Morbi-Mortality Linked to Unsafe Abortions—Difficulties in Accessing Safe Abortions in Cameroon: Meta-Analysis and Systematic Review

Background: Unsafe abortions are one of the leading causes of maternal mortality, especially in developing countries. In Cameroon, the maternal mortality rate remains high, and the scarcity of data on abortions leads to a lack of solid evidence to advocate on the extent of the abortions related complications. Our objective was to evaluate the unsafe abortions related complications, and to assess the difficulties of accessing safe abortions in our setting. Methods: We carried out a meta-analytic and systematic review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon. The keywords used for the search are seen in table I. Selection of studies was simultaneously done by two authors. Data were extracted through a form designed on Google Form. We used a random-effect model for proportion estimation, and The I2 and Q statistics to assess the extent of heterogeneity. Results: A total of 430 studies were identified, from which 28 were included and analysed. About 5% (95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was 17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe sepsis, and septic shock. Case reports described uterine perforations, uterine rupture during the following pregnancy. Abortion was performed in the practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1% of cases, in a private clinic in 21.2% of cases, drugs selling places and in traditional healer clinics. The restriction of abortion laws, the stigma surrounding abortion and its consequences at any level of the society, lead to the underreporting of unsafe abortions and a deep reluctance to advocate for safe abortion services. Conclusion: The strengthening of awareness campaigns for provider behavior change communication, family planning, the de-stigmatization of abortions, the training of health personnel in post-abortion care, a multidisciplinary and multicentric action would contribute to the reduction in morbidity and mortality due to abortions.

A model of unsafe behavior in coal mines based on game theory

Behavior choice, coal mine monitoring, and control intensity are combined in a general mathematical model established from the perspective of a behavioral game. A case study is provided with effective conditions of monitoring provided. This paper defines the expected value difference of control return and behavior cost difference and discusses the measurement and optimization of variable indexes, including the monitoring intensity and costs of control. The results imply that the control of unsafe behavior can be more effective when monitoring and control of coal mines are both improved. Monitoring will be useful when the rewards for displaying safe behavior, and the monitoring of unsafe behavior, are improved to a high level.

Quantifying the parameter dependent basin of the unsafe regime of asymmetric Lévy-noise-induced critical transitions

In real systems,the unpredictable jump changes of the random environment can induce the critical transitions(CTs)between two non-adjacent states,which are more catastrophic.Taking an asymmetric Lévy-noise-induced tri-stable model with desirable,sub-desirable,and undesirable states as a prototype class of real systems,a prediction of the noise-induced CTs from the desirable state directly to the undesirable one is carried out.We first calculate the region that the current state of the given model is absorbed into the undesirable state based on the escape probability,which is named as the absorbed region.Then,a new concept of the parameter dependent basin of the unsafe regime(PDBUR)under the asymmetric Lévy noise is introduced.It is an efficient tool for approximately quantifying the ranges of the parameters,where the noise-induced CTs from the desirable state directly to the undesirable one may occur.More importantly,it may provide theoretical guidance for us to adopt some measures to avert a noise-induced catastrophic CT.

LARCs after unsafe abortion in Libreville (Gabon): Women accept quickly but the time interval for the insertion is longer than that of injectable contraceptives

Objectives: To determine the percentage of women who accepted a LARC after abortion, specify the interval time for the insertion of the LARC and compare such interval time with that of injectable and oral contraceptives. Patients and Methods: This is a prospective, descriptive and comparative study conducted in Libreville (Gabon), from February 1, 2013 to August 31, 2013. After receiving post-abortion care (PAC), all patients with stable general states were counseled about three types of contraceptive methods: combined oral contraceptive pills, LARCs (Jadelle? implants, Copper IUDs) and injectable Medroxyprogesterone Acetate (DMPA). Results: 231 women received PAC and among them 215 (93%) wanted to use one of the three proposed contraceptive methods. At the end of the study, only 193 women (89.7%) used contraception and 22 others (10.3%) abandoned their intentions. LARCs were used by 31 (16.0%) women. The average period for the insertion of LARCs was 15.4 ± 15.5 days with extremes of 1 to 53 days. This period for the insertion of LARCS was significantly longer than that of other methods (p < 0.001). LARCs were inserted more often after the 2nd day than immediately (same day) with a highly significant difference (p < 0.0001). Conclusion: LARCs could constitute an appropriate approach to reducing unintended pregnancies in Gabon. However, in order to increase their rates of use, it is necessary to improve women awareness.

Morbidity and Mortality Linked to Unsafe Abortions in Cameroon—Difficulties in Accessing Safe Abortions: Systematic Review and Meta-Analysis. A Study Proposal

Unsafe abortions constitute a public health problem. It is one of the causes of maternal mortality in the world and particularly in developing countries. Despite the progress made, maternal mortality remains high in Cameroon. The scarcity and disparity of data on abortions lead to a lack of strong evidence to advocate to decision-makers on the extent of the problems associated with abortions in Cameroon. Our objective is to estimate the rates of mortalities and complications related to unsafe abortions, as well as the difficulties of accessing safe abortions in Cameroon. We will carry out a systematic and meta-analytical review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online (AJOL) concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon, without date or language restriction. Gray literature will be also consulted. Two authors will simultaneously select the studies and data extraction will be done using a Google Form. Proportions will be estimated on a random-effect model. The I2 and Q statistics will be used to assess the extent of heterogeneity across the studies. The outcome of both the quantitative and qualitative parts of the study will be commented. Death and morbidity due to abortions can be prevented. A concerted multidisciplinary and multicentric action would be essential.

Research Priorities for Preventing Unsafe Abortions in the WHO Africa Region

Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.

Risk assessment method of major unsafe hydroelectric project

Based on the characteristics of major unsafe hydroelectric projects and the data from field detection, in situ monitoring, and regular safety inspection, the funda-mental principles of operation risk assessment are proposed in this paper. Mean-while, a three layer hierarchical system is constructed, and an improved analytical hierarchical process combining genetic algorithm and analytical hierarchical process is established, with corresponding program. The operation risk of some unsafe dam was assessed with the principles, method and program presented in this paper and the major factors which would affect the operation of the dam were pointed out.

Investigating unsafe behaviours in traffic conflict situations:An observational study in Nigeria

Although road users are aware of the possible risks of engaging in unsafe behaviours while driving,they continue to do so.These behaviours often contribute to traffic incidents and crashes involving them and other road users.This study set out to analyse the effect of road user type,location and time of day on unsafe driving behaviours observed in traffic conflict situations.Data were collected by road side observation at three different locations in the eastern part of Nigeria using the traffic conflict technique(TCT).This approach was adopted to overcome the inherent problems associated with reliable,inadequate and accessible crash data in Nigeria.In total 946 traffic conflicts were observed and statistical testing showed that drivers were involved in one or more unsafe behaviours prior to these conflicts.Of all unsafe behaviours observed,the incorrect use of indicators(13.3%) and tailgating(11.3%) were found to be the most prevalent,while road user type,location and time of day were found to be statistically associated with passenger scouting and other unsafe behaviours.Tricycle drivers were significantly more likely to engage in unsafe behaviours than vehicle drivers.Drivers are also more likely to engage in unsafe behaviours on straight roads.Additionally,a greater number of these unsafe behaviours were observed during the peak periods.It is recommended that better road infrastructure,more effective regulations and enforcement,and proper road safety education could help improve traffic safety in Nigeria.

Process and Modeling of Unsafe Behaviors Early Warning in Metro Construction

Safety accidents occure frequently during metro construction, which are mainly caused by human factors, and the incidence of accidents can be increased due to the overlap of human factors and physical factors. The human factors are taken as breakthrough to make early warning for the human insecurity factors in the metro construction, which can effectively reduce the occurrence of safety accidents. This paper proposes the principle of total monitoring and early-warning management. The unsafe behaviors in metro construction when approaching the hazardous area and non-standard safety prevention measures are analyzed to design and model the early warning process of unsafe behaviors in metro construction. Finally, the model is analyzed and verified using actual examples.

Unsafe Appreciation

After a researcher at the Chinese Academy of Social Sciences (CASS) proposed a 10-percent increase in the Chinese currency to upgrade the industrial structure, many economists in China disputed his statement and pointed out the risks of abrupt renminbi (yuan) appreciation. Zhu Daming, an independent economic analyst in Shanghai, published his concerns in the Economic Information Daily. Edited excerpts follow:

Comparative study of HFACS and the 24Model accident causation models

A comparative study is conducted to compare the theory and application effect of two accident causation models, the human factors analysis and classification system（HFACS） and the accident causation ＂2-4＂ model（24 Model）, as well as to provide a reference for safety researchers and accident investigators to select an appropriate accident analysis method. The two models are compared in terms of their theoretical foundations, cause classifications, accident analysis processes, application ranges, and accident prevention strategies. A coal and gas outburst accident is then analyzed using both models, and the application results are compared. This study shows that both the 24 Model and HFACS have strong theoretical foundations, and they can each be applied in various domains. In addition, the cause classification in HFACS is more practical, and its accident analysis process is more convenient. On the other hand, the 24 Model includes external factors, which makes the cause analysis more systematic and comprehensive. Moreover, the 24 Model puts forward more corresponding measures to prevent accidents.

Health care-associated hepatitis C virus infection

Hepatitis C virus(HCV)is a blood-borne pathogen that has a worldwide distribution and infects millions of people.Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health.The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified:(1)infected patient to non-infected patient;(2)infected patient to non-infected health careworker(HCW);and(3)infected HCW to non infected patient.For each condition,the circumstances of contamination are described together with the means to prevent them.As a whole,the more important risk is represented by unsafe practices regarding injections,notably with the improper use of multidose vials used for multiple patients.The questions of occupational exposures and infected HCWs are also discussed.In terms of prevention and surveillance,the main arm for combating care-associated HCV infections is the implementation of standard precautions in all the fields of cares,with training programs and audits to verify their good application.HCWs must be sensitized to the risk of blood-borne pathogens,notably by the use of safety devices for injections and good hygiene practices in the operating theatre and in all the invasive procedures.The providers performing exposed-prone procedures must monitor their HCV serology regularly in order to detect early any primary infection and to treat it without delay.With the need to stay vigilant because HCV infection is often a hidden risk,it can be hoped that the number of people infected by HCV via health care will decrease very significantly in the next years.

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress

AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries(i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventionsto change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.

Risk Index Prediction of Civil Aviation Based on Deep Neural Network

Safety is the foundation of sustainable development in civil aviation.Although catastrophic accidents are rare,indicators of potential incidents and unsafe events frequently materialize.Therefore,a history of unsafe data are considered in predicting safety risks.A deep learning method is adopted for extracting reactions in safety risks.The deep neural network(DNN)model for safety risk prediction is shown to extract complex data characteristics better than a shallow network model.Using extended unsafe data and monthly risk indices,hidden layers and iterations are determined.The effectiveness of DNN is also revealed in comparison with the traditional neural network.Through early risk detection using the method in the paper,airlines and the government can mitigate potential risk and take proactive measures to improve civil aviation safety.

Urgent Need for Contraceptive Education and Services in Chinese Unmarried Undergraduates:A Multi-campus Survey

In order to ascertain prevalence rate of premarital sexual intercourse,unintended pregnancy and abortion,and evaluate associated factors of unintended pregnancy among undergraduates from all over China,the representative sample of unmarried undergraduates was obtained by using a multi-stage,stratified,probability cluster design,and data were collected by using a survey questionnaire.62 326 available responders were gained.11.6% of them acknowledged having experiences of premarital sexual intercourse（standardized prevalence rate of sexual intercourse was 13.8%）.31.5% of students active in premarital sex acknowledged undergoing unintended pregnancy.76.2% of pregnant students selected abortion to end it.Of students active in premarital sex,46.2% used contraception at the first sexual intercourse,28.2% replied ＂always＂ using contraception in sexual intercourse.The rate of using condoms,oral contraceptives（OCs）,and withdrawal among students who had used contraception was 52.0%,31.0%,and 27.2% respectively.＂No preparation for sex＂（40.3%）,＂pleasure decrement＂（32.1%）,＂won＇t-be-pregnancy in occasional sexual intercourse＂（30.2%） were their common excuses for using no contraception.The identified risk factors for unintended pregnancy among students active in premarital sex by multivariate analysis were as follows：having no steady lover [having no steady lover vs having a steady lover：odds ratio（OR）,1.875;95% confidence interval（CI）,1.629-2.158],unaware of the course of conception（unaware vs aware：OR,2.023;95% CI,1.811-2.260）,considering abortion not endanger women＇s physical and mental health（no endangerment vs endangerment：OR,2.659;95% CI,2.265-3.121）,nonuse of contraception（never use vs always use：OR,1.682;95% CI,1.295-2.185）.Medical students were not less likely to experience an unintended pregnancy than nonmedical students（OR,1.111;95% CI,0.906-1.287）.The substantial proportion of unintended pregnancy among undergraduates indicates a need for convenient and targeted contraceptive education and services.

Tools to make C programs safe: a deeper study

The C programming language is expressive and flexible, but not safe; as its expressive power and flexibility are obtained through unsafe language features, and improper use of these features can lead to program bugs whose causes are hard to identify. Since C is widely used, and it is impractical to rewrite all existing C programs in safe languages, so ways must be found to make C programs safe. This paper deals with the unsafe features of C and presents a survey on existing solutions to make C pro- grams safe. We have studied binary-level instrumentation tools, source checkers, source-level instrumentation tools and safe dialects of C, and present a comparison of different solutions, summarized the strengths and weaknesses of different classes of solutions, and show measures that could possibly improve the accuracy or alleviate the overhead of existing solutions.

A Cognitive Perspective on the Safety Communication Factors That Affect Worker Behavior

Communication is vital for construction safety, but how it influences unsafe behavior in the work-place remains unclear. This study aims to explore the relationships between communication, cognitive failure, and unsafe behaviors in order to clarify those mechanics. We defined communication as management input, worker cognitive failure as process, and actual behaviors as management output. We collected data from three Chinese steel construction crews and utilized experience/behavior sampling and questionnaire surveys to collect project information. Bivariate statistical analyses were conducted to explain how communication affected unsafe behavior. The results showed that, rather than communication frequency, management communication style was significantly related to worker cognitive failure;specifically, communication style was related to perception of convenience and self-capacity, which could be upstream factors explaining unsafe behavior at the construction jobsite. This research provided statistical evidence supporting the hypothesized association among safety communication, cognitive failure, and behavior, bridging the missing gaps of previous research. Nonetheless, readers should interpret the results cautiously because of the limitations listed as follows. First, sample size is relatively small. In addition, crew turnover may mediate the relationship between communication and safe behaviors therefore, the impact of communication on cognitive failure can be blurred and a longitudinal study on specific crews working on the same job site could be used to evaluate it. Third, future research should focus on communication style, as it directly relates to the human cognitions that affect unsafe behavior at construction sites.

利用Visual C#处理数字图像

Visual C#GDI+虽然提供了许多基本的图像对象和方法功能,但要进行比较复杂的图像处理,需要结合图像处理算法才能实现．这里利用C#语言的GDI+原理,论述怎样使用颜色矩阵和Unsafe不安全代码类两种方法,对数字图象进行处理,包括图像的亮度处理、灰度处理、透明处理等．用Unsafe方法实现类似C指针原理,对图像进行逐个象素处理,功能强大;用颜色矩阵方法实现简单,只要对不同的图象处理定义不同的颜色矩阵,但有部分图象处理功能无法定义出矩阵．

Application of dual structure theory on motivating safe behavior of coal mine staff

Based on behavior science and direct causes analysis of serious accidents in Chinese coal mines in recent 5 years, a conclusion that unsafe behaviors of coal mine staff were the direct causes of these serious accidents was drawn, accounting for 91.3%. If staff was divided into executor and manager, percentages of the executor＇s and manager＇s unsafe behaviors in direct causes of the accidents were 69% and 54%, respectively, with executor＇s unsafe behavior as direct causes and manager＇s unsafe behavior as essential reasons after thorough analysis of these accidents. Further, on the basis of dual structure theory analysis, three new understandings, including transformation, hierarchy classification and representativeness of behavior factors were il- lustrated. Behavior factors of executors and managers in Chinese coal mines were summarized and classified by new recogni- tion. Then, dual structure theory was applied in a coal mine in Hebei Province of China; weakening unsafe behaviors and strengthening safe factors can attain the purpose of motivating safer behaviors in the coal mine.