via makeuseof.com
The findings, published in the medical journal The Lancet, challenge the prevailing view of maternal mortality as an intractable problem that has defied every effort to solve it.
“The overall message, for the first time in a generation, is one of persistent and welcome progress,” the journal’s editor, Dr. Richard Horton, wrote in a comment accompanying the article, published online on Monday.
The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.
But some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, Dr. Horton said in a telephone interview.
“I think this is one of those instances when science and advocacy can conflict,” he said.
Dr. Horton said the advocates, whom he declined to name, wanted the new information held and released only after certain meetings about maternal and child health had already taken place.
He said the meetings included one at the United Nations this week, and another to be held in Washington in June, where advocates hope to win support for more foreign aid for maternal health from Secretary of State Hillary Rodham Clinton. Other meetings of concern to the advocates are the Pacific Health Summit in June, and the United Nations General Assembly meeting in December.
“People who have spent many years committed to the issue of maternal health were understandably worried that these figures could divert attention from an issue that they care passionately about,” Dr. Horton said. “But my feeling is that they are misguided in their view that this would be damaging. My view is that actually these numbers help their cause, not hinder it.”
He said the new study was based on more and better data, and more sophisticated statistical methods than were used in a previous analysis by a different research team that estimated more deaths, 535,900 in 2005. The authors of the earlier analysis, published in The Lancet, in 2007, included researchers from Unicef, Harvard, the World Bank, the World Health Organization and the Johns Hopkins School of Public Health. The World Health Organization still reports about half a million maternal deaths a year, but is expected to issue new statistics of its own this year.
The new report comes from the University of Washington and the University of Queensland in Brisbane, Australia, and was paid for by the Bill and Melinda Gates Foundation.
A spokesman for Unicef said it had no comment on the new findings, and there was no response to messages that were left late Tuesday for W.H.O. officials.
Dr. Christopher J. L. Murray, the director of the institute for health metrics and evaluation at the University of Washington, in Seattle, and an author of the study, said, “There has been a perception of no progress.”
But, he said, “some of the policies and programs pursued may be having an effect, as opposed to all that effort with little to show for it.”
“It really is an important positive finding for global health,” he said.
Dr. Murray said no one had approached him directly about delaying the release of his findings; he heard about those efforts from The Lancet, and described them as “disappointing.” He said, “We believe in the process of peer-reviewed science, and it’s the proper way to pursue these sorts of studies.”
The researchers analyzed maternal mortality in 181 countries from 1980 to 2008, using whatever information they could glean from each country: death records, censuses, surveys and published studies. They ultimately gathered about three times as much data as the previous researchers had found.
Among poor countries with longstanding high death rates, progress varied considerably. For instance, from 1990 to 2008, the maternal death rate dropped 8.8 percent a year in the Maldives, but rose 5.5 percent in Zimbabwe. Sub-Saharan Africa has the highest maternal death rates. Brazil improved more than Mexico, Egypt more than Turkey. Six countries accounted for more than half of all the maternal deaths in 2008: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.
But India has made steady progress, and because its population is so large, its improvements have helped considerably to decrease the worldwide rate of maternal deaths. China has also made considerable progress. In India, there were 408 to 1,080 maternal deaths per 100,000 live births in 1980, and by 2008, there were 154 to 395, the new study found. In China, there were 144 to 187 deaths per 100,000 live births in 1980, and 35 to 46 in 2008.
Dr. Murray said the findings came as a surprise. What also surprised him and his colleagues, he said, was the number of pregnant women who died from AIDS: about 60,000.
“Really to a large extent that’s why maternal mortality is rising in eastern and southern Africa,” Dr. Murray said.
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via marcandangel.com
Early on, before I began case work, one manager I befriended gave me some advice. To survive, he told me, I needed to remember The Ratio. 50 percent of the job is nodding your head at whatever is being said. 20 percent is honest work and intelligent thinking. The remaining 30 percent is having the courage to speak up, but the wisdom to shut up when you are saying something that your manager does not want to hear.
I spoke up once. And when it became clear that I would be committing career suicide to press on, I shut up.
With a diligent enough effort, one can morally justify nearly anything. It was clear that the client was going to go forward with their decision regardless of how I acted. How could I be responsible for a foregone conclusion? And if I had no power to change things, then why shouldn’t I take the course of action that lets me keep my job? Who would it benefit for me to give up my paycheck? With my salary, I could make large and regular contributions to Red Cross or Doctors Without Borders — without it I would just be another unemployed bum.
But there is a large difference between telling yourself a story and believing it. Ultimately, the core reason I stayed silent wasn’t altruistic, but selfish. At my salary level, and with my expected advancement path, I could comfortably retire in my thirties. That would mean nearly a full lifetime at my disposal, a solid forty years to find true love and raise a family without distraction. It was the opportunity to travel, to achieve great things, to self-actualize. It was the prospect of living a life free of want and need. Who was I kidding? I wasn’t going to donate half my salary to Red Cross. I was going to deposit it into an index fund and speed off as soon as I was sure there was enough gas in the car.
The conscience is a pesky thing. It was no consolation that I had gotten the moral calculus to work out in my favor. I should have been the most relaxed man on the planet, and yet every day I went back to my hotel room and spent most of my time nervously pacing. I couldn’t sleep at night. I’d fill up a bathtub and scream into it. I couldn’t get over the feeling that this was not how I was supposed to spend my life.
Staying silent was agonizing. Nominally, my job was to provide advice and aid in my client’s decision-making process. In practice, my job consisted of sitting quietly and resisting the urge to dissent. Each day was like a punishment from Greek mythology; with every meeting my liver would grow anew to be eaten again by eagles.
I was reminded of the Milgram experiment. I wanted to quit. I didn’t want to have any hand in this, I didn’t want the responsibility of being the destroyer. But the man in the lab coat was telling me that the experiment must continue. Burnout soon followed.
It wasn’t just that I lost all motivation for my job; it was also that it is much harder than one would expect to do unsound analysis. There is an interesting kabuki dance to be done when crafting figures to fit a conclusion. The conclusion may be wrong, but you still need to make it believable. You still need numbers to fill out your PowerPoint slides, and the numbers need to have enough internal consistency not to throw up red flags at a casual glance. Honest analysis, even when it has weak areas, is easy to defend. If the numbers look fishy, there’s an explanation — you didn’t have direct data on such and such and had to use estimates from another report, or made a reasonable assumption somewhere. But when the numbers actually are fishy, and there’s no underlying logic to defend, you can’t have any rough areas for others to poke at. And when you know everything is fishy, you can’t tell what will look fishy to someone who hasn’t seen any numbers before.
This leads to what I like to call, “Find me a rock” problems. The classic “find me a rock” story is as follows: A manager goes to his engineer one day and asks for a rock. “A rock?” asks the engineer. “Yes, a rock. That isn’t going to be a problem, is it?” replies the manager. The engineer laughs and tells the manager he’ll go pick one up during his lunch break and it will be no problem. After lunch, the manager visits the engineer again and the engineer shows him the rock. The manager looks at it for a moment before telling the engineer, “No, that one won’t work at all. I need a rock.”
“Find me a rock” problems sound dead simple, but in actuality have requirements that are poorly stated or unknown. You never know what you’re looking for; you only know that you’ll know it when you see it.
When you disconnect analysis from reality, it would seem like you are freeing yourself up to do your job any way you like. In actuality, you are exchanging one set of clear objectives and rules for another that is complex and ill-defined. At one point my manager said to me, “Change the numbers, but don’t change the conclusion.” Of course, there’s no trouble in changing the numbers — it’s not as if there was much of a basis for this set of numbers over another — but change them how, and to what? Who knows? Find me a rock.
I don’t know if I’ll ever have kids. Still, when I find myself in a moral quandary, I like to think it through by imagining how I would explain the situation to my future, hypothetical children. What would I say? How would they react? Could I justify my actions as having been in their best interest?
I wasn’t sure at the time, but having had enough free time of late to ponder such questions, I think I’ve come to the conclusion that having a father who can pay for a top-notch education outweighs the disadvantage of being raised by a hypocrite. Sticking with the job for the sake of a paycheck passes the children test.
I was not surprised the day I lost my job. The writing was on the wall. BCG’s management might have been releasing reports claiming countries like Dubai would be islands of stability in the world’s rough financial seas, but to the ground troops, it was obvious the economy was not doing well. From the very beginning of my employment, I hadn’t met a single employee who planned on staying with the company — all of them were scrambling for lifeboats, trying to land cushy jobs with cash-stuffed clients or find their way back to their home countries.
What did surprise me was the offer BCG made to me as I was on the way out the door. In exchange for me signing an agreement, BCG would give me the rough equivalent of $16,000 in UAE dirhams. Much of it looked boilerplate, like any common compromise agreement used in Europe — in return for some money, I would stipulate that I hadn’t been discriminated against on the basis of race or gender, etc.
But the rest was very clearly a non-disclosure agreement, and it made me uncomfortable. I signed a non-disclosure agreement when I first took the job, but that only covered BCG’s intellectual property and client identities, things that seemed entirely reasonable to protect. This agreement went much further. Not only did it bar me from making any disparaging comments about BCG or my work experience, but I wouldn’t even be allowed to reveal the existence of the non-disclosure agreement itself. The implication was clear: I could either be a cheerleader for BCG or stay silent, but anything else would bring swift legal retribution. When I asked to have the non-disclosure clauses removed, I was told that the agreement was a standard offer to employees, and that its terms were non-negotiable.
As hard as it was to decide whether or not to stay at my job, it was easy to pass up the hush money. Mistake or not, my future hypothetical children deserved to hear their father’s story, and $16,000 did not seem like a lot of money in the grand scheme of things. After rejecting the offer, I enjoyed a full night’s rest.
This is the third in a four-part series on the author’s experiences as a consultant in Dubai.
via tech.mit.edu
Watch World Famous Chefs Teach Basic Techniques (in Video)
The recent star-chef-studded "Techniques" episode of the Travel Channel's No Reservations was so good, we had to point it out. Now we've got a few clips to share, of knife skills, chicken roasting, basic pasta and red sauce, and better omelette making.
First up, Anthony Bourdain, the host of No Reservations and a well-known, no-nonsense chef and food writer, demonstrates how to hold a knife and get your first rough chop out of an onion. We've previously posted our own onion cutting how-to, but Bourdain's bit has, shall we say, vastly superior production values:
Next up, Jacques Pépin, the French chef who authored the seminal how-to tome La Technique, makes you totally rethink how you make an omelette, start to finish. Breaking the egg, mixing it, stirring it in the pan—there's a technique to all of it.
Scott Conant, the chef at New York's renowned Scarpetta, digs into his heritage to demonstrate a pasta and red sauce. "Basic" only in that there's no meat or fancy white sauces going on here. It's just fresh ingredients, handled the right way.
Finally, Thomas Keller shows us how to make a roast chicken. When the guy who founded the French Laundry and Per Se restaurants tells you to bring your chicken up to temperature before handling it, you should do so.
As noted in our previous post, the full episode is available on iTunes, and may also hit the rerun realm on the Travel Channel at some point. It's definitely worth a watch.
Send an email to Kevin Purdy, the author of this post, at kevin@lifehacker.com.
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I've Googled like crazy trying to find a Julia Child/Jacques Pepin episode where he showed a unique way to roast a turkey that is hands down the best way to prepare a turkey that you will ever see. This is the best that I could do: [goo.gl] You'll just have to check your local PBS station to see if you can catch it.He shows you how to butcher the bird in such a way that it can be reassembled and stuffed and the result is a bird that cooks faster and is unbelievably moist and tasty and is the easiest to carve you will ever put a knife to. Easy to do too, you just need to see how to make the cuts. Reply
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