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.

A Framework supporting collaboration on the distributed design of integrated systems

The work described in this thesis aims to support the distributed design of integrated systems and considers specifically the need for collaborative interaction among designers. Particular emphasis was given to issues which were only marginally considered in previous approaches, such as the abstraction of the distribution of design automation resources over the network, the possibility of both synchronous and asynchronous interaction among designers and the support for extensible design data models. Such issues demand a rather complex software infrastructure, as possible solutions must encompass a wide range of software modules: from user interfaces to middleware to databases. To build such structure, several engineering techniques were employed and some original solutions were devised. The core of the proposed solution is based in the joint application of two homonymic technologies: CAD Frameworks and object-oriented frameworks. The former concept was coined in the late 80's within the electronic design automation community and comprehends a layered software environment which aims to support CAD tool developers, CAD administrators/integrators and designers. The latter, developed during the last decade by the software engineering community, is a software architecture model to build extensible and reusable object-oriented software subsystems. In this work, we proposed to create an object-oriented framework which includes extensible sets of design data primitives and design tool building blocks. Such object-oriented framework is included within a CAD Framework, where it plays important roles on typical CAD Framework services such as design data representation and management, versioning, user interfaces, design management and tool integration. The implemented CAD Framework - named Cave2 - followed the classical layered architecture presented by Barnes, Harrison, Newton and Spickelmier, but the possibilities granted by the use of the object-oriented framework foundations allowed a series of improvements which were not available in previous approaches: - object-oriented frameworks are extensible by design, thus this should be also true regarding the implemented sets of design data primitives and design tool building blocks. This means that both the design representation model and the software modules dealing with it can be upgraded or adapted to a particular design methodology, and that such extensions and adaptations will still inherit the architectural and functional aspects implemented in the object-oriented framework foundation; - the design semantics and the design visualization are both part of the object-oriented framework, but in clearly separated models. This allows for different visualization strategies for a given design data set, which gives collaborating parties the flexibility to choose individual visualization settings; - the control of the consistency between semantics and visualization - a particularly important issue in a design environment with multiple views of a single design - is also included in the foundations of the object-oriented framework. Such mechanism is generic enough to be also used by further extensions of the design data model, as it is based on the inversion of control between view and semantics. The view receives the user input and propagates such event to the semantic model, which evaluates if a state change is possible. If positive, it triggers the change of state of both semantics and view. Our approach took advantage of such inversion of control and included an layer between semantics and view to take into account the possibility of multi-view consistency; - to optimize the consistency control mechanism between views and semantics, we propose an event-based approach that captures each discrete interaction of a designer with his/her respective design views. The information about each interaction is encapsulated inside an event object, which may be propagated to the design semantics - and thus to other possible views - according to the consistency policy which is being used. Furthermore, the use of event pools allows for a late synchronization between view and semantics in case of unavailability of a network connection between them; - the use of proxy objects raised significantly the abstraction of the integration of design automation resources, as either remote or local tools and services are accessed through method calls in a local object. The connection to remote tools and services using a look-up protocol also abstracted completely the network location of such resources, allowing for resource addition and removal during runtime; - the implemented CAD Framework is completely based on Java technology, so it relies on the Java Virtual Machine as the layer which grants the independence between the CAD Framework and the operating system. All such improvements contributed to a higher abstraction on the distribution of design automation resources and also introduced a new paradigm for the remote interaction between designers. The resulting CAD Framework is able to support fine-grained collaboration based on events, so every single design update performed by a designer can be propagated to the rest of the design team regardless of their location in the distributed environment. This can increase the group awareness and allow a richer transfer of experiences among them, improving significantly the collaboration potential when compared to previously proposed file-based or record-based approaches. Three different case studies were conducted to validate the proposed approach, each one focusing one a subset of the contributions of this thesis. The first one uses the proxy-based resource distribution architecture to implement a prototyping platform using reconfigurable hardware modules. The second one extends the foundations of the implemented object-oriented framework to support interface-based design. Such extensions - design representation primitives and tool blocks - are used to implement a design entry tool named IBlaDe, which allows the collaborative creation of functional and structural models of integrated systems. The third case study regards the possibility of integration of multimedia metadata to the design data model. Such possibility is explored in the frame of an online educational and training platform.

The distribution of average and marginal effective tax rates in European Union member states

Macro-based summary indicators of effective tax burdens do not capture differences in effective tax rates facing different sub-groups of the population. They also cannot provide information on the level or distribution of the marginal effective tax rates thought to influence household behaviour. I use EUROMOD, an EU-wide tax-benefit microsimulation model, to compute distributions of average and marginal effective tax rates across the household population in fourteen European Union Member States. Using different definitions of ‘net taxes’, the tax base and the unit of analysis I present a range of measures showing the contribution of the tax-benefit system to household incomes, the average effective tax rates applicable to income from labour and marginal effective tax rates faced by working men and women. In a second step, effective tax rates are broken down to separately show the influence of each type of tax-benefit instrument. The results show that measures of effective tax rates vary considerably depending on incomes, labour market situations and family circumstances. Using single averages or macro-based indicators will therefore provide an inappropriate picture of tax burdens faced by large parts of the population.

Growth process in business and social entrepreneurship: the case of Brazil

The purpose of the dissertation is to investigate in depth the difference between the challenges social and business entrepreneurs face in the growth phase of their business in the particular environment of Brazil. This objective has been achieved through a two-steps methodology. The first step is a set of in-depth interviews carried out with industry experts such as professors, venture capitalists, consultants, fund managers or people involved in the support of growing startups (i.e. accelerators). These interviews allowed, first, to build a general perspective on the environment entrepreneurs operate into and to identify a list of challenges entrepreneurs face in the growth process of their business. This list was completed with the additional challenges identified in the previous literature. The second step of the methodology was to test the relevance of these challenges in the mind and experience of social and traditional entrepreneurs. A questionnaire was then submitted to 145 social and 286 traditional entrepreneurs. The results were statistically analyzed to test the relative relevance of these challenges for one group of entrepreneurs with respect to the other. The outcome of the analysis was significant. The most relevant challenges identified were, for both groups, taxation, bureaucracy, finding the right employees, creating effective teams, measuring firm performance and social value creation and obtaining funds. On the other side motivation, innovation, competition and lack of market space for growth represented the least relevant issues in the minds of entrepreneurs. This rank however did not differ significantly from social to traditional entrepreneurs. This testifies that in Brazil social and traditional entrepreneurs face the same set of challenges despite the widespread belief of the opposite.

An evaluation of the Business Model Canvas by technology-oriented startups in Brazil : a qualitative study about the usage of the tool by Brazilian entrepreneurs

The following paper was conducted with the support of several entrepreneurs and startups from Brazil. The aim of the research was to find out which impact the Business Model Canvas, further abbreviated as BMC, has on technology-oriented startups in Brazil. The first step of the study was identify some general concepts of entrepreneurship, as well as the conditions and environment of the country. Afterwards, it was focused on defining and comparing different business model tools and concepts to the BMC. After the literature review and meeting with several professionals in the area of entrepreneurship and startups, a questionnaire was formulated in order to conduct the qualitative study and identify the main impact of the tool. The questionnaire was answered by ten startups. In order to check the validity and credibility of the research outcomes, theory and investigator triangulation was used. As a result, the usage of the BMC could be evaluated by obtaining the outcomes and the theory, which showed that Brazilian tech startups are using Osterwalder’s model for the reason of idea creation and testing, validating and pivoting their business model. Interestingly, the research revealed that the entrepreneurs are using the tool often not in the traditional way of printing it, but rather applying it as a thinking approach. Besides, the entrepreneurs are focusing mostly on developing a strong Value Proposition, Customer Segment and sustainable Revenue Streams, while afterwards the remaining building blocks are built. Moreover, the research showed that the startups are using also other concepts, such as the Customer Development Process or Build-Measure-Learn Feedback Loop. These methodologies are often applied together with the BMC and helps to identify the most sustainable components of the business idea. Keywords: Business

Compositional analysis for an unbiased measure of soil aggregation

Soil aggregation is an index of soil structure measured by mean weight diameter (MWD) or scaling factors often interpreted as fragmentation fractal dimensions (D-f). However, the MWD provides a biased estimate of soil aggregation due to spurious correlations among aggregate-size fractions and scale-dependency. The scale-invariant D-f is based on weak assumptions to allow particle counts and sensitive to the selection of the fractal domain, and may frequently exceed a value of 3, implying that D-f is a biased estimate of aggregation. Aggregation indices based on mass may be computed without bias using compositional analysis techniques. Our objective was to elaborate compositional indices of soil aggregation and to compare them to MWD and D-f using a published dataset describing the effect of 7 cropping systems on aggregation. Six aggregate-size fractions were arranged into a sequence of D-1 balances of building blocks that portray the process of soil aggregation. Isometric log-ratios (ilrs) are scale-invariant and orthogonal log contrasts or balances that possess the Euclidean geometry necessary to compute a distance between any two aggregation states, known as the Aitchison distance (A(x,y)). Close correlations (r>0.98) were observed between MWD, D-f, and the ilr when contrasting large and small aggregate sizes. Several unbiased embedded ilrs can characterize the heterogeneous nature of soil aggregates and be related to soil properties or functions. Soil bulk density and penetrater resistance were closely related to A(x,y) with reference to bare fallow. The A(x,y) is easy to implement as unbiased index of soil aggregation using standard sieving methods and may allow comparisons between studies. (C) 2012 Elsevier B.V. All rights reserved.

Observational Characterization of the Downward Atmospheric Longwave Radiation at the Surface in the City of São Paulo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Theoretical study of the structure and stability of NbxOy, and NbxOy+ (x = 1-3; y = 2-5, 7, 8) clusters

Geometric, thermodynamic and electronic properties of cluster neutrals NbxOy and cations NbxOy+ (x = 1-3; y = 2-5, 7, 8) have been characterized theoretically. A DFT calculation using a hybrid combination of B3LYP with contracted Huzinaga basis sets. Numerical results of the relative stabilities, ionization potentials and band gaps of different clusters are in agreement with experiment. Analysis of dissociation channels supports the more stable building blocks as formed by NbO2, NbO2+ NbO3 and NbO3+ stoichiometries. The net atomic charges suggest that oxygen donor molecules can interact more favorably on central niobium atoms of cluster cations, while the interaction with oxygen acceptor molecules is more favorable on the terminal oxygen atoms of neutral clusters. A topological analysis of the electron localization function gradient field indicates that the clusters may be described as having a strong ionic interaction between Nb and O atoms. Published by Elsevier B.V. B.V.

Femtosecond laser ablation on dental hard tissues-Analysis of ablated profile near an interface using local effective intensity

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Hadronic interactions from effective chiral Lagrangians of quarks and gluons

Effective chiral Lagrangians involving constituent quarks, Goldstone bosons and long-distance gluons are believed to describe the strong interactions in an intermediate energy region between the confinement scale and the chiral symmetry breaking scale. Baryons and mesons in such a description are bound states of constituent quarks. We discuss the combined use of the techniques of effective chiral field theory and of the field theoretic method known as Fock-Tani representation to derive effective hadron interactions. The Fock-Tani method is based on a change of representation by means of a unitary transformation such that the composite hadrons are redescribed by elementary-particle field operators. Application of the unitary transformation on the microscopic quark-quark interaction derived from a chiral effective Lagrangian leads to chiral effective interactions describing all possible processes involving hadrons and their constituents. The formalism is illustrated by deriving the one-pion-exchange potential between two nucleons using the quark-gluon effective chiral Lagrangian of Manohar and Georgi. We also present the results of a study of the saturation properties of nuclear matter using this formalism.

Purine nucleoside phosphorylase: A potential target for the development of drugs to treat T-cell- and apicomplexan parasite-mediated diseases

Purine nucleoside phosphorylase (PNP) catalyzes the reversible phosphorolysis of nucleosides and deoxynucleosides, generating ribose 1-phosphate and the purine base, which is an important step of purine catabolism pathway. The lack of such an activity in humans, owing to a genetic disorder, causes T-cell impairment, and thus drugs that inhibit human PNP activity have the potential of being utilized as modulators of the immunological system to treat leukemia, autoimmune diseases, and rejection in organ transplantation. Besides, the purine salvage pathway is the only possible way for apicomplexan parasites to obtain the building blocks for RNA and DNA synthesis, which makes PNP from these parasites an attractive target for drug development against diseases such as malaria. Hence, a number of research groups have made efforts to elucidate the mechanism of action of PNP based on structural and kinetic studies. It is conceivable that the mechanism may be different for PNPs from diverse sources, and influenced by the oligomeric state of the enzyme in solution. Furthermore, distinct transition state structures can make possible the rational design of specific inhibitors for human and apicomplexan enzymes. Here, we review the current status of these research efforts to elucidate the mechanism of PNP-catalyzed chemical reaction, focusing on the mammalian and Plamodium falciparum enzymes, targets for drug development against, respectively, T-Cell and Apicomplexan parasites-mediated diseases.

Stimuli-responsive controlled growth of mono- and bidimensional particles from basic zirconium sulfate hydrosols

A thermostimulated sol-gel transition in a system prepared by mixing a ZrOCl(2) acidified solution to a hot H(2)SO(4) aqueous solution was studied by dynamic theological measurements and quasi-elastic light scattering. The effect of temperature and of molar ratio R(S) = [Zr]/[SO(4)] on the gelation kinetics was analyzed using the mass fractal aggregate growth model. This study shows that the linear growth of aggregates occurs at the early period of transformation, while bidimensional growth occurs at the advanced stage. The bidimensional growth can be shifted toward monodimensional growth by decreasing the aggregation rate by controlling the temperature and/or molar ratio R(S). EXAFS and Raman results gave evidence that the linear chain growth is supported by covalent sulfate bonding between primary building blocks. At the advanced stage of aggregation, the assembly of linear chains through hydrogen bonding gave rise to the growth of bidimensional particles.

End-to-end validation of EPS / MetOp GOME-2 trace gas data

Within the next decade, the improved version 2 of Global Ozone Monitoring Experiment (GOME-2), a ultraviolet-visible spectrometer dedicated to the observation of key atmospheric trace species from space, will be launched successively on board three EUMETSAT Polar System (EPS) MetOp satellites. Starting with the launch of MetOp-1 scheduled for summer 2006, the GOME-2 series will extend till 2020 the global monitoring of atmospheric composition pioneered with ERS-2 GOME-1 since 1995 and enhanced with Envisat SCIAMACHY since 2002 and EOS-Aura OMI since 2004. For more than a decade, an international pool of scientific teams active in ground-and space-based ultraviolet-visible remote sensing have contributed to the successful post-launch validation of trace gas data products and the associated maturation of retrieval algorithms for the latter satellites, ensuring that geophysical data products are/become reliable and accurate enough for intended research and applications. Building on this experience, this consortium plans now to develop and carry out appropriate validation of a list of GOME-2 trace gas column data of both tropospheric and stratospheric relevance: nitrogen dioxide (NO 2), ozone (O 3), bromine monoxide (BrO), chlorine dioxide (OClO), formaldehyde (HCHO), and sulphur dioxide (SO 2). The proposed investigation will combine four complementary approaches resulting in an end-to-end validation of expected column data products.

Bilateralism and regionalism: re-establishing the primacy of multilateralism a Latin American and Caribbean perspective

Includes bibliography

Green teams: Understanding their roles in the environmental management of companies located in Brazil

Green teams are frequently considered in the state-of-the-art literature as an essential factor for companies aiming to implement and improve environmental management approaches and practices. However, most of the available literature on green teams is conceptual and theoretical by nature. Therefore, the main purpose of this article is to evaluate the main characteristics of green teams in Brazilian companies and to analyse the relationships between green teams and the maturity level of environmental management in those companies. Based on a conceptual background on corporate environmental management and green teams, a research was done in two complementary phases: a survey of 94 companies with ISO 14001 certification; and a multiple case study of four industrial companies. Survey results suggest that 82% of the studied companies have cross-functional green teams, i.e. involving various companies' departments; and 65% have functional green teams, i.e. individual department teams. The results of the case study suggest that the use of green teams is an instrument to the greening of companies with ISO 14001 in Brazil. The company with the most proactive and advanced environmental management is the same company which uses green teams more intensely. Green teams are especially necessary for implementing more technical environmental management practices, e.g. Life Cycle Assessment. Since this is one of the first studies analysing green teams, the results presented can be useful for companies and public policies aiming to implementation of environmental initiatives. © 2012 Elsevier Ltd. All rights reserved.