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

Paper dimensional stability in sheet-fed offset printing : Papperets dimensionsstabilitet i en arkoffsetpress

In offset printing, dampening solution is used to create a good balance in the process. If too much water is transferred to the paper, the sheet can change its size between the printing units, due to water absorption, and cause a problem with the colour register. This phenomenon is usually referred to as fanout. In this degree project, an investigation was made to see if the paper dimensions changed through its way in the sheet-fed printing process. The instrument Luchs Register Measuring Systems (Lynx) was used, and a method for measuring if the paper changed its dimensions with this instrument, was developed. Paper qualities with three different grammages were used, 90, 130 and 250 gsm. This investigation showed that all paper qualities changed their size with widening in the gripper edge in the range of 10 - 70 µm and in the trailing edge the increase was 10 - 130 µm. The elongations of the papers were in the range of 10- 300 µm. The papers with lowest grammage changed more than the heavier. To see if the print had been affected of the widening and elongation, print quality parameters like relative contrast, dot gain and mottle were correlated with the Lynx data from the sheets. The group of papers that gave correlations were in 130 gsm. The sheets had visual doubling and the combined standard deviation from the Lynx marks K3, K5 and K21 correlated with dot gain. When the variations increased so did the dot gain and this indicates that the doubling was due to the widening. There was also a correlation between the standard deviation from K3 and Mottle. The sheets widened with an average of 30 µm in the gripper edge and since there probably were doubling due to widening it also affected the Mottle values. What the widening depends on is hard to tell. Since widening was so small, it could be due to water absorption, papers being ironed out or maybe the sheets have been flattened out. It probably needs a more detailed investigation to find out what causes the widening. Further investigations about how print quality is affected by the register accuracy of a printing machine should include a print form with measuring areas close to the Lynx marks. The measuring areas should contain fine hairlines, negative text printed with at least two colours and some pictures to evaluate together with standard measuring should give a good knowledge about the subject.