Implementing E-MOTIVE for detection and treatment of postpartum haemorrhage in South Africa.

Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.

Spatial and temporal structure of edge-localized modes.

This Letter provides information on the spatial and temporal structure of periodic eruptions observed in magnetically confined laboratory fusion plasmas, called edge-localized modes (ELMs), and highlights similarities with solar eruptions. Taken together, the observations presented in this Letter provide strong evidence for ELMs being associated with a filamentlike structure. These filaments are extended along a field line, are generated on a 100 micros time scale, erupt from the outboard side, and connect back into the plasma. Such structures are predicted by a theoretical model based on the "ballooning" instability, developed for both solar and tokamak applications.

L-H transition in the mega-amp spherical tokamak.

H-mode plasmas have been achieved on the MAST spherical tokamak at input power considerably higher than predicted by conventional threshold scalings. Following L- H transition, a clear improvement in energy confinement is obtained, exceeding recent international scalings even at densities approaching the Greenwald density limit. Transition is accompanied by an order-of-magnitude increase in edge-density gradient, a marked decrease in turbulence, the efficient conversion of internal electron Bernstein waves into free space waves, and the onset and saturation of edge poloidal rotation.

Sexual abuse and adolescent maladjustment: differences between male and female victims.

In this study data from a large representative community sample of adolescents were analysed to investigate the relationship between a history of sexual abuse and adolescent functioning. Emotional problems, behavioural problems, suicidal thoughts and behaviour of boys and girls with a history of sexual abuse were compared to those in a matched control group of boys and girls without such a history. Both sexually abused boys and girls reported significantly more emotional problems, behavioural problems, suicidal thoughts and suicide attempts than their non-abused counterparts. The results also indicated that the experience of sexual abuse carried far more consequences for boys than for girls regarding the use of alcohol, aggressive/criminal behaviour, use of drugs, and the amount of truancy, as well as regarding suicidal thoughts and behaviour. For example, whereas 2.6% of the non-abused boys reported a former suicide attempt, this percentage was 13 times higher for the sexually abused boys (26.5%). The results of this paper lend support to the call for further research investigating gender differences in response to sexual abuse.

[Electrophysiological evaluation of the treatment of patients with recurrent ventricular tachycardia]. / Evaluación electrofisiológica del tratamiento de pacientes con taquicardia ventricular recurrente.

In order to asses the predictive value of serial electrophysiologic studies in the selection of an effective long-term effective antiarrhythmic regimen, we studied 16 patients with recurrent sustained ventricular tachycardia (VT), resistant to conventional medical treatment. (group 1) Eleven patients in this group had chronic chagas myocarditis, and several hospitalizations and cardioversions had been required for therapy of VT. In addition, 35 patients (group 2: control) underwent electrophysiological studies to evaluate rhythm disturbances differences to TV. Ventricular Tachycardia was successfully initiated and terminate with programmed electrical stimulation of the right ventricle only in the group 1. After control studies, the effects of several drugs (ajmalin, amiodarone, carbamazepine, disopyramide, diphenilhydantoin, mexiletine, procainamide, propranolol, quinidine and verapamil on the ability to initiate VT were assessed. A drug was considered effective only if it prevented the initiation of VT and allowed long-term suppression o clinical VT. All the patients of group 1 were placed on chronic oral therapy with the effective agent and were followed for an average period of 16 months (range 5 to 47 months). In all 16 patients we could document complete long-term prophylaxis against VT. This method offers advantage in terms of morbidity, mortality, duration of therapy, and promptness of choosing an effective drug add expense to the patient over traditional empirical methods of drug selection.