Littérature scientifique sur le sujet « Maternal Near Mi »

IntroductionMaternal immunization (MI) with tetanus toxoid containing vaccine, is a safe and cost-effective way of preventing neonatal tetanus. Given the prospect of introducing new maternal vaccines in the near future, it is essential to identify and understand current policies, practices and unmet needs for introducing and/or scaling up MI in low-income and middle-income countries (LMICs).Methods and analysisThe Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) is a mixed methods, cross-sectional study that will collect data in four phases: (1) a review of global databases for selected health indicators in 136 LMICs; (2) a structured online survey directed at Maternal, Newborn and Child Health and Expanded Programme on Immunization focal points in all 136 LMICs; (3) semistructured telephone interviews of 30 selected LMICs and (4) 10 week-long country visits, including key informant interviews, health facility visits and focus group discussions. The principal analyses will assess correlations between the various aspects of MI delivery strategies and proxy measures of health systems performance related to vaccine-preventable disease control. The primary outcome will be a typology of existing MI delivery models, and secondary outcomes will include country profiles of child and maternal health indicators, and a MI gaps and needs analysis.Ethics and disseminationThe protocol was approved by the WHO Ethics Review Committee (ERC.0002908). The results will be made available in a project report and submitted for publication in peer-reviewed journals that will be shared broadly among global health decision-makers, researchers, product developers and country-level stakeholders.

Abstract Maternal inflammation induces intrauterine growth restriction (MI-IUGR) of the fetus, which compromises metabolic health in human offspring and reduces value in livestock. The objective of this study was to determine the effect of maternal inflammation at midgestation on fetal skeletal muscle growth and myoblast profiles at term. Pregnant Sprague-Dawley rats were injected daily with bacterial endotoxin (MI-IUGR) or saline (controls) from the 9th to the 11th day of gestational age (dGA; term = 21 dGA). At necropsy on dGA 20, average fetal mass and upper hindlimb cross-sectional areas were reduced (P < 0.05) in MI-IUGR fetuses compared with controls. MyoD+ and myf5+ myoblasts were less abundant (P < 0.05), and myogenin+ myoblasts were more abundant (P < 0.05) in MI-IUGR hindlimb skeletal muscle compared with controls, indicating precocious myoblast differentiation. Type I and Type II hindlimb muscle fibers were smaller (P < 0.05) in MI-IUGR fetuses than in controls, but fiber type proportions did not differ between experimental groups. Fetal blood plasma TNFα concentrations were below detectable amounts in both experimental groups, but skeletal muscle gene expression for the cytokine receptors TNFR1, IL6R, and FN14 was greater (P < 0.05) in MI-IUGR fetuses than controls, perhaps indicating enhanced sensitivity to these cytokines. Maternal blood glucose concentrations at term did not differ between experimental groups, but MI-IUGR fetal blood contained less (P < 0.05) glucose, cholesterol, and triglycerides. Fetal-to-maternal blood glucose ratios were also reduced (P < 0.05), which is indicative of placental insufficiency. Indicators of protein catabolism, including blood plasma urea nitrogen and creatine kinase, were greater (P < 0.05) in MI-IUGR fetuses than in controls. From these findings, we conclude that maternal inflammation at midgestation causes muscle-centric fetal programming that impairs myoblast function, increases protein catabolism, and reduces skeletal muscle growth near term. Fetal muscle sensitivity to inflammatory cytokines appeared to be enhanced after maternal inflammation, which may represent a mechanistic target for improving these outcomes in MI-IUGR fetuses.

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257

Background: Maternal health is an integral part of health care system. Maternal mortality is an indicator of maternal health and health care delivery system. Severe morbid conditions require comprehensive approach. Hence the concept of Maternal Near Miss (MNM) has emerged. The data of maternal near miss helps to reduce the maternal death and helps to achieve the goals related to reduce the maternal mortality rate of the country as well as the world and to improve the quality of life of the woman population by a quality care. Objectives of present study were to identify and analyze the strategies undertaken in the management of maternal near miss and outcome, measures to improve the quality of care and to assess the various indicators of MNM.Methods: With the permission from the hospital administrators and after taking the ethical clearance from the institutional ethical committee, a retrospective observational study was conducted for the period of one year between January 2016 to December 2016 at district teaching hospital of Kodagu Institute of Medical Sciences, Madikeri, by collecting data from hospital records. Admissions to the ICU as well as wards which fit in to the WHO maternal near miss criteria were included and studied.Results: WHO criteria for the MNM was followed. In present study, there were 25 MNM cases and four Maternal Deaths out of 3347 live births giving a maternal mortality ratio of 119/100000 live births (LB), Maternal Near Miss ratio of 7.46/1000LB, MNM:1MD ratio is 6.25 and mortality index (MI) is 13.79%. Twenty five cases of obstetric emergencies with serious concerns for maternal health were selected out of 97 cases who met the WHO criteria for MNM (25.77%). Twelve cases (48%) received multiple blood-transfusions, 8 cases (32%) of sepsis, 7 (28%) of PPH, and 5 (20%) of hypertensive disorder of pregnancy (pre-eclampsia, eclampsia). There were 12 cases (48%) that had more than one inclusion criteria. Surgical intervention was required in 8 (32%) i.e. 2 peripartum hysterectomies, 2 laparotomies, 1 manual removal of placenta, 1 uterine reposition and 2 traumatic PPH repair.Conclusions: Maternal-Near-Miss (MNM/SAMM) and its relation to maternal mortality contribute as sensitive measures of pregnancy outcome than mortality alone. Proper documentation is of paramount importance in analysis of data, to make conclusions and recommendation. Prospective structured study is required to get a clear picture and to suggest corrective measures which can be taken as far as obstetric care is concerned, to reduce maternal mortality and to achieve the sustainable developmental Goal (SDG) of maternal mortality ratio <70/100000 LB by 2030.

Background. This facility-based study analyzed the epidemiology and incidence of maternal near miss (MNM) and mortality by hospital level as part of Hunan Province’s efforts to raise the quality of hospital care for women. Methods. We used data for MNM and mortality cases for 2012–2018 from 17 hospitals (12 resource-poor facilities, five resource-rich facilities) that receive referrals for obstetric complications in Hunan Province. Data were drawn from China’s National Maternal Near Miss Surveillance System and collected using the World Health Organization near miss tool. We calculated the ratio of severe maternal outcomes (SMO) (i.e., MNM and maternal death (MD) cases), mortality index (MI), and MNM to mortality ratio (MNM : MD), and epidemiological factors, organ dysfunction, and maternal complications stratified by hospital level. The chi-square tests to examine differences between groups and total ratios and 95% CI were calculated. Results. There were 518 SMO cases (489 MNM and 29 MD) among 279407 live births (LBs) and 1299 SMO cases (1262 MNM and 37 MD) among 232386 LBs in resource-poor and resource-rich facilities. The total MNM ratio in resource-poor and resource-rich hospitals was 1.75 (95% CI: 1.60–1.91) and 5.43 (95% CI: 5.14–5.74) per 1000 LBs, respectively. There were differences in SMO cases between resource-poor and resource-rich hospitals in maternal age, education, parity, antenatal visits, and history of cesarean sections. In MNM cases, coagulation dysfunction was the main organ dysfunction (resource-poor hospitals: 59.10%; resource-rich hospitals: 79.32%), and the main maternal complications were obstetric hemorrhage (resource-poor hospitals: 71.98%) and hepatopathy (resource-rich hospitals: 69.49%). For MD cases, the main maternal complications were neurologic dysfunction (resource-poor hospitals: 41.38%) and coagulation dysfunction (resource-rich hospitals: 42.55%). Anemia was the main maternal complication for SMO cases in both resource-poor (69.69%) and resource-rich (68.59%) hospitals. Conclusions. MNM and MD are higher in resource-rich hospitals compared with resource-poor hospitals. The obstetric emergency capacity of resource-rich hospitals is higher than that of resource-poor hospitals. Future government policies should consider upgrading the obstetric emergency treatment capacity in resource-poor hospitals or to redistinguish the social functions of different medical institutions.

Advancing maternal age has long been identified as the primary risk factor for human chromosome trisomy. More recently, altered patterns of meiotic recombination have been found to be associated with non-disjunction. We have used trisomy 21 as a model for human non-disjunction that occurs during the formation of oocytes to understand the role of maternal age and recombination. Patterns of recombination that increase the risk for non-disjunction of chromosome 21 include absence of any exchange, an exchange near the centromere or a single, telomeric exchange. Our recent work has shown that different susceptibility patterns are associated with the origin of the meiotic error and maternal age. For MI (meiosis I) errors, the proportion of oocytes with susceptible recombination patterns is highest among young mothers and decreases significantly in the oldest age group. In fact, the pattern of exchanges among the oldest age group mimics the pattern observed among normally disjoining chromosomes 21. These results suggest that oocytes of younger women, with functional meiotic apparatus and/or robust ovarian environment, are able to properly resolve all but the most susceptible exchange patterns. As women age, however, meiotic mechanisms erode, making it difficult to resolve even stable exchange events. Interestingly, our preliminary recombination results on MII errors reveal the opposite relationship with maternal age: susceptible pericentromeric exchanges occur most often in the older age group compared with the younger age group. If confirmed, we will have further evidence for multiple risk factors for non-disjunction that act at different times in the meiotic process.

Purpose The aims of this paper is to study the effects of the V/III ratio of indium gallium nitride (InGaN) quantum wells (QWs) on the structural, optical and electrical properties of near-ultraviolet light-emitting diode (NUV-LED). Design/methodology/approach InGaN-based NUV-LED is successfully grown on the c-plane patterned sapphire substrate at atmospheric pressure using metal organic chemical vapor deposition. Findings The indium composition and thickness of InGaN QWs increased as the V/III ratio increased from 20871 to 11824, according to high-resolution X-ray diffraction. The V/III ratio was also found to have an important effect on the surface morphology of the InGaN QWs and thus the surface morphology of the subsequent layers. Apart from that, the electroluminescence measurement revealed that the V/III ratio had a major impact on the light output power (LOP) and the emission peak wavelength of the NUV-LED. The LOP increased by up to 53% at 100 mA, and the emission peak wavelength of the NUV-LED changed to a longer wavelength as the V/III ratio decreased from 20871 to 11824. Originality/value This study discovered a relation between the V/III ratio and the properties of QWs, which resulted in the LOP enhancement of the NUV-LED. High TMIn flow rates, which produced a low V/III ratio, contribute to the increased LOP of NUV-LED.

Purpose This paper aims to describe the fabrication and characterization of current mirror-integrated microelectromechanical systems (MEMS)-based pressure sensor. Design/methodology/approach The integrated pressure-sensing structure consists of three identical 100-µm long and 500-µm wide n-channel MOSFETs connected in a resistive loaded current mirror configuration. The input transistor of the mirror acts as a constant current source MOSFET and the output transistors are the stress sensing MOSFETs embedded near the fixed edge and at the center of a square silicon diaphragm to sense tensile and compressive stresses, respectively, developed under applied pressure. The current mirror circuit was fabricated using standard polysilicon gate complementary metal oxide semiconductor (CMOS) technology on the front side of the silicon wafer and the flexible pressure sensing square silicon diaphragm, with a length of 1,050 µm and width of 88 µm, was formed by bulk micromachining process using tetramethylammonium hydroxide solution on the backside of the wafer. The pressure is monitored by the acquisition of drain voltages of the pressure sensing MOSFETs placed near the fixed edge and at the center of the diaphragm. Findings The current mirror-integrated pressure sensor was successfully fabricated and tested using in-house developed pressure measurement system. The pressure sensitivity of the tested sensor was found to be approximately 0.3 mV/psi (or 44.6 mV/MPa) for pressure range of 0 to 100 psi. In addition, the pressure sensor was also simulated using Intellisuite MEMS Software and simulated pressure sensitivity of the sensor was found to be approximately 53.6 mV/MPa. The simulated and measured pressure sensitivities of the pressure sensor are in close agreement. Originality/value The work reported in this paper validates the use of MOSFETs connected in current mirror configuration for the measurement of tensile and compressive stresses developed in a silicon diaphragm under applied pressure. This current mirror readout circuitry integrated with MEMS pressure-sensing structure is new and fully compatible to standard CMOS processes and has a promising application in the development CMOS-MEMS-integrated smart sensors.

Purpose – This paper aims to analyze the effect of Au wire size and location of hook during wire pulling test to identify the variation of results obtained. Design/methodology/approach – Two hook locations, namely, location A and location B were used to analyze the effect of hook location. Location A was the same as the hook location required by MIL-STD-883E standard, whereas location B was located near to the second bond. The correlation between new purposed failure modes and MIL-STD-883E standard was developed to reflect on the pull strength with the physical failure. Findings – It was observed that fine pitch Au wire has higher variation and lower process capability of pull strength. Au wire pulled by the hook at location B provides a more representative result compared to that at location A. Fifty per cent or more of Au remnant is required to be considered as a good and reliable Au wedge bond based on the new purposed failure modes. Originality/value – The evaluation of gold (Au) wedge bond requires a new proper wire pulling test method. This is due to the large variation obtained from the application of current practice of wire pulling test.

Purpose – The purpose of this paper is to provide a systematic review on technical findings and discuss the feasibility and future of gold (Au) wirebonding in microelectronics packaging. It also aims to study and compare the cost, quality and wear-out reliability performance of Au wirebonding with respect to other wire alloys such as copper (Cu) and silver (Ag) wirebonding. This paper discusses the influence of wire type on the long-term reliability tests. Design/methodology/approach – Literature reviews are conducted based on cost and wire selections of Au, Cu or Ag wirebonding. Detailed wear-out failure findings and wire selection with cost considerations are presented in this review paper. The future and the status of Au wirebonding in microelectronics packaging are discussed in this paper. Findings – This paper briefly reviews selected aspects of the Au ball and other alternative bonding options, focusing on reliability performance, and discusses the future of Au wirebonding in the near future in semiconductor packaging. Practical implications – The paper reveals the technical considerations when choosing the wire types for future microelectronics packaging. Originality/value – The in-depth technical review and strategies of the selection of wire types (Au, Cu or the latest Ag alloy) in microelectronics packaging are discussed in this paper based on previous literature studies.

Stato dell'arte: gli studi che indagano la mortalità materna offrono preziose informazioni per migliorare la salute di donne e neonati. Tuttavia, in Paesi come l'Italia la mortalità materna è rara. Per ogni donna deceduta, molti altre vanno incontro a gravi complicanze durante il percorso nascita che comportano diversi conseguenze. Le condizioni pericolose per la vita, definite near miss, possono quindi arricchire la conoscenza in campo ostetrico fornendo dati relativi a fattori di rischio, prevenzione e trattamento di qeuste patologie ostetriche, per migliorare l'assistenza ostetrica e la salute di madre e neonati. Il Sistema di Sorveglianza Ostetrico Italiano (ItOSS) è stato generato per monitorare condizioni ostetriche rare in Italia. Nel 2017 ItOSS ha attivato un progetto per raccogliere near miss materni dovuti a sepsis, eclampsia, embolia di liquido amniotico (AFE) e emoperitoneo spontaneo in gravidanza (SHiP) in 9 Regioni italiane. Scopo: stimare l'incidenza di eclampsia, sepsi, AFE e SHiP e descrivere l'assistenza erogata alle donne. Metodi: studio descrittivo population-based, associato a studio caso-controllo per i casi di spesi nel post-partum con l'obiettivo di valutare i fattori di rischio associati al tale complicanza. I dati sono stati raccolti prospetticamente tramite schede di raccolta dati appositamente sviluppate all'interno di una piattaforma on-line tramite il seguente link: http://www.salutedonnabambino.it/ITOSS/login.asp. La conferma dello "zero mensile" era richiesta nel caso non fossero avvenuti casi. La raccolta dati ha avuto inizio in data 1/11/2017, concludendosi in data 31/10/2019 per i casi di sepsi e proseguendo fino al 31/3/2020 per i casi dovuti alle altre complicanze. L'analisi statistica è stata condotta considerando i casi di eclampsia e sepsi peripartum; i dati raccolti relativi ad AFE e SHiP saranno utilizzati per partecipare ad uno studio multi-nazione, promosso dall'International Obstetric Surveillance System Network (INOSS) per fornire dati validi su queste complicanze estremamente rare. La presente tesi fornirà i risultati relativi ad eclampsia e sepsi, poichè il numero di casi raccolti permette di restituire dati significativi ai professionisti sanitari Risultati: lo studio ha raggiunto un buon tasso di partecipazione. Sono stati raccolti 109 casi di near miss dovuti ad eclampsia per un'incidenza di 0.15 ogni 1000 parti. I risultati indicano che vi è ampio spazio per il miglioramento nell'utilizzo profilattico di magnesio solfato nelle donne con precedente pre-eclampsia e di aspirina a basso dosaggio nelle donne alto rischio. Più di 3 donne ogni 10 hanno sviluppato una complicanza grave dopo l'episodio di eclampsia, probabilmente a causa di un'inappropriata stabilizzazione prima dell'espletamento del parto. L'incidenza di sepsi è stata stimata di 0.87 casi ogni 1000 parti. I risultati mostrano che 1 donna ogni 4 sviluppa gravi complicanze a seguito della sepsi. Questo potrebbe trovare una spiegazione nelle diverse criticità rilevate: diagnosi tardiva, trattamento tardivo ed inappropriato, numero eccessivo di esplorazioni vaginali in travaglio e mancata tecnica asettica durante le procedure. Conclusioni: questa ricerca offre informazioni significative sulla popolazione italiana, non disponibili in precedenza. Lo studio rappresenta una fonte di informazioni unica per permettere l'identificazione delle criticità relative all'assistenza, che orientino verso strategie di intervento mirate al miglioramento della qualità delle cure e alla promozione di una pratica ostetrica basata sulle evidenze.
Background: Data on maternal mortality offers valuable information to improve women’s health. In countries such as Italy maternal mortality is a rare event. For each death, many other women survive serious complications during pregnancy, birth and the post-natal period that lead to different degree of sequelae. Life-threating conditions, defined as near miss, could provide additional information on disease risk factors, prevention and treatment for promoting best practices, improving quality of care and achieving better health for mothers and babies. The Italian Obstetric Surveillance System (ItOSS) was set up to monitor the maternal morbidity rate in Italy. In 2017 ItOSS activated a project to collect maternal near miss cases due to sepsis, eclampsia, amniotic fluid embolism (AFE) and spontaneous haemoperitoneum in pregnancy (SHiP) in 9 Italian Regions. Aim: To estimate the incidence rate of eclampsia, sepsis, amniotic fluid embolism and spontaneous haemoperitoneum in pregnancy and to describe the care provided during the near miss episode. Method: A Population-based descriptive study was conducted, a case-control design was applied only on post-partum sepsis cases to evaluate risk factors associated to the complication. Data were obtained through a prospective active collection of cases by a monthly call according to the principle of nothing-to-report, along with data collection forms that confirm the diagnosis and gather detailed information. Data collection occurred web-based since November 2017 through http://www.salutedonnabambino.it/ITOSS/login.aspx and was completed on the 31st of October 2019 for the sepsis cases, while the remaining complications were investigated until the 31st of March 2020. Statistical analysis was performed on eclampsia and peripartum sepsis cases; data collected on AFE and SHiP will be used to participate into a multi-national study promoted by INOSS, with the aim to give a stable incidence about this extremely rare conditions. For this reason this thesis will present findings regarding Eclampsia and Sepsis, of which there are sufficiently enough cases to give a useful feedback to healthcare professionals. Results: Our study achieved good participation and response rates. A total of 109 near misses of eclampsia were identified, representing an estimated incidence rate of 0.15 cases per 1,000 births. Findings indicated that there is space to improve the use of magnesium sulphate as prophylactic treatment in women diagnosed with pre-eclampsia and underlighted the importance of population risk stratification to administer low-dose aspirin to high risk women and at the appropriate time. More than 3 women in 10 developed sever complications after the eclamptic episode, this could be due to an inappropriate stabilization before birth. Sepsis estimated incidence rate was 0.87 cases per 1,000 births. The high rate of women who developed severe complications, might reflect the inappropriate time of diagnosis and treatment prescribed to our population. Findings reported different major criticisms during the care of women with sepsis: delayed diagnosis and treatment, the administration of inappropriate antibiotic therapy, the high number of vaginal examinations in labour and the need of correct aseptic technique during all procedures. This might reflect the high rate of women, 1 in 4, with severe complications after sepsis. Conclusions: This research developed significant information concerning obstetric disorders related to the Italian population, prior to this project no Italian data were available. The present study offers an unique source of information and allows to identify the Italian system or clinical practice related-failures, in order to address strategies and strengths to improve the quality of maternal health care and promote an evidence-based practice.

General Electric (GE) has developed silicon carbide fiber reinforced SiC-Si matrix composites by silicon melt infiltration (MI) for use in gas turbine engine applications. This paper focuses on a process based on tow prepreging and lamination of unidirectional tapes. Silicon melt infiltration yields a fully dense, near net shape composite with a relatively high thermal conductivity, actually higher than many superalloys at temperatures up to 800°C, and a high proportional limit, or matrix cracking stress. Room and elevated temperature mechanical properties of the composite are presented. Following exposure to various simulated turbine environments this material shows relatively good retention of strength and toughness. The fabrication of turbine shroud and combustor liner components for high pressure combustion rig testing is also described.

Abstract Electrical resistance has been used to detect in situ changes to SiC based material as damage occurs. Damage in the composite, typically in the form of matrix cracking, increases the resistance due to the local constrain of current flow. Efforts have been ongoing to quantify the effects of increasing potential drop with crack growth in a pre-preg SiC-based composite. Two variations of the pre-preg SiC-based composite were studied: one with a single layer of SiC monofilaments with carbon core (1 fiber/mm) inserted in the center of the composite and extending through the length of the composite and the other possessed three layers of monofilaments, one layer in the center of the composite and the other two layers near both surfaces of the composite. It was found that the high conductive Si phase varied considerably for the different variations of composites and dominated the current flow rather than C. Tension-tension fatigue tests were conducted at 815 °C in a static furnace for both composite systems, electrical resistance was monitored during the test along with acoustic emission. A ply level electric circuit was constructed, and ply resistivity at temperature was obtained based on the Si content in each ply. The function of the electric circuit was to interpret the change in resistance obtained during the fatigue testing of the MI material with the morphology of transverse crack growth. Microscopy and energy dispersive spectroscopy were conducted to better understand the crack morphology.