The Ontario Mother and Infant Study (TOMIS) III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year

Abstract Background The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge. Methods and design The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings. Discussion The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to hospital- and community-based postpartum care providers, managers, and administrators in guiding risk assessment and early intervention strategies. Finally, the research findings can provide the basis for policy modification and implementation strategies to improve outcomes and reduce costs of care

Formation mechanisms and yields of small imidazoles from reactions of glyoxal with NH4+ in water at neutral pH

SSCI-VIDE+ATARI+AMX:BNO:HMEInternational audienceImidazoles have numerous applications in pharmacology, chemistry, optics and electronics, making the development of their environmentally-friendly synthetic procedures worthwhile. In this work, the formation of imidazole, imidazole-2-carboxaldehyde, and 2,2-bis-1H-imidazole was investigated in the self-reaction of glyoxal and its cross-reactions with each of these compounds in aqueous solutions of inorganic ammonium salts at pH = 7. Such conditions are relevant both as cheap and environmentally-friendly synthetic procedures and for the chemistry of natural environments where NH4+ is abundant, such as in atmospheric aerosols. These reactions were investigated both by H-1-NMR and UV-Vis absorption spectroscopy at room temperature with the objective to determine the formation pathways of the three imidazoles and the parameters affecting their yields, to identify the optimal conditions for their synthesis. The results show that only the simplest imidazole is produced by the self-reaction of glyoxal and that imidazole-2-carboxaldehyde and 2,2-bis-1H-imidazole are produced by cross-reactions of glyoxal with imidazole and imidazole-2-carboxaldehyde, respectively. The yields of imidazole-2-carboxaldehyde and 2,2-bis-1H-imidazole formed by the cross-reactions were close to unity, but the yield of imidazole formed by the self-reaction of glyoxal, Y-Im, was small and varied inversely with the initial glyoxal concentration, [G](0): Y-Im > 10% only for [G](0) < 0.1 M. The latter result was attributed to the kinetic competition between the imidazole-forming condensation pathway and the acetal/oligomer formation pathway of the glyoxal self-reaction and constitutes a bottleneck for the formation of higher imidazoles. Other parameters such as pH and the NH4+ concentration did not affect the yields. Thus, by maintaining small glyoxal concentrations, high imidazole yields can be achieved in environmentally-friendly aqueous ammonium solutions at neutral pH. Under the same conditions, higher yields are expected expected from substituted carbonyl compounds, regardless of their concentration, as they produce less acetals

An advanced dynamic repair of edge crack aluminum plate with a composite patch

In this work, repaired crack in 2024 T3 aluminium plate with composite patch is presented, the problem is handled in plane stress condition under tensile Mode I crack growth. In the numerical simulation, firstly we determine the displacement, strain and stress, also the first six mode shapes of the plate, secondly we compare the first results with result of a cracked plate, thirdly we repair the crack with composite patch for different materials (Glass, Boron, carbon) and for (2 layers, 4 layers). Finally the comparison of stress, strain, displacement and six first natural frequencies between uncracked, crack initiation and composite patch repair crack. The best offer operating according to the need is selecte