Use of Antenatal and Skilled Care During Delivery: A Systematic Review and Meta-analysis of Effectiveness of Interventions Implemented in Developing Countries

Background Complications due to pregnancy and child bearing are among the leading causes of death and disability among women of child bearing age in developing countries. Skilled antenatal care (ANC) and care during delivery are indispensably important in the reduction of Maternal Mortality Rates (MMR). Interventions to increase use of maternal care have been implemented. Meta-analysis is important to ascertain the effectiveness of these interventions. Purpose The objective of this study was to conduct a systematic review and meta-analysis of the effectiveness of interventions implemented in developing countries to improve use of antenatal services and skilled care during delivery. Methods Interventions were identified from MEDLINE, PAIS International and GLOBAL HEALTH databases. Meta-analysis was performed. Effect sizes (ES) were calculated as odds ratios. Random effects model was used for meta-analysis. Main results A total of 1960 articles were retrieved data bases. Final selection resulted into 12 articles for delivery care and 13 articles for antenatal care. Results for delivery and antenatal care interventions showed that, overall effect size was significant; 2.406 (95% CI 1.847 - 3.135), P-value \u3c=0.001 and 2.548 (95% CI 1.207-5.382), P=0.014 respectively. Heterogeneity between studies was significantly high for both delivery and antenatal care interventions. Subgroup analysis with moderator variables such as study design, types of outcomes and region of study did not show any evidence of these variables to have contributed to the observed high heterogeneity. Conclusion Interventions were significantly effective. Heterogeneity was substantially high. Subgroup analysis did not show any evidence of such variables to have contributed to the observed heterogeneity. Key words: antenatal, delivery

Estimating plasma volume in neonatal Holstein calves fed one or two feedings of a lacteal-based colostrum replacer using Evans blue dye and hematocrit values at various time points.

Twenty-eight Holstein calves were blocked by birth date and randomly assigned to one of two treatments to investigate the effect of colostrum replacer (CR) feeding regimen on plasma volume (PV). Treatments were: 1) one feeding of CR (C1; 3L of reconstituted CR 675 g of powder providing 184.5 g of IgG at birth) or 2) two feedings of CR (C2; 2L of reconstituted CR at birth and 1 L of reconstituted CR at six h). By 6 h of age, all calves had received 3L of CR providing 184.5 g of IgG. Plasma volume was estimated at six, 12, 18, and 24 h after birth using Evans blue dye (EBD). No treatment effects were noted at any time points (P \u3e 0.05). Mean PV for all calves regardless of treatment at six, 12, 18, and 24 h were 78.6, 89.2, 83.9, and 90.7 mL kg-1 of BW, respectively. Plasma volume was correlated with hematocrit (HCT), initial HCT, and treatment. Hematocrit was correlated with PV, initial HCT, and body weight. Hematocrit for six, 12, 18 and 24 h after birth can be predicted with an initial precolostral HCT determination

Germany, France and NATO

U.S. national strategy and U.S. Army doctrine explicitly establish the overwhelming need for, and value of, coalitions and alliances in the post-cold war era. Two generations of U.S. civil officials and military officers have been inculcated with the precept of NATO\u27s importance to security and stability in Europe. Free of the confines of the cold war, competing national interests and different national perceptions have transformed the Alliance. While NATO retains its value to U.S. national interests in Europe, the lack of a common threat now is producing a different Alliance. Clearly, if the Alliance is to survive and remain meaningful, an understanding of NATO and its political subtleties will be essential. To provide a wider understanding of the changed nature of the Alliance, Dr. Peter Schmidt of the Stiftung Wissenschaft und Politik in Ebenhausen, Germany, examines the current policies of France and Germany, the two largest continental NATO powers, toward NATO. Dr. Schmidt presented this paper in June 1994 to a roundtable sponsored by the American Institute for Contemporary Germany Studies and the Chief of Staff of the Army\u27s Strategic Outreach Program. Approximately two dozen European experts participated in this roundtable ably recorded by Ms Maria Alongi.https://press.armywarcollege.edu/monographs/1888/thumbnail.jp

The Schistosoma mansoni Cytochrome P450 (CYP3050A1) Is Essential for Worm Survival and Egg Development.

Schistosomiasis affects millions of people in developing countries and is responsible for more than 200,000 deaths annually. Because of toxicity and limited spectrum of activity of alternatives, there is effectively only one drug, praziquantel, available for its treatment. Recent data suggest that drug resistance could soon be a problem. There is therefore the need to identify new drug targets and develop drugs for the treatment of schistosomiasis. Analysis of the Schistosoma mansoni genome sequence for proteins involved in detoxification processes found that it encodes a single cytochrome P450 (CYP450) gene. Here we report that the 1452 bp open reading frame has a characteristic heme-binding region in its catalytic domain with a conserved heme ligating cysteine, a hydrophobic leader sequence present as the membrane interacting region, and overall structural conservation. The highest sequence identity to human CYP450s is 22%. Double stranded RNA (dsRNA) silencing of S. mansoni (Sm)CYP450 in schistosomula results in worm death. Treating larval or adult worms with antifungal azole CYP450 inhibitors results in worm death at low micromolar concentrations. In addition, combinations of SmCYP450-specific dsRNA and miconazole show additive schistosomicidal effects supporting the hypothesis that SmCYP450 is the target of miconazole. Treatment of developing S. mansoni eggs with miconazole results in a dose dependent arrest in embryonic development. Our results indicate that SmCYP450 is essential for worm survival and egg development and validates it as a novel drug target. Preliminary structure-activity relationship suggests that the 1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethan-1-ol moiety of miconazole is necessary for activity and that miconazole activity and selectivity could be improved by rational drug design

When to keep it simple - adaptive designs are not always useful.

BACKGROUND: Adaptive designs are a wide class of methods focused on improving the power, efficiency and participant benefit of clinical trials. They do this through allowing information gathered during the trial to be used to make changes in a statistically robust manner - the changes could include which treatment arms patients are enrolled to (e.g. dropping non-promising treatment arms), the allocation ratios, the target sample size or the enrolment criteria of the trial. Generally, we are enthusiastic about adaptive designs and advocate their use in many clinical situations. However, they are not always advantageous. In some situations, they provide little efficiency advantage or are even detrimental to the quality of information provided by the trial. In our experience, factors that reduce the efficiency of adaptive designs are routinely downplayed or ignored in methodological papers, which may lead researchers into believing they are more beneficial than they actually are. MAIN TEXT: In this paper, we discuss situations where adaptive designs may not be as useful, including situations when the outcomes take a long time to observe, when dropping arms early may cause issues and when increased practical complexity eliminates theoretical efficiency gains. CONCLUSION: Adaptive designs often provide notable efficiency benefits. However, it is important for investigators to be aware that they do not always provide an advantage. There should always be careful consideration of the potential benefits and disadvantages of an adaptive design

A correlation between the timing of skeletal maturity and dental development in black South African Patients

The growth potential of patients has a significant influence on the timing of orthodontic intervention and treatment modalities. Skeletal maturity and dental development are biological maturity indicators which can be used to determine the growth status of an individual.ObjectivesTo correlate the dental maturational stages of black South African individuals with the stages of skeletal maturation and to determine the diagnostic accuracy of using dental developmental stages to identify an individual’s skeletal maturity.DesignRetrospective, cross-sectional study.MethodsSkeletal maturity and dental development of 224 subjects were assessed using lateral cephalograms and panoramic radiographs, respectively. Statistical analyses included descriptive statistics, Spearman’s correlation coefficient and positive likelihood ratios (LHR).ResultsThe highest (rs =0.759, p<0.001) correlation with skeletalmaturity was identified for the second molar and the lowest correlation (rs=0.662, p<0.001) for the canine. Positive LHR>10 combined with sensitivity and specificity testing revealed that the second premolar (stage E), second molar (stage F) and second molar (stage H) have the most significant diagnostic reliability to identify the pre-pubertal, pubertal and post-pubertal growth phases, respectively. ConclusionDental development is a valuable diagnostic tool to assess skeletal maturation. The calcification of the second molar (stage F) is predictive of the pubertal growth phase

Expanding Rural Elder Care Options: Models That Work

Rural communities and elders need better access to elder care options that enable them to continue to live in the community. Despite a larger proportion of the population over age 65 than urban and suburban America, rural communities lack the services and care coordination systems older adults need to continue living independently in their own communities as they age. In November 2008, the Rural Long Term Care Workgroup convened a national Rural Long Term Care: Access and Options Workshop to identify lessons and strategies for building and sustaining rural community-based elder care services. Finding and building on successful models is an important step towards addressing the challenges faced by rural elders seeking care options in their communities. These options include home, community, and facility-based care supported by care coordination systems that enhance autonomy and quality of life of rural elders. These proceedings of the Workshop are organized around the following topics: The challenges and opportunities for expanding rural elder care options; Five rural elder care models that work; A Rural Elder Care Options Model, a web-based, interactive tool that rural communities can use to customize the options to their specific community; The organizational attributes and strong partnerships needed to build rural community options for elder care; Strategies for increasing access and options for elder care in rural communities; and Steps to move forward in building rural communities that support elder care

GridCertLib: a Single Sign-on Solution for Grid Web Applications and Portals

This paper describes the design and implementation of GridCertLib, a Java library leveraging a Shibboleth-based authentication infrastructure and the SLCS online certificate signing service, to provide short-lived X.509 certificates and Grid proxies. The main use case envisioned for GridCertLib, is to provide seamless and secure access to Grid/X.509 certificates and proxies in web applications and portals: when a user logs in to the portal using Shibboleth authentication, GridCertLib can automatically obtain a Grid/X.509 certificate from the SLCS service and generate a VOMS proxy from it. We give an overview of the architecture of GridCertLib and briefly describe its programming model. Its application to some deployment scenarios is outlined, as well as a report on practical experience integrating GridCertLib into portals for Bioinformatics and Computational Chemistry applications, based on the popular P-GRADE and Django softwares.Comment: 18 pages, 1 figure; final manuscript accepted for publication by the "Journal of Grid Computing