WorldWideScience

Sample records for included delivery mode

  1. Drug delivery device including electrolytic pump

    KAUST Repository

    Foulds, Ian G.

    2016-03-31

    Systems and methods are provided for a drug delivery device and use of the device for drug delivery. In various aspects, the drug delivery device combines a “solid drug in reservoir” (SDR) system with an electrolytic pump. In various aspects an improved electrolytic pump is provided including, in particular, an improved electrolytic pump for use with a drug delivery device, for example an implantable drug delivery device. A catalytic reformer can be incorporated in a periodically pulsed electrolytic pump to provide stable pumping performance and reduced actuation cycle.

  2. Mode of delivery and subsequent fertility.

    Science.gov (United States)

    Evers, E C; McDermott, K C; Blomquist, J L; Handa, V L

    2014-11-01

    When compared with vaginal delivery, is Cesarean delivery associated with reduced childbearing, a prolonged inter-birth interval or infertility? Women whose first delivery was by Cesarean section were not significantly different from those who delivered vaginally with respect to subsequent deliveries, inter-birth interval or infertility after delivery. Some studies have suggested that delivery by Cesarean section reduces subsequent fertility, while others have reported no association. This was a planned secondary analysis of the Mothers' Outcomes After Delivery study, a longitudinal cohort study. This analysis included 956 women with 1835 deliveries, who completed a study questionnaire at 6-11 years (median [interquartile range]: 8.1 [7.1, 9.8]) after their first delivery. Exclusion criteria regarding the first birth were: maternal age 50 years, delivery at delivery was by Cesarean section for 534 women and by vaginal birth for 422 women. Infertility was self-reported. To compare maternal characteristics by mode of first delivery, P-values were calculated using Fisher's exact test or Pearson's χ(2) test for categorical variables and a Kruskall-Wallis test for continuous variables. We also considered whether, across all deliveries to date, a prior Cesarean is associated with decreased fertility. In this analysis, self-reported infertility after each delivery (across all participants) was considered as a function of one or more prior Cesarean births, using generalized estimating equations to control for within-woman correlation. No differences were observed between the Cesarean and vaginal groups (for first delivery) with respect to infertility after their most recent delivery (7 versus 6%, P = 0.597), the interval between their first and second births (30.8 versus 30.6 months, P = 0.872), or multiparity (75 versus 76%, P = 0.650). Across all births, a history of Cesarean delivery was not significantly associated with infertility (odds ratio [OR], 0.90; 95

  3. Breech at term--mode of delivery?

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, T

    1995-01-01

    : Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS: A total...... of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores......) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS: Register data on singleton term breech deliveries imply...

  4. Salivary microflora and mode of delivery

    DEFF Research Database (Denmark)

    Boustedt, Katarina; Roswall, Josefine; Dahlén, Gunnar

    2015-01-01

    BACKGROUND: Previous cross-sectional studies have suggested that the mode of delivery can influence the composition of oral microflora. The aim of this prospective study was to compare the salivary colonization in vaginally delivered children with children delivered by Caesarian section (C...... months. A saliva sample from the mothers was obtained 6 months after delivery. The parents were asked to complete a questionnaire on socioeconomic factors, lifestyle, and hygiene at baseline and throughout the study period. All samples were analyzed with 13 pre-determined bacterial probes using...

  5. Mode of delivery and Pelvic floor disorder

    International Nuclear Information System (INIS)

    Noor, R.; Neelam, H.; Bashir, M.S.

    2017-01-01

    Objective: To compare pelvic floor dysfunction in non pregnant women who had delivered vaginally versus those with cesarean delivery. Methodology: The prevalence of pelvic floor disorders among non pregnant women was assesses by using a standardized tool pelvic floor distress inventory short form (PFDI-20). Data was collected from Jinnah Hospital Lahore, Pakistan. Results: Total numbers of participants were 278. 47.12% subjects had moderate, 36.69% miner and 16.19% had severe pelvic floor dysfunction. The symptoms of pelvic organ prolapse were more prevalent (mean value is 59.1876) than Urinary Distress (mean value is 40.5426), while the Colorectal-Anal Distress (mean value is 35.9150) were least prevalent. Conclusion: Pelvic floor disorders are very common among females and are strongly associated with mode of delivery. Although spontaneous vaginal birth was extensively associated with pelvic floor disorders the instrumental delivery affects most. (author)

  6. Mode of delivery is not associated with celiac disease.

    Science.gov (United States)

    Dydensborg Sander, Stine; Hansen, Anne Vinkel; Størdal, Ketil; Andersen, Anne-Marie Nybo; Murray, Joseph A; Husby, Steffen

    2018-01-01

    The purpose of this study was to investigate the association between mode of delivery and the risk of celiac disease in two large population-based birth cohorts with different prevalence of diagnosed celiac disease. This is an observational register-based cohort study using two independent population cohorts. We used data from administrative registers and health administrative registers from Denmark and Norway and linked the data at the individual level. We included all children who were born in Denmark from January 1, 1995 to December 31, 2010 and all children who were born in Norway from January 1, 2004 to December 31, 2012. We included 1,051,028 children from Denmark. Cesarean sections were registered for 196,512 children (18.9%). Diagnosed celiac disease was registered for 1,395 children (0.13%). We included 537,457 children from Norway. Cesarean sections were registered for 90,128 children (16.8%). Diagnosed celiac disease was registered for 1,919 children (0.35%). We found no association between the mode of delivery and the risk of diagnosed celiac disease. The adjusted odds ratio for celiac disease for children delivered by any type of cesarean section compared to vaginal delivery was 1.11 (95% CI: 0.96-1.29) in the Danish cohort and 0.96 (95% CI: 0.84-1.09) in the Norwegian cohort. The adjusted odds ratio for celiac disease for children delivered by elective cesarean section compared to vaginal delivery was 1.20 (95% CI: 1.00-1.43) in the Danish cohort and 0.96 (95% CI: 0.79-1.17) in the Norwegian cohort. In this large registry-based study, mode of delivery was not associated with an increased risk of diagnosed celiac disease.

  7. Association Between Senior Obstetrician Supervision of Resident Deliveries and Mode of Delivery.

    Science.gov (United States)

    Bardos, Jonah; Loudon, Holly; Rekawek, Patricia; Friedman, Frederick; Brodman, Michael; Fox, Nathan S

    2017-03-01

    In December 2012, the Mount Sinai Hospital implemented a program to have senior obstetricians (more than 20 years of experience) supervise residents on labor and delivery during the daytime. The objective of this study was to estimate the association of resident supervision by senior obstetricians with mode of delivery. This was a retrospective cohort study of all resident deliveries at Mount Sinai from July 2011 to June 2015. We included all patients with live, term, singleton, vertex fetuses. We compared delivery outcomes between patients delivered before December 2012 and patients delivered December 2012 and later using logistic regression analysis to control for age, body mass index, parity, induction, and prior cesarean delivery. During the study period there were no other specific departmental initiatives to increase forceps deliveries aside from having six obstetricians with significant experience in operative deliveries supervise and teach residents on labor and delivery. There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1-23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55-0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74-13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53-0.89). The increase in forceps deliveries and the decrease in cesarean deliveries were seen only in daytime hours (7 AM to 7 PM), that is, the shift that was covered by senior obstetricians. Having senior obstetricians supervise

  8. Association between mode of delivery and astigmatism in preschool children.

    Science.gov (United States)

    Liu, Fengyang; Yang, Xubo; Tang, Angcang; Liu, Longqian

    2018-03-01

    To determine whether mode of delivery has any impact on astigmatism. This case-control study was performed in the Department of Ophthalmology in 2015. Exposure was mode of delivery [vaginal delivery (VD) or caesarean section (CS), which here included both elective and emergency CS]. Outcome was astigmatism (≥2.5 D), which was determined by cycloplegic refraction. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were computed to assess the associations between mode of delivery and astigmatism from logistic regression models. Of the 659 children studied here (341 boys; mean age, 4.37 years), 440 were born by CS and 219 by VD. The incidence of severe astigmatism (≥2.5 D) in the CS and VD groups was 22.06% and 13.24%, respectively. Children delivered by CS had a 77.9% higher risk of severe astigmatism compared with vaginally delivered children (OR = 1.779; 95% CI, 1.121 to 2.824). After dividing CS into elective CS and emergency CS, children delivered by elective CS had an 87.3% increased risk of severe astigmatism (OR = 1.873; 95% CI, 1.157 to 3.032), but children delivered by emergency CS did not differ from vaginally delivered children. In addition, the children whose mothers had histories of breastfeeding had a 44.6% lower risk of severe astigmatism than children whose mother did not breastfeed them (OR = 0.554, 95% CI, 0.335-0.914). Birth by CS, especially elective CS, increases the risk of severe astigmatism (≥2.50 D) in childhood. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  9. Engineering Design Education: Effect of Mode of Delivery

    OpenAIRE

    Kinda Khalaf; Shadi Balawi; George W. Hitt; Mohammad A.M. Siddiqi

    2013-01-01

    This work reports on the gradual transformation from traditional teaching to student-centered, pure problem-based-learning (PBL) in engineering design education. Three different PBL-based modes of delivery with various degrees of modulation or freedom were used in conjunction with the prescriptive design cycle. The aim is to study the effect of the mode of delivery (PBL at various degrees of integration) on engineering design education and design thinking skills, specifically on the developme...

  10. Postpartum urinary tract infection by mode of delivery

    DEFF Research Database (Denmark)

    Gundersen, Tina Djernis; Krebs, Lone; Loekkegaard, Ellen Christine Leth

    2018-01-01

    OBJECTIVES: To examine the association between postpartum urinary tract infection and intended mode of delivery as well as actual mode of delivery. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: All live births in Denmark between 2004 and 2010 (n=450 856). Births were classified...... was postpartum urinary tract infection (n=16 295) within 30 days post partum, defined as either a diagnosis of urinary tract infection in the National Patient Registry or redemption of urinary tract infection-specific antibiotics recorded in the Register of Medicinal Product Statistics. RESULTS: We found that 4.......6% of women with intended caesarean delivery and 3.5% of women with intended vaginal delivery were treated for postpartum urinary tract infection.Women with intended caesarean delivery had a significantly increased risk of postpartum urinary tract infection compared with women with intended vaginal delivery...

  11. Mode of delivery and subsequent reproductive patterns. A national follow-up study.

    Science.gov (United States)

    Fussing-Clausen, Caroline; Geirsson, Reynir T; Hansen, Thomas; Rasmussen, Steen; Lidegaard, Øjvind; Hedegaard, Morten

    2014-10-01

    To investigate associations between mode of delivery and subsequent reproductive outcomes. Cohort study. Women with term singleton live births from 1987 to 2009. Denmark, birth registration data. Women with a first singleton delivery after 37 weeks were followed until the end of 2010, from a first birth to include subsequent live births. We used Cox's proportional hazards model stratified by parity to compare the likelihood for subsequent delivery according to mode of delivery at first and later births, estimating maternal age effects and lag time to next delivery. Likelihood of a subsequent live-born child by previous delivery mode. We identified 642,052 women with a first delivery. Compared with women with a non-instrumental vaginal delivery, delivering a child by elective cesarean section implied a 23% (95% CI 0.76-0.787) decreased likelihood for subsequent delivery. Emergency cesarean section meant 16% fewer (95% CI 0.84-0.85), and vaginal instrumental delivery 4% fewer subsequent deliveries (95% CI 0.95-0.96). Hazard ratios were largely unchanged after controlling for parity and year of birth. Small age-trends were seen, with hazard ratios affected by maternal age at birth. Delivery mode at first birth affected marginally the time lag until next birth. Fecundity, measured as likelihood of a successive live-born child, varied with mode of delivery at the first and also subsequent births. A first or later delivery by cesarean section implied decreased likelihood of subsequent delivery compared with women with a first vaginal birth. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Nanoemulsion: an advanced mode of drug delivery system

    OpenAIRE

    Jaiswal, Manjit; Dudhe, Rupesh; Sharma, P. K.

    2014-01-01

    An advanced mode of drug delivery system has been developed to overcome the major drawbacks associated with conventional drug delivery systems. This review gives a detailed idea about a nanoemulsion system. Nanoemulsions are nano-sized emulsions, which are manufactured for improving the delivery of active pharmaceutical ingredients. These are the thermodynamically stable isotropic system in which two immiscible liquids are mixed to form a single phase by means of an emulsifying agent, i.e., s...

  13. A pulsed mode electrolytic drug delivery device

    KAUST Repository

    Yi, Ying

    2015-09-14

    This paper reports the design of a proof-of-concept drug delivery device that is actuated using the bubbles formed during electrolysis. The device uses a platinum (Pt) coated nickel (Ni) metal foam and a solid drug in reservoir (SDR) approach to improve the device\\'s performance. This electrochemically-driven pump has many features that are unlike conventional drug delivery devices: it is capable of pumping periodically and being refilled automatically; it features drug release control; and it enables targeted delivery. Pt-coated metal foam is used as a catalytic reforming element, which reduces the period of each delivery cycle. Two methods were used for fabricating the Pt-coated metal: sputtering and electroplating. Of these two methods, the sputtered Pt-coated metal foam has a higher pumping rate; it also has a comparable recombination rate when compared to the electroplated Pt-coated metal foam. The only drawback of this catalytic reformer is that it consumes nickel scaffold. Considering long-term applications, the electroplated Pt metal foam was selected for drug delivery, where a controlled drug release rate of 2.2 μg ± 0.3 μg per actuation pulse was achieved using 4 mW of power.

  14. A pulsed mode electrolytic drug delivery device

    International Nuclear Information System (INIS)

    Yi, Ying; Foulds, Ian G; Buttner, Ulrich; Carreno, Armando A A; Conchouso, David

    2015-01-01

    This paper reports the design of a proof-of-concept drug delivery device that is actuated using the bubbles formed during electrolysis. The device uses a platinum (Pt) coated nickel (Ni) metal foam and a solid drug in reservoir (SDR) approach to improve the device’s performance. This electrochemically-driven pump has many features that are unlike conventional drug delivery devices: it is capable of pumping periodically and being refilled automatically; it features drug release control; and it enables targeted delivery. Pt-coated metal foam is used as a catalytic reforming element, which reduces the period of each delivery cycle. Two methods were used for fabricating the Pt-coated metal: sputtering and electroplating. Of these two methods, the sputtered Pt-coated metal foam has a higher pumping rate; it also has a comparable recombination rate when compared to the electroplated Pt-coated metal foam. The only drawback of this catalytic reformer is that it consumes nickel scaffold. Considering long-term applications, the electroplated Pt metal foam was selected for drug delivery, where a controlled drug release rate of 2.2 μg  ±  0.3 μg per actuation pulse was achieved using 4 mW of power. (paper)

  15. Transverse multibunch modes for non-rigid bunches, including mode coupling

    Energy Technology Data Exchange (ETDEWEB)

    Berg, J.S.; Ruth, R.D. [Stanford Linear Accelerator Center, Menlo Park, CA (United States)

    1996-08-01

    A method for computing transverse multibunch growth rates and frequency shifts in rings, which has been described previously, is applied to the PEP-II B factory. The method allows multibunch modes with different internal-bunch oscillation modes to couple to one another, similar to single-bunch mode coupling. Including coupling between the multibunch modes gives effects similar to those seen in single-bunch mode coupling. These effects occur at currents that are lower than the single-bunch mode coupling threshold. (author)

  16. The Effect of Mode of Delivery on Postpartum Sexual Functioning in Primiparous Women

    Directory of Open Access Journals (Sweden)

    Fatemeh Dabiri

    2014-07-01

    Full Text Available Objective: To evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. Methods: In this cross-sectional descriptive study, 150 primiparous women in postpartum period, who attended the family planning or vaccination clinics, were enrolled for the study. Eighty-one had vaginal delivery with episiotomy and 69 had experienced cesarean section. Sexual function was evaluated by the Female Sexual Function Index within 3 and 6 months postpartum. Results: About 29% in vaginal delivery group and 37% in cesarean delivery group had resumed their sexual intercourses four weeks after delivery (p=0.280.There were no significant differences between mode of delivery and sexual functioning, including desire, arousal, lubrication, orgasm, satisfaction and pain. Conclusion: The present study showed that postpartum sexual functioning was not associated with the type of delivery.

  17. How do delivery mode and parity affect pelvic organ prolapse?

    Science.gov (United States)

    Yeniel, A Özgür; Ergenoglu, A Mete; Askar, Niyazi; Itil, Ismaıl Mete; Meseri, Reci

    2013-07-01

    To determine the association between mode of delivery, parity, and pelvic organ prolapse, as assessed by the pelvic organ prolapse quantification system. Cross-sectional study. Tertiary referral center, Turkey. A total of 1964 women with benign gynecological disorders who presented between October 2009 and July 2011. Evaluation using the pelvic organ prolapse quantification system and questionnaire assessing previous obstetrics and medical history. Difference in pelvic organ prolapse stages between nulliparous and multiparous women, impact of parity and mode of delivery. In the study population, 86.4, 7.2 and 6.4% had pelvic organ prolapse of stages 0-I, II, and III-IV, respectively, and 7.9% had significant prolapse beyond the hymen. The mean age, parity, and number of vaginal deliveries were significantly higher in the prolapse than in the non-prolapse group. Vaginal delivery was associated with an odds ratio of 2.92 (95% confidence interval 1.19-7.17) for prolapse when compared with nulliparity. Each vaginal delivery increased the risk of prolapse (odds ratio 1.23; 95% confidence interval 1.12-1.35) after controlling for all confounding factors. Cesarean delivery had no impact on the odds for prolapse. Vaginal delivery was an independent risk factor for prolapse, and additional vaginal deliveries significantly increased the risk. However, cesarean delivery had no effect on the development of prolapse in this material. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  18. Impact of delivery mode on the colostrum microbiota composition.

    Science.gov (United States)

    Toscano, Marco; De Grandi, Roberta; Peroni, Diego Giampietro; Grossi, Enzo; Facchin, Valentina; Comberiati, Pasquale; Drago, Lorenzo

    2017-09-25

    Breast milk is a rich nutrient with a temporally dynamic nature. In particular, numerous alterations in the nutritional, immunological and microbiological content occur during the transition from colostrum to mature milk. The objective of our study was to evaluate the potential impact of delivery mode on the microbiota of colostrum, at both the quantitative and qualitative levels (bacterial abundance and microbiota network). Twenty-nine Italian mothers (15 vaginal deliveries vs 14 Cesarean sections) were enrolled in the study. The microbiota of colostrum samples was analyzed by next generation sequencing (Ion Torrent Personal Genome Machine). The colostrum microbiota network associated with Cesarean section and vaginal delivery was evaluated by means of the Auto Contractive Map (AutoCM), a mathematical methodology based on Artificial Neural Network (ANN) architecture. Numerous differences between Cesarean section and vaginal delivery colostrum were observed. Vaginal delivery colostrum had a significant lower abundance of Pseudomonas spp., Staphylococcus spp. and Prevotella spp. when compared to Cesarean section colostrum samples. Furthermore, the mode of delivery had a strong influence on the microbiota network, as Cesarean section colostrum showed a higher number of bacterial hubs if compared to vaginal delivery, sharing only 5 hubs. Interestingly, the colostrum of mothers who had a Cesarean section was richer in environmental bacteria than mothers who underwent vaginal delivery. Finally, both Cesarean section and vaginal delivery colostrum contained a greater number of anaerobic bacteria genera. The mode of delivery had a large impact on the microbiota composition of colostrum. Further studies are needed to better define the meaning of the differences we observed between Cesarean section and vaginal delivery colostrum microbiota.

  19. [Condylomata acuminata and mode of delivery].

    Science.gov (United States)

    Lehnen, H

    1988-01-01

    Condyloma acuminatum is a widespread infectious disease which can be sexually transmitted. The virus responsible for this condition belongs to the family Papovaviridae. At onset of the disease small wart-shaped papules are found, which multiply to form a cauliflower-like or cockscomb-like mass. The present paper describes three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata. Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients. So far no indication of a papillomavirus infection has been seen in any of the three female children at regular pediatric check-ups. Three additional therapeutic possibilities during pregnancy are described: electrocauterization, CO2 laser therapy, and cryotherapy. The efficacy of these types of therapy is discussed with reference to the literature. The goal of therapy is to prevent the newborn from contracting the disease by infection with papillomavirus in the birth canal.

  20. Medical cannabis use in Canada: vapourization and modes of delivery.

    Science.gov (United States)

    Shiplo, Samantha; Asbridge, Mark; Leatherdale, Scott T; Hammond, David

    2016-10-29

    The mode of medical cannabis delivery-whether cannabis is smoked, vapourized, or consumed orally-may have important implications for its therapeutic efficacy and health risks. However, there is very little evidence on current patterns of use among Canadian medical cannabis users, particularly with respect to modes of delivery. The current study examined modes of medical cannabis delivery following regulatory changes in 2014 governing how Canadians access medical cannabis. A total of 364 approved adult Canadian medical cannabis users completed an online cross-sectional survey between April and June 2015. The survey examined patterns of medical cannabis use, modes of delivery used, and reasons for use. Participants were recruited through a convenience sample from nine Health Canada licensed producers. Using a vapourizer was the most popular mode of delivery for medical cannabis (53 %), followed by smoking a joint (47 %). The main reason for using a vapourizer was to reduce negative health consequences associated with smoking. A majority of current vapourizer users reported using a portable vapourizer (67.2 %), followed by a stationary vapourizer (41.7 %), and an e-cigarette or vape pen (19.3 %). Current use of a vapourizer was associated with fewer respiratory symptoms (AOR = 1.28, 95 % CI 1.05-1.56, p = 0.01). The findings suggest an increase in the popularity of vapourizers as the primary mode of delivery among approved medical users. Using vapourizers has the potential to prevent some of the adverse respiratory health consequences associated with smoking and may serve as an effective harm reduction method. Monitoring implications of such current and future changes to medical cannabis regulations may be beneficial to policymakers.

  1. Determining the lowest-cost hydrogen delivery mode

    OpenAIRE

    Yang, Christopher; Ogden, Joan M

    2007-01-01

    Hydrogen delivery is a critical contributor to the cost, energy use and emissions associated with hydrogen pathways involving central plant production. The choice of the lowest-cost delivery mode (compressed gas trucks, cryogenic liquid trucks or gas pipelines) will depend upon specific geographic and market characteristics (e.g. city population and radius, population density, size and number of refueling stations and market penetration of fuel cell vehicles). We developed models to character...

  2. Engineering Design Education: Effect of Mode of Delivery

    Directory of Open Access Journals (Sweden)

    Kinda Khalaf

    2013-03-01

    Full Text Available This work reports on the gradual transformation from traditional teaching to student-centered, pure problem-based-learning (PBL in engineering design education. Three different PBL-based modes of delivery with various degrees of modulation or freedom were used in conjunction with the prescriptive design cycle. The aim is to study the effect of the mode of delivery (PBL at various degrees of integration on engineering design education and design thinking skills, specifically on the development of expert-like attitudes toward design problem solving.

  3. Medical cannabis use in Canada: vapourization and modes of delivery

    Directory of Open Access Journals (Sweden)

    Samantha Shiplo

    2016-10-01

    Full Text Available Abstract Background The mode of medical cannabis delivery—whether cannabis is smoked, vapourized, or consumed orally—may have important implications for its therapeutic efficacy and health risks. However, there is very little evidence on current patterns of use among Canadian medical cannabis users, particularly with respect to modes of delivery. The current study examined modes of medical cannabis delivery following regulatory changes in 2014 governing how Canadians access medical cannabis. Methods A total of 364 approved adult Canadian medical cannabis users completed an online cross-sectional survey between April and June 2015. The survey examined patterns of medical cannabis use, modes of delivery used, and reasons for use. Participants were recruited through a convenience sample from nine Health Canada licensed producers. Results Using a vapourizer was the most popular mode of delivery for medical cannabis (53 %, followed by smoking a joint (47 %. The main reason for using a vapourizer was to reduce negative health consequences associated with smoking. A majority of current vapourizer users reported using a portable vapourizer (67.2 %, followed by a stationary vapourizer (41.7 %, and an e-cigarette or vape pen (19.3 %. Current use of a vapourizer was associated with fewer respiratory symptoms (AOR = 1.28, 95 % CI 1.05–1.56, p = 0.01. Conclusions The findings suggest an increase in the popularity of vapourizers as the primary mode of delivery among approved medical users. Using vapourizers has the potential to prevent some of the adverse respiratory health consequences associated with smoking and may serve as an effective harm reduction method. Monitoring implications of such current and future changes to medical cannabis regulations may be beneficial to policymakers.

  4. Modes of delivery assistance in Bangladesh | Rahman | Tanzania ...

    African Journals Online (AJOL)

    Tanzania Journal of Health Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Modes of delivery assistance in Bangladesh.

  5. Mode of delivery after obstetric anal sphincter injury.

    Science.gov (United States)

    Karmarkar, Roopali; Bhide, Alka; Digesu, Alex; Khullar, Vik; Fernando, Ruwan

    2015-11-01

    To assess the effect of vaginal delivery and caesarean section on faecal symptoms and structure and function of anal sphincter in women who sustained obstetric anal sphincter injuries (OASIS) in their previous pregnancy and were advised about the mode of delivery based on faecal incontinence symptoms, anal manometry and endoanal ultrasound. It is a descriptive study on a cohort of women who had OASIS from 2006 to 2013. They were assessed after OASIS and during subsequent pregnancy with a questionnaire, endoanal ultrasound and anal manometry. Vaginal delivery was recommended to asymptomatic women with normal investigations. Elective caesarean section was recommended to women with faecal symptoms, anal sphincter defects of more than 30° or low resting or incremental anal pressures. All women were reassessed after subsequent delivery. Fifty women who had pregnancies after OASIS, were seen after OASIS, during subsequent pregnancy and after the second delivery. 15 women had faecal symptoms after OASIS. The external, internal and combined anal sphincter defects were seen in 13, 11 and 9 women respectively. Low resting and incremental pressure were seen in 15 and 11 women respectively. Caesarean section was done in 22 women and 28 women delivered vaginally. Worsening of faecal symptoms and reduction in anal pressures were not observed in planned vaginal delivery or elective caesarean section groups. Faecal symptoms were worse with reduced anal pressures in three women from the planned caesarean section group. One of the women had a vaginal delivery and two women had emergency caesarean section at 7cm and 10cm dilatation. There were no new sphincter defects or recurrent OASIS in any of the women in the study group. Decision about the mode of delivery of pregnancy after OASIS based on symptoms, anal manometry and endoanal ultrasound helps in preserving the anal sphincter function and avoiding unnecessary caesarean sections. Further follow-up of these patients is essential

  6. Mode of Delivery according to Leisure Time Physical Activity before and during Pregnancy

    DEFF Research Database (Denmark)

    Nielsen, Emilie Nor; Andersen, Per Kragh; Hegaard, Hanne Kristine

    2017-01-01

    Objectives: To examine the association between maternal leisure time physical activity and mode of delivery. Study Design: Population-based multicentre cohort. From the Danish Dystocia Study, we included 2,435 nulliparous women, who delivered a singleton infant in cephalic presentation at term...... increasing leisure time physical activity before and during pregnancy associated with a less complicated delivery among low-risk, nulliparous women....

  7. Resistive mode in rotating plasma columns including the hall current

    International Nuclear Information System (INIS)

    Galvao, R.M.O.

    1983-01-01

    A new resistive mode is shown to exist in rotating plasma columns. The mode is localized in the neighbourhood of the radius where the angular velocity of the bulk plasma is equal to minus half the local angular velocity of the ions. This singular point is caused by the Hall term in the generalized Ohm law. The growth rate of the mode scales with eta sup(1/2), where eta is the plasma resistivity. (Author) [pt

  8. Plasmon modes of metallic nanowires including quantum nonlocal effects

    Energy Technology Data Exchange (ETDEWEB)

    Moradi, Afshin, E-mail: a.moradi@kut.ac.ir [Department of Engineering Physics, Kermanshah University of Technology, Kermanshah, Iran and Department of Nano Sciences, Institute for Studies in Theoretical Physics and Mathematics (IPM), Tehran (Iran, Islamic Republic of)

    2015-03-15

    The properties of electrostatic surface and bulk plasmon modes of cylindrical metallic nanowires are investigated, using the quantum hydrodynamic theory of plasmon excitation which allows an analytical study of quantum tunneling effects through the Bohm potential term. New dispersion relations are obtained for each type of mode and their differences with previous treatments based on the standard hydrodynamic model are analyzed in detail. Numerical results show by considering the quantum effects, as the value of wave number increases, the surface modes are slightly red-shifted first and then blue-shifted while the bulk modes are blue-shifted.

  9. Diabetes in pregnancy: timing and mode of delivery.

    Science.gov (United States)

    Maso, Gianpaolo; Piccoli, Monica; Parolin, Sara; Restaino, Stefano; Alberico, Salvatore

    2014-07-01

    Diabetes in pregnancy represents a risk condition for adverse maternal and feto-neonatal outcomes and many of these complications might occur during labor and delivery. In this context, the obstetrician managing women with pre-existing and gestational diabetes should consider (1) how these conditions might affect labor and delivery outcomes; (2) what are the current recommendations on management; and (3) which other factors should be considered to decide about the timing and mode of delivery. The analysis of the studies considered in this review leads to the conclusion that the decision to deliver should be primarily intended to reduce the risk of stillbirth, macrosomia, and shoulder dystocia. In this context, this review provides useful information for managing specific subgroups of diabetic women that may present overlapping risk factors, such as women with insulin-requiring diabetes and/or obesity and/or prenatal suspicion of macrosomic fetus. To date, the lack of definitive evidences and the complexity of the problem suggest that the "appropriate" clinical management should be customized according with the clinical condition, the type and mode of intervention, its consequences on outcomes, and considering the woman's consent and informed decisions.

  10. Project Delivery System Mode Decision Based on Uncertain AHP and Fuzzy Sets

    Science.gov (United States)

    Kaishan, Liu; Huimin, Li

    2017-12-01

    The project delivery system mode determines the contract pricing type, project management mode and the risk allocation among all participants. Different project delivery system modes have different characteristics and applicable scope. For the owners, the selection of the delivery mode is the key point to decide whether the project can achieve the expected benefits, it relates to the success or failure of project construction. Under the precondition of comprehensively considering the influence factors of the delivery mode, the model of project delivery system mode decision was set up on the basis of uncertain AHP and fuzzy sets, which can well consider the uncertainty and fuzziness when conducting the index evaluation and weight confirmation, so as to rapidly and effectively identify the most suitable delivery mode according to project characteristics. The effectiveness of the model has been verified via the actual case analysis in order to provide reference for the construction project delivery system mode.

  11. The effect of mode of delivery, parity, and birth weight on risk of urinary incontinence.

    Science.gov (United States)

    Connolly, Thomas J; Litman, Heather J; Tennstedt, Sharon L; Link, Carol L; McKinlay, John B

    2007-09-01

    To examine the relationship between symptoms of urinary incontinence (UI) and mode of delivery, parity, and birth weight, data were obtained from a population-based random sample of 3,205 black, Hispanic, and white women age 30-79 in the Boston Area Community Health Survey. Measures include UI symptoms [>or=3 (moderate/severe) Sandvik's severity index]; reproductive history [live birth(s), no live births, never pregnant]; mode of delivery for live births (>or=1 vaginal birth, cesarean delivery only); parity (1, 2, >or=3); and maximum birth weight of live births (or=4,000 g). Using logistic regression, women having >or=1 vaginal delivery had twice the odds of UI compared to women with no pregnancies (P = 0.002) or only cesarean deliveries (P = 0.032). There was no difference in odds of UI between cesarean delivery only and never pregnant, by parity or birth weight. Vaginal delivery contributes to risk of UI for black, Hispanic, and white women.

  12. Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery.

    Science.gov (United States)

    Wu, Erica; Kaimal, Anjali J; Houston, Kathryn; Yee, Lynn M; Nakagawa, Sanae; Kuppermann, Miriam

    2014-05-01

    We sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. We conducted a longitudinal study of mode of delivery preferences among women who were preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale). Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone. Copyright © 2014 Mosby, Inc. All rights reserved.

  13. The relationship between mode of delivery and sexual health outcomes after childbirth.

    Science.gov (United States)

    Faisal-Cury, Alexandre; Menezes, Paulo Rossi; Quayle, Julieta; Matijasevich, Alicia; Diniz, Simone Grilo

    2015-05-01

    Several factors are implicated in the women's sexuality after childbirth. Nevertheless, there is conflicting evidence about the influence of mode of delivery (MD) AIM: To prospectively evaluate the relationship between MD and sexual health outcomes after childbirth A prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The exposure variable was MD: uncomplicated vaginal delivery (spontaneous vaginal delivery without episiotomy or any kind of perineal laceration); complicated vaginal delivery (either forceps or normal, with episiotomy or any kind of perineal laceration) and cesarean delivery. Socio-demographic and obstetric data were obtained through a questionnaire applied during the antenatal and postnatal period. Crude and adjusted risk ratios, with 95% confidence intervals, were calculated using Poisson regression to examine the associations between MD and sexual health outcomes. The three main sexual health outcomes were later resumption of sexual life, self-perception of decline of sexual life (DSL), and presence of sexual desire. One hundred and forty-one women (21.9%) resumed sexual life 3 or more months after delivery. Although 87.1% of women had desire, DSL occurred in 21.1% of the cohort. No associations were found between MD and sexual health outcomes. Women's sexuality after childbirth were not influenced by the type of delivery. Efforts to improve the treatment of sexual problems after childbirth should focus beyond MD. © 2015 International Society for Sexual Medicine.

  14. Mode of delivery among women admitted with polyhydramnios.

    Science.gov (United States)

    Suleiman, Abeer; Salim, Raed

    2017-05-01

    A retrospective matched case control study was conducted to examine the incidence of caesarean delivery (CD) among women admitted with polyhydramnios with and without a trial of labour compared to women with normal amniotic fluid index (AFI). Singleton pregnancies diagnosed with polyhydramnios upon admission to labour between 2003 and 2013 were included. A control group (normal AFI) matched at a ratio of 1:1 was randomly selected. Primary outcome was the incidence of CD. A total of 588 women were included. The overall incidence of CD was significantly higher among women with polyhydramnios (31.3%) compared to the controls (18.7%), (p polyhydramnios compared to the controls (p = .007 and p = .01, respectively). On a multiple logistic regression model, polyhydramnios was found to be an independent risk factor for delivery by a caesarean (p = .0015; OR 2.0; 95%CI 1.30-2.90).

  15. Preference toward future mode of delivery: how do antepartum preferences and prior delivery experience contribute?

    Science.gov (United States)

    Sparks, Teresa N; Yeaton-Massey, Amanda; Granados, Jesus M; Handler, Stephanie J; Meyer, Michelle R; Caughey, Aaron B

    2015-01-01

    Examine postpartum preferences toward future mode of delivery (MOD), considering recent MOD, antepartum preferences, and demographics. Prospective cohort study where a survey was distributed in outpatient obstetrics clinics to pregnant women over 18 years at 28 weeks gestation or later. Surveys gathered demographics, obstetric history, and preference toward vaginal delivery (VD) versus cesarean delivery (CD). Women were again surveyed at 6-8 weeks postpartum. Chi-square test compared proportions, and logistic regression controlled for potential confounders. A total of 299 women returned postpartum surveys and expressed preferences. Comparing women who experienced VD versus CD, the majority who had a VD (92.1%) would choose this again, while only 1.9% preferred CD. Among the CD group, preferences were mixed: 29.4% desired repeat CD, 34.1% preferred VD, and 36.5% were undecided (p cesarean and prior experience with CD were important factors. This highlights the impact of individual desires and experience, and underscores importance of antenatal counseling.

  16. Leadership Development Using Three Modes of Educational Delivery: Online, Blended and Face to Face

    Science.gov (United States)

    Ladyshewsky, Richard; Taplin, Ross

    2014-01-01

    This research explores differences in the development of life long learning skills that support leadership development across three different modes of educational delivery. Performance outcomes from 550 students across three modes of educational delivery in a post graduate leadership and management course were compared. The 12 module course and…

  17. Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts

    DEFF Research Database (Denmark)

    Rusconi, Franca; Zugna, Daniela; Annesi-Maesano, Isabella

    2017-01-01

    Evidence on the association between mode of delivery and asthma at school age is inconclusive. We assessed the associations between specific modes of delivery and asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted ...

  18. Revisiting the mode of delivery and outcome of singleton breech ...

    African Journals Online (AJOL)

    There was an increased rate of special care baby unit admission in the group that had assisted vaginal breech delivery than in those that had elective caesarean section. There was no difference in terms of birth injury, neonatal death and maternal morbidities between those that had assisted vaginal breech delivery and ...

  19. Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status.

    Science.gov (United States)

    Attanasio, Laura B; Hardeman, Rachel R; Kozhimannil, Katy B; Kjerulff, Kristen H

    2017-12-01

    Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P socioeconomic status women may be more able to realize their preferences in childbirth. © 2017 Wiley Periodicals, Inc.

  20. Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study.

    Science.gov (United States)

    Gundersen, Tina Djernis; Krebs, Lone; Loekkegaard, Ellen Christine Leth; Rasmussen, Steen Christian; Glavind, Julie; Clausen, Tine Dalsgaard

    2018-03-14

    To examine the association between postpartum urinary tract infection and intended mode of delivery as well as actual mode of delivery. Retrospective cohort study. All live births in Denmark between 2004 and 2010 (n=450 856). Births were classified by intended caesarean delivery (n=45 053) or intended vaginal delivery (n=405 803), and by actual mode of delivery: spontaneous vaginal delivery, operative vaginal delivery, emergency or planned caesarean delivery in labour or prelabour. The primary outcome measure was postpartum urinary tract infection (n=16 295) within 30 days post partum, defined as either a diagnosis of urinary tract infection in the National Patient Registry or redemption of urinary tract infection-specific antibiotics recorded in the Register of Medicinal Product Statistics. We found that 4.6% of women with intended caesarean delivery and 3.5% of women with intended vaginal delivery were treated for postpartum urinary tract infection.Women with intended caesarean delivery had a significantly increased risk of postpartum urinary tract infection compared with women with intended vaginal delivery (OR 1.33, 95% CI 1.27 to 1.40), after adjustment for age at delivery, smoking, body mass index, educational level, gestational diabetes mellitus, infection during pregnancy, birth weight, preterm delivery, preterm prelabour rupture of membranes, pre-eclampsia, parity and previous caesarean delivery (adjusted OR 1.24, 95% CI 1.17 to 1.46).Using actual mode of delivery as exposure, all types of operative delivery had an equally increased risk of postpartum urinary tract infection compared with spontaneous vaginal delivery. Compared with intended vaginal delivery, intended caesarean delivery was significantly associated with a higher risk of postpartum urinary tract infection. Future studies should focus on reducing routine catheterisation prior to operative vaginal delivery as well as improving procedures related to catheterisation. © Article author

  1. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor

    Directory of Open Access Journals (Sweden)

    Murat Bozkurt

    2014-12-01

    Full Text Available Pelvic floor dysfunction (PFD, although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed.

  2. Defining the Most Appropriate Delivery Mode in Women with Inflammatory Bowel Disease: A Systematic Review.

    Science.gov (United States)

    Foulon, Arthur; Dupas, Jean-Louis; Sabbagh, Charles; Chevreau, Julien; Rebibo, Lionel; Brazier, Franck; Bouguen, Guillaume; Gondry, Jean; Fumery, Mathurin

    2017-05-01

    High cesarean section (CS) rates are observed in patients with inflammatory bowel disease (IBD), but limited data are available to support this decision. We conducted a comprehensive review to evaluate the most appropriate mode of delivery in women with IBD according to disease phenotype and activity, as well as surgical history. We searched MEDLINE (source PubMed) and international conference abstracts, and included all studies that evaluated digestive outcome after delivery in patients with IBD. A total of 41 articles or abstracts were screened, and 18 studies were considered in this review, with sample sizes ranging from 4 to 229 patients and follow-up ranging from 2 months to 7.7 years. Pooled CS rates in patients without Perianal Crohn's disease (PCD), healed PCD or active PCD, were 27%, 43%, and 46%, respectively. Regarding the median rate of new PCD (3.0% [IQR, 1.5-11.5] versus 6.5% [0-19.7]) or PCD recurrence (13.5% [3.2-32.7] versus 45% [0-58]), no increase was observed in patients with vaginal delivery compared to CS, but for patients with an active disease, worsening of symptoms was noted in two-thirds of cases. Episiotomy, perianal tears, and instrumental delivery did not influence the incidence of PCD. In patients with ileal pouch anal anastomosis, uncomplicated vaginal delivery seemed to moderately influence pouch function, with no significant difference in terms of overall continence, daytime, or night-time stool frequency, or incontinence. However, these parameters seemed negatively impacted by a complicated vaginal delivery. New long-term data from well-designed studies are needed, but our review suggests that systematic CS in patients suffering from IBD should probably be limited to women at risk of perineal tears and obstetric injuries, with an active PCD, or with ileal pouch anal anastomosis.

  3. Review of the Recent Literature on the Mode of Delivery for Singleton Vertex Preterm Babies

    Directory of Open Access Journals (Sweden)

    Smriti Ray Chaudhuri Bhatta

    2011-01-01

    Full Text Available Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.

  4. Association between levator hiatal dimensions on ultrasound during first pregnancy and mode of delivery

    NARCIS (Netherlands)

    van Veelen, G. A.; Schweitzer, K. J.; van Hoogenhuijze, N. E.; van der Vaart, C. H.

    Objectives To determine the association between levator hiatal dimensions, measured using transperineal ultrasound, in women during their first pregnancy and the subsequent mode of delivery, stratified by the indication for intervention. Methods In this prospective observational study, 280

  5. Association Between Mode of Delivery and Risk of Infection in Early Childhood

    DEFF Research Database (Denmark)

    Christensen, Nikolas; Søndergaard, Jens; Christesen, Henrik Thybo

    2018-01-01

    BACKGROUND: Infections are the leading cause of morbidity and mortality in children. Caesarean section as a potential risk factor for infection has recently gained interest. Delivery by caesarean section has increased greatly with non-medical reasons playing an increasing role. We aimed to analyze...... the association between mode of delivery and hospitalizations due to infection and symptoms of infection at home in early childhood. METHODS: A cohort study, based on the Odense Child Cohort, following infants from gestation until a mean age of 3.5 years. Data on hospitalization due to infections were collected...... and mode of delivery. Symptom specific sub analyses showed contrasting results. CONCLUSIONS: Mode of delivery showed a strong association to hospitalization due to infectious disease during early childhood. Overall, no association was present between rate of symptoms of infection at home and mode...

  6. Development of upper respiratory tract microbiota in infancy is affected by mode of delivery

    NARCIS (Netherlands)

    Bosch, A.A.T.M.; Levin, E.; van Houten, M.A.; Hasrat, R.; Kalkman, G.; Biesbroek, G.; de Steenhuijsen Piters, W.A.A.; de Groot, P.-K.C.M.; Pernet, P.; Keijser, B.J.F.; Sanders, E.A.M.; Bogaert, D.

    2016-01-01

    Birth by Caesarian section is associated with short- and long-term respiratory morbidity. We hypothesized that mode of delivery affects the development of the respiratory microbiota, thereby altering its capacity to provide colonization resistance and consecutive pathobiont overgrowth and

  7. Mode of Delivery among HIV-Infected Pregnant Women in Philadelphia, 2005-2013.

    Science.gov (United States)

    Thompson, Dana R; Momplaisir, Florence M; Adams, Joëlla W; Yehia, Baligh R; Anderson, Emily A; Alleyne, Gregg; Brady, Kathleen A

    2015-01-01

    Current guidelines call for HIV-infected women to deliver via scheduled Caesarean when the maternal HIV viral load (VL) is >1,000 copies/ml. We describe the mode of delivery among HIV-infected women and evaluate adherence to relevant recommendations. We performed a population-based surveillance analysis of HIV-infected pregnant women in Philadelphia from 2005 to 2013, comparing mode of delivery (vaginal, scheduled Caesarean, or emergent Caesarean) by VL during pregnancy, closest to the time of delivery (≤1,000 copies/ml versus an unknown VL or VL >1,000 copies/ml) and associated factors in multivariable analysis. Our cohort included 824 deliveries from 648 HIV-infected women, of whom 69.4% had a VL ≤1,000 copies/ml and 30.6% lacked a VL or had a VL >1,000 copies/ml during pregnancy, closest to the time of delivery. Mode of delivery varied by VL: 56.6% of births were vaginal, 30.1% scheduled Caesarean, and 13.3% emergent Caesarean when the VL was ≤1,000 copies/ml; when the VL was unknown or >1,000 copies/ml, 32.9% of births were vaginal, 49.9% scheduled Caesarean and 17.5% emergent Caesarean. In multivariable analyses, Hispanic women (adjusted odds ratio (AOR) 0.17, 95% Confidence Interval (CI) 0.04-0.76) and non-Hispanic black women (AOR 0.27, 95% CI 0.10-0.77) were less to likely to deliver via scheduled Caesarean compared to non-Hispanic white women. Women who delivered prior to 38 weeks' gestation (AOR 0.37, 95% CI 0.18-0.76) were also less likely to deliver via scheduled Caesarean compared to women who delivered after 38 weeks' gestation. An interaction term for race and gestational age at delivery was significant in multivariable analysis. Non-Hispanic black (AOR 0.06, 95% CI 0.01-0.36) and Hispanic women (AOR 0.03, 95% CI 0.00-0.59) were more likely to deliver prematurely and less likely to deliver via scheduled C-section compared to non-Hispanic white women. Having a previous Caesarean (AOR 27.77, 95% CI 8.94-86.18) increased the odds of scheduled

  8. Translating data to dialogue: how to discuss mode of delivery with your patient with twins.

    Science.gov (United States)

    Meyer, Marjorie C

    2006-10-01

    Patients are given options with regard to the mode of delivery with increasing frequency. The manner in which obstetricians frame the risk/benefit information can have dramatic impact on the ultimate decision made by the patient. Recently published epidemiologic data reported increased morbidity and mortality to the second twin on the basis of mode of delivery. In this analysis, the findings of the epidemiologic studies were translated from odds ratio into the number of cesarean deliveries that would be required to prevent an adverse outcome for the second twin. For gestations of > or = 36 weeks, 97 cesarean deliveries would need to be performed to prevent a single serious morbidity or mortality in a second twin. This number is within the range needed to prevent uterine rupture associated with trial of labor following cesarean delivery (556) or morbidity related to vaginal breech delivery (167). Number needed to treat may be more useful than odds risk assessment in patient counseling.

  9. Mode of delivery and subsequent reproductive patterns. A national follow-up study

    DEFF Research Database (Denmark)

    Fussing-Clausen, Caroline; Geirsson, Reynir T; Hansen, Thomas

    2014-01-01

    OBJECTIVE: To investigate associations between mode of delivery and subsequent reproductive outcomes. DESIGN: Cohort study. POPULATION: Women with term singleton live births from 1987 to 2009. SETTING: Denmark, birth registration data. METHODS: Women with a first singleton delivery after 37 weeks...

  10. Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery.

    Science.gov (United States)

    Ampt, Amanda J; Patterson, Jillian A; Roberts, Christine L; Ford, Jane B

    2015-12-01

    To determine whether rates of obstetric anal sphincter injuries (OASIS) are continuing to increase and whether risk of OASIS according to mode of delivery is constant over time. In a retrospective population-based study, data were obtained for vaginal singleton vertex deliveries at 37-41 weeks of pregnancy among primiparous women in New South Wales, Australia, between January 2001 and December 2011. Annual OASIS rates were determined among non-instrumental, forceps, and vacuum deliveries with and without episiotomy. Multivariable logistic regression was used to determine adjusted odds ratios for each delivery mode category by year. Trends in adjusted odds ratios over time for each delivery category were compared. OASIS occurred in 955 (4.1%) of 23 081 deliveries in 2001 and 1487 (5.9%) of 25 081 deliveries in 2011. After adjustment for known risk factors, the only delivery categories to show statistically significant increases in OASIS over the study period were non-instrumental deliveries without episiotomy (linear trend Pdeliveries with episiotomy (linear trend P=0.004). Overall, OASIS rates have continued to increase. Known risk factors do not fully explain the increase in OASIS rates in non-instrumental deliveries without an episiotomy and in forceps deliveries with an episiotomy. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Failure Mode and Effect Analysis for Delivery of Lung Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Perks, Julian R., E-mail: julian.perks@ucdmc.ucdavis.edu [University of California Davis Medical Center, Sacramento, CA (United States); Stanic, Sinisa; Stern, Robin L.; Henk, Barbara; Nelson, Marsha S.; Harse, Rick D.; Mathai, Mathew; Purdy, James A.; Valicenti, Richard K.; Siefkin, Allan D.; Chen, Allen M. [University of California Davis Medical Center, Sacramento, CA (United States)

    2012-07-15

    Purpose: To improve the quality and safety of our practice of stereotactic body radiation therapy (SBRT), we analyzed the process following the failure mode and effects analysis (FMEA) method. Methods: The FMEA was performed by a multidisciplinary team. For each step in the SBRT delivery process, a potential failure occurrence was derived and three factors were assessed: the probability of each occurrence, the severity if the event occurs, and the probability of detection by the treatment team. A rank of 1 to 10 was assigned to each factor, and then the multiplied ranks yielded the relative risks (risk priority numbers). The failure modes with the highest risk priority numbers were then considered to implement process improvement measures. Results: A total of 28 occurrences were derived, of which nine events scored with significantly high risk priority numbers. The risk priority numbers of the highest ranked events ranged from 20 to 80. These included transcription errors of the stereotactic coordinates and machine failures. Conclusion: Several areas of our SBRT delivery were reconsidered in terms of process improvement, and safety measures, including treatment checklists and a surgical time-out, were added for our practice of gantry-based image-guided SBRT. This study serves as a guide for other users of SBRT to perform FMEA of their own practice.

  12. The Relationship between Mode of Delivery and Sexual Function in Nulliparous Women

    Directory of Open Access Journals (Sweden)

    Aytay Alesheikh

    2016-07-01

    Full Text Available Background & aim: Sexual activity is one of the most important aspects of a marital life. Childbirth is also a major event in the life of women, and the period of postpartum is a time of emotional upheaval. Since women believe that vaginal delivery could negatively affect their sexual function after childbirth, they tend to give birth through caesarean section. Therefore, this study aimed to evaluate the relationship between mode of delivery and sexual function in nulliparous women referred to healthcare centers in Mashhad, Iran. Methods: This correlational study was conducted on 450 nulliparous women, divided into two groups of vaginal delivery and cesarean section in 2014. Suubjects were selected via multistage sampling. Data collection tools included Female Sexual Function Index (FSFI, Depression, Anxiety and Stress scale (DASS-21, and Cassidy social support scale. Data was analyzed in SPSS version 16 using Spearman correlation coefficient and Mann-Whitney test, T-test, ANOVA, and Kruskal-Wallis. Moreover, general linear model was used to control confounding variables, and P-value of less than 0.05 was considered statistically significant. Results: Independent t-test results indicated that mean scores of sexual function in two groups of the study were 26.11±4.36 and 26.38±4.41, respectively, which revealed no statistically significant difference between the groups (P=0.509. Conclusion: No significant difference was observed between the vaginal delivery and caesarean section groups regarding sexual function. Therefore, it seems that cesarean section does not necessarily lead to pleasing sexual relationships in postpartum period compared to vaginal delivery.

  13. Oxidative stress in newborns by different modes of delivery

    Czech Academy of Sciences Publication Activity Database

    Veleminský Jr., M.; Ambrož, Antonín; Rössner ml., Pavel; Rössnerová, Andrea; Švecová, Vlasta; Milcová, Alena; Dostál, Miroslav; Pastorková, Anna; Pulkrabová, J.; Hajslová, J.; Solanský, Ivo; Hanzl, M.; Šrám, Radim

    2016-01-01

    Roč. 37, č. 6 (2016), s. 445-451 ISSN 0172-780X R&D Projects: GA ČR(CZ) GA13-13458S Institutional support: RVO:68378041 Keywords : vaginal delivery * Cesarean section * newborns Subject RIV: DN - Health Impact of the Environment Quality OBOR OECD: Public and environmental health Impact factor: 0.918, year: 2016

  14. Predicting mode of delivery using mid‑pregnancy ultrasonographic ...

    African Journals Online (AJOL)

    Background: It has been recognized that preterm labor is related to short cervical length and that poor progress in labor is a major indication for cesarean section at term. We therefore hypothesize that long cervix is not associated with increased risk of cesarean delivery during labor at term. Objectives: The objective is to ...

  15. Mode of first delivery and severe maternal complications in the subsequent pregnancy

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Krebs, Lone; Klungsøyr, Kari

    2017-01-01

    INTRODUCTION: Severe obstetric complications increase by the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended...... mode of second delivery. MATERIAL AND METHOD: A two-year population-based data-collection of severe maternal complications in women with two deliveries in the Nordic countries (n=213 518). Denominators were retrieved from the national medical birth registers. RESULTS: Out of 35 450 first cesarean...... deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than a first vaginal delivery and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than...

  16. Sources of influence on pregnant women's preferred mode of delivery in Buenos Aires, Argentina.

    Science.gov (United States)

    Amyx, Melissa; Gibbons, Luz; Xiong, Xu; Mazzoni, Agustina; Althabe, Fernando; Buekens, Pierre; Belizán, José M

    2018-03-01

    Understanding influences on women's preferred delivery mode is vital for planning interventions to reduce cesarean rates and for ensuring that women receive correct information. Our objectives were to: determine if sources of information influencing a pregnant woman's preferred delivery mode and knowledge of cesarean indications differ by sociodemographic characteristics; to conduct a factor analysis of items related to information sources influencing this preference; and to determine if knowledge differs by information sources influencing this preference or their underlying latent constructs. Data from a prospective cohort study conducted in Buenos Aires was analyzed. Healthy nulliparous women aged 18-35, at >32 weeks of gestation and with live, singleton pregnancies participated. The primary research questions were evaluated using Chi-square tests, factor analysis, logistic regression, and generalized estimating equations. A total of 382 women participated in the study. Women of lower socioeconomic status were more influenced by people, magazines and TV/movies in their mode of delivery preferences, and had poorer knowledge of cesarean indications. Sources of influence for preferred delivery mode and factors derived in factor analysis were not associated with knowledge level when considered individually or together, or when adjusted for sociodemographic characteristics, or when accounting for clustering by the hospital sector (public or private). Higher socioeconomic status is associated with being less influenced by people and with better knowledge of indications for cesarean delivery. Knowledge of cesarean indications was not associated with the source of information about mode of delivery preferences. © 2017 Wiley Periodicals, Inc.

  17. A Monte Carlo tool for evaluating VMAT and DIMRT treatment deliveries including planar detectors

    International Nuclear Information System (INIS)

    Asuni, G; Van Beek, T A; Venkataraman, S; McCurdy, B M C; Popescu, I A

    2013-01-01

    The aim of this work is to describe and validate a new general research tool that performs Monte Carlo (MC) simulations for volumetric modulated arc therapy (VMAT) and dynamic intensity modulated radiation therapy (DIMRT), simultaneously tracking dose deposition in both the patient CT geometry and an arbitrary planar detector system. The tool is generalized to handle either entrance or exit detectors and provides the simulated dose for the individual control-points of the time-dependent VMAT and DIMRT deliveries. The MC simulation tool was developed with the EGSnrc radiation transport. For the individual control point simulation, we rotate the patient/phantom volume only (i.e. independent of the gantry and planar detector geometries) using the gantry angle in the treatment planning system (TPS) DICOM RP file such that each control point has its own unique phantom file. After MC simulation, we obtained the total dose to the phantom by summing dose contributions for all control points. Scored dose to the sensitive layer of the planar detector is available for each control point. To validate the tool, three clinical treatment plans were used including VMAT plans for a prostate case and a head-and-neck case, and a DIMRT plan for a head-and-neck case. An electronic portal imaging device operated in ‘movie’ mode was used with the VMAT plans delivered to cylindrical and anthropomorphic phantoms to validate the code using an exit detector. The DIMRT plan was delivered to a novel transmission detector, to validate the code using an entrance detector. The total MC 3D absolute doses in patient/phantom were compared with the TPS doses, while 2D MC doses were compared with planar detector doses for all individual control points, using the gamma evaluation test with 3%/3 mm criteria. The MC 3D absolute doses demonstrated excellent agreement with the TPS doses for all the tested plans, with about 95% of voxels having γ 90% of percentage pixels with γ <1. We found that over

  18. Breech at term--mode of delivery? A register-based study

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, Tom

    1995-01-01

    ) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply......BACKGROUND. The present study was designed to determine neonatal mortality and morbidity in non-malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other. METHODS....... Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total...

  19. Examination of program exposure across intervention delivery modes: face-to-face versus internet

    Directory of Open Access Journals (Sweden)

    Mummery W Kerry

    2007-03-01

    Full Text Available Abstract Background There has been increasing interest in the ability of the internet to produce behaviour change. The focus of this study was to describe program exposure across three intervention groups from a randomised trial (RT comparing traditional face-to-face, internet-mediated (combined internet plus face-to-face, and internet-only program delivery. Methods Baseline and immediately post-intervention survey data, and exposure rates from participants that commenced the RT were included (n = 192. Exposure was defined as either face-to-face attendance, website usage, or a combination of both for the internet-mediated group. Characteristics of participants who were exposed to at least 75% of the program material were explored. Descriptive analysis and logistical regression were used to examine differences between groups for program exposure. Results All groups showed decrease in program exposure over time. Differences were also observed (χ2 = 10.37, p Conclusion These results suggest that the internet groups were as effective as the face-to-face delivery mode in engaging participants in the program material. However, different delivery methods may be more useful to different sub-populations. It is important to explore which target groups that internet-based programs are best suited, in order to increase their impact.

  20. Mode of Delivery in Drug-Dependent Pregnant Women: A Case Control Study.

    Science.gov (United States)

    Neves, Ana Raquel; Neves, Fabiane; Santos Silva, Isabel; Almeida, Maria do Céu; Monteiro, Pitorra

    2017-01-01

    Objective . To determine the contribution of drug use during pregnancy to the route of delivery. Methods . A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women ( n = 236) were compared with a control group of low risk women ( n = 228) in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v. 23.0 (IBM Corp.). p values Drug-dependent women presented a lower rate of cesarean delivery (18.2 versus 28.9%, p = 0.006). After adjusting for the factors that were significantly related to the mode of delivery, drug dependency influenced the rate of cesarean section ( β = 0.567; 95% CI = 0.328-0.980). Within the drug-dependent group, the mode of delivery was significantly related to previous cesarean or vaginal delivery ( p = 0.008 and p drug, route of administration, or substitution maintenance therapy. Conclusions . The drug-dependent group presented a significantly higher rate of vaginal delivery. However, this was not associated with the behavioral factors analyzed. We hypothesize that other social and psychological factors might explain this difference.

  1. Mode of Delivery in Drug-Dependent Pregnant Women: A Case Control Study

    Directory of Open Access Journals (Sweden)

    Ana Raquel Neves

    2017-01-01

    Full Text Available Objective. To determine the contribution of drug use during pregnancy to the route of delivery. Methods. A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women (n=236 were compared with a control group of low risk women (n=228 in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v. 23.0 (IBM Corp.. p values < 0.05 were considered statistically significant. Results. Drug-dependent women presented a lower rate of cesarean delivery (18.2 versus 28.9%, p=0.006. After adjusting for the factors that were significantly related to the mode of delivery, drug dependency influenced the rate of cesarean section (β=0.567; 95% CI = 0.328–0.980. Within the drug-dependent group, the mode of delivery was significantly related to previous cesarean or vaginal delivery (p=0.008 and p<0.001, resp. and fetal presentation (p<0.001, but not with the type of drug, route of administration, or substitution maintenance therapy. Conclusions. The drug-dependent group presented a significantly higher rate of vaginal delivery. However, this was not associated with the behavioral factors analyzed. We hypothesize that other social and psychological factors might explain this difference.

  2. Maturation of the Infant Microbiome Community Structure and Function Across Multiple Body Sites and in Relation to Mode of Delivery

    Science.gov (United States)

    Chu, Derrick M.; Ma, Jun; Prince, Amanda L.; Antony, Kathleen M.; Seferovic, Maxim D.; Aagaard, Kjersti M.

    2017-01-01

    Human microbial communities are characterized by their taxonomic, metagenomic, and metabolic diversity, which varies by distinct body sites and influences human physiology. However, when and how microbial communities within each body niche acquire unique taxonomical and functional signatures in early life remains underexplored. We thus sought to assess the taxonomic composition and potential metabolic function of the neonatal and early infant microbiota across multiple body sites, and assess the impact of mode of delivery and its potential confounders or modifiers. A cohort of pregnant women in their early 3rd trimester (n=81) were prospectively enrolled for longitudinal sampling through 6 weeks post-delivery, and a second matched cross-sectional cohort (n=81) was additionally recruited for sampling once at delivery. Samples were collected for each maternal-infant dyad across multiple body sites, including stool, oral gingiva, nares, skin and vagina. 16S rRNA gene sequencing analysis and whole genome shotgun sequencing was performed to interrogate the composition and function of the neonatal and maternal microbiota. We found that the neonatal microbiota and its associated functional pathways were relatively homogenous across all body sites at delivery, with the notable exception of neonatal meconium. However, by 6 weeks, the infant microbiota structure and function had significantly expanded and diversified, with body site serving as the primary determinant of the bacterial community composition and its functional capacity. Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with Cesarean delivery in some body sites (oral, nares, and skin; R2 = 0.038), this was not true in neonatal stool (meconium, Mann-Whitney p>0.05) and there was no observable difference in community function regardless of delivery mode. By 6 weeks of age, the infant microbiota structure and function had expanded and diversified with

  3. Congenital anomalies: Impact of prenatal diagnosis on mode of delivery.

    LENUS (Irish Health Repository)

    Dempsey, M A

    2010-03-01

    An important aspect of prenatal diagnosis is the avoidance of emergency caesarean delivery (CD) where the abnormality is considered lethal and the infant will not survive. A consecutive cohort of 211,163 women delivered of infants weighing 500 grams or more in three tertiary referral centers from 01\\/95 to 12\\/04, was analyzed for perinatal death attributed to congenital malformations. In the group that died in the neonatal period, the emergency CD rate was significantly lower where anomaly was detected versus undetected (17.5% versus 31%). Further, in contrast to undiagnosed anomalies, the indication for emergency CD was more often maternal in the diagnosed group (42% versus 19%, p=0.019). When a diagnosis of lethal congenital anomaly has been made in the prenatal period, the reduction in the emergency CD rate by almost half in this study supports a pivotal role for prenatal diagnosis in optimizing maternal care.

  4. Respiratory morbidity in twins by birth order, gestational age and mode of delivery.

    Science.gov (United States)

    Bricelj, Katja; Tul, Natasa; Lasic, Mateja; Bregar, Andreja Trojner; Verdenik, Ivan; Lucovnik, Miha; Blickstein, Isaac

    2016-10-01

    To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery. All twin deliveries at birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30-36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2-5.1 and OR 2.0, 95% CI 1.2-3.5 for 33-36 weeks and 30-32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1-13.0 for 28-29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages birth order have a gestational age dependent effect on the incidence of RDS.

  5. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    Roya Kokabi

    2017-08-01

    Conclusion: Vaginal delivery is associated with a twofold increased risk of postpartum SUI in primipara women compared with elective cesarean section. Age and birth weight are the main risk factors of postpartum SUI in both modes of delivery. Tool-assisted delivery and episiotomy were determined as the risk factors of postpartum SUI in vaginal delivery.

  6. Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

    Science.gov (United States)

    MacArthur, Christine; Glazener, Cathryn M A; Wilson, P Don; Lancashire, Robert J; Herbison, G Peter; Grant, Adrian M

    2006-02-01

    To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. Longitudinal study. Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Women (4214) who returned postal questionnaires three months and six years after the index birth. Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. Urinary incontinence-persistent (at three months and six years after index birth) and long term (at six years after index birth). The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by caesarean section was associated with both less persistent (OR=0.46, 95% CI 0.32-0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40-0.63). Caesarean section birth in addition to vaginal delivery, however, was not associated with significantly less persistent incontinence (OR 0.93, 95% CI 0.67-1.29). There were no significant associations between persistent or long term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. The risk of persistent and long term urinary incontinence is significantly lower following caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by caesarean section, the prevalence of persistent symptoms (14%) is still high.

  7. Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran.

    Science.gov (United States)

    Rajabi, Abdolhalim; Maharlouei, Najmeh; Rezaianzadeh, Abbas; Rajaeefard, Abdolreza; Keshavarzi, Sareh; Lankarani, Kamran B; Gholami, Ali

    2016-11-01

    Assessment of the contribution of non-medical factors to mode of delivery and birth preference in Iranian pregnant women in southwestern Iran. This cohort study used data from a structured questionnaire completed in early pregnancy and information about the subsequent delivery obtained through personal contact. Women were recruited by random sampling from antenatal clinics when scheduling visits over the course of 5 weeks from December 2012 to February 2013 and were followed-up 1 month after birth. Of the 2199 women recruited, 99.63% were eligible for the study. Of the 748 women who expressed a desire to deliver their babies by cesarean section (CS) in early pregnancy, 87% had an elective cesarean section. The logistic regression analyses showed that normative beliefs (odds ratio [OR] 1.792, 95% confidence interval (1) 1.073-2.993), control beliefs (OR: 0.272, 95% CI: 0.162-0.459), and evaluation of outcomes (OR: 0.431, 95% CI: 0.268-0.692) favored the preference for cesarean section. The desire for delivery by elective cesarean section was associated with normative beliefs (OR: 1.138; 95% CI: 1.001-1.294), control beliefs (OR: 0.804; 95% CI: 0.698-0.927), and expectations about maternity care (OR: 0.772; 95% CI: 0.683-0.873), medical influences (OR: 1.150; 95% CI: 1.023-1.291), evaluation of outcome (OR: 0.789; 95% CI: 0.696-0.894), age, preference for cesarean section (OR: 5.445; 95% CI: 3.928-7.546), spouse educational level, and number of live births. A woman's preference for delivery by cesarean section influenced their subsequent mode of delivery. Asking women in early pregnancy about their preferred mode of delivery provides the opportunity to extend their supports which might reduce the rate of elective cesarean section. This decision is affected by age, spouse educational level, number of live births, and preconceived maternal attitudes about delivery.

  8. Mode of delivery and birthweight among teenage and adult primigravida Saudi women: A retrospective comparative study.

    Science.gov (United States)

    Mohamed, Abdelrahim Awadelkarim Abdelrahman; Almalaq, Abdulrahman Ahmed Abdullah; Almansour, Raed Dawood Mohammed; Alanazi, Haitham Samer Abdulaziz; Al-Khamali, Mohammad Mosa; Shommo, Sohair Ali Mohammed

    2015-11-01

    The aim of this study was to determine the mode of delivery and birthweight among teenagers in comparison to adult pregnant Saudi women. This was a retrospective comparative study. We included all primigravid teenage girls aged 19 years or younger and adult women aged 20-29 years with singleton term normal pregnancies who delivered at Hail Maternity Hospital during 1 January-31 December 2013. Incidence of vaginal delivery among teenagers was higher than that in adults, at 105 (80.2%) and 588 (70.5%), respectively. There was a lower incidence of vacuum extraction and cesarean section among the teenage group compared to the adult group (1 [0.8%] vs 25 [3.0%], and 25 [19.1%] vs 221 [26.5%], respectively [P > 0.05]). Incidence of low birthweight among the teenage group was higher than that in adults (28 [21.4%] and 84 [10.1%], respectively [P teenage pregnancy is associated with a high risk of low birthweight (P  0.05). Adequate antenatal care, community education and raising awareness might decrease the number of teenage pregnancies, which was 13.6% in our study. © 2015 Japan Society of Obstetrics and Gynecology.

  9. Tissue factor-dependent blood coagulation is enhanced following delivery irrespective of the mode of delivery

    NARCIS (Netherlands)

    Boer, K.; den Hollander, I. A.; Meijers, J. C. M.; Levi, M. [=Marcel M.

    2007-01-01

    BACKGROUND: The risk of thrombosis is clearly increased in the postpartum period. Mice with a targeted deletion of the transmembrane domain of tissue factor (TF) develop serious activation of blood coagulation and widespread thrombosis after delivery. OBJECTIVE AND METHODS: We hypothesized that TF,

  10. Mode of delivery following successful external cephalic version : Comparison with spontaneous cephalic presentations at delivery

    NARCIS (Netherlands)

    Kuppens, S.M.; Hutton, E.K.; Hasaart, T.H.; Aichi, N.; Wijnen, H.; Pop, V.J.M.

    2013-01-01

    Objective To compare the obstetric outcomes of pregnant women after successful external cephalic version (ECV) (cases) with a large group of pregnant women with a spontaneously occurring cephalic fetal position at delivery (controls). Methods We conducted a retrospective matched cohort study in a

  11. Association of First-Trimester Echogenicity of the Puborectalis Muscle With Mode of Delivery

    NARCIS (Netherlands)

    Grob, Anique T M; Withagen, Mariëlla I J; van de Waarsenburg, Maria K; Schweitzer, Karlijn J; van der Vaart, Carl H

    OBJECTIVE: To evaluate the association between mean echogenicity of the puborectalis muscle, measured using transperineal ultrasonography, in women during their first pregnancy and the subsequent mode of delivery. METHODS: This is a secondary analysis of a prospective observational study on the

  12. Mode of delivery decisions among HIV -infected mothers at an urban ...

    African Journals Online (AJOL)

    Objectives: To quantify the use of elective Caesarean section (ECS) for prevention of mother-to-child transmission of HIV (PMTCT) at an urban Kenyan maternity hospital, to describe mode of delivery decision making among HIV positive women, and to understand patient knowledge and attitudes regarding ECS for PMTCT.

  13. Exploring Differences in Business Undergraduate Perceptions by Preferred Classroom Delivery Mode

    Science.gov (United States)

    Blau, Gary; Drennan, Rob

    2017-01-01

    The purpose of this study was to compare business undergraduate online/hybrid course perceptions across three different preferred classroom environment delivery modes: online, hybrid, or face-toface (F2F). Four different perceptions were measured: perceived favorability of online/hybrid courses (PFoOC); intent to recommend online/hybrid courses;…

  14. Mode of Delivery Shapes Gut Colonization Pattern and Modulates Regulatory Immunity in Mice

    DEFF Research Database (Denmark)

    H. F. Hansen, Camilla; S. F. Andersen, Line; Krych, Łukasz

    2014-01-01

    Delivery mode has been associated with long-term changes in gut microbiota composition and more recently also with changes in the immune system. This has further been suggested to link Cesarean section (C-section) with an increased risk for development of immune-mediated diseases such as type 1...... revealed that mice born by C-section had a distinct bacterial profile at weaning characterized by higher abundance of Bacteroides and Lachnospiraceae, and less Rikenellaceae and Ruminococcus. No clustering according to delivery method as determined by principal component analysis of denaturing gradient gel...... immune system that was also evident in NOD mice, a model of type 1 diabetes, born by C-section. However, no effect of delivery mode was seen on diabetes incidence or insulitis development. In conclusion, the first exposure to microorganisms seems to be crucial for the early life gut microbiota...

  15. MODE OF DELIVERY AND FOETAL OUTCOME IN MECONIUM-STAINED LIQUOR: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Anitha Narasimhaiah

    2016-08-01

    Full Text Available AIMS AND OBJECTIVES To study the incidence of MSL, mode of delivery and foetal outcome in women with MSL in labour. MATERIALS AND METHODS A retrospective study was conducted from January 2014 to December 2015 on patients admitted in labour room of Dr. B. R. Ambedkar Medical College and Hospital and assessed for MSL, mode of delivery and foetal outcome. RESULTS Out of the 1661 deliveries 195 (11.73 % were complicated with MSL. Chi square test was applied to analyse Grades of meconium and APGAR score at 95 % confidence and p value of < 0.05 was obtained which was statistically significant. CONCLUSION MSL alone is not an indication for Caesarean Section and is not associated with adverse neonatal outcome. Increase in the grades of MSL is associated with more adverse outcome.

  16. Improved Prediction of Preterm Delivery Using Empirical Mode Decomposition Analysis of Uterine Electromyography Signals.

    Directory of Open Access Journals (Sweden)

    Peng Ren

    Full Text Available Preterm delivery increases the risk of infant mortality and morbidity, and therefore developing reliable methods for predicting its likelihood are of great importance. Previous work using uterine electromyography (EMG recordings has shown that they may provide a promising and objective way for predicting risk of preterm delivery. However, to date attempts at utilizing computational approaches to achieve sufficient predictive confidence, in terms of area under the curve (AUC values, have not achieved the high discrimination accuracy that a clinical application requires. In our study, we propose a new analytical approach for assessing the risk of preterm delivery using EMG recordings which firstly employs Empirical Mode Decomposition (EMD to obtain their Intrinsic Mode Functions (IMF. Next, the entropy values of both instantaneous amplitude and instantaneous frequency of the first ten IMF components are computed in order to derive ratios of these two distinct components as features. Discrimination accuracy of this approach compared to those proposed previously was then calculated using six differently representative classifiers. Finally, three different electrode positions were analyzed for their prediction accuracy of preterm delivery in order to establish which uterine EMG recording location was optimal signal data. Overall, our results show a clear improvement in prediction accuracy of preterm delivery risk compared with previous approaches, achieving an impressive maximum AUC value of 0.986 when using signals from an electrode positioned below the navel. In sum, this provides a promising new method for analyzing uterine EMG signals to permit accurate clinical assessment of preterm delivery risk.

  17. Does delivery mode affect women's postpartum quality of life in rural China?

    Science.gov (United States)

    Huang, Kun; Tao, Fangbiao; Liu, Liu; Wu, Xiaoyan

    2012-06-01

    To explore the impact of delivery mode on women's postpartum quality of life in rural China and probe factors influencing postnatal quality of life. Childbirth significantly affects puerpera's physical, psychological and social domains of quality of life. Under the circumstance of increasing high caesarean section rate in rural China, the impact of delivery mode on postnatal quality of life remains unclear. Cross-sectional study design. Women residing in rural areas and in their 0-12 months after childbirth from 30 rural townships participated in a household survey. A structured questionnaire was used to evaluate women's socio-demographic characteristics, previous pregnant experiences, foetal characteristics and use of maternal health services. The scale for rural postnatal quality of life was adopted to assess postnatal quality of life from six dimensions: physical complaints and pain, sleep and energy, sex satisfaction, interpersonal communication, self-evaluated living stress and perceived life satisfaction. The overall caeserean section rate was 70·0% (962/1375), and most of them (59·7%) were selected by maternal request. None of six dimensions and total score of quality of life displayed significant difference between women with normal delivery and cesaerean section. It was found that postnatal home visit related to good postnatal quality of life and lower husband education level, male gender of infant were associated with poor quality of life. Delivery mode did not affect postpartum quality of life in rural China. Socio-cultural determinants may contribute more in influencing postnatal quality of life. Null findings in impact of delivery mode on postpartum quality of life may cause more difficulties in maternal decision-making for vaginal delivery in rural China. The importance of postnatal home visit could justify available and quality postnatal care in improving postpartum quality of life. Further research needs to explore the effective prevention

  18. Mode of delivery and the probability of subsequent childbearing: a population-based register study.

    Science.gov (United States)

    Elvander, C; Dahlberg, J; Andersson, G; Cnattingius, S

    2015-11-01

    To investigate the relationship between mode of first delivery and probability of subsequent childbearing. Population-based study. Nationwide study in Sweden. A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010. Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs). Probability of having a second and third child; interpregnancy interval. Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95-0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84-0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80-0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability. A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

  19. Breech at term--mode of delivery? A register-based study

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, Tom

    1995-01-01

    . Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total...... of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores......) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply...

  20. How to Choose “Last Mile” Delivery Modes for E-Fulfillment

    Directory of Open Access Journals (Sweden)

    Xuping Wang

    2014-01-01

    Full Text Available “Last mile” delivery has become one of the bottlenecks of e-logistics. This paper aims to explore the competitiveness of three “Last mile” delivery modes—attended home delivery (AHD, reception box (RB, and collection-and-delivery points (CDPs in different scenarios, especially in high population density scenario. The advantages and disadvantages of each mode are introduced first. Then each mode’s operation efficiency is solved with different kinds of vehicle routing problem (VRP models and genetic algorithm (GA. Finally the cost of each mode is calculated on the basis of cost structures and operation efficiencies. The results show that different modes are suitable for different scenarios: (i AHD and independent reception box work better in a scenario with sparse population or small order quantity; (ii shared reception box and CDPs are more appropriate in the scenario with high population density and large order quantity, and the better one depends on the cost of labors and facilities; (iii RB is desirable in some circumstances as delivering fresh vegetables and fruits to the ones living in high-grade communities.

  1. Mode of delivery in women with antepartum fetal death and prior cesarean delivery.

    Science.gov (United States)

    Ramirez, Mildred M; Gilbert, Sharon; Landon, Mark B; Rouse, Dwight J; Spong, Catherine Y; Varner, Michael W; Caritis, Steve N; Wapner, Ronald J; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M; O'Sullivan, Mary J; Sibai, Baha M; Langer, Oded; Thorp, John M; Mercer, Brian M

    2010-11-01

    We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥20 weeks' gestation or 500 g were evaluated. Two hundred nine patients met inclusion criteria for analysis. The mean gestational age ± standard deviation at delivery was 31.3 ± 6.5 weeks. The trial of labor rate was 75.6% (158/209), and the vaginal birth after cesarean (VBAC) success rate was 86.7%. Labor induction or augmentation occurred in 83.3% of attempted VBAC. Uterine rupture occurred in five women (2.4%), and in 3.4% of those being induced but none of these required hysterectomy. Women with a history of previous CD and an IUFD often undergo trial of labor with a high VBAC success rate. Uterine rupture complicates 2.4% of such cases. © Thieme Medical Publishers.

  2. REPRODUCTIVE OUTCOME, DURATION OF PREGNANCY AND MODE OF DELIVERY AFTER HYSTEROSCOPIC METROPLASTY IN PATIENTS WITH INFERTILITY

    Directory of Open Access Journals (Sweden)

    Tofoski Gligor

    2016-07-01

    Full Text Available Introduction: Reproductive outcome can be negatively affected in patients with congenital uterine anomalies (CUA, increasing the number of unsuccessful pregnancies and obstetric complications. Standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies is hysteroscopic metroplasty (HM. The aim of the study was to analyze the reproductive outcome, duration of pregnancy and mode of delivery in group of patients with infertility after hysteroscopic metroplasty. Material and methods: We analyzed 48 patients with previous history of fetal loss (abortion to whom hysteroscopy was done in the period of 01.11.2009 to 01.05.2013 year at the University Clinic of Obstetrics and Gynecology in Skopje. In patients who were diagnosed having CUA hysteroscopic metroplasty was done. Patients and their reproductive outcome were followed for a period of at least 2 years after the intervention. Reproductive outcome was followed considering pregnancy rate, fetal loss (abortion up to 22 gestational week, rates of preterm and term deliveries, live births and mode of delivery. Statistical analysis was performed using computer software and value for the confidence interval (± 95% CI was considered to be statistically significant with level of p<0.05. Results: After hysteroscopic metroplasty, there was a significant decrease of the abortion rate to 13.9%, and significant increase in pregnancy rates of 86.1%. Overall pregnancy rate was 75%, and term delivery was noted in 93,6 % of the patients, with spontaneus deliveries in 58,6 %. There were no complications during the hysteroscopic metroplasty, nor during the deliveries. Conclusion: Hysteroscopic metroplasty has a significant effect on the reproductive outcome, resulting in a large number of live births and no significant complication during consecutive pregnancy and delivery.

  3. [Mode of delivery and perinatal outcomes in women with premature rupture of membranes at term].

    Science.gov (United States)

    Hou, L; Wang, X; Zou, L Y; Ruan, Y; Chen, Y; Li, G H; Zhang, W Y

    2016-04-05

    Comparative study of delivery mode and perinatal outcomes in women with premature rupture of membranes at term compared to those with intact membranes. A cross sectional survey of all deliveries in 39 hospitals in 3 geographic regions of mainland China from January 1 to December 31, 2011 was carried out to investigate the demographic data and delivery outcomes. In our analysis of 103 124 pregnancies, 14 073(13.6%) were complicated by premature rupture of membranes. Compared to those with intact membrane, the risks of postpartum hemorrhage, maternal complications and neonatal complications were increased significantly for women with premature rupture of membranes at term, especially the prevalence of neonatal respiratory distress syndrome(NRDS) and meconium aspiration syndrome. The risk of low Apgar (premature rupture of membranes at term. The adverse perinatal outcomes are slightly higher in women with term premature rupture of membranes than those with intact membrane.

  4. The mode of delivery affects the diversity and colonization pattern of the gut microbiota during the first year of infants' life: a systematic review.

    Science.gov (United States)

    Rutayisire, Erigene; Huang, Kun; Liu, Yehao; Tao, Fangbiao

    2016-07-30

    The human gut is the habitat for diverse and dynamic microbial ecosystem. The human microbiota plays a critical role in functions that sustain health and is a positive asset in host defenses. Establishment of the human intestinal microbiota during infancy may be influenced by multiple factors including delivery mode. Present review compiles existing evidences on the effect of delivery mode on the diversity and colonization pattern of infants gut microbiota. Two investigators searched for relevant scientific publications from four databases (Pubmed, Medline, Embase, and Web of Science). The last search was performed on September 21, 2015, using key terms ((delivery mode OR caesarean delivery OR cesarean section OR vaginal delivery) AND (gut microbiota OR gut microbiome OR gut microflora OR intestinal microflora OR microbial diversity) AND (infants OR children)). All included studies described at least two types of gut microbiota in relation to delivery mode (caesarean section vs vaginal delivery) and used fecal samples to detect gut microbiota. Seven out of 652 retrieved studies met inclusion criteria, were included in systematic analysis. Caesarean Section (CS) was associated with both lower abundance and diversity of the phyala Actinobacteria and Bacteroidetes, and higher abundance and diversity of the phylum Firmicute from birth to 3 months of life. At the colonization level, Bifidobacterium, and Bacteroides genera seems to be significantly more frequent in vaginally delivered infants compared with CS delivered. These infants were more colonized by the Clostridium, and Lactobacillus genera. From the reports, it is tempting to say that delivery mode has less effect on colonization and diversity of Bifidobacteria, Bacteroides, Clostridium, and Lactobacillus genera from the age of 6 to 12 months of life. The diversity and colonization pattern of the gut microbiota were significantly associated to the mode of delivery during the first three months of life, however

  5. Development of Upper Respiratory Tract Microbiota in Infancy is Affected by Mode of Delivery

    Directory of Open Access Journals (Sweden)

    Astrid A.T.M. Bosch

    2016-07-01

    Full Text Available Birth by Caesarian section is associated with short- and long-term respiratory morbidity. We hypothesized that mode of delivery affects the development of the respiratory microbiota, thereby altering its capacity to provide colonization resistance and consecutive pathobiont overgrowth and infections. Therefore, we longitudinally studied the impact of mode of delivery on the nasopharyngeal microbiota development from birth until six months of age in a healthy, unselected birth cohort of 102 children (n = 761 samples. Here, we show that the respiratory microbiota develops within one day from a variable mixed bacterial community towards a Streptococcus viridans-predominated profile, regardless of mode of delivery. Within the first week, rapid niche differentiation had occurred; initially with in most infants Staphylococcus aureus predominance, followed by differentiation towards Corynebacterium pseudodiphteriticum/propinquum, Dolosigranulum pigrum, Moraxella catarrhalis/nonliquefaciens, Streptococcus pneumoniae, and/or Haemophilus influenzae dominated communities. Infants born by Caesarian section showed a delay in overall development of respiratory microbiota profiles with specifically reduced colonization with health-associated commensals like Corynebacterium and Dolosigranulum, thereby possibly influencing respiratory health later in life.

  6. Effect of mode of delivery on vertical human papillomavirus transmission - A meta-analysis.

    Science.gov (United States)

    Chatzistamatiou, K; Sotiriadis, A; Agorastos, T

    2016-01-01

    A systematic review of the literature has been conducted (last update March 2014) for clinical studies reporting the prevalence of human papillomavirus (HPV) in the offspring of HPV-infected women in association to their mode of delivery. A meta-analysis was carried out according to the identification of concordant neonatal to maternal HPV types. Overall eight studies were included in the meta-analysis. Our pooled results, showed that caesarean section is associated with significantly lower rates of HPV transmission than vaginal birth (14.9% vs. 28.2%, risk ratio or RR: 0.515, 95% confidence interval or CI: 0.34-0.78). The number of caesarean sections needed to prevent one case of perinatal infection (number needed to treat or NNT) would be 7.5. As a conclusion it should be noted that caesarean section decreases the risk for perinatal HPV transmission by approximately 46%. Perinatal transmission still occurs in approximately 15% of the children born by caesarean section.

  7. How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries.

    Science.gov (United States)

    Langhaug, Lisa F; Sherr, Lorraine; Cowan, Frances M

    2010-03-01

    To systematically review comparative research from developing countries on the effects of questionnaire delivery mode. We searched Medline, EMbase and PsychINFO and ISSTDR conference proceedings. Randomized control trials and quasi-experimental studies were included if they compared two or more questionnaire delivery modes, were conducted in a developing country, reported on sexual behaviours and occurred after 1980. A total of 28 articles reporting on 26 studies met the inclusion criteria. Heterogeneity of reported trial outcomes between studies made it inappropriate to combine trial outcomes. Eighteen studies compared audio computer-assisted survey instruments (ACASI) or its derivatives [personal digital assistant (PDA) or computer-assisted personal interview (CAPI)] against another self-administered questionnaires, face-to-face interviews or random response technique. Despite wide variation in geography and populations sampled, there was strong evidence that computer-assisted interviews lowered item-response rates and raised rates of reporting sensitive behaviours. ACASI also improved data entry quality. A wide range of sexual behaviours were reported including vaginal, oral, anal and/or forced sex, age of sexual debut, condom use at first and/or last sex. Validation of self-reports using biomarkers was rare. These data reaffirm that questionnaire delivery modes do affect self-reported sexual behaviours and that use of ACASI can significantly reduce reporting bias. Its acceptability and feasibility in developing country settings should encourage researchers to consider its use when conducting sexual health research. Triangulation of self-reported data using biomarkers is recommended. Standardizing sexual behaviour measures would allow for meta-analysis.

  8. [Postpartum urinary and fecal incontinence in gemelar pregnancy according to route and mode of delivery].

    Science.gov (United States)

    Cuerva González, Marcos Javier; López Carpintero, Nayara; de la Calle Fernández, Miranda María; Usandizaga, Ramón; González, Antonio

    2011-09-01

    The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida. To determine the different risk factors for urinary incontinence after a twin pregnancy. 331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence. The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058). The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.

  9. Mode of delivery and cord blood cytokines: a birth cohort study

    Directory of Open Access Journals (Sweden)

    DuBois Andrea M

    2006-09-01

    Full Text Available Abstract Background The mechanisms for the association between birth by cesarean section and atopy and asthma are largely unknown. Objective To examine whether cesarean section results in neonatal secretion of cytokines that are associated with increased risk of atopy and/or asthma in childhood. To examine whether the association between mode of delivery and neonatal immune responses is explained by exposure to the maternal gut flora (a marker of the vaginal flora. Methods CBMCs were isolated from 37 neonates at delivery, and secretion of IL-13, IFN-γ, and IL-10 (at baseline and after stimulation with antigens [dust mite and cat dander allergens, phytohemagglutinin, and lipopolysaccharide] was quantified by ELISA. Total and specific microbes were quantified in maternal stool. The relation between mode of delivery and cord blood cytokines was examined by linear regression. The relation between maternal stool microbes and cord blood cytokines was examined by Spearman's correlation coefficients. Results Cesarean section was associated with increased levels of IL-13 and IFN-γ. In multivariate analyses, cesarean section was associated with an increment of 79.4 pg/ml in secretion of IL-13 by CBMCs after stimulation with dust mite allergen (P Conclusion Cesarean section is associated with increased levels of IL-13 and IFN-γ, perhaps because of lack of labor and/or reduced exposure to specific microbes (e.g., gram-positive anaerobes at birth.

  10. Role of transperineal ultrasound measurements in women with prolonged second stage of labor as predictors of the mode of delivery

    Directory of Open Access Journals (Sweden)

    Mohamed A. Amin

    2014-12-01

    Conclusion: Angle of progression measured by transperineal ultrasound, is an easy, simple, reliable, and noninvasive method for prediction of mode of delivery in women with prolonged second stage of labor rather than head progression distance.

  11. [Effects of birth order, maternal abortion and mode of delivery on childhood acute leukemia risk: a meta-analysis].

    Science.gov (United States)

    Zou, Guobin; Sha, Xia

    2014-03-01

    To evaluate the associations between birth order, maternal abortion and mode of delivery and childhood acute leukemia risk. Multiple electronic databases were searched to identify relevant studies up to March 2013 using the search terms "childhood leukemia", "acute lymphoblastic leukemia", "acute myeloid leukemia","birth order", "abortion", "miscarriage", "cesarean", "birth characteristics" and "prenatal risk factor". Data from cohort and case-control studies were analyzed using the Stata software. Twenty-three studies were included in this meta-analysis according to the selection criteria. No significant associations were identified for birth order and mode of delivery (birth order = 2: OR = 0.97, 95%CI: 0.89-1.05; birth order = 3: OR = 1.00, 95%CI: 0.91-1.11; birth order ≥ 4: OR = 1.02, 95%CI: 0.87-1.20; mode of delivery: OR = 1.05, 95%CI: 0.96-1.15). However, there was a significant association between maternal abortion and childhood acute leukemia risk (spontaneous abortion: OR = 1.21, 95%CI: 1.05-1.41; induced abortion: OR = 1.23, 95%CI: 1.07-1.43). Furthermore, the stratified analysis by disease subtypes showed that spontaneous and induced abortions were significantly associated with the risks of childhood acute myeloid leukemia (OR = 1.71, 95%CI: 1.09-2.70) and acute lymphoblastic leukemia (OR = 1.23, 95%CI: 1.05-1.42), respectively. This meta-analysis revealed that maternal abortion might contribute to the childhood acute leukemia risk.

  12. In vitro evaluation of aerosol delivery by different nebulization modes in pediatric and adult mechanical ventilators.

    Science.gov (United States)

    Wan, Gwo-Hwa; Lin, Hui-Ling; Fink, James B; Chen, Yen-Hey; Wang, Wei-Jhen; Chiu, Yu-Chun; Kao, Yu-Yao; Liu, Chia-Jung

    2014-10-01

    Aerosol delivery through mechanical ventilation is influenced by the type of aerosol generator, pattern of nebulization, and a patient's breathing pattern. This study compares the efficiency of pneumatic nebulization modes provided by a ventilator with adult and pediatric in vitro lung models. Three pneumatic nebulization modes (inspiratory intermittent [IIM], continuous [CM], and expiratory intermittent [EIM]) provided by the Galileo Gold ventilator delivered medical aerosol to collection filters distal to an endotracheal tube with adult and pediatric test lungs. A unit dose of 5 mg/2.5 mL albuterol was diluted into 4 mL with distilled water and added to a jet nebulizer. The nebulizer was placed proximal to the ventilator, 15 cm from the inlet of the heated humidifier chamber with a T-piece and corrugated aerosol tubing and powered by gas from the ventilator in each of the 3 modes. Time for nebulization was recorded in minutes. Albuterol samples collected in the inhalation filter, nebulizer, T-piece, and corrugated tubing were eluted with distilled water and analyzed with a spectrophotometer. The inhaled drug, as a percentage of total dose in both lung models, was 5.1-7.5%, without statistical significance among the 3 modes. Median nebulization times for IIM, CM, and EIM were 38.9, 14.3, and 17.7 min, respectively, and nebulization time for the 3 modes significantly differed (P ventilator was not dependent on nebulization mode during simulated pediatric and adult conventional mechanical ventilation. Use of expiratory intermittent mode and continuous nebulization should be considered to reduce treatment time. Copyright © 2014 by Daedalus Enterprises.

  13. Optimal mode for delivery of seasonal malaria chemoprevention in Ouelessebougou, Mali: A cluster randomized trial.

    Science.gov (United States)

    Barry, Amadou; Issiaka, Djibrilla; Traore, Tiangoua; Mahamar, Almahamoudou; Diarra, Boubacar; Sagara, Issaka; Kone, Diakalia; Doumbo, Ogobara K; Duffy, Patrick; Fried, Michal; Dicko, Alassane

    2018-01-01

    Seasonal malaria chemoprevention (SMC), the administration of complete therapeutic courses of antimalarials to children aged 3-59 months during the malaria transmission season, is a new strategy recommended by the World Health Organization (WHO) for malaria control in Sahelian countries such as Mali with seasonal transmission. The strategy is a highly cost-effective approach to reduce malaria burden in these areas. Despite the substantial benefits of SMC on malaria infection and disease, the optimal approach to deliver SMC remains to be determined. While fixed-point delivery (FPD) and non-directly observed treatment (NDOT) by community health workers are logistically attractive, these need to be evaluated and compared to other modes of delivery for maximal coverage. To determine the optimal mode fixed-point (FPD) vs door-to-door delivery (DDD); directly observed treatment (DOT) vs. non- directly observed treatment (NDOT)), 31 villages in four health sub-districts were randomized to receive three rounds of SMC with Sulfadoxine-pyrimethamine plus Amodiaquine (SP+AQ) at monthly intervals using one of the following methods: FPD+DOT; FPD+NDOT; DDD+DOT; DDD+NDOT. The primary endpoint was SMC coverage assessed by cross-sectional survey of 2,035 children at the end of intervention period. Coverage defined as the proportion of children who received all three days of SMC treatment during the three monthly rounds based information collected by interview (primary endpoint) was significantly higher in children who received SMC using DDD 74% (95% CI 69% - 80%) compared to FPD 60% (95% CI 50% - 70%); p = 0.009. It was similar in children who received SMC using DOT or NDOT 65%, (95% CI 55% - 76%) versus 68% (95% CI 57% - 79%); p = 0.72. In summary, door-to-door delivery of SMC provides better coverage than FPD. Directly observed therapy, which requires more time and resources, did not improve coverage with SMC. ClinicalTrials.gov NCT02646410.

  14. Effect of mode of delivery and parities on the occurrence of urinary incontinence during pregnancy

    Directory of Open Access Journals (Sweden)

    Mônica Cruvinel de Lima

    Full Text Available Introduction The urinary incontinence (UI is a common pathology among women. In the gestation period, it is even more predominant, affecting between 20% and 67%. Objective To evaluate the relation between modes of delivery and parity on the occurrence of urinary incontinence during pregnancy. Methodology 80 pregnant and postpartum women, treated at the Hospital da Mulher, in Campo Grande, MS, Brazil, were selected during September and October 2011, following the inclusion and exclusion criteria of the research. The evaluation protocol consisted of a questionnaire on the clinical history of the patients, gynecological complications, urogynecologic and obstetric information. Results For independent samples, the comparison between the main values observed for the UI was given by the Mann-Whitney test and correlations between urinary incontinence and other variables were given by the Spearman's rank correlation coefficient. The studied group consisted of 40 (50% primiparous and 40 (50% multiparous women. The correlation between the following variables was not significant: parity and UI (r = 0.04, p = 0.7; parity and SUI (r = -0.81, p = 0.5; and parity and urge incontinence (r = 0.14, p = 0.19. In addition, the correlation obtained between vaginal delivery and the presence of urinary incontinence in primiparous (r = 0.08, p = 0.61 and in multiparous (r = -0.05, p = 0.76 was also not significant. The same occurs when cesarean delivery is correlated to urinary incontinence in primiparous (r = -0.08, p = 0.61 and multiparous women (r = -0.10, p = 0.5. Conclusion Parity and mode of delivery were not significantly associated with the occurrence of urinary incontinence during pregnancy.

  15. 77 FR 67399 - Hewlett-Packard Company, Design Delivery Organization (DDO), Including On-Site Leased Workers...

    Science.gov (United States)

    2012-11-09

    ... Employment and Training Administration Hewlett-Packard Company, Design Delivery Organization (DDO), Including...; Hewlett-Packard Company, Ink Jet & Web Services, World Wide Design Group, Vancouver, WA; Amended... workers of Hewlett-Packard Company, Design Delivery Organization (DDO), Corvallis, Oregon. The Department...

  16. Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China.

    Directory of Open Access Journals (Sweden)

    Lei Hou

    Full Text Available Cesarean delivery (CD rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China's One Child Policy era (1979-2015 most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD.Univariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR, 99% confidence intervals (CI.Among 108,847 deliveries, 59,415 were CD (54.6% with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH (aOR = 0.80, CI = 0.69-0.92 and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy. Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50-1.89 compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06-0.34, neonatal ICU admission (aOR = 0.50, CI = 0.36-0.69, 5-minute Apgar<4 (aOR = 0.06, CI = 0.10-0.36, and respiratory distress syndrome (RDS (aOR = 0.31, CI = 0.16-0.58, but not significantly associated with changes in rates of infection, hypoxic ischemic encephalopathy (HIEE, birth trauma or meconium aspiration rates.In 2011 when 81% of deliveries were women having their first child antepartum non-indicated CD had short-term maternal and perinatal outcomes as safe as SVD. Now that all Chinese women can have a second child the safety profile may change.

  17. Comparison of Two Modes of Delivery of First Aid Training Including Basic Life Support

    Science.gov (United States)

    Lippmann, John; Livingston, Patricia; Craike, Melinda J.

    2011-01-01

    Aims: Flexible-learning first aid courses are increasingly common due to reduced classroom contact time. This study compared retention of first aid knowledge and basic life support (BLS) skills three months after a two-day, classroom-based first aid course (STD) to one utilizing on-line theory learning at home followed by one day of classroom…

  18. A study on ethosomes as mode for transdermal delivery of an antidiabetic drug.

    Science.gov (United States)

    Bodade, Siddhodhan S; Shaikh, Karimunnisa Sameer; Kamble, Meghana S; Chaudhari, Praveen D

    2013-01-01

    A transdermal delivery system is warranted for repaglinide (RPG) which possesses half-life of 1 h and oral bioavailability of 56%. Ethosomes are useful tools for transdermal drug delivery. To prepare and evaluate ethosomes as mode for transdermal delivery of RPG. Ethosomes loaded with RPG were prepared from dipalmitoyl phosphatidylcholine and ethanol by the cold method. They were characterized using Fourier transform infrared spectroscopy and differential scanning calorimetry. They were evaluated for vesicle size, entrapment efficiency and ex-vivo skin permeation. Ethosomal composition was optimized using the 3(2) factorial design. Gel containing optimzsed ethosomes was studied for antidiabetic activity in rats. RPG ethosomes possessing the size of 0.171-1.727 µm and entrapment efficiency of 75-92% were obtained. They demonstrated a significantly higher permeation (64-97% of the administered dose) across excised rat skin when compared to free drug and its hydro alcoholic solution. In-vivo, RPG ethosomal system caused sustained antidiabetic effect. The lipid and ethanol concentration affected the physicochemical attributes and performance of ethosomes. The flexible ethosomes permeated the stratum corneum and improvized the availability of RPG for antidiabetic action. They prolonged the antidiabetic effect of RPG over a significantly longer period of time in comparison with the equivalent oral dose. Ethosomal system can successfully deliver RPG transdermally; sustain its effect and thus reduce its dosing frequency. Ethosomes are useful for enhancing the efficacy of RPG in the treatment of diabetes.

  19. Postnatal Sexual Concerns Regarding the Selection of Delivery Mode among Iranian Women: A Qualitative Content Analysis

    Directory of Open Access Journals (Sweden)

    Zahra Abbaspoor

    2016-04-01

    Full Text Available Background & aim: Several factors influence the choice of cesarean section and its increasing rate among pregnant women. It seems that sexual satisfaction after childbirth plays a pivotal role in the selection of delivery mode. This study aimed to describe the experiences of pregnant women regarding postnatal sexual concerns and delivery mode selection. Methods:This conventional qualitative content analysis was based on the study by Graneheim & Lundman (2004. Sample population consisted of 18 pregnant women undergoing natural vaginal delivery (NVD or elective cesarean section (CS at term in three hospitals and two healthcare centers of Tehran, Iran. Data collection and analysis were performed concurrently, and interviews continued until data saturation was achieved. Results: In this study, the main extracted theme was “decision-making influenced by socio-cultural childbirth beliefs.” One of the main categories comprising the content of the interviews was “meeting the sexual satisfaction of spouse" with subcategories of “spouse dissatisfaction after NVD” and “preserved sexual satisfaction after CS.” The other category was "preserving the original shape of genital organs” with subcategories of “necessity of cosmetic surgery after NVD” and “maintaining an intact genital system after CS.” Conclusion: According to the results of this study, sexual attitudes and beliefs in the Iranian society are essentially involved in women's preference of CS over NVD. Choice of CS by pregnant women is often influenced by the opinion of the spouse, family members, peers, and friends. Therefore, it is recommended that the knowledge of couples in this regard be enhanced through related educational programs.

  20. Salivary microflora and mode of delivery: a prospective case control study.

    Science.gov (United States)

    Boustedt, Katarina; Roswall, Josefine; Dahlén, Gunnar; Dahlgren, Jovanna; Twetman, Svante

    2015-12-03

    Previous cross-sectional studies have suggested that the mode of delivery can influence the composition of oral microflora. The aim of this prospective study was to compare the salivary colonization in vaginally delivered children with children delivered by Caesarian section (C-section) during their first 6 months of life. The study group consisted of 149 consecutively enrolled infants, delivered either vaginally (n = 96) or by C-section (n = 53) that volunteered after consent of their parents. Saliva samples were collected within 2 days after birth and then after 1, 3, and 6 months. A saliva sample from the mothers was obtained 6 months after delivery. The parents were asked to complete a questionnaire on socioeconomic factors, lifestyle, and hygiene at baseline and throughout the study period. All samples were analyzed with 13 pre-determined bacterial probes using checkerboard DNA-DNA hybridization. The groups were balanced at baseline concerning all relevant background factors. Gram-positive streptococci (S. mitis, S. salivarius) displayed the highest counts in both groups but a greater diversity was observed in the vaginally delivered group. A. naeslundi, A. odontolytics, F. nucleatum and L. salivarius were only detected among the vaginally delivered infants. The prevalence of S. sanguinis, S. gordoni, R. denticariosa, and B. dentinum increased by age in both groups but the prevalence was significantly lower in the C-section group (p < 0.05). There was a link between the mothers and their offspring's concerning the salivary microbial profile. The microbial composition in saliva differs by the mode of delivery during the first six months of life.

  1. 76 FR 4726 - Avaya Global Services, AOS Service Delivery, Worldwide Services Group, Including Workers Whose...

    Science.gov (United States)

    2011-01-26

    ... workers are related to the supply of service desk/help desk services providing the first level of... Employment and Training Administration Avaya Global Services, AOS Service Delivery, Worldwide Services Group... Assistance on October 20, 2010, applicable to workers of Avaya Global Services, AOS Service Delivery...

  2. Mode of delivery affects the bacterial community in the newborn gut.

    Science.gov (United States)

    Biasucci, Giacomo; Rubini, Monica; Riboni, Sara; Morelli, Lorenzo; Bessi, Elena; Retetangos, Cristiana

    2010-07-01

    The first colonisation of the intestine is one of the most profound immunological exposures faced by the newborn and it is influenced by external and internal factors. The early composition of human microbiota could have long-lasting metabolic effects and the initial composition of human intestinal bacteria is also known to affect postnatal immune system development, as we are already aware that reduced microbial stimulation during infancy would result in slower postnatal maturation of the immune system and development of an optimal balance between TH1 and TH2-like immunity. Mode of delivery has a major role on the composition of intestinal microbiota in early infancy, as it has been shown that infants born by Caesarean section (CS) have lower numbers of Bifidobacteria and Bacteroides compared with vaginally born infants. We designed a study to investigate the influence of mode of delivery (CS vs. vaginal delivery) on intestinal microbial composition on day 3 of life using PCR-denaturing gradient gel electrophoresis (DGGE) and PCR-temperature gradient gel electrophoresis (TGGE). Both DGGE and TGGE analyses have been used, together with the specific amplifications for 10 Bifidobacterium sp., 3 Ruminococcus sp., and Bacteroides that all have a highly relevant physiological role in the intestinal ecosystem of the newborn. A total of 46 term infants were enrolled in the study, consecutively recruiting all the CS-delivered babies (n=23; 8 males and 15 females) and the immediately following spontaneously delivered babies (n=23; 11 males and 12 females). DGGE analysis carried out with Bifidobacterium-specific primers revealed the presence of this genus in 13 of 23 (56.5%) samples derived from vaginally delivered newborns but in none of the samples obtained from newborns delivered by CS. PCR analysis with Bifidobacterium-species-specific primers showed that naturally delivered infants had a large number of bifidobacterial species, whereas in CS-delivered babies only two

  3. Fuzzy-neural-network inherited sliding-mode control for robot manipulator including actuator dynamics.

    Science.gov (United States)

    Wai, Rong-Jong; Muthusamy, Rajkumar

    2013-02-01

    This paper presents the design and analysis of an intelligent control system that inherits the robust properties of sliding-mode control (SMC) for an n-link robot manipulator, including actuator dynamics in order to achieve a high-precision position tracking with a firm robustness. First, the coupled higher order dynamic model of an n-link robot manipulator is briefy introduced. Then, a conventional SMC scheme is developed for the joint position tracking of robot manipulators. Moreover, a fuzzy-neural-network inherited SMC (FNNISMC) scheme is proposed to relax the requirement of detailed system information and deal with chattering control efforts in the SMC system. In the FNNISMC strategy, the FNN framework is designed to mimic the SMC law, and adaptive tuning algorithms for network parameters are derived in the sense of projection algorithm and Lyapunov stability theorem to ensure the network convergence as well as stable control performance. Numerical simulations and experimental results of a two-link robot manipulator actuated by DC servo motors are provided to justify the claims of the proposed FNNISMC system, and the superiority of the proposed FNNISMC scheme is also evaluated by quantitative comparison with previous intelligent control schemes.

  4. Delivery Mode and the Transition of Pioneering Gut-Microbiota Structure, Composition and Predicted Metabolic Function.

    Science.gov (United States)

    Mueller, Noel T; Shin, Hakdong; Pizoni, Aline; Werlang, Isabel C; Matte, Ursula; Goldani, Marcelo Z; Goldani, Helena A S; Dominguez-Bello, Maria G

    2017-12-04

    Cesarean (C-section) delivery, recently shown to cause excess weight gain in mice, perturbs human neonatal gut microbiota development due to the lack of natural mother-to-newborn transfer of microbes. Neonates excrete first the in-utero intestinal content (referred to as meconium) hours after birth, followed by intestinal contents reflective of extra-uterine exposure (referred to as transition stool) 2 to 3 days after birth. It is not clear when the effect of C-section on the neonatal gut microbiota emerges. We examined bacterial DNA in carefully-collected meconium, and the subsequent transitional stool, from 59 neonates [13 born by scheduled C-section and 46 born by vaginal delivery] in a private hospital in Brazil. Bacterial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq (San Diego, CA, USA) platform. We found evidence of bacterial DNA in the majority of meconium samples in our study. The bacterial DNA structure (i.e., beta diversity) of meconium differed significantly from that of the transitional stool microbiota. There was a significant reduction in bacterial alpha diversity (e.g., number of observed bacterial species) and change in bacterial composition (e.g., reduced Proteobacteria) in the transition from meconium to stool. However, changes in predicted microbiota metabolic function from meconium to transitional stool were only observed in vaginally-delivered neonates. Within sample comparisons showed that delivery mode was significantly associated with bacterial structure, composition and predicted microbiota metabolic function in transitional-stool samples, but not in meconium samples. Specifically, compared to vaginally delivered neonates, the transitional stool of C-section delivered neonates had lower proportions of the genera Bacteroides , Parabacteroides and Clostridium . These differences led to C-section neonates having lower predicted abundance of microbial genes related to metabolism of amino and

  5. Delivery Mode and the Transition of Pioneering Gut-Microbiota Structure, Composition and Predicted Metabolic Function

    Directory of Open Access Journals (Sweden)

    Noel T. Mueller

    2017-12-01

    Full Text Available Cesarean (C-section delivery, recently shown to cause excess weight gain in mice, perturbs human neonatal gut microbiota development due to the lack of natural mother-to-newborn transfer of microbes. Neonates excrete first the in-utero intestinal content (referred to as meconium hours after birth, followed by intestinal contents reflective of extra-uterine exposure (referred to as transition stool 2 to 3 days after birth. It is not clear when the effect of C-section on the neonatal gut microbiota emerges. We examined bacterial DNA in carefully-collected meconium, and the subsequent transitional stool, from 59 neonates [13 born by scheduled C-section and 46 born by vaginal delivery] in a private hospital in Brazil. Bacterial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq (San Diego, CA, USA platform. We found evidence of bacterial DNA in the majority of meconium samples in our study. The bacterial DNA structure (i.e., beta diversity of meconium differed significantly from that of the transitional stool microbiota. There was a significant reduction in bacterial alpha diversity (e.g., number of observed bacterial species and change in bacterial composition (e.g., reduced Proteobacteria in the transition from meconium to stool. However, changes in predicted microbiota metabolic function from meconium to transitional stool were only observed in vaginally-delivered neonates. Within sample comparisons showed that delivery mode was significantly associated with bacterial structure, composition and predicted microbiota metabolic function in transitional-stool samples, but not in meconium samples. Specifically, compared to vaginally delivered neonates, the transitional stool of C-section delivered neonates had lower proportions of the genera Bacteroides, Parabacteroides and Clostridium. These differences led to C-section neonates having lower predicted abundance of microbial genes related to metabolism of

  6. Nonlinear gyrokinetic simulation of fast ion-driven modes including continuum interaction

    Science.gov (United States)

    Cole, M. D. J.; Borchardt, M.; Kleiber, R.; Könies, A.; Mishchenko, A.

    2018-01-01

    Energetic particle transport in toroidal magnetic confinement fusion devices can be enhanced by the particles' interaction with electromagnetic global modes. This process has been modelled numerically. The most extensive work has been with reduced models, which may use a simplified description of the bulk plasma, assuming a perturbative approximation for mode structure evolution, restrict simulation to the linear phase, or some combination. In this work, nonlinear non-perturbative simulations are performed using a fully gyrokinetic and reduced models of the bulk plasma. Previous linear investigation of a simple model tokamak case is extended to show that, at least under some conditions, dramatic qualitative differences in mode structure and saturated mode amplitude can exist due to non-perturbative response in the linear and nonlinear phases that depends upon the bulk plasma physics. This supports analytical work which has shown that the non-perturbative energetic particle response should depend upon the magnetic geometry and kinetic physics. It is also shown that energetic particle modes that dominate in the linear phase can be subdominant to a non-perturbative toroidal Alfvén eigenmode-based global structure in the nonlinear phase.

  7. "Trying, But Failing" - The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence.

    Science.gov (United States)

    Braido, Fulvio; Chrystyn, Henry; Baiardini, Ilaria; Bosnic-Anticevich, Sinthia; van der Molen, Thys; Dandurand, Ronald J; Chisholm, Alison; Carter, Victoria; Price, David

    2016-01-01

    Inhaled therapies are the backbone of asthma and chronic obstructive pulmonary disease management, helping to target therapy at the airways. Adherence to prescribed treatment is necessary to ensure achievement of the clinician's desired therapeutic effect. In the case of inhaled therapies, this requires patients' acceptance of their need for inhaled therapy together with successful mastery of the inhaler technique specific to their device(s). This article reviews a number of challenges and barriers that inhaled mode of delivery can pose to optimum adherence-to therapy initiation and, thereafter, to successful implementation and persistence. The potential effects on adherence of different categories of devices, their use in multiplicity, and the mixing of device categories are discussed. Common inhaler errors identified by the international Implementing Helping Asthma in Real People (iHARP) study are summarized, and adherence intervention opportunities for health care professionals are offered. Better knowledge of common errors can help practicing clinicians identify their occurrence among patients and prompt remedial actions, such as tailored education, inhaler technique retraining, and/or shared decision making with patients regarding suitable alternatives. Optimizing existing therapy delivery, or switching to a suitable alternative, can help avoid unnecessary escalation of treatment and health care resources. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Stability Analysis of a Class of Second Order Sliding Mode Control Including Delay in Input

    Directory of Open Access Journals (Sweden)

    Pedro R. Acosta

    2013-01-01

    Full Text Available This paper deals with a class of second order sliding mode systems. Based on the derivative of the sliding surface, sufficient conditions are given for stability. However, the discontinuous control signal depend neither on the derivative of sliding surface nor on its estimate. Time delay in control input is also an important issue in sliding mode control for engineering applications. Therefore, also sufficient conditions are given for the time delay size on the discontinuous input signal, so that this class of second order sliding mode systems might have amplitude bounded oscillations. Moreover, amplitude of such oscillations may be estimated. Some numerical examples are given to validate the results. At the end, some conclusions are given on the possibilities of the results as well as their limitations.

  9. Voltage-Mode All-Pass Filters Including Minimum Component Count Circuits

    Directory of Open Access Journals (Sweden)

    Sudhanshu Maheshwari

    2007-01-01

    Full Text Available This paper presents two new first-order voltage-mode all-pass filters using a single-current differencing buffered amplifier and four passive components. Each circuit is compatible to a current-controlled current differencing buffered amplifier with only two passive elements, thus resulting in two more circuits, which employ a capacitor, a resistor, and an active element, thus using a minimum of active and passive component counts. The proposed circuits possess low output impedance, and hence can be easily cascaded for voltage-mode systems. PSPICE simulation results are given to confirm the theory.

  10. Impact of caesarean section on mode of delivery, pregnancy-induced and pregnancy-associated disorders, and complications in the subsequent pregnancy in Germany

    Directory of Open Access Journals (Sweden)

    Jacob, Louis

    2016-06-01

    Full Text Available Objectives: To analyze the impact of caesarean section (CS on mode of delivery, pregnancy-induced and pregnancy-associated disorders, as well as complications in the subsequent pregnancy within German gynecological practices.Methods: 1,801 women with CS and 1,801 matched women with vaginal delivery (VD from the IMS Disease Analyzer database were included. The impact of previous CS on the mode of delivery and pregnancy-associated disorders as well as complications prior to or during birth in the subsequent pregnancy were analyzed. Cox regressions were used to determine the influence of CS with regard to these outcomes.Results: Medical abortion and single spontaneous delivery were significantly less frequent in women with a history of CS compared to VD (OR equal to 0.52 and 0.04 respectively, whereas CS after CS was the significantly more common mode of delivery (79.0% versus 9.3%, OR=36.47. Gestational hypertension without significant proteinuria, gestational hypertension with significant proteinuria, and polyhydramnios were more frequent in women with CS than in women with VD (OR equal to 6.80, 1.71, and 2.29. Hemorrhage and maternal care for known or suspected disproportion were more common in the CS group than in the VD group (OR equal to 1.34 and 3.75. Prolonged pregnancy, preterm labor, abnormalities arising from forces of labor, and perineal laceration during delivery were significantly less frequent in women with CS than in women with VD (OR between 0.32 and 0.75, whereas long labor was more common (OR=2.09.Conclusion: Women with CS were more likely to undergo further CS and to develop major pregnancy-associated diseases in the following pregnancy compared to women with VD.

  11. A new kinetic description for turbulent collisions including mode-coupling

    International Nuclear Information System (INIS)

    Misguich, J.H.; Tchen, C.M.

    1982-07-01

    The usual introduction of higher-order mode-coupling terms in the description of turbulent collisions beyond usual Renormalized Quasi-Linear approximation (RQL) is briefly analyzed. Here new results are derived in the framework of the general kinetic theory, and the equivalence is proved with the long time limit of simple results deduced from the Vlasov equation. The correction to the RQL turbulent collision term is analyzed and a new approximation is proposed. Turbulent collisions are also described by perturbation around the Lagrangian autocorrelation of fluctuating fields. For an homogeneous turbulence, however, the asymptotic integral of this Lagrangian autocorrelation vanishes identically, similarly to what occurs in Brownian motion. For inhomogeneous turbulence this method can nevertheless be used, and higher-order mode-coupling terms can be interpreted as a shielding of elementary Lagrangian turbulent collisions

  12. Mode of delivery in women with class III obesity: planned cesarean compared with induction of labor.

    Science.gov (United States)

    Subramaniam, Akila; Jauk, Victoria Chapman; Goss, Amy Reed; Alvarez, Mitchell Dean; Reese, Crystal; Edwards, Rodney Kirk

    2014-12-01

    To compare maternal and neonatal outcomes between planned cesarean delivery and induction of labor in women with class III obesity (body mass index ≥40 kg/m(2)). In this retrospective cohort study, we identified all women with a body mass index ≥40 kg/m(2) who delivered a singleton at our institution from January 2007 to February 2013 via planned cesarean or induction of labor (regardless of eventual delivery route) at 37-41 weeks. Patients in spontaneous labor were excluded. The primary outcome was a composite of maternal morbidity including death as well as operative, infection, and thromboembolic complications. The secondary outcome was a neonatal morbidity composite. Additional outcomes included individual components of the composites. Student t, χ(2), and Fisher exact tests were used for statistical analysis. To calculate adjusted odds ratios, covariates were analyzed via multivariable logistic regression. There are 661 mother-infant pairs that met enrollment criteria-399 inductions and 262 cesareans. Groups were similar in terms of prepregnancy weight, pregnancy weight gain, and delivery body mass index. Of the 399 inductions, 258 had cervical ripening (64.7%) and 163 (40.9%) had a cesarean delivery. After multivariable adjustments, there was no significant difference in the maternal morbidity composite (adjusted odds ratio, 0.98; 95% confidence interval, 0.55-1.77) or in the neonatal morbidity composite (adjusted odds ratio, 0.81; 95% confidence interval, 0.37-1.77) between the induction and cesarean groups. In term pregnant women with class III obesity, planned cesarean does not appear to reduce maternal and neonatal morbidity compared with induction of labor. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. How Mode of Delivery Affects Comprehension of an Operations Management Simulation: Online vs Face-to-Face Classrooms

    Science.gov (United States)

    Riley, Jason M.; Ellegood, William A.; Solomon, Stanislaus; Baker, Jerrine

    2017-01-01

    Purpose: This study aims to understand how mode of delivery, online versus face-to-face, affects comprehension when teaching operations management concepts via a simulation. Conceptually, the aim is to identify factors that influence the students' ability to learn and retain new concepts. Design/methodology/approach: Leveraging Littlefield…

  14. The effects of mode of delivery and sex of newborn on placental morphology in control and diabetic pregnancies

    DEFF Research Database (Denmark)

    Mayhew, T M; Sørensen, Flemming Brandt; Klebe, J G

    1993-01-01

    Placentae from control and diabetic subjects were analysed using stereological techniques in order to assess the effects of mode of delivery (vaginal versus caesarean) and sex of neonate on parenchymal morphology. Effects were assessed using indices of peripheral villous and fetal capillary growt...

  15. A higher-order-mode fiber delivery for Ti:Sapphire femtosecond lasers

    DEFF Research Database (Denmark)

    Jespersen, Kim Giessmann; Le, Tuan; Grüner-Nielsen, Lars Erik

    2010-01-01

    compressed in a quartz rod to nearly chirp-free 110fs pulses. Femtosecond pulse delivery is achieved by launching the laser output directly into the delivery fiber without any pre-chirping of the input pulse. The demonstrated pulse delivery scheme suggests scaling to >20meters for pulse delivery in harsh...

  16. An assessment of mode of delivery in history indicated versus ultrasound indicated vaginally placed cervical cerclage.

    Science.gov (United States)

    Story, Lisa; Shennan, Andrew

    2017-03-01

    Treatment modalities to reduce the incidence of preterm birth are currently limited. Cerclage, is a common and established intervention in most obstetrics units worldwide, however, many questions regarding its efficacy, with respect to pregnancy outcomes remain unanswered. This study aims to investigate whether an antenatal placed cerclage affects the subsequent mode of delivery in women at high risk of preterm birth who labour. A retrospective case controlled study was performed at St Thomas's Hospital London. Women who had undergone cervical cerclage were identified using a pre-existing database (n=152). Cases were excluded where a C-section had been performed prior to labour (n=26), datasets were incomplete (n=5) or a rescue cerclage was performed (n=2). Remaining cases were categorised into those who had: history indicated (n=68) or ultrasound indicated (n=51) cerclage. Control cases were obtained from the same database who also laboured but had not undergone cerclage, matched according to gestational age at delivery and parity (n=114). Demographic details and outcome data were recorded. Groups were compared using Chi Squared analysis for discrete variables and t-test for continuous variables using IBM SPSS Statistics version 22. There was no statistical difference in the emergency C-section rate between history indicated and ultrasound indicated cerclage, or between patients who received cerclage and those who had not (p=0.592). The emergency C-section rate for each group was: history indicated, 25%, ultrasound indicated 18% and no cerclage 18%. Women at risk of preterm birth have high rates of emergency C-section despite the fact that the majority were multiparous. However, they can be reassured that cervical cerclage does not increase this risk. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Relation between generalized Bogoliubov and Bogoliubov-de Gennes approaches including Nambu-Goldstone mode

    International Nuclear Information System (INIS)

    Mine, M.; Okumura, M.; Yamanaka, Y.

    2005-01-01

    The two approaches of consistent quantum field theory for systems of the trapped Bose-Einstein condensates are known, one is the Bogoliubov-de Gennes approach and the other is the generalized Bogoliubov approach. In this paper, we investigate the relation between the two approaches and show that they are formally equivalent to each other. To do this one must carefully treat the Nambu-Goldstone mode which plays a crucial role in the condensation. It is emphasized that the choice of vacuum is physically relevant

  18. Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study.

    Science.gov (United States)

    Spiliopoulos, Michail; Kareti, Aparna; Jain, Neetu J; Kruse, Lakota K; Hanlon, Alex; Dandolu, Vani

    2011-06-01

    To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history. A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey Department of Health was used to obtain information from birth certificates and hospital discharge records. Using multivariate logistic regression, various demographic and clinical factors were assessed for association with peripartum hysterectomy. A total of 1,004,116 births were identified between 1997 and 2005 and 853 peripartum hysterectomies were performed (0.85/1,000 deliveries). Parity increased the risk of hysterectomy with nulliparous women having approximately half the risk compared to multiparous women. Cesarean delivery with no previous c-section almost doubled the risk (OR 2.20, CI 1.80-26.69) while in the presence of a previous c-section the risk was almost four times higher (OR 4.51, CI 3.76-5.40). Operative vaginal delivery did not result in any increase in the risk. Mode of delivery and prior obstetric history are major risk factors for peripartum hysterectomy. Patients desiring cesarean delivery need to be counseled on the risk of this serious complication.

  19. Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics

    DEFF Research Database (Denmark)

    Adeltoft, Teresa Ajslev; Andersen, C S; Gamborg, M

    2011-01-01

    , with information on maternal pre-pregnancy BMI, delivery mode and antibiotic administration in infancy, were assessed. Logistic regression analyses were performed with childhood height and weight at the 7-year follow-up as outcome measures. Results: Delivery mode was not significantly associated with childhood...

  20. A phantom model demonstration of tomotherapy dose painting delivery, including managed respiratory motion without motion management

    Energy Technology Data Exchange (ETDEWEB)

    Kissick, Michael W; Mo Xiaohu; McCall, Keisha C; Mackie, Thomas R [Department of Medical Physics, Wisconsin Institutes for Medical Research, 111 Highland Avenue, University of Wisconsin-Madison, Madison, WI 53705 (United States); Schubert, Leah K [Radiation Oncology Department, University of Nebraska Medical Center, Omaha, NE 68198 (United States); Westerly, David C, E-mail: mwkissick@wisc.ed [Department of Radiation Oncology, University of Colorado Denver, Aurora, CO 80045 (United States)

    2010-05-21

    The aim of the study was to demonstrate a potential alternative scenario for accurate dose-painting (non-homogeneous planned dose) delivery at 1 cm beam width with helical tomotherapy (HT) in the presence of 1 cm, three-dimensional, intra-fraction respiratory motion, but without any active motion management. A model dose-painting experiment was planned and delivered to the average position (proper phase of a 4DCT scan) with three spherical PTV levels to approximate dose painting to compensate for hypothetical hypoxia in a model lung tumor. Realistic but regular motion was produced with the Washington University 4D Motion Phantom. A small spherical Virtual Water(TM) phantom was used to simulate a moving lung tumor inside of the LUNGMAN(TM) anthropomorphic chest phantom to simulate realistic heterogeneity uncertainties. A piece of 4 cm Gafchromic EBT(TM) film was inserted into the 6 cm diameter sphere. TomoTherapy, Inc., DQA(TM) software was used to verify the delivery performed on a TomoTherapy Hi-Art II(TM) device. The dose uncertainty in the purposeful absence of motion management and in the absence of large, low frequency drifts (periods greater than the beam width divided by the couch velocity) or randomness in the breathing displacement yields very favorable results. Instead of interference effects, only small blurring is observed because of the averaging of many breathing cycles and beamlets and the avoidance of interference. Dose painting during respiration with helical tomotherapy is feasible in certain situations without motion management. A simple recommendation is to make respiration as regular as possible without low frequency drifting. The blurring is just small enough to suggest that it may be acceptable to deliver without motion management if the motion is equal to the beam width or smaller (at respiration frequencies) when registered to the average position.

  1. A phantom model demonstration of tomotherapy dose painting delivery, including managed respiratory motion without motion management

    International Nuclear Information System (INIS)

    Kissick, Michael W; Mo Xiaohu; McCall, Keisha C; Mackie, Thomas R; Schubert, Leah K; Westerly, David C

    2010-01-01

    The aim of the study was to demonstrate a potential alternative scenario for accurate dose-painting (non-homogeneous planned dose) delivery at 1 cm beam width with helical tomotherapy (HT) in the presence of 1 cm, three-dimensional, intra-fraction respiratory motion, but without any active motion management. A model dose-painting experiment was planned and delivered to the average position (proper phase of a 4DCT scan) with three spherical PTV levels to approximate dose painting to compensate for hypothetical hypoxia in a model lung tumor. Realistic but regular motion was produced with the Washington University 4D Motion Phantom. A small spherical Virtual Water(TM) phantom was used to simulate a moving lung tumor inside of the LUNGMAN(TM) anthropomorphic chest phantom to simulate realistic heterogeneity uncertainties. A piece of 4 cm Gafchromic EBT(TM) film was inserted into the 6 cm diameter sphere. TomoTherapy, Inc., DQA(TM) software was used to verify the delivery performed on a TomoTherapy Hi-Art II(TM) device. The dose uncertainty in the purposeful absence of motion management and in the absence of large, low frequency drifts (periods greater than the beam width divided by the couch velocity) or randomness in the breathing displacement yields very favorable results. Instead of interference effects, only small blurring is observed because of the averaging of many breathing cycles and beamlets and the avoidance of interference. Dose painting during respiration with helical tomotherapy is feasible in certain situations without motion management. A simple recommendation is to make respiration as regular as possible without low frequency drifting. The blurring is just small enough to suggest that it may be acceptable to deliver without motion management if the motion is equal to the beam width or smaller (at respiration frequencies) when registered to the average position.

  2. [The influence of mode of delivery on the level of catecholamines in umbilical cord blood of neonates].

    Science.gov (United States)

    Wang, Jing-xuan; Zhang, Wei-yuan

    2009-05-19

    To determine whether mode of delivery is associated with the level of catecholamines in umbilical cord blood of neonates. A study was carried out on 150 neonates. Among them 90 were healthy while 60 were diagnosed fetal distress. Then the subjects were first divided into 5 groups according to different modes of delivery: 30 were delivered by spontaneous labor for vaginal delivery without any pain relief; 30 by vaginal delivery with epidural anaesthesia; 30 by caesarean section without labor; 30 by vaginal delivery with low forceps because of fetal distress and 30 by caesarean section of emergency because of fetal distress. After delivery, umbilical cord blood of both artery and vein was collected for determination of norepinephrine (NE), epinephrine (E), and dopamine (DA). (1) The concentration of NE and E of umbilical artery were different in each group (P < 0.01), the group with the highest concentrations of NE and E was the ones delivered by vaginal delivery with low forceps [(73 +/- 6) ng/L, (37.8 +/- 1.8) ng/L] while caesarean section [(35 +/- 5) ng/L, (27.2 +/- 1.2) ng/L] was associated with significantly lower concentrations of NE and E of umbilical artery. The ones delivered by vaginal delivery with low forceps [(33.7 +/- 4.5) ng/L] and caesarean section of emergency [(32.9 +/- 4.5) ng/L] had higher concentrations of DA compared with any other group (P < 0.01). (2) The concentration of NE and E of umbilical vein were different in each group (P < 0.01) just like that of umbilical artery. The ones delivered by vaginal delivery with low forceps and caesarean section of emergency had higher concentrations of DA compared with any other group (P < 0.01). (3) The neonates with fetal distress had higher levels of catecholamine both in umbilical artery and umbilical vein than the healthy ones (P < 0.01); at the same time, the ones with fetal distress got lower Apgar scores 1, 5, 10 min after born contrasted to the healthy ones. If no indication for caesarean section

  3. Evaluation of different delivery modes of an interactive e-learning programme for teaching cultural diversity.

    Science.gov (United States)

    Hawthorne, Kamila; Prout, Hayley; Kinnersley, Paul; Houston, Helen

    2009-01-01

    UK medical schools find it challenging to provide standardised teaching to expanding year intakes. In addition, developing and implementing diversity training can cause difficulties. This paper describes the evaluation of an interactive e-learning programme to raise awareness and understanding of communication difficulties in diversity consultations. The programme was part of an undergraduate portfolio-based community module. Three hundred and two students were assigned to one of three delivery methods--a large group setting, small groups with a facilitator, and as part of distance learning while on community placement. The evaluation included analysis of their coursework marks, a self-completed evaluation questionnaire, and small group discussions. Two hundred and twenty-three students took part in the evaluation. They were able to apply the concepts they learnt to clinical examples from their own experiences. Type of delivery did not affect coursework marks, but students tended to prefer the e-learning as part of a distance learning package. They offered helpful suggestions to improve its complexity and range. The acceptability and utility of this e-learning module both in face to face teaching and remote placement has been demonstrated, and evaluation by the students has provided valuable information for its further development. All medical schools should include some diversity training, and further research should concentrate on the effects of this type of learning on longer term outcomes such as attitude and performance tests. Such tools could reduce demands on staff time in facilitation of small groupwork, and their cost effectiveness could be increased by making them available to other medical schools.

  4. Grouping Parturients by Parity, Previous-Cesarean, and Mode of Delivery (P-C-MoD Classification) Better Identifies Groups at Risk for Postpartum Hemorrhage.

    Science.gov (United States)

    Reichman, Orna; Gal, Micahel; Sela, Hen Y; Khayyat, Izzat; Emanuel, Michael; Samueloff, Arnon

    2016-10-01

    Objective We aimed to create a clinical classification to better identify parturients at risk for postpartum hemorrhage (PPH). Method A retrospective cohort, including all women who delivered at a single tertiary care medical center, between 2006 and 2014. Parturients were grouped by parity and history of cesarean delivery (CD): primiparas, multipara, and multipara with previous CD. Each were further subgrouped by mode of delivery (spontaneous vaginal delivery [SVD], operative vaginal delivery [OVD], emergency or elective CD). In all, 12 subgroups, based on parity, previous cesarean, and mode of delivery, formed the P-C-MoD classification. PPH was defined as a decrease of ≥3 gram% hemoglobin from admission and/or transfusion of blood products. Univariate analysis followed by multivariate analysis was performed to assess risk for PPH, controlling for confounders. Results The crude rate of PPH among 126,693 parturients was 7%. The prevalence differed significantly among independent risk factors: primiparity, 14%; multiparity, 4%; OVD, 22%; and CD, 15%. The P-C-MoD classification, segregated better between parturients at risk for PPH. The prevalence of PPH was highest for primiparous undergoing OVD (27%) compared with multiparous with SVD (3%), odds ratio [OR] = 12.8 (95% confidence interval [CI],11.9-13.9). These finding were consistent in the multivariate analysis OR = 13.1 (95% CI,12.1-14.3). Conclusion Employing the P-C-MoD classification more readily identifies parturients at risk for PPH and is superior to estimations based on single risk factors. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices.

    Science.gov (United States)

    Sage, Adam; Blalock, Susan J; Carpenter, Delesha

    This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Impact of mode of delivery on pregnancy outcomes in women with premature rupture of membranes after 28 weeks of gestation in a low-resource setting: A prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Herbert Kayiga

    Full Text Available Despite the high prevalence of premature rupture of membranes (PROM in low-resource settings, the preferred mode of delivery remains unclear. We compared the perinatal mortality in a prospective cohort of women with PROM after 28 weeks following vaginal or caesarean delivery at Mulago Hospital with the aim of adopting evidence based practice and improving patient care.Between November 2015 and May 2016, 1455 women with PROM after 28 weeks of gestation and their newborns were prospectively followed from admission to discharge at Mulago Hospital. The primary outcome was perinatal mortality. Secondary neonatal outcomes included sepsis and admission to the Special Care Unit. Maternal outcomes included maternal deaths and complications. Outcomes were compared between women who had vaginal vs. caesarean delivery using multivariable logistic regression. All statistical tests were 2-sided with the level of statistical significance set at p < 0.05.The incidence of PROM was 12.1%. The perinatal mortality following PROM was 65 per 1000 live births. Of the 1425 women with PROM, 991 (69.5% had vaginal delivery and 434 (30.5% underwent Caesarean section. There was no statistical difference in perinatal mortality by the mode of delivery (vaginal vs. caesarean in PROM (p = 0.12. The risk factors for perinatal mortality included chorioamnionitis, failure to administer corticosteroids in preterm PROM, gestational age (28-33 weeks, duration of drainage of liquor (24-48 hours, and presence of maternal complications. Caesarean delivery was associated with increased maternal postpartum infections, admission to the Special Care Unit and maternal death.In low resource settings, vaginal delivery is the preferred mode of delivery for PROM after 28 weeks gestation. It is associated with lesser maternal and perinatal morbidity when compared to caesarean delivery.

  7. Mode of Delivery Preferences in a Diverse Population of Pregnant Women

    Science.gov (United States)

    YEE, Lynn M.; KAIMAL, Anjali J.; HOUSTON, Kathryn A.; WU, Erica; THIET, Mari-Paule; NAKAGAWA, Sanae; CAUGHEY, Aaron B.; FIROUZIAN, Atoosa; KUPPERMANN, Miriam

    2014-01-01

    OBJECTIVE To assess women’s preferences for vaginal versus cesarean delivery in four contexts: prior cesarean, twins, breech presentation, and absent indication for cesarean. STUDY DESIGN Cross-sectional study of pregnant women at 24-40 weeks gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these two delivery approaches. RESULTS Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the four contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean before choosing a planned cesarean, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. While uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-to-1 scale with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable to those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity. CONCLUSIONS While most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently employed to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach. PMID:25446662

  8. A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy.

    Science.gov (United States)

    Gu, Chunyi; Zhu, Xinli; Ding, Yan; Setterberg Simone; Wang, Xiaojiao; Tao, Hua; Zhang, Yu

    2018-03-20

    To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. Qualitative descriptive design with in-depth semi-structured interviews. Postnatal wards at a tertiary specialized women's hospital in Shanghai, China. 21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation. In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Nonlocal continuum-based modeling of breathing mode of nanowires including surface stress and surface inertia effects

    International Nuclear Information System (INIS)

    Ghavanloo, Esmaeal; Fazelzadeh, S. Ahmad; Rafii-Tabar, Hashem

    2014-01-01

    Nonlocal and surface effects significantly influence the mechanical response of nanomaterials and nanostructures. In this work, the breathing mode of a circular nanowire is studied on the basis of the nonlocal continuum model. Both the surface elastic properties and surface inertia effect are included. Nanowires can be modeled as long cylindrical solid objects. The classical model is reformulated using the nonlocal differential constitutive relations of Eringen and Gurtin–Murdoch surface continuum elasticity formalism. A new frequency equation for the breathing mode of nanowires, including small scale effect, surface stress and surface inertia is presented by employing the Bessel functions. Numerical results are computed, and are compared to confirm the validity and accuracy of the proposed method. Furthermore, the model is used to elucidate the effect of nonlocal parameter, the surface stress, the surface inertia and the nanowire orientation on the breathing mode of several types of nanowires with size ranging from 0.5 to 4 nm. Our results reveal that the combined surface and small scale effects are significant for nanowires with diameter smaller than 4 nm.

  10. Nonlocal continuum-based modeling of breathing mode of nanowires including surface stress and surface inertia effects

    Science.gov (United States)

    Ghavanloo, Esmaeal; Fazelzadeh, S. Ahmad; Rafii-Tabar, Hashem

    2014-05-01

    Nonlocal and surface effects significantly influence the mechanical response of nanomaterials and nanostructures. In this work, the breathing mode of a circular nanowire is studied on the basis of the nonlocal continuum model. Both the surface elastic properties and surface inertia effect are included. Nanowires can be modeled as long cylindrical solid objects. The classical model is reformulated using the nonlocal differential constitutive relations of Eringen and Gurtin-Murdoch surface continuum elasticity formalism. A new frequency equation for the breathing mode of nanowires, including small scale effect, surface stress and surface inertia is presented by employing the Bessel functions. Numerical results are computed, and are compared to confirm the validity and accuracy of the proposed method. Furthermore, the model is used to elucidate the effect of nonlocal parameter, the surface stress, the surface inertia and the nanowire orientation on the breathing mode of several types of nanowires with size ranging from 0.5 to 4 nm. Our results reveal that the combined surface and small scale effects are significant for nanowires with diameter smaller than 4 nm.

  11. TH-A-9A-10: Prostate SBRT Delivery with Flattening-Filter-Free Mode: Benefit and Accuracy

    International Nuclear Information System (INIS)

    Li, T; Yuan, L; Sheng, Y; Wu, Q

    2014-01-01

    Purpose: Flattening-filter-free (FFF) beam mode offered on TrueBeam™ linac enables delivering IMRT at 2400 MU/min dose rate. This study investigates the benefit and delivery accuracy of using high dose rate in the context of prostate SBRT. Methods: 8 prostate SBRT patients were retrospectively studied. In 5 cases treated with 600-MU/min dose rate, continuous prostate motion data acquired during radiation-beam-on was used to analyze motion range. In addition, the initial 1/3 of prostate motion trajectories during each radiation-beam-on was separated to simulate motion range if 2400-MU/min were used. To analyze delivery accuracy in FFF mode, MLC trajectory log files from an additional 3 cases treated at 2400-MU/min were acquired. These log files record MLC expected and actual positions every 20ms, and therefore can be used to reveal delivery accuracy. Results: (1) Benefit. On average treatment at 600-MU/min takes 30s per beam; whereas 2400-MU/min requires only 11s. When shortening delivery time to ~1/3, the prostate motion range was significantly smaller (p<0.001). Largest motion reduction occurred in Sup-Inf direction, from [−3.3mm, 2.1mm] to [−1.7mm, 1.7mm], followed by reduction from [−2.1mm, 2.4mm] to [−1.0mm, 2.4mm] in Ant-Pos direction. No change observed in LR direction [−0.8mm, 0.6mm]. The combined motion amplitude (vector norm) confirms that average motion and ranges are significantly smaller when beam-on was limited to the 1st 1/3 of actual delivery time. (2) Accuracy. Trajectory log file analysis showed excellent delivery accuracy with at 2400 MU/min. Most leaf deviations during beam-on were within 0.07mm (99-percentile). Maximum leaf-opening deviations during each beam-on were all under 0.1mm for all leaves. Dose-rate was maintained at 2400-MU/min during beam-on without dipping. Conclusion: Delivery prostate SBRT with 2400 MU/min is both beneficial and accurate. High dose rates significantly reduced both treatment time and intra-beam prostate

  12. Accurate inspiral-merger-ringdown gravitational waveforms for nonspinning black-hole binaries including the effect of subdominant modes

    Science.gov (United States)

    Mehta, Ajit Kumar; Mishra, Chandra Kant; Varma, Vijay; Ajith, Parameswaran

    2017-12-01

    We present an analytical waveform family describing gravitational waves (GWs) from the inspiral, merger, and ringdown of nonspinning black-hole binaries including the effect of several nonquadrupole modes [(ℓ=2 ,m =±1 ),(ℓ=3 ,m =±3 ),(ℓ=4 ,m =±4 ) apart from (ℓ=2 ,m =±2 )]. We first construct spin-weighted spherical harmonics modes of hybrid waveforms by matching numerical-relativity simulations (with mass ratio 1-10) describing the late inspiral, merger, and ringdown of the binary with post-Newtonian/effective-one-body waveforms describing the early inspiral. An analytical waveform family is constructed in frequency domain by modeling the Fourier transform of the hybrid waveforms making use of analytical functions inspired by perturbative calculations. The resulting highly accurate, ready-to-use waveforms are highly faithful (unfaithfulness ≃10-4- 10-2 ) for observation of GWs from nonspinning black-hole binaries and are extremely inexpensive to generate.

  13. 'How poor are you?' -- a comparison of four questionnaire delivery modes for assessing socio-economic position in rural zimbabwe.

    Science.gov (United States)

    Pascoe, Sophie J S; Hargreaves, James R; Langhaug, Lisa F; Hayes, Richard J; Cowan, Frances M

    2013-01-01

    Assessing socio-economic position can be difficult, particularly in developing countries. Collection of socio-economic data usually relies on interviewer-administered questionnaires, but there is little research exploring how questionnaire delivery mode (QDM) influences reporting of these indicators. This paper reports on results of a trial of four QDMs, and the effect of mode on poverty reporting. This trial was nested within a community-randomised trial of an adolescent reproductive health intervention conducted in rural Zimbabwe. Participants were randomly allocated to one of four QDMs (three different self-administered modes and one interviewer-administered mode); a subset was randomly selected to complete the questionnaire twice. Questions covered three socio-economic domains: i) ownership of sellable and fixed assets; ii) ability to afford essential items; and iii) food sufficiency. Statistical analyses assessed the association between QDM and reporting of poverty, and compared the extent of response agreement between questionnaire rounds. 96% (n = 1483) of those eligible took part; 395 completed the questionnaire twice. Reported levels of poverty were high. Respondents using self-administered modes were more likely to report being unable to afford essential items and having insufficient food. Among those completing the questionnaire twice using different modes, higher levels of poverty and food insufficiency were reported when they completed the questionnaire using a self-administered mode. These data suggest that QDM plays a significant role in how different socio-economic indicators are reported, and reminds us to consider the mode of collection when identifying indicators to determine socio-economic position.

  14. 'How poor are you?' -- a comparison of four questionnaire delivery modes for assessing socio-economic position in rural zimbabwe.

    Directory of Open Access Journals (Sweden)

    Sophie J S Pascoe

    Full Text Available Assessing socio-economic position can be difficult, particularly in developing countries. Collection of socio-economic data usually relies on interviewer-administered questionnaires, but there is little research exploring how questionnaire delivery mode (QDM influences reporting of these indicators. This paper reports on results of a trial of four QDMs, and the effect of mode on poverty reporting.This trial was nested within a community-randomised trial of an adolescent reproductive health intervention conducted in rural Zimbabwe. Participants were randomly allocated to one of four QDMs (three different self-administered modes and one interviewer-administered mode; a subset was randomly selected to complete the questionnaire twice. Questions covered three socio-economic domains: i ownership of sellable and fixed assets; ii ability to afford essential items; and iii food sufficiency. Statistical analyses assessed the association between QDM and reporting of poverty, and compared the extent of response agreement between questionnaire rounds.96% (n = 1483 of those eligible took part; 395 completed the questionnaire twice. Reported levels of poverty were high. Respondents using self-administered modes were more likely to report being unable to afford essential items and having insufficient food. Among those completing the questionnaire twice using different modes, higher levels of poverty and food insufficiency were reported when they completed the questionnaire using a self-administered mode.These data suggest that QDM plays a significant role in how different socio-economic indicators are reported, and reminds us to consider the mode of collection when identifying indicators to determine socio-economic position.

  15. Maternal post natal hospital readmission-trends and association with mode of delivery.

    LENUS (Irish Health Repository)

    Ade-Conde, J A

    2012-02-01

    The aim of this study is to examine the trend in maternal postnatal readmission within six weeks of discharge from childbirth hospitalisation. It is a retrospective review of the maternity computer records system, patient\\'s clinical notes and HIPE data base. All women who delivered babies weighing > 500 g and\\/ > or = 24 weeks gestational age at Our Lady of Lourdes Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who were re-hospitalised within six weeks of discharge from hospital following child birth were included in the study. A total of 15782 women were delivered over the four year study period. Of these, 236 were readmitted. A series of chi-square analysis were conducted to assess the difference in readmission rates between the year 2008 86 (2.03%) and the years 2005-51(1.46%), 2006-39 (1.01%) and 2007-60 (1.42%). The readmission rate was found to be significantly higher in 2008 compared with the three preceding years. Complications of Caesarean section and secondary postpartum haemorrhage following spontaneous vaginal delivery constitute the major indications for readmission.

  16. Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder: A Population-Based Sibling Design Study.

    Science.gov (United States)

    Curran, Eileen A; Dalman, Christina; Kearney, Patricia M; Kenny, Louise C; Cryan, John F; Dinan, Timothy G; Khashan, Ali S

    2015-09-01

    Because the rates of cesarean section (CS) are increasing worldwide, it is becoming increasingly important to understand the long-term effects that mode of delivery may have on child development. To investigate the association between obstetric mode of delivery and autism spectrum disorder (ASD). Perinatal factors and ASD diagnoses based on the International Classification of Diseases, Ninth Revision (ICD-9),and the International Statistical Classification of Diseases, 10th Revision (ICD-10),were identified from the Swedish Medical Birth Register and the Swedish National Patient Register. We conducted stratified Cox proportional hazards regression analysis to examine the effect of mode of delivery on ASD. We then used conditional logistic regression to perform a sibling design study, which consisted of sibling pairs discordant on ASD status. Analyses were adjusted for year of birth (ie, partially adjusted) and then fully adjusted for various perinatal and sociodemographic factors. The population-based cohort study consisted of all singleton live births in Sweden from January 1, 1982, through December 31, 2010. Children were followed up until first diagnosis of ASD, death, migration, or December 31, 2011 (end of study period), whichever came first. The full cohort consisted of 2,697,315 children and 28,290 cases of ASD. Sibling control analysis consisted of 13,411 sibling pairs. Obstetric mode of delivery defined as unassisted vaginal delivery (VD), assisted VD, elective CS, and emergency CS (defined by before or after onset of labor). The ASD status as defined using codes from the ICD-9 (code 299) and ICD-10 (code F84). In adjusted Cox proportional hazards regression analysis, elective CS (hazard ratio, 1.21; 95% CI, 1.15-1.27) and emergency CS (hazard ratio, 1.15; 95% CI, 1.10-1.20) were associated with ASD when compared with unassisted VD. In the sibling control analysis, elective CS was not associated with ASD in partially (odds ratio [OR], 0.97; 95% CI, 0

  17. Stress urinary incontinence: pre-pregnancy history and effects of mode of delivery on its postpartum persistency.

    Science.gov (United States)

    Hantoushzadeh, Sedighgeh; Javadian, Pouya; Shariat, Mamak; Salmanian, Bahram; Ghazizadeh, Shirin; Aghssa, Malekmansour

    2011-06-01

    We aimed to determine the prevalence of mild stress urinary incontinence (SUI) 1 year postpartum in relation to mode of delivery and pre-pregnancy SUI. This cohort study was performed on 618 primiparous women who delivered by elective cesarean section and NVD. Development of SUI during pregnancy till 12 months after delivery was studied. Frequency of mild SUI among patients with and without pre-pregnancy SUI was compared at the ante-partum (RR, 5.75), 40 days postpartum (RR, 9.3), 3 months postpartum (RR, 10.1), 6 months postpartum (RR, 10.1), and 12 months postpartum (RR, 16.8). Regarding the mode of delivery, incidence of SUI showed significant difference at 40 days, 3 and 6 months postpartum in both patients with and without pre-pregnancy history of SUI (Pdelivery had significant effect on the persistency of SUI up to 6 months postpartum, while pre-pregnancy SUI revealed such effect till 1 year.

  18. [Factors associated with mode of delivery in women with pre-eclampsia].

    Science.gov (United States)

    Linhares, José Juvenal; Macêdo, Nadesna Martins Queiroz; Arruda, Guarany Mont'alverne de; Vasconcelos, Janssen Loiola Melo; Saraiva, Thiago De Vasconcelos; Ribeiro, Amélia Frota

    2014-06-01

    To analyze the factors related to route of delivery in patients with pre-eclampsia. A retrospective analytical study was conducted from January 2009 to January 2011, during which 250 medical records of patients diagnosed with pre-eclampsia who gave birth to live fetuses with a gestational age of 28 weeks or more were selected. The variables evaluated were: maternal age (19 years, 20-34 years and over 35 full years), gestational age at delivery (28-37 weeks and more than 37 weeks), parity (primiparous or multiparous), previous cesarean section, history of pre-eclampsia or chronic hypertension, current diagnosis of mild or severe pre-eclampsia, and birth weight of the newborn. The information was transcribed to a questionnaire based on the variables being investigated. The chi-square test was applied to identify the relationship between the variables, with the level of significance set at pcesarean section. In this study, we observed a 78.4% rate of cesarean delivery, with 54.1% of the patients submitted to the procedure having a gestational age of 28 to 37 weeks (OR=3.1; phistory of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR=2.5; pcesarean were submitted to cesarean delivery in the current pregnancy (pcesarean delivery than those with mild pre-eclampsia (OR=3.3; pdelivery.

  19. Changes in Maternal Plasma Adiponectin from Late Pregnancy to the Postpartum Period According to the Mode of Delivery: Results from a Prospective Cohort in Rio de Janeiro, Brazil.

    Directory of Open Access Journals (Sweden)

    Fernanda Rebelo

    Full Text Available Maternal plasma adiponectin is inversely related to insulin resistance, atherosclerosis and child health. However, little is known about its concentrations in the perinatal period, especially according to mode of delivery. Our aim is to evaluate the association between mode of delivery and changes in maternal plasma adiponectin from 3rd trimester of pregnancy to 30-45 days postpartum.A cohort was recruited in Rio de Janeiro, Brazil, with four waves of follow-up: 5-13th, 22-26th, 30-36th gestational weeks and 30-45 days postpartum. Eligible subjects should be between 20-40 years of age, be free of chronic and infectious diseases and presenting with a singleton pregnancy. The mode of delivery was classified as vaginal (VD or cesarean (CS. Plasma adiponectin concentration (μg/mL was measured using commercial ELISA kits. Statistical analyses included the Wilcoxon rank-sum test and the multiple linear mixed effects model.A total of 159 participated in the study. Median adiponectin concentrations were higher for the VD group (n = 99; 8.25, IQR: 5.85-11.90 than for the CS group (n = 60; 7.34, IQR: 4.36-9.76; p = 0.040 in the postpartum samples but were not different between the two groups in the 3rd trimester. Women who underwent CS had a lower rate of increase in adiponectin concentration from the 3rd trimester to 30-45 days postpartum compared to those who underwent VD (β = -.15, 95% CI: -.28-.02, p = 0.030.The CS procedure was associated with lower maternal circulating concentrations of adiponectin at 30-45 days postpartum, compared to the VD.

  20. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network.

    Science.gov (United States)

    Humberg, Alexander; Härtel, Christoph; Paul, Pia; Hanke, Kathrin; Bossung, Verena; Hartz, Annika; Fasel, Laura; Rausch, Tanja K; Rody, Achim; Herting, Egbert; Göpel, Wolfgang

    2017-05-01

    Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). A total cohort of 2203 singleton VLBWI with a birth weight 30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

    DEFF Research Database (Denmark)

    NN, NN; Boer, K; England, K

    2010-01-01

    The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between ...

  2. Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

    NARCIS (Netherlands)

    Boer, K.; England, K.; Godfried, M. H.; Thorne, C.

    2010-01-01

    Objectives The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations

  3. The effects of mode of delivery and sex of newborn on placental morphology in control and diabetic pregnancies

    DEFF Research Database (Denmark)

    Mayhew, T M; Sørensen, Flemming Brandt; Klebe, J G

    1993-01-01

    Placentae from control and diabetic subjects were analysed using stereological techniques in order to assess the effects of mode of delivery (vaginal versus caesarean) and sex of neonate on parenchymal morphology. Effects were assessed using indices of peripheral villous and fetal capillary growth...... of glucose and glycated haemoglobin levels. Neonatal and placental weights were recorded and placentae sampled in a systematic random fashion. Fields of view on formalin-fixed, paraffin-embedded sections were analysed to obtain estimates of volumes, surface areas, lengths and diffusion (harmonic mean...

  4. Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy

    NARCIS (Netherlands)

    van Nimwegen, Frederika A.; Penders, John; Stobberingh, Ellen E.; Postma, Dirkje S.; Koppelman, Gerard H.; Kerkhof, Marjan; Reijmerink, Naomi E.; Dompeling, Edward; van den Brandt, Piet A.; Ferreira, Isabel; Mommers, Monique; Thijs, Carel

    2011-01-01

    Background: Both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. However, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied

  5. Influence of mode of delivery at term on the neonatal respiratory morbidity

    International Nuclear Information System (INIS)

    Dehdashtian, M.

    2008-01-01

    Respiratory morbidity is an important complication of elective cesarean section. Our objective was to find out the incidence of respiratory distress in term neonates delivered by elective cesarean section and compare it with neonates delivered vaginally. We evaluated one thousands infants delivered by elective cesarean section and normal vaginal delivery for respiratory distress. Among 500 cesarean done, 27 (5.4%) neonates had respiratory distress and among 500 vaginal delivery infants, 8(1.6%) developed respiratory Distress (P<0.001). The odd ratio for neonatal respiratory distress was 3.38, almost threefold higher in cesarean section group than those delivered vaginally. (author)

  6. Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    .01), and low Apgar scores at 1 minute (45% vs. 36%, p or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p ... complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited....

  7. Social Capital from Online Discussion Forums: Differences between Online and Blended Modes of Delivery

    Science.gov (United States)

    Carceller, Charles; Dawson, Shane; Lockyer, Lori

    2015-01-01

    This study explored the concept of social capital in higher education contexts by investigating student discussion forum activity and academic performance. To address these aims online discussion forum logs, student marks and teaching delivery method (blended or fully online) data were extracted from the universities learning management system…

  8. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery

    DEFF Research Database (Denmark)

    Foldspang, Anders; Hvidman, Lone; Mommsen, Søren

    2004-01-01

    Aim.  The aim was to estimate the postpartum urinary incontinence (PP UI) impact of precursory UI during pregnancy (PR UI) and delivery performed by cesarean section (CS) vs. vaginal childbirth (VC). Methods.  Among the members of two population samples, in total 8610 women aged 20–59 years, 1232...

  9. HIV Mother-to-Child Transmission, Mode of Delivery, and Duration of Rupture of Membranes: Experience in the Current Era

    Directory of Open Access Journals (Sweden)

    Siobhan Mark

    2012-01-01

    Full Text Available Objective. To evaluate whether the length of time of rupture of membranes (ROM in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART with low viral loads (VL is predictive of the risk of mother to child transmission (MTCT of the human immunodeficiency virus (HIV. Study Methods. A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. Results. Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL for the majority of the women (167, 80%, and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51% and cesarean in 103 (49%. The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours for the entire group and 2.56 hours (range 0 to 53.90 hours for those who had a vaginal birth. Among women with undetectable VL, 90 (54% had a vaginal birth and 77 (46% had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. Conclusions. There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.

  10. Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes.

    Science.gov (United States)

    Ponnusamy, Vellapandian; Grove, J Robert

    2014-09-01

    Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key pointsConsultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services.Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values.Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach.Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year.

  11. Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes

    Science.gov (United States)

    Ponnusamy, Vellapandian; Grove, J. Robert

    2014-01-01

    Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key points Consultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services. Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values. Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach. Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year. PMID:25177193

  12. Explaining Student Interaction and Satisfaction: An Empirical Investigation of Delivery Mode Influence

    Science.gov (United States)

    Johnson, Zachary S.; Cascio, Robert; Massiah, Carolyn A.

    2014-01-01

    How interpersonal interactions within a course affect student satisfaction differently between face-to-face and online modes is an important research question to answer with confidence. Using students from a marketing course delivered face-to-face and online concurrently, our first study demonstrates that student-to-professor and…

  13. Impact of prior breast cancer on mode of delivery and pregnancy-associated disorders: a retrospective analysis of subsequent pregnancy outcomes.

    Science.gov (United States)

    Jacob, Louis; Kalder, Matthias; Arabin, Birgit; Kostev, Karel

    2017-06-01

    The aim of this paper is to analyze the impact of prior breast cancer (BC) on mode of delivery and pregnancy-associated disorders. A database from 262 German gynecological practices including 289,712 women between the ages of 18 and 45 with documented pregnancies between 2000 and 2014 was used to search for patients with a history of BC up to 10 years prior to pregnancy. A total of 165 patients with a history of BC were found and matched with 165 patients without a history of any cancer (1:1) by age, physician, obesity, and documented referral to a fertility center up to 12 months before the index pregnancy. The impact of prior BC on the mode of delivery and pregnancy-associated disorders was analyzed using Cox regression models. The mean maternal age at first visit was 34.6 years in both groups. The early and late pregnancy loss was significantly reduced (17.7 versus 29.9%, OR 0.50) and delivery of a live-born child more frequent (82.3 versus 70.1%, OR 2.00) in women who had had BC than in controls. Furthermore, preterm contractions without preterm birth were less frequent in women with BC compared to controls (9.2 versus 18.9%, OR 0.43). No significant differences were found for other pregnancy complications, such as suspected fetal growth restriction, genito-urinary infections, fetal malpresentation, gestational diabetes, pre-eclampsia, or breastfeeding issues. Based on the decreased rate of early and late pregnancy loss and the absence of significant differences in most documented pregnancy-associated disorders, women with the previous BC can be assured of the possibility of a good outcome on a subsequent pregnancy.

  14. Rate of vertical transmission of human papillomavirus from mothers to infants: Relationship between infection rate and mode of delivery

    Directory of Open Access Journals (Sweden)

    Park Hyun

    2012-04-01

    Full Text Available Abstract Background In contrast to consistent epidemiologic evidence of the role of sexual transmission of human papillomavirus (HPV in adults, various routes may be related to HPV infection in infants. We have assessed the extent of HPV infection during the perinatal period, and the relationship between mode of delivery and vertical transmission. Results A total of 291 pregnant women over 36 weeks of gestation were enrolled with informed consent. Exfoliative cells were collected from maternal cervix and neonatal buccal mucosa. HPV infection and genotypes were determined with an HPV DNA chip, which can recognise 24 types. The HPV-positive neonates were re-evaluated 6 months after birth to identify the presence of persistent infection. HPV DNA was detected in 18.9 % (55/291 of pregnant women and 3.4 % (10/291 of neonates. Maternal infection was associated with abnormal cytology (p = 0.007 and primiparity (p = 0.015. The infected neonates were all born to HPV-positive mothers. The rate of vertical transmission was estimated at 18.2 % (10/55 which was positively correlated with maternal multiple HPV infection (p = 0.003 and vaginal delivery (p = 0.050, but not with labour duration and premature rupture of membranes. The rate of concordance of genotype was 100 % in mother-neonate pairs with vertical transmission. The neonatal HPV DNAs found at birth were all cleared at 6 months after delivery. Conclusions Vertical transmission of HPV DNA from HPV infected mother to the neonate increased when the infant was delivered through an infected cervix. However, the absence of persistent infection in infants at 6 months after delivery may suggest temporary inoculation rather than true vertical infection.

  15. Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil.

    Science.gov (United States)

    Araujo Júnior, Edward; de Freitas, Rogério Caixeta Moraes; Di Bella, Zsuzsanna Ilona Katalin de Jármy; Alexandre, Sandra Maria; Nakamura, Mary Uchiyama; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes

    2013-03-01

    To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm(2), respectively, versus 12.4 cm(2) in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

  16. The associations between labor and delivery mode and maternal and placental oxidative stress.

    Science.gov (United States)

    Hung, Tai-Ho; Chen, Szu-Fu; Hsieh, T'sang-T'ang; Lo, Liang-Ming; Li, Meng-Jen; Yeh, Yi-Ling

    2011-02-01

    To study oxidative stress differences between women with normal vaginal deliveries (VD) and those with elective cesarean sections without labor (CS), total antioxidant capacity (TAC), erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity, 8-isoprostane, nitrotyrosine and 8-hydroxydeoxyguanosine (8-OHdG) in blood, urine, and placental samples were assessed. The VD group had significantly higher placental 8-isoprostane and 8-OHdG levels as well as greater plasma TAC and 8-OHdG levels and lower erythrocyte SOD activity in umbilical venous blood. Women with VD exhibited differential changes in maternal oxidative stress before and after delivery compared with women with CS. Furthermore, we found that repetitive hypoxia-reoxygenation increased the 8-isoprostane and 8-OHdG levels in villous explants compared with the normoxic controls. Together, these results indicate that labor is associated with increased placental oxidative stress and has an influence on maternal oxidative stress. Therefore, women with VD exhibit different oxidative stress indicators than do those with CS. Copyright © 2010 Elsevier Inc. All rights reserved.

  17. Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes

    Directory of Open Access Journals (Sweden)

    Vellapandian Ponnusamy, J. Robert Grove

    2014-09-01

    Full Text Available Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217. The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures.

  18. Medical students’ personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

    Directory of Open Access Journals (Sweden)

    Watanabe Tatiane

    2012-07-01

    Full Text Available Abstract Background The increase in overall rates of cesarean sections (CS in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students. Methods A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice. Results A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student’s own or a partner’s pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03–8.30. Pain associated with vaginal delivery was usually the reason for choosing a CS. Conclusions A higher number of sixth year students preferred a CS for their own pregnancy (or their partner’s compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen

  19. Deliveries among teenage women – with emphasis on incidence and mode of delivery: a Swedish national survey from 1973 to 2010

    Science.gov (United States)

    2013-01-01

    Background Since the 1970-ies Sweden has actively developed strategies in social care, education and health care in order to counteract the negative consequences of adolescent parenthood. The aims of this study are to determine the annual incidence of singleton delivery among adolescents 1973–2010 and analyse obstetric and neonatal outcomes. Methods A retrospective cohort study, using data from the Swedish Medical Birth Register was conducted. All singleton deliveries in Sweden between 1973 and 2010 were included. Totally 1,941,940 women had 3,761,576 deliveries during the period. Analyses of obstetric and neonatal outcome were restricted to 1992–2010. Adolescents were subdivided into three groups: teenage births decreased significantly from 7.7 to 1.6%. Teenagers were more likely to deliver normally vaginally (aOR 1.70 (95%CI 1.64-1.75), less likely to have Caesarean section (aOR 0.61 (95%CI 0.58-0.64), and had a greater risk of delivering prematurely ( 1000 ml and perineal rupture were significantly lower among teenagers. Although the rate with Apgar score teenager’s neonates showed less fetal distress and meconium aspiration. Conclusion Adolescent births have steadily decreased in Sweden. Adolescents were more likely to be delivered vaginally than the adult women. The risks for obstetric maternal complications for adolescents were lower than for adult women except for the risk of prematurity. PMID:24207112

  20. Integrated simulations of H-mode operation in ITER including core fuelling, divertor detachment and ELM control

    Science.gov (United States)

    Polevoi, A. R.; Loarte, A.; Dux, R.; Eich, T.; Fable, E.; Coster, D.; Maruyama, S.; Medvedev, S. Yu.; Köchl, F.; Zhogolev, V. E.

    2018-05-01

    ELM mitigation to avoid melting of the tungsten (W) divertor is one of the main factors affecting plasma fuelling and detachment control at full current for high Q operation in ITER. Here we derive the ITER operational space, where ELM mitigation to avoid melting of the W divertor monoblocks top surface is not required and appropriate control of W sources and radiation in the main plasma can be ensured through ELM control by pellet pacing. We apply the experimental scaling that relates the maximum ELM energy density deposited at the divertor with the pedestal parameters and this eliminates the uncertainty related with the ELM wetted area for energy deposition at the divertor and enables the definition of the ITER operating space through global plasma parameters. Our evaluation is thus based on this empirical scaling for ELM power loads together with the scaling for the pedestal pressure limit based on predictions from stability codes. In particular, our analysis has revealed that for the pedestal pressure predicted by the EPED1  +  SOLPS scaling, ELM mitigation to avoid melting of the W divertor monoblocks top surface may not be required for 2.65 T H-modes with normalized pedestal densities (to the Greenwald limit) larger than 0.5 to a level of current of 6.5–7.5 MA, which depends on assumptions on the divertor power flux during ELMs and between ELMs that expand the range of experimental uncertainties. The pellet and gas fuelling requirements compatible with control of plasma detachment, core plasma tungsten accumulation and H-mode operation (including post-ELM W transient radiation) have been assessed by 1.5D transport simulations for a range of assumptions regarding W re-deposition at the divertor including the most conservative assumption of zero prompt re-deposition. With such conservative assumptions, the post-ELM W transient radiation imposes a very stringent limit on ELM energy losses and the associated minimum required ELM frequency. Depending on

  1. Dispersive-cavity actively mode-locked fiber laser for stable radio frequency delivery

    International Nuclear Information System (INIS)

    Dai, Yitang; Wang, Ruixin; Yin, Feifei; Xu, Kun; Li, Jianqiang; Lin, Jintong

    2013-01-01

    We report a novel technique for highly stable transfer of a radio frequency (RF) comb over long optical fiber link, which is highly dispersive and is a part of an actively mode-locked fiber laser. Phase fluctuation along the fiber link, which is mainly induced by physical vibration and temperature fluctuations, is automatically compensated by the self-adapted wavelength shifting. Without phase-locking loop or any tunable parts, stable radio frequency is transferred over a 2-km fiber link, with a time jitter suppression ratio larger than 110. (letter)

  2. Mode of delivery and risk of asthma in children 5-14 years old in Tabriz, Iran

    Directory of Open Access Journals (Sweden)

    Roya Sahebi

    2015-11-01

    Full Text Available Introduction: It has been suggested that a cesarean section increases risk of developing asthma due to lack of exposure to maternal microflora during birth. To investigate the association between the mode of delivery and the risk of asthma in children aged 5-14 years in Tabriz, Iran. Methods: A case-control study was performed on 233 (case = 81, control = 152 children aged 5-14 years referred to outpatient clinics of Tabriz Children’s Hospital and Sheikhorrais Clinic in 2014. Clinical asthma diagnosis was done according to Global Initiative for Asthma Criteria. A questionnaire was administered to obtain a demographic, environmental, and clinical history. Age-sex frequency matching with cases was carried out during sampling for controlling of possible cofounding effects of age and sex for asthma. Results: Of 233 children, 53.6% of them were male (case group = 54.3% and control group = 53.3%. Over half (54.5%, the participants had been delivered by caesarian section. Cases were not significantly more likely to have been delivered by caesarian section as compared to controls [adjusted odds ratio (AOR = 0.69; 95% confidence interval (CI = 0.34-1.42]. However, more frequent episodes of common cold [b = 0.094; standard error (SE (b = 0.031, P < 0.001], birth order (second born children compared to firstborns (AOR = 2.54; 95% CI = 1.18-5.46, high maternal education levels: 12 years (AOR = 3.76; 95% CI = 1.10-12.9, collegiate (AOR = 6.12; 95% CI = 1.43-26.20, and intra-family marriage (AOR = 2.89; 95% CI = 1.21-6.89 were associated with childhood asthma. Conclusion: Delivery mode was not associated with risk of developing childhood asthma in our study. Intra-family marriage increased the odds of childhood asthma. Further study on the relationship between maternal education and the odds of asthma is proposed.

  3. Treatment history and outcome of 24 deliveries worldwide after autotransplantation of cryopreserved ovarian tissue, including two new Danish deliveries years after autotransplantation

    DEFF Research Database (Denmark)

    Macklon, Kirsten T; Jensen, Annette Klüver; Loft, Anne

    2014-01-01

    PURPOSE: To report another two successful pregnancies and deliveries resulting from autotransplanted cryopreserved ovarian tissue several years after the autotransplantation procedure took place. Further, to review the literature on the treatment history, number of live births and their outcome so......'s lymphoma. Both suffered from premature ovarian insufficiency after treatment. Because of a pregnancy wish they later had pieces of thawed cortical tissue transplanted to the remaining ovary and the anterior abdominal wall. PubMed was searched for reports of deliveries resulting from cryopreserved ovarian...

  4. Trends in Canadian faculties of education: An overview of graduate programs, curricular offerings, exit requirements, and modes of delivery.

    Directory of Open Access Journals (Sweden)

    Carla Abreu Ellis

    2008-07-01

    Full Text Available Introduction This research investigated universities registered with the Association of Universities and Colleges of Canada (AUCC whose primary instructional language was English. A content analysis was performed on university web pages related to the following content: (a frequency of graduate programs being offered, (b types of degrees being offered, (c frequency and variation of program of study offerings, (d variation of exit requirements, and (e modalities of course delivery. This research provides an overview and analysis of graduate level programs, more precisely Masters and Doctorate degrees, offered through faculties of education in Canada. An understanding of the findings of this research may benefit Canadian university administrative bodies in providing a source in which they may compare findings with their current offerings and programming. Prospective students of graduate programs in education may also benefit from the information provided in this study when choosing a program of study by ameliorating their knowledge of current programs, curriculum offerings, and modes of course delivery being offered by faculties of education in Canada.

  5. Monolithic Ytterbium All-single-mode Fiber Laser with Direct Fiber-end Delivery of nJ-level Femtosecond Pulses

    DEFF Research Database (Denmark)

    Turchinovich, Dmitry

    2008-01-01

    We demonstrate a monolithic, i.e. without any free-space coupling, all-single-mode passively modelocked Yb-fiber laser, with direct fiber-end delivery of 364−405 fs pulses of 4 nJ pulse energy using a low-loss hollow-core photonic crystal fiber compression.......We demonstrate a monolithic, i.e. without any free-space coupling, all-single-mode passively modelocked Yb-fiber laser, with direct fiber-end delivery of 364−405 fs pulses of 4 nJ pulse energy using a low-loss hollow-core photonic crystal fiber compression....

  6. Mode of Delivery and Long-Term Health-Related Quality-of-Life Outcomes: A Prospective Population-Based Study.

    Science.gov (United States)

    Petrou, Stavros; Kim, Sung Wook; McParland, Penny; Boyle, Elaine M

    2017-06-01

    Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics. The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32 +0 and 36 +6 weeks' gestation and a sample of term-born controls. Perinatal data were extracted from the mothers' maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes. The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (-0.026; p = 0.038) and among mothers of term-born infants (-0.062; p quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery. © 2016 Wiley Periodicals, Inc.

  7. Mode of delivery at birth and the metabolic syndrome in midlife: the role of the birth environment in a prospective birth cohort study.

    Science.gov (United States)

    Bouhanick, Béatrice; Ehlinger, Virginie; Delpierre, Cyrille; Chamontin, Bernard; Lang, Thierry; Kelly-Irving, Michelle

    2014-05-15

    The aim of this study is to examine the hypothesis that mode of delivery at birth may be associated with metabolic disorders in adult midlife. Population cohort study The National Child Development Study consists of individuals born during 1 week in 1958 in Great Britain. Respondents with biomedical data on the metabolic syndrome at age 45 were included. The metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III classification. 7156 were born naturally; among the caesarean births, 106 were non-elective and 85 were elective caesareans. The metabolic syndrome is present in 37.7% of those born by non-elective caesareans, 25.9% of those born by elective caesarean and 27.5% of those born by vaginal delivery. In a multivariate logistic regression model adjusted for antenatal factors, birth history, mother's characteristics and the socioeconomic environment at birth, only birth by non-elective caesarean remained associated with the metabolic syndrome in adulthood compared with vaginal delivery (OR 1.51, 95% CI 1.00 to 2.30). Mother's obesity (OR 1.61, 95% CI 1.12 to 2.34) and low maternal education level (OR 1.47, 95% CI 1.30 to 1.67) were also independently associated with midlife metabolic syndrome. Birth by non-elective caesarean in 1958 may be associated with metabolic syndrome in adulthood after adjusting for prior confounding factors. We suggest that the birth context of emergency caesareans in 1958 is suggestive of a 'fetal stress' mechanism affecting health across the lifecourse. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Plasmonic modes in nanowire dimers: A study based on the hydrodynamic Drude model including nonlocal and nonlinear effects

    Science.gov (United States)

    Moeferdt, Matthias; Kiel, Thomas; Sproll, Tobias; Intravaia, Francesco; Busch, Kurt

    2018-02-01

    A combined analytical and numerical study of the modes in two distinct plasmonic nanowire systems is presented. The computations are based on a discontinuous Galerkin time-domain approach, and a fully nonlinear and nonlocal hydrodynamic Drude model for the metal is utilized. In the linear regime, these computations demonstrate the strong influence of nonlocality on the field distributions as well as on the scattering and absorption spectra. Based on these results, second-harmonic-generation efficiencies are computed over a frequency range that covers all relevant modes of the linear spectra. In order to interpret the physical mechanisms that lead to corresponding field distributions, the associated linear quasielectrostatic problem is solved analytically via conformal transformation techniques. This provides an intuitive classification of the linear excitations of the systems that is then applied to the full Maxwell case. Based on this classification, group theory facilitates the determination of the selection rules for the efficient excitation of modes in both the linear and nonlinear regimes. This leads to significantly enhanced second-harmonic generation via judiciously exploiting the system symmetries. These results regarding the mode structure and second-harmonic generation are of direct relevance to other nanoantenna systems.

  9. Socioeconomic position early in adolescence and mode of delivery later in life: findings from a Portuguese birth cohort.

    Directory of Open Access Journals (Sweden)

    Cristina Teixeira

    Full Text Available This study assessed the influence of socioeconomic position at 12 years of age (SEP-12 on the variability in cesarean rates later in life.As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005-September/2006. Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women's SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR and respective 95% confidence interval (95% CI.The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p = 0.100 among primiparous women; 14.2%, 11.6% and 15.5% (p = 0.04 among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p = 0.08 among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR = 1.12;95%CI:1.01-1.24 comparing high with low SEP-12 and RR = 1.03:95%CI:0.94-1.14 comparing intermediate with low SEP-12 not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean.The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth.

  10. Effects of Country and Delivery Mode on Perceived Risk in International Higher Education

    Science.gov (United States)

    Kamal Basha, Norazlyn; Sweeney, Jillian C.; Soutar, Geoff

    2015-01-01

    Higher education is an increasingly competitive global market. Consequently, it is crucial that universities fully understand students' motivations in university selection. While past research mainly focused on university-level attributes, this study extends the factors used to evaluate different international universities to include both the…

  11. A comparison of student performance in human development classes using three different modes of delivery: Online, face-to-face, and combined

    Science.gov (United States)

    Kalsow, Susan Christensen

    1999-11-01

    The problem. The dual purposes of this research were to determine if there is a difference in student performance in three Human Development classes when the modes of delivery are different and to analyze student perceptions of using Web-based learning as all or part of their course experience. Procedures. Data for this study were collected from three Human Development courses taught at Drake University. Grades from five essays, projects, and overall grades were used in the three classes and analyzed using a single factor analysis of variance to determine if there was a significant difference. Content analysis was used on the evaluation comments of the participants in the online and combined classes to determine their perceptions of Web-based learning. Findings. The single factor analysis of variance measuring student performance showed no significant difference among the online, face-to-face, and combined scores at the .05 level of significance, however, the difference was significant at the .06. The content analysis of the online and combined course showed the three major strengths of learning totally or partly online to be increased comfort in using the computer, the quality of the overall experience, and convenience in terms of increased access to educational opportunities. The barriers included lack of human interaction and access to the professor. Conclusions. The study indicates that Web-based learning is a viable option for postsecondary educational delivery in terms of student performance and learning. On the average, performance is at least as good as performance in traditional face-to-face classrooms. Improved performance, however, is contingent on adequate access to equipment, faculty skill in teaching using a new mode of delivery, and the personality of the student. The convenient access to educational opportunities and becoming more comfortable with technology are benefits that were important to these two groups. Web-based learning is not for everyone

  12. SWRT: A package for semi-analytical solutions of surface wave propagation, including mode conversion, across transversely aligned vertical discontinuities

    Directory of Open Access Journals (Sweden)

    A. Datta

    2018-03-01

    Full Text Available We present a suite of programs that implement decades-old algorithms for computation of seismic surface wave reflection and transmission coefficients at a welded contact between two laterally homogeneous quarter-spaces. For Love as well as Rayleigh waves, the algorithms are shown to be capable of modelling multiple mode conversions at a lateral discontinuity, which was not shown in the original publications or in the subsequent literature. Only normal incidence at a lateral boundary is considered so there is no Love–Rayleigh coupling, but incidence of any mode and coupling to any (other mode can be handled. The code is written in Python and makes use of SciPy's Simpson's rule integrator and NumPy's linear algebra solver for its core functionality. Transmission-side results from this code are found to be in good agreement with those from finite-difference simulations. In today's research environment of extensive computing power, the coded algorithms are arguably redundant but SWRT can be used as a valuable testing tool for the ever evolving numerical solvers of seismic wave propagation. SWRT is available via GitHub (https://github.com/arjundatta23/SWRT.git.

  13. SWRT: A package for semi-analytical solutions of surface wave propagation, including mode conversion, across transversely aligned vertical discontinuities

    Science.gov (United States)

    Datta, Arjun

    2018-03-01

    We present a suite of programs that implement decades-old algorithms for computation of seismic surface wave reflection and transmission coefficients at a welded contact between two laterally homogeneous quarter-spaces. For Love as well as Rayleigh waves, the algorithms are shown to be capable of modelling multiple mode conversions at a lateral discontinuity, which was not shown in the original publications or in the subsequent literature. Only normal incidence at a lateral boundary is considered so there is no Love-Rayleigh coupling, but incidence of any mode and coupling to any (other) mode can be handled. The code is written in Python and makes use of SciPy's Simpson's rule integrator and NumPy's linear algebra solver for its core functionality. Transmission-side results from this code are found to be in good agreement with those from finite-difference simulations. In today's research environment of extensive computing power, the coded algorithms are arguably redundant but SWRT can be used as a valuable testing tool for the ever evolving numerical solvers of seismic wave propagation. SWRT is available via GitHub (https://github.com/arjundatta23/SWRT.git).

  14. Pelvic floor in females with anorectal malformations--findings on perineal ultrasonography and aspects of delivery mode.

    Science.gov (United States)

    Stenström, Pernilla; Hambraeus, Mette; Arnbjörnsson, Einar; Örnö, Ann-Kristin

    2015-04-01

    Advice on the mode of delivery to females born with anorectal malformation (ARM) is needed. The primary aim was to evaluate the anatomy of the pelvic floor muscles in females with ARM operated with posterior sagittal anorectal plasty (PSARP). The second aim was to correlate the extent of muscle defects to the bowel symptoms. This interventional study with perineal 4D/3D ultrasonography describes the smooth muscles in the intestinal wall (neo-IAS), external sphincter, levators and anal canal using a muscle score (0-6 worst). The bowel symptoms were prospectively registered with Krickenbeck criteria score (0-7 worst). Forty females with different subtypes of ARM, median age 13 (4-21), were followed up regarding bowel symptoms. Seventeen were examined with ultrasonography. Bowel symptoms were similar for those examined with ultrasonography and those not, median score 5 and 3 (1-7) respectively, (p=0.223, Fisher's exact test). All the females had at least one muscular defect. There was no significant correlation between muscle defects and bowel symptoms (p=0.094, Spearman's correlation). Females with ARM have considerable defects in the pelvic floor without any significant correlation to bowel symptoms. All women with ARM would benefit from individualized predelivery evaluations and caesarian section should be considered. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  15. DISCOVERY OF PULSATIONS, INCLUDING POSSIBLE PRESSURE MODES, IN TWO NEW EXTREMELY LOW MASS, He-CORE WHITE DWARFS

    Energy Technology Data Exchange (ETDEWEB)

    Hermes, J. J.; Montgomery, M. H.; Winget, D. E.; Bell, Keaton J.; Harrold, Samuel T. [Department of Astronomy, University of Texas at Austin, Austin, TX 78712 (United States); Brown, Warren R.; Kenyon, Scott J. [Smithsonian Astrophysical Observatory, 60 Garden Street, Cambridge, MA 02138 (United States); Gianninas, A.; Kilic, Mukremin, E-mail: jjhermes@astro.as.utexas.edu [Homer L. Dodge Department of Physics and Astronomy, University of Oklahoma, 440 W. Brooks Street, Norman, OK 73019 (United States)

    2013-03-10

    We report the discovery of the second and third pulsating extremely low mass (ELM) white dwarfs (WDs), SDSS J111215.82+111745.0 (hereafter J1112) and SDSS J151826.68+065813.2 (hereafter J1518). Both have masses < 0.25 M{sub Sun} and effective temperatures below 10, 000 K, establishing these putatively He-core WDs as a cooler class of pulsating hydrogen-atmosphere WDs (DAVs, or ZZ Ceti stars). The short-period pulsations evidenced in the light curve of J1112 may also represent the first observation of acoustic (p-mode) pulsations in any WD, which provide an exciting opportunity to probe this WD in a complimentary way compared to the long-period g-modes that are also present. J1112 is a T{sub eff} =9590 {+-} 140 K and log g =6.36 {+-} 0.06 WD. The star displays sinusoidal variability at five distinct periodicities between 1792 and 2855 s. In this star, we also see short-period variability, strongest at 134.3 s, well short of the expected g-modes for such a low-mass WD. The other new pulsating WD, J1518, is a T{sub eff} =9900 {+-} 140 K and log g =6.80 {+-} 0.05 WD. The light curve of J1518 is highly non-sinusoidal, with at least seven significant periods between 1335 and 3848 s. Consistent with the expectation that ELM WDs must be formed in binaries, these two new pulsating He-core WDs, in addition to the prototype SDSS J184037.78+642312.3, have close companions. However, the observed variability is inconsistent with tidally induced pulsations and is so far best explained by the same hydrogen partial-ionization driving mechanism at work in classic C/O-core ZZ Ceti stars.

  16. A SESAM passively mode-locked fiber laser with a long cavity including a band pass filter

    International Nuclear Information System (INIS)

    Song, Rui; Chen, Hong-Wei; Chen, Sheng-Ping; Hou, Jing; Lu, Qi-Sheng

    2011-01-01

    A semiconductor saturable absorber mirror (SESAM) passively mode-locked fiber laser with a long cavity length over 700 m is demonstrated. A band pass filter is inserted into the laser cavity to stabilize the lasing wavelength. Some interesting phenomena are observed and discussed. The central wavelength, repetition rate, average power and single pulse energy of the laser are 1064 nm, 281.5 kHz, 11 mW and 39 nJ, respectively. The laser operates stably without Q-switching instabilities, which greatly reduces the damage opportunities of the SESAM

  17. [Evaluation of adherence to French guidelines concerning the information of the women having a scarred uterus on their mode of delivery].

    Science.gov (United States)

    Aubert, M; Heckenroth, H; Guidicelli, B; Cravello, L; d'Ercole, C; Courbiere, B

    2016-05-01

    To evaluate adherence of obstetricians from our maternity to French practice guidelines concerning information to give to pregnant patients with a history of scarred uterus. Observational retrospective study performed on medical files from June to August 2014 and concerning women with a scarred uterus that gave live-birth after 37weeks of gestation. Information of patients had to concern the risks of a history of caesarean, the benefits and risks of the various delivery modes. On 758 deliveries, 77 cases were studied: 48 patients were followed up from the beginning of pregnancy, 23 from the 2nd trimester and 6 were not followed. Among patients followed from the beginning, no data was written on medical file concerning information that should to be given in immediate post-partum, in preconception counseling, and at the beginning of pregnancy about the risks of scarred uterus and the mode of delivery. In the 8th month, information about benefits and risks of the planned delivery mode was noticed in 45% of files. The information that need in theory to be given to the patients with scarred uterus appeared little or insufficiently noticed on medical files; which can be due either to an inaccurate information, or to a lack of transcription of the information nevertheless given. A check-list in obstetrical file would help to systematize the information to provide in scarred uterus patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Modelling of transitions between L- and H-mode in JET high plasma current plasmas and application to ITER scenarios including tungsten behaviour

    Science.gov (United States)

    Koechl, F.; Loarte, A.; Parail, V.; Belo, P.; Brix, M.; Corrigan, G.; Harting, D.; Koskela, T.; Kukushkin, A. S.; Polevoi, A. R.; Romanelli, M.; Saibene, G.; Sartori, R.; Eich, T.; Contributors, JET

    2017-08-01

    The dynamics for the transition from L-mode to a stationary high Q DT H-mode regime in ITER is expected to be qualitatively different to present experiments. Differences may be caused by a low fuelling efficiency of recycling neutrals, that influence the post transition plasma density evolution on the one hand. On the other hand, the effect of the plasma density evolution itself both on the alpha heating power and the edge power flow required to sustain the H-mode confinement itself needs to be considered. This paper presents results of modelling studies of the transition to stationary high Q DT H-mode regime in ITER with the JINTRAC suite of codes, which include optimisation of the plasma density evolution to ensure a robust achievement of high Q DT regimes in ITER on the one hand and the avoidance of tungsten accumulation in this transient phase on the other hand. As a first step, the JINTRAC integrated models have been validated in fully predictive simulations (excluding core momentum transport which is prescribed) against core, pedestal and divertor plasma measurements in JET C-wall experiments for the transition from L-mode to stationary H-mode in partially ITER relevant conditions (highest achievable current and power, H 98,y ~ 1.0, low collisionality, comparable evolution in P net/P L-H, but different ρ *, T i/T e, Mach number and plasma composition compared to ITER expectations). The selection of transport models (core: NCLASS  +  Bohm/gyroBohm in L-mode/GLF23 in H-mode) was determined by a trade-off between model complexity and efficiency. Good agreement between code predictions and measured plasma parameters is obtained if anomalous heat and particle transport in the edge transport barrier are assumed to be reduced at different rates with increasing edge power flow normalised to the H-mode threshold; in particular the increase in edge plasma density is dominated by this edge transport reduction as the calculated neutral influx across the

  19. Development of a novel ArcCHECK™ insert for routine quality assurance of VMAT delivery including dose calculation with inhomogeneities

    International Nuclear Information System (INIS)

    Fakir, H.; Gaede, S.; Mulligan, M.; Chen, J. Z.

    2012-01-01

    Purpose: To design a versatile, nonhomogeneous insert for the dose verification phantom ArcCHECK ™ (Sun Nuclear Corp., FL) and to demonstrate its usefulness for the verification of dose distributions in inhomogeneous media. As an example, we demonstrate it can be used clinically for routine quality assurance of two volumetric modulated arc therapy (VMAT) systems for lung stereotactic body radiation therapy (SBRT): SmartArc ® (Pinnacle 3 , Philips Radiation Oncology Systems, Fitchburg, WI) and RapidArc ® (Eclipse ™ , Varian Medical Systems, Palo Alto, CA). Methods: The cylindrical detector array ArcCHECK ™ has a retractable homogeneous acrylic insert. In this work, we designed and manufactured a customized heterogeneous insert with densities that simulate soft tissue, lung, bone, and air. The insert offers several possible heterogeneity configurations and multiple locations for point dose measurements. SmartArc ® and RapidArc ® plans for lung SBRT were generated and copied to ArcCHECK ™ for each inhomogeneity configuration. Dose delivery was done on a Varian 2100 ix linac. The evaluation of dose distributions was based on gamma analysis of the diode measurements and point doses measurements at different positions near the inhomogeneities. Results: The insert was successfully manufactured and tested with different measurements of VMAT plans. Dose distributions measured with the homogeneous insert showed gamma passing rates similar to our clinical results (∼99%) for both treatment-planning systems. Using nonhomogeneous inserts decreased the passing rates by up to 3.6% in the examples studied. Overall, SmartArc ® plans showed better gamma passing rates for nonhomogeneous measurements. The discrepancy between calculated and measured point doses was increased up to 6.5% for the nonhomogeneous insert depending on the inhomogeneity configuration and measurement location. SmartArc ® and RapidArc ® plans had similar plan quality but RapidArc ® plans had

  20. The Response of a Two-Wire Transmission Line to Incident Field and Voltage Excitation, Including the Effects of Higher Order Modes

    Science.gov (United States)

    1981-08-01

    8217 INCLUDING THE EFFECTS OF HIGHER "ORDER MODES Syracuse University Yehuda Leviatan Arlon T. Adams APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED] C9 2...GRANT NUMSERf() Yecthuda Leviatan Arlon T. Adams F30602-79-C-0011 9. PERNORMING ORGANIZATION NAME ANO ADDRESS 10. PROGRAM ELEMENT, PROJECT, TASK...39 Fig. Al Illustration of the contours in the k Plano .............. 41 • o..... II 1. Introduction El in this report a study has been made of

  1. Which Combinations of Techniques and Modes of Delivery in Internet-Based Interventions Effectively Change Health Behavior? A Meta-Analysis.

    Science.gov (United States)

    van Genugten, Lenneke; Dusseldorp, Elise; Webb, Thomas Llewelyn; van Empelen, Pepijn

    2016-06-07

    Many online interventions designed to promote health behaviors combine multiple behavior change techniques (BCTs), adopt different modes of delivery (MoD) (eg, text messages), and range in how usable they are. Research is therefore needed to examine the impact of these features on the effectiveness of online interventions. This study applies Classification and Regression Trees (CART) analysis to meta-analytic data, in order to identify synergistic effects of BCTs, MoDs, and usability factors. We analyzed data from Webb et al. This review included effect sizes from 52 online interventions targeting a variety of health behaviors and coded the use of 40 BCTs and 11 MoDs. Our research also developed a taxonomy for coding the usability of interventions. Meta-CART analyses were performed using the BCTs and MoDs as predictors and using treatment success (ie, effect size) as the outcome. Factors related to usability of the interventions influenced their efficacy. Specifically, subgroup analyses indicated that more efficient interventions (interventions that take little time to understand and use) are more likely to be effective than less efficient interventions. Meta-CART identified one synergistic effect: Interventions that included barrier identification/ problem solving and provided rewards for behavior change reported an average effect size that was smaller (ḡ=0.23, 95% CI 0.08-0.44) than interventions that used other combinations of techniques (ḡ=0.43, 95% CI 0.27-0.59). No synergistic effects were found for MoDs or for MoDs combined with BCTs. Interventions that take little time to understand and use were more effective than those that require more time. Few specific combinations of BCTs that contribute to the effectiveness of online interventions were found. Furthermore, no synergistic effects between BCTs and MoDs were found, even though MoDs had strong effects when analyzed univariately in the original study.

  2. The effect of prenatal education curriculum on mother's prenatal examination utilization, delivery mode and recovery status: a cross-sectional survey in China.

    Science.gov (United States)

    Shi, Yuhui; Wang, Dongxu; Yuan, Yanfei; Jiang, Ying; Zeng, Qingqi; Chang, Chun

    2015-11-01

    To examine the participation, implementation, and effect of the prenatal education curriculum provided by hospitals in China, and to provide evidence for the improvement of prenatal education. A cross-sectional survey was conducted in the hospitals in Hunan Province, China. Mothers aged 20-45 years who had given birth between 1 May 2011 and 1 May 2012 and not diagnosed with pregnancy-related complications were invited to participate in the study. A self-administered, structured questionnaire was used to examine the effect of prenatal education curriculum on prenatal examination utilization, delivery mode, and recovery status from delivery. Among the total 604 respondents, only 175 (29.1 %) surveyed mothers participated in prenatal education curriculum provided by hospitals during their latest delivery. These mothers had a higher rate of attending all the required prenatal examinations (57.9 vs. 48.3 %), and a higher rate of recovering very well and well (80 vs. 73.7 %) from the latest delivery, than those who did not participate in prenatal education curriculum (P curriculum provided by hospitals. Prenatal education is indispensable for the improvement of maternal and child health, and thus should be advocated. In China, a standard and convenient specification prenatal education curriculum provided by hospitals and their doctors is appropriated for providing prenatal education to pregnant women.

  3. Electrodes for high-definition transcutaneous DC stimulation for applications in drug delivery and electrotherapy, including tDCS.

    Science.gov (United States)

    Minhas, Preet; Bansal, Varun; Patel, Jinal; Ho, Johnson S; Diaz, Julian; Datta, Abhishek; Bikson, Marom

    2010-07-15

    Transcutaneous electrical stimulation is applied in a range of biomedical applications including transcranial direct current stimulation (tDCS). tDCS is a non-invasive procedure where a weak direct current (<2 mA) is applied across the scalp to modulate brain function. High-definition tDCS (HD-tDCS) is a technique used to increase the spatial focality of tDCS by passing current across the scalp using <12 mm diameter electrodes. The purpose of this study was to design and optimize "high-definition" electrode-gel parameters for electrode durability, skin safety and subjective pain. Anode and cathode electrode potential, temperature, pH and subjective sensation over time were assessed during application of 2 mA direct current, for up to 22 min on agar gel or subject forearms. A selection of five types of solid-conductors (Ag pellet, Ag/AgCl pellet, rubber pellet, Ag/AgCl ring and Ag/AgCl disc) and seven conductive gels (Signa, Spectra, Tensive, Redux, BioGel, Lectron and CCNY-4) were investigated. The Ag/AgCl ring in combination with CCNY-4 gel resulted in the most favorable outcomes. Under anode stimulations, electrode potential and temperature rises were generally observed in all electrode-gel combinations except for Ag/AgCl ring and disc electrodes. pH remained constant for all solid-conductors except for both Ag and rubber pellet electrodes with Signa and CCNY-4 gels. Sensation ratings were independent of stimulation polarity. Ag/AgCl ring electrodes were found to be the most comfortable followed by Ag, rubber and Ag/AgCl pellet electrodes across all gels. Copyright 2010 Elsevier B.V. All rights reserved.

  4. Electrodes for high-definition transcutaneous DC stimulation for applications in drug-delivery and electrotherapy, including tDCS

    Science.gov (United States)

    Minhas, Preet; Bansal, Varun; Patel, Jinal; Ho, Johnson S.; Diaz, Julian; Datta, Abhishek; Bikson, Marom

    2010-01-01

    Transcutaneous electrical stimulation is applied in a range of biomedical applications including Transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive procedure where a weak direct current (<2 mA) is applied across the scalp to modulate brain function. High-Definition tDCS (HD-tDCS) is a technique used to increase the spatial focality of tDCS by passing current across the scalp using <12 mm diameter electrodes. The purpose of this study was to design and optimize “high-definition” electrode-gel parameters for electrode durability, skin safety, and subjective pain. Anode and cathode electrode potential, temperature, pH, and subjective sensation over time were assessed during application of 2 mA direct current, for up to 22 minutes on agar gel or subject forearms. A selection of 5 types of solid-conductors (Ag pellet, Ag/AgCl pellet, Rubber pellet, Ag/AgCl ring, and Ag/AgCl disc) and 7 conductive gels (Signa, Spectra, Tensive, Redux, BioGel, Lectron, and CCNY-4) were investigated. The Ag/AgCl ring in combination with CCNY-4 gel resulted in the most favorable outcomes. Under anode stimulations, electrode potential and temperature rises were generally observed in all electrode-gel combinations except for Ag/AgCl ring and disc electrodes. pH remained constant for all solid-conductors except for both Ag and Rubber pellet electrodes with Signa and CCNY-4 gels. Sensation ratings were independent of stimulation polarity. Ag/AgCl ring electrodes were found to be the most comfortable followed by Ag, Rubber, and Ag/AgCl pellet electrodes across all gels. PMID:20488204

  5. Assessment of the effect of gaseous fuel delivery mode on thermal efficiency and fuel losses during the valve overlap period in a dual-fuel compression ignition engine

    Science.gov (United States)

    Skrzek, T.

    2016-09-01

    The paper describes the effect of dual fuelling of single cylinder AVL test CI engine with the use of two ways of gas delivery to the engine manifold. The engine was fuelled diesel oil and propane. For all the tests, gas consumption was maintained at the same level. In the first mode the gas was delivered by injector located under inlet valve. In the second method, there was used a mixer fitted to the intake manifold. The paper compares the results of thermal efficiency and emissions of propane in the exhaust for both fuelling modes. Research clearly show how important it is to synchronize the injector opening time of the intake stroke. This is especially important for supercharged engines in which there is a valve overlap.

  6. Emergency peripartum hysterectomy and risk factors by mode of delivery and obstetric history: a 10-year review from Helsinki University Central Hospital.

    Science.gov (United States)

    Macharey, Georg; Ulander, Veli-Matti; Kostev, Karel; Väisänen-Tommiska, Mervi; Ziller, Volker

    2015-11-01

    This study aims to estimate the occurrence of emergency peripartum hysterectomy (EPH) and to quantify its risk factors in connection with the mode of delivery and the obstetric history of patients at the Helsinki University Central Hospital, Finland. In a retrospective, matched case-control study we identified 124 cases of EPH from 2000 to 2010 at our hospital. These were matched with 248 control patients. The incidence rate of EPH was 9.9/10,000. Patients whose current delivery was vaginal, and had a cesarean section (CS) in their history had a six-fold risk for EPH. Women who underwent their first CS had a nine times higher risk, while patients who currently underwent CS and had a history of previous CS, had a 22 times higher risk. Those who experienced prostaglandin-E1 induction had a five-fold risk. Maternal age >35 years, previous curettage, and twin pregnancy were identified as significant risk factors. In 41 cases, interventions to reduce bleeding were performed. Obstetric emergency training and guidelines for massive hemorrhage should be established in any delivery department. Moreover, all possible precautions should be taken to avoid the first CS if it is obstetrically unnecessary. Induction with prostaglandin-E1, maternal age >35 years, previous curettage, twin pregnancies, and early gestation were identified as risk factors for EPH.

  7. The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study.

    Science.gov (United States)

    Garthus-Niegel, Susan; von Soest, Tilmann; Knoph, Cecilie; Simonsen, Tone Breines; Torgersen, Leila; Eberhard-Gran, Malin

    2014-06-05

    This study aimed to examine whether a mismatch between a woman's preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women's preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even

  8. The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

    Science.gov (United States)

    2014-01-01

    Background This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. Methods The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Results Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. Conclusions The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear

  9. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers.

    Science.gov (United States)

    Gossman, Michael S; Wilkinson, Jeffrey D; Mallick, Avishek

    2014-01-01

    In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient׳s sex; patient׳s age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient׳s medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards. Copyright

  10. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: Retrospective physician surveys including chart reviews at numerous centers

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: MGossman@TSRCC.com [Regulation Directive Medical Physics, Russell, KY (United States); Wilkinson, Jeffrey D. [Medtronic, Inc., Mounds View, MN (United States); Mallick, Avishek [Department of Mathematics, Marshall University, Huntington, WV (United States)

    2014-01-01

    In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient's sex; patient's age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient's medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards.

  11. Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan.

    Science.gov (United States)

    Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

    2016-01-01

    The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03-0.25) in women's awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women's preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22-0.85); P>0.001). The results of this study showed that an increase in the density of midwives

  12. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy

    Science.gov (United States)

    Joseph, Judith; Yardley, Lucy; Michie, Susan

    2010-01-01

    Background The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. Objectives The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. Methods We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. Results We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d+ = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d+ = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. Conclusions The review provides a framework for the

  13. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.

    Science.gov (United States)

    Webb, Thomas L; Joseph, Judith; Yardley, Lucy; Michie, Susan

    2010-02-17

    The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. The review provides a framework for the development of a science of Internet

  14. Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

    International Nuclear Information System (INIS)

    McCowan, P. M.; McCurdy, B. M. C.

    2016-01-01

    Purpose: The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., “movie” mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID’s angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, less EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments. Methods: Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into “frame-averaged” EPID images using MATLAB. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged

  15. Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

    Energy Technology Data Exchange (ETDEWEB)

    McCowan, P. M., E-mail: pmccowan@cancercare.mb.ca [Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada and Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); McCurdy, B. M. C. [Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); Department of Radiology, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9 (Canada)

    2016-01-15

    Purpose: The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., “movie” mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID’s angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, less EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments. Methods: Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into “frame-averaged” EPID images using MATLAB. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged

  16. Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002-2014

    DEFF Research Database (Denmark)

    Ørbaek, M; Thorsteinsson, K; Helleberg, M

    2017-01-01

    OBJECTIVES: We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS: All WLWH giving birth to live...... in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective...

  17. Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support.

    Science.gov (United States)

    Mendler, Marc R; Weber, Claudia; Hassan, Mohammad A; Huang, Li; Mayer, Benjamin; Hummler, Helmut D

    2017-01-01

    There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP. © 2016 S. Karger AG, Basel.

  18. Self reported fear of childbirth and its association with women's birth experience and mode of delivery: a longitudinal population-based study.

    Science.gov (United States)

    Nilsson, Christina; Lundgren, Ingela; Karlström, Annika; Hildingsson, Ingegerd

    2012-09-01

    To explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery. A longitudinal population-based study. Pregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden. Differences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used. FOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5-10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2-5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1-20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4-11.7), emergency caesarean section (RR 2.4, CI 1.2-4.5) and primiparity (RR 1.9, CI 1.2-3.1). FOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women's perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women's experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  19. Probiotics for the prevention and treatment of allergies, with an emphasis on mode of delivery and mechanism of action.

    Science.gov (United States)

    Prakash, Satya; Tomaro-Duchesneau, Catherine; Saha, Shyamali; Rodes, Laetitia; Kahouli, Imen; Malhotra, Meenakshi

    2014-01-01

    Allergy, also termed type I hypersensitivity, is defined as a "disease following a response by the immune system to an otherwise innocuous antigen". The prevalence of allergies is high and escalating, with almost half the populations of North America and Europe having allergies to one or more common environmental antigens. Although rarely life-threatening allergies cause much distress and pose an important economic burden. Recent studies demonstrate the importance of the commensal bacteria of the gastrointestinal tract, termed the microbiota, in stimulating and modulating the immune system. This goes hand-in-hand with the hygiene hypothesis, proposed by Strachan in 1989. With this in mind, the use of pre- and probiotics has gained interest to prevent and treat allergies through modulation of the gut microbiota and the immune system. Probiotics, namely Lactobacilli and Bifidobacteria, are live microorganisms that can be incorporated in the diet in the form of functional foods or dietary supplements to beneficially influence the host. In recent studies, probiotic formulations demonstrated the capability to successfully modulate allergic rhinitis, atopic disorders and food-related allergies. A number of probiotic mechanisms of action are involved in controlling hypersensitivity responses, many of which are still not yet understood. Microencapsulation has gained importance as a device for the oral delivery of probiotic cells and may play an important role in the development of a successful probiotic formulation to treat and prevent allergies. Despite the promising research on probiotic biotherapeutics, further investigations are required to develop a successful therapeutic to treat and prevent allergies.

  20. A comparison of student outcomes in a physical therapy neurologic rehabilitation course based on delivery mode: hybrid vs traditional.

    Science.gov (United States)

    Veneri, Diana A; Gannotti, Mary

    2014-01-01

    Physical therapy (PT) educators have been charged by the American Physical Therapy Association's Vision 2020 with the aim of developing critically reflective knowledge about teaching and learning using innovative teaching methods. Computer-assisted learning (CAL) affords the opportunity to supplement face-to-face teaching methods. The purpose of this study was to compare student performance and preferred instruction mode between a hybrid model using CAL modules and a traditional lecture-based model. The posttest-only control design used mixed methods to assess two successive student cohorts (2011 and 2012). Cohort 1 was instructed using only traditional teaching methods of lecture and laboratory experiences, while Cohort 2 was taught using both traditional teaching methods and the CAL modules created for 10 content areas. Students viewed each CAL module after the in-class lecture, prior to the corresponding laboratory. Student performance was assessed with weekly 10-question quizzes. One-minute papers and focus group discussions were administered to Cohort 2 to gauge satisfaction and perceptions of the CAL modules. Results revealed that the mean quiz grades for Cohort 2 were higher than those for Cohort 1, 86.1 vs 80.4. When comparing final exam grades and final grades for the course between groups, a statistically significant difference exists with the final exam grade, pInnovative, interactive, and varied teaching methodologies will serve to better engage students as lifelong learners.

  1. First comparative study of primate morphological and molecular evolutionary rates including muscle data: implications for the tempo and mode of primate and human evolution

    Science.gov (United States)

    Diogo, Rui; Peng, Zuogang; Wood, Bernard

    2013-01-01

    Here we provide the first report about the rates of muscle evolution derived from Bayesian and parsimony cladistic analyses of primate higher-level phylogeny, and compare these rates with published rates of molecular evolution. It is commonly accepted that there is a ‘general molecular slow-down of hominoids’, but interestingly the rates of muscle evolution in the nodes leading and within the hominoid clade are higher than those in the vast majority of other primate clades. The rate of muscle evolution at the node leading to Homo (1.77) is higher than that at the nodes leading to Pan (0.89) and particularly to Gorilla (0.28). Notably, the rates of muscle evolution at the major euarchontan and primate nodes are different, but within each major primate clade (Strepsirrhini, Platyrrhini, Cercopithecidae and Hominoidea) the rates at the various nodes, and particularly at the nodes leading to the higher groups (i.e. including more than one genera), are strikingly similar. We explore the implications of these new data for the tempo and mode of primate and human evolution. PMID:23320764

  2. A survey of ophthalmologists and gynecologists regarding termination of pregnancy and choice of delivery mode in the presence of eye diseases.

    Science.gov (United States)

    Mohammadi, Seyed-Farzad; Letafat-Nejad, Mojgan; Ashrafi, Elham; Delshad-Aghdam, Hanieh

    2017-06-01

    To evaluate and compare the attitudes of ophthalmologists and gynecologists in suggesting appropriate approach to pregnancy in different ocular conditions. Specialty-specific questionnaires on delivery mode and abortion indications for ophthalmic patients (refractive, vascular, oncologic, retinal, glaucoma, postoperation, posttrauma, and infectious) were designed and distributed among physician staff of Farabi Eye Hospital and Yas Women Hospital in Tehran. Attitudes and preferences of the ophthalmologists and gynecologists were quantified and compared. Participants were 29 ophthalmologists and 19 gynecologists. Their mean age was 49.73 ± 7.57 and 46.79 ± 1.36 years, respectively. More than 50-70% ophthalmologists were in favor of normal vaginal delivery (NVD) in all ocular diseases. All gynecologists (100%) expressed their need for an ophthalmologist's opinion for decision-making. Ophthalmologists' top choices for conditions potentially requiring a caesarean section were corneal transplants (34.5%), high myopia (23%), retinal detachment (29%), and orbital tumors (34.5%), while two gynecologists recommended abortion in the presence of intraocular and orbital tumors and retinal detachment. In the case of a history of refractive surgery, orbital tumor and intraocular tumor, ophthalmologists recommend NVD over caesarean section twice as much as their gynecologist peers. For history of retinal detachment, glaucoma, retinal vascular accident and intraocular hemorrhage, no single gynecologist recommend NVD. The corresponding figure for ophthalmologist-recommended NVD were 67, 84, 72, and 81%. There is extreme inconsistency among ophthalmologists and gynecologists in managing ophthalmic-obstetric scenarios, especially for caesarean section indications. Clinical guideline development and consultation for decision-making in challenging cases are recommended.

  3. Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study.

    Science.gov (United States)

    Bickford, Celeste D; Janssen, Patricia A

    2015-01-01

    As rates for cesarean births continue to rise, more women are faced with the choice to plan a vaginal or a repeat cesarean birth after a previous cesarean. The objective of this population-based retrospective cohort study was to compare the safety of planned vaginal birth with cesarean birth after 1-2 previous cesarean sections. We identified singleton term births in British Columbia from 2000 to 2008 using data from the British Columbia Perinatal Data Registry. Women carrying a singleton fetus in cephalic presentation at term (37-41 weeks of gestation completed) with 1-2 prior cesarean births were included. Those with gestational hypertension, pre-existing diabetes and cardiac disease were excluded. Maternal and neonatal outcomes were classified as either life-threatening or non-life threatening. We compared outcomes among women with none versus at least 1 previous vaginal birth, by planned method of delivery. We estimated relative risks (RR) and 95% confidence intervals (CI) for composite outcomes using Poisson regression. Of the 33 812 women in the sample, 5406 had a history of vaginal delivery and 28 406 did not. The composite risk for life-threatening maternal outcomes was elevated among women planning vaginal compared with cesarean birth both with and without a prior vaginal birth (RR 2.06, 95% CI 1.20-3.52) and (2.52, 95% CI 2.04-3.11). Absolute differences (attributable risk [AR]) were 1.01% and 1.31% respectively. Non-life threatening maternal outcomes were decreased among women planning a vaginal birth if they had had at least 1 prior vaginal delivery (RR 0.51, 95% CI 0.33-0.77; AR 1.17%). The composite risk of intrapartum stillbirth, neonatal death or life-threatening neonatal outcomes did not differ among women planning vaginal or cesarean birth with a prior vaginal delivery and non-life threatening neonatal outcomes were decreased, (RR 0.67, 95% CI 0.52-0.86); AR 1.92%). After 1 or 2 previous cesarean births, risks for adverse outcomes between planned

  4. Effect of maternal labor and mode of delivery on neutrophil actin response to N-formylmethionyl-leucyl-phenylalanine in healthy neonates.

    Science.gov (United States)

    Chen, W Y; Lu, C C

    1996-02-01

    Diminished actin response to N-formyl-methionyl-leucyl-phenylalanine (FMLP) has been used to explain the impaired chemotaxis of neonatal neutrophils, but the effect of labor on this response has not been evaluated before. Therefore, we tested the hypothesis that labor stress may have an effect on actin response of cord blood neutrophils to FMLP. This response is compared by phallacidin stain of neutrophil F-actin and flow cytometry analysis among 3 groups of healthy neonates: group I, 16 vaginally delivered neonates; group II, 16 neonates delivered by elective cesarean section without labor; and group III, 16 neonates delivered by cesarean section after labor. In the group III, 10 infants were delivered by an emergency cesarean section because of fetal heart rate deceleration indicating fetal distress (one minute Apgar score < 7 in 5 cases [50%]), and the other 6 infants were delivered because of failure of progression of labor (one minute Apgar score < 7 in 2 cases [33.3%]). Stimulated relative F-actin content of neutrophils in group III was increased compared with groups I and II. There was no such difference between neutrophils from infants of groups I and II. The results of this study indicate that fetal distress may enhance neutrophil actin response to FMLP, while labor or mode of delivery might not have such effect.

  5. Resuscitation of newborn in high risk deliveries

    International Nuclear Information System (INIS)

    Yousaf, U.F.; Hayat, S.

    2015-01-01

    High risk deliveries are usually associated with increased neonatal mortality and morbidity. Neonatal resuscitation can appreciably affect the outcome in these types of deliveries. Presence of personnel trained in basic neonatal resuscitation at the time of delivery can play an important role in reducing perinatal complications in neonates at risk. The study was carried out to evaluate the effects of newborn resuscitation on neonatal outcome in high risk deliveries. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore. Ninety consecutive high risk deliveries were included and attended by paediatricians trained in newborn resuscitation. Babies delivered by elective Caesarean section, normal spontaneous vaginal deliveries and still births were excluded. Neonatal resuscitation was performed in babies who failed to initiate breathing in the first minute after birth. Data was analyzed using SPSS-16.0. Results: A total of 90 high risk deliveries were included in the study. Emergency caesarean section was the mode of delivery in 94.4% (n=85) cases and spontaneous vaginal delivery in 5.6% (n=5). Preterm pregnancy was the major high risk factor. Newborn resuscitation was required in 37.8% (n=34) of all high risk deliveries (p=0.013). All the new-borns who required resuscitation survived. Conclusion: New-born resuscitation is required in high risk pregnancies and personnel trained in newborn resuscitation should be available at the time of delivery. (author)

  6. Human beta-defensin 1, 2 and 3 production by amniotic epithelial cells with respect to human papillomavirus (HPV) infection, HPV oncogenic potential and the mode of delivery.

    Science.gov (United States)

    Szukiewicz, Dariusz; Alkhalayla, Habib; Pyzlak, Michal; Watroba, Mateusz; Szewczyk, Grzegorz; Wejman, Jaroslaw

    2016-08-01

    Human beta-defensins (HBD) produced by human amniotic epithelial cells (HAEC) co-create an innate antiviral immune response in the materno-placento-fetal unit. Oncogenic potential of HPV may reflect its ability to avoid immune recognition. In this study we assessed the risk of HAEC infection with human papillomavirus (HPV) in relation to the type of labor and the impact of the oncogenic potential of HPV on HBD production in HAEC. A comparative analysis [HPV(+) vs. HPV(-)HAEC] of the production of HBD were performed. HAEC were isolated from placentas of 116 HPV(+) and 36 HPV(-) parturients (groups I and II, respectively) using trypsin-based method. The cases of premature rupture of membranes (PROM), natural labors (NL) and cesarean sections (CS) were analysed in respective subgroups. High-risk (HR-HPV) and low-risk (LR-HPV) genotypes of HPV in cervical smears and HAEC were identified using the Roche Linear Array(®) HPV Genotyping Test. HBD-1,-2,-3 concentrations in the HAEC culture supernatant were assessed using ELISA. The highest percentage (42.1%) of HPV transmission to HAEC occurred in PROM, an intermediate value was observed after NL (38.5%), and the lowest (25.6%) after CS. The mean concentrations of HBD-2 and HBD-3 in group I were up to 3.1- and 2.8-fold higher (p infection compared with HR-HPV. The course of labor and the mode of delivery influence the risk of HPV transmission to the HAEC. HPV infection upregulates HBD-2 and HBD-3 production in HAEC. Smaller increases in HBD-2 level after HR-HPV infection as compared to LR-HPV may affect cancerogenesis. Therapeutic potential of HBD-2 for HR-HPV infection should be assessed in future studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. PREFACE: 9th International Fröhlich's Symposium: Electrodynamic Activity of Living Cells (Including Microtubule Coherent Modes and Cancer Cell Physics)

    Science.gov (United States)

    Cifra, Michal; Pokorný, Jirí; Kucera, Ondrej

    2011-12-01

    This volume contains papers presented at the International Fröhlich's Symposium entitled 'Electrodynamic Activity of Living Cells' (1-3 July 2011, Prague, Czech Republic). The Symposium was the 9th meeting devoted to physical processes in living matter organized in Prague since 1987. The hypothesis of oscillation systems in living cells featured by non-linear interaction between elastic and electrical polarization fields, non-linear interactions between the system and the heat bath leading to energy downconversion along the frequency scale, energy condensation in the lowest frequency mode and creation of a coherent state was formulated by H Fröhlich, founder of the theory of dielectric materials. He assumed that biological activity is based not only on biochemical but also on biophysical mechanisms and that their disturbances form basic links along the cancer transformation pathway. Fröhlich outlined general ideas of non-linear physical processes in biological systems. The downconversion and the elastic-polarization interactions should be connected in a unified theory and the solution based on comprehensive non-linear characteristics. Biochemical and genetic research of biological systems are highly developed and have disclosed a variety of cellular and subcellular structures, chemical reactions, molecular information transfer, and genetic code sequences - including their pathological development. Nevertheless, the cancer problem is still a big challenge. Warburg's discovery of suppressed oxidative metabolism in mitochondria in cancer cells suggested the essential role of physical mechanisms (but his discovery has remained without impact on cancer research and on the study of physical properties of biological systems for a long time). Mitochondria, the power plants of the cell, have several areas of activity-oxidative energy production is connected with the formation of a strong static electric field around them, water ordering, and liberation of non

  8. If you needed an organ transplant would you have one? The effect of reciprocity priming and mode of delivery on organ donor registration intentions and behaviour.

    Science.gov (United States)

    O'Carroll, Ronan E; Haddow, Lorna; Foley, Laura; Quigley, Jody

    2017-09-01

    subsequent willingness to register. What does this study add? Novel evidence that employing a simple reciprocity prime increases organ donor registration intentions. Replication of findings across two separate studies. Novel examination of the impact of mode of delivery of messages to encourage organ donation. A basis for further research into the translation of intentions into organ donor registration behaviour. © 2017 The British Psychological Society.

  9. Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery.

    Science.gov (United States)

    Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Ofek Shlomai, Noa; Porat, Shay

    2018-02-24

    Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score cesarean group compared with those delivered by the vaginal route alone. Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Development of a novel ArcCHECK(™) insert for routine quality assurance of VMAT delivery including dose calculation with inhomogeneities.

    Science.gov (United States)

    Fakir, H; Gaede, S; Mulligan, M; Chen, J Z

    2012-07-01

    To design a versatile, nonhomogeneous insert for the dose verification phantom ArcCHECK(™) (Sun Nuclear Corp., FL) and to demonstrate its usefulness for the verification of dose distributions in inhomogeneous media. As an example, we demonstrate it can be used clinically for routine quality assurance of two volumetric modulated arc therapy (VMAT) systems for lung stereotactic body radiation therapy (SBRT): SmartArc(®) (Pinnacle(3), Philips Radiation Oncology Systems, Fitchburg, WI) and RapidArc(®) (Eclipse(™), Varian Medical Systems, Palo Alto, CA). The cylindrical detector array ArcCHECK(™) has a retractable homogeneous acrylic insert. In this work, we designed and manufactured a customized heterogeneous insert with densities that simulate soft tissue, lung, bone, and air. The insert offers several possible heterogeneity configurations and multiple locations for point dose measurements. SmartArc(®) and RapidArc(®) plans for lung SBRT were generated and copied to ArcCHECK(™) for each inhomogeneity configuration. Dose delivery was done on a Varian 2100 ix linac. The evaluation of dose distributions was based on gamma analysis of the diode measurements and point doses measurements at different positions near the inhomogeneities. The insert was successfully manufactured and tested with different measurements of VMAT plans. Dose distributions measured with the homogeneous insert showed gamma passing rates similar to our clinical results (∼99%) for both treatment-planning systems. Using nonhomogeneous inserts decreased the passing rates by up to 3.6% in the examples studied. Overall, SmartArc(®) plans showed better gamma passing rates for nonhomogeneous measurements. The discrepancy between calculated and measured point doses was increased up to 6.5% for the nonhomogeneous insert depending on the inhomogeneity configuration and measurement location. SmartArc(®) and RapidArc(®) plans had similar plan quality but RapidArc(®) plans had significantly

  11. CISN Display - Reliable Delivery of Real-time Earthquake Information, Including Rapid Notification and ShakeMap to Critical End Users

    Science.gov (United States)

    Rico, H.; Hauksson, E.; Thomas, E.; Friberg, P.; Given, D.

    2002-12-01

    earthquake information on the Web. The links are automatically created when product generators deliver CUBE formatted packets to a Quake Data Distribution System (QDDS) hub (new distribution methods may be used later). The "feeder" modules tap into the QDDS hub and convert the packets into XML-messages. These messages are forwarded to message queues, and then distributed to clients where URLs are dynamically created for these products and linked to events on the CISN Display map. The products may be downloaded out-of-band; and with the inclusion of a GIS mapping tool users can plot organizational assets on the CISN Display map and overlay them against key spectral data, such as ground accelerations. This gives Emergency Response Managers information useful in allocating limited personnel and resources after a major event. At the heart of the system's robustness is a well-established and reliable set of communication protocols for best-effort delivery of data. For critical users a Common Object Request Broker Architecture (CORBA) state-full connection is used via a dedicated signaling channel. The system employs several CORBA methods that alert users of changes in the link status. Loss of connectivity triggers a strategy that attempts to reconnect through various physical and logical paths. Thus, by building on past application successes and proven Internet advances the CISN Display targets a specific audience by providing enhancements previously not available from other applications.

  12. Development of a novel ArcCHECK{sup Trade-Mark-Sign} insert for routine quality assurance of VMAT delivery including dose calculation with inhomogeneities

    Energy Technology Data Exchange (ETDEWEB)

    Fakir, H.; Gaede, S.; Mulligan, M.; Chen, J. Z. [Department of Physics, London Regional Cancer Program, London, Ontario N6A 4L6 (Canada)

    2012-07-15

    Purpose: To design a versatile, nonhomogeneous insert for the dose verification phantom ArcCHECK{sup Trade-Mark-Sign} (Sun Nuclear Corp., FL) and to demonstrate its usefulness for the verification of dose distributions in inhomogeneous media. As an example, we demonstrate it can be used clinically for routine quality assurance of two volumetric modulated arc therapy (VMAT) systems for lung stereotactic body radiation therapy (SBRT): SmartArc{sup Registered-Sign} (Pinnacle{sup 3}, Philips Radiation Oncology Systems, Fitchburg, WI) and RapidArc{sup Registered-Sign} (Eclipse{sup Trade-Mark-Sign }, Varian Medical Systems, Palo Alto, CA). Methods: The cylindrical detector array ArcCHECK{sup Trade-Mark-Sign} has a retractable homogeneous acrylic insert. In this work, we designed and manufactured a customized heterogeneous insert with densities that simulate soft tissue, lung, bone, and air. The insert offers several possible heterogeneity configurations and multiple locations for point dose measurements. SmartArc{sup Registered-Sign} and RapidArc{sup Registered-Sign} plans for lung SBRT were generated and copied to ArcCHECK{sup Trade-Mark-Sign} for each inhomogeneity configuration. Dose delivery was done on a Varian 2100 ix linac. The evaluation of dose distributions was based on gamma analysis of the diode measurements and point doses measurements at different positions near the inhomogeneities. Results: The insert was successfully manufactured and tested with different measurements of VMAT plans. Dose distributions measured with the homogeneous insert showed gamma passing rates similar to our clinical results ({approx}99%) for both treatment-planning systems. Using nonhomogeneous inserts decreased the passing rates by up to 3.6% in the examples studied. Overall, SmartArc{sup Registered-Sign} plans showed better gamma passing rates for nonhomogeneous measurements. The discrepancy between calculated and measured point doses was increased up to 6.5% for the nonhomogeneous

  13. Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version.

    Science.gov (United States)

    Andrews, Suzanne; Leeman, Lawrence; Yonke, Nicole

    2017-09-01

    Breech presentation affects 3-4% of pregnancies at term and malpresentation is the primary indication for 10-15% of cesarean deliveries. External cephalic version is an effective intervention that can decrease the need for cesarean delivery; however, timely identification of breech presentation is required. We hypothesized that women with a fetus in a breech presentation that is diagnosed after 38 weeks' estimated gestational age have a decreased likelihood of external cephalic version attempted and an increased likelihood of cesarean delivery. This was a retrospective cohort study. A chart review was performed for 251 women with breech presentation at term presenting to our tertiary referral university hospital for external cephalic version, cesarean for breech presentation, or vaginal breech delivery. Vaginal delivery was significantly more likely (31.1% vs 12.5%; Ppresentation diagnosed before 38 weeks' estimated gestational age as external cephalic version was offered, and subsequently attempted in a greater proportion of women diagnosed before 38 weeks. External cephalic version was more successful when performed by physicians with greater procedural volume during the 3.5 year period of the study (59.1% for providers performing at least 10 procedures vs 31.3% if performing fewer than 10 procedures, Ppresentation as well as improved patient counseling and use of experienced providers for external cephalic version. © 2017 Wiley Periodicals, Inc.

  14. High Temperature Superconductors: From Delivery to Applications (Presentation from 2011 Ernest Orlando Lawrence Award-winner, Dr. Amit Goyal, and including introduction by Energy Secretary, Dr. Steven Chu)

    International Nuclear Information System (INIS)

    Goyal, Amit

    2012-01-01

    Dr. Amit Goyal, a high temperature superconductivity (HTS) researcher at Oak Ridge National Laboratory, was named a 2011 winner of the Department of Energy's Ernest Orlando Lawrence Award honoring U.S. scientists and engineers for exceptional contributions in research and development supporting DOE and its mission. Winner of the award in the inaugural category of Energy Science and Innovation, Dr. Goyal was cited for his work in 'pioneering research and transformative contributions to the field of applied high temperature superconductivity, including fundamental materials science advances and technical innovations enabling large-scale applications of these novel materials.' Following his basic research in grain-to-grain supercurrent transport, Dr. Goyal focused his energy in transitioning this fundamental understanding into cutting-edge technologies. Under OE sponsorship, Dr. Goyal co-invented the Rolling Assisted Bi-Axially Textured Substrate technology (RABiTS) that is used as a substrate for second generation HTS wires. OE support also led to the invention of Structural Single Crystal Faceted Fiber Substrate (SSIFFS) and the 3-D Self Assembly of Nanodot Columns. These inventions and associated R and D resulted in 7 R and D 100 Awards including the 2010 R and D Magazine's Innovator of the Year Award, 3 Federal Laboratory Consortium Excellence in Technology Transfer National Awards, a DOE Energy100 Award and many others. As a world authority on HTS materials, Dr. Goyal has presented OE-sponsored results in more than 150 invited talks, co-authored more than 350 papers and is a fellow of 7 professional societies.

  15. Developing the continuum of dental education: including dental foundation trainers in the delivery of a community-based clinical teaching programme.

    Science.gov (United States)

    Lynch, C D; Ash, P J; Chadwick, B L; Herbert, R A; Cowpe, J G

    2012-11-01

    Despite advances in evidence-based dental school educational programmes, the charge is sometimes made that dental students are 'no longer as good as they used to be'. Recent modifications have meant that dental education is now a 'life-long experience', of which dental school is the initial, albeit very important, component. Contemporary dental students will normally enter dental foundation (DF) training on completion of dental school. As such there may be value in including DF trainers in dental school teaching programmes. The aim of this paper is to report the experiences, feedback and opinions of these DF trainers following their first-hand experience of the community-based clinical teaching programme at Cardiff, and assess if their perspectives of contemporary dental student education changed following this. DF trainers were invited to attend the community-based clinical teaching programme at Cardiff on an observer basis. Twenty-four DF trainers attended, following which evaluation questionnaires were completed. Information sought included opinions and attitudes to the teaching programme, the physical environment in which the teaching programme took place, knowledge and attitudes towards community-based clinical teaching and modifications that DF trainers would make to the teaching programme to further improve the knowledge, skills and attributes of dental school graduates for DF training. Responses were received from 20 DF trainers (response rate = 83%). All 20 respondents felt that the teaching provided within the community-based clinical teaching programme was appropriate, with one respondent noting that it was like 'a day in the life of a dental practice', 'where anything could present'. Sixteen respondents were satisfied with the scope and content of the community-based clinical teaching programme, with a small number recommending inclusion of teaching in relation to inlays/onlays (n = 2), simple orthodontics (n = 1) and splinting (n = 1). Eighteen

  16. Cesarean deliveries and maternal weight retention.

    Science.gov (United States)

    Kapinos, Kandice A; Yakusheva, Olga; Weiss, Marianne

    2017-10-04

    Cesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery. We used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally. We found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy. After accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

  17. eDelivery

    Data.gov (United States)

    US Agency for International Development — eDelivery provides the electronic packaging and delivery of closed and complete OPM investigation files to government agencies, including USAID, in a secure manner....

  18. Prenatal counseling regarding cesarean delivery.

    Science.gov (United States)

    Leeman, Lawrence M

    2008-09-01

    In 1970, the cesarean delivery rate in the United States was 5.5% and women receiving prenatal care only required the knowledge that cesarean delivery was an uncommon solution to dire obstetric emergencies. In 2008, when almost one in three women deliver by cesarean, counseling on cesarean delivery must be part of each woman's prenatal care. The content of that discussion varies based on the woman's obstetric history and the anticipated mode of delivery.

  19. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery.

    Science.gov (United States)

    Kottwitz, Anita

    2014-05-01

    Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Articulating feedstock delivery device

    Science.gov (United States)

    Jordan, Kevin

    2013-11-05

    A fully articulable feedstock delivery device that is designed to operate at pressure and temperature extremes. The device incorporates an articulating ball assembly which allows for more accurate delivery of the feedstock to a target location. The device is suitable for a variety of applications including, but not limited to, delivery of feedstock to a high-pressure reaction chamber or process zone.

  1. Impacto da idade materna sobre os resultados perinatais e via de parto Impact of maternal age on perinatal outcomes and mode of delivery

    Directory of Open Access Journals (Sweden)

    Graciete Helena Nascimento dos Santos

    2009-07-01

    ício tardio e menor número de consultas no pré-natal, uso de abortivo no início da gestação, baixa escolaridade, ausência de companheiro, baixo peso ao nascer, prematuridade e menor incidência de desproporção céfalo-pélvica e pré-eclâmpsia. No grupo de gestantes com idade avançada houve maior freqüência de diabetes, pré-eclâmpsia, ruptura prematura das membranas, índice de Apgar no quinto minuto menor que sete e maior frequência de parto operatório cesáreo.PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old, adults (20 to 34 years old, and aged women (>35 years old. Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR or the cross product ratio, with confidence intervals (CI of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88, and low birth weight (OR=1.47; CI95%=1.13- 1.90, higher incidence of normal delivery as compared to the other groups (65.2%, besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43, lower number of appointments (OR=2.03; CI95%=1.57-2.63, and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98. Among aged women, there was strong association with diabetes mellitus

  2. Maternal morbidity and mortality associated with delivery after intrauterine death

    International Nuclear Information System (INIS)

    Ifnan, F.; Jameel, M.B.

    2006-01-01

    To determine the maternal morbidity and mortality associated with delivery after intrauterine fetal death (IUFD) and to find out the place of fetal destructive procedures and cesarean section. All women were included in the present study who presented before the onset of labour pains, after intrauterine fetal death at 26 weeks or onward with singleton pregnancy. Assessment of maternal demographic characteristics, gestational age at fetal demise, delivery-IUFD interval, mode of delivery; vaginal with or without fetal destructive procedures/cesarean section and maternal complications were the main outcome measures. There were 1834 live birth and 63 deliveries with intrauterine fetal death. Mode of delivery was vaginal in 87.4% and cesarean section in 12.6% of the cases. Twelve (21%) of the vaginal deliveries were complicated by lower urogenital tract injuries in certain cases, whereas 75% (6/8) of patients delivered by cesarean section developed major postoperative complications like postpartum haemorrhage, shock, endometritis, peritonitis and wound dehiscence. No maternal death was identified. Rate of delivery with intrauterine fetal death was 34.3/1000 live-birth deliveries. (author)

  3. Delivery presentations

    Science.gov (United States)

    Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation ... The mother can walk, rock, and try different delivery positions during labor to help encourage the baby ...

  4. Risk of Asthma from Cesarean Delivery Depends on Membrane Rupture

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Stokholm, Jakob; Bisgaard, Hans

    2016-01-01

    OBJECTIVE: To assess our prospective mother-child cohort and the national registry data to analyze the risk of asthma by delivery mode and whether cesarean delivery before or after membrane rupture affects this risk differently. STUDY DESIGN: The Copenhagen Prospective Studies on Asthma...... in Childhood2000 is a high-risk birth cohort of 411 Danish children. Asthma was diagnosed prospectively by physicians at the research site, and associations with cesarean delivery were investigated using Cox proportional hazard models. From the Danish national prospective registry we included data from 1997......-2010. Childhood asthma was defined from recurrent use of inhaled corticosteroids filled at pharmacies. Cesarean delivery was classified as either before or after rupture of membranes, and the risk of asthma was compared with vaginal delivery. Results were adjusted stepwise for age and calendar year, sex, birth...

  5. Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network.

    Science.gov (United States)

    Boyle, Annelee; Preslar, Jessica P; Hogue, Carol J R; Silver, Robert M; Reddy, Uma M; Goldenberg, Robert L; Stoll, Barbara J; Varner, Michael W; Conway, Deborah L; Saade, George R; Bukowski, Radek; Dudley, Donald J

    2017-04-01

    To describe delivery management of singleton stillbirths in a population-based, multicenter case series. We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented). Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture. Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.

  6. Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery.

    Science.gov (United States)

    Cassadó Garriga, Jordi; Pessarrodona Isern, Antoni; Espuña Pons, Montserrat; Durán Retamal, Montserrat; Felgueroso Fabregas, Anna; Rodriguez-Carballeira, Monica

    2011-08-01

    The aim of the study was to evaluate the association of avulsion and postnatal hiatal dimensions with delivery mode. These anatomical changes on pelvic floor muscle may be assessed by 3-4D ultrasonography. This is a prospective observational study that included 164 women: 20 nulliparous, 20 primigravid, and 124 postpartum women (62 at 1 month, 62 at 9 months postpartum). We performed an introital 3-4D ultrasonography to assess levator ani muscle's integrity, levator hiatal area at rest, on Valsalva, and on contraction. Levator ani avulsion was diagnosed in 59.5% of forceps deliveries. There were no statistically significant differences in postnatal hiatal dimensions between normal vaginal deliveries at 9 months postpartum and nulligravid. Levator hiatal area was significantly higher after forceps delivery. Low incidence of levator avulsion takes place in normal vaginal deliveries. However, forceps delivery is the riskiest type of delivery for pelvic floor pathology and its recovery.

  7. Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA.

    Science.gov (United States)

    Kjerulff, Kristen H; Attanasio, Laura B; Edmonds, Joyce K; Kozhimannil, Katy B; Repke, John T

    2017-09-01

    Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery-the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors-including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97-2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications. © 2017 Wiley Periodicals, Inc.

  8. Evaluating Student Perceptions of Course Delivery Platforms

    Science.gov (United States)

    Bramorski, Tom; Madan, Manu S.

    2016-01-01

    In this paper we evaluate effectiveness of course delivery mode on three dimensions: values, networking opportunities and learning. While students and their future employers are two important customers for the business program, we focus on the perception of students regarding the effectiveness of course delivery mode on program performance. The…

  9. [Low urinary tract symptoms after Thierry's spatula delivery at first pregnancy].

    Science.gov (United States)

    Provansal, M; Bretelle, F; Bannier, M; Gamerre, M; Mazouni, C

    2007-11-01

    This study was undertaken to evaluate prevalence of low urinary tract symptoms (LUTS) after Thierry's spatula delivery at first pregnancy. A retrospective study of 236 primiparous with instrumental delivery or spontaneous delivery who had delivered from January 2001 to December 2002. Low urinary tract symptoms (LUTS) were evaluated one year after delivery with a questionnaire. Incidence of LUTS was compared depending on mode of delivery. Of the 236 patients included, 88.1% replied to the questionnaire, 106 who delivered spontaneously and 102 who underwent Thierry's spatula delivery. The incidence of urinary incontinence was similar after instrumental deliveries and after spontaneous vaginal deliveries (34.9 versus 24.5%, p=0.10). In univariate analysis, symptoms of urinary urgency and urinary frequency were higher after instrumental delivery than after spontaneous delivery, respectively, 34.9 versus 22.5%, p=0.049 and 19.8 versus 8.8%, p=0.03. After controlling for confounding factors, no difference in LUTS was observed between the two groups; the respective adjusted odds-ratios (95% IC) were 1,5 (0.8-3) for urinary incontinence, 1.7 (0.9-3.5) for urgency and 2.5 (0.9-6.3) for urinary frequency. One year after delivery, one third of patients will present urinary incontinence and more than 50% will complain of bladder instability symptoms. Compared to spontaneous vaginal delivery, the use of Thierry's spatulas at first pregnancy does not induce higher risk of LUTS.

  10. EAMJ Jan. Mode of Delivery10.indd

    African Journals Online (AJOL)

    2010-01-01

    Jan 1, 2010 ... ... or less (52.8%) living in single room homes. (71.2%), often in one of Nairobi 's slums (41.6%). All women in this study received some form of antenatal care with a median number of four clinic visits (range: 1-17), though most women attended small satellite city council clinics around Nairobi (71.2%) rather.

  11. User contributions and public extension delivery modes ...

    African Journals Online (AJOL)

    The high recurrent costs faced by the public extension service constraint the number of visits farmers receive. This study examined a number of extension communication channels through which farmers received farm management services/information from the public extension agent. The idea was, first, to find out the ...

  12. Awareness and perceptions of Turkish women towards delivery methods

    Directory of Open Access Journals (Sweden)

    Şükrü Yıldız

    2014-06-01

    Full Text Available Objective: Our aim is to identify the causes of the women’s preferences of vaginal delivery vs. cesarean section and their attitudes for an elective cesarean section. Methods: 400 healthy woman who had applied for antenatal care were included in the study. A questionnaire which is consisted of 21 questions, focused on preference toward mode of delivery and the etiology of these preferences was conducted as a face to face interview. According to history of delivery methods, women have separated into three groups as; women have never given birth/nulliparous (group 1, women who had only vaginal deliveries (group 2, and women who had at least one cesarean deliveries/previous cesarean section (group 3. Results: Of the 400 women questioned, 348 (%87 opted for vaginal delivery, whereas only 52 (%13 opted for an elective caesarean delivery. Ratios of cesarean delivery preference is high in group 3 (%47.5 than group 1( %26 and 2 (%2.7 . Main reasons for vaginal delivery preference: feeling of less pain, fast and easy recovery and less bleeding and infection risc for mothers were the most common preference reasons among all 3 groups. The most common reasons for choosing caesarean delivery were: ‘more comfortable and easy’ in group 1 and ‘tubal ligation demand’ in group 3. ‘Less pain’ and ‘fear of tearing (episiotomy’ also other common reasons for choosing cesarean delivery among all 3 groups. Conclusion: In order to reduce the rate of implemented cesarean section, it is substantially important to encourage educated women and those who have experienced advanced maternal age for increasing the rate of vaginal delivery. J Clin Exp Invest 2014; 5 (2: 173-178

  13. Leisure Service Delivery Systems: Are They Adequate

    Science.gov (United States)

    Rene Fukuhara Dahl

    1992-01-01

    This presentation explores a model of service delivery ranging from direct service provision to advocacy and reports findings on the delivery mode most prevalent in park and recreation departments that serve Asian groups in their community. The implications of the role of the professional, the range of service delivery, and the manner in which ethnic groups are...

  14. After Delivery

    Science.gov (United States)

    ... Size: A A A Listen En Español After Delivery After your baby arrives, your body begins to recover from the hard work of pregnancy and delivery. Some new mothers have better blood glucose control ...

  15. Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations.

    Science.gov (United States)

    Lappen, Justin R; Hackney, David N; Bailit, Jennifer L

    2016-10-01

    The prevailing obstetric practice of planned cesarean delivery for triplet gestations is largely empiric and data on the optimal route of delivery are limited. The primary objectives of this study are to determine the likelihood of success in an attempted vaginal delivery and assess maternal and neonatal outcomes of attempted vaginal vs planned cesarean delivery of triplets using a multiinstitution obstetric cohort. We performed a retrospective cohort study using data from the Consortium on Safe Labor, identifying triplet pregnancies with delivery at a gestational age ≥28 weeks. Women with a history of cesarean delivery and pregnancies complicated by chromosomal or congenital anomalies, twin-twin transfusion syndrome, or a fetal demise were excluded. The attempted vaginal group included all women with spontaneous or induced labor and excluded all women delivering by prelabor cesarean delivery, including those coded as elective or for fetal malpresentation. Primary maternal outcomes included infection (composite of chorioamnionitis, endometritis, wound separation, and wound infection), blood transfusion, or transfer to the intensive care unit. Primary neonatal outcomes included neonatal asphyxia, mechanical ventilation, and composite neonatal morbidity, consisting of ≥1 of the following: birth injury, 5-minute Apgar delivery group was restricted to include only women with evidence of induction or augmentation or labor. 188 triplet sets were identified of which 80 sets (240 neonates) met inclusion criteria and 24 sets (30%) had an attempted vaginal delivery. The rate of successful attempted vaginal delivery was 16.7% (4 triplet sets; 12 neonates). No women had a combined mode of delivery. Women attempting vaginal delivery were more likely to have preterm labor (45.8 vs 12.5%, P delivery did not differ by mode of delivery. Attempted vaginal delivery was associated with a higher risk of maternal transfusion (20.8% vs 3.6%, P = .01) and neonatal mechanical

  16. Sliding mode control and observation

    CERN Document Server

    Shtessel, Yuri; Fridman, Leonid; Levant, Arie

    2014-01-01

    The sliding mode control methodology has proven effective in dealing with complex dynamical systems affected by disturbances, uncertainties and unmodeled dynamics. Robust control technology based on this methodology has been applied to many real-world problems, especially in the areas of aerospace control, electric power systems, electromechanical systems, and robotics. Sliding Mode Control and Observation represents the first textbook that starts with classical sliding mode control techniques and progresses toward newly developed higher-order sliding mode control and observation algorithms and their applications. The present volume addresses a range of sliding mode control issues, including: *Conventional sliding mode controller and observer design *Second-order sliding mode controllers and differentiators *Frequency domain analysis of conventional and second-order sliding mode controllers *Higher-order sliding mode controllers and differentiators *Higher-order sliding mode observers *Sliding mode disturbanc...

  17. Single-Mode VCSELs

    Science.gov (United States)

    Larsson, Anders; Gustavsson, Johan S.

    The only active transverse mode in a truly single-mode VCSEL is the fundamental mode with a near Gaussian field distribution. A single-mode VCSEL produces a light beam of higher spectral purity, higher degree of coherence and lower divergence than a multimode VCSEL and the beam can be more precisely shaped and focused to a smaller spot. Such beam properties are required in many applications. In this chapter, after discussing applications of single-mode VCSELs, we introduce the basics of fields and modes in VCSELs and review designs implemented for single-mode emission from VCSELs in different materials and at different wavelengths. This includes VCSELs that are inherently single-mode as well as inherently multimode VCSELs where higher-order modes are suppressed by mode selective gain or loss. In each case we present the current state-of-the-art and discuss pros and cons. At the end, a specific example with experimental results is provided and, as a summary, the most promising designs based on current technologies are identified.

  18. Vacuum Delivery in Jos University Teaching Hospital, Jos, Nigeria ...

    African Journals Online (AJOL)

    Obstetric practice continues to change, particularly assisted vaginal delivery. Vacuum delivery is a mode of delivery technique in Jos University Teaching Hospital (JUTH) in the maternity unit. The objective of the study was to determine the rate of ventouse delivery, its indications, and maternal and fetal morbidity in our ...

  19. Drug delivery with living cells

    NARCIS (Netherlands)

    Fliervoet, Lies A L; Mastrobattista, Enrico

    2016-01-01

    The field of drug delivery has grown tremendously in the past few decades by developing a wide range of advanced drug delivery systems. An interesting category is cell-based drug delivery, which includes encapsulation of drugs inside cells or attached to the surface and subsequent transportation

  20. Redefining continuing education delivery.

    Science.gov (United States)

    Carlton, K H

    1997-01-01

    Just as technology is transforming the delivery of education, the Internet and advanced telecommunication applications are changing the "face" of CE and the connotation of "lifelong learning." As late as the mid-1980s, a discussion of computer applications in nursing CE focused on the "timely" transition to microcomputers as tools for the enhancement of managerial tasks for increased productivity. Even as recently as 1990, there seemed to be "time" for those providers who were "slower to adopt innovation" to "catch up." Now, the CE provider who does not integrate the microcomputer and advanced telecommunications as an integral component of their delivery modalities may be outsourced rapidly by an educational or commercial competitive unit that is able to utilize the communication medium, mergers and partnerships, enterprise, and individual lifestyle and learning patterns that will epitomize the CE unit of the 21st century. As with the "re-engineering" of nursing education, the "re-engineered" delivery modalities of evolving CE entity might now best be conceptualized on a continuum from the traditional mode that time and place dependent to a mode of synchronous and asynchronous data and advanced telecommunication. Delivery methods will need to be selected according to the target populations, content, and situation. The health-care educational provider may discover, as in other industries, that a combination of distance and residential offerings will be the most successful medium for the delivery of CE to the progressively more "information and technologically savvy" lifelong learner of the 21st century. In addressing the dramatic effects of the information technology era on the refocused multimedia/interactive delivery method for student education, educators amply quoted Bob Dylan's phrase of the 1960s, "The times, they are a-changing." And so, we see that the times are also changing at an astronomical rate for the health-care educational provider as well as the

  1. The impact of treatment complexity and computer-control delivery technology on treatment delivery errors

    International Nuclear Information System (INIS)

    Fraass, Benedick A.; Lash, Kathy L.; Matrone, Gwynne M.; Volkman, Susan K.; McShan, Daniel L.; Kessler, Marc L.; Lichter, Allen S.

    1998-01-01

    Purpose: To analyze treatment delivery errors for three-dimensional (3D) conformal therapy performed at various levels of treatment delivery automation and complexity, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system (CCRS). Methods and Materials: All treatment delivery errors which occurred in our department during a 15-month period were analyzed. Approximately 34,000 treatment sessions (114,000 individual treatment segments [ports]) on four treatment machines were studied. All treatment delivery errors logged by treatment therapists or quality assurance reviews (152 in all) were analyzed. Machines 'M1' and 'M2' were operated in a standard manual setup mode, with no record and verify system (R/V). MLC machines 'M3' and 'M4' treated patients under the control of the CCRS system, which (1) downloads the treatment delivery plan from the planning system; (2) performs some (or all) of the machine set up and treatment delivery for each field; (3) monitors treatment delivery; (4) records all treatment parameters; and (5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3; therefore, it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments, nonaxial and noncoplanar plans, multisegment intensity modulation, and pseudoisocentric treatments studied for a 6-month period (505 patients) concurrent with the period in which the delivery errors were obtained. Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines; therefore, this analysis does not depend on fixed therapist staff on particular

  2. Forceps Delivery

    Science.gov (United States)

    ... 2015. Related Signs of labor Forceps delivery About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  3. Snoring during Pregnancy and Delivery Outcomes: A Cohort Study

    Science.gov (United States)

    O'Brien, Louise M.; Bullough, Alexandra S.; Owusu, Jocelynn T.; Tremblay, Kimberley A.; Brincat, Cynthia A.; Chames, Mark C.; Kalbfleisch, John D.; Chervin, Ronald D.

    2013-01-01

    Study Objective: This cohort study examined the impact of maternal snoring on key delivery outcomes such as mode of delivery, infant birth centile, and small-for-gestational age. Design: Cohort study. Setting: A large tertiary medical center. Patients or Participants: Pregnant women in their third trimester were recruited between March 2007 and December 2010. Measurements and Results: Women were screened for habitual snoring, as a known marker for sleep disordered breathing. Outcome data were obtained from medical records following delivery and birth centiles were calculated. Of 1,673 women, a total of 35% reported habitual snoring (26% with pregnancy-onset snoring and 9% with chronic snoring). After adjusting for confounders, chronic snoring was associated with small-forgestational age (OR 1.65, 95%CI 1.02-2.66, P = 0.041) and elective cesarean delivery (OR 2.25, 95%CI 1.22-4.18, P = 0.008). Pregnancy-onset snoring was associated with emergency cesarean delivery (OR 1.68, 95%CI 1.22-2.30, P = 0.001). Conclusion: Maternal snoring during pregnancy is a risk factor for adverse delivery outcomes including cesarean delivery and small-for-gestational age. Screening pregnant women for symptoms of SDB may provide an early opportunity to identify women at risk of poor delivery outcomes. Clinical Trials Registration: Identifier: NCT01030003. Citation: O'Brien LM; Bullough AS; Owusu JT; Tremblay KA; Brincat CA; Chames MC; Kalbfleisch JD; Chervin RD. Snoring during pregnancy and delivery outcomes: a cohort study. SLEEP 2013;36(11):1625-1632. PMID:24179294

  4. Term breech delivery in The Netherlands

    NARCIS (Netherlands)

    Rietberg, C.C.

    2006-01-01

    The management of the term breech delivery has been a subject of discussion for many years. Only a few randomized trials had been performed on outcome in relation to the mode of delivery in case of breech position. In october 2000 the results of the Term Breech Trial (TBT) were published, in which

  5. Does alcohol increase the risk of preterm delivery?

    DEFF Research Database (Denmark)

    Kesmodel, Ulrik; Olsen, Sjúrður Fróði; Secher, Niels Jørgen

    2000-01-01

    We evaluated the association between alcohol intake during pregnancy and preterm delivery. Women attending routine antenatal care at Aarhus University Hospital, Denmark, from 1989–1991 and 1992–1996 were eligible. We included 18,228 singleton pregnancies in the analyses. We obtained prospective...... information on alcohol intake at 16 and 30 weeks of gestation, other lifestyle factors, maternal characteristics, and obstetrical risk factors from self-administered questionnaires and hospital files. For women with alcohol intake of 1–2, 3–4, 5–9, and >=10 drinks/week the risk ratio (RR) of preterm delivery.......78–7.13) at 30 weeks. Adjustment for smoking habits, caffeine intake, age, height, pre-pregnant weight, marital status, occupational status, education, parity, chronic diseases, previous preterm delivery, mode of initiation of labor, and sex of the child did not change the conclusions, nor did restriction...

  6. Mode decomposition evolution equations.

    Science.gov (United States)

    Wang, Yang; Wei, Guo-Wei; Yang, Siyang

    2012-03-01

    easily used for secondary processing. Various simplifications of the proposed MoDEEs, including a linearized version, and an algebraic version, are discussed for computational convenience. The Fourier pseudospectral method, which is unconditionally stable for linearized the high order MoDEEs, is utilized in our computation. Validation is carried out to mode separation of high frequency adjacent modes. Applications are considered to signal and image denoising, image edge detection, feature extraction, enhancement etc. It is hoped that this work enhances the understanding of high order PDEs and yields robust and useful tools for image and signal analysis.

  7. Cultural perceptions and preferences of Iranian women regarding cesarean delivery

    Science.gov (United States)

    Latifnejad-Roudsari, Robab; Zakerihamidi, Maryam; Merghati-Khoei, Effat; Kazemnejad, Anoshirvan

    2014-01-01

    Background: Data was reported in Iran in 2013 has shown that almost 42 percent of deliveries in public hospitals and 90 percent in private hospitals were carried out with cesarean section. This high rate of cesarean requires careful consideration. It seems that making decision for cesarean is done under the influence of cultural perceptions and beliefs. So, this study was conducted to explore pregnant women's preferences and perceptions regarding cesarean delivery. Materials and Methods: A focused ethnographic study was used. 12 pregnant women and 10 delivered women, seven midwives, seven gynecologist and nine non-pregnant women referred to the health clinics of Tonekabon, who selected purposively, were included in the study. To collect data semi-structured in-depth interviews and participant observation were used. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using thematic analysis and MAXQDA software. Results: Four themes emerged from the data including personal beliefs, fear of vaginal delivery, cultural norms and values and also social network. These concepts played main roles in how women develop meanings toward caesarean, which affected their perceptions and preferences in relation to caesarean delivery. Conclusion: Most of pregnant women believed that fear of vaginal delivery is a major factor to choose caesarean delivery. Hence, midwives and physicians could help them through improving the quality of prenatal care and giving them positive perception towards vaginal delivery through presenting useful information about the nature of different modes of delivery, and their advantages and disadvantages, as well as the alternative ways to control labor pain. PMID:25949249

  8. Failure Modes

    DEFF Research Database (Denmark)

    Jakobsen, K. P.; Burcharth, H. F.; Ibsen, Lars Bo

    1999-01-01

    The present appendix contains the derivation of ten different limit state equations divided on three different failure modes. Five of the limit state equations can be used independently of the characteristics of the subsoil, whereas the remaining five can be used for either drained or undrained...

  9. Sonophoresis in transdermal drug deliverys.

    Science.gov (United States)

    Park, Donghee; Park, Hyunjin; Seo, Jongbum; Lee, Seunghun

    2014-01-01

    Transdermal drug delivery (TDD) has several significant advantages compared to oral drug delivery, including elimination of pain and sustained drug release. However, the use of TDD is limited by low skin permeability due to the stratum corneum (SC), the outermost layer of the skin. Sonophoresis is a technique that temporarily increases skin permeability such that various medications can be delivered noninvasively. For the past several decades, various studies of sonophoresis in TDD have been performed focusing on parameter optimization, delivery mechanism, transport pathway, or delivery of several drug categories including hydrophilic and high molecular weight compounds. Based on these various studies, several possible mechanisms of sonophoresis have been suggested. For example, cavitation is believed to be the predominant mechanism responsible for drug delivery in sonophoresis. This review presents details of various studies on sonophoresis including the latest trends, delivery of various therapeutic drugs, sonophoresis pathways and mechanisms, and outlook of future studies. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    Babović Ivana

    2010-01-01

    Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

  11. Assisted Vaginal Delivery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Assisted Vaginal Delivery Home For Patients Search FAQs Assisted Vaginal Delivery ... Delivery FAQ192, February 2016 PDF Format Assisted Vaginal Delivery Labor, Delivery, and Postpartum Care What is assisted ...

  12. Persistent Pain After Cesarean Delivery and Vaginal Delivery: A Prospective Cohort Study.

    Science.gov (United States)

    Kainu, J Petter; Halmesmäki, Erja; Korttila, Kari T; Sarvela, P Johanna

    2016-12-01

    Persistent pain after cesarean delivery and vaginal delivery has been the subject of only a few research articles. The primary outcome of our prospective study was the incidence of persistent pain and its association to mode of delivery. We also studied the nature and intensity of pain after delivery. A questionnaire was distributed on postpartum day 2 to 1052 women who had given birth vaginally and to 502 who had undergone cesarean delivery in a tertiary maternity hospital in Helsinki, Finland, in 2010. A second questionnaire was mailed to the women 1 year later. We recorded the women's health history, obstetric history and previous pain history, details of cesarean delivery or vaginal delivery, and description of pain, if present. The incidence of persistent pain at 1 year after delivery was greater after cesarean delivery (85/379 [22%]) than after vaginal delivery (58/713 [8%]: P delivery as a predictor of persistent pain. The incidence of persistent pain graded as moderate or more severe (25/379 [7%] vs 25/713 [4%]: P = .022, relative risk 1.9, 95% confidence interval 1.1-3.2) was also greater after cesarean delivery than vaginal delivery. The incidence of persistent pain was significantly more common in women with a history of previous pain and among primiparous women in logistic regression analysis. The women with persistent pain had experienced more pain the day after cesarean delivery (P = .023) and during vaginal delivery (P = .030) than those who did not report persistent pain. Complications such as perineal trauma, episiotomy, vacuum extraction, endometritis, wound infection, or ante- or postpartum depression did not predispose women to persistent pain. Dyspareunia was reported by 41% of women after vaginal delivery and by 2% after cesarean delivery among women with persistent pain at 1 year. The incidence of persistent pain at 1 year is greater after cesarean delivery than after vaginal delivery. Pain shortly after cesarean delivery and during vaginal

  13. The association between manual mode defibrillation, pre-shock pause duration and appropriate shock delivery when employed by basic life support paramedics during out-of-hospital cardiac arrest.

    Science.gov (United States)

    Cheskes, Sheldon; Hillier, Morgan; Byers, Adam; Verbeek, P Richard; Drennan, Ian R; Zhan, Cathy; Morrison, Laurie J

    2015-05-01

    Pre-shock pause duration of defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by advanced life support paramedics (ALS) whereas defibrillator only paramedics (basic life support or BLS) routinely use the defibrillator in automatic mode. We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and rate of inappropriate shocks when defibrillation is provided by ALS vs. BLS trained in manual mode defibrillation. We performed a retrospective review of all treated non-traumatic adult out-of-hospital cardiac arrest (OHCA) presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by BLS with pre-shock pause duration of defibrillation was performed in 155 (46%) of these cases (196 shocks by ALS, 143 shocks by BLS). There were no differences in the proportion of shocks delivered with pre-shock pause duration defibrillation by BLS paramedics produced similar measures of pre-shock pause duration when compared to ALS paramedics without increasing the incidence of inappropriate shocks. Further study is required to determine the potential impact of BLS manual mode defibrillation on clinical outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy

    OpenAIRE

    Webb, Thomas L; Joseph, Judith; Yardley, Lucy; Michie, Susan

    2010-01-01

    Background: The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness.Objectives: The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions...

  15. Using the internet to promote health behavior change: A\\ud systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy

    OpenAIRE

    Webb, Thomas L.; Joseph, Judith; Yardley, Lucy; Michie, Susan

    2010-01-01

    Background: The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness.\\ud \\ud Objectives: The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based inter...

  16. Twin deliveries in Sacred Heart Catholic Hospital Obudu ...

    African Journals Online (AJOL)

    The case files of all patients who had twin deliveries from 1st January 2009 to 31st December 2014 were studied. The data extracted were age, parity; presentation of foetuses, mode of delivery, gestational age at delivery, maternal and foetal complications, Apgar score and foetal outcome. The data was analysed using IBM ...

  17. Delivery validation of an automated modulated electron radiotherapy plan

    International Nuclear Information System (INIS)

    Connell, T.; Papaconstadopoulos, P.; Alexander, A.; Serban, M.; Devic, S.; Seuntjens, J.

    2014-01-01

    Purpose: Modulated electron radiation therapy (MERT) represents an active area of interest that offers the potential to improve healthy tissue sparing in treatment of certain cancer cases. Challenges remain however in accurate beamlet dose calculation, plan optimization, collimation method, and delivery accuracy. In this work, the authors investigate the accuracy and efficiency of an end-to-end MERT plan and automated delivery method. Methods: Treatment planning was initiated on a previously treated whole breast irradiation case including an electron boost. All dose calculations were performed using Monte Carlo methods and beam weights were determined using a research-based treatment planning system capable of inverse optimization. The plan was delivered to radiochromic film placed in a water equivalent phantom for verification, using an automated motorized tertiary collimator. Results: The automated delivery, which covered four electron energies, 196 subfields, and 6183 total MU was completed in 25.8 min, including 6.2 min of beam-on time. The remainder of the delivery time was spent on collimator leaf motion and the automated interfacing with the accelerator in service mode. Comparison of the planned and delivered film dose gave 3%/3mm gamma pass rates of 62.1%, 99.8%, 97.8%, 98.3%, and 98.7% for the 9, 12, 16, and 20 MeV, and combined energy deliveries, respectively. Delivery was also performed with a MapCHECK device and resulted in 3%/3  mm gamma pass rates of 88.8%, 86.1%, 89.4%, and 94.8% for the 9, 12, 16, and 20 MeV energies, respectively. Conclusions: Results of the authors’ study showed that an accurate delivery utilizing an add-on tertiary electron collimator is possible using Monte Carlo calculated plans and inverse optimization, which brings MERT closer to becoming a viable option for physicians in treating superficial malignancies

  18. Document delivery services contrasting views

    CERN Document Server

    1999-01-01

    Design and maintain document delivery services that are ideal for academic patrons! In Document Delivery Services: Contrasting Views, you'll visit four university library systems to discover the considerations and challenges each library faced in bringing document delivery to its clientele. This book examines the questions about document delivery that are most pressing in the profession of library science. Despite their own unique experiences, you'll find common practices among all four?including planning, implementation of service, and evaluation of either user satisfaction and/or vendor per

  19. Electronic Nicotine Delivery Systems Key Facts Infographic

    Data.gov (United States)

    U.S. Department of Health & Human Services — Explore the Electronic Nicotine Delivery Systems Key Facts Infographic which outlines key facts related to electronic nicotine delivery systems (ENDS), including...

  20. A prova de trabalho e a via de parto em primíparas com uma cesárea anterior Factors associated with mode of delivery among primipara women with one previous cesarean section and undergoing a trial of labor

    Directory of Open Access Journals (Sweden)

    Jacinta Pereira Matias

    2007-04-01

    Full Text Available OBJETIVO: Identificar fatores associados à cesárea em mulheres com um único parto anterior por cesárea e submetidas à prova de trabalho de parto. MÉTODOS: Estudo de corte transversal retrospectivo, incluindo 1746 mulheres com uma cesárea anterior submetidas à prova de trabalho de parto no segundo parto ocorrendo entre 1986 e 1998. Foram excluídos os casos com atual gestação múltipla e/ou com malformações fetais incompatíveis com a vida. Elas foram divididas pelo tipo de parto atual em dois grupos: cesárea (n=731 e parto vaginal após cesárea (PVAC, n=1015. A análise estatística para a identificação de fatores associados ao tipo de parto foi feita por meio do cálculo da razão de prevalência (RP e IC 95%, sendo feito também o ajuste por idade, excluindo-se os casos com informações ignoradas em cada análise. RESULTADOS: A taxa total de parto vaginal após cesárea foi de 58,1%. Os fatores significativamente associados com parto por cesárea foram: maior idade materna, maior altura uterina (RP 1,5; IC 95% 1,19-1,88, rotura prematura de membranas (1,3; 1,08-1,54, líquido amniótico não claro (1,22; 1,04-1,43 ou com quantidade alterada (1,32; 1,01-1,73, alteração dos batimentos cardíacos fetais (1,96; 1,68-2,28, apresentação não cefálica (2,03; 1,54-2,66, indução do parto (1,74; 1,42-2,11 e ausência de analgesia (2,57; 2,11-3,11. CONCLUSÃO: Os fatores associados ao parto por cesárea foram a maior idade, apresentação não-cefálica, rotura prematura de membranas, fetos grandes, necessidade de indução do trabalho de parto, e sinais de comprometimento da vitalidade fetal.OBJECTIVE: To identify factors associated with cesarean section in women with only one previous delivery by cesarean section and undergoing a trial of labor. METHODS: A retrospective cross sectional study was performed from 1986 to 1998 including a total of 1746 women with one prior cesarean section and delivering after a trial of labor

  1. Higher order mode optical fiber Raman amplifiers

    DEFF Research Database (Denmark)

    Rottwitt, Karsten; Friis, Søren Michael Mørk; Usuga Castaneda, Mario A.

    2016-01-01

    We review higher order mode Raman amplifiers and discuss recent theoretical as well as experimental results including system demonstrations.......We review higher order mode Raman amplifiers and discuss recent theoretical as well as experimental results including system demonstrations....

  2. Drug delivery and formulations.

    Science.gov (United States)

    Breitkreutz, Jörg; Boos, Joachim

    2011-01-01

    Paediatric drug delivery is a major challenge in drug development. Because of the heterogeneous nature of the patient group, ranging from newborns to adolescents, there is a need to use appropriate excipients, drug dosage forms and delivery devices for different age groups. So far, there is a lack of suitable and safe drug formulations for children, especially for the very young and seriously ill patients. The new EU legislation will enforce paediatric clinical trials and drug development. Current advances in paediatric drug delivery include interesting new concepts such as fast-dissolving drug formulations, including orodispersible tablets and oral thin strips (buccal wafers), and multiparticulate dosage forms based on mini-tabletting or pelletization technologies. Parenteral administration is likely to remain the first choice for children in the neonatal period and for emergency cases. Alternative routes of administration include transdermal, pulmonary and nasal drug delivery systems. A few products are already available on the market, but others still need further investigations and clinical proof of concept.

  3. Higher Order Mode Fibers

    DEFF Research Database (Denmark)

    Israelsen, Stine Møller

    . In the second part of the thesis, a new scheme for constructing chirped microbend long period gratings is presented. The method presents a versatile platform for tailoring the chirp to the phase matching profile of the targeted HOM conversion in the fiber under test. The scheme introduces the ability......This PhD thesis considers higher order modes (HOMs) in optical fibers. That includes their excitation and characteristics. Within the last decades, HOMs have been applied both for space multiplexing in optical communications, group velocity dispersion management and sensing among others......-radial polarization as opposed to the linear polarization of the LP0X modes. The effect is investigated numerically in a double cladding fiber with an outer aircladding using a full vectorial modesolver. Experimentally, the bowtie modes are excited using a long period grating and their free space characteristics...

  4. Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review.

    Science.gov (United States)

    Garvey, Gráinne Patricia; Wasade, Vibhangini S; Murphy, Kellie E; Balki, Mrinalini

    2017-09-01

    Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken. Hospital records and electronic databases were interrogated using International Classification of Diseases, 10th Revision codes and the keywords "syringomyelia," "syringobulbia," and "pregnancy." Data regarding demographics, diagnosis, radiology reports, neurological symptoms, mode of delivery, anesthetic management, and maternal-fetal outcomes were collected. We collected and analyzed data on a total of 43 pregnancies in 39 patients. The most common location for syrinx was in the cervicothoracic region (41.9%). The large majority of patients (n = 34; 87%) demonstrated signs and symptoms associated with syringomyelia before delivery. Syringomyelia associated with Arnold Chiari malformation was documented in 49% (n = 21) cases. General anesthesia was the most commonly used (n = 21/30, 70%) anesthetic technique for cesarean delivery. The majority (n = 9/13, 69%) of patients had an epidural sited for labor analgesia. There were no maternal or neonatal complications associated with neuraxial anesthesia; however, 3 cases (14%) raised concerns regarding general anesthesia including difficult intubation, transient worsening of neurological symptoms postpartum, and prolonged muscle paralysis after atracurium. Despite concerns regarding aggravation of the syrinx with vaginal delivery, this mode of delivery has never caused any documented long-term worsening of neurological

  5. Regional Delivery of Chimeric Antigen Receptor (CAR T-Cells for Cancer Therapy

    Directory of Open Access Journals (Sweden)

    Praveen Sridhar

    2017-07-01

    Full Text Available Chimeric Antigen Receptor (CAR T-cells are T-cells with recombinant receptors targeted to tumor antigens. CAR-T cell therapy has emerged as a mode of immunotherapy and is now being extensively explored in hematologic cancer. In contrast, CAR-T cell use in solid tumors has been hampered by multiple obstacles. Several approaches have been taken to circumvent these obstacles, including the regional delivery of CAR-T cells. Regional CAR-T cell delivery can theoretically compensate for poor T-cell trafficking and tumor antigen specificity while avoiding systemic toxicity associated with intravenous delivery. We reviewed completed clinical trials for the treatment of glioblastoma and metastatic colorectal cancer and examined the data in these studies for safety, efficacy, and potential advantages that regional delivery may confer over systemic delivery. Our appraisal of the available literature revealed that regional delivery of CAR-T cells in both glioblastoma and hepatic colorectal metastases was generally well tolerated and efficacious in select instances. We propose that the regional delivery of CAR-T cells is an area of potential growth in the solid tumor immunotherapy, and look towards future clinical trials in head and neck cancer, mesothelioma, and peritoneal carcinomatosis as the use of this technique expands.

  6. Regional Delivery of Chimeric Antigen Receptor (CAR) T-Cells for Cancer Therapy.

    Science.gov (United States)

    Sridhar, Praveen; Petrocca, Fabio

    2017-07-18

    Chimeric Antigen Receptor (CAR) T-cells are T-cells with recombinant receptors targeted to tumor antigens. CAR-T cell therapy has emerged as a mode of immunotherapy and is now being extensively explored in hematologic cancer. In contrast, CAR-T cell use in solid tumors has been hampered by multiple obstacles. Several approaches have been taken to circumvent these obstacles, including the regional delivery of CAR-T cells. Regional CAR-T cell delivery can theoretically compensate for poor T-cell trafficking and tumor antigen specificity while avoiding systemic toxicity associated with intravenous delivery. We reviewed completed clinical trials for the treatment of glioblastoma and metastatic colorectal cancer and examined the data in these studies for safety, efficacy, and potential advantages that regional delivery may confer over systemic delivery. Our appraisal of the available literature revealed that regional delivery of CAR-T cells in both glioblastoma and hepatic colorectal metastases was generally well tolerated and efficacious in select instances. We propose that the regional delivery of CAR-T cells is an area of potential growth in the solid tumor immunotherapy, and look towards future clinical trials in head and neck cancer, mesothelioma, and peritoneal carcinomatosis as the use of this technique expands.

  7. Socio-Cultural Beliefs, Values and Traditions Regarding Women's Preferred Mode of Birth in the North of Iran.

    Science.gov (United States)

    Latifnejad Roudsari, Robab; Zakerihamidi, Maryam; Merghati Khoei, Effat

    2015-07-01

    Pregnant women rely heavily on informal information while making a decision about the mode of delivery they would rather have, either as normal vaginal delivery (NVD) or cesarean section (CS). Through recognition of social attitudes towards different modes of delivery, societies can be directed towards a positive understanding of vaginal delivery, which can ultimately lead to maternal health promotion. Thus, this study aimed to explore the common beliefs, values and traditions surrounding women's preferred mode of birth in the North of Iran. Using a focused ethnographic approach, twelve pregnant women, 10 women with previous experience of childbirth, seven midwives, seven obstetricians, and nine non-pregnant women were included in this study through a purposeful sampling in health clinics of Tonekabon in the North of Iran. Semi-structured interviews and participant observations were used for data collection. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using Braun & Clarke thematic analysis (2006) and MAXqda software. Through analysis, three major themes and 10 subthemes emerged.  They included: 1) sociocultural childbirth beliefs with five subthemes: a) CS as protector of genital tract integrity, b) blind imitation in choosing mode of birth, c) NVD as a low cost type of delivery,  d) CS as a prestigious mode of birth and, e) NVD as a symbol of woman's power and ability; 2) traditional health beliefs with two subthemes: a) NVD as a guarantee for woman's health, b) traditional childbirth facilitators; 3) religious beliefs and values with three subthemes: a) NVD as a symbol of God's power, b) call for help from the Mighty God, and c) NVD as a sacred phenomenon. The results of this study indicated that cultural beliefs, values and traditions can significantly affect individuals' attitudes towards modes of delivery, their definitions of different modes, and the decisions

  8. Socio-Cultural Beliefs, Values and Traditions Regarding Women’s Preferred Mode of Birth in the North of Iran

    Science.gov (United States)

    Latifnejad Roudsari, Robab; Zakerihamidi, Maryam; Merghati Khoei, Effat

    2015-01-01

    Background Pregnant women rely heavily on informal information while making a decision about the mode of delivery they would rather have, either as normal vaginal delivery (NVD) or cesarean section (CS). Through recognition of social attitudes towards different modes of delivery, societies can be directed towards a positive understanding of vaginal delivery, which can ultimately lead to maternal health promotion. Thus, this study aimed to explore the common beliefs, values and traditions surrounding women’s preferred mode of birth in the North of Iran. Methods Using a focused ethnographic approach, twelve pregnant women, 10 women with previous experience of childbirth, seven midwives, seven obstetricians, and nine non-pregnant women were included in this study through a purposeful sampling in health clinics of Tonekabon in the North of Iran. Semi-structured interviews and participant observations were used for data collection. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using Braun & Clarke thematic analysis (2006) and MAXqda software. Results Through analysis, three major themes and 10 subthemes emerged.  They included: 1) sociocultural childbirth beliefs with five subthemes: a) CS as protector of genital tract integrity, b) blind imitation in choosing mode of birth, c) NVD as a low cost type of delivery,  d) CS as a prestigious mode of birth and, e) NVD as a symbol of woman’s power and ability; 2) traditional health beliefs with two subthemes: a) NVD as a guarantee for woman’s health, b) traditional childbirth facilitators; 3) religious beliefs and values with three subthemes: a) NVD as a symbol of God’s power, b) call for help from the Mighty God, and c) NVD as a sacred phenomenon. Conclusion The results of this study indicated that cultural beliefs, values and traditions can significantly affect individuals’ attitudes towards modes of delivery, their

  9. Caesarean delivery and risk of developing asthma in the offspring

    DEFF Research Database (Denmark)

    Werner, Anette; Ramlau-Hansen, Cecilia Høst; Jeppesen, Simone K

    2007-01-01

    AIM: To evaluate the association between caesarean section and risk of developing asthma. METHOD: We evaluated this association in a Danish cohort, comprising of 11,147 mothers and their babies of which 7119 mother-child pairs were included in the analyses. The mothers' reported asthma data...... on their children were linked to hospitalization records on mode of delivery. RESULTS: The adjusted odds ratio for developing asthma was 1.11 (95% CI, 0.88-1.39) for caesarean sections versus vaginal births. CONCLUSION: We found no evidence that children being delivered by caesarean section have an increased risk...... of asthma....

  10. Ex vivo culture of patient tissue & examination of gene delivery.

    LENUS (Irish Health Repository)

    Rajendran, Simon

    2012-01-31

    This video describes the use of patient tissue as an ex vivo model for the study of gene delivery. Fresh patient tissue obtained at the time of surgery is sliced and maintained in culture. The ex vivo model system allows for the physical delivery of genes into intact patient tissue and gene expression is analysed by bioluminescence imaging using the IVIS detection system. The bioluminescent detection system demonstrates rapid and accurate quantification of gene expression within individual slices without the need for tissue sacrifice. This slice tissue culture system may be used in a variety of tissue types including normal and malignant tissue and allows us to study the effects of the heterogeneous nature of intact tissue and the high degree of variability between individual patients. This model system could be used in certain situations as an alternative to animal models and as a complementary preclinical mode prior to entering clinical trial.

  11. [Delivery of the IUGR fetus].

    Science.gov (United States)

    Perrotin, F; Simon, E G; Potin, J; Laffon, M

    2013-12-01

    The purpose of this paper is to review available data regarding the management of delivery in intra uterine growth retarded fetuses and try to get recommendations for clinical obstetrical practice. Bibliographic research performed by consulting PubMed database and recommendations from scientific societies with the following words: small for gestational age, intra-uterine growth restriction, fetal growth restriction, very low birth weight infants, as well as mode of delivery, induction of labor, cesarean section and operative delivery. The diagnosis of severe IUGR justifies the orientation of the patient to a referral centre with all necessary resources for very low birth weight or premature infants Administration of corticosteroids for fetal maturation (before 34 WG) and a possible neuroprotective treatment by with magnesium sulphate (before 32-33 WG) should be discussed. Although elective caesarean section is common, there is no current evidence supporting the use of systematic cesarean section, especially when the woman is in labor. Induction of labor, even with unfavorable cervix is possible under continuous FHR monitoring, in favorable obstetric situations and in the absence of severe fetal hemodynamic disturbances. Instrumental delivery and routine episiotomy are not recommended. For caesarean section under spinal anesthesia, an adequate anesthetic management must ensure the maintenance of basal blood pressure. Compared with appropriate for gestational age fetus, IUGR fetus is at increased risk of metabolic acidosis or perinatal asphyxia during delivery. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Report of the Production and Delivery Subgroup

    Energy Technology Data Exchange (ETDEWEB)

    Glass, R; Zalesky, R

    2004-11-01

    The Production and Delivery Subgroup was tasked with evaluating the various options that could be used for hydrogen production and delivery in terms of availability/industry readiness, technical and economic barriers, and environmental considerations. Hydrogen can be produced using a variety of feedstocks and conversion technologies. The feedstock options include water, natural gas, coal, petroleum, methanol, ethanol, biomass, and organic waste streams. Ultimately, using these domestic resources we will be able to produce all the hydrogen we will need for the complete conversion of our transportation infrastructure. The various conversion technologies include electrolysis, reforming (principally of natural gas, but also ethanol and methanol), photobiological and photoelectrochemical, biofermentation, pyrolysis and gasification of biomass and coal, high temperature thermochemical, and catalytic membranes. All of these production technologies are being actively researched by DOE's Office of Hydrogen, Fuel Cells and Infrastructure Technologies (HFCIT); and other offices within DOE support work that complements the HFCIT Program activities. In addition, private industry is also dedicating significant resources to these efforts. In establishing the California Hydrogen Highway Network (CA H2 Net) we must utilize both distributed (that is, hydrogen that is produced at the point of use) as well as centralized production of hydrogen. Because of technical and economic barriers, most of the technologies for hydrogen production listed above will not become practical for either mode of hydrogen production in large quantities until at least the 2015-2030 timeframe. In the near term, that is, the transitional period between now and 2010 when we will establish a widely available hydrogen fueling infrastructure in California, the distributed production options of reforming and electrolysis will play the dominant role. In addition, production of hydrogen at centralized plants

  13. Effect of heterogeneous microvasculature distribution on drug delivery to solid tumour

    International Nuclear Information System (INIS)

    Zhan, Wenbo; Xu, Xiao Yun; Gedroyc, Wladyslaw

    2014-01-01

    Most of the computational models of drug transport in vascular tumours assume a uniform distribution of blood vessels through which anti-cancer drugs are delivered. However, it is well known that solid tumours are characterized by dilated microvasculature with non-uniform diameters and irregular branching patterns. In this study, the effect of heterogeneous vasculature on drug transport and uptake is investigated by means of mathematical modelling of the key physical and biochemical processes in drug delivery. An anatomically realistic tumour model accounting for heterogeneous distribution of blood vessels is reconstructed based on magnetic resonance images of a liver tumour. Numerical simulations are performed for different drug delivery modes, including direct continuous infusion and thermosensitive liposome-mediated delivery, and the anti-cancer effectiveness is evaluated through changes in tumour cell density based on predicted intracellular concentrations. Comparisons are made between regions of different vascular density, and between the two drug delivery modes. Our numerical results show that both extra- and intra-cellular concentrations in the liver tumour are non-uniform owing to the heterogeneous distribution of tumour vasculature. Drugs accumulate faster in well-vascularized regions, where they are also cleared out more quickly, resulting in less effective tumour cell killing in these regions. Compared with direct continuous infusion, the influence of heterogeneous vasculature on anti-cancer effectiveness is more pronounced for thermosensitive liposome-mediated delivery. (paper)

  14. Previous prelabor or intrapartum cesarean delivery and risk of placenta previa.

    Science.gov (United States)

    Downes, Katheryne L; Hinkle, Stefanie N; Sjaarda, Lindsey A; Albert, Paul S; Grantz, Katherine L

    2015-05-01

    The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before the onset of labor from intrapartum cesarean delivery. We conducted a retrospective cohort study of electronic medical records from 20 Utah hospitals (2002-2010) with restriction to the first 2 singleton deliveries of nulliparous women at study entry (n=26,987). First pregnancy delivery mode was classified as (1) vaginal (reference), (2) cesarean delivery before labor onset (prelabor), or (3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by previous delivery mode with the use of logistic regression and was adjusted for maternal age, insurance, smoking, comorbidities, previous pregnancy loss, and history of previa. Most first deliveries were vaginal (82%; n=22,142), followed by intrapartum cesarean delivery (14.6%; n=3931), or prelabor cesarean delivery (3.4%; n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by previous delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (Pdelivery, previous prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62; 95% confidence interval, 1.24-5.56). There was no significant association between previous intrapartum cesarean delivery and previa (adjusted odds ratio, 1.22; 95% confidence interval, 0.68-2.19). Previous prelabor cesarean delivery was associated with a >2-fold significantly increased risk of previa in the second delivery, although the approximately 20% increased risk of previa that was associated with previous intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after previous prelabor cesarean delivery may be important when considering nonmedically indicated prelabor cesarean delivery. Published by Elsevier Inc.

  15. Prior Prelabor or Intrapartum Cesarean Delivery and Risk of Placenta Previa

    Science.gov (United States)

    Downes, Katheryne L.; Hinkle, Stefanie N.; Sjaarda, Lindsey A.; Albert, Paul S.; Grantz, Katherine L.

    2015-01-01

    Objective To examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery prior to onset of labor from intrapartum cesarean delivery. Study Design Retrospective cohort study of electronic medical records from 20 Utah hospitals (2002–2010) with restriction to the first two singleton deliveries of women nulliparous at study entry (n=26,987). First pregnancy delivery mode was classified as 1) vaginal (reference); 2) cesarean delivery prior to labor onset (prelabor); or 3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by prior delivery mode using logistic regression and adjusted for maternal age, insurance, smoking, co-morbidities, prior pregnancy loss, and history of previa. Results The majority of first deliveries were vaginal (82%, n=22,142), followed by intrapartum cesarean delivery (14.6%, n=3,931), or prelabor cesarean delivery (3.4%, n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by prior delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (Pdelivery, prior prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62 [95% confidence interval, 1.24–5.56]). There was no significant association between prior intrapartum cesarean delivery and previa [adjusted odds ratio, 1.22 (95% confidence interval, 0.68–2.19)]. Conclusion Prior prelabor cesarean delivery was associated with a more than two-fold significantly increased risk of previa in the second delivery, while the approximately 20% increased risk of previa associated with prior intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after prior prelabor cesarean delivery may be important when considering non-medically indicated prelabor cesarean delivery. PMID:25576818

  16. Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature.

    Science.gov (United States)

    Dall'Asta, Andrea; Ghi, Tullio; Pedrazzi, Giuseppe; Frusca, Tiziana

    2016-09-01

    Vacuum extractor has been increasingly used over the last decades and is acknowledged as a risk factor for shoulder dystocia (SD). In this meta-analysis we assess the actual risk of SD following a vacuum delivery compared to spontaneous vaginal delivery (SVD) and forceps. Systematic literature search (English literature only) on MEDLINE, EMBASE, ScienceDirect, the Cochrane library and ClinicalTrials.gov conducted up to May 2015. Key search terms included: Operative/Vacuum/Forceps delivery [Mesh] and shoulder dystocia and subheadings. 2 stage-process study selection. We included only studies where data concerning the occurrence of SD following operative vaginal delivery were reported as adjusted odds ratio (AOR) and no significant difference in confounding factors for SD was recorded. Included trials clustered according to the delivery mode (1) vacuum vs. SVD, (2) forceps vs. vacuum. Methodological quality of each study evaluated with the Newcastle-Ottawa System (NOS). 87 potentially relevant papers. After applying inclusion and exclusion criteria only 7 were selected for the meta-analysis. Vacuum delivery appeared associated with a higher risk of SD than SVD in both fixed and random model (OR 2.87 and 2.98 respectively). No difference in the rate of SD was found between vacuum and forceps (p>0.05). Vacuum extractor carries an increased risk of SD compared with spontaneous vaginal delivery whereas the occurrence of SD does not seem to vary following vacuum or forceps. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Cry protein crystals: a novel platform for protein delivery.

    Science.gov (United States)

    Nair, Manoj S; Lee, Marianne M; Bonnegarde-Bernard, Astrid; Wallace, Julie A; Dean, Donald H; Ostrowski, Michael C; Burry, Richard W; Boyaka, Prosper N; Chan, Michael K

    2015-01-01

    Protein delivery platforms are important tools in the development of novel protein therapeutics and biotechnologies. We have developed a new class of protein delivery agent based on sub-micrometer-sized Cry3Aa protein crystals that naturally form within the bacterium Bacillus thuringiensis. We demonstrate that fusion of the cry3Aa gene to that of various reporter proteins allows for the facile production of Cry3Aa fusion protein crystals for use in subsequent applications. These Cry3Aa fusion protein crystals are efficiently taken up and retained by macrophages and other cell lines in vitro, and can be delivered to mice in vivo via multiple modes of administration. Oral delivery of Cry3Aa fusion protein crystals to C57BL/6 mice leads to their uptake by MHC class II cells, including macrophages in the Peyer's patches, supporting the notion that the Cry3Aa framework can be used to stabilize cargo protein against degradation for delivery to gastrointestinal lymphoid tissues.

  18. Cry protein crystals: a novel platform for protein delivery.

    Directory of Open Access Journals (Sweden)

    Manoj S Nair

    Full Text Available Protein delivery platforms are important tools in the development of novel protein therapeutics and biotechnologies. We have developed a new class of protein delivery agent based on sub-micrometer-sized Cry3Aa protein crystals that naturally form within the bacterium Bacillus thuringiensis. We demonstrate that fusion of the cry3Aa gene to that of various reporter proteins allows for the facile production of Cry3Aa fusion protein crystals for use in subsequent applications. These Cry3Aa fusion protein crystals are efficiently taken up and retained by macrophages and other cell lines in vitro, and can be delivered to mice in vivo via multiple modes of administration. Oral delivery of Cry3Aa fusion protein crystals to C57BL/6 mice leads to their uptake by MHC class II cells, including macrophages in the Peyer's patches, supporting the notion that the Cry3Aa framework can be used to stabilize cargo protein against degradation for delivery to gastrointestinal lymphoid tissues.

  19. Cry Protein Crystals: A Novel Platform for Protein Delivery

    Science.gov (United States)

    Bonnegarde-Bernard, Astrid; Wallace, Julie A.; Dean, Donald H.; Ostrowski, Michael C.; Burry, Richard W.; Boyaka, Prosper N.; Chan, Michael K.

    2015-01-01

    Protein delivery platforms are important tools in the development of novel protein therapeutics and biotechnologies. We have developed a new class of protein delivery agent based on sub-micrometer-sized Cry3Aa protein crystals that naturally form within the bacterium Bacillus thuringiensis. We demonstrate that fusion of the cry3Aa gene to that of various reporter proteins allows for the facile production of Cry3Aa fusion protein crystals for use in subsequent applications. These Cry3Aa fusion protein crystals are efficiently taken up and retained by macrophages and other cell lines in vitro, and can be delivered to mice in vivo via multiple modes of administration. Oral delivery of Cry3Aa fusion protein crystals to C57BL/6 mice leads to their uptake by MHC class II cells, including macrophages in the Peyer’s patches, supporting the notion that the Cry3Aa framework can be used to stabilize cargo protein against degradation for delivery to gastrointestinal lymphoid tissues. PMID:26030844

  20. The association between cesarean delivery on maternal request and method of newborn feeding in China.

    Directory of Open Access Journals (Sweden)

    Xinxue Liu

    Full Text Available Cesarean delivery has increased significantly during the last decades. This study aimed to investigate the association between planned mode of delivery and method of feeding.A cohort was created retrospectively using data from a population-based maternal and child health surveillance system, which covers 27 study sites in China from 1993 to 2006. The cohort consisted of 431,704 women for analysis, including 22,462 women with planned cesarean delivery on maternal request (CDMR and 409,242 women with planned vaginal delivery (VD. Logistic regression models were used to examine the association between mode of delivery and method of feeding adjusting for selected covariates. In this cohort, 398,176 (92.2% women exclusively breastfed their baby, 28,798 (6.7% women chose mixed feeding, and 4,730 (1.1% women chose formula feeding before hospital discharge. Women who planned CDMR were less likely to exclusively breastfeed and more likely to formula feed their babies than those who planned VD. After adjusting for covariates, the odds ratios were 0.85 (95% CI: 0.81-0.89 for exclusive breastfeeding and 1.61 (95% CI: 1.45-1.79 for formula feeding. Associations between planned mode of delivery and method of feeding in the south, north, rural and urban areas yielded similar results.This study demonstrated that planned CDMR was associated with a lower rate of exclusive breastfeeding and a higher rate of formula feeding in a low-risk Chinese population.

  1. The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

    Science.gov (United States)

    Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

    2018-03-01

     The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Assisted delivery with forceps

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000509.htm Assisted delivery with forceps To use the sharing features on ... called vacuum assisted delivery . When is a Forceps Delivery Needed? Even after your cervix is fully dilated ( ...

  3. Vaginal delivery - discharge

    Science.gov (United States)

    Pregnancy - discharge after vaginal delivery ... return in: 4 to 9 weeks after your delivery if you're not breastfeeding 3 to 12 ... can start sexual activity around 6 weeks after delivery, if the discharge or lochia has stopped. Women ...

  4. A meta-analysis of overall effects of weight loss interventions delivered via mobile phones and effect size differences according to delivery mode, personal contact, and intervention intensity and duration

    NARCIS (Netherlands)

    Schippers, M; Adam, P C G; Smolenski, D J; Wong, H T H; de Wit, J B F|info:eu-repo/dai/nl/06883652X

    Weight loss interventions are delivered through various mediums including, increasingly, mobile phones. This systematic review and meta-analysis assesses whether interventions delivered via mobile phones reduce body weight and which intervention characteristics are associated with efficacy. The

  5. Oral delivery of anticancer drugs

    DEFF Research Database (Denmark)

    Thanki, Kaushik; Gangwal, Rahul P; Sangamwar, Abhay T

    2013-01-01

    The present report focuses on the various aspects of oral delivery of anticancer drugs. The significance of oral delivery in cancer therapeutics has been highlighted which principally includes improvement in quality of life of patients and reduced health care costs. Subsequently, the challenges...... incurred in the oral delivery of anticancer agents have been especially emphasized. Sincere efforts have been made to compile the various physicochemical properties of anticancer drugs from either literature or predicted in silico via GastroPlus™. The later section of the paper reviews various emerging...... trends to tackle the challenges associated with oral delivery of anticancer drugs. These invariably include efflux transporter based-, functional excipient- and nanocarrier based-approaches. The role of drug nanocrystals and various others such as polymer based- and lipid based...

  6. Mucoadhesive drug delivery systems

    Directory of Open Access Journals (Sweden)

    Rahamatullah Shaikh

    2011-01-01

    Full Text Available Mucoadhesion is commonly defined as the adhesion between two materials, at least one of which is a mucosal surface. Over the past few decades, mucosal drug delivery has received a great deal of attention. Mucoadhesive dosage forms may be designed to enable prolonged retention at the site of application, providing a controlled rate of drug release for improved therapeutic outcome. Application of dosage forms to mucosal surfaces may be of benefit to drug molecules not amenable to the oral route, such as those that undergo acid degradation or extensive first-pass metabolism. The mucoadhesive ability of a dosage form is dependent upon a variety of factors, including the nature of the mucosal tissue and the physicochemical properties of the polymeric formulation. This review article aims to provide an overview of the various aspects of mucoadhesion, mucoadhesive materials, factors affecting mucoadhesion, evaluating methods, and finally various mucoadhesive drug delivery systems (buccal, nasal, ocular, gastro, vaginal, and rectal.

  7. Document Delivery: Evaluating the Options.

    Science.gov (United States)

    Ward, Suzanne M.

    1997-01-01

    Discusses options available to libraries for document delivery. Topics include users' needs; cost; copyright compliance; traditional interlibrary loan; types of suppliers; selection criteria, including customer service; new developments in interlibrary loan, including outsourcing arrangements; and the need to evaluate suppliers. (LRW)

  8. Protein nanoparticles for therapeutic protein delivery.

    Science.gov (United States)

    Herrera Estrada, L P; Champion, J A

    2015-06-01

    Therapeutic proteins can face substantial challenges to their activity, requiring protein modification or use of a delivery vehicle. Nanoparticles can significantly enhance delivery of encapsulated cargo, but traditional small molecule carriers have some limitations in their use for protein delivery. Nanoparticles made from protein have been proposed as alternative carriers and have benefits specific to therapeutic protein delivery. This review describes protein nanoparticles made by self-assembly, including protein cages, protein polymers, and charged or amphipathic peptides, and by desolvation. It presents particle fabrication and delivery characterization for a variety of therapeutic and model proteins, as well as comparison of the features of different protein nanoparticles.

  9. Scaling service delivery in a failed state

    NARCIS (Netherlands)

    Muilerman, Sander; Vellema, Sietze

    2017-01-01

    The increased use of sustainability standards in the international trade in cocoa challenges companies to find effective modes of service delivery to large numbers of small-scale farmers. A case study of the Sustainable Tree Crops Program targeting the small-scale cocoa producers in Côte d’Ivoire

  10. Sci—Thur PM: Planning and Delivery — 03: Automated delivery and quality assurance of a modulated electron radiation therapy plan

    International Nuclear Information System (INIS)

    Connell, T; Papaconstadopoulos, P; Alexander, A; Serban, M; Devic, S; Seuntjens, J

    2014-01-01

    Modulated electron radiation therapy (MERT) offers the potential to improve healthy tissue sparing through increased dose conformity. Challenges remain, however, in accurate beamlet dose calculation, plan optimization, collimation method and delivery accuracy. In this work, we investigate the accuracy and efficiency of an end-to-end MERT plan and automated-delivery workflow for the electron boost portion of a previously treated whole breast irradiation case. Dose calculations were performed using Monte Carlo methods and beam weights were determined using a research-based treatment planning system capable of inverse optimization. The plan was delivered to radiochromic film placed in a water equivalent phantom for verification, using an automated motorized tertiary collimator. The automated delivery, which covered 4 electron energies, 196 subfields and 6183 total MU was completed in 25.8 minutes, including 6.2 minutes of beam-on time with the remainder of the delivery time spent on collimator leaf motion and the automated interfacing with the accelerator in service mode. The delivery time could be reduced by 5.3 minutes with minor electron collimator modifications and the beam-on time could be reduced by and estimated factor of 2–3 through redesign of the scattering foils. Comparison of the planned and delivered film dose gave 3%/3 mm gamma pass rates of 62.1, 99.8, 97.8, 98.3, and 98.7 percent for the 9, 12, 16, 20 MeV, and combined energy deliveries respectively. Good results were also seen in the delivery verification performed with a MapCHECK 2 device. The results showed that accurate and efficient MERT delivery is possible with current technologies

  11. Caesarean delivery: An experience from a tertiary institution in North ...

    African Journals Online (AJOL)

    increasing use of CS as a mode of delivery in Europe and the. USA is because of fear of malpractice litigation, increased ... Daniel and Singh: Caesarean delivery, Nigeria. 19. Nigerian Journal of Clinical Practice • Jan-Feb ..... Efetie RE, Umezulike AC, Agboghoroma CO. Caesarean section at the. National Hospital, Abuja ...

  12. Outcome of Term Singleton Breech Deliveries in a Tertiary Health ...

    African Journals Online (AJOL)

    Context: Breech delivery is generally associated with higher perinatal morbidity and mortality than cephalic presentation, and the optimal mode of delivery continues to be a source of debate. Objective:The aim of this study was to evaluate the perinatal and maternal morbidity and mortality associated with term breech ...

  13. Outcome of Breech Deliveries at a Tertiary Health Institution in ...

    African Journals Online (AJOL)

    Outcome of Breech Deliveries at a Tertiary Health Institution in Southwestern Nigeria. AS Adeyemi, DA Adekanle, AF Afolabi, FF Fadero. Abstract. The aetiology of breech presentation is not clear, however, several factors had been found to be associated with increased risk of breech presentation. The mode of delivery of ...

  14. Management of preterm delivery in women with abnormal fetal presentation

    NARCIS (Netherlands)

    Bergenhenegouwen, L.A.

    2015-01-01

    The aim of the thesis was to answer the following questions. 1. What is the optimal mode of delivery in preterm breech presentation? 2. Does an intended caesarean section reduce the risk of perinatal mortality and morbidity as compared to intended vaginal delivery in preterm breech presentation? 3.

  15. Intracellular Protein Delivery for Treating Breast Cancer

    Science.gov (United States)

    2014-08-01

    Intracellular delivery of such proteins, including human tumor suppressors (such as p53) (Brown et al., 2009) and exogenous tumor-killing proteins...vivo systems. Nature materials 11, 1038-1043. Chorny, M., Hood, E., Levy, R.J., and Muzykantov, V.R. (2010). Endothelial delivery of antioxidant ...for the ntracellular delivery of such proteins, including human umor suppressors [7] and exogenous tumor-killing proteins 8—10]), is attractive as a

  16. 37 CFR 255.4 - Definition of digital phonorecord delivery.

    Science.gov (United States)

    2010-07-01

    ... phonorecord delivery. 255.4 Section 255.4 Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF... delivery. A “digital phonorecord delivery” is each individual delivery of a phonorecord by digital... time or for a specified number of performances. A digital phonorecord delivery includes all...

  17. 48 CFR 552.211-80 - Age on Delivery.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Age on Delivery. 552.211... on Delivery. As prescribed in 511.404(a)(2) insert the following clause: Age on Delivery (FEB 1996) Included in the description of each shelf-life item is a statement regarding the “age on delivery.” The age...

  18. Clinical impact of and contributing factors to urinary incontinence in women 5 years after first delivery.

    Science.gov (United States)

    Liang, Ching-Chung; Wu, Ming-Ping; Lin, Shu-Jen; Lin, Yu-Jr; Chang, Shuenn-Dhy; Wang, Hui-Hsuan

    2013-01-01

    This study was conducted to investigate the prevalence of and contributing factors to urinary incontinence (UI) in women 5 years after their first birth and to evaluate the associations of UI with delivery mode and quality of life. Between 2005 July and 2006 March, primiparous women who delivered at term in a tertiary hospital were recruited into this cohort study. Immediately postpartum, the women completed a structured urogynecological questionnaire regarding lower urinary tract symptoms. Then the same urogynecological questionnaire, the Incontinence Impact Questionnaire (IIQ-7), and the Urinary Distress Inventory (UDI-6) were mailed to them 5 years later to follow up on UI. Three hundred and twelve women responding to the mailed questionnaires were included in the analyses. The prevalence 5 years after first delivery of stress (SUI) and urge (UUI) UI were 43.6 % and 19.2 %, respectively. Women with UI during their first pregnancy were more likely to develop UI 5 years postpartum than those without it; women who delivered their first child vaginally had a greater incidence of UI than those having cesarean birth; UUI in women following cesarean delivery more negatively impacted emotional health than it did following vaginal birth, whereas the impact of SUI did not significantly differ between delivery groups. UI during the first pregnancy and vaginal delivery in primiparous women may predict an increased risk of having UI 5 years after delivery. UUI adversely affected women's emotional health, especially in those undergoing cesarean section.

  19. Defibulation during vaginal delivery for women with type III female genital mutilation.

    Science.gov (United States)

    Rouzi, Abdulrahim A; Al-Sibiani, Sharifa A; Al-Mansouri, Nisma M; Al-Sinani, Nawal S; Al-Jahdali, Eetedal A; Darhouse, Khalid

    2012-07-01

    To assess the routine practice of defibulation during vaginal delivery for women who have undergone female genital mutilation or cutting. A case-control study was conducted on women from Sudan, Somalia, Ethiopia, Egypt, and Yemen who delivered at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 1, 2000, to November 30, 2011. Women who had defibulation were identified, and their records were examined. For each woman who had defibulation, a woman from the same nationality who delivered without defibulation on the same day or the next days was chosen as a control. Data collected included demographics, mode of delivery, blood loss, intraoperative and postoperative complications, and labor outcome. During the study period, 388 women underwent defibulation during vaginal delivery. Women who did not have defibulation were chosen as a control group (n=388). In the defibulation group, 300 (77.3%) women were registered during pregnancy; 88 (22.7%) women were unregistered. Defibulation during vaginal delivery was successfully performed by residents and senior residents under the care of the attending on call. No cesarean delivery was performed because of female genital mutilation or cutting, and no spontaneous rupture of the scar occurred. There were no statistically significant differences between women who had defibulation with those who did not or between infibulated registered and unregistered women in the duration of labor, episiotomy rates, blood loss, Apgar score, or fetal birth weight. Defibulation during vaginal delivery is a valid management option. Labor attendants should be trained to perform it.

  20. Elective repeat cesarean delivery compared with trial of labor after a prior cesarean delivery: a propensity score analysis

    NARCIS (Netherlands)

    Kok, N.; Ruiter, L.; Lindeboom, R.; de Groot, C.; Pajkrt, E.; Mol, B. W.; Kazemier, B. M.

    2015-01-01

    To determine neonatal and short term maternal outcomes according to intentional mode of delivery following a cesarean delivery (CD). Women pregnant after CD between January 2000 and December 2007 were categorized according to whether they had an elective repeat CD (ERCD) or a Trial of Labor (TOL).

  1. Fiber coupled optical spark delivery system

    Science.gov (United States)

    Yalin, Azer; Willson, Bryan; Defoort, Morgan

    2008-08-12

    A spark delivery system for generating a spark using a laser beam is provided, the spark delivery system including a laser light source and a laser delivery assembly. The laser delivery assembly includes a hollow fiber and a launch assembly comprising launch focusing optics to input the laser beam in the hollow fiber. In addition, the laser delivery assembly includes exit focusing optics that demagnify an exit beam of laser light from the hollow fiber, thereby increasing the intensity of the laser beam and creating a spark. In accordance with embodiments of the present invention, the assembly may be used to create a spark in a combustion engine. In accordance with other embodiments of the present invention, a method of using the spark delivery system is provided. In addition, a method of choosing an appropriate fiber for creating a spark using a laser beam is also presented.

  2. Incidence of Incisional Hernia after Cesarean Delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Krebs, Lone; Ladelund, Steen

    2014-01-01

    OBJECTIVE: To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. METHODS: This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery...... between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had...... a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery. RESULTS: We...

  3. Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

    Science.gov (United States)

    Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Erkilinc, Selcuk; Aksakal, Orhan Seyfi; Doganay, Melike

    2015-05-01

    To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

  4. H-mode physics

    International Nuclear Information System (INIS)

    Itoh, Sanae.

    1991-06-01

    After the discovery of the H-mode in ASDEX ( a tokamak in Germany ) the transition between the L-mode ( Low confinement mode ) and H-mode ( High confinement mode ) has been observed in many tokamaks in the world. The H-mode has made a breakthrough in improving the plasma parameters and has been recognized to be a universal phenomena. Since its discovery, the extensive studies both in experiments and in theory have been made. The research on H-mode has been casting new problems of an anomalous transport across the magnetic surface. This series of lectures will provide a brief review of experiments for explaining H-mode and a model theory of H-mode transition based on the electric field bifurcation. If the time is available, a new theoretical model of the temporal evolution of the H-mode will be given. (author)

  5. Assessment of the administration of healthcare service delivery in ...

    African Journals Online (AJOL)

    The study examined the structure and mode of administration in Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria; and also assessed the impact of the structure and mode of administration on the service delivery in the hospital. These were with a view to assessing the administration of healthcare ...

  6. Localized Acoustic Surface Modes

    KAUST Repository

    Farhat, Mohamed

    2015-08-04

    We introduce the concept of localized acoustic surface modes (ASMs). We demonstrate that they are induced on a two-dimensional cylindrical rigid surface with subwavelength corrugations under excitation by an incident acoustic plane wave. Our results show that the corrugated rigid surface is acoustically equivalent to a cylindrical scatterer with uniform mass density that can be represented using a Drude-like model. This, indeed, suggests that plasmonic-like acoustic materials can be engineered with potential applications in various areas including sensing, imaging, and cloaking.

  7. Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form.

    Science.gov (United States)

    Moragianni, Vasiliki A; Hacker, Michele R; Craparo, Frank J

    2011-10-24

    Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution's obstetrical record in August 2003. A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, Pshoulder delivery interval (76.5% vs. 15.0% without the form, Pshoulder dystocia, and second stage duration. Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components.

  8. Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation.

    Science.gov (United States)

    de Gregorio, Nikolaus; Friedl, Thomas; Schramm, Amelie; Reister, Frank; Janni, Wolfgang; Ebner, Florian

    2017-08-25

    Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure. © 2017 S. Karger AG, Basel.

  9. Systematics of adiabatic modes: flat universes

    Science.gov (United States)

    Pajer, E.; Jazayeri, S.

    2018-03-01

    Adiabatic modes are cosmological perturbations that are locally indistinguishable from a (large) change of coordinates. At the classical level, they provide model independent solutions. At the quantum level, they lead to soft theorems for cosmological correlators. We present a systematic derivation of adiabatic modes in spatially-flat cosmological backgrounds with asymptotically-perfect fluids. We find several new adiabatic modes including vector, time-dependent tensor and time-dependent scalar modes. The new vector and tensor modes decay with time in standard cosmologies but are the leading modes in contracting universes. We present a preliminary derivation of the related soft theorems. In passing, we discuss a distinction between classical and quantum adiabatic modes, we clarify the subtle nature of Weinberg's second adiabatic mode and point out that the adiabatic nature of a perturbation is a gauge dependent statement.

  10. Scheduled Cesarean Delivery: Maternal and Neonatal Risks in Primiparous Women in a Community Hospital Setting

    Science.gov (United States)

    Quiroz, Lieschen H.; Chang, Howard; Blomquist, Joan L.; Okoh, Yvonne K.; Handa, Victoria L.

    2011-01-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications. PMID:19021093

  11. Cancer Nanomedicine: From Targeted Delivery to Combination Therapy

    Science.gov (United States)

    Xu, Xiaoyang; Ho, William; Zhang, Xueqing; Bertrand, Nicolas; Farokhzad, Omid

    2015-01-01

    The advent of nanomedicine marks an unparalleled opportunity to advance the treatment of a variety of diseases, including cancer. The unique properties of nanoparticles, such as large surface-to volume ratio, small size, the ability to encapsulate a variety of drugs, and tunable surface chemistry, gives them many advantages over their bulk counterparts. This includes multivalent surface modification with targeting ligands, efficient navigation of the complex in vivo environment, increased intracellular trafficking, and sustained release of drug payload. These advantages make nanoparticles a mode of treatment potentially superior to conventional cancer therapies. This article highlights the most recent developments in cancer treatment using nanoparticles as drug-delivery vehicles, including promising opportunities in targeted and combination therapy. PMID:25656384

  12. Breastfeeding practices: does method of delivery matter?

    Science.gov (United States)

    Ahluwalia, Indu B; Li, Ruowei; Morrow, Brian

    2012-12-01

    Objective of this study was to assess the relationship between method of delivery and breastfeeding. Using data (2005-2006) from the longitudinal Infant Feeding Practices Study II (n = 3,026) we assessed the relationship between delivery method (spontaneous vaginal, induced vaginal, emergency cesarean, and planned cesarean) and breastfeeding: initiation, any breastfeeding at 4 weeks, any breastfeeding at 6 months, and overall duration. We used SAS software to analyze data using multivariable analyses adjusting for several confounders, including selected demographic characteristics, participants' pre-delivery breastfeeding intentions and attitude, and used event-history analysis to estimate breastfeeding duration by delivery method. We found no significant association between delivery method and breastfeeding initiation. In the fully adjusted models examining breastfeeding duration to 4 weeks with spontaneous vaginal delivery group as the reference, those with induced vaginal deliveries were significantly less likely to breastfeed [adjusted odds ratio (AOR) = 0.53; 95 % CI = 0.38-0.71]; and no significant relationship was observed for those who had planned or emergency cesarean deliveries. Again, compared with spontaneous vaginal delivery group, those with induced vaginal [AOR = 0.60; 96 % CI = 0.47-0.78] and emergency cesarean [AOR = 0.68; 96 % CI = 0.48-0.95] deliveries were significantly less likely to breastfeed at 6 months. Median breastfeeding duration was 45.2 weeks among women with spontaneous vaginal, 38.7 weeks among planned cesarean, 25.8 weeks among induced vaginal and 21.5 weeks among emergency cesarean deliveries. While no significant association was observed between delivery method and breastfeeding initiation; breastfeeding duration varied substantially with method of delivery, perhaps indicating a need for additional support for women with assisted deliveries.

  13. National Rates of Uterine Rupture are not Associated with Rates of Previous Caesarean Delivery

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Langhoff-Roos, Jens; Jakobsson, Maija

    2017-01-01

    BACKGROUND: Previous caesarean delivery and intended mode of delivery after caesarean are well-known individual risk factors for uterine rupture. We examined if different national rates of uterine rupture are associated with differences in national rates of previous caesarean delivery and intende...

  14. Predicting mode of delivery using mid-pregnancy ultrasonographic ...

    African Journals Online (AJOL)

    2011-11-11

    Nov 11, 2011 ... countries such as Nigeria, the rate of Cesarean section has also been rising due the increase in the .... rising cesarean section rates in these hospitals, especially emergency cases with its attendant ..... Mile Four Hospital Abakaliki, Ebonyi State for permitting us to use their facility for the conduct of this ...

  15. Modes of delivery assistance in Bangladesh | Rahman | Tanzania ...

    African Journals Online (AJOL)

    Tanzania Journal of Health Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected ...

  16. Time on Task in Intensive Modes of Delivery

    Science.gov (United States)

    Kuiper, Alison; Solomonides, Ian; Hardy, Lara

    2015-01-01

    This paper reports on an investigation into how staff teaching in compressed courses can encourage student engagement and enhance student use of learning time, despite significant restraints of time as well as distance. Typically these courses (described here as units) are expected to have comparable learning outcomes to their full-semester…

  17. Predicting mode of delivery using mid-pregnancy ultrasonographic ...

    African Journals Online (AJOL)

    2011-11-11

    Nov 11, 2011 ... women with previous history of Cesarean section and extremely short-statured women or a previous history of a preterm birth, due to cervical incompetence who were counseled for cervical cerclage. Also pregnant women who were not sure that they will deliver in the study facilities were excluded.

  18. Caracterização das mães, partos e recém-nascidos em Campinas, São Paulo, 2001 e 2005 Characterization of mothers, mode of deliveries and newborns in Campinas, São Paulo, 2001 and 2005

    Directory of Open Access Journals (Sweden)

    André Moreno Morcillo

    2010-09-01

    Full Text Available OBJETIVO: Comparar dados pré-natais, dos partos e dos recém-nascidos de Campinas em 2001 e 2005. MÉTODOS: Estudo transversal que analisou 13.656 documentos do Sistema de Informações sobre Nascidos Vivos (Sinasc de 2005, comparando-as aos resultados de 2001. Analisou-se o local de moradia e parto, idade materna, estado civil, escolaridade, ocupação, paridade, consultas de pré-natal, tipo de parto, duração da gestação e peso ao nascer. Para avaliar a associação entre as variáveis, utilizou-se o teste de qui-quadrado, sendo significante pOBJECTIVE: To compare data related to prenatal care, deliveries and newborns from Campinas, Brazil, in 2001 and 2005. METHODS: This cross-sectional study analyzed 13,656 Live Birth Certificates from 2005, comparing them to of 2001. The analyzed variables were: place of birth and dwelling, maternal age, marital status, schooling, number of births, number of prenatal consultations, mode of delivery, length of pregnancy and birthweight. Association between variables was evaluated by the chi-square test, being significant p<0.05. RESULTS: In 2005, there was a decrease in the number of newborns from Health Districts with worse living conditions in comparison to 2001. The rate of teenage pregnancies varied from 17.7% in 2001 to 14.7% in 2005. Working mothers were 42.9% of the sample in 2005 and 39.4% in 2001. In 2005, single mothers were 54.3% compared to 35.9% in 2001. Mothers with seven or less years of schooling were 37.8% in 2001, compared to 25.7% in 2005. In 2005, 86.6% of mothers had more than six prenatal visits compared to 74.4% in 2001. There was an increase in the rates of cesarean section (from 54.9% in 2001 to 60.3% in 2005 and prematurity (from 7.1% in 2001 to 8.9% in 2005. No significant changes in birthweight were observed. CONCLUSIONS: This study shows a decrease in the rate of births in the Health Districts with worse conditions of living and in teenage pregnancies. Rates of working

  19. Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients.

    Science.gov (United States)

    Lee, Hyun Joo; Jeon, Gyeong Sik; Kim, Man Deuk; Kim, Sang Heum; Lee, Jong Tae; Choi, Min Jeong

    2013-01-01

    To evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery. A retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24-46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention. The technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women. The cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  20. Multi-channel gas-delivery system

    Energy Technology Data Exchange (ETDEWEB)

    Rozenzon, Yan; Trujillo, Robert T.; Beese, Steven C.

    2016-09-13

    One embodiment of the present invention provides a gas-delivery system for delivering reaction gas to a reactor chamber. The gas-delivery system includes a main gas-inlet port for receiving reaction gases and a gas-delivery plate that includes a plurality of gas channels. A gas channel includes a plurality of gas holes for allowing the reaction gases to enter the reactor chamber from the gas channel. The gas-delivery system further includes a plurality of sub-gas lines coupling together the main gas-inlet port and the gas-delivery plate, and a respective sub-gas line is configured to deliver a portion of the received reaction gases to a corresponding gas channel.

  1. Recent Patents in Pulmonary Delivery of Macromolecules.

    Science.gov (United States)

    Ray, Animikh; Mandal, Abhirup; Mitra, Ashim K

    2015-01-01

    Pulmonary delivery is a non-invasive form of delivery that holds tremendous therapeutic promise for topical and systemic administration of several macromolecules. Oral administration of macromolecules has several limitations such as low bioavailability, degradation of drug before reaching circulation and insufficient absorption across intestinal membrane. Administration of macromolecules such as proteins, peptides and nucleic acids via inhalation offers great potential due to the avoidance of first pass metabolism, higher surface area and rapid clinical response. However, delivery of reproducible, uniform and safe doses of inhaled particles remains a major challenge for clinical translation. Recent advances in the fields of biotechnology and particle engineering led to progress in novel pulmonary drug delivery systems. Moreover, significant developments in carriers and delivery devices prevent denaturation of macromolecules and control their release within the lungs. This article reviews the advances in pulmonary drug delivery systems by focusing on the recent patents in delivery of macromolecules. Furthermore, recent patents in gene delivery to the lungs have also been discussed. List of patents included in this review is comprehensive in terms of pulmonary delivery of therapeutics. It includes inventions related to proteins and peptides, DNA therapeutics, siRNA and other genetic materials with therapeutic applications. The diseases targeted by these therapeutic molecules are varied including but not limited to different forms of cancer, respiratory diseases etc.

  2. Vacuum-assisted delivery

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000514.htm Vacuum-assisted delivery To use the sharing features on this page, ... through the birth canal. When is Vacuum-assisted Delivery Needed? Even after your cervix is fully dilated ( ...

  3. Delivery by Cesarean Section

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Delivery by Cesarean Section Page Content Article Body More ... mother has had a previous baby by Cesarean delivery The obstetrician feels that the baby’s health might ...

  4. SNV's modes of ordering

    NARCIS (Netherlands)

    Hummel, John; Duim, van der Rene

    2016-01-01

    This article adopts an aidnographic approach to examine how internal organizational modes of ordering have influenced tourism development practices of SNV Netherlands Development Organisation (SNV). Our research revealed six modes of ordering: administration, project management, enterprising,

  5. Prodrugs in site-selective delivery of radiopharmaceuticals

    Energy Technology Data Exchange (ETDEWEB)

    Baranowska-Kortylewicz, J.; Kortylewicz, Z. P.; Hoffman, D.; Dalrymple, G. V. [Omaha, Univ. of Nebraska (United States). Dept. of Radiation Oncology. J. Bruce Henriksen Lab.

    1997-06-01

    This paper reviews basic rules for the design of site-selective prodrugs and various modes of their activation with particular emphasis on the applications of prodrugs to targeted delivery of radiopharmaceuticals. Although many radiopharmaceuticals are ``targeted`` to specific tissues or organs, they will discuss only agents that are either chemically or metabolically transformed producing an active form that is retained by its target. Site-specific prodrugs of diagnostic radiopharmaceuticals are routine in the nuclear medicine applications but the instances of targeting of radiotherapeutic prodrugs are surprisingly rare. They have concentrated on their own efforts to design and synthesize site-selective prodrugs of 5-{sup [125}I]iodo-2`-deoxyuridine ({sup 125}IUdR) for cancer radiotherapy. The prodrugs of {sup 125}IUdR for targeted delivery include several derivatives with altered permeability, 3`, 5`- dioctanoyl, 3`, 5`-dioleoyl, 3`- and 5`-N-alkyl-dihydropyridyl, 3`- and 5`-N-dihydroisoquinolyl, and 3`- and 5`-N-alkyl-dihydroacridinyl esters of {sup 125}IUdR; polymeric and macromolecular prodrugs of {sup 125}IUdR for a carrier-mediated or local delivery; metabolically trapped {sup 125}IUdR prodrugs; and glycoconjugate prodrugs for oral colon-specific delivery of {sup 125}IU{sub D}R, {sup 125}IU{sub D}R-5`-{beta}-d-cellobioside, {sup 125}IU{sub D}R-5`-{beta}-d-glucopyranoside, {sup 125}IU{sub D}R-5`-{beta}-d-galactopyranoside and {sup 125}IU{sub D}R-5`-{beta}-d-glucoronide. They also describe prodrugs of several diagnostic agents in the context of the metabolic trapping as the primary targeting modality. For various diagnostic agents the prodrug target-associated enzymes are discussed and examples of the site.specific release of the active agent are given. A brief overview of an emerging role of residualizing labels in radioimmunotherapy is included.

  6. The evolution of transmission mode

    Science.gov (United States)

    Forbes, Mark R.; Hauffe, Heidi C.; Kallio, Eva R.; Okamura, Beth; Sait, Steven M.

    2017-01-01

    This article reviews research on the evolutionary mechanisms leading to different transmission modes. Such modes are often under genetic control of the host or the pathogen, and often in conflict with each other via trade-offs. Transmission modes may vary among pathogen strains and among host populations. Evolutionary changes in transmission mode have been inferred through experimental and phylogenetic studies, including changes in transmission associated with host shifts and with evolution of the unusually complex life cycles of many parasites. Understanding the forces that determine the evolution of particular transmission modes presents a fascinating medley of problems for which there is a lack of good data and often a lack of conceptual understanding or appropriate methodologies. Our best information comes from studies that have been focused on the vertical versus horizontal transmission dichotomy. With other kinds of transitions, theoretical approaches combining epidemiology and population genetics are providing guidelines for determining when and how rapidly new transmission modes may evolve, but these are still in need of empirical investigation and application to particular cases. Obtaining such knowledge is a matter of urgency in relation to extant disease threats. This article is part of the themed issue ‘Opening the black box: re-examining the ecology and evolution of parasite transmission’. PMID:28289251

  7. Secondary fuel delivery system

    Science.gov (United States)

    Parker, David M.; Cai, Weidong; Garan, Daniel W.; Harris, Arthur J.

    2010-02-23

    A secondary fuel delivery system for delivering a secondary stream of fuel and/or diluent to a secondary combustion zone located in the transition piece of a combustion engine, downstream of the engine primary combustion region is disclosed. The system includes a manifold formed integral to, and surrounding a portion of, the transition piece, a manifold inlet port, and a collection of injection nozzles. A flowsleeve augments fuel/diluent flow velocity and improves the system cooling effectiveness. Passive cooling elements, including effusion cooling holes located within the transition boundary and thermal-stress-dissipating gaps that resist thermal stress accumulation, provide supplemental heat dissipation in key areas. The system delivers a secondary fuel/diluent mixture to a secondary combustion zone located along the length of the transition piece, while reducing the impact of elevated vibration levels found within the transition piece and avoiding the heat dissipation difficulties often associated with traditional vibration reduction methods.

  8. Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

    LENUS (Irish Health Repository)

    Contag, Stephen A

    2010-06-01

    We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks\\' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

  9. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew

    2014-10-07

    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  10. Microspheres and Nanotechnology for Drug Delivery.

    Science.gov (United States)

    Jóhannesson, Gauti; Stefánsson, Einar; Loftsson, Thorsteinn

    2016-01-01

    Ocular drug delivery to the posterior segment of the eye can be accomplished by invasive drug injections into different tissues of the eye and noninvasive topical treatment. Invasive treatment involves the risks of surgical trauma and infection, and conventional topical treatments are ineffective in delivering drugs to the posterior segment of the eye. In recent years, nanotechnology has become an ever-increasing part of ocular drug delivery. In the following, we briefly review microspheres and nanotechnology for drug delivery to the eye, including different forms of nanotechnology such as nanoparticles, microparticles, liposomes, microemulsions and micromachines. The permeation barriers and anatomical considerations linked to ocular drug delivery are discussed and a theoretical overview on drug delivery through biological membranes is given. Finally, in vitro, in vivo and human studies of x03B3;-cyclodextrin nanoparticle eyedrop suspensions are discussed as an example of nanotechnology used for drug delivery to the eye. © 2016 S. Karger AG, Basel.

  11. Modes of log gravity

    NARCIS (Netherlands)

    Bergshoeff, Eric A.; Hohm, Olaf; Rosseel, Jan; Townsend, Paul K.

    2011-01-01

    The physical modes of a recently proposed D-dimensional "critical gravity'', linearized about its anti-de Sitter vacuum, are investigated. All "log mode'' solutions, which we categorize as "spin-2'' or "Proca'', arise as limits of the massive spin-2 modes of the noncritical theory. The linearized

  12. Microcontainers for Intestinal Drug Delivery

    DEFF Research Database (Denmark)

    Tentor, Fabio; Mazzoni, Chiara; Keller, Stephan Sylvest

    Among all the drug administration routes, the oral one is the most preferred by the patients being less invasive, faster and easier. Oral drug delivery systems designed to target the intestine are produced by powder technology and capsule formulations. Those systems including micro- and nano...

  13. Dissipative double-well potential: Nonlinear stationary and pulsating modes

    International Nuclear Information System (INIS)

    Zezyulin, Dmitry A.; Konotop, Vladimir V.; Alfimov, Georgy L.

    2010-01-01

    The analysis of nonlinear modes in a complex absorbing double-well potential supported by linear gain is presented. Families of the nonlinear modes and their bifurcations are found numerically by means of the properly modified 'shooting' method. Linear stability and dynamics of the modes are studied. It is shown that no stable modes exist in the case of attractive nonlinearity, while stable modes, including nonsymmetric ones, are found when the nonlinearity is repulsive. Varying a control parameter (e.g., the height of barrier between the wells) results in switching from one mode to another. Apart from stationary modes we have found pulsating solutions emergent from unstable modes.

  14. Preoperative predictors of thrombocytopenia in Caesarean delivery ...

    African Journals Online (AJOL)

    Preoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary? ... moderate thrombocytopenia. All asymptomatic patients, including those who were HIV positive, had platelet counts > 70 000/μl. Keywords: Caesarean delivery, HIV, obstetrics, pregnancy, thrombocytopenia ...

  15. [Operative vaginal deliveries training].

    Science.gov (United States)

    Dupuis, O

    2008-12-01

    The appropriate use of forceps, vacuums or spatulas facilitates the rapid delivery of foetuses faced with life-threatening situations. It also makes possible the relief of certain cases of prolonged second-stage labor. In France, operative vaginal delivery (OVD) accounts for approximately 10% of all births. OVD training aims to optimize maternal, as well as neonatal safety. It should enable trainees to indicate or contraindicate an OVD safely, as well as to choose the appropriate instrument, use it correctly, and master quality control principles. Traditional OVD training is confronted with both spatial and time-related limitations. Spatial constraints involve both the teacher and trainee who only have limited visual access to the pelvic canal, and the head of the foetus; the time constraint occurs whenever the OVD occurs in an emergency setting. These limitations have been further aggravated by new constraints: decreasing time dedicated to training (European safety rules prohibit work the day after night duty), increasing litigation, and constraints imposed by society. Training by means of simulation removes such limitations making it possible to both avoid exposing pregnant women to the hazards of traditional training, and adapt the training to the skills of each trainee. OVD training should include forceps, vacuums and the use of spatulas. The OVD skills of obstetricians should be audited regularly on both a personal and a confidential level. Such audits could be based on a method using a simulator. Prospective studies comparing traditional and simulation-based training should be encouraged.

  16. Optical modulator including grapene

    Science.gov (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  17. Cumulative results including obstetrical and neonatal outcome of fresh and frozen-thawed cycles in elective single versus double fresh embryo transfers.

    Science.gov (United States)

    Fauque, Patricia; Jouannet, Pierre; Davy, Céline; Guibert, Juliette; Viallon, Vivian; Epelboin, Sylvie; Kunstmann, Jean-Marie; Patrat, Catherine

    2010-08-01

    To assess the efficacy of elective single embryo transfer (e-SET) compared to a double embryo transfer (DET) in a selected population including obstetrical and neonatal outcome of fresh and frozen-thawed cycles. Prospective nonrandomized study. Department of reproductive medicine. Elective single embryo transfer was proposed to women 0.05). Twin delivery rate was significantly different between the two groups (3.5% versus 37.5% respectively, P<0.05). Neonatal outcome in twins resulting from IVF-ICSI was found to be poorer than in singletons, considering the mean gestational age, mode of delivery, birthweight, and risk of neonatal intensive care unit admission for the infants. In a selected population, the elective transfer of one embryo with high implantation potential helped to avoid twin pregnancies without decreasing delivery rate. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Buccal and sublingual vaccine delivery.

    Science.gov (United States)

    Kraan, Heleen; Vrieling, Hilde; Czerkinsky, Cecil; Jiskoot, Wim; Kersten, Gideon; Amorij, Jean-Pierre

    2014-09-28

    Because of their large surface area and immunological competence, mucosal tissues are attractive administration and target sites for vaccination. An important characteristic of mucosal vaccination is its ability to elicit local immune responses, which act against infection at the site of pathogen entry. However, mucosal surfaces are endowed with potent and sophisticated tolerance mechanisms to prevent the immune system from overreacting to the many environmental antigens. Hence, mucosal vaccination may suppress the immune system instead of induce a protective immune response. Therefore, mucosal adjuvants and/or special antigen delivery systems as well as appropriate dosage forms are required in order to develop potent mucosal vaccines. Whereas oral, nasal and pulmonary vaccine delivery strategies have been described extensively, the sublingual and buccal routes have received considerably less attention. In this review, the characteristics of and approaches for sublingual and buccal vaccine delivery are described and compared with other mucosal vaccine delivery sites. We discuss recent progress and highlight promising developments in the search for vaccine formulations, including adjuvants and suitable dosage forms, which are likely critical for designing a successful sublingual or buccal vaccine. Finally, we outline the challenges, hurdles to overcome and formulation issues relevant for sublingual or buccal vaccine delivery. Copyright © 2014. Published by Elsevier B.V.

  19. Bladder Injury During Cesarean Delivery

    Science.gov (United States)

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  20. UAV Delivery Monitoring System

    Directory of Open Access Journals (Sweden)

    San Khin Thida

    2018-01-01

    Full Text Available UAV-based delivery systems are increasingly being used in the logistics field, particularly to achieve faster last-mile delivery. This study develops a UAV delivery system that manages delivery order assignments, autonomous flight operation, real time control for UAV flights, and delivery status tracking. To manage the delivery item assignments, we apply the concurrent scheduler approach with a genetic algorithm. The present paper describes real time flight data based on a micro air vehicle communication protocol (MAVLink. It also presents the detailed hardware components used for the field tests. Finally, we provide UAV component analysis to choose the suitable components for delivery in terms of battery capacity, flight time, payload weight and motor thrust ratio.

  1. Streaming tearing mode

    Science.gov (United States)

    Shigeta, M.; Sato, T.; Dasgupta, B.

    1985-01-01

    The magnetohydrodynamic stability of streaming tearing mode is investigated numerically. A bulk plasma flow parallel to the antiparallel magnetic field lines and localized in the neutral sheet excites a streaming tearing mode more strongly than the usual tearing mode, particularly for the wavelength of the order of the neutral sheet width (or smaller), which is stable for the usual tearing mode. Interestingly, examination of the eigenfunctions of the velocity perturbation and the magnetic field perturbation indicates that the streaming tearing mode carries more energy in terms of the kinetic energy rather than the magnetic energy. This suggests that the streaming tearing mode instability can be a more feasible mechanism of plasma acceleration than the usual tearing mode instability.

  2. Mode selection laser

    DEFF Research Database (Denmark)

    2014-01-01

    The invention relates to a semiconductor mode selection laser, particularly to a VCSEL laser (200) having mode selection properties. The mode selection capability of the laser is achieved by configuring one of the reflectors (15,51) in the resonance cavity so that a reflectivity of the reflector...... (15) varies spatially in one dimension or two dimensions. Accordingly, the reflector (15) with spatially varying reflectivity is part both of the resonance cavity and the mode selection functionality of the laser. A plurality of the lasers configured with different mode selectors, i.e. different...... spatial reflector variations, may be combined to generate a laser beam containing a plurality of orthogonal modes. The laser beam may be injected into a few- mode optical fiber, e.g. for the purpose of optical communication. The VCSEL may have intra-cavity contacts (31,37) and a Tunnel junction (33...

  3. Determinants of institutional delivery among childbearing age women in Western Ethiopia, 2013: unmatched case control study.

    Science.gov (United States)

    Feyissa, Tesfaye Regassa; Genemo, Gebi Agero

    2014-01-01

    Place of delivery is a crucial factor which affects the health and wellbeing of the mother and newborn. Institutional delivery helps the women to access skilled assistance, drugs, equipment, and referral transport. Even though 34% of pregnant women received at least one antenatal care from a skilled provider in Ethiopia by 2013, institutional delivery was 10%. The main objective of the study was to assess determinants of institutional delivery in Western Ethiopia. Retrospective unmatched case control study design was used to assess determinants of institutional delivery in Western Ethiopia from September to October 2013. A total of 320 respondents from six districts of East Wollega zone, West Ethiopia were included. Data were collected using pretested and structured questionnaires. Data were entered and cleaned by Epi-info then exported and analyzed using SPSS software. Statistical significance was determined through a 95% confidence level. Education [Adjusted Odds Ratio (AOR) (95% Confidence Interval (CI)) = 2.754(1.510-8.911)], family size [AOR (95% CI) = .454(.209-.984)], residence [AOR (95% CI) = 3.822 (1.766-8.272)] were important predictors of place of delivery. Four or more antenatal care [(ANC) (AOR (95% CI) = 2.914(1.105-7.682)], birth order [(AOR (95% CI) = .136(.054-.344), age at last delivery [(AOR (95% CI) = 9.995(2.101-47.556)], birth preparedness [AOR (95% CI) = 6.957(2.422-19.987)], duration of labour [AOR (95% CI) = 3.541(1.732-7.239)] were significantly associated with institutional delivery. Moreover service related factors such as distance from health institutions [AOR (95% CI) = .665(.173-.954)], respondents' awareness of skill of health care professionals [AOR (95% CI) = 2.454 (1.663-6.255)], mode of transportations [AOR (95% CI) = .258(.122-.549)] were significantly associated with institutional delivery. Policy makers, health service organizations, community leaders and other concerned bodies have

  4. Determinants of institutional delivery among childbearing age women in Western Ethiopia, 2013: unmatched case control study.

    Directory of Open Access Journals (Sweden)

    Tesfaye Regassa Feyissa

    Full Text Available BACKGROUND: Place of delivery is a crucial factor which affects the health and wellbeing of the mother and newborn. Institutional delivery helps the women to access skilled assistance, drugs, equipment, and referral transport. Even though 34% of pregnant women received at least one antenatal care from a skilled provider in Ethiopia by 2013, institutional delivery was 10%. The main objective of the study was to assess determinants of institutional delivery in Western Ethiopia. METHODS: Retrospective unmatched case control study design was used to assess determinants of institutional delivery in Western Ethiopia from September to October 2013. A total of 320 respondents from six districts of East Wollega zone, West Ethiopia were included. Data were collected using pretested and structured questionnaires. Data were entered and cleaned by Epi-info then exported and analyzed using SPSS software. Statistical significance was determined through a 95% confidence level. RESULTS: Education [Adjusted Odds Ratio (AOR (95% Confidence Interval (CI = 2.754(1.510-8.911], family size [AOR (95% CI = .454(.209-.984], residence [AOR (95% CI = 3.822 (1.766-8.272] were important predictors of place of delivery. Four or more antenatal care [(ANC (AOR (95% CI = 2.914(1.105-7.682], birth order [(AOR (95% CI = .136(.054-.344, age at last delivery [(AOR (95% CI = 9.995(2.101-47.556], birth preparedness [AOR (95% CI = 6.957(2.422-19.987], duration of labour [AOR (95% CI = 3.541(1.732-7.239] were significantly associated with institutional delivery. Moreover service related factors such as distance from health institutions [AOR (95% CI = .665(.173-.954], respondents' awareness of skill of health care professionals [AOR (95% CI = 2.454 (1.663-6.255], mode of transportations [AOR (95% CI = .258(.122-.549] were significantly associated with institutional delivery. CONCLUSIONS AND RECOMMENDATIONS: Policy makers, health service

  5. Cesarean delivery on maternal request.

    Science.gov (United States)

    Viswanathan, Meera; Visco, Anthony G; Hartmann, Katherine; Wechter, Mary Ellen; Gartlehner, Gerald; Wu, Jennifer M; Palmieri, Rachel; Funk, Michele Jonsson; Lux, Linda; Swinson, Tammeka; Lohr, Kathleen N

    2006-03-01

    The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed the evidence on the trend and incidence of cesarean delivery (CD) in the United States and in other developed countries, maternal and infant outcomes of cesarean delivery on maternal request (CDMR) compared with planned vaginal delivery (PVD), factors affecting the magnitude of the benefits and harms of CDMR, and future research directions. We searched MEDLINE, Cochrane Collaboration resources, and Embase and identified 1,406 articles to examine against a priori inclusion criteria. We included studies published from 1990 to the present, written in English. Studies had to include comparison between the key reference group (CDMR or proxies) and PVD. A primary reviewer abstracted detailed data on key variables from included articles; a second senior reviewer confirmed accuracy. We identified 13 articles for trends and incidence of CD, 54 for maternal and infant outcomes, and 5 on modifiers of CDMR. The incidence of CDMR appears to be increasing. However, accurately assessing either its true incidence or trends over time is difficult because currently CDMR is neither a well-recognized clinical entity nor an accurately reported indication for diagnostic coding or reimbursement. Virtually no studies exist on CDMR, so the knowledge base rests chiefly on indirect evidence from proxies possessing unique and significant limitations. Furthermore, most studies compared outcomes by actual routes of delivery, resulting in great uncertainty as to their relevance to planned routes of delivery. Primary CDMR and planned vaginal delivery likely do differ with respect to individual outcomes for either mothers or infants. However, our comprehensive assessment, across many different outcomes, suggests that no major differences exist between primary CDMR and planned vaginal delivery, but the evidence is too weak to conclude definitively that differences

  6. Unstable oscillatory Pierce modes of neutralized electron beams

    International Nuclear Information System (INIS)

    Cary, J.R.; Lemons, D.S.

    1982-01-01

    Oscillatory modes of the Pierce system have been calculated. These modes are found to have growth rates comparable to the previously investigated purely growing modes. When these modes are included, it is found that the Pierce system is unstable for most values of ω/sub p/ L/V 0 >π

  7. Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil Avaliação do assoalho pélvico por meio da ultrassonografia tridimensional de mulheres primíparas de acordo com o tipo de parto: experiência inicial de um centro de referência do Brasil

    Directory of Open Access Journals (Sweden)

    Edward Araujo Júnior

    2013-03-01

    Full Text Available PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10, vaginal delivery (n=16, and forceps delivery (n=9. Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean. Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25, however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5. CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.OBJETIVO: Avaliar as mudanças no assoalho pélvico de mulheres primíparas em diversos tipos de partos por meio da ultrassonografia tridimensional. MÉTODOS: Estudo de corte transversal prospectivo com 35 primigestas, divididas em grupos com relação ao

  8. Medical abortion service delivery.

    Science.gov (United States)

    Breitbart, V; Rogers, M K; Vanderhei, D

    2000-08-01

    Medical abortion with mifepristone and methotrexate regimens may be offered in a variety of American medical practice settings. In this article the new provider will find information on all aspects of the patient care delivery system for medical abortion, including physical space requirements, staffing and training, patient flow, cost, security, marketing, and quality assurance. Because of the limited published data available regarding logistic issues surrounding abortion care, the information in this article derives largely from the experiences of providers who have established medical abortion practices in their offices or clinics. Its goals are to help make the initial start-up phase briefer and more rewarding for new providers, to offer helpful guidelines for incorporation of medical abortion into practice, and to encourage more practitioners to see the benefits of adding this option to their practices.

  9. Renormalized modes in cuprate superconductors

    Science.gov (United States)

    Gupta, Anushri; Kumari, Anita; Verma, Sanjeev K.; Indu, B. D.

    2018-04-01

    The renormalized mode frequencies are obtained with the help of quantum dynamical approach of many body phonon Green's function technique via a general Hamiltonian (excluding BCS Hamiltonian) including the effects of phonons and electrons, anharmonicities and electron-phonon interactions. The numerical estimates have been carried out to study the renormalized mode frequency of high temperature cuprate superconductor (HTS) YBa2Cu3O7-δ using modified Born-Mayer-Huggins interaction potential (MBMHP) best applicable to study the dynamical properties of all HTS.

  10. Delivery by Cesarean Section is not Associated With Decreased at-Birth Fracture Rates in Osteogenesis Imperfecta

    Science.gov (United States)

    Bellur, S; Jain, M; Cuthbertson, D; Krakow, D; Shapiro, JR; Steiner, RD; Smith, PA; Bober, MB; Hart, T; Krischer, J; Mullins, M; Byers, PH; Pepin, M; Durigova, M; Glorieux, FH; Rauch, F; Sutton, VR; Lee, B; Nagamani, SC

    2015-01-01

    Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI. PMID:26426884

  11. Jurassic climate mode governed by ocean gateway

    OpenAIRE

    Korte, Christoph; Hesselbo, Stephen P.; Ullmann, Clemens Vinzenz; Dietl, Gerd; Ruhl, Micha; Schweigert, Guenter; Thibault, Nicolas

    2015-01-01

    The Jurassic (?201?145?Myr ago) was long considered a warm ?greenhouse' period; more recently cool, even ?icehouse' episodes have been postulated. However, the mechanisms governing transition between so-called Warm Modes and Cool Modes are poorly known. Here we present a new large high-quality oxygen-isotope dataset from an interval that includes previously suggested mode transitions. Our results show an especially abrupt earliest Middle Jurassic (?174?Ma) mid-latitude cooling of seawater by ...

  12. Reconfigurable Mixed Mode Universal Filter

    Directory of Open Access Journals (Sweden)

    Neelofer Afzal

    2014-01-01

    Full Text Available This paper presents a novel mixed mode universal filter configuration capable of working in voltage and transimpedance mode. The proposed single filter configuration can be reconfigured digitally to realize all the five second order filter functions (types at single output port. Other salient features of proposed configuration include independently programmable filter parameters, full cascadability, and low sensitivity figure. However, all these features are provided at the cost of quite large number of active elements. It needs three digitally programmable current feedback amplifiers and three digitally programmable current conveyors. Use of six active elements is justified by introducing three additional reduced hardware mixed mode universal filter configurations and its comparison with reported filters.

  13. A cyclically actuated electrolytic drug delivery device

    KAUST Repository

    Yi, Ying

    2015-01-01

    This work, focusing on an implantable drug delivery system, presents the first prototype electrolytic pump that combines a catalytic reformer and a cyclically actuated mode. These features improve the release performance and extend the lifetime of the device. Using our platinum (Pt)-coated carbon fiber mesh that acts as a catalytic reforming element, the cyclical mode is improved because the faster recombination rate allows for a shorter cycling time for drug delivery. Another feature of our device is that it uses a solid-drug-in-reservoir (SDR) approach, which allows small amounts of a solid drug to be dissolved in human fluid, forming a reproducible drug solution for long-term therapies. We have conducted proof-of-principle drug delivery studies using such an electrolytic pump and solvent blue 38 as the drug substitute. These tests demonstrate power-controlled and pulsatile release profiles of the chemical substance, as well as the feasibility of this device. A drug delivery rate of 11.44 ± 0.56 μg min-1 was achieved by using an input power of 4 mW for multiple pulses, which indicates the stability of our system. © The Royal Society of Chemistry 2015.

  14. The heritability of preterm delivery.

    Science.gov (United States)

    Ward, Kenneth; Argyle, VeeAnn; Meade, Mary; Nelson, Lesa

    2005-12-01

    To study the heritability of preterm delivery. Women who delivered a singleton infant at less than 36 weeks of gestation were asked about their family history. Twenty-eight families were identified in which the proband had at least five first- or second-degree relatives with preterm delivery. An extensive genealogy database (GenDB) was constructed using more than 9,000 genealogy sources in the public domain (records before 1929). GenDB documents the relationships between more than 17.5 million ancestors and 3.5 million descendants of approximately 10,000 individuals who moved to Utah in the mid 1800s. This database was searched for the names, birth dates, and birthplaces of the four grandparents for each of the 28 probands. Pairwise coefficients of kinship were determined for the 93 preterm delivery grandparents identified, and for sets of 100 individuals born in the 1920s who were randomly selected from the population database. Probands had a mean of 3.3 grandparents included in this database. The average coefficient of kinship for controls was 1.5 x 10(6) (standard deviation = 0.6 x 10(6)). This measure agrees with previous calculations for the Utah population. The coefficient of kinship for familial preterm delivery grandparents was more than 50 standard deviations higher (3.4 x 10(5) [P < .001]). This study confirms the familial nature of preterm delivery. On average, gravidae randomly selected from our population are 23rd degree relatives, while these preterm delivery probands are eighth-degree relatives. A genome-wide scan using these affected families is underway.

  15. Streaming gravity mode instability

    International Nuclear Information System (INIS)

    Wang Shui.

    1989-05-01

    In this paper, we study the stability of a current sheet with a sheared flow in a gravitational field which is perpendicular to the magnetic field and plasma flow. This mixing mode caused by a combined role of the sheared flow and gravity is named the streaming gravity mode instability. The conditions of this mode instability are discussed for an ideal four-layer model in the incompressible limit. (author). 5 refs

  16. Project delivery system (PDS)

    CERN Document Server

    2001-01-01

    As business environments become increasingly competitive, companies seek more comprehensive solutions to the delivery of their projects. "Project Delivery System: Fourth Edition" describes the process-driven project delivery systems which incorporates the best practices from Total Quality and is aligned with the Project Management Institute and ISO Quality Standards is the means by which projects are consistently and efficiently planned, executed and completed to the satisfaction of clients and customers.

  17. Antipastorialism : Resistant Georgic Mode

    National Research Council Canada - National Science Library

    Zimmerman, Donald

    2000-01-01

    .... Abolitionists, women, Afro-British slaves, and those who protested land enclosure developed a multivalent, resistant mode of writing, which I name 'antipastoralism', that countered orthodox, poetical...

  18. Dual-Mode Combustor

    Science.gov (United States)

    Trefny, Charles J (Inventor); Dippold, Vance F (Inventor)

    2013-01-01

    A new dual-mode ramjet combustor used for operation over a wide flight Mach number range is described. Subsonic combustion mode is usable to lower flight Mach numbers than current dual-mode scramjets. High speed mode is characterized by supersonic combustion in a free-jet that traverses the subsonic combustion chamber to a variable nozzle throat. Although a variable combustor exit aperture is required, the need for fuel staging to accommodate the combustion process is eliminated. Local heating from shock-boundary-layer interactions on combustor walls is also eliminated.

  19. Nonlinear drift tearing mode

    International Nuclear Information System (INIS)

    Zelenyj, L.M.; Kuznetsova, M.M.

    1989-01-01

    Nonlinear study of magnetic perturbation development under single-mode conditions in collision-free plasma in configurations with the magnetic field shear is investigated. Results are obtained with regard of transverse component of electrical field and its effect on ion dynamics within wide range of ion Larmor radius value and values of magnetic field shear. Increments of nonlinear drift tearing mode are obtained and it is shown that excitation drastic conditions of even linearly stable modes are possible. Mechanism of instability nonlinear stabilization is considered and the value of magnetic island at the saturation threshold is estimeted. Energy of nonlinear drift tearing mode is discussed

  20. Nineteen-port photonic lantern with multimode delivery fiber

    DEFF Research Database (Denmark)

    Noordegraaf, Danny; Skovgaard, Peter M. W.; Sandberg, Rasmus Kousholt

    2012-01-01

    We demonstrate efficient multimode (MM) to single-mode (SM) conversion in a 19-port photonic lantern with a 50 μm core MM delivery fiber. The photonic lantern can be used within the field of astrophotonics for coupling MM starlight to an ensemble of SM fibers in order to perform fiber-Bragg-grati......We demonstrate efficient multimode (MM) to single-mode (SM) conversion in a 19-port photonic lantern with a 50 μm core MM delivery fiber. The photonic lantern can be used within the field of astrophotonics for coupling MM starlight to an ensemble of SM fibers in order to perform fiber......-Bragg-grating-based spectral filtering. An MM delivery fiber spliced to the photonic lantern offers the advantage that the delivery fiber guides the light from the focal plane of the telescope to the splitter. Therefore, it is no longer necessary to have the splitter mounted directly in the focal plane of the telescope...

  1. New Insights into Modes of GPCR Activation.

    Science.gov (United States)

    Wang, Wenjing; Qiao, Yuhui; Li, Zijian

    2018-01-30

    In classical G-protein-coupled receptor (GPCR) activation, GPCRs couple to a variety of heterotrimeric G proteins on the membrane and then activate downstream signaling pathways. More recently, GPCRs have been found to couple to different effector proteins, including different G protein subtypes and regulatory proteins, such as arrestins. Some novel modes of GPCR activation have been proposed to explain their complex behaviors. In this review, we summarize the main novel modes of GPCR activation, including biased activation, intracellular activation, dimerization activation, transactivation, and biphasic activation. In addition, we also discuss the relationship among the five modes to show the complex picture of GPCR activation. The complex activation modes regulate precisely GPCR downstream signaling, including physiological and pathological signaling. Thus, there is the potential to develop GPCR precision drugs that target precise GPCR activation modes to accurately strengthen their beneficial functions and block specific pathological processes. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Transportation Modes Classification Using Sensors on Smartphones

    Directory of Open Access Journals (Sweden)

    Shih-Hau Fang

    2016-08-01

    Full Text Available This paper investigates the transportation and vehicular modes classification by using big data from smartphone sensors. The three types of sensors used in this paper include the accelerometer, magnetometer, and gyroscope. This study proposes improved features and uses three machine learning algorithms including decision trees, K-nearest neighbor, and support vector machine to classify the user’s transportation and vehicular modes. In the experiments, we discussed and compared the performance from different perspectives including the accuracy for both modes, the executive time, and the model size. Results show that the proposed features enhance the accuracy, in which the support vector machine provides the best performance in classification accuracy whereas it consumes the largest prediction time. This paper also investigates the vehicle classification mode and compares the results with that of the transportation modes.

  3. Factors determining the choice of a place of delivery among ...

    African Journals Online (AJOL)

    85 (60.7%) chose to deliver in the hospital, while 55 (39.3%) opted for home delivery in the index pregnancy. Determinants of choice of delivery place include cost of hospital bill ... thus achieving the millennium development goals (MDGs) 4 and 5. Keywords: Factors, delivery, birth attendants, pregnant women, MDGs ...

  4. Reasons For Preference Of Delivery In Spiritual Church-Based ...

    African Journals Online (AJOL)

    Results: Various reasons for preferring church delivery included: Spiritual protection against satanic attacks and safe delivery in 975 (36.8%) lack of funds in 629(30.5%), harsh attitude of health workers in 249 (12.1%), convenience in 212 (10.3%), faith in God and previous delivery in church 83 (4.0%) each help and good ...

  5. Novel colloidal carriers for psoriasis: current issues, mechanistic insight and novel delivery approaches.

    Science.gov (United States)

    Pradhan, Madhulika; Singh, Deependra; Singh, Manju Rawat

    2013-09-28

    Psoriasis is an autoimmune disorder of the skin with relapsing episodes of inflammation and hyperkeratosis. Numerous approaches have been explored to treat this dreadful disease using different antipsoriatic drugs with different modes of action and routes of administration. But, till date there is no cure for psoriasis due to lack of an ideal carrier for safe and effective delivery of antipsoriatic drugs. Constant progression in the development of newer formulations utilizing colloidal drug delivery systems has led to effective treatment of psoriasis. Colloidal carriers include vesicular and particulate systems like liposome, transferosome, niosomes, ethosomes, solid lipid nanoparticles, microspheres, micelles, dendrimers etc. have gained unique position as drug cargoes. Present review is an attempt to contemplate on psoriasis in terms of pathogenesis, role of cytokines, major hindrances in psoriasis treatment, currently available treatment options pertaining to mode of action, pharmacokinetics, marketed products, side effects of individual antipsoriatic drugs and recent developments in the delivery of various antipsoriatic drugs through novel colloidal drug carriers. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Viscoresistive g-modes and ballooning

    International Nuclear Information System (INIS)

    Dagazian, R.Y.; Paris, R.B.

    1980-01-01

    The resistive G-mode and its particular form, the resistive ballooning mode, are treated as limits of a single simple model. MHD theory including parallel and perpendicular viscosity, finite shear, and finite beta is employed to study their linear stability

  7. Distortional Modes of Thin-Walled Beams

    DEFF Research Database (Denmark)

    Jönsson, Jeppe; Andreassen, Michael Joachim

    2009-01-01

    The classic thin-walled beam theory for open and closed cross-sections can be generalized by including distortional displacement modes. The introduction of additional displacement modes leads to coupled differential equations, which seems to have prohibited the use of exact shape functions in the...

  8. Recovering from Delivery

    Science.gov (United States)

    ... site Sitio para adolescentes Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Recovering From Delivery KidsHealth / For Parents / Recovering From Delivery What's in ...

  9. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Larsen, Marcus M.; Bharati, Pratyush

    2013-01-01

    This article examines antecedents and performance implications of global delivery models (GDMs) in global business services. GDMs require geographically distributed operations to exploit both proximity to clients and time-zone spread for efficient service delivery. We propose and empirically show...... digitalized services, time zones increasingly affect....

  10. 6. Home deliveries

    African Journals Online (AJOL)

    Sitwala

    determine factors associated with home deliveries. Main outcome .... Multiple logistic regression analyses were used to assess and estimate the factors and magnitude of effect on home deliveries. The variables in the model were age or age group, marital .... This finding coupled with lack of transport, made it very difficult for ...

  11. Prediction of preterm delivery

    NARCIS (Netherlands)

    Wilms, F.F.

    2014-01-01

    Preterm delivery is in quantity and in severity an important issue in the obstetric care in the Western world. There is considerable knowledge on maternal and obstetric risk factors of preterm delivery. Of the women presenting with preterm labor, the majority is pregnant with a male fetus and in

  12. Delivery is key

    DEFF Research Database (Denmark)

    Godfrey, Caroline; Desviat, Lourdes R.; Smedsrød, Bård

    2017-01-01

    is the relatively poor delivery of antisense oligonucleotides to target tissues after systemic delivery. We are a group of researchers closely involved in the development of these therapies and would like to communicate our discussions concerning the validity of standard methodologies currently used in their pre...

  13. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  14. The pickup and delivery problem with cross-docking opportunity

    DEFF Research Database (Denmark)

    Petersen, Hanne Løhmann; Røpke, Stefan

    2011-01-01

    delivery by one truck, or by being picked up and transported to the cross-dock by one vehicle, and subsequently delivered at its final destination by another vehicle. Handling times at customers sites and terminal are given. A typical daily instance includes 500-1,000 requests. We solve the problem using......In this paper, we consider the pickup and delivery problem with cross-docking opportunity (PDPCD). The problem arises from an industry application, and includes pickup requests, delivery requests, and pickup-and-delivery requests. Each pickup-and-delivery request can be served either as direct...

  15. Examination of the Relationship of Community College Opticianry Student Outcomes with Instructional Delivery Methods and Student Age

    Science.gov (United States)

    Underwood, William B.; Hernandez-Gantes, Victor M.

    2017-01-01

    The purpose of this study was to determine whether student outcomes are a function of participation in different modes of delivery and student age in an Opticianry program at the community college level. The three instructional delivery methods were traditional face-to-face instruction, online delivery, and a hybrid format where students take…

  16. Acupuncture as pain relief during delivery: a randomized controlled trial

    DEFF Research Database (Denmark)

    Borup, Lissa; Wurlitzer, Winnie; Hedegaard, Morten

    2009-01-01

    BACKGROUND: Many women need some kind of analgesic treatment to relieve pain during childbirth. The objective of our study was to compare the effect of acupuncture with transcutaneous electric nerve stimulation (TENS) and traditional analgesics for pain relief and relaxation during delivery...... assessed by a visual analogue scale, birth experience and satisfaction with delivery, and pain relief evaluated at 2 months postpartum. Secondary obstetric outcomes were duration of labor, use of oxytocin, mode of delivery, postpartum hemorrhage, Apgar score, and umbilical cord pH value. Analysis complied...... to existing pain relief methods....

  17. Delivering elsewhere between the first and second deliveries is a risk marker for obstetric complications in the second delivery.

    Science.gov (United States)

    Reichman, Orna; Gal, Michael; Nezer, Meirav; Shen, Ori; Calderon-Margalit, Ronit; Farkash, Rivka; Samueloff, Arnon

    2016-11-01

    We speculate that parturients who deliver elsewhere between the first and second deliveries compose a unique clinical group, characterized by higher rates of cesarean section (CS) both in the first and second deliveries, compared with parturients who deliver both deliveries at the same hospital. A retrospective study conducted at Shaare Zedek Medical Center in a tertiary university-affiliated hospital. The cohort included all women in the second delivery, aged ≤24 years with a singleton pregnancy who delivered their second child in our medical center during 2010-2012. Parturients who delivered both the first and second children in our medical center ("stayers") were compared with parturients who delivered their first child in a different hospital ("switchers"). Groups were compared in regard to history of CS in the first delivery and obstetric complications in the second delivery, including CS, instrumental vaginal delivery (IVD), preterm delivery (PTD), and postpartum hemorrhage (PPH). Logistic regressions were constructed to study if delivering elsewhere between the first and second deliveries was a risk for adverse pregnancy outcome, followed by multivariate analysis controlling for confounders. In all, 4166 parturients were included: "stayers" = 3163 and "switchers" = 1003. History of CS in the first delivery was approximately twice as prevalent in "switchers" (12 versus 6.3 %, p delivery; hence, the decision to deliver elsewhere after the first delivery should be considered as a risk marker for obstetric complication.

  18. Mathematical modeling of drug delivery.

    Science.gov (United States)

    Siepmann, J; Siepmann, F

    2008-12-08

    Due to the significant advances in information technology mathematical modeling of drug delivery is a field of steadily increasing academic and industrial importance with an enormous future potential. The in silico optimization of novel drug delivery systems can be expected to significantly increase in accuracy and easiness of application. Analogous to other scientific disciplines, computer simulations are likely to become an integral part of future research and development in pharmaceutical technology. Mathematical programs can be expected to be routinely used to help optimizing the design of novel dosage forms. Good estimates for the required composition, geometry, dimensions and preparation procedure of various types of delivery systems will be available, taking into account the desired administration route, drug dose and release profile. Thus, the number of required experimental studies during product development can be significantly reduced, saving time and reducing costs. In addition, the quantitative analysis of the physical, chemical and potentially biological phenomena, which are involved in the control of drug release, offers another fundamental advantage: The underlying drug release mechanisms can be elucidated, which is not only of academic interest, but a pre-requisite for an efficient improvement of the safety of the pharmaco-treatments and for effective trouble-shooting during production. This article gives an overview on the current state of the art of mathematical modeling of drug delivery, including empirical/semi-empirical and mechanistic realistic models. Analytical as well as numerical solutions are described and various practical examples are given. One of the major challenges to be addressed in the future is the combination of mechanistic theories describing drug release out of the delivery systems with mathematical models quantifying the subsequent drug transport within the human body in a realistic way. Ideally, the effects of the design

  19. Oral transmucosal delivery of naratriptan.

    Science.gov (United States)

    Sattar, Mohammed; Lane, Majella E

    2016-11-30

    Naratriptan (NAR) is currently used as the hydrochloride salt (NAR.HCl) for the treatment of migraine and is available in tablet dosage forms for oral administration. Buccal drug delivery offers a number of advantages compared with conventional oral delivery including rapid absorption, avoidance of first pass metabolism and improved patient compliance. We have previously prepared and characterised the base form of NAR and shown that it has more favourable properties for buccal delivery compared with NAR.HCl. This study describes the design and evaluation of a range of formulations for oral transmucosal delivery of NAR base. Permeation studies were conducted using excised porcine buccal tissue mounted in Franz cells. Of the neat solvents examined, Transcutol ® P (TC) showed the greatest enhancement effects and was the vehicle in which NAR was most soluble. The mechanisms by which TC might promote permeation were further probed using binary systems containing TC with either buffer or Miglyol 812 ® (MG). Mass balance studies were also conducted for these systems. The permeation of TC as well as NAR was also monitored for TC:MG formulations. Overall, TC appears to promote enhanced membrane permeation of NAR because of its rapid uptake into the buccal tissue. Synergistic enhancement of buccal permeation was observed when TC was combined with MG and this is attributed to the increased thermodynamic activity of NAR in these formulations. Significantly enhanced permeation of NAR was achieved for TC:MG and this was also associated with less TC remaining on the tissue or in the tissue at the end of the experiment. To our knowledge this is the first report where both enhancer and active have been monitored in buccal permeation studies. The findings underline the importance of understanding the fate of vehicle components for rational formulation design of buccal delivery systems. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. The Modes of Data Development in the Internet Age

    Directory of Open Access Journals (Sweden)

    Yuxian Wu

    2007-12-01

    Full Text Available It is historical that data development has its own mode (collect, treatment, delivery, store, and use, from Manual mode, Mechanism mode, and Electronic mode, now to the Network mode. And search engine plus self-learning is the advanced mode of data development. Network mode has also been changing, the underlying motivation exits in the development & progress of Internet itself. There are two huge trends force the mode of data development to face new challenge & make decision. One is the revolution resulted by the change of the user market need & represented by Web2.0. Another is the revolution resulted by technological developing tendency & represented by Grid. Squeezed by the two huge trends from opposite directions, the lagging, crude and inefficient mode will change revolutionarily forced by wise decision-making or silent market. As for data-development mode, the change of technology & operation need the change of game rule simultaneously. So eliminating barriers, promoting resource-sharing, rationalize relations of market/non-market is to be a big inescapable work

  1. Degree of bother from pelvic floor dysfunction in women one year after first delivery.

    Science.gov (United States)

    Lipschuetz, Michal; Cohen, Sarah M; Liebergall-Wischnitzer, Michal; Zbedat, Kifah; Hochner-Celnikier, Drorith; Lavy, Yuval; Yagel, Simcha

    2015-08-01

    To investigate rates and range of pelvic floor dysfunction complaints, including anterior and posterior compartments and sexual function, in an unselected population of primiparous women one year from delivery, and examine the degree of bother they cause. Cross sectional study. Primiparous women who delivered their first child in our delivery wards 10-14 months previously, were approached by phone and asked to complete the Pelvic Floor Symptom Bother Questionnaire (PFBQ) and provide general demographic information. Details regarding participants' labor and delivery were extracted from electronic medical records. PFBQ score was correlated to demographic and labor and delivery parameters. 198 women completed the questionnaire. Response rate was 94%. Scores ranged from 0 to 44.4 (out of a possible 100). At least one symptom of PFD was reported by 64% of respondents. Various degrees of urinary incontinence were reported by 9.1-12.1% of women. Some degree of fecal or flatus incontinence was reported by 10.1% of women; 11.1% reported some degree of obstructed defecation. Severe degree of bother from one or more PFD symptoms was reported by 40.1-90.9%. Some level of dyspareunia was reported by 37.3%. A "dose response" trend between mode of delivery and rate of dyspareunia was observed. Two-thirds of primiparous women one year after delivery suffer PFD symptoms that cause some degree of bother. When asked, women are willing to discuss pelvic floor function; caregivers should initiate discussion and refer women promptly to interventions where necessary. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. The preference of Iranian women to have normal vaginal or cesarean deliveries

    Directory of Open Access Journals (Sweden)

    Najmeh Maharlouei

    2013-01-01

    Full Text Available Background: The cesarean section (C-section has higher risk compared to normal vaginal delivery (NVD. The aim of this population-based study was to evaluate the frequency of mothers′ tendency toward the mode of delivery and the factors that can affect this inclination. Materials and Methods: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20 th to 30 th weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother′s preference for the route of delivery. Results: Of 6921 participants, 2197 (31.7% preferred C-section and 4308 (62.2% favored NVD while 416 (6% had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1% participants was zero, and 1261 women (18.2% achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother′s unacceptable level of knowledge regarding complications of C-section, and mother′s and husband′s positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. Conclusion: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.

  3. Switch mode power supply

    International Nuclear Information System (INIS)

    Kim, Hui Jun

    1993-06-01

    This book concentrates on switch mode power supply. It has four parts, which are introduction of switch mode power supply with DC-DC converter such as Buck converter boost converter, Buck-boost converter and PWM control circuit, explanation for SMPS with DC-DC converter modeling and power mode control, resonance converter like resonance switch, converter, multi resonance converter and series resonance and parallel resonance converters, basic test of SMPS with PWM control circuit, Buck converter, Boost converter, flyback converter, forward converter and IC for control circuit.

  4. Surface modes in physics

    CERN Document Server

    Sernelius, Bo E

    2011-01-01

    Electromagnetic surface modes are present at all surfaces and interfaces between material of different dielectric properties. These modes have very important effects on numerous physical quantities: adhesion, capillary force, step formation and crystal growth, the Casimir effect etc. They cause surface tension and wetting and they give rise to forces which are important e.g. for the stability of colloids.This book is a useful and elegant approach to the topic, showing how the concept of electromagnetic modes can be developed as a unifying theme for a range of condensed matter physics. The

  5. Study of complex modes

    International Nuclear Information System (INIS)

    Pastrnak, J.W.

    1986-01-01

    This eighteen-month study has been successful in providing the designer and analyst with qualitative guidelines on the occurrence of complex modes in the dynamics of linear structures, and also in developing computer codes for determining quantitatively which vibration modes are complex and to what degree. The presence of complex modes in a test structure has been verified. Finite element analysis of a structure with non-proportional dumping has been performed. A partial differential equation has been formed to eliminate possible modeling errors

  6. Intracellular Delivery of Molecular Cargo Using Cell-Penetrating Peptides and the Combination Strategies

    Directory of Open Access Journals (Sweden)

    Hua Li

    2015-08-01

    Full Text Available Cell-penetrating peptides (CPPs can cross cellular membranes in a non-toxic fashion, improving the intracellular delivery of various molecular cargos such as nanoparticles, small molecules and plasmid DNA. Because CPPs provide a safe, efficient, and non-invasive mode of transport for various cargos into cells, they have been developed as vectors for the delivery of genetic and biologic products in recent years. Most common CPPs are positively charged peptides. While delivering negatively charged molecules (e.g., nucleic acids to target cells, the internalization efficiency of CPPs is reduced and inhibited because the cationic charges on the CPPs are neutralized through the covering of CPPs by cargos on the structure. Even under these circumstances, the CPPs can still be non-covalently complexed with the negatively charged molecules. To address this issue, combination strategies of CPPs with other typical carriers provide a promising and novel delivery system. This review summarizes the latest research work in using CPPs combined with molecular cargos including liposomes, polymers, cationic peptides, nanoparticles, adeno-associated virus (AAV and calcium for the delivery of genetic products, especially for small interfering RNA (siRNA. This combination strategy remedies the reduced internalization efficiency caused by neutralization.

  7. Through-Metal-Wall Power Delivery and Data Transmission for Enclosed Sensors: A Review

    Directory of Open Access Journals (Sweden)

    Ding-Xin Yang

    2015-12-01

    Full Text Available The aim of this review was to assess the current viable technologies for wireless power delivery and data transmission through metal barriers. Using such technologies sensors enclosed in hermetical metal containers can be powered and communicate through exterior power sources without penetration of the metal wall for wire feed-throughs. In this review, we first discuss the significant and essential requirements for through-metal-wall power delivery and data transmission and then we: (1 describe three electromagnetic coupling based techniques reported in the literature, which include inductive coupling, capacitive coupling, and magnetic resonance coupling; (2 present a detailed review of wireless ultrasonic through-metal-wall power delivery and/or data transmission methods; (3 compare various ultrasonic through-metal-wall systems in modeling, transducer configuration and communication mode with sensors; (4 summarize the characteristics of electromagnetic-based and ultrasound-based systems, evaluate the challenges and development trends. We conclude that electromagnetic coupling methods are suitable for through thin non-ferromagnetic metal wall power delivery and data transmission at a relatively low data rate; piezoelectric transducer-based ultrasonic systems are particularly advantageous in achieving high power transfer efficiency and high data rates; the combination of more than one single technique may provide a more practical and reliable solution for long term operation.

  8. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    Science.gov (United States)

    Gonzales, Gustavo F; Tapia, Vilma L; Fort, Alfredo L; Betran, Ana Pilar

    2013-01-01

    A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P cesarean than vaginal deliveries (P cesarean section (P cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. PMID:24124393

  9. What Is a Cesarean Delivery?

    Science.gov (United States)

    ... Twitter Pinterest Email Print What is a cesarean delivery? A cesarean delivery is a surgical procedure in which a fetus ... 32.2% of U.S. births were by cesarean delivery. 2 The CDC also found that the number ...

  10. Calcium phosphate ceramics in drug delivery

    Science.gov (United States)

    Bose, Susmita; Tarafder, Solaiman; Edgington, Joe; Bandyopadhyay, Amit

    2011-04-01

    Calcium phosphate (CaP) particulates, cements and scaffolds have attracted significant interest as drug delivery vehicles. CaP systems, including both hydroxyapaptite and tricalcium phosphates, possess variable stoichiometry, functionality and dissolution properties which make them suitable for cellular delivery. Their chemical similarity to bone and thus biocompatibility, as well as variable surface charge density contribute to their controlled release properties. Among specific research areas, nanoparticle size, morphology, surface area due to porosity, and chemistry controlled release kinetics are the most active. This article discusses CaP systems in their particulate, cements, and scaffold forms for drug, protein, and growth factor delivery toward orthopedic and dental applications.

  11. Kidney–targeted drug delivery systems

    Directory of Open Access Journals (Sweden)

    Peng Zhou

    2014-02-01

    Full Text Available Kidney-targeted drug delivery systems represent a promising technology to improve drug efficacy and safety in the treatment of renal diseases. In this review, we summarize the strategies that have been employed to develop kidney-targeted drug delivery systems. We also describe how macromolecular carriers and prodrugs play crucial roles in targeting drugs to particular target cells in the kidney. New technologies render it possible to create renal targeting conjugates and other delivery systems including nanoparticles and liposomes present promising strategies to achieve the goal of targeting drugs to the kidney.

  12. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush

    We investigate antecedents and contingencies of location configurations supporting global delivery models (GDMs) in global outsourcing. GDMs are a new form of IT-enabled client-specific investment promoting services provision integration with clients by exploiting client proximity and time......-zone spread allowing for 24/7 service delivery and access to resources. Based on comprehensive data we show that providers are likely to establish GDM configurations when clients value access to globally distributed talent pools and speed of service delivery, and in particular when services are highly...... commoditized. Findings imply that coordination across time zones increasingly affects international operations in business-to-business and born-global industries....

  13. Sonographic large fetal head circumference and risk of cesarean delivery.

    Science.gov (United States)

    Lipschuetz, Michal; Cohen, Sarah M; Israel, Ariel; Baron, Joel; Porat, Shay; Valsky, Dan V; Yagel, Oren; Amsalem, Hagai; Kabiri, Doron; Gilboa, Yinon; Sivan, Eyal; Unger, Ron; Schiff, Eyal; Hershkovitz, Reli; Yagel, Simcha

    2018-03-01

    Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient's risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures than neonatal birthweight. In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within 1 week of delivery with delivery mode. This was a multicenter electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within 1 week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal background, obstetric, and neonatal outcome parameters. Elective cesarean deliveries were excluded. Multinomial regression analysis provided adjusted odds ratios for instrumental delivery and unplanned cesarean delivery when the fetal head circumference was ≥35 cm or estimated fetal weight ≥3900 g, while controlling for possible confounders. In all, 11,500 cases were collected; 906 elective cesarean deliveries were excluded. A fetal head circumference ≥35 cm increased the risk for unplanned cesarean delivery: 174 fetuses with fetal head circumference ≥35 cm (32%) were delivered by cesarean, vs 1712 (17%) when fetal head circumference cesarean delivery by an adjusted odds ratio of 1.75 (95% confidence interval, 1.4-2.18) controlling for gestational age, fetal gender, and epidural anesthesia. The rate of prolonged second stage of labor was significantly increased when either the fetal head circumference was ≥35 cm or the estimated fetal weight ≥3900 g, from 22.7% in the total

  14. Oral delivery of peptides and proteins using lipid-based drug delivery systems

    DEFF Research Database (Denmark)

    Li, Ping; Nielsen, Hanne Mørck; Müllertz, Anette

    2012-01-01

    INTRODUCTION: In order to successfully develop lipid-based drug delivery systems (DDS) for oral administration of peptides and proteins, it is important to gain an understanding of the colloid structures formed by these DDS, the mode of peptide and protein incorporation as well as the mechanism...... by which intestinal absorption of peptides and proteins is promoted. AREAS COVERED: The present paper reviews the literature on lipid-based DDS, employed for oral delivery of peptides and proteins and highlights the mechanisms by which the different lipid-based carriers are expected to overcome the two...... most important barriers (extensive enzymatic degradation and poor transmucosal permeability). This paper also gives a clear-cut idea about advantages and drawbacks of using different lipidic colloidal carriers ((micro)emulsions, solid lipid core particles and liposomes) for oral delivery of peptides...

  15. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.

    Science.gov (United States)

    Zhao, Rong; Wang, Xin; Zou, Liying; Li, Guanghui; Chen, Yi; Li, Changdong; Zhang, Weiyuan

    2017-01-01

    To estimate the association between uterine fibroids and adverse obstetric outcomes. This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7-2.0), breech presentation (AOR 1.3, 95% CI 1.2-1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1-1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (Pobstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.

  16. More about solar g modes

    Science.gov (United States)

    Fossat, E.; Schmider, F. X.

    2018-04-01

    Context. The detection of asymptotic solar g-mode parameters was the main goal of the GOLF instrument onboard the SOHO space observatory. This detection has recently been reported and has identified a rapid mean rotation of the solar core, with a one-week period, nearly four times faster than all the rest of the solar body, from the surface to the bottom of the radiative zone. Aim. We present here the detection of more g modes of higher degree, and a more precise estimation of all their parameters, which will have to be exploited as additional constraints in modeling the solar core. Methods: Having identified the period equidistance and the splitting of a large number of asymptotic g modes of degrees 1 and 2, we test a model of frequencies of these modes by a cross-correlation with the power spectrum from which they have been detected. It shows a high correlation peak at lag zero, showing that the model is hidden but present in the real spectrum. The model parameters can then be adjusted to optimize the position (at exactly zero lag) and the height of this correlation peak. The same method is then extended to the search for modes of degrees 3 and 4, which were not detected in the previous analysis. Results: g-mode parameters are optimally measured in similar-frequency bandwidths, ranging from 7 to 8 μHz at one end and all close to 30 μHz at the other end, for the degrees 1 to 4. They include the four asymptotic period equidistances, the slight departure from equidistance of the detected periods for l = 1 and l = 2, the measured amplitudes, functions of the degree and the tesseral order, and the splittings that will possibly constrain the estimated sharpness of the transition between the one-week mean rotation of the core and the almost four-week rotation of the radiative envelope. The g-mode periods themselves are crucial inputs in the solar core structure helioseismic investigation.

  17. Anal sphincter defects and faecal incontinence 15-24 years after first delivery: a cross-sectional study.

    Science.gov (United States)

    Guzmán Rojas, Rodrigo A; Salvesen, Kjell Å; Volløyhaug, Ingrid

    2017-08-06

    To establish the prevalence of external (EAS) and internal anal sphincter (IAS) defects 15-24 years after childbirth in association to mode of delivery and faecal incontinence (FI), and compare the proportion of obstetric anal sphincter injuries (OASIS) reported at delivery with defects on ultrasound. This was a cross-sectional study including 563 women, who delivered their first child from 1990-97. Women responded to a validated questionnaire (PFDI) in 2013-14. The proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent 4D transperineal ultrasound examination. A defect of the EAS and IAS of ≥30° in ≥4/6 planes on tomographic ultrasound was registered. Multiple logistic regression was used to calculate adjusted odds ratios (aOR) for comparison of prevalence of EAS defects between different modes of delivery and in association to FI. Fisher's exact test was used for IAS defects. Defects of EAS and IAS were found after normal delivery (n = 201): 10% and 1%; forceps (n = 144): 32% and 7%; vacuum (n = 120): 15% and 4%, and no defects after caesarean section (n = 98). Forceps was associated with increased risk of EAS defects compared to normal delivery (aOR 4.1, 95% CI 2.3-7.2) and vacuum (aOR 3.0, 95% CI 1.6-5.6) and increased risk of IAS defects compared to normal delivery (cOR 7.4, 95% CI 1.5-70.5). The difference between vacuum and normal delivery was not significant. FI was indicated by 18% of women with EAS defects, 29% with IAS defects and 8% without sphincter defects. EAS and IAS defects were associated with increased risk of FI (aOR 2.5, 95% CI 1.3-4.9; cOR 4.2, 95% CI 1.1-13.5). 80% of ultrasonographical sphincter defects were not reported as OASIS at first or subsequent deliveries. Anal sphincter defects visualized by transperineal ultrasound 15-24 years after delivery were associated with forceps and FI. Undetected OASIS was frequent. This article is

  18. [Ileocystoplasty, pregnancy and delivery].

    Science.gov (United States)

    Walder, R; Mouriquand, P; Ruffion, A; Rudigoz, R-C

    2016-04-01

    Bladder augmentation is commonly used in neurological and other congenital anomalies of the lower urinary tract. In pregnant women, this reconstructive surgery may affect pregnancy and delivery. The obstetrical consequences of these urological procedures are scarcely reported in literature. Eight pregnancies in 6 pregnant women with ileocystoplasty were followed in our institution between 1998 and 2014. Urinary tract infections were the most frequent undesirable record event (5 patients, 7 pregnancies). Obstetrical complications were not more frequent compared to common pregnancies. Delivery was programmed at 37WA. Cesarean section was favoured in this group although natural delivery is possible. Urological complications were the major problem in this series. The type of delivery depends on the past surgical history and the obstetrical prognosis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Continuous software delivery

    OpenAIRE

    Krmavnar, Nina

    2015-01-01

    The main purpose of the thesis is the demonstration of one of the best possible approaches to an automated continuous delivery process as it relates to certain application types. In the introductory part, the main reason for choosing the subject is presented, along with a few examples of why nowadays - in order to keep pace with the competition - such an approach seems necessary. Following chapters discuss the basics of software delivery, starting with configuration and version control manage...

  20. Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins.

    Science.gov (United States)

    Anselem, O; Mephon, A; Le Ray, C; Marcellin, L; Cabrol, D; Goffinet, F

    2015-11-01

    To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options. Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation. Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0-36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores. Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Predictors of vaginal delivery in nulliparous mothers | Adeyemi ...

    African Journals Online (AJOL)

    Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was ...

  2. Users and deployment of delivery vans in the Netherlands

    NARCIS (Netherlands)

    Groot, C. de; Verweij, K.; Vos, G.; Hoen, A.; Otten, M.; Breejen, J. den; Pool, J.; Schoo, R.; Engel, A. van den; Kindt, M.; Riske, J.; Ligterink, N.E.; Sluijk, N.; Spreen, J.S.; Verbeek, M.M.J.F.

    2017-01-01

    The delivery van is the workhorse of both companies and the self-employed within the Dutch economy. And with good reason: it is a multifunctional and flexible mode of transport and compared to (smaller) trucks and cars it is allo cheap to buy and use. Moreover, a drivering license B is sufficient to

  3. Learner Autonomy and Curriculum Delivery in Higher Education: The Case of University of Uyo, Nigeria

    Science.gov (United States)

    Udosen, Alice E.

    2014-01-01

    Nigeria has much hope on her higher education for the production of manpower needs of the nation. And manpower production is a function of the curriculum and its delivery modes which can only be as good as its teachers. It is no gain saying that the traditional methods of curriculum delivery can no longer serve our purpose. Efforts are being made…

  4. Cell-Penetrating Peptides as Carriers for Oral Delivery of Biopharmaceuticals

    DEFF Research Database (Denmark)

    Kristensen, Mie; Nielsen, Hanne Mørck

    2016-01-01

    Oral delivery of biopharmaceuticals, for example peptides and proteins, constitutes a great challenge in drug delivery due to their low chemical stability and poor permeation across the intestinal mucosa, to a large extent limiting the mode of administration to injections, which is not favouring...

  5. An Analysis of Intensive Mode Pedagogy in Management Education in India

    Science.gov (United States)

    Mishra, Sita; Nargundkar, Rajendra

    2015-01-01

    Purpose: Management education is at its peak in India. But pedagogy and modes of delivery are not always innovative compared to top international Business Schools. It is through experimentation that the paper may be able to discover what works best in our context. The purpose of this paper is to determine the effectiveness of intensive mode of…

  6. Advanced drug delivery approaches against periodontitis.

    Science.gov (United States)

    Joshi, Deeksha; Garg, Tarun; Goyal, Amit K; Rath, Goutam

    2016-01-01

    Periodontitis is an inflammatory disease of gums involving the degeneration of periodontal ligaments, creation of periodontal pocket and resorption of alveolar bone, resulting in the disruption of the support structure of teeth. According to WHO, 10-15% of the global population suffers from severe periodontitis. The disease results from the growth of a diverse microflora (especially anaerobes) in the pockets and release of toxins, enzymes and stimulation of body's immune response. Various local or systemic approaches were used for an effective treatment of periodontitis. Currently, controlled local drug delivery approach is more favorable as compared to systemic approach because it mainly focuses on improving the therapeutic outcomes by achieving factors like site-specific delivery, low dose requirement, bypass of first-pass metabolism, reduction in gastrointestinal side effects and decrease in dosing frequency. Overall it provides a safe and effective mode of treatment, which enhances patient compliance. Complete eradication of the organisms from the sites was not achieved by using various surgical and mechanical treatments. So a number of polymer-based delivery systems like fibers, films, chips, strips, microparticles, nanoparticles and nanofibers made from a variety of natural and synthetic materials have been successfully tested to deliver a variety of drugs. These systems are biocompatible and biodegradable, completely fill the pockets, and have strong retention on the target site due to excellent mucoadhesion properties. The review summarizes various available and recently developing targeted delivery devices for the treatment of periodontitis.

  7. Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea.

    Directory of Open Access Journals (Sweden)

    Seung Ju Kim

    Full Text Available Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN care.We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery.We found that 150,256 (35.9% total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93-0.96compared to other hospitals Medical costs (0.74% and length of stay (1% in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57% in specialty hospitals compared with other hospitals.We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.

  8. 29 CFR 780.154 - Delivery “to market.”

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Delivery âto market.â 780.154 Section 780.154 Labor... of Agriculture Specified Delivery Operations § 780.154 Delivery “to market.” The term “delivery * * * to market” includes taking agricultural or horticultural commodities, dairy products, livestock, bees...

  9. The energy spectrum of electromagnetic normal modes in dissipative media: modes between two metal half spaces

    International Nuclear Information System (INIS)

    Sernelius, Bo E

    2008-01-01

    The energy spectrum of electromagnetic normal modes plays a central role in the theory of the van der Waals and Casimir interaction. Here we study the modes in connection with the van der Waals interaction between two metal half spaces. Neglecting dissipation leads to distinct normal modes with real-valued frequencies. Including dissipation seems to have the effect that these distinct modes move away from the real axis into the complex frequency plane. The summation of the zero-point energies of these modes render a complex-valued result. Using the contour integration, resulting from the use of the generalized argument principle, gives a real-valued and different result. We resolve this contradiction and show that the spectrum of true normal modes forms a continuum with real frequencies

  10. Stability of longitudinal modes in a bunched beam with mode coupling

    International Nuclear Information System (INIS)

    Satoh, K.

    1981-06-01

    In this paper we study a longitudinal coherent bunch instability in which the growth time is comparable to or less than the period of synchrotron oscillations. Both longitudinal and transverse bunch instabilities have been studied. In most treatments, however, the coherent force is assumed to be small and is treated as a perturbation compared with the synchrotron force. This makes the problem simpler because an individual synchrotron mode is decoupled. As bunch current increases, the coherent force is no longer small and the mode frequency shift becomes significant compared with the synchrotron frequency. Therefore in this case it is necessary to include coupling of the synchrotron modes. Recently a fast blow-up instability which comes from mode coupling was studied. Their method is to derive a dispersion relation for a bunched beam using the Vlasov equation and to analyze it as in a coasting beam. They showed that if mode coupling is included the Vlasov equation predicts a fast microwave instability with a stability condition similar to that for a coasting beam. In this paper we will partly follow their method and present a formalism which includes coupling between higher-order radial modes as well as coupling between synchrotron modes. The formalism is considered to be generalization of the Sacherer formalism without mode coupling. This theory predicts that instability is induced not only by coupling between different synchrotron modes, but also by coupling between positive and negative modes, since negative synchrotron modes are included in the theory in a natural manner. This formalism is to be used for a Gaussian bunch and a parabolic bunch, and is also useful for transverse problems

  11. Nanotechnology based targeted drug delivery.

    Science.gov (United States)

    Ruggiero, Carmelina; Pastorino, Laura; Herrera, Oscar L

    2010-01-01

    NANOTECHNOLOGY is having a great impact on many industrial applications, such as manufacturing, semiconductors, nanostructured materials and biotechnology. As relates to the latter, nanobiotechnology focuses on the ability to work at the molecular and atomic level to fabricate structures combining biological materials and synthetic materials, taking into account engineering, physics, chemistry, genomics and proteomics. The main goals relate to biosensors, nanosized microchips, and more generally to medical applications at the molecular level. Nanotechnology has been recently extensively applied to treatment and diagnosis of diseases and the new term nanomedicine has been introduced, for which several definitions have so far been proposed [1]-[3] which focus on the use of engineered nano-devices and nanostructures for diagnosis and treatment. One of the key aspects of nanomedicine is targeted drug delivery by nanoscale drug carriers. At present, 95 % of all new potential therapeutics have poor pharmaco kinetics and biopharmaceutical properties, there is therefore a great need to develop drug delivery [4] systems that convey the therapeutically active molecules only to the site of action, without affecting other organs and tissues [5]. This allows to lower required doses of drugs and to increase their therapeutic indices and safety profiles. It is possible to fabricate nanoparticles or nanocapsules with different properties as relates to drug encapsulation and release. A great amount of nanoscale systems for drug delivery has been investigated; they include liposomes, dendrimers, quantum dots, nanotubes, polymeric biodegradable nanoparticles and nanocapsules [6].

  12. Characterization of particulate drug delivery systems for oral delivery of Peptide and protein drugs

    DEFF Research Database (Denmark)

    Christophersen, Philip Carsten; Fano, Mathias; Saaby, Lasse

    2015-01-01

    Oral drug delivery is a preferred route because of good patient compliance. However, most peptide/ protein drugs are delivered via parenteral routes because of the absorption barriers in the gastrointestinal (GI) tract such as enzymatic degradation by proteases and low permeability acrossthe...... biological membranes. To overcome these barriers, different formulation strategies for oral delivery of biomacromolecules have been proposed, including lipid based formulations and polymer-based particulate drug delivery systems (DDS). The aim of this review is to summarize the existing knowledge about oral...... delivery of peptide/protein drugs and to provide an overview of formulationand characterization strategies. For a better understanding of the challenges in oral delivery of peptide/protein drugs, the composition of GI fluids and the digestion processes of different kinds of excipients in the GI tract...

  13. Micro- and nanotechnologies for intracellular delivery.

    Science.gov (United States)

    Yan, Li; Zhang, Jinfeng; Lee, Chun-Sing; Chen, Xianfeng

    2014-11-01

    The majority of drugs and biomolecules need to be delivered into cells to be effective. However, the cell membranes, a biological barrier, strictly resist drugs or biomolecules entering cells, resulting in significantly reduced intracellular delivery efficiency. To overcome this barrier, a variety of intracellular delivery approaches including chemical and physical ways have been developed in recent years. In this review, the focus is on summarizing the nanomaterial routes involved in making use of a collection of receptors for the targeted delivery of drugs and biomolecules and the physical ways of applying micro- and nanotechnologies for high-throughput intracellular delivery. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Biodegradable polymeric nanocarriers for pulmonary drug delivery.

    Science.gov (United States)

    Rytting, Erik; Nguyen, Juliane; Wang, Xiaoying; Kissel, Thomas

    2008-06-01

    Pulmonary drug delivery is attractive for both local and systemic drug delivery as a non-invasive route that provides a large surface area, thin epithelial barrier, high blood flow and the avoidance of first-pass metabolism. Nanoparticles can be designed to have several advantages for controlled and targeted drug delivery, including controlled deposition, sustained release, reduced dosing frequency, as well as an appropriate size for avoiding alveolar macrophage clearance or promoting transepithelial transport. This review focuses on the development and application of biodegradable polymers to nanocarrier-based strategies for the delivery of drugs, peptides, proteins, genes, siRNA and vaccines by the pulmonary route. The selection of natural or synthetic materials is important in designing particles or nanoparticle clusters with the desired characteristics, such as biocompatibility, size, charge, drug release and polymer degradation rate.

  15. Numerical analysis of intermodal delay in few-mode fibers for mode division multiplexing in optical fiber communication systems

    Science.gov (United States)

    Munir, Abid; Xin, Xiang-jun; Liu, Bo; Latif, Abdul; Hussain, Aftab; Niazi, Shahab Ahmad

    2012-03-01

    In order to achieve higher spectral efficiency, mode division multiplexing (MDM) in few-mode fibers is a new research area. The idea faces lots of technical issues including intermodal delay and mode coupling which limit the achievable length of the system. This paper is designated to complete the analysis of intermodal delay in step-index few-mode fibers. We analyze numerically all the parameters of fiber, which could impact intermodal delay in few-mode fibers and identify the conditions which can increase the number of multiplex modes without significant increase in maximum intermodal delay.

  16. Mode og mozzarella

    DEFF Research Database (Denmark)

    Nielsen, Jakob Isak

    2013-01-01

    Under en samtale i Paolo Sorrentinos La grande bellezza/da. Den store skønhed (2013) anføres det, at Italiens primære eksportvarer er mode og mozzarella. Selve filmen vidner om, at Italien har andet at byde på – heriblandt filmkunst og Roms righoldige kulturhistorie.......Under en samtale i Paolo Sorrentinos La grande bellezza/da. Den store skønhed (2013) anføres det, at Italiens primære eksportvarer er mode og mozzarella. Selve filmen vidner om, at Italien har andet at byde på – heriblandt filmkunst og Roms righoldige kulturhistorie....

  17. Advanced SLARette delivery machine

    International Nuclear Information System (INIS)

    Bodner, R.R.

    1995-01-01

    SLARette 1 equipment, comprising of a SLARette Delivery Machine, SLAR Tools, SLAR power supplies and SLAR Inspection Systems was designed, developed and manufactured to service fuel channels of CANDU 6 stations during the regular yearly station outages. The Mark 2 SLARette Delivery Machine uses a Push Tube system to provide the axial and rotary movements of the SLAR Tool. The Push Tubes are operated remotely but must be attached and removed manually. Since this operation is performed at the Reactor face, there is radiation dose involved for the workers. An Advanced SLARette Delivery Machine which incorporates a computer controlled telescoping Ram in the place of the Push Tubes has been recently designed and manufactured. Utilization of the Advanced SLARette Delivery Machine significantly reduces the amount of radiation dose picked up by the workers because the need to have workers at the face of the Reactor during the SLARette operation is greatly reduced. This paper describes the design, development and manufacturing process utilized to produce the Advanced SLARette Delivery Machine and the experience gained during the Gentilly-2 NGS Spring outage. (author)

  18. The KRAKEN normal mode program

    Science.gov (United States)

    Porter, M. B.

    1992-05-01

    In the late 1970's, several normal-mode models existed which were widely used for predicting acoustic transmission-loss in the ocean; however, each had its own problems. Typical difficulties included numerical instabilities for certain types of sound-speed profiles and failures to compute a complete set of ocean modes. In short, there was a need for a model that was robust, accurate, and efficient. In order to resolve these problems, a new algorithm was developed forming the basis for the KRAKEN normal mode model. Over subsequent years, KRAKEN was greatly extended, with options for modeling ocean environments that are range-independent, range-dependent, or fully 3-dimensional. The current version offers the specialist a vast number of options for treating ocean-acoustics problems (or more generally acousto-elastic waveguides). On the other hand, it is easy for a less sophisticated user to learn the small subset of tools needed for the common problem of transmission-loss modeling in range-independent ocean environments. This report addresses the need for a more complete user's guide to supplement the on-line help files. The first chapters give a fairly technical description of the mathematical and numerical basis of the model. Additional chapters give a simpler description of its use and installation in a manner that is accessible to less scientifically-oriented readers.

  19. Completeness of non-normalizable modes

    International Nuclear Information System (INIS)

    Mannheim, Philip D; Simbotin, Ionel

    2006-01-01

    We establish the completeness of some characteristic sets of non-normalizable modes by constructing fully localized square steps out of them, with each such construction expressly displaying the Gibbs phenomenon associated with trying to use a complete basis of modes to fit functions with discontinuous edges. As well as being of interest in and of itself, our study is also of interest to the recently introduced large extra dimension brane-localized gravity program of Randall and Sundrum, since the particular non-normalizable mode bases that we consider (specifically the irregular Bessel functions and the associated Legendre functions of the second kind) are associated with the tensor gravitational fluctuations which occur in those specific brane worlds in which the embedding of a maximally four-symmetric brane in a five-dimensional anti-de Sitter bulk leads to a warp factor which is divergent. Since the brane-world massless four-dimensional graviton has a divergent wavefunction in these particular cases, its resulting lack of normalizability is thus not seen to be any impediment to its belonging to a complete basis of modes, and consequently its lack of normalizability should not be seen as a criterion for not including it in the spectrum of observable modes. Moreover, because the divergent modes we consider form complete bases, we can even construct propagators out of them in which these modes appear as poles with residues which are expressly finite. Thus, even though normalizable modes appear in propagators with residues which are given as their finite normalization constants, non-normalizable modes can just as equally appear in propagators with finite residues too-it is just that such residues will not be associated with bilinear integrals of the modes

  20. HIFU Monitoring and Control with Dual-Mode Ultrasound Arrays

    Science.gov (United States)

    Casper, Andrew Jacob

    The biological effects of high-intensity focused ultrasound (HIFU) have been known and studied for decades. HIFU has been shown capable of treating a wide variety of diseases and disorders. However, despite its demonstrated potential, HIFU has been slow to gain clinical acceptance. This is due, in part, to the difficulty associated with robustly monitoring and controlling the delivery of the HIFU energy. The non-invasive nature of the surgery makes the assessment of treatment progression difficult, leading to long treatment times and a significant risk of under treatment. This thesis research develops new techniques and systems for robustly monitoring HIFU therapies for the safe and efficacious delivery of the intended treatment. Systems and algorithms were developed for the two most common modes of HIFU delivery systems: single-element and phased array applicators. Delivering HIFU with a single element transducer is a widely used technique in HIFU therapies. The simplicity of a single element offers many benefits in terms of cost and overall system complexity. Typical monitoring schemes rely on an external device (e.g. diagnostic ultrasound or MRI) to assess the progression of therapy. The research presented in this thesis explores using the same element to both deliver and monitor the HIFU therapy. The use of a dual-mode ultrasound transducer (DMUT) required the development of an FPGA based single-channel arbitrary waveform generator and high-speed data acquisition unit. Data collected from initial uncontrolled ablations led to the development of monitoring and control algorithms which were implemented directly on the FPGA. Close integration between the data acquisition and arbitrary waveform units allowed for fast, low latency control over the ablation process. Results are presented that demonstrate control of HIFU therapies over a broad range of intensities and in multiple in vitro tissues. The second area of investigation expands the DMUT research to an

  1. Timing of administration of epidural analgesia and risk of operative delivery in nulliparous women: A case–control randomised study

    Directory of Open Access Journals (Sweden)

    Ipsita Chattopadhyay

    2018-01-01

    Full Text Available >Background and Aim: Epidural analgesia (EA offers an effective form of labour analgesia. The time of administration of EA and its relationship with the mode of delivery is controversial. Our study tried to assess whether early initiation of epidural analgesia influences the obstetric outcome in nulliparous women.Materials and Methods: This was a case control, randomised study which included 60 parturients in spontaneous labour divided into two equal groups, the cases and controls. Cases received EA with 10 mL of 0.125% injection bupivacaine, whereas the control group received a systemic opioid (injection pethidine 100 mg intramuscularly for pain relief. Cases were further divided into parturients receiving EA at a cervical dilatation of 3 cm or less classified as the early epidural group and those receiving EA at 4 cm or more classified as the late epidural group. The modes of delivery for the study population were recorded. Data analysis was done using Wilcoxon two-sample test. P < 0.05 was considered statistically significant.Results: The rate of instrumental vaginal delivery between the early epidural group [95% confidence interval (CI 0.358–10.821; P = 0.43] and late epidural group (95% CI 0.150–6.055; P = 0.96 was not significantly different. The cesarean-delivery rate was also not significantly different between those receiving early EA (P = 0.95 and late EA (P = 0.58 when compared with control group.Conclusion: This study showed no significant difference in the incidence of caesarean or instrumental delivery for women receiving early epidural analgesia when compared with late epidurals or no EA.

  2. Cesarean delivery rates and obstetric culture - an Italian register-based study.

    Science.gov (United States)

    Plevani, Cristina; Incerti, Maddalena; Del Sorbo, Davide; Pintucci, Armando; Vergani, Patrizia; Merlino, Luca; Locatelli, Anna

    2017-03-01

    Cesarean delivery rates are rising due to multiple factors, including less use of operative vaginal delivery and vaginal birth after cesarean delivery, which often reflect local obstetric practices. Objectives of the study were to analyze the relations between cesarean delivery, these practices, and perinatal outcomes. We included all deliveries in the 72 hospitals of Lombardia, a region in northern Italy, during the year 2013. The delivery certificate was used as data source. Pearson's correlation coefficient and logistic regression were used for statistical analysis. We included 87 896 deliveries. The number of deliveries per hospital ranged from 140 to 6123. The rate of cesarean delivery was 28.3% (range 9.9-86.4%), operative vaginal delivery 4.7% (range 0.2-10.0%), and vaginal birth after cesarean 17.3% (range 0-79.2%). We found a significant inverse correlation between rates of overall cesarean delivery and operative vaginal delivery (r = -0.25, p = 0.04). The correlation between rate of overall cesarean delivery and vaginal birth after cesarean was also inverse and significant (r = -0.57, p cesarean delivery rate and the rates of Apgar score at 5 min cesarean delivery, could reduce the rising cesarean delivery rate. This will require a change in obstetric culture, continuing education of healthcare providers, and leadership. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Electronically Tunable Resistorless Mixed Mode Biquad Filters

    OpenAIRE

    Yesil, A.; Kacar, F.

    2013-01-01

    This paper presents a new realization of elec¬tronically tunable mixed mode (including transadmittance- and voltage-modes) biquad filter with single input, three outputs or three inputs, single output using voltage differ-encing transconductance amplifier (VDTA), a recently introduced active element. It can simultaneously realize standard filtering signals: low-pass, band-pass and high-pass or by selecting input terminals, it can realize all five different filtering signals: low-pass, band-pa...

  4. Pulmonary drug delivery system: newer patents.

    Science.gov (United States)

    Kaur, Shahid Sukhbir

    2017-09-01

    Inhalational route for drug delivery and desired effects has been known since centuries. This lung-targeted therapy has benefited asthmatics and those with chronic respiratory problems. The technique has evolved greatly from crude pots and pipes to modern sophisticated drug-dispensing devices. This mode is effective, rapid and safe. Its outcome, however, is majorly determined by drug formulation, device structure and patient's coordinating skill. In spite of great advances in this field, more efforts are required to meet the unmet needs. This noninvasive mode is being increasingly studied for transfer of drugs for systemic action with promising results. The present article is an attempt to capture the recent development and progress in this field and review relevant newer patents.

  5. The ACTS propagation terminal delivery and support

    Science.gov (United States)

    Stutzman, Warren L.

    1993-01-01

    Viewgraphs on the Advanced Communications Technology Satellite (ACTS) propagation terminal delivery and support are included. Topics covered include: the ACTS propagation terminal (APT) development program; terminal overview; physical units; test results; status of terminals and schedule; shipping cartons; and site support.

  6. Distance Learning Delivery Systems: Instructional Options.

    Science.gov (United States)

    Steele, Ray L.

    1993-01-01

    Discusses the availability of satellite and cable programing to provide distance education opportunities in school districts. Various delivery systems are described, including telephones with speakers, personal computers, and satellite dishes; and a sidebar provides a directory of distance learning opportunities, including telecommunications…

  7. Theories and Modes

    Science.gov (United States)

    Apsche, Jack A.

    2005-01-01

    In his work on the Theory of Modes, Beck (1996) suggested that there were flaws with his cognitive theory. He suggested that though there are shortcomings to his cognitive theory, there were not similar shortcomings to the practice of Cognitive Therapy. The author suggests that if there are shortcomings to cognitive theory the same shortcomings…

  8. Thermodynamics of Radiation Modes

    Science.gov (United States)

    Pina, Eduardo; de la Selva, Sara Maria Teresa

    2010-01-01

    We study the equilibrium thermodynamics of the electromagnetic radiation in a cavity of a given volume and temperature. We found three levels of description, the thermodynamics of one mode, the thermodynamics of the distribution of frequencies in a band by summing over the frequencies in it and the global thermodynamics by summing over all the…

  9. Magnetic modes in superlattices

    International Nuclear Information System (INIS)

    Oliveira, F.A.

    1990-04-01

    A first discussion of reciprocal propagation of magnetic modes in a superlattice is presented. In the absence of an applied external magnetic field a superllatice made of alternate layers of the type antiferromagnetic-non-magnetic materials presents effects similar to those of phonons in a dielectric superlattice. (A.C.A.S.) [pt

  10. Study Mode Negotiation.

    Science.gov (United States)

    Vasan, Mani Le; Sargunan, Rajeswary

    This paper outlines a model of study mode negotiation between clients and English Language Training providers that has been developed at the University of Malaya, specifically related to English language writing skills as taught to corporate clients. Negotiation is used to reach decisions concerning the goals and methodology of learning to ensure…

  11. Ariadne: The Next Generation of Electronic Document Delivery Systems.

    Science.gov (United States)

    Roes, Hans; Dijkstra, Joost

    1994-01-01

    Describes an approach to electronic document delivery which has evolved at Tilburg University (Netherlands), leading to the development of a system called Ariadne. Highlights include various generations of electronic document delivery systems; standards, including the work of the Group on Electronic Document Interchange; and a description of the…

  12. Cytokines and the Risk of Preterm Delivery in Twin Pregnancies

    DEFF Research Database (Denmark)

    Rode, Line; Klein, Katharina; Larsen, Helle

    2012-01-01

    To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment.......To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment....

  13. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Møller Larsen, Marcus; Bharati, Pratyush M.

    2015-01-01

    Global delivery models (GDMs) are transforming the global IT and business process outsourcing industry. GDMs are a new form of client-specific investment promoting service integration with clients by combining client proximity with time-zone spread for 24/7 service operations. We investigate...... antecedents and contingencies of setting up GDM structures. Based on comprehensive data we show that providers are likely to establish GDM location configurations when clients value access to globally distributed talent and speed of service delivery, in particular when services are highly commoditized....... Findings imply that coordination across time zones increasingly affects international operations in business-to-business and born-global industries....

  14. Cement composite delivery system.

    Science.gov (United States)

    Convery, F R; Devine, S D; Hollis, J M; Woo, S L

    1986-09-01

    Several new and innovative techniques have recently been introduced that purport to increase the strength of polymethyl methacrylate bone cement. One of these concepts is the use of carbon and polymer fibers to form a cement composite. Bone cement composites usually 1% fiber, are very difficult to use clinically. The composite is very sticky and viscous, which precludes effective hand packing or the use of conventional delivery systems. A new delivery system for very viscous materials is presented and examples of in vitro application are shown.

  15. Optimization to reduce fuel consumption in charge depleting mode

    Science.gov (United States)

    Roos, Bryan Nathaniel; Martini, Ryan D.

    2014-08-26

    A powertrain includes an internal combustion engine, a motor utilizing electrical energy from an energy storage device, and a plug-in connection. A Method for controlling the powertrain includes monitoring a fuel cut mode, ceasing a fuel flow to the engine based upon the fuel cut mode, and through a period of operation including acceleration of the powertrain, providing an entirety of propelling torque to the powertrain with the electrical energy from the energy storage device based upon the fuel cut mode.

  16. Hollow-core fibers for high power pulse delivery

    DEFF Research Database (Denmark)

    Michieletto, Mattia; Lyngsø, Jens K.; Jakobsen, Christian

    2016-01-01

    picosecond pulses. A novel fiber with 7 tubes and a core of 30 mu m was fabricated and it is here described and characterized, showing remarkable low loss, low bend loss, and good mode quality. Its optical properties are compared to both a 10 mu m and a 18 mu m core diameter photonic band gap hollow......We investigate hollow-core fibers for fiber delivery of high power ultrashort laser pulses. We use numerical techniques to design an anti-resonant hollow-core fiber having one layer of non-touching tubes to determine which structures offer the best optical properties for the delivery of high power......-core fiber. The three fibers are characterized experimentally for the delivery of 22 picosecond pulses at 1032nm. We demonstrate flexible, diffraction limited beam delivery with output average powers in excess of 70W. (C) 2016 Optical Society of America...

  17. Fractographic study of epoxy fractured under mode I loading and mixed mode I/III loading

    Energy Technology Data Exchange (ETDEWEB)

    Ren, Fei [ORNL; Wang, Jy-An John [ORNL; Bertelsen, Williams D. [Gougeon Brothers, Inc.

    2011-01-01

    Fiber reinforced polymeric composite materials are widely used in structural components such as wind turbine blades, which are typically subject to complicated loading conditions. Thus, material response under mixed mode loading is of great significance to the reliability of these structures. Epoxy is a thermosetting polymer that is currently used in manufacturing wind turbine blades. The fracture behavior of epoxy is relevant to the mechanical integrity of the wind turbine composite materials. In this study, a novel fracture testing methodology, the spiral notch torsion test (SNTT), was applied to study the fracture behavior of an epoxy material. SNTT samples were tested using either monotonic loading or cyclic loading, while both mode I and mixed mode I/III loading conditions were used. Fractographic examination indicated the epoxy samples included in this study were prone to mode I failure even when the samples were subject to mixed mode loading. Different fatigue precracks were observed on mode I and mixed mode samples, i.e. precracks appeared as a uniform band under mode I loading, and a semi-ellipse under mixed mode loading. Fracture toughness was also estimated using quantitative fractography.

  18. Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database.

    Directory of Open Access Journals (Sweden)

    Sarah J Stock

    Full Text Available There is evidence that induction of labour (IOL around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery. However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management.We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176. Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401 of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]. There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]. In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75] and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00].A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.

  19. Ethical issues in cesarean delivery.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2017-08-01

    Cesarean delivery is the most common and important surgical intervention in obstetric practice. Ethics provides essential guidance to obstetricians for offering, recommending, recommending against, and performing cesarean delivery. This chapter provides an ethical framework based on the professional responsibility model of obstetric ethics. This framework is then used to address two especially ethically challenging clinical topics in cesarean delivery: patient-choice cesarean delivery and trial of labor after cesarean delivery. This chapter emphasizes a preventive ethics approach, designed to prevent ethical conflict in clinical practice. To achieve this goal, a preventive ethics approach uses the informed consent process to offer cesarean delivery as a medically reasonable alternative to vaginal delivery, to recommend cesarean delivery, and to recommend against cesarean delivery. The limited role of shared decision making is also described. The professional responsibility model of obstetric ethics guides this multi-faceted preventive ethics approach. Copyright © 2017. Published by Elsevier Ltd.

  20. Application of failure mode and effects analysis in a clinical chemistry laboratory.

    Science.gov (United States)

    Jiang, Yuanyuan; Jiang, Hongmin; Ding, Siyi; Liu, Qin

    2015-08-25

    Timely delivery of correct results has long been considered as the goal of quality management in clinical laboratory. With increasing workload as well as complexities of laboratory testing and patient care, the traditional technical adopted like internal quality control (IQC) and external quality assessment (EQA) may not enough to cope with quality management problems for clinical laboratories. We applied failure mode and effects analysis (FMEA), a proactive tool, to reduce errors associated with the process beginning with sample collection and ending with a test report in a clinical chemistry laboratory. Our main objection was to investigate the feasibility of FMEA in a real-world situation, namely the working environment of hospital. A team of 8 people (3 laboratory workers, 2 couriers, 2 nurses, and 1 physician) from different departments who were involved in the testing process were recruited and trained. Their main responsibility was to analyze and score all possible clinical chemistry laboratory failures based on three aspects: the severity of the outcome (S), the likeliness of occurrence (O), and the probability of being detected (D). These three parameters were multiplied to calculate risk priority numbers (RPNs), which were used to prioritize remedial measures. Failure modes with RPN≥200 were deemed as high risk, meaning that they needed immediate corrective action. After modifications that were put, we compared the resulting RPN with the previous one. A total of 33 failure modes were identified. Many of the failure modes, including the one with the highest RPN (specimen hemolysis) appeared in the pre-analytic phase, whereas no high-risk failure modes (RPN≥200) were found during the analytic phase. High-priority risks were "sample hemolysis" (RPN, 336), "sample delivery delay" (RPN, 225), "sample volume error" (RPN, 210), "failure to release results in a timely manner" (RPN, 210), and "failure to identify or report critical results" (RPN, 200). The

  1. Exploring educational disparities in risk of preterm delivery

    DEFF Research Database (Denmark)

    Poulsen, Gry; Strandberg-Larsen, Katrine; Mortensen, Laust

    2015-01-01

    data. METHODS: The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22-36 completed weeks...... characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 [95% CI 1.1, 3.3] and 4.0 [95% CI 1.4, 6.6] excess preterm deliveries per 100 singleton deliveries among the educationally most......BACKGROUND: An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort...

  2. Renewable energy delivery systems and methods

    Science.gov (United States)

    Walker, Howard Andrew

    2013-12-10

    A system, method and/or apparatus for the delivery of energy at a site, at least a portion of the energy being delivered by at least one or more of a plurality of renewable energy technologies, the system and method including calculating the load required by the site for the period; calculating the amount of renewable energy for the period, including obtaining a capacity and a percentage of the period for the renewable energy to be delivered; comparing the total load to the renewable energy available; and, implementing one or both of additional and alternative renewable energy sources for delivery of energy to the site.

  3. Two-mode Gaussian density matrices and squeezing of photons

    International Nuclear Information System (INIS)

    Tucci, R.R.

    1992-01-01

    In this paper, the authors generalize to 2-mode states the 1-mode state results obtained in a previous paper. The authors study 2-mode Gaussian density matrices. The authors find a linear transformation which maps the two annihilation operators, one for each mode, into two new annihilation operators that are uncorrelated and unsqueezed. This allows the authors to express the density matrix as a product of two 1-mode density matrices. The authors find general conditions under which 2-mode Gaussian density matrices become pure states. Possible pure states include the 2-mode squeezed pure states commonly mentioned in the literature, plus other pure states never mentioned before. The authors discuss the entropy and thermodynamic laws (Second Law, Fundamental Equation, and Gibbs-Duhem Equation) for the 2-mode states being considered

  4. Delivery outcomes of term pregnancy complicated by idiopathic polyhydramnios.

    Science.gov (United States)

    Zeino, S; Carbillon, L; Pharisien, I; Tigaizin, A; Benchimol, M; Murtada, R; Boujenah, J

    2017-04-01

    Polyhydramnios is associated with an increased risk of cesarean section. The aetiology of polyhydramnios and the characteristics of the labour may be confounding factors. The objective was to study the characteristics and mode of delivery in case of pregnancy complicated with idiopathic polyhydramnios. This retrospective matched and controlled study included all pregnant women with idiopathic polyhydramnios (amniotic index>25cm or single deepest pocket>8cm) diagnosed at the 2nd or 3rd trimester and persistent at term delivery (>37weeks of pregnancy) in our institution. We excluded pregnancies in which the polyhydramnios could be explained by infection, gestational diabetes, congenital malformation, abnormal karyotype, placental anomalies, alloimmunization as well as pregnancies in which an amniocentesis for the purpose of diagnosis had not been performed. Data were gathered from a tertiary care university hospital register from 1998-2015. Cases of polyhydramnios were matched with the following two women who presented for labour management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index. The main outcome measure was the risk of cesarean section. Univariate and multivariate adjusted analysis were performed. We identified 108 women with idiopathic polyhydramnios and compared them with 216 matched women. Among them, 94 and 188 attempted a trial of labour. Maternal age, mean term delivery and birthweight were 31 years, 39+5weeks gestation and 3550 g. We did not observe differences in maternal characteristics, epidural analgesia and rate of abnormal fetal heart tracing. Induced labour and non-vertex presentations (forehead, bregma, face) were more frequent in the polyhydramnios group (respectively 57.9% versus 27.8%, Ppolyhydramnios in the overall population (45.4% versus 8%, Ppolyhydramnios (55.8% versus 39.1%, Ppolyhydramnios was found to be a risk factor for cesarean section (OR 21.02; CI 95% 8

  5. Transdermal delivery of ketorolac.

    Science.gov (United States)

    Amrish, Chandra; Kumar, Sharma Pramod

    2009-03-01

    A reservoir type transdermal patch for delivery of ketorolac, a potent analgesic agent was studied. The low permeability of skin is the rate-limiting step for delivery of most of the drugs. Studies were carried out to investigate the effect of permeation enhancers on the in vitro permeation of ketorolac across rat skin. The reservoir type transdermal patch was fabricated and the core was filled with gel system of a non ionic polymer HPMC (hydroxypropyl methyl cellulose) formulated in PBS (phosphate buffer saline) solution of pH of 5.4 along with isopropyl alcohol at 25% w/w concentration. Various permeation enhancers' viz. dimethyl sulphoxide, d-limonene, eucalyptus oil and transcutol (diethylene glycol monoethyl ether) were incorporated into the gel system. Permeation enhancement of ketorolac with different enhancers followed the order eucalyptus oil> transcutol> DMSO> d-limonene. Cyclic terpene containing eucalyptus oil was found to be the most promising chemical permeation enhancer for transdermal delivery of ketorolac. The increase in concentration of eucalyptus oil further enhanced drug permeation with maximum flux being achieved at 10% w/w of 66.38 microg/cm(2)/h. Further enhancement of permeation rate of ketorolac across skin was attained by application of abrading gel containing crushed apricot seed onto the skin. There was 5.16 times enhancement and flux of 93.10 microg/cm(2)/h was attained. A reservoir type transdermal patch for delivery of ketorolac thus appears to be feasible of delivering ketorolac across skin.

  6. Caesarean delivery: conflicting interests.

    Science.gov (United States)

    Osuna, Eduardo; Pérez Cárceles, Maria Dolores; Sánchez Ferrer, Maria Luisa; Machado, Francisco

    2015-12-01

    Within the maternal-fetal relationship, interests may sometimes diverge. In this paper, a pregnant woman's refusal to undergo a caesarean delivery, which was recommended both to save the life of the fetus and to minimize risks to her, is described. The legal aspects involved in the conflict between maternal autonomy and fetal well-being are analysed. The patient requested an abortion because of the poor condition of the fetus; however, according to Spanish legislation, the possibility of abortion was rejected as the pregnancy was in its 27th week. The woman still persisted in her refusal to accept a caesarian delivery. After the medical team sought guidance on the course to follow, the Duty Court authorized a caesarean delivery against the wishes of the patient. From a legal point of view, at stake were the freedom of the woman - expressed by the decision to reject a caesarean delivery - and the life of the unborn child. In clinical treatment, the interests of the fetus are generally aligned with those of the pregnant woman. When they are not, it is the pregnant woman's autonomy that should be respected, and coercion should form no part of treatment, contrary to the decision of this court. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  7. A Medical Delivery Device

    DEFF Research Database (Denmark)

    2010-01-01

    The present invention relates to a medical delivery device comprising at least two membrane electrode assembly units each of which comprises three layers: an upper and a lower electrode and a selective ionic conductive membrane provided there-between. At least one of the three layers are shared...

  8. Microfabricated injectable drug delivery system

    Science.gov (United States)

    Krulevitch, Peter A.; Wang, Amy W.

    2002-01-01

    A microfabricated, fully integrated drug delivery system capable of secreting controlled dosages of multiple drugs over long periods of time (up to a year). The device includes a long and narrow shaped implant with a sharp leading edge for implantation under the skin of a human in a manner analogous to a sliver. The implant includes: 1) one or more micromachined, integrated, zero power, high and constant pressure generating osmotic engine; 2) low power addressable one-shot shape memory polymer (SMP) valves for switching on the osmotic engine, and for opening drug outlet ports; 3) microfabricated polymer pistons for isolating the pressure source from drug-filled microchannels; 4) multiple drug/multiple dosage capacity, and 5) anisotropically-etched, atomically-sharp silicon leading edge for penetrating the skin during implantation. The device includes an externally mounted controller for controlling on-board electronics which activates the SMP microvalves, etc. of the implant.

  9. Observations on resistive wall modes

    International Nuclear Information System (INIS)

    Gerwin, R.A.; Finn, J.M.

    1996-01-01

    Several results on resistive wall modes and their application to tokamaks are presented. First, it is observed that in the presence of collisional parallel dynamics there is an exact cancellation to lowest order of the dissipative and sound wave effects for an ideal Ohm's law. This is easily traced to the fact that the parallel dynamics occurs along the perturbed magnetic field lines for such electromagnetic modes. Such a cancellation does not occur in the resistive layer of a tearing-like mode. The relevance to models for resistive wall modes using an electrostatic Hammett-Perkins type operator to model Landau damping will be discussed. Second, we observe that with an ideal Ohm's law, resistive wall modes can be destabilized by rotation in that part of parameter space in which the ideal MHD modes are stable with the wall at infinity. This effect can easily be explained by interpreting the resistive wall instability in terms of mode coupling between the backward stable MHD mode and a stable mode locked into the wall. Such an effect can occur for very small rotation for tearing-resistive wall modes in which inertia dominates viscosity in the layer, but the mode is stabilized by further rotation. For modes for which viscosity dominates in the layer, rotation is purely stabilizing. For both tearing models, a somewhat higher rotation frequency gives stability essentially whenever the tearing mode is stable with a perfectly conducting wall. These tearing/resistive wall results axe also simply explained in terms of mode coupling. It has been shown that resonant external ideal modes can be stabilized in the presence of resistive wall and resistive plasma with rotation of order the nominal tearing mode growth rate. We show that these modes behave as resistive wall tearing modes in the sense above. This strengthens the suggestion that rotational stabilization of the external kink with a resistive wall is due to the presence of resistive layers, even for ideal modes

  10. Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term.

    Science.gov (United States)

    Froehlich, Rosemary J; Sandoval, Grecio; Bailit, Jennifer L; Grobman, William A; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Blackwell, Sean C; Tolosa, Jorge E

    2016-09-01

    To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery. This was a secondary analysis of a multicenter observational cohort of 115,502 deliveries from 2008 to 2011. Data were abstracted by trained and certified study personnel. We included women at 37 weeks of gestation or greater attempting vaginal delivery with live, nonanomalous, singleton, vertex fetuses and no history of cesarean delivery. Rates and odds ratios (ORs) were calculated for women with ultrasonography or clinical estimated fetal weight compared with women without documentation of estimated fetal weight. Further subgroup analyses were performed for estimated fetal weight categories (less than 3,500, 3,500-3,999, and 4,000 g or greater) stratified by diabetic status. Multivariable analyses were performed to adjust for important potential confounding variables. We included 64,030 women. Cesarean delivery rates were 18.5% in the ultrasound estimated fetal weight group, 13.4% in the clinical estimated fetal weight group, and 11.7% in the no documented estimated fetal weight group (Pcesarean delivery was 1.44 (95% confidence interval [CI] 1.31-1.58, Pcesarean delivery. When ultrasound estimated fetal weight was 4,000 g or greater, the adjusted OR was 2.15 (95% CI 1.55-2.98, Pdelivery at term, documentation of estimated fetal weight (obtained clinically or, particularly, by ultrasonography) was associated with increased odds of cesarean delivery. This relationship was strongest at higher fetal weight estimates, even after controlling for the effects of birth weight and other factors associated with increased cesarean delivery risk.

  11. Reduction of treatment delivery variances with a computer-controlled treatment delivery system

    International Nuclear Information System (INIS)

    Fraass, B.A.; Lash, K.L.; Matrone, G.M.; Lichter, A.S.

    1997-01-01

    Purpose: To analyze treatment delivery variances for 3-D conformal therapy performed at various levels of treatment delivery automation, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system. Materials and Methods: All external beam treatments performed in our department during six months of 1996 were analyzed to study treatment delivery variances versus treatment complexity. Treatments for 505 patients (40,641 individual treatment ports) on four treatment machines were studied. All treatment variances noted by treatment therapists or quality assurance reviews (39 in all) were analyzed. Machines 'M1' (CLinac (6(100))) and 'M2' (CLinac 1800) were operated in a standard manual setup mode, with no record and verify system (R/V). Machines 'M3' (CLinac 2100CD/MLC) and ''M4'' (MM50 racetrack microtron system with MLC) treated patients under the control of a computer-controlled conformal radiotherapy system (CCRS) which 1) downloads the treatment delivery plan from the planning system, 2) performs some (or all) of the machine set-up and treatment delivery for each field, 3) monitors treatment delivery, 4) records all treatment parameters, and 5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3, so it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments (ports), non-axial and non-coplanar plans, multi-segment intensity modulation, and pseudo-isocentric treatments (and other plans with computer-controlled table motions). Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines, so this analysis

  12. Nuclear scissors modes and hidden angular momenta

    Energy Technology Data Exchange (ETDEWEB)

    Balbutsev, E. B., E-mail: balbuts@theor.jinr.ru; Molodtsova, I. V. [Joint Institute for Nuclear Research (Russian Federation); Schuck, P. [Université Paris-Sud, Institut de Physique Nucléaire, IN2P3–CNRS (France)

    2017-01-15

    The coupled dynamics of low-lying modes and various giant resonances are studied with the help of the Wigner Function Moments method generalized to take into account spin degrees of freedom and pair correlations simultaneously. The method is based on Time-Dependent Hartree–Fock–Bogoliubov equations. The model of the harmonic oscillator including spin–orbit potential plus quadrupole–quadrupole and spin–spin interactions is considered. New low-lying spin-dependent modes are analyzed. Special attention is paid to the scissors modes. A new source of nuclear magnetism, connected with counter-rotation of spins up and down around the symmetry axis (hidden angular momenta), is discovered. Its inclusion into the theory allows one to improve substantially the agreement with experimental data in the description of energies and transition probabilities of scissors modes.

  13. Inward particle transport by plasma collective modes

    International Nuclear Information System (INIS)

    Antonsen, T.; Coppi, B.; Englade, R.

    1979-01-01

    A model for the rate of density rise observed when neutral gas is fed into a plasma-containing chamber is presented for regimes where known collisional transport processes do not provide an adequate explanation. A dense layer of cold plasma produced at the edge of the plasma column and the resulting relatively sharp ion temperature gradient, as compared with the local density gradient, can lead to the excitation of electron temperature fluctuations driven by ion drift modes. The net inflow of electrons and ions that is produced by these modes has been included in a one-dimensional transport code used to simulate experiments performed by the Alcator device. The linear and quasi-linear theories of these modes are given for the regimes of interest. The cold-plasma-layer model is also consistent with the presence of an outflow of impurity ions, due to impurity driven modes, that balance the inflow produced by discrete collisions. (author)

  14. Influence of toroidal rotation on tearing modes

    Science.gov (United States)

    Cai, Huishan; Cao, Jintao; Li, Ding

    2017-10-01

    Tearing modes stability analysis including toroidal rotation is studied. It is found that rotation affects the stability of tearing modes mainly through the interaction with resistive inner region of tearing mode. The coupling of magnetic curvature with centrifugal force and Coriolis force provides a perturbed perpendicular current, and a return parallel current is induced to affect the stability of tearing modes. Toroidal rotation plays a stable role, which depends on the magnitude of Mach number and adiabatic index Γ, and is independent on the direction of toroidal rotation. For Γ >1, the scaling of growth rate is changed for typical Mach number in present tokamaks. For Γ = 1 , the scaling keeps unchanged, and the effect of toroidal rotation is much less significant, compared with that for Γ >1. National Magnetic Confinement Fusion Science Program and National Science Foundation of China under Grants No. 2014GB106004, No. 2013GB111000, No. 11375189, No. 11075161 and No. 11275260, and Youth Innovation Promotion Association CAS.

  15. Electrostatic effect for the collisionless tearing mode

    International Nuclear Information System (INIS)

    Hoshino, M.

    1987-01-01

    Electron dynamics has not been self-consistently considered in collisionless tearing mode theories to date because of the mathematical complexity of the Vlasov-Maxwell equations. We have found using computer simulations that electrostatic fields play an important role in the tearing mode. Vlasov theory, including the electrostatic field, is investigated for topologies with both antiparallel and nonantiparallel magnetic field lines. The electrostatic field influences the resonant current in the neutral sheet which is a non-MHD effect, and modifies the linear growth rate. At the magnetopause, where the field lines are not antiparallel, the electrostatic effect acts to raise the linear growth rate of the tearing mode. On the other hand, in the magnetotail, where magnetic field lines are antiparallel, the electrostatic effect reduces the tearing mode growth rate. copyright American Geophysical Union 1987

  16. Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women

    OpenAIRE

    Maja Milosavljevic; Dusica Lecic Tosevski; Ivan Soldatovic; Olivera Vukovic; Cedo Miljevic; Amir Peljto; Milutin Kostic; Miranda Olff

    2016-01-01

    Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women we...

  17. Evolution of reactor control modes

    International Nuclear Information System (INIS)

    Mourlevat, J.L.

    2007-01-01

    The article reviews the different reactor control modes: mode A, mode G and mode X that are used in PWR reactors designed by Areva. The purpose of reactor controlling is to compensate reactivity effects (xenon poisoning and counter-reaction effects) generated by load changes. A control mode is the strategy followed by using both soluble boron and the control rods to handle these reactivity effects. Soluble boron plays an important role in mode A but is less efficiency toward the end-of-cycle. Generally soluble boron is used to compensate slow reactivity effects. Mode G is based on the optimization of the use of the control rods and allows a quick return to the nominal power. Mode X combines the uses of control rods and soluble boron to cope with the operator's wishes: sparing effluents or having a quick return to nominal power. The mode X appears to be more penalizing concerning the fuel-cladding interaction. (A.C.)

  18. Protein-Based Nanomedicine Platforms for Drug Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Ma Ham, Aihui; Tang, Zhiwen; Wu, Hong; Wang, Jun; Lin, Yuehe

    2009-08-03

    Drug delivery systems have been developed for many years, however some limitations still hurdle the pace of going to clinical phase, for example, poor biodistribution, drug molecule cytotoxicity, tissue damage, quick clearance from the circulation system, solubility and stability of drug molecules. To overcome the limitations of drug delivery, biomaterials have to be developed and applied to drug delivery to protect the drug molecules and to enhance the drug’s efficacy. Protein-based nanomedicine platforms for drug delivery are platforms comprised of naturally self-assembled protein subunits of the same protein or a combination of proteins making up a complete system. They are ideal for drug delivery platforms due to their biocompatibility and biodegradability coupled with low toxicity. A variety of proteins have been used and characterized for drug delivery systems including the ferritin/apoferritin protein cage, plant derived viral capsids, the small Heat shock protein (sHsp) cage, albumin, soy and whey protein, collagen, and gelatin. There are many different types and shapes that have been prepared to deliver drug molecules using protein-based platforms including the various protein cages, microspheres, nanoparticles, hydrogels, films, minirods and minipellets. There are over 30 therapeutic compounds that have been investigated with protein-based drug delivery platforms for the potential treatment of various cancers, infectious diseases, chronic diseases, autoimmune diseases. In protein-based drug delivery platforms, protein cage is the most newly developed biomaterials for drug delivery and therapeutic applications. Their uniform sizes, multifunctions, and biodegradability push them to the frontier for drug delivery. In this review, the recent strategic development of drug delivery has been discussed with a special emphasis upon the polymer based, especially protein-based nanomedicine platforms for drug delivery. The advantages and disadvantages are also

  19. Tranfusion risk: is "two-step" vaginal delivery a risk for postpartum hemorrhage?

    Science.gov (United States)

    Straface, Gianluca; Bassi, Emma; De Santis, Marco; Scambia, Giovanni; Zanardo, Vincenzo

    2015-01-01

    In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery. This is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of PPH verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion. We found 17 cases of PPH (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two-step vaginal delivery (RR = 0.81 (0.56-1.22)), emergency cesarean section (RR = 2.88 (1.27-7.77)) and operative vaginal delivery (RR = 2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between PPH and as emergency cesarean delivery (p < 0.05) as operative vaginal delivery (p < 0.05). "Two-step" delivery approach did not increase the risk of PPH with respect to operative delivery, elective caesarean section and emergency caesarean section.

  20. Multi-mode ultrasonic welding control and optimization

    Science.gov (United States)

    Tang, Jason C.H.; Cai, Wayne W

    2013-05-28

    A system and method for providing multi-mode control of an ultrasonic welding system. In one embodiment, the control modes include the energy of the weld, the time of the welding process and the compression displacement of the parts being welded during the welding process. The method includes providing thresholds for each of the modes, and terminating the welding process after the threshold for each mode has been reached, the threshold for more than one mode has been reached or the threshold for one of the modes has been reached. The welding control can be either open-loop or closed-loop, where the open-loop process provides the mode thresholds and once one or more of those thresholds is reached the welding process is terminated. The closed-loop control provides feedback of the weld energy and/or the compression displacement so that the weld power and/or weld pressure can be increased or decreased accordingly.

  1. Self-nanoemulsifying drug delivery systems for oral insulin delivery

    DEFF Research Database (Denmark)

    Li, Ping; Tan, Angel; Prestidge, Clive A

    2014-01-01

    This study aims at evaluating the combination of self-nanoemulsifying drug delivery systems (SNEDDS) and enteric-coated capsules as a potential delivery strategy for oral delivery of insulin. The SNEDDS preconcentrates, loaded with insulin-phospholipid complex at different levels (0, 2.5 and 10% w...

  2. Complications during pregnancy, delivery, and postnatal stages and place of delivery in rural Bangladesh.

    Science.gov (United States)

    Islam, M Ataharul; Chowdhury, Rafiqul I; Akhter, Halida H

    2006-10-01

    The utilization of safe motherhood services including maternity care in Bangladesh is very poor. Only a very small proportion of deliveries takes place in a hospital/clinic. This study is based on data from a follow-up study on maternal morbidity in rural Bangladesh. Analysis is performed on the nature of complications by place of delivery. Most of the deliveries have taken place in the women's own or her mother's home. In addition, home deliveries are mostly assisted either by an untrained birth attendant or by relatives or others. Education, economic status, whether pregnancy was wanted or not, regular visits for antenatal care, past history of breathing problems and liver diseases, and palpitation during pregnancy appear to have significant association with place of delivery in rural Bangladesh. The utilization of a hospital/clinic instead of birth at home is higher among women with secondary or higher level of education, who desired the pregnancy, and who made regular visits for antenatal care. Delivery at a mother's home appears to be positively associated with higher economic status, desired pregnancy, gainful employment, and visits for antenatal care. If the respondents suffer from diseases/symptoms, then it is more likely that the delivery would take place in the mother's home.

  3. Improving the Quality of Child Care. Hearing of the Committee on Labor and Human Resources on Examining Proposals To Improve the Quality of Child Care in the United States, Including the Proposed Creating Improved Delivery of Child Care: Affordable, Reliable, and Educational Act of 1997. United States Senate, One Hundred Fifth Congress. First Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    These hearings transcripts present testimony on proposals to improve the quality of child care in the United States. Both oral and submitted written statements are included. Contributors are: Representative Peter Deutsch (Florida); Senator James M. Jeffords, committee chairman; Senator Mike Enzi (Wyoming); Senator Edward M. Kennedy…

  4. Antioxidant Nanoplatforms for Dermal Delivery: Melatonin.

    Science.gov (United States)

    Milan, Aroha Sanchez; Campmany, Ana Cristina Calpena; Naveros, Beatriz Clares

    2017-01-01

    Melatonin is emerging as a promising therapeutic agent, mainly due to its role as antioxidant. Substantial evidences show that melatonin is potentially effective in a variety of diseases as cancer, inflammation and neurodegenerative diseases. The excellent antioxidant capacity with pharmacokinetics characteristics and the emerging search for new pharmaceutical nanotechnology based systems, make it particularly attractive to elaborate nanoplatforms based on melatonin for biomedical or cosmetic dermal applications. Different nanosystems for dermal delivery have been investigated. This review focuses on nanocarrier production strategies, dermal melatonin application and delivery advances in vivo and in vitro. Equally, future perspectives of this assisted melatonin delivery have also been discussed. In the current review, we have revised relevant articles of the available literature using the major scientific databases. One hundred and thirteen papers were included in the review, the majority of which represent latest researches in nanosized platforms for the dermal delivery of melatonin including liposomes, ethosomes, niosomes, polymeric nanoparticles, solid lipid nanoparticles and cyclodextrins. Furthermore, relevant papers reporting in vitro and in vivo application studies of these nano-based melatonin platforms were also discussed. The use of nanoplatforms for the dermal melatonin delivery as antioxidant agent could improve the efficacy of conventional melatonin administration due to the preservation of the drug from premature oxidation and the enhancement of drug permeation through the skin providing greater exposure times. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Capillary electrophoresis analysis of poly(ethylene glycol) and ligand-modified polylysine gene delivery vectors.

    Science.gov (United States)

    Guo, Yan; Sun, Ye; Gu, Jianren; Xu, Yuhong

    2007-04-15

    Cationic polymers including polylysine (PLL) and polyethylenimine are being widely tested as gene delivery vectors in various gene therapy applications. In many cases, the polymers were further modified by hydrophilic polymer grafting or ligand conjugation, which had been shown to greatly affect the vector stability, delivery efficiency and specificity. The characterization of modified polycation is particularly critical for quality control and vector development. Here several different separation modes using capillary electrophoresis for the analytical characterization of the modified polymers are described. PLL molecules were grafted with poly(ethylene glycol) (PEG) chain or conjugated with epidermal growth factor and analyzed under various analytical conditions. Poly(N,N'-dimethylacrylamide)-coated capillary was used to analyze the modified PLL to reduce the interaction between the samples and the capillary wall. PLLs containing different numbers of conjugated ligands were well separated with the coating method but, for PLL-g-PEG, the separation was poor under the same conditions. A method using low buffer pH and hydroxypropylmethyl cellulose additive was developed. These methods are useful to characterize various polycations and important for the quality control and application of potential gene delivery vectors.

  6. A Survey of Perioperative and Postoperative Anesthetic Practices for Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Leinani Aiono-Le Tagaloa

    2009-01-01

    Full Text Available The aim of this survey was to review cesarean delivery anesthetic practices. An online survey was sent to members of the Society of Obstetric Anesthesia and Perinatology (SOAP. The mode of anesthesia, preferred neuraxial local anesthetic and opioid agents, postoperative analgesic regimens, and monitoring modalities were assessed. 384 responses from 1,081 online survey requests were received (response rate = 36%. Spinal anesthesia is most commonly used for elective cesarean delivery (85% respondents, with 90% of these respondents preferring hyperbaric bupivacaine 0.75%. 79% used intrathecal fentanyl and 77% used morphine (median [range] dose 200 mcg [50–400]. 91% use respiratory rate, 61% use sedation scores, and 30% use pulse oximetry to monitor for postoperative respiratory depression after administration of neuraxial opioids. Postoperative analgesic regimens include: nonsteroidal anti-inflammatory agents, acetaminophen, oxycodone, and hydrocodone by 81%, 45%, 25%, and 27% respondents respectively. The majority of respondents use spinal anesthesia and neuraxial opioids for cesarean delivery anesthesia. There is marked variability in practices for monitoring respiratory depression postdelivery and for providing postoperative analgesia. These results may not be indicative of overall practice in the United States due to the select group of anesthesiologists surveyed and the low response rate.

  7. Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.

    Directory of Open Access Journals (Sweden)

    Rong Zhao

    Full Text Available To estimate the association between uterine fibroids and adverse obstetric outcomes.This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed.Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68% women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7-2.0, breech presentation (AOR 1.3, 95% CI 1.2-1.5 and postpartum hemorrhage (AOR 1.2, 95% CI 1.1-1.4. The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001. And the location of fibroid (intramural, submucosal or subserosal also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural].Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids.

  8. Learning from experience: development of a cognitive task-list to assess the second stage of labour for operative delivery.

    Science.gov (United States)

    Hodges, Ryan; Simpson, Andrea; Gurau, David; Secter, Michael; Mocarski, Eva; Pittini, Richard; Snelgrove, John; Windrim, Rory; Higgins, Mary

    2015-04-01

    Ensuring the availability of operative vaginal delivery is one strategy for reducing the rising Caesarean section rate. However, current training programs appear inadequate. We sought to systematically identify the core steps in assessing women in the second stage of labour for safe operative delivery, and to produce an expert task-list to assist residents and obstetricians in deciding on the safest mode of delivery for their patients. Labour and delivery nursing staff of three large university-associated hospitals identified clinicians they considered to be skilled in operative vaginal deliveries. Obstetricians who were identified consistently were invited to participate in the study. Participants were filmed performing their normal assessment of the second stage of labour on a model. Two clinicians reviewed all videos and documented all verbal and non-verbal components of the assessment; these components were grouped into overarching themes and combined into an integrated expert task-list. The task-list was then circulated to all participants for additional comments, checked against SOGC guidelines, and redrafted, allowing production of a final expert task-list. Thirty clinicians were identified by this process and 20 agreed to participate. Themes identified were assessment of suitability, focused history, physical examination including importance of an abdominal examination, strategies to accurately assess fetal position, station, and the likelihood of success, cautionary signs to prompt reassessment in the operating room, and warning signs to abandon operative delivery for Caesarean section. Communication strategies were emphasized. Having expert clinicians teach assessment in the second stage of labour is an important step in the education of residents and junior obstetricians to improve confidence in managing the second stage of labour.

  9. Usefulness of the WHO C-Model to optimize the cesarean delivery rate in a tertiary hospital setting.

    Science.gov (United States)

    Abdel-Aleem, Hany; Darwish, Atef; Abdelaleem, Ahmad A; Mansur, Manal

    2017-04-01

    To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate. A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification. In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%. The WHO C-Model is valid and can be used in hospital settings to optimize CD rates. © 2017 International Federation of Gynecology and Obstetrics.

  10. Intrinsic localized modes and nonlinear impurity modes in curved ...

    Indian Academy of Sciences (India)

    structure of the localized modes induced by an isotopic light-mass impurity in this chain. We further demonstrate that a ... direct physical meaning and can describe polymers and biomolecular systems. The motion of the chain is confined to .... mode center (n = 0) the local mode must obey the expression (10). Equation (8).

  11. Mode-to-mode energy transfers in convective patterns

    Indian Academy of Sciences (India)

    Abstract. We investigate the energy transfer between various Fourier modes in a low- dimensional model for thermal convection. We have used the formalism of mode-to-mode energy transfer rate in our calculation. The evolution equations derived using this scheme is the same as those derived using the hydrodynamical ...

  12. WE-G-BRA-09: Microsphere Brachytherapy Failure Mode and Effects Analysis in a Dual-Vendor Environment

    Energy Technology Data Exchange (ETDEWEB)

    Younge, K C; Lee, C I; Feng, M; Novelli, P; Moran, J M; Prisciandaro, J I [Univ Michigan Medical Center, Ann Arbor, MI (United States)

    2015-06-15

    Purpose: To improve the safety and quality of a dual-vendor microsphere brachytherapy program with failure mode and effects analysis (FMEA). Methods: A multidisciplinary team including physicists, dosimetrists, a radiation oncologist, an interventional radiologist, and radiation safety personnel performed an FMEA for our dual-vendor microsphere brachytherapy program employing SIR-Spheres (Sirtex Medical Limited, Australia) and Theraspheres (BTG, England). We developed a program process tree and step-by-step instructions which were used to generate a comprehensive list of failure modes. These modes were then ranked according to severity, occurrence rate, and detectability. Risk priority numbers (RPNs) were calculated by multiplying these three scores together. Three different severity scales were created: one each for harmful effects to the patient, staff, or the institution. Each failure mode was ranked on one or more of these scales. Results: The group identified 164 failure modes for the microsphere program. 113 of these were ranked using the patient severity scale, 52 using the staff severity scale, and 50 using the institution severity scale. The highest ranked items on the patient severity scale were an error in the automated dosimetry worksheet (RPN = 297.5), and the incorrect target specified on the planning study (RPN = 135). Some failure modes ranked differently between vendors, especially those corresponding to dose vial preparation because of the different methods used. Based on our findings, we made several improvements to our QA program, including documentation to easily identify which product is being used, an additional hand calculation during planning, and reorganization of QA steps before treatment delivery. We will continue to periodically review and revise the FMEA. Conclusion: We have applied FMEA to our dual-vendor microsphere brachytherapy program to identify potential key weaknesses in the treatment chain. Our FMEA results were used to

  13. WE-G-BRA-09: Microsphere Brachytherapy Failure Mode and Effects Analysis in a Dual-Vendor Environment

    International Nuclear Information System (INIS)

    Younge, K C; Lee, C I; Feng, M; Novelli, P; Moran, J M; Prisciandaro, J I

    2015-01-01

    Purpose: To improve the safety and quality of a dual-vendor microsphere brachytherapy program with failure mode and effects analysis (FMEA). Methods: A multidisciplinary team including physicists, dosimetrists, a radiation oncologist, an interventional radiologist, and radiation safety personnel performed an FMEA for our dual-vendor microsphere brachytherapy program employing SIR-Spheres (Sirtex Medical Limited, Australia) and Theraspheres (BTG, England). We developed a program process tree and step-by-step instructions which were used to generate a comprehensive list of failure modes. These modes were then ranked according to severity, occurrence rate, and detectability. Risk priority numbers (RPNs) were calculated by multiplying these three scores together. Three different severity scales were created: one each for harmful effects to the patient, staff, or the institution. Each failure mode was ranked on one or more of these scales. Results: The group identified 164 failure modes for the microsphere program. 113 of these were ranked using the patient severity scale, 52 using the staff severity scale, and 50 using the institution severity scale. The highest ranked items on the patient severity scale were an error in the automated dosimetry worksheet (RPN = 297.5), and the incorrect target specified on the planning study (RPN = 135). Some failure modes ranked differently between vendors, especially those corresponding to dose vial preparation because of the different methods used. Based on our findings, we made several improvements to our QA program, including documentation to easily identify which product is being used, an additional hand calculation during planning, and reorganization of QA steps before treatment delivery. We will continue to periodically review and revise the FMEA. Conclusion: We have applied FMEA to our dual-vendor microsphere brachytherapy program to identify potential key weaknesses in the treatment chain. Our FMEA results were used to

  14. Maternal CD4+ microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section.

    Science.gov (United States)

    Buxmann, H; Reitter, A; Bapistella, S; Stürmer, M; Königs, C; Ackermann, H; Louwen, F; Bader, P; Schlößer, R L; Willasch, A M

    2016-07-01

    Maternal CD4+ cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. To evaluate maternal CD4+ cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4+ cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4+ cells (95% confidence interval (CI): 0.00-0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01-0.66% maternal cells (95% CI: -0.06-0.16; P=0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4+ cells in one (0.05%; 95% CI: -0.02-0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: -0.06-0.16; P=0.04). There was no MTCT in any of the newborns. In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4+ cell transfer to newborns compared to planned caesarean section. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve

    2011-01-01

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  16. Supersaturating drug delivery systems

    DEFF Research Database (Denmark)

    Laitinen, Riikka; Löbmann, Korbinian; Grohganz, Holger

    2017-01-01

    Amorphous solid dispersions (ASDs) are probably the most common and important supersaturating drug delivery systems for the formulation of poorly water-soluble compounds. These delivery systems are able to achieve and maintain a sustained drug supersaturation which enables improvement...... of the bioavailability of poorly water-soluble drugs by increasing the driving force for drug absorption. However, ASDs often require a high weight percentage of carrier (usually a hydrophilic polymer) to ensure molecular mixing of the drug in the carrier and stabilization of the supersaturated state, often leading...... strategy for poorly-soluble drugs. While the current research on co-amorphous formulations is focused on preparation and characterization of these systems, more detailed research on their supersaturation and precipitation behavior and the effect of co-formers on nucleation and crystal growth inhibition...

  17. Social video content delivery

    CERN Document Server

    Wang, Zhi; Zhu, Wenwu

    2016-01-01

    This brief presents new architecture and strategies for distribution of social video content. A primary framework for socially-aware video delivery and a thorough overview of the possible approaches is provided. The book identifies the unique characteristics of socially-aware video access and social content propagation, revealing the design and integration of individual modules that are aimed at enhancing user experience in the social network context. The change in video content generation, propagation, and consumption for online social networks, has significantly challenged the traditional video delivery paradigm. Given the massive amount of user-generated content shared in online social networks, users are now engaged as active participants in the social ecosystem rather than as passive receivers of media content. This revolution is being driven further by the deep penetration of 3G/4G wireless networks and smart mobile devices that are seamlessly integrated with online social networking and media-sharing s...

  18. Azimuthal decomposition of optical modes

    CSIR Research Space (South Africa)

    Dudley, Angela L

    2012-07-01

    Full Text Available This presentation analyses the azimuthal decomposition of optical modes. Decomposition of azimuthal modes need two steps, namely generation and decomposition. An azimuthally-varying phase (bounded by a ring-slit) placed in the spatial frequency...

  19. Optimal delivery for preterm breech fetuses: is there any consensus?

    Science.gov (United States)

    To, William W K

    2013-06-01

    The optimal route for delivery of preterm breech-presenting fetuses remains a clinical dilemma. Available data from the literature are largely based on retrospective cohort studies, and randomised controlled trials are considered impossible to conduct. Consistently however, large population-based surveys have shown that planned caesarean sections for these fetuses were associated with better neonatal outcomes compared with those following vaginal delivery. Nevertheless, the increased surgical risks for the mother having caesarean delivery of an early preterm breech fetus must be balanced with the probable neonatal survival benefits. Planned caesarean section should probably be limited to gestations with at least a fair chance of independent neonatal survival, where vaginal delivery is not imminent, and in the absence of other maternal risk factors. Vaginal delivery would probably include those fetuses that are of marginal viability, and that additional protection from abdominal delivery was unlikely to be beneficial to neonatal outcome.

  20. Applications of polymeric nanocapsules in field of drug delivery systems.

    Science.gov (United States)

    Rong, Xinyu; Xie, Yinghua; Hao, Xiaomei; Chen, Tao; Wang, Yingming; Liu, Yuanyuan

    2011-09-01

    Drug-loaded polymeric nanocapsules have exhibited potential applications in the field of drug delivery systems in recent years. This article entails the biodegradable polymers generally used for preparing nanocapsules, which include both natural polymers and synthetic polymers. Furthermore, the article presents a general review of the different preparation methods: nanoprecipitation method, emulsion-diffusion method, double emulsification method, emulsion-coacervation method, layer-by-layer assembly method. In addition, the analysis methods of nanocapsule characteristics, such as mean size, morphology, surface characteristics, shell thickness, encapsulation efficiency, active substance release, dispersion stability, are mentioned. Also, the applications of nanocapsules as carriers for use in drug delivery systems are reviewed, which primarily involve targeting drug delivery, controlled/sustained release drug delivery systems, transdermal drug delivery systems and improving stability and bioavailability of drugs. Nanocapsules, prepared with different biodegradable polymers, have received more and more attention and have been regarded as one of the most promising drug delivery systems.

  1. The Costs and Their Determinant of Cesarean Section and Vaginal Delivery: An Exploratory Study in Chongqing Municipality, China

    Directory of Open Access Journals (Sweden)

    Zhifei He

    2016-01-01

    Full Text Available Objectives. This study aims to analyze the cesarean section (CS rates and vaginal delivery rates in tertiary hospitals of China, explore the costs of two different deliveries, and examine the relative influencing factors of the costs in both CS and vaginal deliveries. Methods. 30,168 anonymized obstetric medical cases were selected from three sample tertiary hospitals in Chongqing Municipality from 2011 to 2013. Chi-square test was used to compare the distributions of CS and vaginal deliveries under different indicators. Mann–Whitney test and Kruskal-Wallis test were adopted to analyze the differences under different items. Multiple linear regression was used to determine the influencing factors of the costs of different delivery modes. Results. (1 The rates of CS were 69%, 65.5%, and 59.2% in the three sample tertiary hospitals in Chongqing from 2011 to 2013. (2 The costs and the length of stay of CS were greater than those of vaginal delivery, which had significant differences (P<0.005. (3 The areas, length of stay, age, medical insurance, and modes of delivery were the influencing factors of both CS and vaginal delivery costs. Discussion. The high CS rates in China must be paid significant attention. The indicators of two modes of delivery should be regulated strictly. CS rate reduction and saving medical resources will be the benefits if vaginal delivery is chosen by pregnant women.

  2. Rotational modes of a simple Earth model

    Science.gov (United States)

    Seyed-Mahmoud, B.; Rochester, M. G.; Rogister, Y. J. G.

    2017-12-01

    We study the tilt-over mode (TOM), the spin-over mode (SOM), the free core nutation (FCN), and their relationships to each other using a simple Earth model with a homogeneous and incompressible liquid core and a rigid mantle. Analytical solutions for the periods of these modes as well as that of the Chandler wobble is found for the Earth model. We show that the FCN is the same mode as the SOM of a wobbling Earth. The reduced pressure, in terms of which the vector momentum equation is known to reduce to a scalar second order differential equation (the so called Poincaŕe equation), is used as the independent variable. Analytical solutions are then found for the displacement eigenfucntions in a meridional plane of the liquid core for the aforementioned modes. We show that the magnitude of motion in the mantle during the FCN is comparable to that in the liquid core, hence very small. The displacement eigenfunctions for these aforementioned modes as well as those for the free inner core nutation (FICN), computed numerically, are also given for a three layer Earth model which also includes a rigid but capable of wobbling inner core. We will discuss the slow convergence of the period of the FICN in terms of the characteristic surfaces of the Poincare equation.

  3. Modes of storage ring coherent instabilities

    International Nuclear Information System (INIS)

    Wang, J.M.

    1986-12-01

    Longitudinal impedance in a beam and various modes of longitudinal coherent instabilities are discussed. The coasting beam coherent instability, microwave instability, and single-bunch longitudinal coherent instabilities are considered. The Vlasov equation is formulated, and a method of solving it is developed. The synchrotron modes are treated, which take the possible bunch shape distortion fully into consideration. A method of treating the synchrotron mode coupling in the case of a small bunch is discussed which takes advantage of the fact that only a few of the synchrotron modes can contribute in such a case. The effect of many bunches on the coherent motion of the beam and the longitudinal symmetric coupled bunch modes are discussed. The transverse impedance is then introduced, and the transverse coasting beam instability is discussed. Various bunched beam instabilities are discussed, including both single bunch instabilities and coupled bunch instabilities. The Vlasov equation for transverse as well as longitudinal motion of particles is introduced as well as a method of solving it within a linear approximation. Head-tail modes and short bunch instabilities and strong coupling instabilities in the long bunch case are covered

  4. Particle Distribution Modification by Low Amplitude Modes

    International Nuclear Information System (INIS)

    White, R.B.; Gorelenkov, N.; Heidbrink, W.W.; Van Zeeland, M.A.

    2009-01-01

    Modification of a high energy particle distribution by a spectrum of low amplitude modes is investigated using a guiding center code. Only through resonance are modes effective in modifying the distribution. Diagnostics are used to illustrate the mode-particle interaction and to find which effects are relevant in producing significant resonance, including kinetic Poincare plots and plots showing those orbits with time averaged mode-particle energy transfer. Effects of pitch angle scattering and drag are studied, as well as plasma rotation and time dependence of the equilibrium and mode frequencies. A specific example of changes observed in a DIII-D deuterium beam distribution in the presence of low amplitude experimentally validated Toroidal Alfven (TAE) eigenmodes and Reversed Shear Alfven (RSAE) eigenmodes is examined in detail. Comparison with experimental data shows that multiple low amplitude modes can account for significant modification of high energy beam particle distributions. It is found that there is a stochastic threshold for beam profile modification, and that the experimental amplitudes are only slightly above this threshold.

  5. Modes of storage ring coherent instabilities

    Energy Technology Data Exchange (ETDEWEB)

    Wang, J.M.

    1986-12-01

    Longitudinal impedance in a beam and various modes of longitudinal coherent instabilities are discussed. The coasting beam coherent instability, microwave instability, and single-bunch longitudinal coherent instabilities are considered. The Vlasov equation is formulated, and a method of solving it is developed. The synchrotron modes are treated, which take the possible bunch shape distortion fully into consideration. A method of treating the synchrotron mode coupling in the case of a small bunch is discussed which takes advantage of the fact that only a few of the synchrotron modes can contribute in such a case. The effect of many bunches on the coherent motion of the beam and the longitudinal symmetric coupled bunch modes are discussed. The transverse impedance is then introduced, and the transverse coasting beam instability is discussed. Various bunched beam instabilities are discussed, including both single bunch instabilities and coupled bunch instabilities. The Vlasov equation for transverse as well as longitudinal motion of particles is introduced as well as a method of solving it within a linear approximation. Head-tail modes and short bunch instabilities and strong coupling instabilities in the long bunch case are covered. (LEW)

  6. Different modes of engagement

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt

    of values from core participants, such as the disabled, the care assistants and the producer. This leads to a discussion of different modes of engagement focusing on the overall questions: To what extend are usage scenarios pre-scripted by the FAR? Taking STS as an analytic resource, this leads...... to a discussion of what the FAR is supposed to attend to and what implications that leads to. What knowledge of the sensible world is for instance inscripted into the FAR and how do different parties take this up? What do we learn about our own (in)sensibilities when we examine the design and use of feeding...

  7. Quasinormal modes and holography

    Science.gov (United States)

    Kovtun, Pavel K.; Starinets, Andrei O.

    2005-10-01

    Quasinormal frequencies of electromagnetic and gravitational perturbations in asymptotically anti-de Sitter spacetime can be identified with poles of the corresponding real-time Green’s functions in a holographically dual finite temperature field theory. The quasinormal modes are defined for gauge-invariant quantities which obey an incoming-wave boundary condition at the horizon and a Dirichlet condition at the boundary. As an application, we explicitly find poles of retarded correlation functions of R-symmetry currents and the energy-momentum tensor in strongly coupled finite temperature N=4 supersymmetric SU(Nc) Yang-Mills theory in the limit of large Nc.

  8. Beliefs And Practice Concerning Pregnancy Delivery And ...

    African Journals Online (AJOL)

    ... taboos specific to pregnancy, but food restrictions were described. Antenatal and intrapartum care by spiritual and traditional midwives was considered superior to orthodox care. Practices by the midwives include turning a baby in an abnormal lie, massaging the vagina with oil in labour; conducting delivery without gloves ...

  9. Generation and delivery device for ozone gas

    Science.gov (United States)

    Andrews, Craig C. (Inventor); Murphy, Oliver J. (Inventor)

    2002-01-01

    The present invention provides an ozone generation and delivery system that lends itself to small scale applications and requires very low maintenance. The system preferably includes an anode reservoir and a cathode phase separator each having a hydrophobic membrane to allow phase separation of produced gases from water. The hydrogen gas, ozone gas and water containing ozone may be delivered under pressure.

  10. 47 CFR 64.1200 - Delivery restrictions.

    Science.gov (United States)

    2010-10-01

    ... Advertising § 64.1200 Delivery restrictions. (a) No person or entity may: (1) Initiate any telephone call... telephone service, specialized mobile radio service, or other radio common carrier service, or any service... expect them to be included given the identification of the caller and the product being advertised. (6...

  11. Conscientious Objection and Reproductive Health Service Delivery ...

    African Journals Online (AJOL)

    HP

    Medical doctors are bound by ethics in their clinical practice – health service delivery. They often discharge their contractual responsibilities under the provisions of their professional ethical code and personal morality. Ethical principles in clinical care include i) Respect for patient's autonomy ii) Doing good (beneficence) ...

  12. Criteria for Selecting Document Delivery Suppliers.

    Science.gov (United States)

    Machovec, George S.

    1994-01-01

    Presents selection criteria for libraries choosing document delivery suppliers as an alternative to traditional interlibrary loan. Categories of commercial services are described, and selection criteria including ease of use, ordering options, charging and billing, copyright issues, enduser access, turnaround time, telecommunications options,…

  13. Medical utilization of kiosks in the delivery of patient education: a systematic review.

    Science.gov (United States)

    Yvonne Chan, Yu-Feng; Nagurka, Roxanne; Bentley, Suzanne; Ordonez, Edgardo; Sproule, William

    2014-01-01

    The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education.

  14. Anaesthesia in the new millennium; new drug, routes and delivery ...

    African Journals Online (AJOL)

    ... and peptides made by the body. Newer delivery systems include patches, ionotrophoretic techniques and transmucosal delivery are being tested and/ or being practiced. This paper highlights on some of the developments and the possible future directions in anaesthesia. The Kenya Veterinarian Vol. 27 2004: pp. 49-51.

  15. beliefs and practice concerning pregnancy delivery and puerperium ...

    African Journals Online (AJOL)

    user

    2007-12-01

    Dec 1, 2007 ... to lie down when you are in pains, they want money before they treat you, your mother cannot enter, they will not discharge you on time and will ... umbilical cord after the delivery of the placenta including the trained TBAs who admitted that they had been trained to do so before placental delivery. Some of ...

  16. Image-guided drug delivery : Preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, G; Kiessling, Fabian; Lammers, Twan

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy.

  17. Image-guided drug delivery: preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, Gerrit; Kiessling, Fabian; Lammers, Twan Gerardus Gertudis Maria

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy.

  18. Healthcare delivery in a frail economy: challenges and way forward ...

    African Journals Online (AJOL)

    It is not in doubt that with worsening economic indicators in a recessed Nigeria, all ingredients germane to achieving qualitative healthcare delivery will be affected. This includes budgetary provision, institutional service delivery, staffing and even the citizens' financial accessibility and affordability of healthcare service.

  19. Raman amplification of OAM modes

    DEFF Research Database (Denmark)

    Ingerslev, Kasper; Gregg, Patrick; Galili, Michael

    2017-01-01

    The set of fibre modes carrying orbital angular momentum (OAM) is a possible basis for mode division multiplexing. In this regard, fibres supporting OAM modes have been fabricated [1], and optical communication using these fibres, has been demonstrated [2]. A vital part of any long range...

  20. ACCA College English Teaching Mode

    Science.gov (United States)

    Ding, Renlun

    2008-01-01

    This paper elucidates a new college English teaching mode--"ACCA" (Autonomous Cooperative Class-teaching All-round College English Teaching Mode). Integrated theories such as autonomous learning and cooperative learning into one teaching mode, "ACCA", which is being developed and advanced in practice as well, is the achievement…