Brazilian Doctor's Perspective On The Second Opinion Strategy Before A C-section

Objective: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Methods: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Results: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Conclusion: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil. © 2006 Faculdade de Saúde Pública da Universidade de Sao Paulo.402233239Althabe, F., Belizan, J.M., Villar, J., Alexander, S., Bergel, E., Ramos, S., Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: A cluster randomised controlled trial (2004) Lancet, 363 (9425), pp. 1934-1940Belizan, J., Althabe, F., Barros, F.C., Alexander, S., Rates and implications of caesarean sections in Latin America: Ecological study (1999) BMJ, 319 (7222), pp. 1397-1402Chacham, A.S., Perpétuo, I.H.O., The incidence of caesarean deliveries in Belo Horizonte, Brazil: Social and economic determinants (1998) Reprod Health Matters, 6 (11), pp. 115-121Faúndes, A., Perpétuo, I.H.O., Cesárea por conveniência e a ética médica (2002) Ser Médico, 5 (19), pp. 32-34Faúndes, A., Pádua, K.S., Osis, M.J.D., Cecatti, J.G., Sousa, M.H., Opiniāo de mulheres e médicos brasileiros sobre a preferência pela via de parto (2004) Rev Saúde Pública, 38 (4), pp. 488-494Hopkins, K., Are brazilian women really choosing to deliver by cesarean? (2000) Soc Sci Med, 51 (5), pp. 725-740Mello e Souza, C., C-sections as ideal births: The cultural constructions of beneficence and patients' rights in Brazil (1994) Camb Q Healthc Ethics, 3 (3), pp. 358-366Moraes, M.S., Goldenberg, P., Cesáreas: Um perfil epidêmico (2001) Cad Saúde Pública, 17 (3), pp. 509-519Murray, S., Relation between private health insurance and high rates of caesarean section in Chile: Qualitative and quantitative study (2000) BMJ, 321 (7275), pp. 1501-1505Myers, S.A., Gleicher, N., A successful program to lower cesarean-section rates (1988) N Engl J Med, 319 (23), pp. 1511-1516(1998), 1. , Organización Panamericana de la Salud - OPAS. La salud en las Americas. Washington (DC)Osis, M.J.D., Pádua, K.S., Duarte, G.A., Souza, T.R., Faúndes, A., The opinion of brazilian women regarding vaginal labor and cesarean section (2001) Int J Gynaecol Obstet, 75 (SUPPL. 1), pp. S59-S66Penna, L., Arulkumaran, S., Cesarean section for non-medical reasons (2003) Int J Gynaecol Obstet, 82 (3), pp. 399-409Potter, J.E., Berquó, E., Perpétuo, I.H.O., Leal, O.F., Hopkins, K., Souza, M.R., Unwanted caesarean sections among public and private patients in Brazil: Prospective study (2001) BMJ, 323 (7322), pp. 1155-1158Rattner, D., Sobre a hipótese de estabilizaçāo das taxas de cesárea do estado de São Paulo, Brasil (1996) Rev Saúde Pública, 30 (1), pp. 19-33Schenker, J.G., Cain, J.M., FIGO committee report: FIGO committee for the ethical aspects of human reproduction and women's health (1999) Int J Gynaecol Obstet, 64 (3), pp. 317-322Sloan, N.L., Pinto, E., Calle, A., Langer, A., Winikoff, B., Fassihian, G., Reduction of cesarean delivery rate in Ecuador (2000) Int J Gynaecol Obstet, 69 (3), pp. 229-236Walker, R., Turnbull, D., Wilkinson, C., Strategies to address global cesarean section rates: A review of the evidence (2002) Birth, 29 (1), pp. 28-39Wolfe, S., Unnecessary cesarean sections: Curing a national epidemic (1994) Public Citiz Health Res Group, 10, pp. 1-

Produção de mudas de abacaxi variedade BRS Imperial em função de tipos de seccionamento de talo.

A produção de mudas de qualidade fitossanitária de abacaxi é um grande gargalo para a expansão e crescimento da área produtiva desta cultura no país, principalmente para variedades novas. A propagação do abacaxizeiro se faz exclusivamente de forma vegetativa, ou seja, as mudas utilizadas no novo plantio são provenientes do cultivo anterior

Geodesics around line defects in elastic solids

Topological defects in solids, usually described by complicated boundary conditions in elastic theory, may be described more simply as sources of a gravity- like deformation field in the geometric approach of Katanaev and Volovich. This way, the deformation field is described by non-Euclidean metric that incorporates the boundary imposed by the defects. A possible way of gaining some insight into the motion of particles in a medium with topological defects (e.g., electrons in a dislocated metal) is to look at the geodesics of the medium around the defect. In this work, we find the exact solution for the geodesic equation for elastic medium with a generic line defect, the dispiration, that can either be a screw dislocation or a wedge disclination for particular choices of its parameters.Comment: 10 pages, Latex, 4 figures, accepted for publication in Phys. Lett.

Preparaciones de base líquida vs. citología convencional: adecuación de las muestras y coincidencia de diagnóstico en lesiones orales

Objetivo: Comparar la efectividad de la muestra y la coincidencia de diagnostico entre preparaciones de base liquida y frotis convencionales en lesiones orales, y probar la viabilidad de la prueba inmuno-citoquimica en preparaciones de base liquida de lesiones de carcinoma oral. Material y Metodos: Se obtuvieron muestras de 44 pacientes. Primeramente se prepararon frotis convencionales, usando un dispositivo cytobrush. A continuacion se sumergio el cepillo que contenia el material residual en un liquido conservante. La muestra en el mismo fue procesada de acuerdo con las indicaciones del fabricante (AutoCyte, Inc. Elon College, North Carolina, USA). Se tineron preparaciones de ambas tecnicas de acuerdo con el metodo de Papanicolaou. Para la prueba inmuno-citoquimica se usaron conjuntamente AE1/AE3 (Dako, CA, USA) para las lesiones de carcinoma oral, de acuerdo con el metodo de la Estreptovidina-biotina-peroxidasa. Se uso la prueba exacta de Fisher; fijandose la probabilidad significativa en p . 0.05. Resultados: Ambas tecnicas coincidieron en el diagnostico citologico en todos los casos donde se uso una muestra adecuada; en 3 casos el frotis convencional mostro hipocelularidad y, por lo tanto, resulto inadecuado para el analisis. En el analisis de muestras, la citologia de base liquida mostro una mejora general estadisticamente significativa), de un 41% en espesura de frotis y de un 66% en la distribucion de celulas (p . 0.05), ademas de una reduccion en la superposicion de celulas y la presencia de sangre (p . 0.05). La morfologia celular se observó mejor en las preparaciones de base líquida. Las reacciones de la prueba inmuno-citoquímica fueron positivas en todos los casos de malignidad, siendo especialmente clara la observación de células inmuno-marcadas. Conclusión: Tanto las preparaciones de base líquida como los frotis convencionales son dignos de confianza desde el punto de vista del diagnóstico; el método de base líquida mostró una mejora general en la preservación de muestras, adecuación de ejemplares, observación de morfología celular y reproducibilidad.Objective: To compare specimen adequacy and diagnostic agreement between liquid-based preparations and conventional smears in oral lesions, and to test the viability of immunocytochemical assay in liquid-based preparations from oral carcinoma lesions. Material and Methods: Samples were collected from 44 patients. Conventional smears were prepared first, using a cytobrush device. Then the brush, containing the residual material, was immersed in a preservative fluid. The sample in the preservative fluid was processed according to the manufacturer directions (AutoCyte, Inc. Elon College, North Carolina, USA). Slides of both techniques were stained by Papanicolaou method. For immunocytochemical assay, a cytokeratin pool AE1/AE3 (Dako, CA, USA) was applied in liquid-based preparations from oral carcinoma lesions following the Streptavidin-biotinperoxidase method. Fisher's exact test was used; significance was set for p = 0.05. Results: Both techniques agreed on cytologic diagnosis in every case they yielded an adequate specimen; in 3 cases conventional smear resulted in hypocellularity and therefore inadequate for analysis. On specimen analysis, the liquid-based cytology demonstrated a statistically significant, 41% overall improvement in smear thickness and 66% in cell distribution (p = 0.05), and a reduction in cell overlapping and presence of blood (p = 0.05). The cell morphology was better visualized in the liquid-based preparations. The immunocytochemical assay reactions were positive in all malignant cases, the visualization of the immu-nostained cells being especially clear. Conclusion: Both, the liquid-based preparation and conventional smear, are diagnostically reliable; the liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility

Generalised Hong-Ou-Mandel Experiments with Bosons and Fermions

The Hong-Ou-Mandel (HOM) dip plays an important role in recent linear optics experiments. It is crucial for quantum computing with photons and can be used to characterise the quality of single photon sources and linear optics setups. In this paper, we consider generalised HOM experiments with $N$ bosons or fermions passing simultaneously through a symmetric Bell multiport beam splitter. It is shown that for even numbers of bosons, the HOM dip occurs naturally in the coincidence detection in the output ports. In contrast, fermions always leave the setup separately exhibiting perfect coincidence detection. Our results can be used to verify or employ the quantum statistics of particles experimentally.Comment: 11 pages, 2 figures, more references adde

Fontes e modos de aplicação de fósforo na produção e nutrição mineral do milho em primeiro cultivo.

Com o objetivo de avaliar o efeito de fontes de P, em diferentes modos de aplicacao, sobre a producao e nutricao mineral do milho, foi conduzido um experimento em condicoes de campo, num Argissolo Vermelho tipico, textura argilosa, sob vegetacao de cerrado. Os tratamentos constituiram-se das fontes de P: superfosfato triplo, termofosfato magnesiano, fosfato reativo de Arad e fosfato de Araxa, aplicadas em area total ou no sulco de plantio, na dose 180 kg ha-1 de P2O5, considerando-se o teor total de P2O5 das fontes. Utilizou-se ainda um tratamento adicional sem aplicação de P. foram analisados os teores de nutrientes nas folhas do milho no florescimento e em diferentes partes da planta na colheita. Determinaram-se tambem a producao de materia seca da parte aerea e de graos e o acumulo de nutrientes. maiores producoes foram obtidas com as fontes mais soluveis (superfosfato triplo e termofosfato magnesiano) aplicadas em area total e com o fosfato reativo no sulco de plantio. O uso localizado de superfosfato triplo no sulco de plantio comprometeu a produtividade da cultura, provocando desordens metabolicas devido a interação P x Zn. a análise foliar no florescimento mostrou-se adequada para avaliacao do equilíbrio P/Zn no milho