Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial.: Intervention to decrease severe postpartum haemorrhage

International audienceOBJECTIVE: Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. DESIGN: Cluster-randomised trial. POPULATION: 106 maternity units in six French regions. METHODS: Maternity units were randomly assigned to receive the intervention, or to have the protocol passively disseminated. The intervention combined outreach visits to discuss the protocol in each local context, reminders, and peer reviews of severe incidents, and was implemented in each maternity hospital by a team pairing an obstetrician and a midwife. MAIN OUTCOME MEASURES: The primary outcome was the incidence of severe PPH, defined as a composite of one or more of: transfusion, embolisation, surgical procedure, transfer to intensive care, peripartum haemoglobin decrease of 4 g/dl or more, death. The main secondary outcomes were PPH management practices. RESULTS: The mean rate of severe PPH was 1.64% (SD 0.80) in the intervention units and 1.65% (SD 0.96) in control units; difference not significant. Some elements of PPH management were applied more frequently in intervention units-help from senior staff (P = 0.005), or tended to - second-line pharmacological treatment (P = 0.06), timely blood test (P = 0.09). CONCLUSION: This educational intervention did not affect the rate of severe PPH as compared with control units, although it improved some practices

Comparação entre o congelamento lento e a vitrificação na criopreservação de tecido ovariano de suínos

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Biologia Animal, 2013.Os avanços nas tecnologias reprodutivas têm aumentado o aproveitamento do material genético de animais de interesse zootécnico ou ameaçados de extinção. A criopreservação de ovócitos imaturos inclusos no tecido ovariano é uma alternativa para a preservação de diversas espécies, particularmente em suínos, visto que ovócitos maduros desse grupo são extremamente sensíveis a baixas temperaturas. A escolha da técnica de criopreservação (congelamento lento ou vitrificação) interfere na eficiência de preservação do material, por isso, são necessários estudos que visem o desenvolvimento de protocolos de conservação das células germinativas inclusas em folículos pré-antrais (FPA) suínos. O objetivo deste trabalho foi comparar o efeito de técnicas de criopreservação, congelamento lento e vitrificação, na morfologia de FPA inclusos no tecido ovariano de suínos. Os fragmentos do tecido ovariano foram submetidos a dois protocolos de vitrificação (V1 e V2) e um de congelamento lento (CL), vitrificados em superfície sólida ou congelados em um freezer programável. Na V1, os fragmentos foram imersos em uma solução de equilíbrio (SE) de DMSO 1,0 M e uma solução de vitrificação (SV) de DMSO 2,0 M + acetamida 1,0 M + propanodiol 3,0 M. Para a V2, utilizou-se SE contendo etilenoglicol 0,6 M e SV contendo etilenoglicol 5,6 M + polivinilpirrolidona 0,45 M e 13,7% sacarose. Para o CL, os fragmentos foram colocados em criotubos com solução de etilenoglicol 1,5 M e 0,4% sacarose. As amostras foram congeladas pelo método lento ou vitrificadas em superfície sólida e todos os fragmentos foram armazenados em nitrogênio líquido. Após o reaquecimento ou descongelamento, as amostras foram fixadas e processadas para microscopia de luz e eletrônica de transmissão. Os dados das porcentagens de folículos morfologicamente normais (FMN) foram submetidos ao teste de Tukey. As médias de FMN foram 97,1±2,6 para o controle, 96,1± 3,0 para a V1, 81,1±14,8 para a V2 e 86,7±7,3 para o CL. As porcentagens de FMN no CL e na V2 foram estatisticamente menores (P<0,05) que a do controle e a da V1, a qual por sua vez foi estatisticamente igual ao controle. Para a análise ultraestrutural, foram avaliados apenas FPA caracterizados como morfologicamente normais nos cortes semi-finos, e somente dos melhores tratamentos. A ultraestrutura celular de FPA criopreservados pelo método V1 apresentou vários sinais de degeneração, enquanto FPA congelados pela técnica CL apresentaram morfologia normal, semelhante ao controle. Em conclusão, a técnica de CL foi mais eficiente para preservar folículos pré-antrais inclusos em tecido ovariano de suínos, entretanto o aperfeiçoamento da técnica de vitrificação para tecido ovariano suíno ainda é necessário.Advances in reproductive technologies have increased the use of genetic material from animals of zootechnical interest or endangered species. Cryopreservation of oocytes enclosed in ovarian tissue is an alternative for preservation of many species, particularly pigs, since mature oocytes of this group are extremely sensitive to low temperatures. The choice of technique for cryopreservation (slow freezing or vitrification) interferes with the efficiency of preservation of the material, thus, studies are needed for the development of protocols for conservation of germ cells enclosed in preantral follicles (PAF) of pigs. The aim of our study was to compare the effect of cryopreservation techniques, slow freezing and vitrification, on morphology of PAF included in the ovarian tissue of pigs. The fragments of ovarian tissue were submitted to two vitrification protocols (V1 and V2) and one slow freezing (SF) protocol, vitrified on solid surface or frozen in a programmable freezer. In V1, fragments were immersed in an equilibrium solution (ES) of DMSO 1.0 M and a vitrification solution (VS) of DMSO 2.0 M + acetamide 1.0 M + propanediol 3.0 M. For V2, ES contained 0.6 M and VS contained ethylene glycol 5.6 M + polyvinylpyrrolidone 0.45 M and 13.7% sucrose. For the SF, fragments were placed in cryotubes with solution of 1.5 M ethylene glycol and 0.4% sucrose. Samples were slow cooled or vitrified by solid surface vitrification and all fragments were stored in liquid nitrogen. After reheating or defrosting, samples were fixed and processed for light microscopy and transmission electron microscopy. Data for the percentage of morphologically normal follicles (MNF) were subjected to Tukey's test. Mean MNF were 97.1±2.6 for control, 96.1±3.0 for V1, 81,1± 14,8 for V2 and 86,7± 7,3 for SF. The percentages of MNF in SF and in V2 were lower (P <0.05) than in the control and in V1, which was statistically equal to control. For ultrastructural analysis, were evaluated only PAF characterized as morphologically normal in the semithin sections and only the best treatments. The cellular ultrastructure of PAF cryopreserved by V1 method showed various signs of degeneration, while PAF frozen by SF technique showed normal morphology, similar to control. In conclusion, the SF technique was more efficient to preserve preantral follicles enclosed in ovarian tissue of pigs; however, the improvement of vitrification technique for porcine ovarian tissue is still needed

Modèles de formation de coalitions stables dans un contexte ad-hoc et stochastique

An ad-hoc and stochastic context prevents : 1- the existence of a global view of the system that reflects a complete image of the deployment environment ; 2- the existence of a priori knowledge because of the lack of a centralized structure, the dynamic of the tasks and the random availability of the entities. We proposed different strategies to facilitate the dynamic stabilization of the interactions between the agents and the convergence towards better coordination states. Our conception of alliances and recommendations allows an agent to evolve independently, to dynamically identify reliable neighboring agents with whom to cooperate and to form Nash-stable or Core stable coalitions according to the requirements of the deployment environment. To face with the challenges of the correlation between local behavior of the agents and the properties of their environment, we use in an original way the Markovian models. We also focused on taking into account the interdependencies between the agents to increase their efficiency in order to optimize the imputed costs of the ad-hoc components where the agents are deployed. This led us to propose both mechanisms, the S-NRB (Sequential Non-return Broadcast) and the P-NRB (Parallel Non-return Broadcast) for distributed coordination seeking to maximize the social welfare of the agents. To highlight the intrinsic properties of our methods, our whole proposals have been studied theoretically and experimentally through our simulatorTravailler dans un contexte ad hoc et dynamique, pour les agents, empêche : 1- l'existence d'une vue globale du système qui reflète une image complète de l'environnement de déploiement ; 2- l'existence de connaissances a priori sur la manière de se coordonner en raison de l'absence d'une structure centralisée et de la disponibilité aléatoire des entités considérés. Nous avons proposé différentes stratégies comportementales pour faciliter la stabilisation dynamique des interactions entre les agents et la convergence vers les meilleurs états de coordination. Notre conception des alliances et des recommandations permet à un agent d'évoluer de manière autonome, d'identifier dynamiquement les agents voisins fiables avec qui coopérer et de former avec son voisinage des partitions Nash-stables selon les exigences de l'environnement de déploiement. Pour répondre à la difficulté de corrélation entre les comportements locaux des agents et les propriétés de l'environnement de déploiement des agents, nous utilisons de manière originale les modèles Markoviens. Nous nous sommes aussi focalisés sur la prise en compte des interdépendances entre les agents pour augmenter leur efficacité dans un souci d'optimisation les coûts imposés aux composants ad-hoc communicants où les agents sont déployés. Cela nous a amené à proposer le modèle S-NRB (Sequentiel Non-return Broadcast) et le modèle P-NRB (Parallel Non-return Broadcast) pour la coordination distribuée qui cherchent à maximiser le bien-être social des agents. Pour mettre en exergue les propriétés intrinsèques de nos méthodes, toutes nos propositions ont été étudiées de manière théorique et expérimentale grâce à notre simulateu