Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Independent Domain of Symmetric Encryption using Least SignificantBit : Computer Vision, Steganography and Cryptography Techniques

The rapid development of data transfer through internet made it easier to send the data accurate and faster to the destination. There are many transmission media to transfer the data to destination like e-mails; at the same time it is may be easier to modify and misuse the valuable information through hacking. So, in order to transfer the data securely to the destination without any modifications, there are many approaches like cryptography and steganography. This paper deals with the image steganography as well as with the different security issues, general overview of cryptography, steganography and digital watermarking approaches.  The problem of copyright violation of multimedia data has increased due to the enormous growth of computer networks that provides fast and error free transmission of any unauthorized duplicate and possibly manipulated copy of multimedia information. In order to be effective for copyright protection, digital watermark must be robust which are difficult to remove from the object in which they are embedded despite a variety of possible attacks. The message to be send safe and secure, we use watermarking. We use invisible watermarking to embed the message using LSB (Least Significant Bit) steganographic technique. The standard LSB technique embed the message in every pixel, but my contribution for this proposed watermarking, works with the hint for embedding the message only on the image edges alone. If the hacker knows that the system uses LSB technique also, it cannot decrypt correct message. To make my system robust and secure, we added cryptography algorithm as Vigenere square. Whereas the message is transmitted in cipher text and its added advantage to the proposed system. The standard Vigenere square algorithm works with either lower case or upper case. The proposed cryptography algorithm is Vigenere square with extension of numbers also. We can keep the crypto key with combination of characters and numbers. So by using these modifications and updating in this existing algorithm and combination of cryptography and steganography method we develop a secure and strong watermarking method. Performance of this watermarking scheme has been analyzed by evaluating the robustness of the algorithm with PSNR (Peak Signal to Noise Ratio) and MSE (Mean Square Error) against the quality of the image for large amount of data. While coming to see results of the proposed encryption, higher value of 89dB of PSNR with small value of MSE is 0.0017. Then it seems the proposed watermarking system is secure and robust for hiding secure information in any digital system, because this system collect the properties of both steganography and cryptography sciences.