Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda : a randomised controlled equivalence trial

BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024. FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded. INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care. FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.

Women's acceptability of misoprostol treatment for incomplete abortion by midwives and physicians : secondary outcome analysis from a randomized controlled equivalence trial at district level in Uganda

OBJECTIVE: This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians. METHODS: This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14-28 days following treatment. Analysis of women's overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024. RESULTS: From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded. CONCLUSIONS: Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women. TRIAL REGISTRATION: ClinicalTrials.gov NCT01844024.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

A contractive method for computing the stationary solution of the euler equation

A contractive method for computing stationary solutions of intertemporal equilibrium models is provide. The method is is implemented using a contraction mapping derived from the first-order conditions. The deterministic dynamic programming problem is used to illustrate the method. Some numerical examples are performed.

Controle preditivo robusto baseado em desigualdades matriciais lineares aplicado a um sistema de tanques acoplados

This work deals with an on-line control strategy based on Robust Model Predictive Control (RMPC) technique applied in a real coupled tanks system. This process consists of two coupled tanks and a pump to feed the liquid to the system. The control objective (regulator problem) is to keep the tanks levels in the considered operation point even in the presence of disturbance. The RMPC is a technique that allows explicit incorporation of the plant uncertainty in the problem formulation. The goal is to design, at each time step, a state-feedback control law that minimizes a 'worst-case' infinite horizon objective function, subject to constraint in the control. The existence of a feedback control law satisfying the input constraints is reduced to a convex optimization over linear matrix inequalities (LMIs) problem. It is shown in this work that for the plant uncertainty described by the polytope, the feasible receding horizon state feedback control design is robustly stabilizing. The software implementation of the RMPC is made using Scilab, and its communication with Coupled Tanks Systems is done through the OLE for Process Control (OPC) industrial protocol

Altered plasma response to zinc and iron tolerance test after Roux-en-Y gastric bypass

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

Position-dependent effective mass Dirac equations with PT-symmetric and non-PT-symmetric potentials

We present a new procedure to construct the one-dimensional non-Hermitian imaginary potential with a real energy spectrum in the context of the position-dependent effective mass Dirac equation with the vector-coupling scheme in 1 + 1 dimensions. In the first example, we consider a case for which the mass distribution combines linear and inversely linear forms, the Dirac problem with a PT-symmetric potential is mapped into the exactly solvable Schrodinger-like equation problem with the isotonic oscillator by using the local scaling of the wavefunction. In the second example, we take a mass distribution with smooth step shape, the Dirac problem with a non-PT-symmetric imaginary potential is mapped into the exactly solvable Schrodinger-like equation problem with the Rosen-Morse potential. The real relativistic energy levels and corresponding wavefunctions for the bound states are obtained in terms of the supersymmetric quantum mechanics approach and the function analysis method.

Fault section estimation in electric power systems using an optimization immune algorithm

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

Ganho genético com base no tamanho efetivo populacional de progênies de seringueira

O objetivo deste trabalho foi estimar os ganhos genéticos de um teste de progênies de seringueira para a produção de borracha seca e, com base no maior tamanho efetivo populacional e maior ganho genético, obter os melhores indivíduos. Foram utilizadas 30 progênies de meios-irmãos, provenientes de sementes de polinização mista - alogamia e autogamia - de testes clonais no Estado de São Paulo. Utilizou-se o delineamento experimental de blocos ao acaso, com 30 tratamentos (progênies), 3 repetições e parcelas lineares de 10 plantas, em um espaçamento de 3x3 m, o que totalizou 900 plantas úteis. Aos três anos, o perímetro, a 50 cm do solo (PA50), e a produção de borracha seca (PBS) foram avaliadas por meio do teste precoce de produção Hamaker Morris-Mann (HMM). As variáveis foram analisadas pelo método de modelo linear misto, via procedimento REML/BLUP, em progênies com sistema reprodutivo misto e taxa de autofecundação de 22%. A identificação dos 20 melhores indivíduos quanto à PBS e ao PA50 proporcionou ganho genético de 67,96 e 16,48%, respectivamente, e um coeficiente de endogamia de aproximadamente 2,82%. O teste de progênies proporciona produção de sementes com melhor valor genético, grande variabilidade e baixa endogamia

Um método semi-automatizado para elicitação de requisitos de acessibilidade Web

In the context of Software Engineering, web accessibility is gaining more room, establishing itself as an important quality attribute. This fact is due to initiatives of institutions such as the W3C (World Wide Web Consortium) and the introduction of norms and laws such as Section 508 that underlie the importance of developing accessible Web sites and applications. Despite these improvements, the lack of web accessibility is still a persistent problem, and could be related to the moment or phase in which this requirement is solved within the development process. From the moment when Web accessibility is generally regarded as a programming problem or treated when the application is already developed entirely. Thus, consider accessibility already during activities of analysis and requirements specification shows itself a strategy to facilitate project progress, avoiding rework in advanced phases of software development because of possible errors, or omissions in the elicitation. The objective of this research is to develop a method and a tool to support requirements elicitation of web accessibility. The strategy for the requirements elicitation of this method is grounded by the Goal-Oriented approach NFR Framework and the use of catalogs NFRs, created based on the guidelines contained in WCAG 2.0 (Web Content Accessibility Guideline) proposed by W3C

Analysis of the electrical conductivity in milking fractions as a mean for detecting and characterizing mastitis in goats

The aim of the work was to study the effect of milking fraction on electrical conductivity of milk (EC) to improve its use in dairy goat mastitis detection using automatic EC measurements during milking. The experiment was carried out on a group of 84 Murciano-Granadina goats (28 primiparous and 56 multiparous). Goats were in the fourth month of lactation. A linear mixed model was used to analyse the relationship between EC or somatic cell count (SCC) of gland milk and parity, mammary gland health status, analysed fraction (first 100 mL=F-1; machine milk=F-2; and stripping milk=F-3) and their first order interactions. Additionally, the mastitis detection characteristics (sensitivity, specificity, positive predictive value and negative predictive value) of SCC and EC were studied at different thresholds.All factors considered were significant for EC and SCC. EC decreased significantly as milking progressed (from F-1 to F-3) in both healthy and infected glands. EC was not significantly different between healthy and infected glands in F-1 and F-2 fractions, but EC of healthy glands (5.01 mS/cm) was significantly lower than in infected glands (5.03 mS/cm) at F-3.Mastitis detection characteristics of EC did not differ amongst studied fractions. The small significant difference of EC between healthy and infected glands obtained in F-3 fraction did not yield better sensitivity results compared to F-1 and F-2. The best EC mastitis detection characteristics were obtained at 5.20 mS/cm threshold (sensitivity of 70% and specificity of 50%). The best SCC mastitis detection characteristics were obtained at 300,000 cells/mL threshold and F-3 fraction (sensitivity of 85% and specificity of 65%).It was concluded that mastitis detection characteristics of EC were similar in the three milking fractions analysed, being slightly better for SCC in F-3 fraction. As shown in previous studies, there are no factors other than the mammary gland health status that affect milk EC and should be considered in the algorithms for mastitis detection to improve the results. (C) 2012 Elsevier B.V. All rights reserved.

Estudo de simulação de modelos lineares mistos com distribuição normal contaminada no melhoramento genético animal

Objetivou-se com esse trabalho comparar estimativas de componentes de variâncias obtidas por meio de modelos lineares mistos Gaussianos e Robustos, via Amostrador de Gibbs, em dados simulados. Foram simulados 50 arquivos de dados com 1.000 animais cada um, distribuídos em cinco gerações, em dois níveis de efeito fixo e três valores fenotípicos distintos para uma característica hipotética, com diferentes níveis de contaminação. Exceto para os dados sem contaminação, quando os modelos foram iguais, o modelo Robusto apresentou melhores estimativas da variância residual. As estimativas de herdabilidade foram semelhantes em todos os modelos, mas as análises de regressão mostraram que os valores genéticos preditos com uso do modelo Robusto foram mais próximos dos valores genéticos verdadeiros. Esses resultados sugerem que o modelo linear normal contaminado oferece uma alternativa flexível para estimação robusta em melhoramento genético animal.

Recursive hierarchic segmentation analysis of bone mineral density changes on digital panoramic images

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Some practical advice on polynomial regression analysis from blocked response surface designs

It is often necessary to run response surface designs in blocks. In this paper the analysis of data from such experiments, using polynomial regression models, is discussed. The definition and estimation of pure error in blocked designs are considered. It is recommended that pure error is estimated by assuming additive block and treatment effects, as this is more consistent with designs without blocking. The recovery of inter-block information using REML analysis is discussed, although it is shown that it has very little impact if thc design is nearly orthogonally blocked. Finally prediction from blocked designs is considered and it is shown that prediction of many quantities of interest is much simpler than prediction of the response itself.

An experimental assessment of landscape configuration effects on frog and toad abundance and diversity in tropical agro-savannah landscapes of southeastern Brazil

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