Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

<p>Abstract</p> <p>Background</p> <p>IUD uptake remains low in Pakistan, in spite of three major efforts to introduce the IUD since the 1960s, the most recent of these being through the private sector. This study examines barriers to IUD recommendation and provision among private providers in Pakistan.</p> <p>Methods</p> <p>A facility-based survey was conducted among randomly selected private providers who were members of the Greenstar network and among similar providers located within 2 Kilometers. In total, 566 providers were interviewed in 54 districts of Pakistan.</p> <p>Logistic regression analysis was conducted to determine whether correct knowledge regarding the IUD, self-confidence in being able to insert the IUD, attitudes towards suitability of candidates for the IUD and medical safety concerns were influenced by provider type (physician vs. Lady Health Visitor), whether the provider had received clinical training in IUD insertion in the last three years, membership of the Greenstar network and experience in IUD insertion. OLS regression was used to identify predictors of provider productivity (measured by IUD insertions conducted in the month before the survey).</p> <p>Results</p> <p>Private providers consider women with children and in their peak reproductive years to be ideal candidates for the IUD. Women below age 19, above age 40 and nulliparous women are not considered suitable IUD candidates. Provider concerns about medical safety, side-effects and client satisfaction associated with the IUD are substantial. Providers' experience in terms of the number of IUDs inserted in their careers, appears to improve knowledge, self-confidence in the ability provide the IUD and to lower age-related attitudinal barriers towards IUD recommendation. Physicians have greater medical safety concerns about the IUD than Lady Health Visitors. Clinical training does not have a consistent positive effect on lowering barriers to IUD recommendation. Membership of the Greenstar network also has little effect on lowering these barriers. Providers' barriers to IUD recommendation significantly lower their monthly IUD insertions.</p> <p>Conclusions</p> <p>Technical training interventions do not reduce providers' attitudinal barriers towards IUD provision. Formative research is needed to better understand reasons for the high levels of provider barriers to IUD provision. "Non-training" interventions should be designed to lower these barriers.</p

La diversidad en la formación hace a lo integral del Ingeniero

La cátedra de Materiales contiene a un plantel docente rentado de 8 ingenieros y 3 estudiantes de ingeniería. A su vez colaboran ad-honorem 1 profesional y 1 alumno. Este plantel atiende cerca de 600 alumnos por año y desde el año 2015 también se encarga de la materia Materiales de la sede de la Facultad de Ingeniería en Bolívar. Si bien por la cantidad de alumnos se pensaría en una cátedra tradicional tendiendo más bien a las clases teóricas, debido a la concepción que tienen los docentes involucrados se está frente a una cátedra que realiza clases teóricas, ejercitación áulica de práctica, laboratorios experimentales (con no más de 18 alumnos por comisión), debates en clases, actividades de extensión y evaluaciones. Todo este sin fin de actividades están pensadas en función del objetivo primordial de la cátedra que es la formación integral del Ingeniero, y es en el presente trabajo donde se describe la propuesta de la cátedra para colaborar en la educación sin descuidar lo técnico pero fortaleciendo las otras áreas de la formación.Eje 1: La enseñanza universitaria en el contexto actual: transformaciones y propuestas. Reflexiones y experiencias en la enseñanza de las Ciencias Exactas.Secretaría de Asuntos Académico

Lung Volume, Breathing Pattern and Ventilation Inhomogeneity in Preterm and Term Infants

BACKGROUND: Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD) have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques. METHODOLOGY/PRINCIPAL FINDINGS: We studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC) and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg) than preterm infants without BPD (23.4 mL/kg) and term-born infants (22.6 mL/kg), though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (t(PTEF)/t(E)) than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity. CONCLUSIONS: Our results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process

Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

<p>Abstract</p> <p>Background</p> <p>Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.</p> <p>Methods</p> <p>A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria.</p> <p>Results</p> <p>A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity.</p> <p>Discussion</p> <p>Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented.</p> <p>Conclusion</p> <p>There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.</p

Observation of the cosmic ray shadow of the Sun with the ANTARES neutrino telescope

[EN] The ANTARES detector is an undersea neutrino telescope in the Mediterranean Sea. The search for pointlike neutrino sources is one of the main goals of the ANTARES telescope, requiring a reliable method to evaluate the detector angular resolution and pointing accuracy. This work describes the study of the Sun ¿shadow¿ effect with the ANTARES detector. The shadow is the deficit in the atmospheric muon flux in the direction of the Sun caused by the absorption of the primary cosmic rays. This analysis is based on the data collected between 2008 and 2017 by the ANTARES telescope. The observed statistical significance of the Sun shadow detection is 3.7¿, with an estimated angular resolution of 0.59° +- 0.10°for downward-going muons. The pointing accuracy is found to be consistent with the expectations and no evidence of systematic pointing shifts is observed.The authors acknowledge the financial support of the funding agencies: Centre National de la Recherche Scientifique, Commissariat `a l'' energie atomique et aux energies alternatives, Commission Europeenne (FEDER fund and Marie Curie Program), Institut Universitaire de France, LabEx UnivEarthS (ANR-10-LABX-0023 and ANR-18-IDEX-0001), R ' egion Ile-de-France (DIM-ACAV), Region Alsace (contract CPER), Region Provence-Alpes-Cote d'Azur, Departement du Var and Ville de La Seyne-sur-Mer, France; Bundesministerium fur Bildung und Forschung, Germany; Istituto Nazionale di Fisica Nucleare, Italy; Nederlandse organisatie voor Wetenschappelijk Onderzoek, the Netherlands; Council of the President of the Russian Federation for Young Scientists and Leading Scientific Schools supporting grants, Russia; Executive Unit for Financing Higher Education, Research, Development and Innovation (UEFISCDI), Romania; Ministerio de Ciencia, Innovacion, Investigacion y Universidades (MCIU): Programa Estatal de Generacion de Conocimiento (refs. PGC2018-096663-B-C41, -A-C42, -B-C43, -B-C44) (MCIU/FEDER), Severo Ochoa Centre of Excellence and MultiDark Consolider (MCIU), Junta de Andalucia (refs. SOMM17/6104/UGR and A-FQM-053-UGR18), Generalitat Valenciana: Grisolia (ref. GRISOLIA/2018/119), Spain; Ministry of Higher Education, Scientific Research and Professional Training, Morocco. We also acknowledge the technical support of Ifremer, AIM and Foselev Marine for the sea operation and the CC-IN2P3 for the computing facilities.Albert, A.; Andre, M.; Anghinolfi, M.; Anton, G.; Ardid Ramírez, M.; Aubert, J.; Aublin, J.... (2020). Observation of the cosmic ray shadow of the Sun with the ANTARES neutrino telescope. Physical Review D: covering particles, fields, gravitation, and cosmology. 102(12):1-7. https://doi.org/10.1103/PhysRevD.102.122007S1710212Ageron, M., Aguilar, J. A., Al Samarai, I., Albert, A., Ameli, F., André, M., … Ardid, M. (2011). ANTARES: The first undersea neutrino telescope. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 656(1), 11-38. doi:10.1016/j.nima.2011.06.103Alexandreas, D. E., Allen, R. C., Berley, D., Biller, S. D., Burman, R. L., Cady, D. R., … Zhang, W. (1991). Observation of shadowing of ultrahigh-energy cosmic rays by the Moon and the Sun. Physical Review D, 43(5), 1735-1738. doi:10.1103/physrevd.43.1735Andreyev, Y. M., Zakidyshev, V. N., Karpov, S. N., & Khodov, V. N. (2002). Cosmic Research, 40(6), 559-564. doi:10.1023/a:1021553713199Borione, A., Catanese, M., Covault, C. E., Cronin, J. W., Fick, B. E., Gibbs, K. G., … van der Velde, J. C. (1994). Observation of the shadows of the Moon and Sun using 100 TeV cosmic rays. Physical Review D, 49(3), 1171-1177. doi:10.1103/physrevd.49.1171Cobb, J. H., Marshak, M. L., Allison, W. W. M., Alner, G. J., Ayres, D. S., Barrett, W. L., … Wall, D. (2000). Observation of a shadow of the Moon in the underground muon flux in the Soudan 2 detector. Physical Review D, 61(9). doi:10.1103/physrevd.61.092002Bartoli, B., Bernardini, P., Bi, X. J., Bleve, C., Bolognino, I., Branchini, P., … Cao, Z. (2012). Measurement of the cosmic ray antiproton/proton flux ratio at TeV energies with the ARGO-YBJ detector. Physical Review D, 85(2). doi:10.1103/physrevd.85.022002Abeysekara, A. U., Albert, A., Alfaro, R., Alvarez, C., Álvarez, J. D., Arceo, R., … Belmont-Moreno, E. (2018). Constraining the p¯/p ratio in TeV cosmic rays with observations of the Moon shadow by HAWC. Physical Review D, 97(10). doi:10.1103/physrevd.97.102005Adamson, P., Andreopoulos, C., Ayres, D. S., Backhouse, C., Barr, G., Barrett, W. L., … Bock, G. J. (2011). Observation in the MINOS far detector of the shadowing of cosmic rays by the sun and moon. Astroparticle Physics, 34(6), 457-466. doi:10.1016/j.astropartphys.2010.10.010Aartsen, M. G., Ackermann, M., Adams, J., Aguilar, J. A., Ahlers, M., Ahrens, M., … Ansseau, I. (2019). Detection of the Temporal Variation of the Sun’s Cosmic Ray Shadow with the IceCube Detector. The Astrophysical Journal, 872(2), 133. doi:10.3847/1538-4357/aaffd1Albert, A., André, M., Anghinolfi, M., Anton, G., Ardid, M., Aubert, J.-J., … Barrios-Martít, J. (2018). The cosmic ray shadow of the Moon observed with the ANTARES neutrino telescope. The European Physical Journal C, 78(12). doi:10.1140/epjc/s10052-018-6451-3First search for neutrinos in correlation with gamma-ray bursts with the ANTARES neutrino telescope. (2013). Journal of Cosmology and Astroparticle Physics, 2013(03), 006-006. doi:10.1088/1475-7516/2013/03/006Aguilar, J. A., Al Samarai, I., Albert, A., André, M., Anghinolfi, M., Anton, G., … Astraatmadja, T. (2011). A fast algorithm for muon track reconstruction and its application to the ANTARES neutrino telescope. Astroparticle Physics, 34(9), 652-662. doi:10.1016/j.astropartphys.2011.01.003BECHERINI, Y., MARGIOTTA, A., SIOLI, M., & SPURIO, M. (2006). A parameterisation of single and multiple muons in the deep water or ice. Astroparticle Physics, 25(1), 1-13. doi:10.1016/j.astropartphys.2005.10.005Carminati, G., Bazzotti, M., Margiotta, A., & Spurio, M. (2008). Atmospheric MUons from PArametric formulas: a fast GEnerator for neutrino telescopes (MUPAGE). Computer Physics Communications, 179(12), 915-923. doi:10.1016/j.cpc.2008.07.014Yepes-Ramírez, H. (2013). Characterization of optical properties of the site of the ANTARES neutrino telescope. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 725, 203-206. doi:10.1016/j.nima.2012.11.143Fusco, L. A., & Margiotta, A. (2016). The Run-by-Run Monte Carlo simulation for the ANTARES experiment. EPJ Web of Conferences, 116, 02002. doi:10.1051/epjconf/201611602002Albert, A., André, M., Anghinolfi, M., Anton, G., Ardid, M., Aubert, J.-J., … Basa, S. (2017). First all-flavor neutrino pointlike source search with the ANTARES neutrino telescope. Physical Review D, 96(8). doi:10.1103/physrevd.96.082001Albert, A., André, M., Anghinolfi, M., Anton, G., Ardid, M., Aubert, J.-J., … Belhorma, B. (2020). ANTARES and IceCube Combined Search for Neutrino Point-like and Extended Sources in the Southern Sky. The Astrophysical Journal, 892(2), 92. doi:10.3847/1538-4357/ab7afbAdrián-Martínez, S., Albert, A., André, M., Anghinolfi, M., Anton, G., Ardid, M., … Basa, S. (2014). SEARCHES FOR POINT-LIKE AND EXTENDED NEUTRINO SOURCES CLOSE TO THE GALACTIC CENTER USING THE ANTARES NEUTRINO TELESCOPE. The Astrophysical Journal, 786(1), L5. doi:10.1088/2041-8205/786/1/l

Trapping in irradiated p-on-n silicon sensors at fluences anticipated at the HL-LHC outer tracker

The degradation of signal in silicon sensors is studied under conditions expected at the CERN High-Luminosity LHC. 200 $\mu$m thick n-type silicon sensors are irradiated with protons of different energies to fluences of up to $3 \cdot 10^{15}$ neq/cm$^2$. Pulsed red laser light with a wavelength of 672 nm is used to generate electron-hole pairs in the sensors. The induced signals are used to determine the charge collection efficiencies separately for electrons and holes drifting through the sensor. The effective trapping rates are extracted by comparing the results to simulation. The electric field is simulated using Synopsys device simulation assuming two effective defects. The generation and drift of charge carriers are simulated in an independent simulation based on PixelAV. The effective trapping rates are determined from the measured charge collection efficiencies and the simulated and measured time-resolved current pulses are compared. The effective trapping rates determined for both electrons and holes are about 50% smaller than those obtained using standard extrapolations of studies at low fluences and suggests an improved tracker performance over initial expectations

Description and performance of track and primary-vertex reconstruction with the CMS tracker

A description is provided of the software algorithms developed for the CMS tracker both for reconstructing charged-particle trajectories in proton-proton interactions and for using the resulting tracks to estimate the positions of the LHC luminous region and individual primary-interaction vertices. Despite the very hostile environment at the LHC, the performance obtained with these algorithms is found to be excellent. For tbar t events under typical 2011 pileup conditions, the average track-reconstruction efficiency for promptly-produced charged particles with transverse momenta of pT > 0.9GeV is 94% for pseudorapidities of |η| < 0.9 and 85% for 0.9 < |η| < 2.5. The inefficiency is caused mainly by hadrons that undergo nuclear interactions in the tracker material. For isolated muons, the corresponding efficiencies are essentially 100%. For isolated muons of pT = 100GeV emitted at |η| < 1.4, the resolutions are approximately 2.8% in pT, and respectively, 10μm and 30μm in the transverse and longitudinal impact parameters. The position resolution achieved for reconstructed primary vertices that correspond to interesting pp collisions is 10–12μm in each of the three spatial dimensions. The tracking and vertexing software is fast and flexible, and easily adaptable to other functions, such as fast tracking for the trigger, or dedicated tracking for electrons that takes into account bremsstrahlung