The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

The cross-entropy method and its application to minimize the ripple of magnetic levitation forces of a maglev system

This paper explores firstly the potential of a new evolutionary method - the Cross-Entropy (CE) method in solving continuous inverse electromagnetic problems. For this purpose, an adaptive updating formula for the smoothing parameter, some mutation operation, and a new termination criterion are proposed. The proposed CE based metaheuristics is applied to reduce the ripple of the magnetic levitation forces of a prototype Maglev system. The numerical results have shown that the ripple of the magnetic levitation forces of the prototype system is reduced significantly after the design optimization using the proposed algorithm.

MOTILIN-IMMUNOREACTIVE CELLS IN THE DUODENUM, PYLORIC STOMACH AND PANCREAS OF CAIMANS (CAIMAN-LATIROSTRIS AND CAIMAN-CROCODILUS, ALLIGATORINAE) - A FURTHER COMPARISON USING REGION-SPECIFIC MOTILIN ANTISERA

Motilin-immunoreactive cells in the duodenum, pyloric stomach and pancreas of Caiman latirostris and Caiman crocodilus were investigated using region specific antisera for porcine and canine motilin molecules. Motilin-immunoreactive cells were found in the duodenum, pyloric stomach and pancreas of both caiman species. These cells were primarily open-type endocrine ones in the epithelium of the duodenum and pyloric stomach. Motilin-immunoreactive cells were observed in both the exocrine and endocrine portions of the pancreas, and frequently exhibited one or more cytoplasmic processes of variable length. Since motilin-immunoreactive cells do not cross-react with serotonin or any of the other pancreatic and gut hormones, they are considered to be cell type independent from any of the other known pancreatic or gut endocrine cells. The molecular similarity between caiman motilin and porcine and canine motilins and the heterogeneity of the motilin molecule in the caiman digestive system is discussed.

Comparison of artificial and natural, new and reused, brackish water for the larviculture of the freshwater prawn Macrobrachium rosenbergii in a recirculating system

Differences in culture duration, metamorphosis rate and the productivity in hatchery culture of M. rosenbergii using a closed system with natural and artificial brackish water were evaluated. Reuse of brackish water in more than one hatchery cycle was also evaluated. Natural and artificial brackish water constituted the two tested treatments, which were distributed in four independent recirculating systems (tank and respective biofilter). Four batches of cultures were conducted and the 2nd and 4th reused the water from the 1st and 3rd, respectively. Mean duration of the hatchery period was 28 d in natural brackish water and 31 d in artificial brackish water. The metamorphosis rate and the average productivity for the natural brackish water treatment were 74% and 60 postlarvae/ L. respectively, and values obtained with artificial brackish water were 55% and 44 postlarvae/L. The successful hatchery culture of M. rosenbergii in this specific artificial brackish water suggests its potential use in enterprises located far from the coast. Brackish water can be used in two consecutive cultures without a negative effect on productivity.

Electromyographic validation of basic exercises for physical conditioning programmes V. The comparison of the response in the deltoid muscle (anterior portion) and the pectoralis major muscle (clavicular portion) determined by the frontal-lateral cross, dumbbells and the rowing exercises

The action potential level for shoulder muscles deltoid-anterior portion (DA) and pectoralis major-clavicular portion (PMC) determined by four different modalities of execution of rowing exercises, each one with two different grips, was recorded. These were compared with the action potential level determined for the same muscles by four different modalities of execution of the frontal-lateral cross, dumbbells exercises. Twenty-four male volunteers were examined using a 2 channel TECA TE4 electromyograph and Hewlett Packard surface electrodes. The statistic analysis showed significant (p<0,05) superiority for all the frontal-lateral cross, dumbbells exercises in comparison to all rowing exercises for the PMC, for the DA this generalized supremacy was not observed.

Electromyographyc evaluation of movements of lower limb in double pulley system equipment: Comparison between gastrocnemius (caput laterale) and gluteus maximus

It was evaluated movements of lower limb in the double pulley system equipment on ten male volunteers during contraction of gastrocnemius (caput laterale ) and gluteus maximus muscles in the following movements: 1) hip extension with extended knee and erect trunk, 2) hip extension with flexed knee and erect trunk, 3) hip extension with flexed knee and erect trunk, 3) hip extension with extended knee and inclined trunk, 5) hip abduction along the midline, 7) hip abduction with extension beyond the midline, 8) adduction with hip flexion beyond the midline, 8) adduction with hip flexion beyond the midline, and 9) adduction with hip extension beyond the midline. Myoelectric signals were taken up by Lec Tec surface electrodes connected to a 6-channel Lynx electromyographic signal amplifier coupled with a computer equipped with a model CAD 10/26 analogue digital conversion board and with a specific software for signal recording and analysis. We observed weak gastrocnemius muscle activity for all movements studied. In the case of gluteus maximus, the most important potentials were observed for movement 2, while for the remaining movements the actions were of reasonable intensity. Compared to gluteus, gastrocnemius was less required for all movements.

Comparison of FACTS STATCOM models for damping oscillations in power system due to small perturbations

This paper presents small-signal stability studies of a multimachine power system, considering Static Synchronous Compensators (STATCOM)and discussed control modes of the STATCOM. The Power Sensitivity Model(PSM)is used to represent the electric power system. The study is based on modal analysis and time domain simulations. The results obtained allow concluding that the STATCOM improves the stabilization in the electric power system. © 2011 IEEE.

Corneal Absorption of a New Riboflavin-Nanostructured System for Transepithelial Collagen Cross-Linking

Corneal collagen cross-linking (CXL) has been described as a promising therapy for keratoconus. According to standard CXL protocol, epithelium should be debrided before treatment to allow penetration of riboflavin into the corneal stroma. However, removal of the epithelium can increase procedure risks. In this study we aim to evaluate stromal penetration of a biocompatible riboflavin-based nanoemulsion system (riboflavin-5-phosphate and riboflavin-base) in rabbit corneas with intact epithelium. Two riboflavin nanoemulsions were developed. Transmittance and absorption coefficient were measured on corneas with intact epithelia after 30, 60, 120, 180, and 240 minutes following exposure to either the nanoemulsions or standard 0.1% or 1% riboflavin-dextran solutions. For the nanoemulsions, the epithelium was removed after measurements to assure that the riboflavin had passed through the hydrophobic epithelium and retained within the stroma. Results were compared to de-epithelialized corneas exposed to 0.1% riboflavin solution and to the same riboflavin nanoemulsions for 30 minutes (standard protocol). Mean transmittance and absorption measured in epithelialized corneas receiving the standard 0.1% riboflavin solution did not reach the levels found on the debrided corneas using the standard technique. Neither increasing the time of exposure nor the concentration of the riboflavin solution from 0.1% to 1% improved riboflavin penetration through the epithelium. When using riboflavin-5-phosphate nanoemulsion for 240 minutes, we found no difference between the mean absorption coefficients to the standard cross-linking protocol (p = 0.54). Riboflavin nanoemulsion was able to penetrate the corneal epithelium, achieving, after 240 minutes, greater stromal concentration when compared to debrided corneas with the standard protocol (p = 0.002). The riboflavin-5-phosphate nanoemulsion diffused better into the stroma than the riboflavin-base nanoemulsion. © 2013 Bottos et al.

How do driver compensation schemes affect bus system performance?: a comparison between fixed wage and "guerra por el boleto" in Santiago, Chile.

Two systems of bus driver compensation exist in Santiago, Chile. The majority of drivers are paid per passenger transported, which leads to drivers trying to maximize the number of passengers each one conveys. Some of these effects are beneficial, such as a more active effort to minimize the problem of bus bunching, while others, such as aggressive driving, can be harmful. Drivers are said to "race" and the term "War for the Fare" is commonly used. Drivers also pay freelance workers called "sapos" to provide spacing information. Similar phenomena occur in other Latin American capitals.The other system, a fixed wage, is used by 2 companies holding recently awarded concessions for routes feeding metro stations.This paper discusses, quantitatively and qualitatively, the effects of these two compensation systems on accidents, quality of service, attitudes of both users and drivers, and average waiting times for passengers.

Endodontic retreatment: clinical comparison of reciprocating systems versus rotary system in disinfecting root canals

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A critical comparison of different approaches to sediment-quality assessments in the Santos estuarine system in Brazil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparison of snow data assimilation system with GPS reflectometry snow depth in the Western United States

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Ex vivo torsional properties of the Targon Vet Nail System in canine femurs: comparison with the 2.4 mm LC-DCP Plate

Pós-graduação em Cirurgia Veterinária - FCAV

Prevalence and Predictors of Potential Drug-Drug Interactions in the Elderly: A Cross-Sectional Study in the Brazilian Primary Public Health System

Purpose. The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. Methods. A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors. Results. The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of = 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving = 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), = 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), = 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), = 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs. Conclusion. Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.