Hasil untuk "Miscellaneous systems and treatments"

Shuai Gao, Lili Zhu, Hao Yao et al.

Background: To explore the effect and safety of electroacupuncture (EA) compared to prucalopride in patients with ultra-severe chronic constipation (USCC), a condition defined by the absence of weekly complete spontaneous bowel movements (CSBMs). Methods: This study was a secondary analysis using data from a multicenter, non-inferiority randomized controlled trial, involving patients with USCC. Participants received either EA or prucalopride treatment. The primary outcome was the mean weekly CSBMs from weeks 1 to 8. Secondary outcomes included the mean weekly CSBMs, the proportion of overall and weekly responders, changes in straining and stool consistency scores, Patient Assessment of Constipation Quality of Life (PAC-QOL) scores, and the proportion of patients using rescue medication. Results: A total of 317 participants with USCC were included (151 in the EA group and 166 in the prucalopride group). From weeks 1 to 8, both groups showed similar increases in the CSBMs (difference: -0.02; 95% confidence interval [CI], -0.34 to 0.30, P < 0.001 for noninferiority). However, during weeks 1 to 2, the prucalopride group showed greater effects than the EA group in increasing CSBMs, alleviating defecation difficulties, and improving stool consistency. The EA group experienced fewer adverse events (AEs) than the prucalopride group. Conclusions: In participants with USCC, EA showed improvements in CSBMs, defecation-related symptoms, and quality of life that were comparable to those observed with prucalopride. The effects of EA might persist for 24 weeks, and EA exhibited a superior safety profile. Trial registration number: NCT02047045 (ClinicalTrials.gov).

Guoliang Li, Rui Feng, Jiayi Yu et al.

Objective: To investigate the anti-inflammatory, antioxidant, and goblet cell-stimulating effects of a suspension of Ophiopogon japonicus (L. f.) Ker Gawl. (O. japonicus, Mai Dong) extract combined with hyaluronic acid (HA) in the mouse model with dry eye disease (DED). Methods: A DED mouse model was induced using benzalkonium chloride (BAK), followed by treatment with O. japonicus extract-containing eye drops at varying concentrations. Experimental groups included a normal control, a DED model control, a positive control, and an O. japonicus extract-treated group. Corneal fluorescein staining and tear break-up time (TBUT) were used to assess tear film stability and ocular surface integrity. Enzyme-linked immunosorbent assay (ELISA) measured inflammatory factor levels in corneal and conjunctival tissues, whereas Western blot (WB) analyzed key antioxidant and inflammatory markers, including nuclear factor erythroid 2-related factor (2Nrf2) and heme oxygenase 1 (HO-1). Periodic acid-schiff (PAS) staining and immunofluorescence were used to evaluate goblet cell density and mucin secretion. Results: O. japonicus extract significantly improved corneal damage, reduced fluorescein staining scores, prolonged TBUT, and increased tear secretion. It downregulated inflammatory markers, including interleukin-8 (IL-8), interleukin-1β (IL-1β), and interferon-γ (IFN-γ) while upregulating Nrf2, HO-1, and the interleukin-13 (IL-13)/IFN-γ ratio, alleviating oxidative stress and inflammation. PAS staining showed increased conjunctival goblet cell density and restored mucin secretion, enhancing tear film stability. Conclusion: O. japonicus extract demonstrated significant anti-inflammatory, antioxidant, and goblet cell-stimulating effects in a DED model, with good biocompatibility and promising therapeutic potential. Future research should optimize extraction processes and validate their efficacy and safety in clinical settings.

Maria Elly Herz Genro, Claudete Lampert, Carlos Alessandro da Silveira et al.

Objetivo: Realizar uma análise abrangente da experiência da Clínica Feminista Antirracista Interseccional (CliFAI), um projeto de extensão universitária, criado em 2019, no Instituto de Psicologia da Universidade Federal do Rio Grande do Sul (UFRGS), composto por docentes, discentes e técnicos administrativos da Instituição. Neste artigo, buscou-se compreender as origens, os movimentos formativos e as interações da CliFAI com comunidades externas. Relato da experiência: A CliFAI surgiu a partir de uma história marcada por movimentos formativos e conexões significativas com comunidades externas. Por meio de uma relação dinâmica entre saberes e poderes, a Clínica tem empreendido ações antirracistas que refletem sua existência e impacto. A trajetória da CliFAI é um relato vivo de como a interseccionalidade pode ser aplicada na prática, promovendo a justiça social e a equidade, já que suas ações buscam atender mulheres da periferia, muitas delas negras e que, por essas condições, sofrem múltiplas violências. Os atendimentos ocorrem por meio de grupos de escuta, de apoio e seminários formativos. A partir das observações, percebe-se o cuidado com as comunidades envolvidas num processo autoavaliativo, na intencionali­dade de manutenção e continuidade do projeto. Conclusão: Na perspectiva de uma formação interseccional, visualizam-se valores e conceitos, como a soli­dariedade, o respeito à diferença, a reciprocidade e espírito comunitário. Essa dinâmica é inspiradora para todos (as) os (as) sujeitos (as) envolvidos (as), pois, para além dos obstáculos e dificuldades, movimenta práticas e pensamentos alternativos na uni­versidade e, sobretudo, aciona formas de (re) existências que impulsionam os caminhos de transformação para a construção de conhecimentos na perspectiva do Bem Viver.

Hagar A. Marzok, Ahmed H. Ashry, Magda G. Sedhom et al.

Abstract Background Cervicogenic headache (CGH), is a secondary headache arising from cervical disorders. Training core muscles have a corrective effect on the whole spine. Moreover, increased deep neck flexors (DNFs) activation is closely linked with balanced core stabilization of the global cervical-thoracic-lumbopelvic chains. This study aimed to investigate the effect of lumbar motor control training combined with cervical stabilization exercises compared to cervical stabilization exercises alone in CGH patients. Methods Fifty-two subjects of both genders with CGH and chronic mechanical neck pain (CMNP) participated in this study. They were recruited from the outpatient Physical Therapy Clinic at Mubarak Central Hospital, Giza, Egypt; their mean age was 28.1 ± 5.8 years and their BMI was 22.8 ± 1.6 kg/m2. They received treatment for three sessions per week for 4 weeks. Subjects were assigned randomly into two equal groups; the control group: received cervical stabilization exercises (axial elongation, cranio-cervical flexion, cervical extension, rowing, and Y-exercise). Study group: received cervical stabilization exercise in addition to lumbar motor control training (abdominal draw-in maneuver, side plank, and quadruped position), each exercise had a 4-week progression. Headache frequency, duration, intensity by visual analog scale (VAS), and neck functional disability by Neck Disability Index (NDI) were measured before the first session and after the last session of the 4 weeks of treatment. Results There was a high statistically significant difference in post-treatment mean values of headache frequency, headache duration, headache intensity, and neck functional disability between the two groups in favor of the study group. Conclusion Adding lumbar motor control training to cervical stabilization exercise is more effective than cervical stabilization alone in decreasing headache frequency, duration, intensity, and neck functional disability in CGH patients with CMNP. Trial registration NCT05952115. Registered 11 July 2023-retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4 .

Tamara Pereira da Silva, Roberto Allan Ribeiro Silva, Fernanda Silva Antunes et al.

Objetivo: Compreender a percepção de usuários da Atenção Básica à Saúde (ABS) quanto aos serviços prestados e dinâmica de trabalho da equipe da Estratégia de Saúde da Família em ambiente rural. Metodologia: Estudo de abordagem qualitativa, conduzido por entrevistas semiestruturadas com usuários da ABS, residentes na zona rural de Janaúba, Minas Gerais, Brasil. A amostra foi intencional por saturação. O material foi analisado pela análise de conteúdo. Resultados: Participaram do estudo 12 usuários. A ABS foi o serviço de primeira opção dos usuários para seu cuidado em saúde. Perceberam a Unidade de Saúde (US) com o papel de oferecer consultas, serviços ambulatoriais e encaminhamentos para especialidades quando necessário, além de prevenir doenças graves, acolher/atender à população de modo resolutivo. Relatos de satisfação foram ligados à qualidade da comunicação nas interações dos usuários com os profissionais da ABS. Identificaram na ABS serviços de assistência farmacêutica e odontológica, consultas de Enfermagem e Psicologia, e imunização. Agentes comunitários de saúde, profissionais da recepção, gerente e enfermeiros foram citados como profissionais de referência na US. Bom atendimento da US, acolhimento, assistência farmacêutica e estrutura física foram aspectos positivos percebidos pelos usuários. Desafios relacionados ao número insuficiente de profissionais, qualificação da equipe, indisponibilidade de transporte para realizar exames na cidade, horário de atendimento do médico e rotatividade de médicos foram apontados. Conclusão: Esta pesquisa destaca-se por trazer a percepção de usuários sobre um serviço de ABS no contexto rural. Seus achados constituem-se ferramentas de planejamento estratégico para a gestão municipal. Ações de educação em saúde nas comunidades rurais são recomendadas.

Sen Zhan, Nikolaos G. Paterakis, Wouter van den Akker et al.

We investigate the real-time voltage regulation problem in distribution systems employing online feedback optimization (OFO) with short-range communication between physical neighbours. OFO does not need an accurate grid model nor estimated consumption of non-controllable loads, affords fast calculations, and demonstrates robustness to uncertainties and disturbances, which render it particularly suitable for real-time distribution system applications. However, many OFO controllers require centralized communication, making them susceptible to single-point failures. This paper proposes a distributed OFO design based on a nested feedback optimization strategy and analyzes its convergence. The strategy preserves end-users' privacy by keeping voltage data local. Numerical study results demonstrate that the proposed design achieves effective voltage regulation and outperforms other distributed and local approaches.

Sonda Fourati, Wael Jaafar, Noura Baccar et al.

Large Language Models (LLMs) have showcased remarkable proficiency in various information-processing tasks. These tasks span from extracting data and summarizing literature to generating content, predictive modeling, decision-making, and system controls. Moreover, Vision Large Models (VLMs) and Multimodal LLMs (MLLMs), which represent the next generation of language models, a.k.a., XLMs, can combine and integrate many data modalities with the strength of language understanding, thus advancing several information-based systems, such as Autonomous Driving Systems (ADS). Indeed, by combining language communication with multimodal sensory inputs, e.g., panoramic images and LiDAR or radar data, accurate driving actions can be taken. In this context, we provide in this survey paper a comprehensive overview of the potential of XLMs towards achieving autonomous driving. Specifically, we review the relevant literature on ADS and XLMs, including their architectures, tools, and frameworks. Then, we detail the proposed approaches to deploy XLMs for autonomous driving solutions. Finally, we provide the related challenges to XLM deployment for ADS and point to future research directions aiming to enable XLM adoption in future ADS frameworks.

MHD Anas Alsakkal, Jayawan Wijekoon

This paper presents a novel FPGA-based neuromorphic cochlea, leveraging the general-purpose spike-coding algorithm, Spiketrum. The focus of this study is on the development and characterization of this cochlea model, which excels in transforming audio vibrations into biologically realistic auditory spike trains. These spike trains are designed to withstand neural fluctuations and spike losses while accurately encapsulating the spatial and precise temporal characteristics of audio, along with the intensity of incoming vibrations. Noteworthy features include the ability to generate real-time spike trains with minimal information loss and the capacity to reconstruct original signals. This fine-tuning capability allows users to optimize spike rates, achieving an optimal balance between output quality and power consumption. Furthermore, the integration of a feedback system into Spiketrum enables selective amplification of specific features while attenuating others, facilitating adaptive power consumption based on application requirements. The hardware implementation supports both spike-based and non-spike-based processors, making it versatile for various computing systems. The cochlea's ability to encode diverse sensory information, extending beyond sound waveforms, positions it as a promising sensory input for current and future spike-based intelligent computing systems, offering compact and real-time spike train generation.

Mi Ju Son, Sungha Kim, Young-Eun Kim et al.

Background: The decoction form of herbal medicine (D-HM) is mainly prescribed to patients with allergic rhinitis (AR) in Korean Medicine (KM) clinics in the Republic of Korea; however, it is difficult to conduct clinical trials of D-HM due to regulatory issues. This study investigated the clinical safety and effectiveness of D-HM combination therapy for the treatment of AR by analyzing the AR outpatient data from 17 KM clinics. Methods: This retrospective cohort study included patients who visited KM clinics for AR treatment from January 1, 2021, to March 31, 2022. Cases were collated using structured case report forms and divided into the D-HM with KM usual care group (D-HM group) and the KM usual care group (UC group). Since D-HM therapy could not be randomly assigned to the study population, we used optimal propensity score (PS) matching to investigate the effectiveness and safety of D-HM combination therapy in the treatment of AR. Results: Data from 228 patients were collected. After PS matching, 144 patients were finally analyzed. The total nasal symptom score (TNSS) and mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ) were significantly improved in the D-HM group compared with those in the UC group (TNSS: p=0.02; mini-RQLQ: p=0.04). Four patients in the D-HM group experienced minor adverse events that were mild and resolved within 15 days. Conclusions: D-HM combination therapy may be beneficial in the management of symptoms and rhinitis-associated quality of life and potentially useful in clinical practice. However, randomized placebo-controlled clinical trials are required to confirm their effectiveness. Study registration: This study has been registered at Clinical Research Information Service (KCT0007242).

Juliana Jacques da Costa Monguilhott, Juliana Fernandes da Nóbrega, Isadora Ferrante Boscoli de Oliveira Alves et al.

Considerando as evidências que indicam o uso restritivo, e não rotineiro, de episiotomia, diferentes técnicas e intervenções estão sendo utilizadas para evitar o trauma perineal, principalmente, por enfermeiras obstétricas e obstetrizes. Com isso, objetivou-se compreender a experiência dos acompanhantes ao realizarem a massagem perineal em suas companheiras durante a gestação. Trata-se de uma pesquisa qualitativa, exploratório-descritiva. A coleta de dados foi realizada entre abril de 2016 e abril de 2017, por meio de entrevistas semiestruturadas e notas descritivas, na residência ou local de trabalho dos participantes. Participaram da pesquisa 10 acompanhantes. Os dados foram interpretados por meio da análise de conteúdo de Bardin, com auxílio do software Visual Qualitative Data Analysis (ATLAS.ti 8.0). Após análise dos resultados obtidos, emergiram cinco categorias: desafios apontados pelos acompanhantes para a realização da massagem perineal; contribuições da massagem perineal para a proteção do períneo; a massagem perineal favorece o envolvimento do acompanhante durante a gestação; estratégias para a realização da massagem perineal; e, recomendações dos acompanhantes a partir de suas experiências. A realização da massagem perineal pelo acompanhante durante a gestação contribui para o pré-natal masculino e favorece o vínculo do casal, sendo uma proposta de cuidado que visa à contínua presença do homem em atividades do ciclo gravídico-puerperal.

Michael Crosscombe, Jonathan Lawry

The design of distributed autonomous systems often omits consideration of the underlying network dynamics. Recent works in multi-agent systems and swarm robotics alike have highlighted the impact that the interactions between agents have on the collective behaviours exhibited by the system. In this paper, we seek to highlight the role that the underlying interaction network plays in determining the performance of the collective behaviour of a system, comparing its impact with that of the physical network. We contextualise this by defining a collective learning problem in which agents must reach a consensus about their environment in the presence of noisy information. We show that the physical connectivity of the agents plays a less important role than when an interaction network of limited connectivity is imposed on the system to constrain agent communication. Constraining agent interactions in this way drastically improves the performance of the system in a collective learning context. Additionally, we provide further evidence for the idea that `less is more' when it comes to propagating information in distributed autonomous systems for the purpose of collective learning.

Yiting Chen, Liliaokeawawa Cothren, Jorge Cortes et al.

This paper considers the problem of regulating a dynamical system to equilibria that are defined as solutions of an input- and state-constrained optimization problem. To solve this regulation task, we design a state feedback controller based on a continuous approximation of the projected gradient flow. We first show that the equilibria of the interconnection between the plant and the proposed controller correspond to critical points of the constrained optimization problem. We then derive sufficient conditions to ensure that, for the closed-loop system, isolated locally optimal solutions of the optimization problem are locally exponentially stable and show that input constraints are satisfied at all times by identifying an appropriate forward-invariant set.

Daniel Hert, Tomas Baca, Pavel Petracek et al.

This paper presents a modular autonomous Unmanned Aerial Vehicle (UAV) platform called the Multi-robot Systems (MRS) Drone that can be used in a large range of indoor and outdoor applications. The MRS Drone features unique modularity with respect to changes in actuators, frames, and sensory configuration. As the name suggests, the platform is specially tailored for deployment within a MRS group. The MRS Drone contributes to the state-of-the-art of UAV platforms by allowing smooth real-world deployment of multiple aerial robots, as well as by outperforming other platforms with its modularity. For real-world multi-robot deployment in various applications, the platform is easy to both assemble and modify. Moreover, it is accompanied by a realistic simulator to enable safe pre-flight testing and a smooth transition to complex real-world experiments. In this manuscript, we present mechanical and electrical designs, software architecture, and technical specifications to build a fully autonomous multi UAV system. Finally, we demonstrate the full capabilities and the unique modularity of the MRS Drone in various real-world applications that required a diverse range of platform configurations.

Benjamin Habib, Elvin Isufi, Ward van Breda et al.

Implementing accurate Distribution System State Estimation (DSSE) faces several challenges, among which the lack of observability and the high density of the distribution system. While data-driven alternatives based on Machine Learning models could be a choice, they suffer in DSSE because of the lack of labeled data. In fact, measurements in the distribution system are often noisy, corrupted, and unavailable. To address these issues, we propose the Deep Statistical Solver for Distribution System State Estimation (DSS$^2$), a deep learning model based on graph neural networks (GNNs) that accounts for the network structure of the distribution system and for the physical governing power flow equations. DSS$^2$ leverages hypergraphs to represent the heterogeneous components of the distribution systems and updates their latent representations via a node-centric message-passing scheme. A weakly supervised learning approach is put forth to train the DSS$^2$ in a learning-to-optimize fashion w.r.t. the Weighted Least Squares loss with noisy measurements and pseudomeasurements. By enforcing the GNN output into the power flow equations and the latter into the loss function, we force the DSS$^2$ to respect the physics of the distribution system. This strategy enables learning from noisy measurements, acting as an implicit denoiser, and alleviating the need for ideal labeled data. Extensive experiments with case studies on the IEEE 14-bus, 70-bus, and 179-bus networks showed the DSS$^2$ outperforms by a margin the conventional Weighted Least Squares algorithm in accuracy, convergence, and computational time, while being more robust to noisy, erroneous, and missing measurements. The DSS$^2$ achieves a competing, yet lower, performance compared with the supervised models that rely on the unrealistic assumption of having all the true labels.

Courtney M. King, Son Tung Do, Juntao Chen

In this work, we study policy poisoning through state manipulation, also known as sensor spoofing, and focus specifically on the case of an agent forming a control policy through batch learning in a linear-quadratic (LQ) system. In this scenario, an attacker aims to trick the learner into implementing a targeted malicious policy by manipulating the batch data before the agent begins its learning process. An attack model is crafted to carry out the poisoning strategically, with the goal of modifying the batch data as little as possible to avoid detection by the learner. We establish an optimization framework to guide the design of such policy poisoning attacks. The presence of bi-linear constraints in the optimization problem requires the design of a computationally efficient algorithm to obtain a solution. Therefore, we develop an iterative scheme based on the Alternating Direction Method of Multipliers (ADMM) which is able to return solutions that are approximately optimal. Several case studies are used to demonstrate the effectiveness of the algorithm in carrying out the sensor-based attack on the batch-learning agent in LQ control systems.

B.T. Punchihewa, M.A.B. Prashantha, P.I. Godakumbura et al.

Lauha Bhasma (LB) is a prominent Ayurveda medicine and is used as an ingredient to prepare other indigenous medicines in Ayurveda. The outcomes of this study on chemical and physical changes during the preparation process of LB become significant to explore ancient knowledge of east within the modern context. The preparation process of LB was carried out under laboratory conditions; starting from the elemental form of the Iron sample to identify the chemical and physical changes. The metallic composition of the starting material and intermediate products formed during the LB preparation process was determined using the AAS technique. The variation of the amount of Fe2+ and Fe3+ throughout the process and formation of nanoparticles was identified using quantitative analysis. Even though the amount of heavy metals (Cr, Cd, Cu, Pb, Zn, and Mn) present in the starting material is low, the trace level of heavy metals in the iron sample significantly reduces during the LB preparation process. Irregular-shaped, agglomerated, blackish red (Pakvajambuphala varna) fine LB powder formed at the end of the Putapaka step. The value of ancient knowledge can be revealed using the chemical and physical changes identified throughout the study on the LB preparation process.

Ankur Kumar, Niranjan Kala, Shirley Telles

Aims: Breath frequency can alter cerebral blood flow. The study aimed to determine bilateral middle cerebral arterial hemodynamics in high-frequency yoga breathing (HFYB) and slow frequency alternate nostril yoga breathing (ANYB) using transcranial Doppler sonography. Methods: Healthy male volunteers were assessed in two separate trials before, during, and after HFYB (2.0 Hz for 1 min, n = 16) and ANYB (12 breaths per minute for 5 min, n = 22). HFYB and ANYB were separately compared to breath awareness (BAW) and to control sessions. Statistical Analysis: The data were analyzed using repeated-measures ANOVA with Bonferroni adjusted post hoc tests. Results: During HFYB there was a decrease in end-diastolic velocity (EDV) and mean flow velocity (MFV) (P < 0.01 for left and P < 0.05 for right middle cerebral arteries; MCA) with an increase in pulsatility index (PI) for the right MCA (P < 0.05). During ANYB, there was a bilateral decrease in peak systolic velocity (P < 0.05 for left and P < 0.01 for right MCA), EDV (P < 0.01) and MFV (P < 0.01 for left and P < 0.001 for right MCA) and an increase in PI (P < 0.01). During BAW of the two sessions there was a decrease in lateralized flow and end-diastolic velocities (P < 0.05) and an increase in PI (P < 0.05). Conclusions: Changes in peak flow velocities and pulsatility indices during and after HFYB, ANYB, and BAW suggest decreased cerebrovascular blood flow and increased flow resistance based on different mechanisms.

Xiangyu Zhang, Abinet Tesfaye Eseye, Bernard Knueven et al.

This paper focuses on the critical load restoration problem in distribution systems following major outages. To provide fast online response and optimal sequential decision-making support, a reinforcement learning (RL) based approach is proposed to optimize the restoration. Due to the complexities stemming from the large policy search space, renewable uncertainty, and nonlinearity in a complex grid control problem, directly applying RL algorithms to train a satisfactory policy requires extensive tuning to be successful. To address this challenge, this paper leverages the curriculum learning (CL) technique to design a training curriculum involving a simpler steppingstone problem that guides the RL agent to learn to solve the original hard problem in a progressive and more effective manner. We demonstrate that compared with direct learning, CL facilitates controller training to achieve better performance. To study realistic scenarios where renewable forecasts used for decision-making are in general imperfect, the experiments compare the trained RL controllers against two model predictive controllers (MPCs) using renewable forecasts with different error levels and observe how these controllers can hedge against the uncertainty. Results show that RL controllers are less susceptible to forecast errors than the baseline MPCs and can provide a more reliable restoration process.

Jonas Pesente, Paulo Galassi, Leonardo Rodrigues et al.

This paper proposes an approach to aggregate nonstructured power system controllers preserving the dynamical characteristics of the original devices. The method is based on linear operations that use the frequency response of the elements, resulting in an accurate input-output description of the equivalent controller when compared to the original ones. The developed method was applied to a model of the future interconnected Paraguayan-Argentinean power system to produce a dynamic equivalent used in a real-time simulator to test the special protection scheme needed for the safe operation of the this future system. Transient and small-signal stability studies presented matching simulation results in the time domain with significantly reduced computational burden and processing time.

Antônia Motta Roth Jobim van Hoogstraten, Ana Paula Ramos de Souza, Anaelena Bragança de Moraes

Objetivo: Analisar a associação entre presença de risco psíquico, a partir do questionário PREAUT, e fatores obstétricos, sociodemográficos e psicossociais, em bebês nascidos a termo e pré-termo entre um e nove meses de idade. Método: A amostra foi de 80 bebês, 25 nascidos pré-termo e 55 a termo avaliados a partir de entrevista semi-estruturada e aplicação do questionário PREAUT. Resultados: Houve associação entre presença de risco psíquico e o fato de a mãe cuidar sozinha do bebê, não apresentar uma atividade profissional, o bebê ser do sexo masculino, apresentar dificuldades alimentares como refluxo e engasgos, bem como não explorar o próprio corpo e o ambiente a sua volta. Conclusão: Houve associação entre presença de risco psíquico, a partir do questionário PREAUT e fatores obstétricos, sociodemográficos e psicossociais.