Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114). RESULTS: There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use. CONCLUSIONS: Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. TRIAL REGISTRATION: Clinicaltrials.gov NCT01827995.

Addressing surprise and uncertain futures in marine science, marine governance, and society

On an increasingly populated planet, with decreasing biodiversity and limited new opportunities to tap unexploited natural resources, there is a clear need to adjust aspects of marine management and governance. Although sectarian management has succeeded in addressing and managing some important threats to marine ecosystems, unintended consequences are often associated with overlooking nonlinear interactions and cumulative impacts that increase the risk of surprises in social-ecological systems. In this paper, we begin to untangle science-governance-society (SGS) interdependencies in marine systems by considering how to recognize the risk of surprise in social and ecological dynamics. Equally important is drawing attention to our state of preparedness, adaptation, and timeliness of response in ecosystem governance and society, which involve fostering transformations away from rigid and nonintegrated structures of governance. More inclusive decision-making processes, deeper understanding of complexity, and colearning across SGS can help to build constructive solutions that are likely to benefit multiple stakeholders and build capacity to understand and respond to change.

Reconciling History and International Law: Territorial and Maritime Claims in the South China Sea and East China Sea

High-ranking Chinese military officials are often quoted in international media as stating that China cannot afford to lose even an inch of Chinese territory, as this territory has been passed down from Chinese ancestors. Such statements are not new in Chinese politics, but recently this narrative has made an important transition. While previously limited to disputes over land borders, such rhetoric is now routinely applied to disputes involving islands and maritime borders. China is increasingly oriented toward its maritime borders and seems unwilling to compromise on delimitation disputes, a transition mirrored by many states across the globe. In a similar vein, scholarship has found that territorial disputes are particularly intractable and volatile when compared with other types of disputes, and a large body of research has grappled with producing systematic knowledge of territorial conflict. Yet in this wide body of literature, an important question has remained largely unanswered - how do states determine which geographical areas will be included in their territorial and maritime claims? In other words, if nations are willing to fight and die for an inch of national territory, how do governments draw the boundaries of the nation? This dissertation uses in-depth case studies of some of the most prominent territorial and maritime disputes in East Asia to argue that domestic political processes play a dominant and previously under-explored role in both shaping claims and determining the nature of territorial and maritime disputes. China and Taiwan are particularly well suited for this type of investigation, as they are separate claimants in multiple disputes, yet they both draw upon the same historical record when establishing and justifying their claims. Leveraging fieldwork in Taiwan, China, and the US, this dissertation includes in-depth case studies of China’s and Taiwan’s respective claims in both the South China Sea and East China Sea disputes. Evidence from this dissertation indicates that officials in both China and Taiwan have struggled with how to reconcile history and international law when establishing their claims, and that this struggle has introduced ambiguity into China's and Taiwan's claims. Amid this process, domestic political dynamics have played a dominant role in shaping the options available and the potential for claims to change in the future. In Taiwan’s democratic system, where national identity is highly contested through party politics, opinions vary along a broad spectrum as to the proper borders of the nation, and there is considerable evidence that Taiwan’s claims may change in the near future. In contrast, within China’s single-party authoritarian political system, where nationalism is source of regime legitimacy, views on the proper interpretation of China’s boundaries do vary, but along a much more narrow range. In the dissertation’s final chapter, additional cases, such as South Korea’s position on Dokdo and Indonesia’s approach to the defense of Natuna are used as points of comparison to further clarify theoretical findings.

Lymphadenopathy after Initiating HAART in an HIV-positive Patient with Kaposi's Sarcoma: a Case of Multicentric Castleman's Disease

We present the case of a 33-year-old lady who was diagnosed with disseminated Kaposi’s sarcoma and HIV infection. The patient improved on highly active antiretroviral therapy (HAART), however, nine days into treatment, she became febrile and dyspnoeic and developed tender cervical and axillary lymphadenopathy. Despite treatment for suspected sepsis and immune reconstitution, she died in intensive care. Lymph node biopsies revealed coexistent Castleman’s disease and Kaposi’s sarcoma. Initiation of HAART can be rarely associated with unmasking and rapid progression of Castleman’s disease, a phenomenon called immune reconstitution. Urgent investigation and treatment with agents such as steroids and cytotoxic drugs can be life-saving.

Theory of mind after mild TBI in preschool children : a longitudinal perspective

Les enfants d’âge préscolaire (≤ 5 ans) sont plus à risque de subir un traumatisme crânio-cérébral (TCC) que les enfants plus agés, et 90% de ces TCC sont de sévérité légère (TCCL). De nombreuses études publiées dans les deux dernières décennies démontrent que le TCCL pédiatrique peut engendrer des difficultés cognitives, comportementales et psychiatriques en phase aigüe qui, chez certains enfants, peuvent perdurer à long terme. Il existe une littérature florissante concernant l'impact du TCCL sur le fonctionnement social et sur la cognition sociale (les processus cognitifs qui sous-tendent la socialisation) chez les enfants d'âge scolaire et les adolescents. Or, seulement deux études ont examiné l'impact d'un TCCL à l'âge préscolaire sur le développement social et aucune étude ne s'est penchée sur les répercussions socio-cognitives d'un TCCL précoce (à l’âge préscolaire). L'objectif de la présente thèse était donc d'étudier les conséquences du TCCL en bas âge sur la cognition sociale. Pour ce faire, nous avons examiné un aspect de la cognition sociale qui est en plein essor à cet âge, soit la théorie de l'esprit (TE), qui réfère à la capacité de se mettre à la place d'autrui et de comprendre sa perspective. Le premier article avait pour but d'étudier deux sous-composantes de la TE, soit la compréhension des fausses croyances et le raisonnement des désirs et des émotions d'autrui, six mois post-TCCL. Les résultats indiquent que les enfants d'âge préscolaire (18 à 60 mois) qui subissent un TCCL ont une TE significativement moins bonne 6 mois post-TCCL comparativement à un groupe contrôle d'enfants n'ayant subi aucune blessure. Le deuxième article visait à éclaircir l'origine de la diminution de la TE suite à un TCCL précoce. Cet objectif découle du débat qui existe actuellement dans la littérature. En effet, plusieurs scientifiques sont d'avis que l'on peut conclure à un effet découlant de la blessure au cerveau seulement lorsque les enfants ayant subi un TCCL sont comparés à des enfants ayant subi une blessure n'impliquant pas la tête (p.ex., une blessure orthopédique). Cet argument est fondé sur des études qui démontrent qu'en général, les enfants qui sont plus susceptibles de subir une blessure, peu importe la nature de celle-ci, ont des caractéristiques cognitives pré-existantes (p.ex. impulsivité, difficultés attentionnelles). Il s'avère donc possible que les difficultés que nous croyons attribuables à la blessure cérébrale étaient présentes avant même que l'enfant ne subisse un TCCL. Dans cette deuxième étude, nous avons donc comparé les performances aux tâches de TE d'enfants ayant subi un TCCL à ceux d'enfants appartenant à deux groupes contrôles, soit des enfants n'ayant subi aucune blessure et à des pairs ayant subi une blessure orthopédique. De façon générale, les enfants ayant subi un TCCL ont obtenu des performances significativement plus faibles à la tâche évaluant le raisonnement des désirs et des émotions d'autrui, 6 mois post-blessure, comparativement aux deux groupes contrôles. Cette étude visait également à examiner l'évolution de la TE suite à un TCCL, soit de 6 mois à 18 mois post-blessure. Les résultats démontrent que les moindres performances sont maintenues 18 mois post-TCCL. Enfin, le troisième but de cette étude était d’investiguer s’il existe un lien en la performance aux tâches de TE et les habiletés sociales, telles qu’évaluées à l’aide d’un questionnaire rempli par le parent. De façon intéressante, la TE est associée aux habiletés sociales seulement chez les enfants ayant subi un TCCL. Dans l'ensemble, ces deux études mettent en évidence des répercussions spécifiques du TCCL précoce sur la TE qui persistent à long terme, et une TE amoindrie seraient associée à de moins bonnes habiletés sociales. Cette thèse démontre qu'un TCCL en bas âge peut faire obstacle au développement sociocognitif, par le biais de répercussions sur la TE. Ces résultats appuient la théorie selon laquelle le jeune cerveau immature présente une vulnérabilité accrue aux blessures cérébrales. Enfin, ces études mettent en lumière la nécessité d'étudier ce groupe d'âge, plutôt que d'extrapoler à partir de résultats obtenus avec des enfants plus âgés, puisque les enjeux développementaux s'avèrent différents, et que ceux-ci ont potentiellement une influence majeure sur les répercussions d'une blessure cérébrale sur le fonctionnement sociocognitif.

Transdiscipline and research in health: Science, society and decision making

Significant advances in science should be given to addressing the needs of society and the historical context of the territories. Although technological developments that began with modernity and the industrial revolution allowed human beings to control the resources of nature to put to your service without limits, it is clear that the crisis of the prevailing development models manifest themselves in many ways but with three common denominators: environmental degradation, social injustice and extreme poverty. Consequently, today should not be possible to think a breakthrough in the development of science without addressing global environmental problems and the deep social injustices that increase at all scales under the gaze, impassively in many occasions, of formal science.

The qualitative research method approach (qurma) : students guide

Qualitative methods are commonly used within the area of Electronic Government as well as other fields in social science. Among students carrying out qualitative approaches in their thesis work, qualitative studies are very common but unfortunately there is often a lack of rigor when using qualitative approaches. Method books discussing qualitative studies are frequent, but they often lack some firm advices about how to actually carry out a qualitative study. There are lots of good advices about interviews and observations. Grounded theory is often mentioned although in rather general terms. The interpretive part is not very thoroughly discussed though. Below we present an outline that might fill the mentioned gap somewhat. Our aim is to give the student a guide in carrying out the qualitative/interpretive approach. By following the ten steps below, students will not only have to prepare the study, they will also find some solid reference support for the necessary steps in the process of research.

El efecto de la definición regulatoria de banda ancha sobre la difusión y la competencia del mercado de servicios de Internet fijo en Colombia

A partir de la dinámica evolutiva de la economía de las Tecnologías de la Información y las Comunicaciones y el establecimiento de estándares mínimos de velocidad en distintos contextos regulatorios a nivel mundial, en particular en Colombia, en el presente artículo se presentan diversas aproximaciones empíricas para evaluar los efectos reales que conlleva el establecimiento de definiciones de servicios de banda ancha en el mercado de Internet fijo. Con base en los datos disponibles para Colombia sobre los planes de servicios de Internet fijo ofrecidos durante el periodo 2006-2012, se estima para los segmentos residencial y corporativo el proceso de difusión logístico modificado y el modelo de interacción estratégica para identificar los impactos generados sobre la masificación del servicio a nivel municipal y sobre las decisiones estratégicas que adoptan los operadores, respectivamente. Respecto a los resultados, se encuentra, por una parte, que las dos medidas regulatorias establecidas en Colombia en 2008 y 2010 presentan efectos significativos y positivos sobre el desplazamiento y el crecimiento de los procesos de difusión a nivel municipal. Por otra parte, se observa sustituibilidad estratégica en las decisiones de oferta de velocidad de descarga por parte de los operadores corporativos mientras que, a partir del análisis de distanciamiento de la velocidad ofrecida respecto al estándar mínimo de banda ancha, se demuestra que los proveedores de servicios residenciales tienden a agrupar sus decisiones de velocidad alrededor de los niveles establecidos por regulación.

On the role of Computational Logic in Data Science: representing, learning, reasoning, and explaining knowledge

In this thesis we discuss in what ways computational logic (CL) and data science (DS) can jointly contribute to the management of knowledge within the scope of modern and future artificial intelligence (AI), and how technically-sound software technologies can be realised along the path. An agent-oriented mindset permeates the whole discussion, by stressing pivotal role of autonomous agents in exploiting both means to reach higher degrees of intelligence. Accordingly, the goals of this thesis are manifold. First, we elicit the analogies and differences among CL and DS, hence looking for possible synergies and complementarities along 4 major knowledge-related dimensions, namely representation, acquisition (a.k.a. learning), inference (a.k.a. reasoning), and explanation. In this regard, we propose a conceptual framework through which bridges these disciplines can be described and designed. We then survey the current state of the art of AI technologies, w.r.t. their capability to support bridging CL and DS in practice. After detecting lacks and opportunities, we propose the notion of logic ecosystem as the new conceptual, architectural, and technological solution supporting the incremental integration of symbolic and sub-symbolic AI. Finally, we discuss how our notion of logic ecosys- tem can be reified into actual software technology and extended towards many DS-related directions.

Granulocyte Colony-stimulating Factor (g-csf) Positive Effects On Muscle Fiber Degeneration And Gait Recovery After Nerve Lesion In Mdx Mice.

G-CSF has been shown to decrease inflammatory processes and to act positively on the process of peripheral nerve regeneration during the course of muscular dystrophy. The aims of this study were to investigate the effects of treatment of G-CSF during sciatic nerve regeneration and histological analysis in the soleus muscle in MDX mice. Six-week-old male MDX mice underwent left sciatic nerve crush and were G-CSF treated at 7 days prior to and 21 days after crush. Ten and twenty-one days after surgery, the mice were euthanized, and the sciatic nerves were processed for immunohistochemistry (anti-p75(NTR) and anti-neurofilament) and transmission electron microscopy. The soleus muscles were dissected out and processed for H&E staining and subsequent morphologic analysis. Motor function analyses were performed at 7 days prior to and 21 days after sciatic crush using the CatWalk system and the sciatic nerve index. Both groups treated with G-CSF showed increased p75(NTR) and neurofilament expression after sciatic crush. G-CSF treatment decreased the number of degenerated and regenerated muscle fibers, thereby increasing the number of normal muscle fibers. The reduction in p75(NTR) and neurofilament indicates a decreased regenerative capacity in MDX mice following a lesion to a peripheral nerve. The reduction in motor function in the crushed group compared with the control groups may reflect the cycles of muscle degeneration/regeneration that occur postnatally. Thus, G-CSF treatment increases motor function in MDX mice. Nevertheless, the decrease in baseline motor function in these mice is not reversed completely by G-CSF.

FiltekTM Silorane and FiltekTM Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (FiltekTM Silorane) and a methacrylate-based nanoparticle resin (FiltekTM Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (?=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

Renin angiotensin system and cardiac hypertrophy after sinoaortic denervation in rats

OBJECTIVE: The aim of this study was to evaluate the role of angiotensin I, II and 1-7 on left ventricular hypertrophy of Wistar and spontaneously hypertensive rats submitted to sinoaortic denervation. METHODS: Ten weeks after sinoaortic denervation, hemodynamic and morphofunctional parameters were analyzed, and the left ventricle was dissected for biochemical analyses. RESULTS: Hypertensive groups (controls and denervated) showed an increase on mean blood pressure compared with normotensive ones (controls and denervated). Blood pressure variability was higher in denervated groups than in their respective controls. Left ventricular mass and collagen content were increased in the normotensive denervated and in both spontaneously hypertensive groups compared with Wistar controls. Both hypertensive groups presented a higher concentration of angiotensin II than Wistar controls, whereas angiotensin 1-7 concentration was decreased in the hypertensive denervated group in relation to the Wistar groups. There was no difference in angiotensin I concentration among groups. CONCLUSION: Our results suggest that not only blood pressure variability and reduced baroreflex sensitivity but also elevated levels of angiotensin II and a reduced concentration of angiotensin 1-7 may contribute to the development of left ventricular hypertrophy. These data indicate that baroreflex dysfunction associated with changes in the renin angiotensin system may be predictive factors of left ventricular hypertrophy and cardiac failure.

Hyperglycemia can delay left ventricular dysfunction but not autonomic damage after myocardial infarction in rodents

Background: Although clinical diabetes mellitus is obviously a high risk factor for myocardial infarction (MI), in experimental studies disagreement exists about the sensitivity to ischemic injury of an infarcted myocardium. Recently, our group demonstrated that diabetic animals presented better cardiac function recovery and cellular resistance to ischemic injury than nondiabetics. In the present study, we evaluated the chronic effects of MI on left ventricular (LV) and autonomic functions in streptozotocin (STZ) diabetic rats. Methods: Male Wistar rats were divided into 4 groups: control (C, n = 15), diabetes (D, n = 16), MI (I, n = 21), and diabetes + MI (DI, n = 30). MI was induced 15 days after diabetes (STZ) induction. Ninety days after MI, LV and autonomic functions were evaluated (8 animals each group). Left ventricular homogenates were analyzed by Western blotting to evaluate the expression of calcium handling proteins. Results: MI area was similar in infarcted groups (similar to 43%). Ejection fraction and + dP/dt were reduced in I compared with DI. End-diastolic pressure was additionally increased in I compared with DI. Compared with DI, I had increased Na(+)-Ca(2+) exchange and phospholamban expression (164%) and decreased phosphorylated phospholamban at serine(16) (65%) and threonine(17) (70%) expression. Nevertheless, diabetic groups had greater autonomic dysfunction, observed by baroreflex sensitivity and pulse interval variability reductions. Consequently, the mortality rate was increased in DI compared with I, D, and C groups. Conclusions: LV dysfunction in diabetic animals was attenuated after 90 days of myocardial infarction and was associated with a better profile of calcium handling proteins. However, this positive adaptation was not able to reduce the mortality rate of DI animals, suggesting that autonomic dysfunction is associated with increased mortality in this group. Therefore, it is possible that the better cardiac function has been transitory, and the autonomic dysfunction, more prominent in diabetic group, may lead, in the future, to the cardiovascular damage.

Circulating Interleukin-6 and High-Sensitivity C-Reactive Protein Decrease After Periodontal Therapy in Otherwise Healthy Subjects

Background: Periodontal disease has been associated with many chronic inflammatory systemic diseases, and a common chronic inflammation pathway has been suggested for these conditions. However, few studies have evaluated whether periodontal disease, in the absence of other known inflammatory conditions and smoking, affects circulating markers of chronic inflammation. This study compared chronic inflammation markers in control individuals and patients with periodontal disease and observed whether non-surgical periodontal therapy affected inflammatory disease markers after 3 months. Methods: Plasma and serum of 20 controls and 25 patients with periodontal disease were obtained prior to and 3 months after non-surgical periodontal therapy. All patients were non-smokers, they did not use any medication, and they had no history or detectable signs and symptoms of systemic diseases. Periodontal and systemic parameters included probing depth, bleeding on probing, clinical attachment level, hematologic parameters, as well as the following inflammatory markers: interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), CD40 ligand, monocyte chemoattractant protein (MCP)-1, soluble P-selectin (sP-selectin), soluble vascular adhesion molecule (sVCAM)-1, and soluble intercellular adhesion molecule (sICAM)-1. Results: There were no differences in the hematologic parameters of the patients in the control and periodontal disease groups. Among the tested inflammatory markers, IL-6 concentrations were higher in the periodontal disease group at baseline compared to the controls (P=0.006). Therapy was highly effective (P<0.001 for all the analyzed clinical parameters), and a decrease in circulating IL-6 and hs-CRP concentrations was observed 3 months after therapy (P=0.001 and P=0.006, respectively). Our results also suggest that the CD40 ligand marker may have been different in the control and periodontal disease groups prior to the therapy (P=0.009). Conclusions: In apparently otherwise healthy patients, periodontal disease is associated with increased circulating concentrations of IL-6 and hs-CRP, which decreased 3 months after non-surgical periodontal therapy. With regard to the CD40 ligand, MCP-1, sP-selectin, sVCAM-1, and sICAM-1, no changes were seen in the periodontal disease group between baseline and 3 months after therapy. J Periodontol 2009;80:594-602.

Lipase Production by Endophytic Fungus Cercospora kikuchii: Stability of Enzymatic Activity after Spray Drying in the Presence of Carbohydrates

The present work deals with improving the production and stabilization of lipases from Cercospora kikuchii. Maximum enzyme production (9.384 U/ml) was obtained after 6 days in a medium supplemented with 2% soybean oil. The lipases were spray dried with different adjuvants, and their stability was studied. The residual enzyme activity after drying with 10% (w/v) of lactose, b- cyclodextrin, maltodextrin, mannitol, gum arabic, and trehalose ranged from 63 to 100%. The enzyme activity was lost in the absence of adjuvants. Most of the adjuvants used kept up at least 50% of the enzymatic activity at 5 degrees C and 40% at 25 degrees C after 8 months. The lipase dried with 10% of beta-cyclodextrin retained 72% of activity at 5 degrees C. Lipases were separated by butyl-sepharose column into 4 pools, and pool 4 was partially purified (33.1%; 269.5 U/mg protein). This pool was also spray dried in maltodextrin DE10, and it maintained 100% of activity.