Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa

SETTING:  Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi). OBJECTIVES:  To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM. METHODS:  An audit of data from a standardised database implemented in all the sites in the study. RESULTS:  Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database. CONCLUSION:  As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed

Analysis of the convergence of the 1/t and Wang-Landau algorithms in the calculation of multidimensional integrals

In this communication, the convergence of the 1/t and Wang - Landau algorithms in the calculation of multidimensional numerical integrals is analyzed. Both simulation methods are applied to a wide variety of integrals without restrictions in one, two and higher dimensions. The errors between the exact and the calculated values of the integral are obtained and the efficiency and accuracy of the methods are determined by their dynamical behavior. The comparison between both methods and the simple sampling Monte Carlo method is also reported. It is observed that the time dependence of the errors calculated with 1/t algorithm goes as N^{-1/2} (with N the MC trials) in quantitative agreement with the simple sampling Monte Carlo method. It is also showed that the error for the Wang - Landau algorithm saturates in time evidencing the non-convergence of the methods. The sources for the error are also determined.Comment: 8 pages, 5 figure

Echocardiography combined with cardiopulmonary exercise testing for the prediction of outcome in idiopathic pulmonary arterial hypertension

BACKGROUND: Right ventricular (RV) function is a major determinant of exercise intolerance and outcome in idiopathic pulmonary arterial hypertension (IPAH). The aim of the study was to evaluate the incremental prognostic value of echocardiography of the RV and cardiopulmonary exercise testing (CPET) on long-term prognosis in these patients. METHODS: One hundred-thirty treatment-naïve IPAH patients were enrolled and prospectively followed. Clinical worsening (CW) was defined by a reduction in 6-minute walk distance plus an increase in functional class, or non elective hospitalization for PAH, or death. Baseline evaluation included clinical, hemodynamic, echocardiographic and CPET variables. Cox regression modeling with c-statistic and bootstrapping validation methods were done. RESULTS: During a mean period of 528 ± 304 days, 54 patients experienced CW (53%). Among demographic, clinical and hemodynamic variables at catheterization, functional class and cardiac index were independent predictors of CW (Model-1). With addition of echocardiographic and CPET variables (Model-2), peak O2 pulse (peak VO2/heart rate) and RV fractional area change (RVFAC) independently improved the power of the prognostic model (AUC: 0.81 vs 0.66, respectively; p=0.005). Patients with low RVFAC and low O2 pulse (low RVFAC + low O2 pulse) and high RVFAC+low O2 pulse showed 99.8 and 29.4 increase in the hazard ratio, respectively (relative risk -RR- of 41.1 and 25.3, respectively), compared with high RVFAC+high O2 pulse (p=0.0001). CONCLUSIONS: Echocardiography combined with CPET provides relevant clinical and prognostic information. A combination of low RVFAC and low O2 pulse identifies patients at a particularly high risk of clinical deterioration

Sexual violence in post-conflict Liberia: survivors and their care.

Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care

Preliminary study on a kinetic energy recovery system for sailing yachts

This paper presents the preliminary theoretical results obtained on a model of a kinetic energy recovery system for sailing yachts, based on the conversion of wave-induced boat oscillations (heave, pitch and roll) into electric energy by means of a linear generator. The recovery system is based on a linear generator, with a mass oscillating along the vertical axis and gaining kinetic energy: the resulting mechanical energy can be extracted (by means of electromagnetic damping) and converted into electricity. The oscillating mass incorporates permanent magnets which, moving in proximity of stator windings, generate electric power due to electromagnetic induction. The device aims at recovering as much kinetic energy as possible from the natural movements of a sailing yacht on the sea, therefore taking the view of a boat as a moving wave energy converter with energy harvesting capability. The boat's motions can be vertical oscillations due to the buoyancy in the presence of sea waves, both when the boat is still or sailing, and rolling and pitching motions originated both by sailing in wavy waters and by the normal boat dynamics due to the sails' propulsion. Linear generators will convert kinetic energy into electrical energy to be used as “green” electricity for any possible application on board. Preliminary calculations show that a properly configured system could be able to recover approximately 100 W under most sea conditions on an almost continuous basis, which can be an extremely attractive result since an electric energy availability of 1–2 kWh on a sailing yacht is of significant interest

Total phallic reconstruction after penile amputation for donkey bite: Case report and review of the literature

There are very few reported cases of traumatic amputation of the male genitalia due to animal bite. The management involves thorough washout of the wounds, debridement, antibiotic prophylaxis, tetanus and rabies immunization followed by immediate reconstruction or primary wound closure with delayed reconstruction, when immediate reconstruction is not feasible. When immediate reconstruction is not feasible, long-term good functional and cosmetic results are still possible in the majority of cases by performing total phallic reconstruction. In particular, it is now possible to fashion a cosmetically acceptable sensate phallus with incorporated neourethra, to allow the patient to void while standing and to ejaculate, and with enough bulk to allow the insertion of a penile prosthesis to guarantee the rigidity necessary to engage in penetrative sexual intercourse

The modulation of sirtuins and apoptotic proteins in rats after exhaustive exercise

A large body of evidence shows that a single bout of strenuous exercise induces oxidative stress in circu- lating human lymphocytes leading to lipid peroxide- tion, DNA damage, mitochondrial perturbations, and protein oxidation. In a training experiment, Wistar rats were divided into control group (CG) and exer- cise group (EG). After a running level exercise until exhaustion, we observed an increase in the mRNA content and protein expression of SIRT1 and SIRT7 in the EG compared to the CG. Moreover, such train- ing exercise did not change mRNA transcripts and protein expression of FOXO3A and GADD45. We also observed an increase of pro-apoptotic protein bax and a decrease of the anti-apoptotic protein bcl-2 in the EG. Accordingly, we observed a caspase-3 activation and poly (ADP-ribose) polymerase (PARP) cleavage only in EG rats. Statistical analysis of the data showed a significant correlation between SIRT1 and SIRT7 expression and apoptotic proteins such as bax, bcl-2 in both tissues. We conclude that, in both muscle, such exercise activates both a damaging apoptotic mecha- nism with bax increase and bcl-2 decrease and a counterbalancing protective mechanism with SIRT1 and SIRT7 increase

Contributo alla flora del Parco Nazionale della Majella

Viene presentato un ulteriore contributo alla ricca flora del Parco Nazionale della Majella. In particolare, 15 nuove entità vengono segnalate per la prima volta ed una viene confermata nell’area protetta. Per altre entità, rare sul territorio regionale, vengono segnalate nuove stazioni all’interno del Parco. Il contributo conferma come la ricerca sul campo sia di fondamentale importanza per approfondire le conoscenze sul patrimonio naturale, anche nel caso di territori abbastanza ben conosciuti come quello del Parco Nazionale della Majella.A further contribution to the rich flora of the Majella National Park is presented. In particular, 15 entities are reported for the first time and one is confirmed in the protected area. New localities are also indicated, inside the Park, for some plant species that are very rare in the Abruzzo region. It is confirmed that field research is of crucial importance in expanding our knowledge of the natural heritage, even in a fairly well known territory as that of the Majella National Park