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.

Teletrabalho como fator de Inclusão social e digital em empresas de call center/contact center

O teletrabalho é uma realidade cada vez mais presente nos países desenvolvidos, tendo sido experimentado por diferentes tipos de empresas. Esta pesquisa teve como objetivo compreender como e por que as empresas de call center e contact center utilizam o teletrabalho na prestação de serviços. As quatro empresas abordadas representam 92% do universo de empresas prestadoras desse serviço no Brasil, por meio de teletrabalhadores residenciais. Utilizou-se o método de pesquisa quali-quanti, com a combinação do método de estudo de caso e o método survey. As conclusões da pesquisa revelaram que o teletrabalho residencial tem sido utilizado com muito equilíbrio. As razões do uso desta modalidade foram: redução de custos; aumento da produtividade; melhoria da qualidade de atendimento aos clientes; possibilidade de oferecer melhor qualidade de vida aos teletrabalhadores residenciais e portadores de deficiência, proporcionando-lhes oportunidades de empregos com inclusão social e digital.

Efeitos da variação da carga por eixo, pressão de inflação e tipo de pneu na resposta elástica de um pavimento

O presente trabalho é uma análise experimental que procura investigar os efeitos dos fatores carga por eixo, pressão de inflação e tipo de pneu sobre o desempenho de pavimentos. Os dados e informações existentes sobre o quadro de cargas por eixo praticada pela frota de veículos pesados é razoável. A ação conjunta dos referidos fatores é ainda uma questão pouco explorada. Assim, para compensar a escassez de dados sobre pressão de inflação e tipo de construção de pneus utilizados na frota de carga, programou-se uma pesquisa de campo na rodovia estadual RS/240. As informações oriundas da pesquisa demonstram que há um acréscimo generalizado no valor da pressão dos pneus e um aumento de uso dos pneus de fabricação radial em relação aos pneus convencionais. Os dados de campo subsidiaram a programação de um experimento fatorial cruzado executado na Área de Pesquisas e Testes de Pavimentos da UFRGS/DAER. A variação dos níveis dos fatores deu-se através de um simulador linear de tráfego atuando sobre uma pista experimental com 20 m de comprimento por 3,5 m de largura. Tendo como resposta estrutural do pavimento a máxima deflexão superficial recuperável medida com uma viga Benkelmam, determinou-se como significantes os efeitos dos fatores carga por eixo e pressão de enchimento dos pneus. Os cálculos estatísticos indicam também que não há diferenças significativas entre os pneus tipo 9.00R20 e 9.00x20 e que todas interações não exercem efeitos significativos sobre a variável de resposta. Em seqüência, determinaram-se as áreas de contato do rodado duplo do simulador de tráfego com a superfície do pavimento ensaiado para as combinações dos níveis dos fatores. Pode-se, então, comparar área de contato medida com área circular calculada, considerada em muitos modelos de dimensionamento de pavimentos. Relacionou-se a variação da pressão de contato com a deflexão recuperável e procedeu-se uma comparação da mesma com a pressão de inflação nominal dos pneus. Apresenta-se um modelo de análise do desempenho do pavimento em função da carga por eixo e da pressão de inflação, nos limites do experimento. Os dados decorrentes do experimento viabilizaram a determinação dos Fatores de Equivalência de Cargas para os níveis dos fatores, considerando-se o pavimento ensaiado. Avaliou-se, via evolução das deflexões e dos Fatores de Equivalência de Cargas, a redução da vida do pavimento, obtendo-se, para a combinação de níveis mais críticos de carregamento, resultados significativos de até 88 % de redução. Propõe-se, por último, uma formulação para o Fator de Equivalência de Cargas que considere também a ação da pressão de inflação.

Inflation and debt indexation : the equivalence of two alternative schemes for the case of periodic payments

The presence of inflation has induced the financial institutions to implement procedures devised to protect the real values of theirs loans. Two of such procedurcs, the floaaing rale scheme and the monetary correction mechanism, tend to lead to very different streams of payments. However, whenever the floating rate scheme follows the rule of Strict adhercnce to lhe Fisher equation, lhe two procedures are financially equivalent.

Linha ocupada, cliente livre!: um estudo sobre contact centers e fidelidade dos clientes de operadoras de telefonia celular

O presente estudo trata da influência do Contact Center na interação de clientes e empresas de telefonia celular e a resultante fidelização desses clientes. A interação entre os clientes e as empresas, quando bem gerenciada, pode ser um diferencial competitivo relevante, num mundo em que as inovações e sua disseminação ocorrem muito rapidamente. Ao contrário, um relacionamento mal gerenciado pode levar à infidelidade dos clientes e à conseqüente troca de fornecedor. Para avaliar a satisfação dos clientes sobre a sua interação com as empresas foi realizado um survey, enviando-se e-mails para usuários residentes no Estado de São Paulo e recebendo-se suas respostas por meio de um endereço na Web. Para a análise do tema, foram utilizadas as teorias de Marketing de Serviços, Marketing de Relacionamento e de Orientação ao Mercado, bem como estudos relacionados aos Contact Centers (ou call centers) e fidelidade. Esta pesquisa contempla três áreas principais: Orientação ao Mercado da empresa; qualidade dos serviços do Contact Center; e fidelidade do cliente. Para a análise dos dados que compõem o escopo desta pesquisa, foram aplicadas técnicas estatísticas de Análise Fatorial e de Análise de Conglomerados (ou Clusters). Além disso, foi realizada uma análise comparativa de fidelidade às principais operadoras e uma simulação para se estimarem as potenciais perdas de clientes. Os resultados apontam para uma grande insatisfação dos clientes com empresas de telefonia celular e com o atendimento em aspectos que lhe são mais urgentes, como o atendimento às suas necessidades e a eficiência do Contact Center. E também assinalam uma forte tendência à infidelidade. Com a vinda da portabilidade do número do celular a partir de 2009, que permite que o usuário mantenha seu número mesmo trocando de operadora, o risco é ainda maior. Neste caso, os resultados mostram que 64% dos clientes declaram sua infidelidade à operadora atual. A relevância deste estudo para as organizações é que o mesmo apresenta uma perspectiva sobre o Contact Center, como ponto de relacionamento e incremento da satisfação do cliente, bem como de um diferencial competitivo que, aparentemente, vem sendo pouco prestigiado pelos profissionais de marketing.

Does liquidity constraints matter for Ricardian equivalence?

The paper analysis a general equilibrium model with two periods, several households and a government that has to finance some expenditures in the first period. Households may have some private information either about their type (adverse selection) or about some action levei chosen in the first period that affects the probability of certain states of nature in the second period (moral hazard). Trade of financiai assets are intermediated by a finite collection of banks. Banks objective functions are determined in equilibrium by shareholders. Due to private information it may be optimal for the banks to introduce constraints in the set of available portfolios for each household as wellas household specific asset prices. In particular, households may face distinct interest rates for holding the risk-free asset. The government finances its expenditures either by taxing households in the first period or by issuing bonds in the first period and taxing households in the second period. Taxes may be state-dependent. Suppose government policies are neutml: i) government policies do not affect the distribution of wealth across households; and ii) if the government decides to tax a household in the second period there is a portfolio available for the banks that generates the Mme payoff in each state of nature as the household taxes. Tben, Ricardian equivalence holds if and only if an appropriate boundary condition is satisfied. Moreover, at every free-entry equilibrium the boundary condition is satisfied and thus Ricardian equivalence holds. These results do not require any particular assumption on the banks' objective function. In particular, we do not assume banks to be risk neutral.

Whole-body cortisol increases after direct and visual contact with a predator in zebrafish, Danio rerio

Ornamental fish may be severely affected by a stressful environment. Stressors impair the immune response, reproduction and growth rate; thus, the identification of possible stressors will aid to improve the overall quality of ornamental fish. The aim of this study was to determine whole-body cortisol of adult zebrafish, Danio rerio, following visual or direct contact with a predator species. Zebrafish were distributed in three groups: the first group, which consisted of zebrafish reared completely isolated of the predator, was considered the negative control; the second group, in which the predator, Parachromis managuensis was stocked together with zebrafish, was considered the positive control; the third group consisted of zebrafish stocked in a glass aquarium, with direct visual contact with the predator. The mean whole-body cortisol concentration in zebrafish from the negative control was 6.78 +/- 1.12 ng g(-1), a concentration statistically lower than that found in zebrafish having visual contact with the predator (9.26 +/- 0.88 ng g(-1)) which, in turn, was statistically lower than the mean whole-body cortisol of the positive control group (12.35 +/- 1.59 ng g(-1)). The higher whole-body cortisol concentration found in fish from the positive control can be attributed to the detection, by the zebrafish, of relevant risk situations that may involve a combination of chemical, olfactory and visual cues. One of the functions of elevated cortisol is to mobilize energy from body resources to cope with stress. The elevation of whole-body cortisol in fish subjected to visual contact with the predator involves only the visual cue in the recognition of predation risk. We hypothesized that the zebrafish could recognize predator characteristics in P managuensis, such as length, shape, color and behavior. Nonetheless, the elevation of whole-body cortisol in zebrafish suggested that the visual contact of the predator may elicit a stress response in prey fish. This assertion has a strong practical application concerning the species distribution in ornamental fish markets in which prey species should not be allowed to see predator species. Minimizing visual contact between prey and predator fish may improve the quality, viability and welfare of small fish in ornamental fish markets. (c) 2007 Elsevier B.V. All rights reserved.

Effects of plant densities and management of purple nutsedge on sugarcane yield and effect of growth stages and main way of herbicides contact and absorption on the control of tubers

Field experiments carried out with Cyperus rotundus L. at low (58-246), medium (318773), and high (675-1198 shoots/m(2)) densities showed sugarcane yield reductions of 13.5, 29.3, and 45.2%, respectively in relation to the control. In the second field experiment, the integration of a mechanic method with two sequences of plowing and disking operations in the dry season, and complementary applications of trifloxysulfuron-sodium + ametrine and sulfentrazone (rainy season) was studied. Average of the chain connected to original shoot showed 92, 95, and 65% of reduction with trifloxysulfuron-sodium + ametrine and surfactant, at the application stages early, preflowering, and full flowering, respectively.