Atom spin sensors occupy a prominent position in the scenario of quantum technology, as they can combine precise measurements with appealing miniature packages which are crucial for many applications. In this work, we report on the design and realization of miniature silicon-wafer cells, with a double-chamber configuration and integrated heaters. The cells are tested by systematically studying the spin dynamics dependence on the main pump parameters, temperature, and bias magnetic field. The results are benchmarked against cm-sized paraffin-coated cells, which allows for optimisation of operating conditions of a radio-frequency driven atomic magnetometer. In particular, we observe that, when indirect optical pumping is performed on the two cells, an analogous line narrowing mechanism appears in otherwise very different cells' conditions. Competitive results are obtained, with magnetic resonance linewidths of roughly 100 Hz at the maximum signal-to-noise ratio, in a non-zero magnetic field setting, and in an atomic shot-noise limited regime.

We explore the benefits of combining properties of the radio frequency atomic magnetometer, namely, its insensitive axis and the ability of vector field measurement, with the symmetry of the primary radio frequency field in inductive imaging of objects. In particular, we present the results of measurements performed with a pair of radio frequency magnetic field coils with the same and opposite polarities, i.e., in- and opposite-phases. Implementing different coil configurations enhances various features of the objects such as surfaces or edges and helps identify the object composition.

BackgroundPrevious studies suggest that cases of Ebola virus disease (EVD) may go unreported because they are asymptomatic or unrecognized, but evidence is limited by study designs and sample size.MethodsA large population-based survey was conducted (n = 3415) to assess animal exposures and behaviors associated with Ebolavirus antibody prevalence in rural Kasai Oriental province of the Democratic Republic of Congo (DRC). Fourteen villages were randomly selected and all healthy individuals ≥1 year of age were eligible.ResultsOverall, 11% of subjects tested positive for Zaire Ebolavirus (EBOV) immunoglobulin G antibodies. Odds of seropositivity were higher for study participants older than 15 years of age and for males. Those residing in Kole (closer to the outbreak site) tested positive at a rate 1.6× higher than Lomela, with seropositivity peaking at a site located between Kole and Lomela. Multivariate analyses of behaviors and animal exposures showed that visits to the forest or hunting and exposure to rodents or duikers predicted a higher likelihood of EBOV seropositivity.ConclusionsThese results provide serologic evidence of Ebolavirus exposure in a population residing in non-EBOV outbreak locations in the DRC and define statistically significant activities and animal exposures that associate with EBOV seropositivity.

Background: Estimated physiologic requirements (PRs) for zinc increase in late pregnancy and early lactation, but the effect on dietary zinc requirements is uncertain.Objective: The aim of this study was to determine changes in daily fractional absorbed zinc and total absorbed zinc (TAZ) from ad libitum diets of differing phytate contents in relation to physiologic zinc requirements during pregnancy and lactation.Methods: This was a prospective observational study of zinc absorption at 8 (phase 1) and 34 (phase 2) wk of gestation and 2 (phase 3) and 6 (phase 4) mo of lactation. Participants were indigenous Guatemalan women of childbearing age whose major food staple was maize and who had been randomly assigned in a larger study to either of 2 ad libitum feeding groups: low-phytate maize (LP; 1.6 mg/g; n = 14) or control maize (C; 7.1 mg/g; n = 8). Total dietary zinc (milligrams per day, TDZ) and phytate (milligrams per day) were determined from duplicate diets and fractional absorption (FAZ) by dual isotope ratio technique (TAZ = TDZ × FAZ). All variables were examined longitudinally and by group and compared with PRs. TAZ values at later phases were compared with phase 1. Measured TAZ was compared with predicted TAZ for nonpregnant, nonlactating (NPNL) women.Results: TAZ was greater in the LP group than in the C group at all phases. All variables increased from phase 1 to phases 2 and 3 and declined at phase 4. TAZ increased by 1.25 mg/d (P = 0.045) in the C group and by 0.81 mg/d (P = 0.058) in the LP group at phase 2. At phase 3, the increases were 2.66 mg/d (P = 0.002) in the C group and 2.28 mg/d (P = 0.0004) in the LP group, compared with a 1.37-mg/d increase in PR. Measured TAZ was greater than predicted values in phases 2-4.Conclusions: Upregulation of zinc absorption in late pregnancy and early lactation matches increases in PRs of pregnant and lactating women, regardless of dietary phytate, which has implications for dietary zinc requirements of pregnant and lactating women.

The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.

Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery. We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g. We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ pre-post intervention, except for an increased proportion of <2500 g newborns and deliveries by caesarean section in the post period. There were no significant differences in PMR among all registry births; however, a post-hoc analysis stratified by birthweight documented improvement in <2500 g mortality in Belgaum in both registry and in HBB-trained facility births. No improvement in <2500 g mortality measures was noted in Nagpur or Kenya and there was no improvement in normal birth weight survival. Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements in <2500 g survival in Belgaum suggest the need for careful implementation of HBB training with attention to the target population, data collection, and ongoing quality monitoring activities. The study was registered at ClinicalTrials.gov: NCT01681017 .

We investigate a method to assess the validity of gravitational-wave detector calibration through the use of gamma-ray bursts as standard sirens. Such signals, as measured via gravitational-wave observations, provide an estimated luminosity distance that is subject to uncertainties in the calibration of the data. If a host galaxy is identified for a given source then its redshift can be combined with current knowledge of the cosmological parameters yielding the true luminosity distance. This will then allow a direct comparison with the estimated value and can validate the accuracy of the original calibration. We use simulations of individual detectable gravitational-wave signals from binary neutron star (BNS) or neutron star-black hole systems, which we assume to be found in coincidence with short gamma-ray bursts, to estimate any discrepancy in the overall scaling of the calibration for detectors in the Advanced LIGO and Advanced Virgo network. We find that the amplitude scaling of the calibration for the LIGO instruments could on average be confirmed to within similar to 10% for a BNS source within 100 Mpc. This result is largely independent of the current detector calibration method and gives an uncertainty that is competitive with that expected in the current calibration procedure. Confirmation of the calibration accuracy to within similar to 20% can be found with BNS sources out to similar to 500 Mpc.

Background: Infants of women with lower education levels are at higher risk for perinatal mortality. Objectives: We explored the impact of training birth attendants and pregnant women in the Essential Newborn Care (ENC) Program on fresh stillbirths (FSBs) and early (7-day) neonatal deaths (END) by maternal education level in developing countries. Methods: A train-the-trainer model was used with local instructors in rural communities in six countries (Argentina, Democratic Republic of the Congo, Guatemala, India, Pakistan, and Zambia). Data were collected using a pre-/post-active baseline controlled study design. Results: A total of 57,643 infants/mothers were enrolled. The follow-up rate at 7 days of age was 99.2%. The risk for FSB and END was higher for mothers with 0-7 years of education than for those with ≥8 years of education during both the pre- and post-ENC periods in unadjusted models and in models adjusted for confounding. The effect of ENC differed as a function of maternal education for FSB (interaction p = 0.041) without evidence that the effect of ENC differed as a function of maternal education for END. The model-based estimate of FSB risk was reduced among mothers with 0-7 years of education (19.7/1,000 live births pre-ENC, CI: 16.3, 23.0 vs. 12.2/1,000 live births post-ENC, CI: 16.3, 23.0, p < 0.001), but was not significantly different for mothers with ≥8 years of education, respectively. Conclusion: A low level of maternal education was associated with higher risk for FSB and END. ENC training was more effective in reducing FSB among mothers with low education levels.

BACKGROUND:Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0-2) and later neonatal mortality (day 3-28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children's Health's Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas.RESULTS:We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22).CONCLUSIONS:Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated.TRIAL REGISTRATION:ClinicalTrials.gov NCT01073475.

Objective: To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries. Methods: Between September 1, 2011, and February 29, 2012, data were collected from consecutive women who were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded. Results: Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%-45% occurred in the hospital and were potentially preventable by better hospital care. Conclusion: The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might help to reduce the in-hospital component of perinatal mortality in low-income countries. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Introduction Of the approximately 8.8 million deaths that occur annually in children under 5 years of age, 41% occur in neonates. (1) A child is 45 times more likely to die within the first 28 days of life than in the entire period from 28 days to 5 years of age. (2) Three quarters of all neonatal deaths, or approximately 2.7 million deaths annually,, occur during the first seven days of life and are termed early neonatal deaths. (3) In addition, an estimated 2.7 million stillbirths occur annually. (4-6) Early neonatal deaths and stillbirths, which together comprise what are termed perinatal deaths, account for the highest proportion of deaths among children less than 15 years of age. In this age group, they account for twice as many deaths as malaria and human immunodeficiency virus (HIV) infection combined. (7) Over 98% of perinatal deaths occur in low- and middle-income countries and more than two thirds occur in community settings, frequently at homey These deaths that take place outside the formal health-care system are rarely included in the vital registers. (10,11) In fact, vital registration data are unavailable for over 97% of perinatal deaths, yet such data are necessary for designing measures to reduce perinatal mortality. A coherent health policy based on accurate information needs to be developed to address the most common causes of perinatal death. (7,12) Verbal autopsy is one of various techniques that have been developed to compensate for the lack of data on the causes of deaths that occur in community settings. (13) It is an indirect method of ascertaining the cause of death where civil registration and health systems are weak. (14) During a verbal autopsy conducted to investigate the causes of a perinatal death, a systematic description of the signs, symptoms and circumstances preceding the death is obtained through an interview with the primary caregiver, traditionally the mother, of a lost fetus or child who has died. (15) In most cases a physician panel uses the data thus obtained to ascertain the cause of death. Less commonly, the cause of death is established by using algorithms, neural networks or probabilistic approaches to interpret these data. (16-18) Verbal autopsy has been validated against more conventional methods for establishing the cause of death and it is used in large surveillance programmes and vital registration systems. (19) Traditionally, the perinatal verbal autopsy respondent is the mother whose neonate or fetus has died. However, birth attendants could make better verbal autopsy respondents than mothers for several reasons: (i) they may be more aware than mothers of the circumstances surrounding the birth; (ii) they are often the first to attempt resuscitation and often have greater insight than the mother into the events that led to the death. Often the circumstances surrounding such deaths become embedded in the memory of birth attendants who live in the same community as the mother. For these reasons, our group undertook a prospective study to investigate whether birth attendants could be a suitable alternative to mothers as respondents during perinatal verbal autopsies. Our a priori hypothesis was that mothers' and birth attendants' responses to selected close-ended items on the verbal autopsy questionnaire would show more than 80% concordance. Methods Study design, setting and subjects This prospective observational study based on verbal autopsy was an ancillary study to the FIRST BREATH Trial, conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women's and Children's Health Research. 20 The FIRST BREATH Trial was a cluster-randomized, controlled trial that investigated the effects of implementing a package of neonatal care practices and neonatal resuscitation in community settings. Our verbal autopsy study included 38 communities in the Democratic Republic of the Congo (Equateur province), Guatemala (Chimaltenango province), Pakistan (Thatta district) and Zambia (Kafue district). …

OBJECTIVE To assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents. METHODS Verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries. Concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. The sensitivity and specificity of individual questions with the birth attendant as respondent were assessed. FINDINGS For early neonatal deaths, concordance across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. Sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Sensitivity and specificity varied across individual questions. Over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent. CONCLUSION Birth attendants can substitute for bereaved mothers as verbal autopsy respondents. The questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.

Each year, an estimated six million perinatal deaths occur worldwide, and 98% of these deaths occur in low-and middle-income countries. These estimates are based on surveys in both urban and rural areas, and they may underrepresent the problem in rural areas. This study was conducted to quantify perinatal mortality, to identify the associated risk factors, and to determine the most common causes of early neonatal death in a rural area of the Democratic Republic of the Congo (DRC). Data were collected on 1,892 births. Risk factors associated with perinatal deaths were identified using multivariate analysis with logistic regression models. Causes of early neonatal deaths were determined by physician-review of information describing death. The perinatal mortality rate was 61 per 1,000 births; the stillbirth rate was 30 per 1,000 births; and the early neonatal death rate was 32 per 1,000 livebirths. Clinically-relevant factors independently associated with perinatal death included: low birthweight [odds ratio (OR)=13.51, 95% confidence interval (CI) 7.82-23.35], breech presentation (OR)=12.41; 95% CI 4.62-33.33), lack of prenatal care (OR=2.70, 95% CI 1.81-4.02), and parity greater than 4 (OR=1.93 95% CI 1.11-3.37). Over one-half of early neonatal deaths (n=37) occurred during the first two postnatal days, and the most common causes were low birthweight/prematurity (47%), asphyxia (34%), and infection (8%). The high perinatal mortality rate in rural communities in the DRC, approximately one-half of which is attributable to early neonatal death, may be modifiable. Specifically, deaths due to breech presentation, the second most common risk factor, may be reduced by making available emergency obstetric care. Most neonatal deaths occur soon after birth, and nearly three-quarters are caused by low birthweight/prematurity or asphyxia. Neonatal mortality might be reduced by targeting interventions to improve neonatal resuscitation and care of larger preterm infants.

Background The World Health Organization endorses the use of artemisinin-based combination therapy for treatment of acute uncomplicated falciparum malaria in the second and third trimesters of pregnancy. However, the effects of pregnancy on the pharmacokinetics of artemisinin derivatives, such as artesunate (AS), are poorly understood. In this analysis, the population pharmacokinetics of oral AS, and its active metabolite dihydroartemisinin (DHA), were studied in pregnant and non-pregnant women at the Kingasani Maternity Clinic in the DRC. Methods Data were obtained from 26 pregnant women in the second (22 - 26 weeks) or the third (32 - 36 weeks) trimester of pregnancy and from 25 non-pregnant female controls. All subjects received 200 mg AS. Plasma AS and DHA were measured using a validated LC-MS method. Estimates for pharmacokinetic and variability parameters were obtained through nonlinear mixed effects modelling. Results A simultaneous parent-metabolite model was developed consisting of mixed zero-order, lagged first-order absorption of AS, a one-compartment model for AS, and a one-compartment model for DHA. Complete conversion of AS to DHA was assumed. The model displayed satisfactory goodness-of-fit, stability, and predictive ability. Apparent clearance (CL/F) and volume of distribution (V/F) estimates, with 95% bootstrap confidence intervals, were as follows: 195 L (139-285 L) for AS V/F, 895 L/h (788-1045 L/h) for AS CL/F, 91.4 L (78.5-109 L) for DHA V/F, and 64.0 L/h (55.1-75.2 L/h) for DHA CL/F. The effect of pregnancy on DHA CL/F was determined to be significant, with a pregnancy-associated increase in DHA CL/F of 42.3% (19.7 - 72.3%). Conclusions In this analysis, pharmacokinetic modelling suggests that pregnant women have accelerated DHA clearance compared to non-pregnant women receiving orally administered AS. These findings, in conjunction with a previous non-compartmental analysis of the modelled data, provide further evidence that higher AS doses would be required to maintain similar DHA levels in pregnant women as achieved in non-pregnant controls.

Objective: To evaluate the impact of prenatal cocaine exposure and small-for-gestational-age (SGA) status on childhood growth.Study design: Cocaine exposure was defined by history or meconium metabolites. Hierarchical linear modeling was used to examine cocaine exposure and SGA status on growth, while controlling for exposure to other drugs and alcohol use.Results: At birth cocaine-exposed infants (n = 364) had significantly lower growth parameters compared to non-exposed children (n = 771). At 6 years, weight was similar between exposed and unexposed children. SGA infants continued to be growth impaired. There was a significant interaction between prenatal cocaine exposure and SGA status at 6 years. The negative effects of cocaine on weight and height were greater among non-SGA than SGA children (432 vs. 280 gm, and 0.7 and 0.5 cm, respectively) while negative effects of SGA status on weight and height were larger in non-cocaine exposed compared to the exposed children (2.3 kg vs.1.6 kg and 2.2 and 1.0 cm).Conclusions: Children exposed to prenatal cocaine were similar in weight to non-exposed children at 6 years of age. Cocaine had an unexplained greater detrimental effect on non-SGA than SGA children. SGA status at birth has an independent detrimental effect on childhood growth. (C) 2011 Elsevier Inc. All rights reserved.

To the Editor: In a recent study,1Carlo W. Wright L.L. Chomba E. McClure E.M. Carlo M.E. Bann C.M. et al.Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country.J Pediatr. 2009; 154 (504-8.e5)Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar Carlo et al assessed the effectiveness of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP)2Bloom R.S. Cropley C. Textbook of neonatal resuscitation.5th ed. American Heart Association, American Academy of Pediatrics, Elk Grove Village, IL2006Google Scholar in improving knowledge, skills, and self-efficacy of 127 nurse midwives in Zambia. After training, written scores (knowledge evaluation) and performance scores (skills evaluation) improved from 57% ± 14% to 80% ± 12% (mean ± SD; P < .0001) and from 43% ± 21% to 88% ± 9% (P < .0001), respectively. The authors concluded that the NRP training improved educational outcomes in college-educated practicing nurse midwives. We reported that Iraqi residents significantly improved their knowledge attainment after participation in the NRP course. However, their performance on clinical simulations was unsatisfactory.3Jabir M.M. Doglioni N. Fadhil T. Zanardo V. Trevisanuto D. Knowledge and practical performance gained by Iraqi residents after participation to a neonatal resuscitation program course.Acta Paediatr. 2009; 98: 1265-1268Crossref PubMed Scopus (15) Google Scholar These findings could be explained by several reasons, including background and experience in NRP of instructors and learners, conduction of skill stations, and performance evaluation to test skills. In that study, we suggested that it would be interesting to use the study design by Carlo et al in future courses in Baghdad to better compare performances in different environments. Recently, a NRP course was held at the Department of Obstetrics and Gynecology, Baghdad Teaching Hospital, Iraq, involving 29 pediatric and obstetrical residents. We used the evaluation method used by Carlo et al in Zambia for assessing participants' performance.1Carlo W. Wright L.L. Chomba E. McClure E.M. Carlo M.E. Bann C.M. et al.Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country.J Pediatr. 2009; 154 (504-8.e5)Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar The Table reports the participants' performance evaluation after the training compared with that reported by Carlo et al.TablePercentage of items performed correctly on the performance evaluation (skills evaluation) immediately after course participation (post-test)Carlo et al1Carlo W. Wright L.L. Chomba E. McClure E.M. Carlo M.E. Bann C.M. et al.Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country.J Pediatr. 2009; 154 (504-8.e5)Abstract Full Text Full Text PDF PubMed Scopus (70) Google ScholarTrevisanuto et alOverall performance evaluation88 (9)78 (35)A. Initial steps87 (11)75 (21) 1. Indicates use of (universal) standard precautions78 (42)25 (41) 2. Prepares for warming98 (12)84 (33) 3. Prepares for positioning or for clearing airway93 (26)74 (39) 4. Prepares for ventilation98 (15)84 (31) 5. Prepares medications72 (45)79 (35) 6. Determines need for the initial steps of resuscitation76 (43)90 (28) 7. Places baby on preheated radiant warmer or on mother with neck slightly extended90 (30)96 (18) 8. Clears mouth and nose94 (23)100 (0) 9. Dries the baby98 (15)71 (46) 10. Removes wet linen84 (37)61 (49) 11. Slaps foot, flicks heel, or rubs back briefly72 (45)61 (49)B. Ventilation88 (12)83 (11) 12. Chooses correct size mask or positions the bag92 (27)89 (31) 13. Checks the seal86 (35)75 (47) 14. Positions the head and applies the face mask96 (20)93 (26) 15. Checks for and removes secretions92 (27)89 (31) 16. Ventilates with mouth slightly open79 (41)68 (47) 17. Increases ventilation pressure75 (44)61 (49) 18. Ventilates 30 seconds at a rate of 40-60 times/min87 (34)96 (18) 19. Achieves visible rise and fall of the chest90 (30)79 (41) 20. Asks for help to administer chest compressions94 (24)75 (44) 21. Continues positive pressure ventilation95 (21)82 (39) 22. Checks the heart rate by palpation or stethoscope85 (36)93 (26) 23. Checks to ensure adequate chest movement87 (34)86 (36) 24. Coordinates ventilations and chest compressions appropriately81 (39)93 (26)C. Chest compressions93 (14)71 (19) 25. Locates appropriate position on lower one-third of baby's sternum95 (21)89 (31) 26. Provides firm support for baby's back93 (26)79 (42) 27. Uses fingertips or ring fingers or distal portion of both thumbs94 (24)39 (50) 28. Compresses sternum approximately one-third of the anterior-posterior diameter of the chest92 (27)75 (44) 29. Maintains cadence of “one- and two- and three- and breathe- and..”.92 (27)75 (44)Data are expressed as means (SD). Open table in a new tab Data are expressed as means (SD). After training, performance scores, although lower than those reported in the study by Carlo et al,1Carlo W. Wright L.L. Chomba E. McClure E.M. Carlo M.E. Bann C.M. et al.Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country.J Pediatr. 2009; 154 (504-8.e5)Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar were higher than those from our earlier courses.3Jabir M.M. Doglioni N. Fadhil T. Zanardo V. Trevisanuto D. Knowledge and practical performance gained by Iraqi residents after participation to a neonatal resuscitation program course.Acta Paediatr. 2009; 98: 1265-1268Crossref PubMed Scopus (15) Google Scholar These data suggest that, in addition to the experience in NRP of instructors and learners, performance evaluation method plays an important role for skill assessment of participants, which could be relevant for developing countries where NRP course standardization needs to be defined. ReplyThe Journal of PediatricsVol. 156Issue 2PreviewTo the Editor: Full-Text PDF