any yes from the total questions considered as “abused or mistreated”; otherwise considered as “not abused or mistreated”.6
Physical force or abrasive behavior with the woman, including slapping or hitting and touches measured using seven criteria.6 A woman who answers yes to at least one criteria was considered as being abused at the time of labour and delivery.
The absence of informed consent, or patient communication, forced procedure, measured using seven criteria.6 A Women who answer yes to at least one criteria was considered as being abused at the time of labour and delivery.
Lack of confidentiality and lack of privacy during maternal care measured using two criteria.6 A woman who answers yes to at least one of the criteria was considered as being abused at the time of labour and delivery.
Non-Dignified Care (Including Verbal Abuse)
Lack of dignity, respect and intentionally humiliating, scolding, or shouting at patient’s value and for women; measured using two criteria.6 A woman who answers yes to at least one of the criteria was considered as being abused at the time of labour and delivery.
Lack of equitable care measured using two criteria.6 A woman who answers yes to at least one criteria was considered as being abused at the time of labour and delivery.
Abandonment or Denial of Care
Lack of right to timely healthcare and to the highest attainable level of health, measured using three criteria,6 and a woman who answers yes to at least one of the criteria was considered as “abused at the time of labour and delivery”.
Women Development Army (WDA)
A women-centered voluntary community strategy to support and own primary health care activities in the community, particularly maternal health services.38 Members of the WDA are organized by the neighborhood. 25–30 women are organized with a leader in the army and five to six sub-groups with five to six members are formed within it. The WDA is expected to hold weekly discussions among members on health needs, to monitor and support pregnant women to ensure the continuum of care from pregnancy to postnatal, and to support the referral system to health care facilities.38,39
Sample Size and Sampling Procedures
The sample size was determined by using a single population proportion formula (n = (Zα/2)2*P (1-P)/(d)2) with the assumptions of 95% confidence level (CI), 5% margin of error, the proportion of disrespect and abuse 66.7% from a study conducted at Bahirdar health facilities among mothers during childbirth28 and 10% for non-response rate, which yields 374. Then, a total of 748 mothers were interviewed for pre- and post-intervention (374 for each) assessment. Moreover, a total of ten key informants (three health care providers, four women development army leaders, and three mothers with at least three ANC visits in the hospital) were involved. The samples were proportionally allocated to the ANC and delivery ward, based on the past three-months hospital average client flow reports. Then, a systematic random sampling technique was employed to obtain the calculated samples from ANC and delivery wards. For the qualitative part; key informants were selected purposively based on their special characteristics such as knowledge, status, communication skills and value for the community under study.
Data Collection Tools and Procedures
A pre-tested interviewer-administered structured questionnaire was used for the quantitative data collection. To ensure consistency, the questionnaire was first developed in English and translated into the local languages (Agew and Amharic) and finally back to English. A total of four non-clinical staff data collectors from the hospital’s antiretroviral therapy clinic and one supervisor were recruited and two days of training were provided before the data collection.
For the qualitative part data were collected through face-to-face interviews using a semi-structured interview guide. The principal investigator designed the guiding questions by considering existing literature on respectful and abusive maternal care, and also reviewed by experts in maternal care. The interviews were conducted by senior midwiferies from the Injibara health center. The interviewer was trained by the principal investigator in the use of the guide and probing for more detail on disrespectful maternal care. The interview was conducted in the local languages, Amharic or Agew at venues convenient to the participant, and took an average of 20 minutes. During each interview audio-records and field notes were taken with the participants’ consent.
Data Quality Control
Before data collection, two days of training was provided to data collectors and supervisors on the basic techniques of data collection and supervision. Supervisors checked data accuracy, consistency, and completeness daily. The pre-test (5% of sample size) was done at the Injibara health center (one of the nearby health facilities with similar characteristics) by the same data collectors. Moreover, to assure the quality of qualitative data, data was collected by experienced data collectors (several years of experience as a midwife). The credibility of the data was determined through triangulation of data between methods of data collection. Recruitment of appropriate key informants was considered, and the participants’ voice was inserted in the result to check its accuracy.
Data Management and Analysis
After appropriate coding, the quantitative data was entered into Epi Info version 7 software and exported to SPSS version 23 software for analysis. Frequencies, proportion and summary statistics were used and the results were presented in narrations, figurative and tabular forms. An independent t-test was done to assess the significance of the intervention. A P-value of < 0.05 and a 95% confidence level (CI) was used to declare the significance of the intervention. The recorded qualitative interviews were transcribed verbatim and translated from Agew or Amharic into English by the first author and local translators. The data collectors also carried out the translations to ensure the original meanings conveyed by the participants were fully captured. Data management and analysis were done using Open Code 4.03 software. The data were coded based on preset categories developed from the literature for thematic analysis.4,6 The first and last author independently analyzed the data, the third author confirmed this, and the second author validated it. The data was analyzed and presented using thematic analysis in the non-physical abuse, respectful care/, consented care, confidential care, abandonment or denial of care, and dignified care themes to complement the quantitative findings.
Ethical approval was obtained from the Ethical Review Committee of the Institute of Public Health, the College of Medicine and Health Sciences of the University of Gondar (Ref. No: IPH8375/06/19). Official letters were received from the Amhara National Regional State Health Bureau and Injibara general hospital prior to contacting the study participants. Full information was given to participants on the purpose and significance of the study. The informed and written consent was then obtained from all participants. We use thumbprints to get consent from those respondents who could not able to read and write. Confidentiality of the information obtained from the participants was maintained by using code numbers instead of personal identifiers and by keeping the questionnaire locked. The written informed consent included consent for the publication of anonymized responses. Finally, the study was carried out in accordance with the Helsinki Declaration.
Socio-Demographic Characteristics of the Respondents
A total of 738 mothers was interviewed in the pre- and post-intervention with a response rate of 98.6%. The majority of the study participants were greater than 25 years old. Nearly ninety-one and ninety four percent of the mothers who participated in the pre-and post-intervention were married, respectively. Regarding their educational status, 77.8% in the pre-intervention and 85% in post-intervention were unable to read and write. Monthly income level was ranged in 1000–3000 Ethiopian Birr (ETB), 55% and greater than 3000 Ethiopian Birr (48%) in post-intervention. Sixty-nine and sixty-six percent of rural dweller mothers have participated in the pre- and post-intervention, respectively. Orthodox Christians were the dominant religion with 89.3% and 88.3% in the baseline and end-line, respectively. A total of 70.6 and 67% of mothers were from Agew Ethnic in the pre- and post-intervention, respectively. Similarly, 65 and 78% of the mothers were housewives in the pre- and post-intervention, respectively (Table 2).
Table 2 Social-Demographic Characteristics of Study Participants at Injibara General Hospital, Northwest Ethiopia, 2019
Disrespect and Abuse of Maternal Care
The overall magnitude of disrespect and abuse during pregnancy and childbirth in the study was 71.8 and 15.9% in the pre- and post-intervention, respectively. Similarly, the disrespect and abuse among labouring mothers were reduced from 78.5% at the pre-intervention to 27.7% at the post-intervention. Whereas disrespect and abuse among ANC follow up mothers were 64.7 and 36.2% in the pre- and post-intervention, respectively (Figure 1).
Figure 1 Disrespect and abuse of women during labour and ANC services at Injibara general hospital, northwest Ethiopia, 2019.
The findings from the key informants highlighted that there was an improvement in respectful care from health care providers in the hospital. Most of the key informants explained that they were glad by the good respect of the healthcare providers especially midwives. However, few of them described that there is still some problem in respecting clients especially in providing informed consent.
“Midwives value their clients not to hurt them physically, but some of their assistants talk to their clients unethically and treat them violently”. (A 24 years old male health care provider)
Most of the key informants agreed that there were good changes in respectful care during service provision compared to the past year. A 32-year old health care provider said that “This is an interesting circumstance to see a new situation in terms of clients that have not been seen in my career as a medical service provider over the last 6 months “. Similarly, A 43 year’s old women development army leader strengthens the idea “Many of the health workers in the ANC and labour ward are good, and we feel comfortable seeing and engaging with them”. Even though, the key informants did not deny the ethics of rare healthcare worker staff might need improvements.
“ … even if there are changes in respectful care, there are still some midwives who behave unethically when providing services, and I encourage them to take lessons from their peers and minimize their unethical act. As a result, the hospital will pay attention to improve the respectful maternal care in general and with the healthcare assistants and midwives in particular”. (51 years old male key informants)
“Midwives’ approach to clients is innocent with a smile and respects essential socio-cultural values and norms that make mothers feel like they are at home especially in the waiting room”. (a 29 years old male health worker)
Most participants described getting the first chance in central triage and card room and facilitators/porter’s service is very encouraging. Majorities agreed that service provided were exempted, privacy issue in ANC room was maintained, guards in delivery ward guiding for clients with courtesy and respect with a large number of clients. Two key informants expressed that;
Even if, there are positive changes in the delivery of compassionate maternal care services relative to the previous years’ service provision, there are still priority concerns in ultrasound and laboratory services and laboratory result release that should be resolved by senior hospital administrators to improve maternal care with a maximum of dignity.
In this study, physical abuse during maternal care was reduced from 61% at baseline to 15.4% at the post-intervention. In line with this, providers hit or slapped, culturally inappropriate way of carrying, not receiving necessary pain-relief treatment, denied from food or fluid in labour unless medically necessitated for labouring mother only were decreased from the pre-intervention by 44.5, 50.9, 58.9 and 44.7%, respectively after the intervention.
Non-consented care was reduced by 54.9% from the pre-intervention. The provider did not explain what is being done, the provider did not give periodic updates on the status and progress of my labour/ANC visits, the provider did not permit me to choose of position for birth and ANC examination and provider did not obtain my consent or permission prior to any procedure were among highly reduced forms of non-consented care through our interventions. The qualitative part reinforces this finding. Some of the key informants react that clients had not been provided with necessary and adequate information about the above respectful maternal care and their maternal health conditions.
“ … Clients have not been provided with accurate information on compassionate maternal care as basic human rights due to the lack of informed consent on what is to be done and the progress of labour and fetal conditions during labouring and also the progress of pregnancy as health professionals”. (A 31 years old female informants)
In addition to those, two of the key informants expressed that the method of information provision used has a problem of language and the clients have to go around repeatedly to get the room where they can get the services.
“The existing information provision is fine for those who can read and write but difficulty for the illiterates/unable to read because there are posters written in English and Amharic versions that are displayed at the service point “. (38 years old male key informants)
The Majority of the participants said that method of information provision for illiterate clients visiting the hospital is needed. Similarly, Non-dignified care was decreased by 53.6% after the implementation of designed interventions. Though providers shouting at or scolding on mothers was decreased, still, there was a significant experience of shout at service area which impacts negatively on dignity.
“midwives respect to their clients not to hurt them physically, but some of their assistants/students shout at clients unethically and made service them with a lot of frustration”. (A 24 years old male key informant)
Furthermore, Non-confidentiality care, discrimination care, and abandonment or denial of care were reduced from the baseline by 54.8%, 59.3% and 68.4%, respectively at the post-intervention (Table 3).
Table 3 Magnitude of Disrespect and Abuse of Women with Their Respective Categories During Delivery and ANC Services at Injibara General Hospital, Northwest Ethiopia, 2019
Significance of the Interventions
An independent t-test was used to test the significance of our intervention. Accordingly, the significance of the intervention was checked for the overall disrespect and abuse care as well as to each category of the disrespect and abusive maternal care. Subsequently, the intervention has significant changes at p-value <0.0001. Among components of disrespect and abusive care highest changes were observed for physical abuse (mean difference: 0.73, 95% CI: 0.67–0.77), and lower change in the confidentiality care domain (mean difference: 0.48, 95% CI: 0.41–0.54). The overall disrespect and abuse have shown a significant change with (mean difference: 0.56, 95% CI: 0.55–0.57) (Table 4).
Table 4 Independent t-test of the Intervention on Disrespect and Abuse of Women with Their Respective Categories During Delivery and ANC Services at Injibara General Hospital, Northwest Ethiopia, 2019
This pre–post interventional study revealed that women’s disrespect and abuse during antenatal care and delivery services at Injibara general hospital was reduced by 55.9% (71.8% at baseline to 15.9% at end-line). The findings suggest the provision of training to healthcare providers, written policies and procedures describing the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing all the required equipment, essential drugs and supplies, regular supportive supervision and mentoring and motivating the employees has the potential to decrease women’s disrespect and abuse during antenatal care and delivery services.
In this study, the magnitude of disrespect and abuse at the post-intervention was consistent with those of studies conducted in Tanzania, Kenya and Malawi among women during childbirth.24,31,40 However, it is much lower than the result of studies done in Ethiopia public health facilities among women during childbirth in Addis Ababa, Arbaminch town and Shambu town in the Wolega zone.27,30,41 Additionally, our finding is lower than the finding of other similar studies.42,43 These differences could have resulted from the difference in study setup, study design as well as the socio-cultural difference of the study participants, moreover, the interventions that were implemented in our study may contribute to these differences.
In this study, the highest change was observed in the domain of abandonment or denial of care. It was decreased from 80% at baseline to 11.6% at the end-line, resulting in a decrease of 68.4%. The possible reason for this achievement is that the respectful maternal care training undertaken in this study has an emphasis on the right to timely healthcare (reduction of waiting times and sometimes harmful delays) and the right to the highest attainable standard of health that can influence the practice of healthcare providers. Additionally, frequent supervision and mentorship with written feedbacks might contribute to this achievement.
The second highest post-intervention change was observed on the non-consented care domain and showed that 54.9% decrement from the pre-intervention. The post-intervention finding in this study was by far lower than a study conducted in Bahirdar, Arbaminch and Addis Ababa, Ethiopia.27,29,30 This better achievement can be explained by the interventions implemented in our study such as frequent supportive supervision, securing the necessary supplies and drugs, employee motivation mechanisms and the training provided to providers reduce non-consented care.
A substantial decremental change was also observed in discrimination care, non-dignified care and physical abuse sub-scales from baseline compared to the end-line. The potential reasons are the training provided also underlined all the sub-dimensions of disrespect and abuse, including asking for consent before performing any procedure and respecting the preference of patients, discrimination by race, ethnicity, age and economic status while providing care. Besides, the roleplays in the training offer opportunity to discuss various elements of verbal and physical abuse. Furthermore, other interventions mentioned elsewhere contribute to this finding as well. Similar findings were also reported in some previous studies where training promotes respectful maternal care during pregnancy and childbirth.44,45
With regard to physical abuse, although there was a decremental change from pre- to post-intervention, 22.5% of respondents still reported that health providers/assistants were shouting or scolding during pregnancy and childbirth. Reports from other nations support this finding. In Ghana, from a qualitative study, Midwiferies witnessed that provision of inadequate care; and verbal, physical, and psychological abuse of women during childbirth at midwifery units of their working health facilities.46
The other categories of disrespect and abuse during pregnancy and childbirth were non-dignified care and non-confidential care. Accordingly, 24.4% and 24.7% of mothers at the post-intervention reported non-dignified care and non-confidential care, respectively. This finding was lower than other studies done in Ethiopia.27,29,47 The possible explanation for the variation may be because of little attention given by health managers to secure supplies and resources required for maternal health provision in the previous studies. Additionally, poor infrastructure and unavailability of motivating strategies for employees from previous studies may explain the variation.
Strength and Limitation of the Study
Since the study was interventional, it provides an opportunity to implement identified strategies to improve respectful maternal care at the baseline study and thus shows the actual influence of the interventions on the outcome variable. Besides, the study was supported by a qualitative study which provides extensive and detailed information on D&A during maternity care. The possible limitation of the study was the use of a specific study area that might not include other factors such as variation of infrastructure across facilities that could affect the intervention, so it would be better to add more facilities to see the difference between the facilities through the interventions. This study also does not address some interventions such as shortage of staff. Furthermore, the absence of a comparison group will make it difficult to know whether the improvements observed were due to the fact that the staff at the facility know they are being assessed and other secular trends, or whether it is a real intervention effect.
Conclusion and Lessons Learned
In this interventional study, respectful maternal care at Injibara general hospital was found to be significantly improved. Alongside this: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care were decreased. The finding suggests that the provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivating high-performing employees have the potential to improve respectful maternal care. Therefore, including such training into pre-service curricula and in‐service training of healthcare workers may advance the practice of respectful maternal care. Similarly, healthcare facilities also need to implement the other interventions mentioned in this document for improving respectful maternal care services.
The authors would like to thank data collectors, supervisors, and all respondents for their willingness to participate in the study. Our appreciation will also go to the University of Gondar and Injibara general hospital for their financial and material support.
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed on the journal to which the article will be submitted; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
All authors declared that they have no competing interest in this work.
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Azzurro restaurant by andrin schweizer company, zurich
Designed by Andrin Schweizer Company Posted in restaurant. Tags: ambience, blue walls, exhibition hall, natural elements, restaurant, ropes, stained glass windows, stores, tiles, wooden shelves, zurich Scrumptious Reads store by Atelier Chen Hung, Brisbane - Australia. The retail design is inspired by ubiquitous paper coffee cup. This commercia. Paul Smith flagship store by Paul Smith 6a Architects, London. The imposing facade incorporates Paul's hand drawings in bespoke cast iron p. Hi store by TDC Co., Cape Town South Africa We developed this concept further and let the store design be inspired by a. Grace Lee showroom by Early Work, Los Angeles - California. We began by dividing the loft into four distinct sectionsa private office.
Azzurro restaurant by Andrin Schweizer Company, Zurich » Retail Design Blog Luxurious mountain view villa in british columbia
October 5th, 2012 by retail design blog The restaurant is located inside the exhibition building in Zurich, each level is.
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How many apples do i need to fill a 10-inch pie plate? And what are the best kind of apples for apple pie?
4-5 granny smiths
For my 9-inch pie, which is about 1 1/2 - 2 inches deep, I use 6 medium apples. For yours, I'd probably do 7 and mound it up and if it didn't seem quite full enough, I'd add 1/2 or 1 more.
My very favorite pie apples are Gravenstein, but they're ripe early in the season and hard to get this time of year. Right now, I'd use a mix of Jonagold and Granny Smith, or Jonagold and Braeburn. You're looking to get a nice balance between sweet and tart, so take a look at the apples available. Fuji or Golden Delicious are nice when you balance them with a very tart apple, like Granny Smith.
6 to 8 large apples, I like apples that hold their shape like Cortland, Baldwin, or Northern spy and it's fun to mix tart and sweet. I usually cut my apples and pile them in the pan (before I line it with pastry) to get the right amount. Then I put them in a bowl with the sugar, etc., line the pan with the dough, and pour them back in the pie. They will cook down a little, so I like to pile them in the center 2 to 3 inches above the rim.
Sally is the first and only person I've ever seen mention Cortlands and Baldwins in a pie. Much of the web seems to say Cortlands turn to mush and don't make a good pie. Not true! I learned from my mom who's been baking apple pies for 55 years. For some strange reason, Baldwins have fallen out of favor and are very difficult to find. For this year's Thanksgiving pie, we'll be making a 40 minute drive to a farm in Bolton, MA to get Baldwins. That's how committed we are to this combination for the best pie!
There is just one supermarket in my area that has a convenient, easy to read chart right above the apples that tells what's good for what. Isn't that an easy great idea?
10" is pretty big pie pan, so I'd use 8 or so apples. (about 8 cups) Mix them up - I like empire, grannies, goldens, macs, etc. so you get a nice assortment of textures/tastes.
I've heard you can slice your apples ahead, mix them w sugar/flour mixture and let them sit for a while (a few hours?) before placing in pie shell, which is supposed to help reduce the empty-pie-shell syndrome.
Whatever kind of apples you use, using two or three different varities usually produces a more dynamic and interesting taste.
I take a variety of apples, some for sweet, some for tart, some that hold their shape, some that don't. Pile them in your pie plate/pan until it "looks" right. Then, I chop the apples and put them back in the pan, reserving an apple or so, if I need to add or subtract. Each pie pan will take a different amount. For a 9" Emile Henri deep dish pan or pyrex deep dish 9", I usually find that about 2.5 lbs is about enough. For a 10", probably about 3 lbs. If you do the "pile and look" method, you can just tell by the "look" if it is what you like.

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Baby's head is just beginning to enter into the pelvis, but only the very top or back of the head can be felt by your doctor or midwife. 3/5. At this point, the widest part of your baby's head. Your midwife records your baby's head engagement in measurements of fifths. If you read 5/5 or 4/5, this means that the head is not engaged yet. Notes of 3/5, 2/5 or less means your baby's head is engaged. That's because - at 3/5ths - the widest part of your baby's head is in your pelvis
Watch the popular children's moral story 'மூன்று சூனிய மகள்கள் - A Three Witch Daughters'. For popular children story, kids songs, children songs, children's. . You may be able to breathe more deeply and eat more, but you'll also need to pee more frequently, and walking may be more difficult. Heavier vaginal discharge with more clear or yellow mucus
Related: When Does Baby Turn Head Down? When You Should Worry. Baby Dropping. Somewhere between 1 and 4 weeks before you start labor, your baby will descend deeply into your pelvis. They'll rest right on top of your cervix and become engaged. If your baby has turned, this will be the next step and is guaranteed before delivery The baby is lying horizontally in the uterus. This position is known as transverse lie. It's extremely rare at delivery, since most babies will turn themselves to be head down prior to their due. Baby's limbs are felt in front, on both sides of the center line. A knee may slide past under the navel. The OP position (occiput posterior fetal position) is when the back of the baby's head is against the mother's back. Here are drawings of an anterior and posterior presentation. Baby Positions The pressure of your baby's head as it descends into the pelvis. It pushes on nerves and causes lightning-like shocks. When cervical dilation begins, it might also cause sharp vaginal pain. #2: Hello bloody sho Scarlett Johansson and husband Colin Jost expecting their first child together; 'Black Widow' star due to deliver baby soon Douglas Booth engaged to Bel Powley Hollywood fraternity mourns demise.
The baby's head should be positioned for birth by being down in order to present first during delivery. Mother: Swelling is common. A woman can also experience a condition called preeclampsia with symptoms of headaches, blurry vision, or extreme swelling. Days 231-237 (Week 33) Baby (fetus): The baby may be cramped, but he or she is still. Brain diseases come in different forms. Infections, trauma, stroke, seizures, and tumors are some of the major categories of brain diseases.Here's an overview of various diseases of the brain. If the baby's head hasn't started its descent, the station is described at minus 3 (-3). When your baby's head is at the zero station, it is at the middle of the birth canal and is engaged in. Cervical effacement symptoms can include: Pelvic discomfort: Some women swear they feel little twinges or sensations down there at the same their cervix is changing. Once your baby's head descends into your pelvis, you may feel that head pushing down on the cervix, which helps cause effacement and can be more than a little uncomfortable
Throughout the year, our board of advisors -- a brain trust of the best pediatric doctors, developmental experts, and educators in the country -- shares the latest thinking about raising happy and. Hydrocephalus, or water on the brain, is a condition where a buildup of cerebrospinal fluid in the brain causes increased pressure in the skull. It can be present at birth or develop later in life If you roll a ball across the floor, your baby will probably turn his or her head to follow the action. Babbling and other new sounds. Babies this age often start to babble chains of consonants. Your baby might respond to sound by making sounds and use his or her voice to express joy Your baby may become engaged around now and as they move down into your pelvis any breathlessness that you may have been feeling can ease. If your baby is born early he or she may need special care in hospital. Read more to find out reasons risks and how to care 35 weeks newborn BabyCenter is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. Our content is doctor approved and evidence based, and our community is moderated, lively, and welcoming.With thousands of award-winning articles and community groups, you can track your pregnancy and baby's growth, get answers to your toughest questions, and connect with.
In obstetrics, the term cephalic presentation is used to describe a situation in which the baby is delivered head first. This delivery presentation is the safest and most common. Abnormal presentations such as a breech, in which the buttocks or feet come out first, can be dangerous, and may require intervention in the form of a caesarian. 4. Following a red object. Lay your baby on his/her back and place a pillow on each side of the baby's head, so that he/she can't turn his/her head from side to side very much. Hold a red ball in your hand and move it slowly from left to right and back again about one foot away from the baby's face
Three months into your pregnancy- you have completed the first milestone- the first trimester. It is an achievement but there is a long path to be trodden and still a significant distance to cover. Read more about body changes, foetus development, tips and more during 3rd pregnancy month A baby boy, only hours hold, was swaddled tightly and very agitated, struggling to get out a cry. He would not nurse and was having spasms in his arms. Asking questions about his birth and the time since then, I dove right in. His respiration was fast and his head was misshapen, more so than in most newborns Fetal Pole Function. The fetal pole appears as a thick area alongside the yolk sac, which is a source of fetal nourishment at the beginning of pregnancy. The fetal pole is a preliminary structure that ultimately develops into a fetus. Curved in appearance, the fetal pole has the head of the embryo at one end and a tail-like structure at the other Here's what you need to know. Children as young as six months old are sent to daycare. That's when the child is more or less trained to develop sleeping and eating habits. That said, parents sometimes send in infants as young as two months old. A lot of young parents are relying on daycares
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The Times of India Photogallery is the largest collection of latest Bollywood Movies Photos, Telugu Movies Photos, Tamil Movies Photos, Kannada Movies Photos, Malayalam Movies Photos, Hollywood. 10. ViparitaKarani (The Legs-Up-the-Wall Pose) This Asana is known to reduce stress, anxiety, and insomnia, all common symptoms of hypothyroidism. This pose can also help relieve swelling and cramping in legs and feet. Steps: · Lie on your back with arms alongside the body & lift your legs along the wall In these situations, the studios and not Cinemark control the nature, amount, and timing of the Rewards. Points redeemed are applied on a first in, first out basis. Members can redeem applicable number of points for 2D movie tickets (Movie Ticket Reward) as part of the Cinemark Movie Rewards Program
COVID-19 surge: Tamil Nadu, Bihar impose night curfew. Bihar and Tamil Nadu have decided to impose night curfew from 9 pm to 5 am and 10pm to 4 am, respectively as COVID-19 cases continue to spike in both states. Bihar has extended closure of schools/colleges/coaching centres until May 15 BIOLOGY NOTES Class 12 Chapter 4 Adolescence Reproductive and Sexual Health (ARSH) opics are to be taken care of to dispel the myths and misconception about this important aspect with focus on: • Reducing risky behavior. • Theories which explain what influences people's sexual choices and behaviour Mum warriors take Covid head on. Princess Diana once said, A mother's arms are more comforting than anyone else's.. And how true is that! She is a mentor, a friend and guide for her.
Labourer Engaged in Installing Drainage Pipeline Buried Alive in Tamil Nadu. Tamil Nadu Govt Revises Coronavirus Guidelines, Test Only for Those Showing Symptoms. Man Tries to Sexually Abuse 2-month-old Daughter, Arrested after Wife Lodges Complaint. How Erode in Tamil Nadu Outsmarted Covid-19, Netted Nizamuddin Returnees With Hawk-eye Vigi Search the world's information, including webpages, images, videos and more. Google has many special features to help you find exactly what you're looking for
Tamil Nadu govt extends lockdown by one week ending 6 am on July 19. Tamil Nadu chief minister M K Stalin on Saturday announced extension of the lockdown by one week till 6am on July 19. The government continues to ban inter-state public and private transport except from Union territory of Puducherry and international air travel except the ones. Stretching can be due to round ligament pull caused by growing uterus, and gives sharp piercing or dull pulling feeling. Some women experience sharp, piercing pain in the vagina. Try relaxation exercises. Place a hot water bottle wrapped in a towel on the ache. Make sure you get plenty of fluids. Take warm water bath Popular Tamil YouTuber, R. Porchezhiyan, who runs the channel 'Saapattu Raman' on YouTube, has been arrested on charges of illegally treating patients with Covid-19 symptoms. Tamil Nadu: Famous. .com - India's Largest Online Store for newborn, baby & kids products. Shop from the best range of Toys, Diapers, Clothes, Footwear, Strollers, Car Seats, Furniture, Gifts, Books and more from the best baby brands with Free Shipping COD Same Day & Next Day delivery options
The main ways you can get HIV are: Sex without a condom. having unprotected sex (meaning sex without a condom, if you are not taking PrEP) with someone who has HIV, particularly unprotected vaginal sex and anal sex. Sharing injecting equipment. sharing needles, syringes or other equipment used to prepare and inject drugs with someone who has HIV.. Your customizable and curated collection of the best in trusted news plus coverage of sports, entertainment, money, weather, travel, health and lifestyle, combined with Outlook/Hotmail, Facebook. Dr. Radhai Prabhakaran, MD., F.A.A.P., is a Pediatrician with Cleveland Clinic Children's department of Community Pediatrics. She practices at Chestnut Commons Family Health Center, Elyria. She is board certified in Pediatrics and is a member of American Academy of Pediatrics. She completed her pediatric residency at Cleveland Clinic
Chennai (Tamil Nadu) [India], July 10 (ANI): Chennaiyin FC (CFC) have roped in the services of Bozidar Bandovic as head coach ahead of the 2021-22 Indian Super League (ISL) season ジュエリー・アクセサリー,メンズジュエリー・アクセサリー,ネックレス・ペンダント お買い得，高品質 FIRST 送料 代引き手数料無料 あす楽対応 アメカジ ハーレー バイカー アクセサリー プレゼント ARROW's ファーストアローズ Small Turquoise Head スモールターコイズヘッド P-29 ジュエリー・アクセサリー,メンズジュエリー・アクセサリー,ネックレス・ペンダント お得，大人気 FIRST 送料 代引き手数料無料 あす楽対応 アメカジ ハーレー バイカー アクセサリー プレゼント ARROW's ファーストアローズ Small Turquoise Head スモールターコイズヘッド P-29 Zika Virus Alert NewsZika virus has also knocked in Kerala in the midst of corona infection. The number of infected with this virus has now increased to 22. Along with Kerala, Mumbai, Delhi have also been alerted. Zika Virus Alert News: In the midst of corona infection, the Zika virus has also knocked in Kerala. [ Press it gently - if the whole baby moves, they might be in a head-down (cephalic) position. Feeling a hard, rounded lump beneath your ribs might be the baby's head, meaning they're in breech (head up) position. If the two round, hard areas (the head and bottom) are at the sides of your belly, your baby may be lying horizontally
Stop drastic dieting, ditch sugar and load up on oysters, eggs, chicken: The 10 foods you should be eating for healthy and shiny hair. Sudden weight loss can impact the health of your hair. Eat. Drainage or pus, Slow or weak urine stream. Blood or red colored urine, Decreased urination, Slow or weak urine stream. Frequent urge to urinate, Pressure or fullness, Slow or weak urine stream, Sudden urge to urinate. Cloudy urine with strong odor, Difficulty urinating, Pain with urination, Slow or weak urine stream Sometimes called heavy petting, foreplay helps to get both people sexually aroused (or turned on) and ready for vaginal sex. It can involve kissing, stroking, caressing, rubbing, touching or oral sex. Foreplay should be enjoyable for both partners. Some people choose to stick to foreplay and not have penetrative sex
One relatively easy strategy, though it requires some commitment, is to adopt a pet on whom you can practice getting and giving emotional rewards. 3. Broken bones of loss and trauma. Distress is a. Refined grains are other foods to avoid with mitral valve prolapse that can cause problems. These are foods such as white bread, white rice, and breakfast cereals, noodles, pancakes, pretzels, rice cakes, waffles, and English muffins. The list is long. In general, it is smart to have a mitral valve prolapse diet plan that is designed to stave. Following an accident, many people can experience emotional distress. It's normal that during the healing process, you may begin to notice signs of increased stress such as Post Traumatic Stress Disorder (PTSD), anxiety, depression, anguish, fearfulness, issues with sleep, reoccurring nightmares about the crash and more Typical symptoms of depression begin in the months following birth, while in some women, they can occur while still pregnant. Persistent Depressive Disorder Considered a milder form of depression, this is an extended depressed mood that lasts for two years or more Deciding on your new baby's name is one of the most exciting (and potentially tricky) things you'll be doing over the next few months of your pregnancy. To help make the process a little easier, we have a range of tools and resources including our baby name search tool, the top 100 boys' names and the top 100 girls' names , with loads more.

domain: medical


U.K.'s NRPB Calls for Precaution
Second Stewart Report
In its report, released today, the board of the NRPB reaffirmed its call for a “precautionary approach” to the use of mobile phones.
One of the key recommendations is that “particular attention be given to how best to minimize exposure of potentially vulnerable subgroups such as children.” In the NRPB , Sir William Stewart, the chair of the board, states that, “The fact is that the widespread use of mobile phones is a relatively recent phenomenon and it is possible that adverse health effects could emerge after years of prolonged use.”
The UK papers led with the risk to children. “ ran the headline in the Sunday Times, when it broke the story ahead of today’s official release. Yesterday, the Daily Telegraph followed with ,” and today the BBC announced, CNN went with the same thread:
Here in the U.S., the Food and Drug Administration (FDA),which has long sought to pacify those worried about possible cell phone health effects, tried to spin the story out of existence. Howard Cyr, the agency's point man on the health effects of electromagnetic radiation at the FDA’s Center for Devices and Radiological Health, sent out an e-mail saying that the FDA “agrees with the NRPB on its basic conclusion that there is no hard evidence of adverse health effects on the general public (the NRPB did say that). But the FDA added: “With regards to the safety of children and use of cell phones by children, the scientific evidence does not show a danger to users of wireless communication devices including children” (that’s the FDA’s emphasis). Given all the bad press that the FDA has been attracting recently (think Vioxx), one might think that warnings put forward by its British counterpart might merit a more considered and less deceptive approach. Perhaps Cyr, who is semiretired, is unaware that Sir William Stewart is the former science advisor to Prime Minister John Major. Perhaps Cyr doesn’t care. He simply sees his job as making sure that the cell phone story sinks somewhere offshore in the Atlantic.
You can download the full NRPB
[Later: The NRPB/HPA has removed the report from easy access.]


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Release: 18th December 2015
Following the success of Himalia’s album ‘Distances’ and the subsequent inclusion of ‘So Long Ago’ on the seminal Cafe Del Mar 21, ‘Distances Remixed’ becomes the cadaver for a number of handpicked producers for Pegdoll. This latest project rides the waves of Drum ‘n’ Bass, Electronica, Future Garage and House music.
The opening gambit is the Bristol duo Despicable Youth with ‘Distances’, reinvigorating the album title track and who’s Drum’n’Bass credentials continue to rise due to support from Loadstar and Friction.


best m1 carbine reproductionbest m1 carbine reproduction
The bolt and trigger are fully functional and the dummy .
As a replica of the U.S. Carbine Caliber 30 M1 the designer of this .22 rimfire did, with a few exceptions noted below, a good job of replicating the parts of an M1 Carbine.
Total length: 35.75". Early Springfield Armory "Gas Trap" M1 Garand Semi-Automatic Rifle: $28,750 (December 2012) .
This awesome reproduction of the M1 bayonet with M7 scabbard is a must have, correct bayonet for the 1903 Springfield, 1903A3 Springfield and the M1 Garand. The Inland Mfg. Find the M1 Carbine magazines that you have been looking for today with Numrich Gun Parts.
The parkerized finish on the gun is 90%. This replica has a wood body like the original. This is absolutely the best quality reproduction available. 1 offer from $23.95. Dec 21, 2009.
I dont want to shoot them as much cause im a bit of a collector. Cracked Stock.These were original WWII era M1 Carbine rifles that were stored oversea's for years before recently being re-imported back into the United States. This IAI M-1 reproduction, 18" barrel and one 15rd magazine.
Cons No negatives. MrMinnesota.
The little M1 Carbine has been around for over 70 years now. M1 carbine early bolt; M1 carbine late bolt
The M1 Carbine was the most produced American Infantry weapon of World War II.
Compact, lightweight and accurate, M1 Carbines were first supplied in mid-1942 to US troops in Europe. 4.4 out of 5 stars.
The metal stock is blued. Product Video: Auto-Ordnance M1 Carbine. Free Shipping Option* Remove from Compare Add to Compare. It is an expensive home-defense option, but we wouldn't mind using it in that role, if push came to shove. I own a 1944 Inland and 1943 Postal Meter. But as we have mentioned, not all of them will be worth buying.
It was historically accurate, and collectors of original M1 Carbines would do themselves a service by shooting a new repro rather than wearing out an original and reducing the value.
This non-firing replica is true to the 1944 original. Watch a video of the Inland Mfg. With the largest selection of current and obsolete parts, Numrich has a wide variety of military surplus M1 Carbine magazines for you to choose from.
As this area of wood was quite thin and often became damaged, the area was reduced on later M1 carbines and became what is known to collectors as "low wood" stock. Our carbine is serviceable but worn. Best Seller in Paintball Sights.
Feyachi Reflex Sight - Adjustable Reticle (4 . M1 CARBINE M4 BAYONET US GI NEW IN BOX. To make sure that you do not get one of them, we have gone through the top-selling models. A little while back I got my hands on a T&E sample of the new reproduction Inland M1 Carbine, and have spent some time with it.
Don't bother with a commercial copy/reproduction.
Round or flat no choice.
M1 Carbine UNDERWOOD, round bolt- complete new in sealed wrap. The rifle has a 4 position rear sight and a fixture for a bayonet.
The 239 Commercial Controls M1 Carbines were assembled from leftover parts and provided to U.S. Army Ordnance in August 1945.
The Auto-Ordnance (A-O) is a copy of the Model M1A1 designed for Paratroopers with a folding wire stock. This product has an average rating of 4.5 stars out of 5 stars from 18 ratings. There are a number of companies out there offering refurbished WWII-era firearms, but Auto-Ordnance is currently the only manufacturer of new M1 Carbines. Okay, confession time.
Where to Buy.
This non-firing replica is true to the 1941 original. The U.S. M1 Garand rifle was first issued with the M1905 16 inch bayonet.
M1 CARBINE BOLT ASSEMBLY PITTED SOLD "AS IS". The M1 Carbine is light, fast, and accurate.
The little carbines are easy to hold and easy to shoot, with relatively low recoil compared to an M1 Garand or M1903 shooting the full-power .30-06 cartridge.
This is a non-firing reproduction. Safe.
We have some PAL with early M8 and a few Utica with early M8A1.
This is one of our best replicas yet.
Pros I purchased this just to display it on my wall.
It is an exciting read about the history of the M1 Carbine, the battle between manufacturers to produce the best possible rifle .
The M3 Scout Carbine is a compact rifle that packs more punch than most pistols. Inland (General Motors) made the most USGI Carbines, and there were several manufacturers (Winchester, Postal Meter, IBM, Saginaw, Underwood, and several others). 4.6 out of 5 stars 31. Only the earliest of M1 Garands utilize a "gas trap" system instead of the standard gas port drilled into the barrel, and with the low serial number of 2838, this rifle readily qualifies. October 19th, 2014 New American-Made Reproduction M1 Carbines. Well suited to the Liberty Training Rifle and Appleseed Project.
M1 Carbine Rifle, .30 Caliber, Semi-Auto, Original U.S. Military Contractors - C & R Eligible - NRA Surplus Good Condition. One of the CMP's most popular competitions is the M1 Carbine Match.
The M1 carbine is modeled after the last production model that Inland manufactured in 1945 and features a type 3 bayonet lug / barrel band, adjustable rear sights, push button safety, round bolt, "low wood" walnut stock, and a 15-round magazine. Free shipping for many products! PLEASE SUPPORT MAC ON PATREON (we are viewer supported): http://www.patreon.com/militaryarmsOriginal M1 Carbines in really good condition are expensive and c. This is one of our best replicas yet.
Review: Auto-Ordnance M1 Carbine. Each stock has a matching handguard so your treasured carbine will look beautiful. 30, M1" ended up being the U.S. military's most-produced arm ever. At this price you can finally own a faithful reproduction of a WWII US Bayonet.
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text:
1 volume (unpaged) : chiefly colour illustrations ; 26 cm
Who is Lottie Person? Is she a gorgeous, fun-loving social media star with a perfect life or a gross, allergy-ridden mess? Enter a world of snot, blood, and tears in this first collection from Bryan Lee O'Malley (Scott Pilgrim, Seconds) and Leslie Hung!
Contains material originally published in single magazine form as Snotgirl #1-5

domain: artistic


text:
Key! is enthusiastic to announce he’s hitting the road for his “I Think I’m on Tour” Tour. With support from ManMan Savage and 21 Savage, Key!’s long-awaited national tour has finally come to life. While on the brink of stardom, these performances are not to be missed. The Atlanta staple is also teaming up with AnimalXHouse for 4 stops on the tour, including Cleveland and Chicago, where they’ll create an even more energizing show experience. Get your tickets via this link.
For more Key!, just click here.


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Open system with user-selected Internet server and "MySQL" database.
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