Zika virus infection in pregnant women in Honduras: study protocol

Background: Although there is increasing evidence for a relationship between symptomatic Zika virus (ZIKV) maternal infection, and microcephaly, a firm causal relation has yet to be established by epidemiologic studies. Studies also need to be conducted in recently infected settings. Our objectives are to assess the frequency of ZIKV infection during pregnancy in Honduras and the association of microcephaly with ZIKV infection. Methods/Design: We will perform a prospective study enrolling pregnant women at their first antenatal visit and following them up until delivery. At the time of enrollment, women will be interviewed to collect socio-demographic data, data needed to locate them for potential additional follow-up, and data about ZIKV symptoms during pregnancy. We will also collect maternal blood as soon as possible after enrollment. A probable maternal ZIKV infection will be defined as positive for maternal ZIKV IgM. A confirmed maternal ZIKV infection will be defined as positive for ZIKV IgM confirmed by plaque reduction neutralization test. Microcephaly at birth will be defined as an occipito-frontal circumference <2SD for sex and gestational age. Our objective is to enroll 2000 pregnant women. In a first step, we will follow a case cohort design and only analyze blood samples for cases and a sub-cohort of 200 women randomly selected. Blood samples for the entire population will be analyzed at a later stage if funds are available. Discussion: This protocol was designed to be implemented with minimal resources. It allows a cohort to be built, which could be a foundation for future in-depth and follow-up studies.Fil: Buekens, Pierre. University of Tulane; Estados UnidosFil: Alger, Jackeline. Universidad Nacional Autónoma de Honduras; HondurasFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bergel, Eduardo. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Bustillo, Carolina. Hospital Escuela. Departamento de Ginecología y Obstetricia; HondurasFil: Cafferata, Maria Luisa. Hospital de Clínicas. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Harville, Emily. University of Tulane; Estados UnidosFil: Rosales, Karla. Región Sanitaria Metropolitana Distrito Central de Francisco Morazán; HondurasFil: Wesson, Dawn M.. University of Tulane; Estados UnidosFil: Zuniga, Concepcion. Hospital Escuela Universitario. Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal; Hondura

Peristaltic Transport of a Physiological Fluid in an Asymmetric Porous Channel in the Presence of an External Magnetic Field

The paper deals with a theoretical investigation of the peristaltic transport of a physiological fluid in a porous asymmetric channel under the action of a magnetic field. The stream function, pressure gradient and axial velocity are studied by using appropriate analytical and numerical techniques. Effects of different physical parameters such as permeability, phase difference, wave amplitude and magnetic parameter on the velocity, pumping characteristics, streamline pattern and trapping are investigated with particular emphasis. The computational results are presented in graphical form. The results are found to be in perfect agreement with those of a previous study carried out for a non-porous channel in the absence of a magnetic field

Application of the penalty coupling method for the analysis of blood vessels

Due to the significant health and economic impact of blood vessel diseases on modern society, its analysis is becoming of increasing importance for the medical sciences. The complexity of the vascular system, its dynamics and material characteristics all make it an ideal candidate for analysis through fluid structure interaction (FSI) simulations. FSI is a relatively new approach in numerical analysis and enables the multi-physical analysis of problems, yielding a higher accuracy of results than could be possible when using a single physics code to analyse the same category of problems. This paper introduces the concepts behind the Arbitrary Lagrangian Eulerian (ALE) formulation using the penalty coupling method. It moves on to present a validation case and compares it to available simulation results from the literature using a different FSI method. Results were found to correspond well to the comparison case as well as basic theory

Fractional-order viscoelasticity applied to describe uniaxial stress relaxation of human arteries.

Viscoelastic models can be used to better understand arterial wall mechanics in physiological and pathological conditions. The arterial wall reveals very slow time-dependent decays in uniaxial stress-relaxation experiments, coherent with weak power-law functions. Quasi-linear viscoelastic (QLV) theory was successfully applied to modeling such responses, but an accurate estimation of the reduced relaxation function parameters can be very difficult. In this work, an alternative relaxation function based on fractional calculus theory is proposed to describe stress relaxation experiments in strips cut from healthy human aortas. Stress relaxation (1 h) was registered at three incremental stress levels. The novel relaxation function with three parameters was integrated into the QLV theory to fit experimental data. It was based in a modified Voigt model, including a fractional element of order α, called spring–pot. The stressrelaxation predictionwas accurate and fast. Sensitivity plots for each parameter presented a minimum near their optimal values. Least-squares errors remained below 2%. Values of order α = 0.1–0.3 confirmed a predominant elastic behavior. The other two parameters of the model can be associated to elastic and viscous constants that explain the time course of the observed relaxation function. The fractional-order model integrated into the QLV theory proved to capture the essential features of the arterial wall mechanical response

Peristaltic Transport of a Couple Stress Fluid: Some Applications to Hemodynamics

The present paper deals with a theoretical investigation of the peristaltic transport of a couple stress fluid in a porous channel. The study is motivated towards the physiological flow of blood in the micro-circulatory system, by taking account of the particle size effect. The velocity, pressure gradient, stream function and frictional force of blood are investigated, when the Reynolds number is small and the wavelength is large, by using appropriate analytical and numerical methods. Effects of different physical parameters reflecting porosity, Darcy number, couple stress parameter as well as amplitude ratio on velocity profiles, pumping action and frictional force, streamlines pattern and trapping of blood are studied with particular emphasis. The computational results are presented in graphical form. The results are found to be in good agreement with those of Shapiro et. al \cite{r25} that was carried out for a non-porous channel in the absence of couple stress effect. The present study puts forward an important observation that for peristaltic transport of a couple stress fluid during free pumping when the couple stress effect of the fluid/Darcy permeability of the medium, flow reversal can be controlled to a considerable extent. Also by reducing the permeability it is possible to avoid the occurrence of trapping phenomenon

Ruin and dividend measures in the renewal dual risk model

In this manuscript we consider the dual risk model with financial application, where the random gains occur under a renewal process. We particularly work the Erlang(n) case for common distribution of the inter-arrival times, from there it is easy to understand that our method or procedures can be generalised to other cases under the matrix-exponential family case. We work several and different problems involving future dividends and ruin. We also show that our results are valid even if the usual income condition is not satisfied. In most known works under the dual model, the main target under study have been the calculation of expected discounted future dividends and optimal strategies, where the dividend calculation have been done on aggregate. We can find works, at first using the classical compound Poisson model, then some examples of other renewal Erlang models. Knowing that ruin is ultimately achieved, we find important that dividends should be evaluated on an individual basis, where the early dividend contribution for the aggregate are of utmost importance. From our calculations we can really see how much important is the contribution of the first dividend. Afonso et al. (Insur Math Econ, 53(3), 906–918, 2013) had worked similar problems for the classical compound Poisson dual model. Besides that we find explicit formulae for both the probability of getting a dividend and the distribution of the amount of a single dividend. We still work the probability distribution of the number of gains to reach a given upper target (like a constant dividend barrier) as well as for the number of gains down to ruin. We complete the study working some illustrative numerical examples that show final numbers for the several problems under study.info:eu-repo/semantics/publishedVersio

A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627]

BACKGROUND: A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. METHODS/DESIGN: The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions

Early Detection of Critical Pulmonary Shunts in Infants

This paper aims to improve the design of modern Medical Cyber Physical Systems through the addition of supplemental noninvasive monitors. Specifically, we focus on monitoring the arterial blood oxygen content (CaO2), one of the most closely observed vital signs in operating rooms, currently measured by a proxy - peripheral hemoglobin oxygen saturation (SpO2). While SpO2 is a good estimate of O2 content in the finger where it is measured, it is a delayed measure of its content in the arteries. In addition, it does not incorporate system dynamics and is a poor predictor of future CaO2 values. Therefore, as a first step towards supplementing the usage of SpO2, this work introduces a predictive monitor designed to provide early detection of critical drops in CaO2 caused by a pulmonary shunt in infants. To this end, we develop a formal model of the circulation of oxygen and carbon dioxide in the body, characterized by unknown patient-unique parameters. Employing the model, we design a matched subspace detector to provide a near constant false alarm rate invariant to these parameters and modeling uncertainties. Finally, we validate our approach on real-patient data from lung lobectomy surgeries performed at the Children\u27s Hospital of Philadelphia. Given 198 infants, the detector predicted 81% of the critical drops in CaO2 at an average of about 65 seconds earlier than the SpO2-based monitor, while achieving a 0:9% false alarm rate (representing about 2 false alarms per hour)