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Service Quality beyond Access: A Multilevel Analysis of Neonatal, Infant, and Under-Five Child Mortality Using the Indian Demographic and Health Survey 2015~2016

  • Kim, Rockli;Choi, Narshil;Subramanian, S.V.;Oh, Juhwan
    • Perspectives in Nursing Science
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    • v.15 no.2
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    • pp.49-69
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    • 2018
  • Purpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or ${\geq}4$) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended ${\geq}4$ ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as "low" quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as "low" quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.

The Specific Plant Species and Naturalized Plants in the Area of Naejangsan National Park, Korea (내장산국립공원 일대의 특정식물과 귀화식물)

  • Lee, Hee-Cheon;CheKar, Eun-Key;Lim, Dong-Ok
    • Korean Journal of Environment and Ecology
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    • v.25 no.3
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    • pp.267-283
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    • 2011
  • Endangered species designated by The Ministry of Environment in region of Naejangsan National Park were found Lycoris chinensis var. sinuolata K.H.Tae & S.T.Ko, Iris koreana Nakai, Cymbidium macrorrhizum Lindl and Vexillabium yakushimensis (Yamam.) F.Maek.(4 taxa). The floristic special plants were recorded to a total of 159 taxa; that is, class I species (91 taxa) were containing as Chloranthus fortunei (A.Gray) Solms, Vicia anguste-pinnata Nakai and Euscaphis japonica (Thunb.) Kanitz, etc, class II species (17 taxa) were Pseudostellaria coreana (Nakai) Ohwi, Dryopteris expansa (C.Presl) Fraser-Jenkins et Jermy and Gymnocarpium dryopteris (L.) Newman, etc, class III species (32 taxa) were containing; Cirsium setidens (Dunn) Nakai, Parasenecio pseudotaimingasa (Nakai) B.U.Oh and Saussurea eriophylla Nakai, etc, class IV species (9 taxa) were Deutzia paniculata Nakai, Carex ligulata Nees and Thuja orientalis L., etc, and class V species (10 taxon) were Orobanche filicicola Nakai, Lycoris chinensis var. sinuolata K.H.Tae & S.T.Ko and Lycoris sanguinea var. koreana (Nakai) T.Koyama, etc. Endemic species of korea were identified 40 taxa such as Broussonetia kazinoki var. humilis Uyeki, Pseudostellaria coreana (Nakai) Ohwi and Silene seoulensis Nakai, etc. Plant species designated as Natural Monument were 2 species that Daphniphyllum macropodum forest(No. 91) and Torreya nucifera forest(No. 153) receive protection. The naturalized plants were identified 30 taxa; Fallopia dumetorum (L.) Holub, Persicaria orientalis (L.) Spach and Rumex crispus L., etc. Among them the ecosystem disturbance wild plants was not discovered.

Effects of Yuldahansotang after kainate administration in the mouse hippocampus area (열다한소탕(熱多寒少湯)이 kainic acid에 의해 유발된 mouse의 해마체 손상에 미치는 영향)

  • Kim, Il-hwan;Kim, Kyung-yo
    • Journal of Sasang Constitutional Medicine
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    • v.11 no.2
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    • pp.283-299
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    • 1999
  • 1. Purpose : Systemic injection of kainic acid in experimental animals induces the limbic seizure and structural damages in hippocampus and amygdala which resembles the changes in human temporal lobe epilepsy. The author performed this study to investigate the neuroprotective effects of Yuldahansotang, on the neurotoxicity induced by kainic acid in the hippocampus in rats. 2. Method : Kainic acid was administered intraperitoneally. And feeding with Yuldahansotang for 3 weeks after kainic acid administration. Seizure were induced in male mice (kainate 10-40 mg/kg i.p) and animals were sacrified at various time-points after injection. The experimental animals were sacrificed at 1, 2, 3day and 1, 3weeks while Yuldahansotang administrations. Seizure were graded using a behavioral scale developed in our laboratory. c-fos belong to immediate early genes(IEGs) known to have rapid and brief responses. And neuronal injury was assayed by examining DNA fragmentation using in situ nick translation histochemistry. 3. Results & Conclusion : Seizure severity paralled kainate dosage. At higher doses DNA fragmentation is seen mainly in hippocampus in area CA3, and variable in CA1, thalamus, amygdala within 24 h, is maximal within 72 h, and is large gene by 7 days after administration of kainate. And we can't see the expression of DNA fragmentation and c-fos in the mice what feeded by Yuldahansotang after 7 days from kainic acid administration. It is consequently suggested that Yuldahansotang may attenuate the kainic acid-induced neuronal degeneration and increase the immunoreactivity of hippocampus in mouse.

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Evaluation of physio-chemical properties and stability of some commercial horticultural substrates by the European Standard Methods (유럽표준분석법에 의한 원예용 상토의 이화학성 및 안정성 평가)

  • Kim, Hyuck-Soo;Kim, Kye-Hoon
    • Korean Journal of Soil Science and Fertilizer
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    • v.43 no.1
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    • pp.44-50
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    • 2010
  • This study was carried out to analyze physico-chemical properties and to determine stability of the 19 commercially available horticultural substrates in Korea by European standard methods (EN methods). The average pH, EC, T-N, $P_2O_5$ were 5.44, 0.62$dS{\cdot}m^{-1}$, 0.98% and 10.54$mg{\cdot}L^{-1}$, respectively. Dry bulk density and particle density were in the range of 124.47~243.16$kg/m^3$ and 2073.94~2249.99$kg/m^3$, respectively. Seventeen out of 19 horticultural substrates used in this study were 'very stable'. The other2 substrates were classified as 'stable'. Korea's own criteria of stability for the organic materials such as growing substrates and compost need to be developed so that farmers can use the optimum organic materials without anxiety.

Growth and Medical Constituents of Saururus chinensis Baill as Affected by Different Amounts of Nitrogen Fertilizer Application (질소 시비량이 삼백초 생육 및 성분함량에 미치는 영향)

  • Ahn, Byung Koo;Kim, Soo Mi;Kim, Jeong Yeob;Kim, Kab Cheol;Ko, Do Young;Lee, Chang Kyu;Jeong, Seong Soo;Lee, Jin Ho
    • Korean Journal of Medicinal Crop Science
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    • v.23 no.4
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    • pp.277-283
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    • 2015
  • This study was conducted to investigate the selected chemical properties of soils in Saururus chinensis Baill (Chinese lizard's tail) cultivation fields to provide optimal fertilizer application rates and to examine the growth and pharmaco-consitituents of Saururus chinensis Baill as influenced by different amounts of nitrogen (N) fertilizer applications. Based on the results of selected soil chemical properties in 37 cultivation sites of the plant, soil pH, organic matter content, and exchangeable $K^{+}$ concentration were lower than optimal values for cultivating general medicinal crops even though relatively high standard deviations were found in some of the values. At the harvesting stage of the plant aerial parts, soil pH, electrical conductivity (EC), available $P_2O_5$, and exchangeable $Ca^{2+}$, $Mg^{2+}$, $Na^{+}$ decreased as comparing with those before transplanting the plant, whereas the concentration of exchangeable $K^{+}$ increased in the plot treated with N 100% and compost. Fresh weight of the plant aerial parts were highest, 492.5kg/10, in the N 100% treatment plot. Correlation equation between N levels treated (X) and yield of the plant aerial parts (Y) presented as $Y=-2.1609X^2+30.082X+344.12$($R^2= 0.7113$) and the optimal rate of N fertilizer application for the plant was 6.6kg/10a. Carbon concentrations in the plant were not different among the different N levels applied. N and K concentrations in the plant were highest in the plot of N 100% with compost applications, the highest P concentration was in N 100% plot, and the highest Ca and S concentrations were in N 200% plot. Quercetin and quercitrin were highest in the N 150% plot and tannin was highest in N 100% or N 100% with compost application plot.

Morphological Characteristics of Pig Blastocysts Produced by Somatic Cell Nuclear Transfer

  • Y.M. Han;D.B. Koo;Park, Y.H.;Park, J.S.;Kim, H.N.;Y.K. Kang;W.K. Chang;Lee, K.K.
    • Proceedings of the KSAR Conference
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    • 2001.03a
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    • pp.68-68
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    • 2001
  • Blastocyst formation, consisting of the inner cell mass (ICM) and trophectoderm (TE), is the first differentiation process during embryonic development in mammals. It has been hypothesized that the proportion of ICM to TE in the blastocyst may be crucial for subsequent developmental competence of early embryos, which it may be expressed as a sensitive indicator for evaluating in vitro systems. In this study ICM/total cell ratio of nuclear transfer (NT) embryos was compared with IVF-derived and in vivo embryos. Somatic cell nuclei obtained from a fetus at Day 40 of gestation were transferred into the enucleated oocyte and then cultured in NCSU 23 medium for 6 days as previously described (Koo et al., Biol. Reprod. 2000; 63:986-992). ICM and TE cells of blastocysts were determined by using a differential staining method (Han et al., Biol. Reprod. 1999; 60:1110-1113). Development rate (9.8$\pm$2.5%, 23/225) to the blastocyst stage of NT embryos was lower than IVF embryos (23.8$\pm$2.7%, 53/223). Thus, a difference was detected in the in vitro developmental rate to blastocyst stage between NT and IVF-derived embryos (P<0.05). In the next experiment, we investigated ICM and TE nuclei to assess the quality of blastocysts that produced by NT, IVF and in vivo, respectively. NT blastocysts (27.6$\pm$8.3) showed a smaller total cell number than IVF-derived (42.6$\pm$17.4) and in vivo embryos (283.9$\pm$103.5) (P<0.05). Ratios of ICM/total cells in NT, IVF and in vivo blastocysts were 15.1$\pm$ 18.6% (n=56), 12.3$\pm$9.2% (n=57) and 30.4$\pm$6.8% (n=40), respectively. Individual blastocysts for the ratio of ICM/total cells were assigned to 3 groups (I; <20%, II; 20 to 40% and III;>40%). As the results, most in vivo blastocysts (97.5%, 39/40) were distributed into group II while most NT (78.6%, 44/56) and IVF-derived blastocysts (82.5%, 47/57) were allocated to group I. Thus, our data show that NT or IVF-derived embryos have aberrant morphology during early development in vitro systems, suggesting that these anomalies may result in developmental failures of the NT embryos to term.

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Characterization of Humic and Fulvic Acids Extracted from Soils in Different Depth: Proton Exchange Capacity, Elemental Composition and 13C NMR Spectrum (깊이별 토양 휴믹산과 풀빅산의 특성 분석: 양성자교환용량, 원소성분비, 13C NMR 스펙트럼)

  • Shin, Hyun-Sang;Lee, Chang-Hoon;Rhee, Dong-Sock;Chung, Kun-Ho;Lee, Chang-Woo
    • Analytical Science and Technology
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    • v.16 no.4
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    • pp.283-291
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    • 2003
  • Humic and fulvic acids present in soils of different depth were extracted and their acidic functional groups and structural characteristics were analyzed and compared. The purpose of this study was to present a basic data needed to evaluate the effect of humic substances on depth distribution and migrational behaviour of radioactive elements deposited on soil. Acidic functional groups of the humic and fulvic acids were analyzed by pH titration method, and their proton exchange capacity (PEC, $mq\;g^{-1}$) and average $pK_a$ values were obtained. Structural characteristics of the humic and fulvic acids were analyzed using their CPMAS $^{13}C$ NMR spectra and elemental composition data. pH titration data showed that fulvic acids have higher acidic functional group contents ranging from 5.5 to $7.0meq\;g^{-1}$ compared with that of humic acids ($3.8{\sim}4.8meq\;g^{-1}$). From depth profiles, it has been found that PEC values of humic acids in deeper soil (> 8 cm) were higher than those at the surface soils. Elemental compositions (H/C ratio) and spectral features ($C_{arom}/C_{aliph}$ ratio) obtained from CPMAS $^{13}C$ NMR spectra showed that the aromatic character in humic acids was a relatively higher than that of fulvic acids, while lower in carboxyl carbon content. The aromatic character and carboxyl carbon contents of humic acids tend to increase as soil depth increased, but those of fulvic acid showed little differences by the soil depth range.

Application of Response Surface Methodology for Optimization of Nature Dye Extraction Process (천연색소 추출공정 최적화를 위한 반응표면분석법의 적용)

  • Lee, Seung Bum;Lee, Won Jae;Hong, In Kwon
    • Applied Chemistry for Engineering
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    • v.29 no.3
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    • pp.283-288
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    • 2018
  • As the use of environmentally friendly and non-disease natural pigments grows, various methods for extracting natural pigments have been studied. The natural color was extracted from parsley, a vegetable ingredient containing natural dyes. Target color codes of green series of natural dyes extracted as variables #50932C (L = 55.0, a = -40.0, b = 46.0) were set with the pH and temperature of extracted natural color coordinates (of the extracted), and the quantitative intensities of natural dyes were analyzed. During the colorimetric analysis predicted by the reaction surface analysis method, a color coordinate analysis was conducted under the optimal conditions of pH 8.0 and extraction temperature of $60.9^{\circ}C$. Under these conditions, predicted figures of L, a, and b were 55.0, -36.3, and 36.8, respectively, while actual experimental ones confirmed were 69.0, -35.9, and 31.4, respectively. In these results, the theory accuracy and actual error rate were confirmed to be 73.0 and 13.8%, respectively. The theoretical optimization condition of the color difference (${\Delta}E$) was at the pH of 9.2 and extraction temperature of $55.2^{\circ}C$. Under these conditions the predicted ${\Delta}E$ figure was 12.4 while the experimental one was 13.0. The difference in color analysis showed 97.5% of the theoretical accuracy and 4.5% of the actual error rate. However, the combination of color coordinates did not represent a desired target color, but rather close to the targeted color by means of an arithmetic mean. Therefore, it can be said that when the reaction surface analysis method was applied to the natural dye extraction process, the use of color coordinates as a response value can be a better method for optimizing the dye extraction process.

Effect of Pre-wilting on the Forage Quality of Organic Sorghum$\times$Sudangrass Silage (예건이 수수$\times$수단그라스 교잡종 유기 사일리지의 품질에 미치는 영향)

  • Lim, Hyun-Jin;Kim, Jong-Duk;Lee, Hyun-Jin;Jeon, Kyeong-Hup;Yang, Ka-Young;Kwon, Chan-Ho;Yoon, Sei-Hyung
    • Korean Journal of Organic Agriculture
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    • v.17 no.4
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    • pp.519-527
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    • 2009
  • The main nutritional problem of sorghum$\times$sudangrass hybrid silage is low quality and dry matter (DM) contents. This experiment was conducted to evaluate whether field pre-wilting treatment of sorghum$\times$sudangrass hybrid silage increases DM content and forage quality of the silage. The experiment was a randomized complete block design with three replications. The treatments were consisted of five different wilting days: 0 day (direct cut silage), 0.5 day, 1 day, 2 days and 3 days. Sorghum$\times$sudangrass hybrid silage with pre-wilting showed low 4.00 pH values, however direct cut silage (control) showed a 4.30 value because of its high moisture content. The DM content of sorghum$\times$sudangrass hybrid silage with pre-wilting was high above 25.1% after 1 days, however that of direct cut silage had 17.6%. And the effluent of wilted silage was decreased with prolonged wilting period, but that of direct cut silage produced effluent of 183 mL/kg. Crude protein and ether extract with wilted silage were decreased, however crude ash was increased with prolonged wilting period. Silage with pre-wilting had higher acid detergent fiber (ADF) and neutral detergent fiber (NDF) contents than control silages, while its non-fiber carbohydrate (NFC) showed the opposite results. Lactic acid and total organic acid were increased with prolonged wilting period. For the palatability of dairy goat, silage with 2 days wilting was highest among silages. The experiment results indicate that wilted sorghum$\times$sudangrass hybrid silage could be recommended as effective method for reducing effluent, increasing pH and forage quality more than direct cut silage. Optimum pre-wilting day of sorghum$\times$sudangrass hybrid silage may be 1 days.

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Densification Behavior and Magnetic Properties of Fe-2%Ni Sintered Compact Fabricated by Metal Injection Molding (사출성형법에 의해 제작된 Fe-2%Ni연자성 소결체의 소결 및 자기적 특성)

  • Lim, Tae-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.1
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    • pp.278-283
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    • 2019
  • 3 kinds of fine powder, Fe-2%Ni alloy powder(N Ltd.) and Fe+2%Ni mixed powder(B Ltd. and S Ltd.), were fabricated into sintered compacts of bending strength specimens and ring type specimens by metal injection molding, debinding and controlling sintering conditions (reduction and sintering atmospheres, sintering temperature, sintering time and cooling rates). Density and magnetic properties of the sintered compacts were evaluated with the following conclusions. (1) When each compact was hold at 1123K for 3.6ks in H2 and sintered at 1623K for 14.4ks in Ar, the density of N, B and S Ltd.'s sintered compacts were measured as 96, 99 and 99%, and oxygen/carbon contents were measured as 0.0041%O/0.0006%C, 0.0027%O/0.0022%C, and 0.160%O/0.0026%C, respectively. (2) Magnetic characteristics of B Ltd. compact in Ar with the best results showed $B_{25}=14.3KG$, $B_r=7.75KG$, and $H_c=2.1Oe$, but not enough as those made by melting process. (3) Magnetic properties of B Ltd. compact which were sintered at 1673K for 14.4ks in Ar gas, and cooled at $0.83Ks^{-1}$ to 1123K and then cooled at $0.083Ks^{-1}$ down to room temperature were measured as $B_{25}=14.8KG$, $B_r=8.3KG$, and $H_c=1.3Oe$, almost similar to those made by melting process. Objected soft magnetic materials properties were obtained through sintering process by controlling sintering conditions (reduction condition, sintering atmosphere, sintering temperature and sintering time) and cooling rates.