Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta

Placenta accreta is a severe pregnancy complication and is currently the most common indication for peripartum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Main risk factor for placenta accreta is a previous cesarean delivery particularly when accompanied with a coexisting placenta previa. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Diagnosis can be achieved by ultrasound in the majority of cases. Women with placenta accreta are usually delivered by a cesarean section. In order to avoid an emergency cesarean and to minimize complications of prematurity it is acceptable to schedule cesarean at 34 to 35 weeks. A multidisciplinary team approach and delivery at a center with adequate resources, including those for massive transfusion are both essential to reduce neonatal and maternal morbidity and mortality. The optimal management after delivery of the neonate is vague since randomized controlled trials and large cohort studies are lacking. Cesarean hysterectomy is probably the preferable treatment. In carefully selected cases, when fertility is desired, conservative management may be considered with caution. The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition

The impact of non-significant variable decelerations appearing in the latent phase on delivery mode: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Variable decelerations are the most frequent fetal heart rate changes that are related to labor. The objective of the study was to estimate the impact of non-significant variable decelerations (NSV) appearing during the latent phase of labor on delivery mode and neonatal outcome.</p> <p>Methods</p> <p>Women at term, who were in the latent phase of labor and had a singleton pregnancy, were prospectively included. Women were divided into three groups. All had a fetal heart rate tracing with normal baseline and variability. The study group was composed of women who had in addition NSV, Category II, according to the National Institute of Child Health and Human Development categorization system. Women who had Category I tracings composed the control group. Women who had non-repetitive severe variables (SV) composed a second control group (Category II-SV). Main outcome compared was mode of delivery. Secondary outcome was cord pH. One-way analysis of variance was used to compare the continuous demographic and clinical variables of the three groups. Backwards stepwise logistic regression using significant univariables was performed to determine which predicted operative delivery. P < 0.05 was considered significant.</p> <p>Results</p> <p>Of 1005 women who delivered during the study period 186 had Category II- NSV tracings (study group), 76 had Category II-SV and 251 had Category I tracings. Mode of delivery and indications for operative delivery were similar between women in Category II-NSV compared to Category I. In addition mean cord pH did not differ between the two groups. Conversely, women in Category II-SV, had a higher rate of cesarean or vacuum deliveries compared to the other groups (p = 0.0001). Beside, they had a significantly higher number of neonates born with cord pH between 7.0 to 7.1 (p = 0.03).</p> <p>Conclusions</p> <p>Non-significant variable decelerations in early stages of labor are probably a non-ominous sign for neonatal outcome and have no impact on delivery mode.</p

Estimasi parameter distribusi weibull yang diperluas untuk data masa hidup: Studi kasus pada data masa hidup baterai

Distribusi weibull yang diperluas (Exponentiated Weibull Distribution) adalah distribusi hasil perluasan dari distribusi weibull. Perluasan ini dilakukan sebagai alternatif apabila terjadi ketidakcocokkan dengan distribusi-distribusi yang sudah ada. Distribusi weibull yang diperluas merupakan hasil modifikasi distribusi weibull standar dengan menambahkan parameter baru, yaitu parameter bentuk. Sama halnya dengan distribusi weibull, distribusi weibull yang diperluas juga menangani masalah reliabilitas atau keandalan. Untuk mengetahui karakteristik dari distribusi weibull yang diperluas dilakukan dengan melihat grafik peluang dengan nilai parameter yang berbeda-beda. Selain itu, dilakukan estimasi parameter distribusi weibull yang diperluas dengan metode maksimum likelihood secara analitis dan secara numerik. Secara numerik estimasi parameter dilakukan dengan menerapkan data penelitian. Pada distribusi weibull yang diperluas, parameter skala mempengaruhi nilai dari fungsi padat peluang distribusi yang jika nilainya semakin besar akan semakin menuju nol. Sedangkan parameter bentuk mempengaruhi kecenderungan bentuk dari grafik peluang distribusi. Setelah dilakukan estimasi parameter, secara analitis didapatkan fungsi estimasi parameter yang implisit sehingga diperlukan suatu metode untuk melakukan estimasi parameter secara numerik. Estimasi parameter secara numerik dilakukan dengan algoritma Newton Raphson, sehingga didapatkan α ̂=3.908092, β ̂=11.708801, dan ν ̂=1.660788 untuk data masa hidup baterai

Formulación de indicadores de evaluación y la relación con el rendimiento académico en alumnos del segundo grado de primaria de la Institución Educativa Nº 4016 Néstor Gambetta Bonatti – Callao

Esta investigación se realizó con la finalidad de determinar cuáles son los indicadores de evaluación que aplican los docentes con el el objetivo de determinar los logros de aprendizaje de los estudiantes del segundo grado de primaria de la Institución Educativa Nº 4016 Néstor Gambetta Bonatti – Callao, La evaluación en la era actual es un factor fundamental para lograr la eficiecia del proceso de enseñanza aprendizaje, así por las múltiple funciones que cumple y diversa tipología ofrece un amplio panorama para el ejercicio docente y la mejora de los aprendizajes de los estudiantes Esta investigación, se realizó bajo el enfoque cuantitativo de tipo no experimental. Habiéndose logrado resultados significativos luego de la contrastación de las hipótesis planteadas , lo cual llevó a una discusión de resultados apoyada por los antecedentes que habíamos encontrado respecto del tema de investigación. Las conclusiones a alas cuales se han arribado resumen el trabajo realizado, luego del tratamiento estadístico de los datos obtenidos mediante la aplicación de los instrumentos de investigación los cuales fueron validados por expertos de la Universidad nacional de Educación Enrique Guzmán y Valle.This research was carried out in order to determine which are the evaluation indicators applied by teachers in order to determine the learning achievements of second grade students of the Educational Institution No. 4016 Néstor Gambetta Bonatti - Callao, Evaluation in the current era is a fundamental factor to achieve the efficiency of the teaching-learning process, thus, due to the multiple functions it fulfills and diverse typology, it offers a broad panorama for teaching and improving student learning. This research was carried out under a non-experimental quantitative approach. Significant results having been achieved after contrasting the hypotheses raised, which led to a discussion of results supported by the antecedents that we had found regarding the research topic. The conclusions that have been reached summarize the work carried out, after the statistical treatment of the data obtained through the application of research instruments which were validated by experts from the Enrique Guzmán y Valle National University of Education

Formulación de indicadores de evaluación y la relación con el rendimiento académico en alumnos del segundo grado e primaria de la Institución Educativa Nº 4016 Néstor Gambetta Bonatti – Callao

Esta investigación se realizó con la finalidad de determinar cuáles son los indicadores de evaluación que aplican los docentes con el el objetivo de determinar los logros de aprendizaje de los estudiantes del segundo grado de primaria de la Institución Educativa Nº 4016 Néstor Gambetta Bonatti – Callao, La evaluación en la era actual es un factor fundamental para lograr la eficiecia del proceso de enseñanza aprendizaje, así por las múltiple funciones que cumple y diversa tipología ofrece un amplio panorama para el ejercicio docente y la mejora de los aprendizajes de los estudiantes Esta investigación, se realizó bajo el enfoque cuantitativo de tipo no experimental. Habiéndose logrado resultados significativos luego de la contrastación de las hipótesis planteadas , lo cual llevó a una discusión de resultados apoyada por los antecedentes que habíamos encontrado respecto del tema de investigación. Las conclusiones a alas cuales se han arribado resumen el trabajo realizado, luego del tratamiento estadístico de los datos obtenidos mediante la aplicación de los instrumentos de investigación los cuales fueron validados por expertos de la Universidad nacional de Educación Enrique Guzmán y Valle.This research was carried out in order to determine which are the evaluation indicators applied by teachers in order to determine the learning achievements of second grade students of the Educational Institution No. 4016 Néstor Gambetta Bonatti - Callao, Evaluation in the current era is a fundamental factor to achieve the efficiency of the teaching-learning process, thus, due to the multiple functions it fulfills and diverse typology, it offers a broad panorama for teaching and improving student learning. This research was carried out under a non-experimental quantitative approach. Significant results having been achieved after contrasting the hypotheses raised, which led to a discussion of results supported by the antecedents that we had found regarding the research topic. The conclusions that have been reached summarize the work carried out, after the statistical treatment of the data obtained through the application of research instruments which were validated by experts from the Enrique Guzmán y Valle National University of Education

Information Literacy Learning Environment of Primary Schools in Iran: An Exploratory Study

This study aims to identify the characteristics of the information literacy learning environment (ILLE) for primary school students in Iran. This research was done by qualitative method and using content analysis. The statistical population was divided into two parts: 1) literature related to the INTE and 2) experts in the field of Information Literacy (IL). A researcher-made checklist was used to collect information in the first part, which was exploratory. The data collection tool from the second part of the community was the Delphi panel questionnaire, which was implemented in two stages. The results showed that ILLE has four dimensions for primary school students in Iran: educator, school library, classroom space, and educational resources. Considering these dimensions, categories, and sub-categories, it can be expected that a suitable environment will be provided for implementing IL programs in primary schools in Iran. Training administrators, curriculum developers, and information literacy educators can use this study's findings to improve ILLE to develop students with information literacy skills. This study is the first comprehensive study conducted in Iran that sought to identify the ILLE for primary school students. The findings are useful in providing a suitable environment for IL within schools in Iran and other countries

Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities. We aimed to compare between oxytocin augmentation, amniotomy and a combination of both on the duration of labor among women with a prolonged latent phase.</p> <p>Methods</p> <p>Women with a singleton fetus in cephalic presentation who have a prolonged latent phase, were randomly allocated to amniotomy (group 1), oxytocin (group 2) or both (group 3). A group of women who progressed spontaneously without intervention composed the control group (group 4). The primary outcome was the duration of time from initiation of augmentation until delivery.</p> <p>Results</p> <p>A total of 213 women were consented and randomized to group 1 (70 women), group 2 (72 women) and group 3 (71 women). Group 4 was composed from additional 70 women. A mean reduction of 120 minutes in labor duration was observed among group 3 compared to group 1 (p = 0.08) and 180 minutes compared to group 2 and 4 (p = 0.001). Women in group 3 had a shorter length of time from augmentation until the beginning of the active phase and a shorter first stage of labor than group 1 (p = 0.03), group 2 (p = 0.001) and group 4 (p = 0.001). Satisfaction was greater among group 3 and 4. Mode of delivery and neonatal outcome were comparable between the groups.</p> <p>Conclusion</p> <p>Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.</p

Efecto del vidrio y viruta de acero en la resistencia a la compresión y flexión del concreto F’c 280 kg/cm2

El concreto viene teniendo una gran importancia en la construcción y desarrollo del hombre, por ello es la búsqueda de mejorar sus propiedades físicas y mecánicas de este. El vidrio es uno de los materiales de construcción más desperdiciados ya que se desechan sin re utilizarlos sin considerar sus propiedades mecánicas, al igual que la viruta de acero que también tiene propiedades de resistencia y flexión. Por ello el objetivo principal de esta investigación es determinar el efecto del vidrio y viruta de acero en la resistencia a la compresión y flexión del concreto f’c 280 kg/cm2. Para esta investigación se consideró como metodología de diseño experimental y de tipo aplicado. Los resultados fueron favorables, ya que ambos aditivos mejoran la resistencia a la compresión y a la flexión, pero sobresaliendo en gran medida el concreto con viruta de acero en un 5%. Por lo cual se concluye que al adicionar la viruta de acero mejora las propiedades mecánicas en proporciones mayores que el vidrio al concreto

Gestión de residuos sólidos y conciencia ambiental en una comunidad universitaria, Trujillo-La Libertad: 2020

The purpose of the research was to determine the relationship between solid waste management and environmental awareness in a university community, Trujillo-La Libertad: 2020. The population and sample consisted of 50 students belonging to a university community in Trujillo, two were employed Data collection instruments, being questionnaires on solid waste management and environmental awareness, the data were processed through graphs, to later describe their behaviors, also the relationship of variables was determined through the Spearman coefficient. A null correlation was obtained (0.169 –p: 0.05). The solid waste management according to dimensions were: knowledge about solid waste management, the value of 40 prevailed in "good", for practices on inert solid waste management the value of 42 prevailed in "good", and in attitude about Inert solid waste management the value of 49 predominated in "good". Environmental awareness according to the dimensions were: cognitive, had the pre-dominant value of 30 in "high", for affective the value of 39 predominated in "high", in The conative value of 42 predominated in "high" and finally, in the active dimension, there was a predominance of 41 "high".La investigación tuvo como propósito determinar la relación entre gestión de residuos sólidos y conciencia ambiental en una comunidad universitaria, Trujillo-La Libertad: 2020. La población y muestra estuvo conformado por 50 estudiantes pertenecientes a una comunidad universitaria en Trujillo, fueron empleados dos instrumentos de recolección de datos, siendo cuestionarios sobre la gestión de residuos sólidos y conciencia ambiental, se procesaron los datos a través de gráficas, para luego describir sus comportamientos, asimismo se determinó la relación de variables a través del coeficiente de Spearman. Se obtuvo una correlación nula (0,169 –p: 0,05). La gestión de residuos sólidos según dimensiones fueron: conocimientos sobre gestión de residuos sólidos, predominó el valor de 40 en “bueno”, para prácticas sobre gestión de residuos sólidos inertes predominó el valor de 42 en “bueno”, y en actitud sobre gestión de residuos sólidos inertes predominó el valor de 49 en “bueno” La conciencia ambiental según las dimensiones fueron: cognitiva, tuvo el valor predominante de 30 en “alto”, para afectiva predomino el valor de 39 en “alto”, en conativa predomino el valor de 42 en “alto” y finalmente en la dimensión activa registro un a predominancia de 41 “alto”