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.

Disclosing the generic behavior of topological solutions: An orbit-based approach

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Can one cure the nommitarity of three-dimensional quadratic gravity using a topological Chern-Simons term?

Quadratic gravity in (2+1)D is nonunitarity at the tree level. When a topological Chern-Simons term is added to this theory, the harmless massive scalar mode of the former gives rise to a troublesome massive spin-0 ghost, while the massive spin-2 ghost is replaced by two massive physical particles both of spin-2. Therefore, unlike what it is claimed in the literature, quadratic Chern-Simons gravity in (2+1)D is nonunitary at the tree level.

Tree-level violation of the equivalence principle

Massive particles of spin 0 and 1 violate the equivalence principle (EP) at the tree level. on the other hand, if these particles are massless, they agree with the EP, which leads us to conjecture that from a semiclassical viewpoint massless particles, no matter what their spin, obey the EP. General relativity predicts a deflection angle of 2.63' for a nonrelativistic spinless massive boson passing close to the Sun, while for a massive vectorial boson of spin 1 the corresponding deflection is 2.62'.

Is the equivalence for the response of static scalar sources in the Schwarzschild and Rindler spacetimes valid only in four dimensions?

It was shown recently that in four dimensions scalar sources with fixed proper acceleration minimally coupled to a massless Klein-Gordon field lead to the same responses when they are (i) uniformly accelerated in Minkowski spacetime (in the inertial vacuum) and (ii) static in the Schwarzschild spacetime (in the Unruh vacuum). Here we show that this equivalence is broken if the spacetime dimension is more than four.

Duffin-Kemmer-Petiau and Klein-Cordon-Fock equations for electromagnetic, Yang-Mills and external gravitational field interactions: proof of equivalence

Starting from the Generating functional for the Green Function (GF), constructed from the Lagrangian action in the Duffin-Kemmer-Petiau (DKP) theory (L-approach) we strictly prove that the physical matrix elements of the S-matrix in DKP and Klein-Gordon-Fock (KGF) theories coincide in cases of interacting spin O particles with external and quantized Maxwell and Yang-Mills fields and in case of external gravitational field (without or with torsion), For the proof we use the reduction formulas of Lehmann, Symanzik and Zimmermann (LSZ). We prove that many photons and Yang-Mills particles GF coincide in both theories too. (C) 2000 Elsevier B.V. B.V. All rights reserved.

SEMICLASSICAL VIOLATION of THE EQUIVALENCE PRINCIPLE IN THE GRAVITATIONAL LENSES REALM

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

LOWER SEMICONTINUITY of PULLBACK ATTRACTORS FOR A SINGULARLY NONAUTONOMOUS PLATE EQUATION

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

Reading, equivalence, and recombination of units: A replication with students with different learning histories

First graders, preschoolers, special education students, and adults received a reading program in which they learned to match printed to dictated words and to construct (copy) printed words. The students not only learned to match the training words but also learned to read them. In addition, most of the students learned to read new words that involved recombinations of the syllables of the training words. The results replicate and extend the generality of a prior analysis of a reading program based on stimulus equivalence and recombination of units.

Testing the principle of equivalence by supernova neutrinos

We study the possible impact of the neutrino oscillation which could be induced by a tiny violation of equivalence principle (VEP) on the observation of neutrinos emitted from supernova driven by gravitational collapse. We show that using supernova neutrinos, one can probe very small values of VEP parameters, delta(tau) less than or similar to O(10(-31)) for massless or degenerated neutrinos and delta(tau) less than or similar to O(10(-16)) x (Deltam(2)/10(-5) eV(2)) for massive neutrinos. (C) 2002 Elsevier B.V. B.V. All rights reserved.

Confinement, solitons and the equivalence between the sine-Gordon and massive Thirring models

We consider a two-dimensional integrable and conformally invariant field theory possessing two Dirac spinors and three scalar fields. The interaction couples bilinear terms in the spinors to exponentials of the scalars. Its integrability properties are based on the sl(2) affine Kac-Moody algebra, and it is a simple example of the so-called conformal affine Toda theories coupled to matter fields. We show, using bosonization techniques, that the classical equivalence between a U(1) Noether current and the topological current holds true at the quantum level, and then leads to a bag model like mechanism for the confinement of the spinor fields inside the solitons. By bosonizing the spinors we show that the theory decouples into a sine-Gordon model and free scalars. We construct the two-soliton solutions and show that their interactions lead to the same time delays as those for the sine-Gordon solitons. The model provides a good laboratory to test duality ideas in the context of the equivalence between the sine-Gordon and Thirring theories. © 2000 Elsevier Science B.V. All rights reserved.

Can one cure the nonunitarity of three-dimensional quadratic gravity using a topological Chern-Simons term?

Quadratic gravity in (2+1)D is nonunitarity at the tree level. When a topological Chern-Simons term is added to this theory, the harmless massive scalar mode of the former gives rise to a troublesome massive spin-0 ghost, while the massive spin-2 ghost is replaced by two massive physical particles both of spin-2. Therefore, unlike what it is claimed in the literature, quadratic Chern-Simons gravity in (2+1)D is nonunitary at the tree level. © 2004 Published by Elsevier B.V.

Is the equivalence principle doomed forever to Dante's Inferno on account of quantum mechanics?

It is commonly assumed that the equivalence principle can coexist without conflict with quantum mechanics. We shall argue here that, contrary to popular belief, this principle does not hold in quantum mechanics. We illustrate this point by computing the second-order correction for the scattering of a massive scalar boson by a weak gravitational field, treated as an external field. The resulting cross-section turns out to be mass-dependent. A way out of this dilemma would be, perhaps, to consider gravitation without the equivalence principle. At first sight, this seems to be a too much drastic attitude toward general relativity. Fortunately, the teleparallel version of general relativity - a description of the gravitational interaction by a force similar to the Lorentz force of electromagnetism and that, of course, dispenses with the equivalence principle - is equivalent to general relativity, thus providing a consistent theory for gravitation in the absence of the aforementioned principle. © World Scientific Publishing Company.