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1.
J Obstet Gynaecol Can ; 45(1): 70-77.e3, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36725134

RESUMO

OBJECTIVES: This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION: All pregnant patients. BENEFITS, RISKS, AND COSTS: Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE: Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized control trials, and observational studies on cervical ripening and induction labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: All providers of obstetrical care. SUMMARY STATEMENTS: Misoprostol OXYTOCIN: RECOMMENDATIONS.


Assuntos
Trabalho de Parto , Obstetrícia , Gravidez , Feminino , Humanos , Revisões Sistemáticas como Assunto , Trabalho de Parto Induzido , Ocitocina
2.
PLoS One ; 18(1): e0271081, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36595497

RESUMO

Spontaneous uterine contractions are initiated when smooth muscle cells (SMCs) within the uterine muscle, or myometrium, transition from a functionally dormant to an actively contractile phenotype at the end of the pregnancy period. We know that this process is accompanied by gestational time point-specific differences in the SMC transcriptome, which can be modulated by the activator protein 1 (AP-1), nuclear factor kappa beta (NF-κß), estrogen receptor (ER), and progesterone receptor (PR) transcription factors. Less is known, however, about the additional proteins that might assist these factors in conferring the transcriptional changes observed at labor onset. Here, we present functional evidence for the roles of two proteins previously understudied in the SMC context-MYB and ELF3-which can contribute to the regulation of labor-driving gene transcription. We show that the MYB and ELF3 genes exhibit elevated transcript expression levels in mouse and human myometrial tissues during spontaneous term labor. The expression of both genes was also significantly increased in mouse myometrium during preterm labor induced by the progesterone antagonist mifepristone (RU486), but not during infection-simulating preterm labor induced by intrauterine infusion of lipopolysaccharide (LPS). Furthermore, both MYB and ELF3 proteins affect labor-driving gene promoter activity, although in surprisingly opposing ways: Gja1 and Fos promoter activation increases in the presence of MYB and decreases in the presence of ELF3. Collectively, our study adds to the current understanding of the transcription factor network that defines the transcriptomes of SMCs during late gestation and implicates two new players in the control of labor timing.


Assuntos
Trabalho de Parto , Miométrio , Feminino , Recém-Nascido , Gravidez , Camundongos , Animais , Humanos , Miométrio/metabolismo , Trabalho de Parto/fisiologia , Contração Uterina , Mifepristona/farmacologia , Fator de Transcrição AP-1/metabolismo , Expressão Gênica , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Proteínas Proto-Oncogênicas c-ets/genética
4.
Int J Community Based Nurs Midwifery ; 11(1): 23-33, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36650848

RESUMO

Background: Pregnancy and labour are defining moments in the lives of women. While these are joyful moments for many, some physical and psychological issues have been reported during labour and pregnancy. This study was conducted to explore the coping experiences of Nigerian women during pregnancy and labour. Methods: This is an exploratory qualitative study using the content analysis. The study was conducted from November 2021 to January 2022 in Ekiti State and Federal Capital Territory, Nigeria. In-depth interviews were conducted with 30 women selected using the purposive sampling technique. Data collection was stopped when we reached data saturation. Data were analyzed through content analysis using the NVIVO software version 12. Results: Two themes emerged from the study including coping strategies during pregnancy and trying to endure labour pain. The theme, coping strategies utilized during pregnancy, included obtaining the relatives' experiences, seeking information, religious practices, and engaging in exercise. The theme, trying to endure labour pain, consisted of exercising for pain relief, relying on God, Positive imagination, giving psychological support, and behaving according to the accepted cultural beliefs. Conclusion: Findings suggested that women utilized many non-pharmacological methods for coping. Interventions to support women during pregnancy and labour should consider these strategies during planning and implementation.


Assuntos
Dor do Parto , Trabalho de Parto , Gravidez , Humanos , Feminino , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Adaptação Psicológica , Manejo da Dor/métodos , Pesquisa Qualitativa
5.
Sci Rep ; 13(1): 1183, 2023 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-36681776

RESUMO

Detection of colorectal polyps through colonoscopy is an essential practice in prevention of colorectal cancers. However, the method itself is labor intensive and is subject to human error. With the advent of deep learning-based methodologies, and specifically convolutional neural networks, an opportunity to improve upon the prognosis of potential patients suffering with colorectal cancer has appeared with automated detection and segmentation of polyps. Polyp segmentation is subject to a number of problems such as model overfitting and generalization, poor definition of boundary pixels, as well as the model's ability to capture the practical range in textures, sizes, and colors. In an effort to address these challenges, we propose a dual encoder-decoder solution named Polyp Segmentation Network (PSNet). Both the dual encoder and decoder were developed by the comprehensive combination of a variety of deep learning modules, including the PS encoder, transformer encoder, PS decoder, enhanced dilated transformer decoder, partial decoder, and merge module. PSNet outperforms state-of-the-art results through an extensive comparative study against 5 existing polyp datasets with respect to both mDice and mIoU at 0.863 and 0.797, respectively. With our new modified polyp dataset we obtain an mDice and mIoU of 0.941 and 0.897 respectively.


Assuntos
Trabalho de Parto , Pólipos , Humanos , Gravidez , Feminino , Colonoscopia , Fontes de Energia Elétrica , Generalização Psicológica , Redes Neurais de Computação , Processamento de Imagem Assistida por Computador
6.
Obstet Gynecol ; 141(2): 387-394, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649352

RESUMO

OBJECTIVE: To evaluate the cost effectiveness of California's statewide perinatal quality collaborative for reducing severe maternal morbidity (SMM) from hemorrhage. METHODS: A decision-analytic model using open source software (Amua 0.30) compared outcomes and costs within a simulated cohort of 480,000 births to assess the annual effect in the state of California. Our model captures both the short-term costs and outcomes that surround labor and delivery and long-term effects over a person's remaining lifetime. Previous studies that evaluated the effectiveness of the CMQCC's (California Maternal Quality Care Collaborative) statewide perinatal quality collaborative initiative-reduction of hemorrhage-related SMM by increasing recognition, measurement, and timely response to postpartum hemorrhage-provided estimates of intervention effectiveness. Primary cost data received from select hospitals within the study allowed for the estimation of collaborative costs, with all other model inputs derived from literature. Costs were inflated to 2021 dollars with a cost-effectiveness threshold of $100,000 per quality-adjusted life-year (QALY) gained. Various sensitivity analyses were performed including one-way, scenario-based, and probabilistic sensitivity (Monte Carlo) analysis. RESULTS: The collaborative was cost effective, exhibiting strong dominance when compared with the baseline or standard of care. In a theoretical cohort of 480,000 births, collaborative implementation added 182 QALYs (0.000379/birth) by averting 913 cases of SMM, 28 emergency hysterectomies, and one maternal mortality. Additionally, it saved $9 million ($17.78/birth) due to averted SMM costs. Although sensitivity analyses across parameter uncertainty ranges provided cases where the intervention was not cost saving, it remained cost effective throughout all analyses. Additionally, scenario-based sensitivity analysis found the intervention cost effective regardless of birth volume and implementation costs. CONCLUSION: California's statewide perinatal quality collaborative initiative to reduce SMM from hemorrhage was cost effective-representing an inexpensive quality-improvement initiative that reduces the incidence of maternal morbidity and mortality, and potentially provides cost savings to the majority of birthing hospitals.


Assuntos
Trabalho de Parto , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Hemorragia Pós-Parto/prevenção & controle , Mortalidade Materna , Análise Custo-Benefício , Anos de Vida Ajustados por Qualidade de Vida
7.
Cochrane Database Syst Rev ; 1: CD013808, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36625680

RESUMO

BACKGROUND: Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. Fetal scalp stimulation (FSS) is a second-line test of fetal well-being that may provide reassurance that the labour can continue. OBJECTIVES: To evaluate methods of FSS as second-line tests of intrapartum fetal well-being in cases of non-reassuring CTG. FSS and CTG were compared to CTG alone, and to CTG with fetal blood sampling (FBS). SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, the WHO ICTRP and conference proceedings), ClinicalTrials.gov (18 October 2022), and reference lists of retrieved studies. SELECTION CRITERIA: Eligible studies were randomised controlled trials (RCTs) that compared any form of FSS to assess fetal well-being in labour. Quasi-RCTs, cluster-RCTs and studies published in abstract form were also eligible for inclusion, but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Two trials, involving 377 women, met the inclusion criteria for this review. Both trials were conducted in hospital settings and included women with singleton, term (37+0 weeks or more) pregnancies, a cephalic presentation, and abnormal CTG. Follow-up was until hospital discharge after the birth. A pilot trial of 50 women in a high-income country (Ireland) compared CTG and digital fetal scalp stimulation (dFSS) with CTG and fetal blood sampling (FBS). A single-centre trial of 327 women in a lower middle-income country (India) compared CTG and manual fetal stimulation (abdominal or vaginal scalp stimulation) with CTG alone. The two included studies were at moderate or unclear risk of bias. Both trials provided clear information on allocation concealment but it was not possible to blind participants or health professionals in relation to the intervention. Although objective outcome measures were reported, outcome assessment was not blinded or blinding was unclear. dFSS and CTG versus FBS and CTG There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. The risk of caesarean section (CS) may be lower with dFSS compared to FBS (risk ratio (RR) 0.38, 95% confidence interval (CI) 0.16 to 0.92; 1 pilot trial, 50 women; very low-certainty evidence) but the evidence is very uncertain. There were no cases of neonatal encephalopathy reported. The evidence was also very uncertain between dFSS and FBS for assisted vaginal birth (RR 1.44, 95% CI 0.76 to 2.75; very low-certainty evidence) and for the spontaneous vaginal birth rate (RR 2.33, 95% CI 0.68 to 8.01, very low-certainty evidence). Maternal acceptability of the procedures was not reported. FSS and CTG versus CTG alone Manual stimulation of the fetus was performed either abdominally (92/164) or vaginally (72/164). There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. There may be little differences in the risk of CS on comparing manual fetal stimulation and CTG with CTG alone (RR 0.83, 95% CI 0.59 to 1.18; 1 trial, 327 women; very low-certainty evidence), but again the evidence was very uncertain. There were no cases of neonatal encephalopathy reported. There may be no differences in the risk of assisted vaginal birth (RR 1.43, 95% CI 0.78 to 2.60; very low-certainty evidence) or in the rates of spontaneous vaginal birth (RR 1.01, 95% CI 0.85 to 1.21, very low-certainty evidence), but again the evidence is very uncertain. Maternal acceptability of abdominal stimulation/FSS was not reported although 13 women withdrew consent after randomisation due to concerns about fetal well-being. AUTHORS' CONCLUSIONS: There is very low-certainty evidence available which makes it unclear whether stimulating the fetal scalp is a safe and effective way to confirm fetal well-being in labour. Evidence was downgraded based on limitations in study design and imprecision. Further high-quality studies of adequate sample size are required to evaluate this research question. In order to be generalisable, these trials should be conducted in different settings, including broad clinical criteria at both preterm and term gestational ages, and standardising the method of stimulation. There is an ongoing study (FIRSST) that will be incorporated into this review in a subsequent update.


Assuntos
Encefalopatias , Trabalho de Parto , Morte Perinatal , Recém-Nascido , Feminino , Gravidez , Humanos , Couro Cabeludo , Parto , Feto
9.
Complement Ther Clin Pract ; 50: 101713, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36509031

RESUMO

BACKGROUND: The use of hypnosis as a complementary therapy in the perinatal field is expanding, however, there is little research for its impact on perinatal mental health. Here, we review studies that evaluate the effect of hypnosis on women's mental health and subjective experiences. METHODS: A systematic review was conducted according to the PRISMA protocol for articles with experimental designs of hypnosis that measured their impact on several psychological variables, such as the presence of symptoms of anxiety, depression or fear of childbirth. Studies were evaluated according to the Critical Appraisal Skills Program Checklists (CASP), and analyzed for their designs and intervention themes. RESULTS: Seven studies were included and six themes emerged: preparation for birth and unexpected events; change in the perception and experience of pain; pregnant body as a natural process; connection with the baby during pregnancy; development of inner resources; and progressive relaxation and guided imagery. Although results were partly mitigated, most studies found positive effects of hypnosis in alleviating anxiety, depression, and fear towards birth, empowering women with a higher sense of confidence and improving the overall emotional experience. Two studies also indicate encouraging outcomes in postnatal wellbeing. CONCLUSION: While it is still argued as to what extent hypnosis has positive effects on physical aspects of labor, the empowerment and the increase in confidence associated with hypnosis seem to bring a significant contribution to a more positive subjective experience of pregnancy and childbirth, and on women's overall wellbeing in the perinatal period.


Assuntos
Hipnose , Trabalho de Parto , Gravidez , Feminino , Humanos , Parto/psicologia , Parto Obstétrico/psicologia , Trabalho de Parto/psicologia , Ansiedade/terapia , Hipnose/métodos
10.
Comput Biol Med ; 153: 106467, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36584602

RESUMO

The localization and segmentation of biomarkers in OCT images are critical steps in retina-related disease diagnosis. Although fully supervised deep learning models can segment pathological regions, their performance relies on labor-intensive pixel-level annotations. Compared with dense pixel-level annotation, image-level annotation can reduce the burden of manual annotation. Existing methods for image-level annotation are usually based on class activation maps (CAM). However, current methods still suffer from model collapse, training instability, and anatomical mismatch due to the considerable variation in retinal biomarkers' shape, texture, and size. This paper proposes a novel weakly supervised biomarkers localization and segmentation method, requiring only image-level annotations. The technique is a Teacher-Student network with joint Self-supervised contrastive learning and Knowledge distillation-based anomaly localization, namely TSSK-Net. Specifically, we treat retinal biomarker regions as abnormal regions distinct from normal regions. First, we propose a novel pre-training strategy based on supervised contrastive learning that encourages the model to learn the anatomical structure of normal OCT images. Second, we design a fine-tuning module and propose a novel hybrid network structure. The network includes supervised contrastive loss for feature learning and cross-entropy loss for classification learning. To further improve the performance, we propose an efficient strategy to combine these two losses to preserve the anatomical structure and enhance the encoding representation of features. Finally, we design a knowledge distillation-based anomaly segmentation method that is effectively combined with the previous model to alleviate the challenge of insufficient supervision. Experimental results on a local dataset and a public dataset demonstrated the effectiveness of our proposed method. Our proposed method can effectively reduce the annotation burden of ophthalmologists in OCT images.


Assuntos
Trabalho de Parto , Doenças Retinianas , Humanos , Gravidez , Feminino , Biomarcadores , Entropia , Retina/diagnóstico por imagem , Processamento de Imagem Assistida por Computador
11.
J Matern Fetal Neonatal Med ; 36(1): 2157717, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36521850

RESUMO

PURPOSE: To determine the association between the occurrence of sporadic and periodic fetal heart rate accelerations during labor and acidemia at birth. MATERIALS AND METHODS: This is a case-control study of fetal heart rate patterns from 364 neonates with acidemia at birth (cord blood pH <7.05 at vaginal birth, or pH <7.10 at birth after first stage cesarean delivery) and 731 controls with pH ≥7.15. The last 30-60 min of the cardiotocographic traces before birth from the neonates born with acidemia and from the corresponding stage in labor for the controls were scrutinized. Odds ratios (OR) with 95% confidence interval for acidemia at birth were determined. RESULTS: During the first stage, ≥2 sporadic accelerations were present in 16% of cases and 78% of controls; OR for acidemia (compared to 0-1 accelerations) 0.05 (0.02-0.10). In the second stage, the corresponding rates were 13% and 60%, OR 0.09 (0.06-0.14). Isolated periodic accelerations were infrequent. A weak negative association between ≥2 periodic accelerations and acidemia (compared with 0-1 accelerations) was found in the second stage, OR 0.51 (0.30-0.86), but was not significant in the first stage, OR 0.24 (0.04-1.4). Even among fetuses with normal fetal heart rate variability (5-25 beats per minute) the occurrence of less than two sporadic accelerations was associated with an increased risk of acidemia, OR 10.3 (7.2-14.8). CONCLUSIONS: Sporadic accelerations indicate a very low probability of acidosis but are absent in 40% of fetuses with normal pH during a 30-60 min second-stage recording.


Assuntos
Cardiotocografia , Trabalho de Parto , Recém-Nascido , Feminino , Gravidez , Humanos , Estudos de Casos e Controles , Cesárea , Frequência Cardíaca Fetal/fisiologia , Concentração de Íons de Hidrogênio
12.
Acta Obstet Gynecol Scand ; 102(2): 130-137, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36541016

RESUMO

Cardiotocography is defined as the recording of fetal heart rate and uterine contractions and is widely used during labor as a screening tool to determine fetal wellbeing. The visual interpretation of the cardiotocography signals by the practitioners, following common guidelines, is subject to a high interobserver variability, and the efficiency of cardiotocography monitoring is still debated. Since the 1990s, researchers and practitioners work on designing reliable computer-aided systems to assist practitioners in cardiotocography interpretation during labor. Several systems are integrated in the monitoring devices, mostly based on the guidelines, but they have not clearly demonstrated yet their usefulness. In the last decade, the availability of large clinical databases as well as the emergence of machine learning and deep learning methods in healthcare has led to a surge of studies applying those methods to cardiotocography signals analysis. The state-of-the-art systems perform well to detect fetal hypoxia when evaluated on retrospective cohorts, but several challenges remain to be tackled before they can be used in clinical practice. First, the development and sharing of large, open and anonymized multicentric databases of perinatal and cardiotocography data during labor is required to build more accurate systems. Also, the systems must produce interpretable indicators along with the prediction of the risk of fetal hypoxia in order to be appropriated and trusted by practitioners. Finally, common standards should be built and agreed on to evaluate and compare those systems on retrospective cohorts and to validate their use in clinical practice.


Assuntos
Hipóxia Fetal , Trabalho de Parto , Gravidez , Feminino , Humanos , Hipóxia Fetal/diagnóstico , Cardiotocografia/métodos , Estudos Retrospectivos , Cuidado Pré-Natal , Frequência Cardíaca Fetal/fisiologia
13.
Arch Gynecol Obstet ; 305(6): 1409-1419, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34542680

RESUMO

BACKGROUND: Labor pain is difficult to measure. The aim of this proof-of-concept study is to implement and test a questionnaire assessing pain sensation during and after vaginal deliveries. Its key aspect is a highly standardized survey of patient-reported outcome (PRO) by staff not involved in routine care. METHODS: Between January and November 2015 339 women were assessed 24-48 h after spontaneous or operative-vaginal delivery of a singleton. German language skills were a prerequisite to participate. The test-retest reliability was calculated in 38 women 24-36 and 48-72 h postpartum between July and October 2017. Primiparae after spontaneous delivery and multiparae with no history of operative deliveries were compared in a subgroup analysis. RESULTS: Maximum labor pain and post-partum pain were reported a median of 9 [8-10] and 4 [3-6]. Higher ratings were associated with younger age, higher gestational ages, infant's biometrics, and the duration of laboring. Only regional analgesia tended to reduce pain perception (NRS 8 vs. 9). Higher-degree injuries were associated with less pain postpartum. The questionnaire proved to be reliable in most aspects (Cronbach's α > 0.6 for 19/21 questions) and showed an acceptable content and criterion validity (Cohen correlation > ± 0.3, interrelation between items). CONCLUSION: Labor is a very painful experience, irrespective of previous obstetric history. Ratings indicate inadequateness of treatment except for patients receiving preventive postoperative pain management. Systematic postpartum pain assessment, hence, is still a pending issue. Adjustments will be made concerning language skills and specific questions on effectiveness of analgesia otherwise good reliability and validity of the questionnaire were proven.


Assuntos
Dor do Parto , Trabalho de Parto , Feminino , Humanos , Percepção da Dor , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários
14.
Wiad Lek ; 75(10): 2379-2385, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36472264

RESUMO

OBJECTIVE: The aim: To conduct analyses of structure and incidence of extragenital pathology, course of pregnancy and labour in pregnant from 2011 to 2020 years. PATIENTS AND METHODS: Materials and methods: Clinical and statistical analysis of 159,367 births over 2011-2020 years in Transcarpathian region was conducted. All complications of pregnancy were divided into 6 subgroups depending on the available obstetric pathology and extragenital pathology. RESULTS: Results: The incidence of extragenital pathology among women born in the Transcarpathian region over the past 10 years has increased by an average of 6-10%. The incidence of placental dysfunction on the background of somatic morbidity in the maternity hospital in Uzhgorod increased during the study period from 6.1% (2011) to 10.9% (2020). A significant reduction in the number of births from 18,168,000 in 2011 to 13,150,000 in 2020 was noted. The incidence of combined somatic pathology increased from 10.4% in 2011 to 23.8% in 2020. (p <0.001). CONCLUSION: Conclusions: It is necessary to develop comprehensive modern measures to prevent obstetric and perinatal complications in this group of pregnant women.


Assuntos
Trabalho de Parto , Complicações na Gravidez , Feminino , Gravidez , Humanos , Incidência , Placenta , Complicações na Gravidez/prevenção & controle , Gestantes
15.
PLoS One ; 17(12): e0278035, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454982

RESUMO

Manually collecting landmarks for quantifying complex morphological phenotypes can be laborious and subject to intra and interobserver errors. However, most automated landmarking methods for efficiency and consistency fall short of landmarking highly variable samples due to the bias introduced by the use of a single template. We introduce a fast and open source automated landmarking pipeline (MALPACA) that utilizes multiple templates for accommodating large-scale variations. We also introduce a K-means method of choosing the templates that can be used in conjunction with MALPACA, when no prior information for selecting templates is available. Our results confirm that MALPACA significantly outperforms single-template methods in landmarking both single and multi-species samples. K-means based template selection can also avoid choosing the worst set of templates when compared to random template selection. We further offer an example of post-hoc quality check for each individual template for further refinement. In summary, MALPACA is an efficient and reproducible method that can accommodate large morphological variability, such as those commonly found in evolutionary studies. To support the research community, we have developed open-source and user-friendly software tools for performing K-means multi-templates selection and MALPACA.


Assuntos
Evolução Biológica , Trabalho de Parto , Gravidez , Feminino , Humanos , Fenótipo , Software
16.
BMJ Open ; 12(12): e061157, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36456016

RESUMO

INTRODUCTION: Infections are a leading cause of neonatal mortality globally and can be transmitted from mother-to-child vertically or horizontally. Fiji has higher rates of serious neonatal infections and infant skin and soft tissue infections (SSTIs) than high-income countries. Research from the Gambia found that a single dose of oral azithromycin in labour decreased bacterial carriage and infections in mothers and infants, particularly infant skin infections. The Bulabula MaPei clinical trial evaluates the safety and efficacy of a single dose of azithromycin in labour in reducing the incidence of maternal and infant SSTIs and other infections and the impact on bacterial carriage. It will also describe the effect of azithromycin on antimicrobial (AMR) resistance, the maternal and infant microbiome, and infant dysbiosis. METHODS AND ANALYSIS: We are conducting a blinded, placebo-controlled randomised clinical trial administering 2 g of oral azithromycin, or placebo, given to healthy, pregnant women (≥18 years) in labour in Suva, Fiji. The primary outcome is the cumulative incidence of SSTIs in infants by 3 months of age. Secondary outcomes include the incidence of other infant and maternal infections, and safety and tolerability of azithromycin in mother and infant. Following informed consent, 2110 pregnant women will be randomised in a 1:1 ratio, with all study staff and participants masked to group allocation. Mother/infant pairs will be followed up for 12 months over six visits collecting clinical data on infections, antimicrobial use, safety and anthropometrics, in addition to nasopharyngeal, oropharyngeal, rectovaginal and vaginal swabs, maternal breastmilk and infant stool samples, in order to compare bacterial carriage, AMR rates and microbiome. Recruitment for Bulabula MaPei started in June 2019. ETHICS AND DISSEMINATION: This trial was approved and is being conducted according to the protocol approved by The Royal Children's Hospital Human Research Ethics Committee, Australia, and the Fiji National Health Research and Ethics Review Committee. The findings of this study will be disseminated in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT03925480.


Assuntos
Azitromicina , Trabalho de Parto , Gravidez , Lactente , Recém-Nascido , Humanos , Feminino , Azitromicina/uso terapêutico , Fiji , Transmissão Vertical de Doenças Infecciosas , Antibacterianos/uso terapêutico , Mães , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMC Womens Health ; 22(1): 539, 2022 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-36550470

RESUMO

Abnormalities of labor are the major causes of maternal and fetal mortality and morbidity. Proper partograph utilization is a key intervention to detect labor abnormalities and subsequent initiation of management. Although a great deals of studies were conducted about partograph utilization, they have failed to explore some critical factors which correlate with correct filling of partograph so far. To assess magnitude and factors associated with proper partograph recording among skilled delivery attendants in public health facilities of Hawassa city, Sidama Ethiopia, in 2021. An institution based cross-sectional study was conducted to assess proper partograph filling practice among skilled delivery providers of public health facilities of Hawassa city, Sidama region, Ethiopia from November to December 15, in 2021. Data were collected using self-administered questionnaire, and client chart review. Data were entered, cleaned, and analyzed using SPSS software. Binary and multivariate logistic regression analysis was used to show association between outcome and explanatory variables. Multi-collinearity test was done using VIF. Adjusted Odds Ratio with 95% CI and p value less than 0.05 was taken as cuff of value for statistically significant value at final model. Out of 405 study participants, only 370 study subjects have provided full response for questions making a response rate of 91.4% in this study. The reason of non-responders was evaluated as not related with the issue of the outcome variable. The mean age of study subjects was 28 ± 3.9 years. Magnitude of proper partograph utilization was found to be58.4% (95% CI, 55.8-60.9%) among skilled delivery attendants in this study. Factors associated with partograph uptake were: On job training (AOR = 1.9, 95% CI: (1.1, 3.2), good knowledge (AOR = 3.1, 95% CI: (1.8, 5.3) and supportive supervision (AOR = 4.5, 95% CI, 2.5, 7.9), client took Uterotonics (AOR = 2.3, 95% CI: 1.4, 3.9), and day time admission (AOR = 3.5, 95% CI, 1.9-6.4). These factors were associated positively with proper partograph utilization. In conclusion, magnitude of proper partograph utilization was found to be lower than magnitude of WHO threshold. Hence, on job training should be enhanced about proper partograph utilization. Furthermore, monitoring, supervision and strengthening the human resource of delivery process would be mandatory by managers of delivery units.


Assuntos
Pessoal de Saúde , Trabalho de Parto , Gravidez , Feminino , Humanos , Adulto Jovem , Adulto , Etiópia , Estudos Transversais , Trabalho de Parto/fisiologia , Instalações de Saúde
18.
Sensors (Basel) ; 22(23)2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36501841

RESUMO

Robust maritime obstacle detection is critical for safe navigation of autonomous boats and timely collision avoidance. The current state-of-the-art is based on deep segmentation networks trained on large datasets. However, per-pixel ground truth labeling of such datasets is labor-intensive and expensive. We propose a new scaffolding learning regime (SLR) that leverages weak annotations consisting of water edges, the horizon location, and obstacle bounding boxes to train segmentation-based obstacle detection networks, thereby reducing the required ground truth labeling effort by a factor of twenty. SLR trains an initial model from weak annotations and then alternates between re-estimating the segmentation pseudo-labels and improving the network parameters. Experiments show that maritime obstacle segmentation networks trained using SLR on weak annotations not only match but outperform the same networks trained with dense ground truth labels, which is a remarkable result. In addition to the increased accuracy, SLR also increases domain generalization and can be used for domain adaptation with a low manual annotation load. The SLR code and pre-trained models are freely available online.


Assuntos
Trabalho de Parto , Aprendizagem , Gravidez , Feminino , Humanos , Aclimatação , Água , Processamento de Imagem Assistida por Computador
19.
Sensors (Basel) ; 22(23)2022 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-36502250

RESUMO

The problem of vehicle re-identification in surveillance scenarios has grown in popularity as a research topic. Deep learning has been successfully applied in re-identification tasks in the last few years due to its superior performance. However, deep learning approaches require a large volume of training data, and it is particularly crucial in vehicle re-identification tasks to have a sufficient amount of varying image samples for each vehicle. To collect and construct such a large and diverse dataset from natural environments is labor intensive. We offer a novel image sample synthesis framework to automatically generate new variants of training data by augmentation. First, we use an attention module to locate a local salient projection region in an image sample. Then, a lightweight convolutional neural network, the parameter agent network, is responsible for generating further image transformation states. Finally, an adversarial module is employed to ensure that the images in the dataset are distorted, while retaining their structural identities. This adversarial module helps to generate more appropriate and difficult training samples for vehicle re-identification. Moreover, we select the most difficult sample and update the parameter agent network accordingly to improve the performance. Our method draws on the adversarial networks strategy and the self-attention mechanism, which can dynamically decide the region selection and transformation degree of the synthesis images. Extensive experiments on the VeRi-776, VehicleID, and VERI-Wild datasets achieve good performance. Specifically, our method outperforms the state-of-the-art in MAP accuracy on VeRi-776 by 2.15%. Moreover, on VERI-Wil, a significant improvement of 7.15% is achieved.


Assuntos
Meio Ambiente , Trabalho de Parto , Gravidez , Feminino , Humanos , Redes Neurais de Computação
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