97 research outputs found

    Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

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    Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

    Probing Metal Defects in CCD Image Sensors

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    The new kid at Sameview elementary : a children's musical for grades 3-5 : a senior honors project(HONRS 499)

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    The New Kid at Sameview Elementary is a one act children's musical which includes six scenes and five original songs. This musical can be performed by boys or girls in grades three through five. The plot of the musical is about children at Sameview Elementary who learn to accept the differences of others and appreciate their own unique opinions when a new student arrives at their school.Thesis (B.?)Honors Colleg

    Match between learning styles and teaching methods: An exploratory study of the effects on nursing student\u27s academic performance, perceived learning, and course evaluations

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    The purpose of this study was to examine the effects of a match versus mismatch between learning styles and teaching methods on a student\u27s academic performance, amount of perceived learning, and course evaluations. A review of past research supported the inclusion of the following student characteristics: age, previous academic performance, and amount of effort put into the course work. In addition, the teaching methodology used by the faculty member was included as an independent variable. First year nursing students enrolled in courses that used three distinctly different instructional strategies were the participants in this study. The following data were collected: student learning profile as measured by the Grasha-Reichmann Student Learning Style Scale; previous academic performance as measured by the students\u27 grade-point average prior to enrollment in nursing program; perceived degree of student effort, amount of perceived learning, and course evaluation as measured by the Student Instructional Report II; and students\u27 final nursing course grade as measured by averaging all exams administered during the course. All data were collected during the fall 1998 semester. A total of 77 students completed both their respective nursing courses and Student Instructional Report II. Stepwise multiple regression indicated the best predictors of the students\u27 final nursing course grade were previous academic performance and the type of teaching methodology used by the faculty. The only predictor of the amount of perceived learning was the perceived degree of student effort put forth in their coursework. Lastly, the best predictors of the course evaluation were the degree of student effort, the type of teaching methodology, and a match versus mismatch of learning styles and teaching methods. The findings suggest that faculty need to design and utilize instructional strategies that actively engage students in the teaching learning process. In addition, students must be made aware of the academic and the personal benefits from assuming a more proactive role in their learning. Finally, the study points to the need to further understand the myriad of variables that impact on student learning and students\u27 perceptions of effective instruction

    Sociality and genetics of a southeastern Arizona coati (Nasua narica) population

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    White-nosed coatis (Nasua narica) are social carnivores that range from the neotropics into the southwestern United States. The majority of previous coati research has focused on tropical populations, where resources are plentiful and density of individuals is high. My study examined effects of differing ecological conditions on the behavior and genetics of coatis at their northern range terminus. The goal of my research was to determine whether the social system found in temperate zone coatis mirrors sociality described in tropical studies. Previous results have characterized coati females as social, living in large closely related matrilines. Adult males are thought to be solitary. Tropical research has shown a sex-bias in dispersal with males dispersing socially, but not spatially from their natal ranges. Inbreeding avoidance, if it occurs, is thought to occur via male forays from natal ranges during breeding. I used a combination of radio telemetry and microsatellite DNA analyses to examine coati behavior in Chiricahua National Monument, Arizona, from 1996-1999 and 2001-2004. I paid particular attention to the dynamic nature of individual associations and devised a novel use of a methodology first proposed by Doncaster (1990). Adult females in my population did not adhere to the previous characterization of bands as closely associating groups of individuals. While adult females were closely related to band members, and spent more time associating with these individuals, interactions between individuals were remarkably loose for a purportedly social species. Density of individuals influenced number of bands in Chiricahua, with more bands at higher densities. Number of females per band remained constant irrespective of density, suggesting an optimal group size. Although adult males in Chiricahua conform to the prediction of being solitary, they dispersed both socially and spatially from their natal ranges. Both females and males in my study area exhibited natal and secondary dispersal. Relatedness of males to their closest female band was relatively low during breeding and non-breeding seasons. Instead of using male forays to avoid inbreeding as is hypothesized in tropical populations, Chiricahua coatis appear to avoid inbreeding via dispersal
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