Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India : study protocol and intervention adaptation of a randomised control trial

The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. Trial design The study is a randomised, controlled, non-superiority trial . Methods Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study is to evaluate the effectiveness of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10-14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This was to optimise and tailor-make the intervention and the study procedures and resulted in the development of the pictorial instruction sheet for how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion. Discussion In this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10-14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor. Trial registration: Clinicaltrials.gov NCT01827995. Registered 04 May 2013

Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

English Vowels: A World English Perspective

In spite of having a fixed standard of pronunciation, English is being used in various ways in parts of the world, particularly in its way of utterance. English vowel is playing one of the significant roles in making different varieties of English language. This essay tries to see into detail how some phonetic features (formant movement, frequency, pitch) of English vowels vary in relation to Bengali, Catalan, Italian, Spanish and Swedish speakers. It has been found that all these speakers vary a lot from each other in the utterance of English vowels.

Vilhelm Ekelund och den fransk-italienska kultursfären : Några nedslag i de tidiga prosaverken - från Antikt ideal (1909) till Attiskt i fågelperspektiv (1919)

Vilhelm Ekelund och den fransk-italienska kultursfären: Några nedslag i de tidiga prosaverken – från Antikt ideal (1909) till Attiskt i fågelperspektiv (1919). (Vilhelm Ekelund and the French and Italian cultural heritage: A study of his early prose – from Antikt ideal (1909) to Attiskt i fågelperspektiv (1919)). The Swedish poet, essayist and aphorist Vilhelm Ekelund was not only influenced by German literature and philosophy, he also wrote extensive literary criticism on the subject of Romance language authors. This article discusses Ekelund’s relationship to some of the most influential French and Italian writers – as it can be seen in his work during the period 1909-1919. This relationship was ambiguous: he paid homage to French authors such as Montaigne, Montesquieu, Stendhal and Comte – as well as to the Italian poet and philosopher Leopardi – but he also severely criticized such distinguished writers as Baudelaire, Rousseau and Maupassant. One conclusion of this article is that the authors praised by Ekelund all venerate the Greek and Roman cultural heritage, whereas the despised novelists and poets were, in his opinion, either too “modern” or too “feminine” – both highly pejorative adjectives in the author’s terminology. It is also noted that Ekelund’s most ferocious attacks date from the first part of the decade, before he entered a more harmonic period with the works Metron (1918) and Attiskt i fågelperspektiv (1919).

L’insegnamento online delle lingue all’Università del Dalarna (Svezia) : Esperienze di collaborazione internazionale e prospettive future

This paper describes the on-line teaching strategies for languages adopted at the University of Dalarna (Sweden) and the experience of a collaboration carried out with the Language Centre of the University of Parma that led to the administration of an international course in Italian for specific purposes. According to the results of its first administration, the promotion of advanced forms of "virtual mobility" together with the prospective of a joint degree in Italian language and culture will be outlined.

The Björling 'Opera' : A children's Nursery Academy and an Italian Conservatory in Miniature

The aim in this chapter is to develop a deeper understanding about the informal Björling 'School' in Sweden. Contextually the example is related to the micro history of opera education contributing to the macro perspective illuminating a provincial example of the concept of domestic opera schooling. The specific focus was on Karl David Björling (1873-1926), the teaching parent of the Swedish tenor Jussi Björling (1911-1960) and his brothers Gösta and Olle.   The Björling family model of opera schooling belongs to the classical canon of domestic home education which was common during the epoch. The phenomenon is also within the field of opera singing an important reference to the historical context of the Nordic opera history of vocal education.   The uniqueness concerning the Björling School seems to be the rigorous and exceptionally early training. David Björling’s pedagogy was rooted in earlier German theories of musical upbringing. It's clear from his results that he was familiar with the neo-humanistic ideal on which reformed music education was based. Of a specific interest is the term Gesang als Unterricht as a concept for developing childrens musical and memorising capacities.   Conceptually the roots of the Björling model are in the eighteenth-century Romantic view of prodigies and their abilities. The extensive touring is connected to the promotion of wonder-children, and David Björling’s educational style to the conservative Master-pupil tradition.   David Björling's vocal ideal was a part of the contemporary debate about “The decadence of the singing art”, and seems to have its roots in an older Italian tradition. There are recurring similarities between his educational methods and the didactic principles of the Lamperti School: Enjoying a revival around the late 1800s and early 1900s, it has been called the natural or the national school. Nevertheless, through authentic experiences and gramophone recordings the Italian tenor Enrico Caruso became David Björling’s pedagogical role model.

Humor in Pride and Prejudice : The Role of Humor in Austen’s Novel of Development

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