Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review

OBJETIVO: Comparar la efectividad, la seguridad y la aceptación de los abortos médicos practicados en el domicilio con aquellos realizados en la clínica. MÉTODOS: Se realizó una búsqueda sistemática de ensayos clínicos controlados aleatorizados y de estudios de cohortes prospectivos, comparando los abortos médicos realizados en el domicilio y en la clínica. Se realizaron búsquedas en el Registro Central de Cochrane de Ensayos Controlados, EMBASE, MEDLINE y Popline. Los resultados de interés principales fueron el fracaso para abortar completamente, los efectos secundarios y la aceptabilidad. Se calcularon las tasas de probabilidad y sus intervalos de confianza (IC) del 95%. Se reunieron los cálculos aproximados utilizando un modelo de efectos aleatorios. RESULTADOS: Nueve estudios cumplieron los criterios de inclusión (n=4522 participantes).Todos fueron estudios de cohortes prospectivos que utilizaron mifepristona y misoprostol para inducir al aborto. El aborto completo se consiguió en el 86- 97% de las mujeres que se sometieron a un aborto en el domicilio (n=3478) y entre el 80% y el 99% de aquellas mujeres que se sometieron a un aborto en una clínica (n = 1044). Los análisis agrupados de todos los estudios no mostraron diferencias en las tasas de aborto completo entre los grupos (tasa de probabilidad=0,8; IC del 95%: 0,5-1,5). Las complicaciones graves del aborto fueron poco frecuentes. El dolor y los vómitos duraron 0,3 días más en aquellas mujeres a las que se les administró misoprostol en el domicilio, en comparación con las que recibieron el tratamiento en la clínica. Las mujeres que optaron por un aborto médico en el domicilio mostraron un mayor grado de satisfacción, que las llevaría a elegir el método de nuevo y recomendárselo a una amiga, que aquellas mujeres que abortaron en la clínica. CONCLUSIÓN: El aborto en el domicilio es seguro siempre que el lugar cuente con las condiciones incluidas en los estudios. Los estudios de cohortes prospectivos por país no han mostrado diferencias en cuanto a efectividad o aceptabilidad entre abortos médicos en el domicilio y en la clínica.

(Table 1) Grain size parameters of intertidal channel sand bars near Sylt, North-Frisian Wadden Sea

The aim of the present study is to investigate directional asymmetric properties and internal structures of the bedforms on the intertidal sand bars in comparison with the migration problems of the sand bodies developed in the channel systems of the tidal basin off the west coast of Schleswig-Holstein. The tidal channel sand bodies studied have 'V'-shaped outlines and are asymmetric in cross-section. Based on such knowledge it was hoped to understand and find possible factors for application to recent and ancient tidal depositional environments. The V-shaped intertidal channel sand bodies developed in the tidal environments between Sylt and Föhr Island are constantly migrating sand bars. The migration directions are in good agreement with the resultant vector mean directions of internal cross-stratification structures of asymmetric sedimentary bedforms. Finally, it is shown that the orientation of the apex of V-shaped sand bar as an equilibrium form alone can not indicate the migration direction, but that the orientation of the resultant vector mean of internal structures of sedimentary bedforms does indicate the migration direction. Based on the analyses of textural parameters of the migrating intertidal bar sands, it seems that sands of typical intertidal sand bars are negatively skewed and well sorted. The high rounding of quarz sand grains of these tidal channel sand bars seems to be an additional characteristical criterion for tidal depositional environments, as also indicated by Balazs and Klein (1972).

(Table 1) Lipid content and organohalogen contaminant concentration in plasma of incubating glaucous gulls (Larus hyperboreus) from Bjørnøya, Norwegian Arctic in 2006

The factors influencing prolactin (PRL) variation in birds and in wildlife in general have rarely been investigated with respect to the physiological impacts of exposure to environmental contaminants. We investigated the associations between circulating baseline PRL levels and concentrations of eight persistent organohalogen contaminant (OHC) classes (i.e., major organochlorines and brominated flame retardants, and associated metabolic products) in blood (plasma) of free-ranging glaucous gulls (Larus hyperboreus), a top predator in the Norwegian Arctic, engaged in the process of incubation. We further examined whether plasma OHC concentrations were associated with the variation of PRL in glaucous gulls exposed to a standardized capture/restraint protocol. Plasma OHC concentrations in male glaucous gulls were 2-to 3-fold higher relative to females. Baseline PRL levels tended to be higher in females compared to males, although not significantly (p = 0.20). In both males and females, the 30-min capture/restraint protocol led on average to a 26% decrease in PRL levels, which resulted in a rate of PRL decrease of 0.76 ng/mL/min. The baseline PRL levels and the rate of decrease in PRL levels tended to vary negatively with plasma OHC concentrations in males, but not in females, although several of these associations did not adhere with the criterion of significance (alpha = 0.05). Present results suggest that in highly OHC-exposed male glaucous gulls, the control of PRL release may be affected by the direct or indirect modulating actions of OHCs and/or their metabolically derived products. We conclude that potentially OHC-mediated impact on PRL secretion in glaucous gulls (males) may be a contributing factor to the adverse effects observed on the reproductive behavior, development and population size of glaucous gulls breeding in the Norwegian Arctic.

Ocean acidification increases cadmium accumulation in marine bivalves: a potential threat to seafood safety

To date, the effects of ocean acidification on toxic metals accumulation and the underlying molecular mechanism remains unknown in marine bivalve species. In the present study, the effects of the realistic future ocean pCO2 levels on the cadmium (Cd) accumulation in the gills, mantle and adductor muscles of three bivalve species, Mytilus edulis, Tegillarca granosa, and Meretrix meretrix, were investigated. The results obtained suggested that all species tested accumulated significantly higher Cd (p<0.05) in the CO2 acidified seawater during the 30 days experiment and the health risk of Cd (based on the estimated target hazard quotients, THQ) via consumption of M. meretrix at pH 7.8 and 7.4 significantly increased 1.21 and 1.32 times respectively, suggesting a potential threat to seafood safety. The ocean acidification-induced increase in Cd accumulation may have occurred due to (i) the ocean acidification increased the concentration of Cd and the Cd2+/Ca2+ in the seawater, which in turn increased the Cd influx through Ca channel; (ii) the acidified seawater may have brought about epithelia damage, resulting in easier Cd penetration; and (iii) ocean acidification hampered Cd exclusion.

Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography.

OBJECTIVES We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance. BACKGROUND Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs. METHODS Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group. RESULTS The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred. CONCLUSION According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.

Analysis of The Key Parameters in Pedestrian Safety Assessment for the European Vehicle Fleet Using Multibody and Finite Element Mathematical Models

Esta tesis investiga cuales son los parámetros más críticos que condicionan los resultados que obtienen en los ensayos de protección de peatones la flota Europea de vehículos, según la reglamentación europea de protección de peatones de 2003 (Directiva CE 2003/102) y el posterior Reglamento de 2009 (Reglamento CE 2009/78). En primer lugar se ha analizado el contexto de la protección de peatones en Europa, viendo la historia de las diferentes propuestas de procedimientos de ensayo así como los cambios (y las razones de los mismos) que han sufrido a lo largo del proceso de definición de la normativa Europea. Con la información disponible de más de 400 de estos ensayos se han desarrollado corredores de rigidez para los frontales de los diferentes segmentos de la flota de vehículos europea, siendo este uno de los resultados más relevantes de esta tesis. Posteriormente, esta tesis ha realizado un estudio accidentológico en detalle de los escenarios de atropello de peatones, identificando sus características más relevantes, los grupos de población con mayor riesgo y los tipos de lesiones más importantes que aparecen (en frecuencia y severidad), que han sentado las bases para analizar con modelos matemáticos hasta qué punto los métodos de ensayo propuestos realmente tienen estos factores en cuenta. Estos análisis no habrían sido posibles sin el desarrollo de las nuevas herramientas que se presentan en esta tesis, que permiten construir instantáneamente el modelo matemático de cualquier vehículo y cualquier peatón adulto para analizar su iteración. Así, esta tesis ha desarrollado una metodología rápida para desarrollar modelos matemáticos de vehículos a demanda, de cualquier marca y modelo y con las características geométricas y de rigidez deseados que permitan representarlo matemáticamente y del mismo modo, ha investigado cómo evoluciona el comportamiento del cuerpo humano durante el envejecimiento y ha implementado una funcionalidad de escalado en edad al modelo de peatón en multicuerpo de MADYMO (ya escalable en tamaño) para permitir modelar ad hoc cualquier peatón adulto (en género y edad). Finalmente, esta tesis también ha realizado, utilizando modelos de elementos finitos del cuerpo humano, diferentes estudios sobre la biomecánica de las lesiones más frecuentes de este tipo de accidentes, (en piernas y cabeza) con el objetivo de mejorar los procedimientos de ensayo para que predigan mejor el tipo de lesiones que se quieren evitar. Con el marco temporal y las condiciones de contorno de esta tesis se han centrado los esfuerzos en reforzar algunos aspectos críticos pero puntuales sobre cómo mejorar el ensayo de cabeza y, sobretodo, en proponer soluciones viables y con un valor añadido real al ensayo de pierna contra parachoques, sin cambiar la esencia del mismo pero proponiendo un nuevo impactador mejorado que incorpore una masa extra que representa a la parte superior del cuerpo y sea válido para toda la flota europea de vehículos independiente de la geometría de su frontal.

Abstraction-carrying code: a model for mobile code safety

Proof-Carrying Code (PCC) is a general approach to mobile code safety in which programs are augmented with a certificate (or proof). The intended benefit is that the program consumer can locally validate the certificate w.r.t. the "untrustcd" program by means of a certificate checker a process which should be much simpler, efficient, and automatic than generating the original proof. The practical uptake of PCC greatly depends on the existence of a variety of enabling technologies which allow both proving programs correct and replacing a costly verification process by an efficient checking proceduri on th( consumer side. In this work we propose Abstraction- Carrying Code (ACC), a novel approach which uses abstract interpretation as enabling technology. We argue that the large body of applications of abstract interpretation to program verification is amenable to the overall PCC scheme. In particular, we rely on an expressive class of safely policies which can be defined over different abstract domains. We use an abstraction (or abstract model) of the program computed by standard static analyzers as a certificate. The validity of the abstraction on ihe consumer side is checked in a single pass by a very efficient and specialized abstract-interpreter. We believe that ACC brings the expressiveness, flexibility and automation which is inherent in abstract interpretation techniques to the area of mobile code safety.

Accident Management Actions In An Upper-Head Small-Break Loss-Of-Coolant Accident With High-Pressure Safety Injection Failed

Since the Three Mile Island accident, an important focus of pressurized water reactor (PWR) transient analyses has been a small-break loss-of-coolant accident (SBLOCA). In 2002, the discovery of thinning of the vessel head wall at the Davis Besse nuclear power plant reactor indicated the possibility of an SBLOCA in the upper head of the reactor vessel as a result of circumferential cracking of a control rod drive mechanism penetration nozzle - which has cast even greater importance on the study of SBLOCAs. Several experimental tests have been performed at the Large Scale Test Facility to simulate the behavior of a PWR during an upper-head SBLOCA. The last of these tests, Organisation for Economic Co-operation and Development Nuclear Energy Agency Rig of Safety Assessment (OECD/NEA ROSA) Test 6.1, was performed in 2005. This test was simulated with the TRACE 5.0 code, and good agreement with the experimental results was obtained. Additionally, a broad analysis of an upper-head SBLOCA with high-pressure safety injection failed in a Westinghouse PWR was performed taking into account different accident management actions and conditions in order to check their suitability. This issue has been analyzed also in the framework of the OECD/NEA ROSA project and the Code Applications and Maintenance Program (CAMP). The main conclusion is that the current emergency operating procedures for Westinghouse reactor design are adequate for these kinds of sequences, and they do not need to be modified.

UPM Results BWR-PWR Exercise I-1 by MCNP5 code

The perturbation approach relies in principle on a unique “NJOY + MCNP5 + SUSD3D”calculation. The inputs are the geometry MCNP5 input file and an ENDF file containing covariances.

Burnup Uncertainty Analysis for PWR-HFP Exercise I-1

Burn-up credit analyses are based on depletion calculations that provide an accurate prediction of spent fuel isotopic contents, followed by criticality calculations to assess keff

An educational initiative between the Universidad Politécnica de Madrid and Spanish Young Generation in Nuclear (Jóvenes Nucleares): The Seminar of Nuclear Safety in Advanced Reactors

Jóvenes Nucleares (Spanish Young Generation in Nuclear, JJNN) is a non-profit organization and a commission of the Spanish Nuclear Society (SNE). The Universidad Politécnica de Madrid (Technical University of Madrid, UPM) is one of the most prestigious technical universities of Spain, and has a very strong curriculum in nuclear engineering training and research. Finishing 2009, JJNN and the UPM started to plan a new and first-of-a-kind Seminar in Nuclear Safety focused on the Advanced Reactors (Generation III, III+ and IV). The scope was to make a general description of the safety in the new reactors, comparing them with the built Generation II reactors from a technical point of view but simple and without the need of strong background in nuclear engineering to try to be interesting for the most number of people possible.

Safety assessment of underground vehicles passing over highly resilient straight tracks in the presence of a broken rail

In this paper, vehicle-track interaction for a new slab track design, conceived to reduce noise and vibration levels has been analyzed, assessing the derailment risk for trains running on curved track when encountering a broken rail. Two different types of rail fastening systems with different elasticities have been analysed and compared. Numerical methods were used in order to simulate the dynamic behaviour of the train-track interaction. Multibody system (MBS) modelling techniques were combined with techniques based on the finite element method (FEM). MBS modelling was used for modelling the vehicle and FEM for simulating the elastic track. The simulation model was validated by comparing simulated results to experimental data obtained in field testing. During the simulations various safety indices, characteristic of derailment risk, were analysed. The simulations realised at the maximum running velocity of 110 km/h showed a similar behaviour for several track types. When reducing the running speed, the safety indices worsened for both cases. Although the worst behaviour was observed for the track with a greater elasticity, in none of the simulations did a derailment occur when running over the broken rail.

Safety assessment of underground vehicles passing over highly resilient curved tracks in the presence of a broken rail

Vehicle–track interaction for a new resilient slab track designed to reduce noise and vibration levels was analysed, in order to assess the derailment risk on a curved track when encountering a broken rail. Sensitivity of the rail support spacing of the relative position of the rail breakage between two adjacent rail supports and of running speed were analysed for two different elasticities of the rail fastening system. In none of the cases analysed was observed an appreciable difference between either of the elastic systems. As was expected, the most unfavourable situations were those with greater rail support spacing and those with greater distance from the breakage to the nearest rail support, although in none of the simulations performed did a derailment occur when running over the broken rail. When varying the running speed, the most favourable condition was obtained for an intermediate speed, due to the superposition of two antagonistic effects.