Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Semantic and Personalised Service Discovery

One of the most pervasive classes of services needed to support e-Science applications are those responsible for the discovery of resources. We have developed a solution to the problem of service discovery in a Semantic Web/Grid setting. We do this in the context of bioinformatics, which is the use of computational and mathematical techniques to store, manage, and analyse the data from molecular biology in order to answer questions about biological phenomena. Our specific application is myGrid (www.mygrid.org.uk) that is developing open source, service-based middleware upon which bioinformatics applications can be built. myGrid is specifically targeted at developing open source high-level service Grid middleware for bioinformatics.

Semantic and Personalised Service Discovery

One of the most pervasive classes of services needed to support e-Science applications are those responsible for the discovery of resources. We have developed a solution to the problem of service discovery in a Semantic Web/Grid setting. We do this in the context of bioinformatics, which is the use of computational and mathematical techniques to store, manage, and analyse the data from molecular biology in order to answer questions about biological phenomena. Our specific application is myGrid (http: //www.mygrid.org.uk) that is developing open source, service-based middleware upon which bioin- formatics applications can be built. myGrid is specif- ically targeted at developing open source high-level service Grid middleware for bioinformatics.

Describing Web Service Architectures through Design-by-Contract

Architectural description languages (ADLs) are used to specify a high-level, compositional view of a software application, specifying how a system is to be composed from coarse-grain components. ADLs usually come equipped with a formal dynamic semantics, facilitating specification and analysis of distributed and event-based systems. In this paper, we describe the TrustME, an ADL framework that provides both a process and a structural view of web service-based systems. We use Petri-net descriptions to give a dynamic view of business workflow for web service collaboration. We adapt the approach of Schmidt to define a form of Meyer's design-by-contract for configuring workflow architectures. This serves as a configuration-level means of constructing safer, more robust systems.

Cooperação e multi-level governance: o caso do Grande Recife Consórcio de Transporte Metropolitano

As primeiras regiões metropolitanas brasileiras foram instituídas de maneira vertical e autoritária como parte da estratégia de desenvolvimento nacional promovida pelo governo militar. Percebidas como instituições não-democráticas e rejeitadas como possível quarto ente federativo, as regiões metropolitanas, desde a Constituição de 1988, foram gradualmente esvaziadas dos seus propósitos originais. Em sua orfandade, os problemas socioeconômicos proliferaram e foram acentuados, e passaram a predominar relações intergovernamentais competitivas em vez de cooperativas. Um dos principais desafios enfrentados pelo modelo federalista brasileiro, em especial quando se trata destas regiões, está relacionado à necessidade de estabelecer maior cooperação e coordenação, tidas como imprescindíveis para garantir um relacionamento mais equilibrado entre os entes federativos, assim como para a efetiva implementação de políticas de enfrentamento das desigualdades e exclusão social nas aglomerações urbanas. Este trabalho analisa o Grande Recife Consórcio Metropolitano de Transportes (CMT), empresa pública multifederativa estabelecida em 2008 entre os governos municipais e estadual da Região Metropolitana de Recife (RMR). Responsável pelo planejamento, gestão e implementação compartilhada da política de transporte público coletivo na RMR, o Grande Recife se tornou realidade com a aprovação e regulamentação da Lei Federal nº 11.107 de 2005, conhecida como a Lei de Consórcios Públicos. O Grande Recife é uma experiência pioneira e inovadora, demonstrando que é possível encontrar uma maneira de superar conflitos e desafios comuns e, ao mesmo tempo, garantir a preservação da autonomia de cada ente, bem como os direitos cidadãos. Neste trabalho consideramos essa experiência de cooperação intergovernamental como um exemplo de multi-level governance (MLG), uma vez que é ilustrativa de um novo arranjo institucional democrático entre distintas esferas governamentais para a gestão compartilhada de um serviço público.

Proposta de modelo qualitativo de gstão de risco para pequenas empresas não-financeiras brasileiras: estudo de caso de uma empresa do setor de serviços em regime de franchising

Pesquisas realizadas por instituições ligadas às pequenas e médias empresas brasileiras, em particular, as não-financeiras, revelam que o índice de mortalidade tem sido elevado ao longo dos últimos anos. A despeito do empenho dos empreendedores em criar as condições necessárias para garantir a sobrevivência de suas empresas, a falta de capacidade gerencial, em geral, na organização dos vários processos e atividades, tem conduzido as empresas para caminhos pouco favoráveis. Neste sentido, a preocupação com os riscos que naturalmente permeiam os negócios de uma empresa são, quase sempre, por desconhecimento, desprezados ou relevados a um segundo plano. Risco é parte do dia-a-dia da existência das empresas, podendo alguns serem menos impactantes enquanto outros, se concretizados, ameaçar a longevidade da empresa. Desta forma, uma perfeita compreensão e domínio dos princípios e processos para uma gestão segura de riscos contribuirá para uma tomada de decisões adequada e para a garantia de melhores resultados para a empresa. Este trabalho tem como propósito apresentar e testar um modelo qualitativo de gestão de risco que possa ser utilizado por pequenas empresas não-financeiras brasileiras. A empresa escolhida para atender a este estudo de caso foi uma pequena empresa brasileira do setor de serviços que opera em regime de franchising. Os resultados obtidos, por meio de toda documentação apresentada à luz do modelo proposto, apontam para a adequabilidade do modelo em empresa deste gênero, bem como para a concordância por parte dos gerentes e do empreendedor quanto à necessidade de implantação deste tipo de gestão como forma de assegurar a sobrevivência da empresa.

Global governance, currency and trade: implications of one on the other, common problems and how to address cooperation through law at the international level

How to deal with the impacts of the exchange rate on the trade balance of Brazil? There is not a single answer to such question. In order to find out some legal approaches for this matter, this paper aims to describe and analyze the role of the IMF, WTO and the governments of Brazil and the United States on the currency misalignments, especially the extraterritorial effects of such misalignment on the Brazil’s bilateral trade with the United States. The article concludes that the Currency Swap Agreements and other bilateral solutions may minimize the distortions that the Brazilian balance of payment against the USA is carrying, due to the lack of legal solutions for the problem of the exchange rate misalignments that Brazil is facing.

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Diagnóstico para implantação do sistema de gestão ambiental em postos revendedores de combustíveis no município de Paranamirim RN: um estudo de caso

natural resources that still enjoy, in the certainty that if we do not, could culminate at the end of that remains. The environmental contamination by fuels in the retail service of oil and biofuels, has been a subject of growing research in Brazil, due to the large pollution potential of this activity. The aim of this study was to evaluate the importance of implementing the Environmental Management System (EMS) in fuel retail service stations in the city of Parnamirim-RN, but also describe the current situation the same as licensing and environmental characterization; identify existing barriers to implementation of EMS on the costs, technologies, knowledge, vision, present the potential benefits for the implementation of the EMS (social, economic and environmental), to identify the existence of plans for future action to implement the EMS , as a subsidy to promote the implementation of it. The methodology was developed through analysis of documents provided by the environmental agency responsible for licensing of retail service stations and fuel pala ANP. For data collection, we used the questionnaire was applied directly to managers or managers of sub-stations. Data were collected in 12 of 30 posts in the municipality. For purposes of data treatment was performed a descriptive analysis with respect to the opinion of twelve managers (respondents). The data acquired, according to the Likert scale were tabulated and analyzed using software SPSS 17.0 and Excel 2003, it was generated tables and graphs to observe the behavior of the data. The results showed that most respondents have a schooling level higher (58.3%) of the jobs surveyed 50% work on average 6 to 10 years and 41.6% are in operation for over 11 years , 75.0% do not have a license to operate and 12 stations, 58.3% were sued for not having a license to operate and are therefore in full commercial activity, 83% of jobs have some practice environmentally responsible, 75% agree in making planning future action to implement 8 the EMS in their ventures, 70% in full agreement that the high cost is a form of impediment to implementation of EMS; 66.67% agreed that resistance to change is an impediment to implementation of EMS; 90.91% agreed that the implementation of EMS is very complex, 80% of respondents agreed in a very significant environmental legislation is also a key factor preventing the implementation of EMS is noteworthy that 100% of respondents agreed that the knowledge about the use of the EMS will help to solve environmental problems in the fuel retail service stations, the implementation of the EMS will benefit with increased efficiency of resources applied to the findings by the agreement of 91.66% of respondents, where only 8, 33% disagreed, there was also a percentage of 100%, agreed that the company's image will be a great benefit, but also a contribution to solving environmental problems in the fuel retail service stations. Thus, the importance of the implementation of EMS in the fuel retail service stations in the city of Parnamirim-RN, with an urgent need to be deployed. And the bodies responsible for policy on state-run and supervise more tightly and action, this type of activity, in order to regulate the sustainable functioning of retail service stations of fuel, thus promoting a better quality of life for the population of the municipality of natal-RN

A framework for monitoring and runtime recovery of web service-based applications

Service provisioning is a challenging research area for the design and implementation of autonomic service-oriented software systems. It includes automated QoS management for such systems and their applications. Monitoring, Diagnosis and Repair are three key features of QoS management. This work presents a self-healing Web service-based framework that manages QoS degradation at runtime. Our approach is based on proxies. Proxies act on meta-level communications and extend the HTTP envelope of the exchanged messages with QoS-related parameter values. QoS Data are filtered over time and analysed using statistical functions and the Hidden Markov Model. Detected QoS degradations are handled with proxies. We experienced our framework using an orchestrated electronic shop application (FoodShop).

Application of wavelets to the evaluation of phantom images for mammography quality control

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Propagator, tree-level unitarity and effective nonrelativistic potential for higher-derivative gravity theories in D dimensions

A prescription for computing the propagator for D-dimensional higher-derivative gravity theories, based on the Barnes-Rivers operators, is presented. A systematic study of the tree-level unitarity of these theories is developed and the agreement of their linearized versions with Newton's law is investigated by computing the corresponding effective nonrelativistic potential. Three-dimensional quadratic gravity with a gravitational Chern-Simons term is also analyzed. A discussion on the issue of light bending within the framework of both D-dimensional quadratic gravity and three-dimensional quadratic gravity with a Chern-Simons term is provided as well. (C) 2002 American Institute of Physics.

Propagator, tree-level unitarity and effective nonrelativistic potential for three-dimensional higher-derivative gravity augmented by a gravitational Chern-Simons term

An algorithm for computing the propagator for three-dimensional quadratic gravity with a gravitational Chern-Simons term, based on an extension of the three-dimensional Barnes-Rivers operators, is proposed. A systematic study of the tree-level unitarity of this theory is developed and its agreement with Newton's law is investigated by computing the effective nonrelativistic potential. (C) 2000 Elsevier B.V. B.V. All rights reserved.

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.