Previous prelabor or intrapartum cesarean delivery and risk of placenta previa.

PubMed

Downes, Katheryne L; Hinkle, Stefanie N; Sjaarda, Lindsey A; Albert, Paul S; Grantz, Katherine L

2015-05-01

The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before the onset of labor from intrapartum cesarean delivery. We conducted a retrospective cohort study of electronic medical records from 20 Utah hospitals (2002-2010) with restriction to the first 2 singleton deliveries of nulliparous women at study entry (n=26,987). First pregnancy delivery mode was classified as (1) vaginal (reference), (2) cesarean delivery before labor onset (prelabor), or (3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by previous delivery mode with the use of logistic regression and was adjusted for maternal age, insurance, smoking, comorbidities, previous pregnancy loss, and history of previa. Most first deliveries were vaginal (82%; n=22,142), followed by intrapartum cesarean delivery (14.6%; n=3931), or prelabor cesarean delivery (3.4%; n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by previous delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (P<.001). Relative to vaginal delivery, previous prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62; 95% confidence interval, 1.24-5.56). There was no significant association between previous intrapartum cesarean delivery and previa (adjusted odds ratio, 1.22; 95% confidence interval, 0.68-2.19). Previous prelabor cesarean delivery was associated with a >2-fold significantly increased risk of previa in the second delivery, although the approximately 20% increased risk of previa that was associated with previous intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after previous prelabor cesarean delivery may be important when considering nonmedically indicated prelabor cesarean delivery

Frequency of placenta previa in previously scarred and non scarred uterus.

PubMed

Majeed, Tayyaba; Waheed, Fatima; Mahmood, Zahid; Saba, Kanwal; Mahmood, Hamis; Bukhari, Mulazim Hussain

2015-01-01

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections (37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus) in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients (47.36%) were between 26-30 years age group, presented with gestational age between 36-40 weeks (70.17%), were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% (37 cases), and frequency in previously scarred uterus was 67.54% (77 cases). Major degree Previa was found in 88 cases (77.19%). There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa (10.67%) from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus.

Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage.

PubMed

Sekiguchi, Atsuko; Nakai, Akihito; Kawabata, Ikuno; Hayashi, Masako; Takeshita, Toshiyuki

2013-01-01

To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery. We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated. Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups. Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is

Type and Location of Placenta Previa Affect Preterm Delivery Risk Related to Antepartum Hemorrhage

PubMed Central

Sekiguchi, Atsuko; Nakai, Akihito; Kawabata, Ikuno; Hayashi, Masako; Takeshita, Toshiyuki

2013-01-01

Purpose: To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery. Methods: We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated. Results: Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups. Conclusion: Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta

Placenta associated pregnancy complications in pregnancies complicated with placenta previa.

PubMed

Baumfeld, Yael; Herskovitz, Reli; Niv, Zehavi Bar; Mastrolia, Salvatore Andrea; Weintraub, Adi Y

2017-06-01

The purpose of our study was to examine the hypothesis that pregnancies complicated with placenta previa have an increased risk of placental insufficiency associated pregnancy complications (IUGR, preeclampsia, placental abruption and perinatal mortality). Our study included all deliveries that occurred at Soroka University Medical Center (Beer Sheva, Israel) between January 1998 and December 2013. Of them 1,249 were complicated by placenta previa and represented our study group. A composite outcome was created to include conditions associated with placental insufficiency. It included hypertensive disorders (i.e. gestational hypertension, mild and severe preeclampsia, HELLP and eclampsia), small for gestational age neonates and placental abruption. Patients with pregnancy complicated by placenta previa had significantly different obstetrical characteristics including bad obstetric history (8% vs. 4%, p < 0.001), recurrent abortions (11% vs. 5%, p < 0.001). Patients with placenta previa had higher rates of vaginal bleeding in the second half of pregnancy (3% vs. 0%, p < 0.001), gestational diabetes (8% vs. 5.5%, p < 0.001), placental abruption (10% vs. 1%, p < 0.001), adherent placenta (4% vs. 0.5%, p < 0.001), preterm delivery (52% vs. 8%, p < 0.001), with a median gestational age of 36 vs. 39 weeks, p < 0.001. The composite outcome was significantly more prevalent in the placenta previa group (21% vs. 13%, p < 0,001). Our study demonstrated an increased rate of placental insufficiency associated complications in women with placenta previa. This is of clinical relevance and suggests that a careful surveillance for women with placenta previa may help in minimizing maternal, fetal and neonatal complications. Copyright © 2017. Published by Elsevier B.V.

Placenta previa and the risk of delivering a small-for-gestational-age newborn.

PubMed

Räisänen, Sari; Kancherla, Vijaya; Kramer, Michael R; Gissler, Mika; Heinonen, Seppo

2014-08-01

To evaluate whether there is an association between placenta previa and delivery of a small-for-gestational-age (SGA) newborn and to quantify the contribution of individual risk factors for SGA that are associated with placenta previa stratified by maternal parity. A cross-sectional study using the Finnish Medical Birth Register during 2000-2010. All singleton births (N=596,562) were included; major congenital anomalies were excluded. An association between SGA (less than 2 standard deviations below the mean) and placenta previa was modeled by parity-specific unadjusted and adjusted statistical models. Placenta previa complicated 625 of 249,476 singleton births among nulliparous women (2.50/1,000) and 915 of 347,086 singleton births among multiparous women (2.64/1,000). Among nulliparous women, the most common risk factor for placenta previa was in vitro fertilization; placenta previa was not associated with an increased prevalence of SGA controlling for maternal age, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.57-1.17). Among multiparous women, placenta previa was associated with a twofold increased risk of SGA controlling for maternal age, parity, prior preterm birth, prior caesarean delivery, prior SGA newborn, prior preeclampsia, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted OR 2.08, 95% CI 1.50-2.89). Furthermore, only one-fourth of the association between SGA and placenta previa could be explained by controlling for risk factors clustering with placenta previa among multiparous women. Placenta previa is associated with impaired fetal growth in multiparous but not nulliparous women. II.

Placenta Previa and the Risk of Delivering a Small-for-Gestational-Age Newborn

PubMed Central

Kancherla, Vijaya; Kramer, Michael R.; Gissler, Mika; Heinonen, Seppo

2014-01-01

Objective To evaluate whether there is an association between placenta previa and delivery of a small-for-gestational-age (SGA) newborn and to quantify the contribution of individual risk factors for SGA that are associated with placenta previa, stratified by maternal parity. Methods A cross sectional study utilizing the Finnish Medical Birth Register during 2000–2010. All singleton births (N=596,562) were included; major congenital anomalies were excluded. An association between SGA (< 2 standard deviations below the mean) and placenta previa was modeled by parity-specific unadjusted and adjusted statistical models. Results Placenta previa complicated 625 of 249,476 singleton births among nulliparous women (2.50/1,000) and (915 of 347,086 singleton births among multiparous women (2.64/1,000). Among nulliparous women, the most common risk factor for placenta previa was in vitro fertilization (IVF); placenta previa was not associated with an increased prevalence of SGA, controlling for maternal age, smoking, IVF, socioeconomic status, and preeclampsia (aOR=0.81; 95% CI=0.57–1.17). Among multiparous women, placenta previa was associated with a two-fold increased risk of SGA, controlling for maternal age, parity, prior preterm birth, prior caesarean delivery, prior SGA newborn, prior preeclampsia, smoking, IVF, socioeconomic status, and preeclampsia (aOR=2.08; 95% CI=1.50–2.89). Further, only one fourth of the association between SGA and placenta previa could be explained by controlling for risk factors clustering with placenta previa among multiparous women. Conclusions Placenta previa is associated with impaired fetal growth in multiparous but not nulliparous women. PMID:25004348

Frequency of placenta previa in previously scarred and non scarred uterus

PubMed Central

Majeed, Tayyaba; Waheed, Fatima; Mahmood, Zahid; Saba, Kanwal; Mahmood, Hamis; Bukhari, Mulazim Hussain

2015-01-01

Objective: To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. Methods: A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections (37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus) in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008– December 2011. Results: Most patients (47.36%) were between 26-30 years age group, presented with gestational age between 36-40 weeks (70.17%), were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% (37 cases), and frequency in previously scarred uterus was 67.54% (77 cases). Major degree Previa was found in 88 cases (77.19%). There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa (10.67%) from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. Conclusion: A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus. PMID:26101491

Transabdominal ultrasonography as a screening test for second-trimester placenta previa.

PubMed

Quant, Hayley S; Friedman, Alexander M; Wang, Eileen; Parry, Samuel; Schwartz, Nadav

2014-03-01

To determine the test characteristics of transabdominal ultrasonography as a screening test for second-trimester placenta previa. This secondary analysis of a prospective cohort study evaluated the distance from the placental edge to the internal os (placenta-cervix distance) through both transabdominal and transvaginal ultrasonography during the anatomic survey. Patients were recruited in the Maternal-Fetal Medicine Ultrasound Unit at the Hospital of the University of Pennsylvania, an urban tertiary care center. Transabdominal placenta-cervix distance cutoffs with high sensitivity for detection of previa and low-lying placenta were identified, and test characteristics were calculated. Follow-up ultrasound data, pregnancy, and delivery outcomes for those with second-trimester previa or low-lying placenta were obtained. One thousand two hundred fourteen women were included in the analysis. A transabdominal placenta-cervix distance cutoff of 4.2 cm was 93.3% sensitive and 76.7% specific for detection of previa with a 99.8% negative predictive value at a screen-positive rate of 25.0%. A cutoff of 2.8 cm was 86.7% sensitive and 90.5% specific with a 99.6% negative predictive value at a screen-positive rate of 11.4%. Only 9.8% (four of 41) of previas and low-lying placentas persisted through delivery. Transabdominal ultrasonography is an effective screening test for second-trimester placenta previa. At centers not performing universal transvaginal ultrasonography at the time of the anatomic survey, evidence-based transabdominal placenta-cervix distance cutoffs can optimize the identification of patients who require further surveillance for previa.

The role of shear wave elastography in the assessment of placenta previa-accreta.

PubMed

Alıcı Davutoglu, Ebru; Ariöz Habibi, Hatice; Ozel, Ayşegül; Yuksel, Mehmet Aytac; Adaletli, Ibrahim; Madazlı, Riza

2018-06-01

To evaluate the value of shear wave elastography (SWE) in the prediction of morbidly adherent placenta. Forty-three women with normal placental location and 26 women with anteriorly localized placenta previa were recruited for this case-control study. Placental elasticity values in both the groups were determined by SWE imaging. SWE values were higher in the placenta previa group in all regions than in normal localized placentas (p < .01). However, there was no statistically significant difference between SWE values of placenta previa with and without morbidly adherent placenta (p > .05). Placental stiffness is significantly higher in placenta previa than normal localized placentas. However, we could not demonstrate any statistically significant difference in the elasticity values between the placenta previa with and without accreta.

Complete Placenta Previa: Ultrasound Biometry and Surgical Outcomes

PubMed Central

Wortman, Alison C.; Schaefer, Stephanie L.; McIntire, Donald D.; Sheffield, Jeanne S.; Twickler, Diane M.

2018-01-01

Objective  To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa. Study Design  This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge. If morbidly adherent placentation was suspected, women were excluded. Receiver operating characteristic (ROC) curves were developed for pertinent surgical outcomes, and multivariate analysis was performed to determine the placental extension with the best predictive discriminatory zone. Results  In total, 157 women had placenta previa, ultrasound, and delivery data: 86 (55%) had a placental extension of <40 mm, and 71 (45%) had a placental extension of ≥40 mm. Women with placental extension of ≥40 mm had increased surgical time, blood loss > 2,000 mL, blood transfusion, and rate of peripartum hysterectomy. After multivariate analysis, only peripartum hysterectomy and surgical time > 90 minutes remained significant, p ≤ 0.05 and p ≤ 0.01, respectively. Conclusion  In women with placenta previa, the placental extension ultrasound measurement of ≥40 mm is a predictor of adverse surgical outcomes. PMID:29686936

Complete Placenta Previa: Ultrasound Biometry and Surgical Outcomes.

PubMed

Wortman, Alison C; Schaefer, Stephanie L; McIntire, Donald D; Sheffield, Jeanne S; Twickler, Diane M

2018-04-01

Objective  To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa. Study Design  This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge. If morbidly adherent placentation was suspected, women were excluded. Receiver operating characteristic (ROC) curves were developed for pertinent surgical outcomes, and multivariate analysis was performed to determine the placental extension with the best predictive discriminatory zone. Results  In total, 157 women had placenta previa, ultrasound, and delivery data: 86 (55%) had a placental extension of <40 mm, and 71 (45%) had a placental extension of ≥40 mm. Women with placental extension of ≥40 mm had increased surgical time, blood loss > 2,000 mL, blood transfusion, and rate of peripartum hysterectomy. After multivariate analysis, only peripartum hysterectomy and surgical time > 90 minutes remained significant, p ≤ 0.05 and p ≤ 0.01, respectively. Conclusion  In women with placenta previa, the placental extension ultrasound measurement of ≥40 mm is a predictor of adverse surgical outcomes.

Relationship between placenta location and resolution of second trimester placenta previa.

PubMed

Feng, Yun; Li, Xue-Yin; Xiao, Juan; Li, Wei; Liu, Jing; Zeng, Xue; Chen, Xi; Chen, Kai-Yue; Fan, Lei; Chen, Su-Hua

2017-06-01

This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20 +0 weeks and 25 +6 weeks. They were grouped according to their placenta location (anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity (P=0.040) and have increased number of dilatation and curettage (P=0.044). The women in cesarean section group were significantly older (P=0.000) and had more parity (P=0.000), gravidity (P=0.000), and dilatation and curettage (P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution (P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group (P=0.002) and non-cesarean section group (P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.

Placenta previa and long-term morbidity of the term offspring.

PubMed

Walfisch, Asnat; Beharier, Ofer; Shoham-Vardi, Ilana; Sergienko, Ruslan; Landau, Daniella; Sheiner, Eyal

2016-08-01

The long-term impact of placenta previa on term infants is unknown. We aimed to investigate whether abnormal placentation increases the risk for long-term morbidity of the term offspring. A population-based cohort study compared the incidence of long-term hospitalizations up to the age of 18 due to cardiovascular, endocrine, neurological, hematological, respiratory and urinary morbidity of children born at term in pregnancies diagnosed with placenta previa and those without. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence over time. A multivariable generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. During the study period 233,123 term deliveries met the inclusion criteria; 0.2% (n=502) of the children were born to mothers with placenta previa. During the follow-up period, children born to mothers with placenta previa did not have an increased risk for long-term cardiovascular, endocrine, hematological, neurological, respiratory, and urinary morbidity. Term offsprings of mothers diagnosed with placenta previa do not appear to be at an increased risk for long-term morbidity up to the age of 18. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Conservative management of placenta previa complicated by abnormal placentation.

PubMed

Bręborowicz, Grzegorz H; Markwitz, Wiesław; Gaca, Michał; Koziołek, Agnieszka; Ropacka-Lesiak, Mariola; Dera, Anna; Brych, Mariusz; Szymankiewicz-Bręborowicz, Marta; Kruszyński, Grzegorz; Gruca-Stryjak, Karolina; Madejczyk, Mateusz; Szpera-Goździewicz, Agata; Krzyścin, Mariola

2013-07-01

Abnormal implantation of placenta previa is life-threatening condition. The purpose of this study was to evaluate the impact of the conservative management of pregnancies with such complication on maternal morbidity rate and the chance for uterine preservation (fertility). Eleven patients with abnormal implantation of placenta previa were analyzed prospectively. This complication was diagnosed antenatally by two-dimensional ultrasound and color flow Doppler. The following outcomes were analyzed: need for blood transfusion, admission and duration of stay in intensive care unit, infections, coagulopathies, time between cesarean section and delivery of placenta, hysterectomy and preservation of uterus. Among the 20 085 women who had a singleton gestation, 11 (0.054%) were identified with placenta previa with abnormal placentation. In five patients (group A), hysterectomy was performed because of hemorrhage or placenta ablation. In six patients (group B), conservative management succeeded and placenta were preserved. In group A, placenta were delivered earlier (2 d-8 weeks) in comparison with group B (6-15 weeks). Estimated blood loss during the delayed delivery of placenta was higher in the group with hysterectomy (respectively, 450-1600 and 300-500 ml). Conservative management of placenta previa with abnormal implantation decreases the risk of severe hemorrhage at the time of delivery and can preserve fertility.

Placenta previa and risk of major congenital malformations among singleton births in Finland.

PubMed

Kancherla, Vijaya; Räisänen, Sari; Gissler, Mika; Kramer, Michael R; Heinonen, Seppo

2015-06-01

Placenta previa has been associated with adverse birth outcomes, but its association with congenital malformations is inconclusive. We examined the association between placenta previa and major congenital malformations among singleton births in Finland. We performed a retrospective population register-based study on all singletons born at or after 22+0 weeks of gestation in Finland during 2000 to 2010. We linked three national health registers: the Finnish Medical Birth Register, the Hospital Discharge Register, and the Register of Congenital Malformations, and examined several demographic and clinical characteristics among women with and without placenta previa, in association with major congenital malformations. We estimated adjusted odds ratios and 95% confidence intervals using multivariable logistic regression models. The prevalence of placenta previa was estimated as 2.65 per 1000 singleton births in Finland (95% confidence interval, 2.53-2.79). Overall, 6.2% of women with placenta previa delivered a singleton infant with a major congenital malformation, compared with 3.8% of unaffected women (p ≤ 0.001). Placenta previa was positively associated with almost 1.6-fold increased risk of major congenital malformations in the offspring, after controlling for maternal age, parity, fetal sex, smoking, socio-economic status, chorionic villus biopsy, In vitro fertilization, pre-existing diabetes, depression, preeclampsia, and prior caesarean section (adjusted odds ratio = 1.55; 95% confidence interval, 1.27-1.90). Using a large population-based study, we found that placenta previa was weakly, but significantly associated with an increased risk of major congenital malformations in singleton births. Future studies should examine the association between placenta previa and individual types of congenital malformations, specifically in high-risk pregnancies. © 2015 Wiley Periodicals, Inc.

Risk Factors and Consequent Outcomes of Placenta Previa: Report From a Referral Center.

PubMed

Saleh Gargari, Soraya; Seify, Zahra; Haghighi, Ladan; Khoshnood Shariati, Maryam; Mirzamoradi, Masoumeh

2016-11-01

 Because of an unknown factor, the frequency of complicated pregnancy with placenta previa has been raised during past decade. This study was designed to deepen our understanding of risk factors and outcomes of placenta previa in our country. This study investigated 694 cases of placenta previa comparing with 600 healthy pregnant women with not overlie placenta in two referral and tertiary Obstetrics and Gynecological Hospital in Iran on the basis of the clinical and para-clinical analysis, in order to find the probable risk factors for occurrence of placenta previa and its effect on maternal and neonatal complications. The most important risk factor for the occurrence of placenta previa was advanced maternal age (P<0.001) and history of stillbirth (OR=117.2, CI=58.3-236.0). In the other hand, the most substantial outcome of this disorder was a reduction of gestational age (P<0.001) and low birth weight neonatally (P<0.001). The conservative follow-up should be programmed for women with placenta previa based on the type of risk factors which can provide the best possible management to decrease the morbidity and mortality of their related complications.

Validation of the Preverbal Visual Assessment (PreViAs) questionnaire.

PubMed

García-Ormaechea, Inés; González, Inmaculada; Duplá, María; Andres, Eva; Pueyo, Victoria

2014-10-01

Visual cognitive integrative functions need to be evaluated by a behavioral assessment, which requires an experienced evaluator. The Preverbal Visual Assessment (PreViAs) questionnaire was designed to evaluate these functions, both in general pediatric population or in children with high risk of visual cognitive problems, through primary caregivers' answers. We aimed to validate the PreViAs questionnaire by comparing caregiver reports with results from a comprehensive clinical protocol. A total of 220 infants (<2 years old) were divided into two groups according to visual development, as determined by the clinical protocol. Their primary caregivers completed the PreViAs questionnaire, which consists of 30 questions related to one or more visual domains: visual attention, visual communication, visual-motor coordination, and visual processing. Questionnaire answers were compared with results of behavioral assessments performed by three pediatric ophthalmologists. Results of the clinical protocol classified 128 infants as having normal visual maturation, and 92 as having abnormal visual maturation. The specificity of PreViAs questionnaire was >80%, and sensitivity was 64%-79%. More than 80% of the infants were correctly classified, and test-retest reliability exceeded 0.9 for all domains. The PreViAs questionnaire is useful to detect abnormal visual maturation in infants from birth to 24months of age. It improves the anamnesis process in infants at risk of visual dysfunctions. Copyright © 2014. Published by Elsevier Ireland Ltd.

A 5-year review of pattern of placenta previa in Ilorin, Nigeria.

PubMed

Omokanye, L O; Olatinwo, A W O; Salaudeen, A G; Ajiboye, A D; Durowade, K A

2017-01-01

Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study. There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a significant association between patients' age, parity, booking status, and types of placenta previa ( P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa ( P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality. From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa.

Cervical varix complicated by placenta previa: A case report and literature review.

PubMed

Tanaka, Mie; Matsuzaki, Shinya; Kumasawa, Keiichi; Suzuki, Yosuke; Endo, Masayuki; Kimura, Tadashi

2016-07-01

Uterine cervical varix is rare, and its clinical course is poorly understood. Therefore, we present a case report of cervical varix complicating placenta previa before describing our findings in the context of an electronic database search of relevant reports. In the case report, we describe the clinical course and imaging results of a 35-year-old woman who was diagnosed with cervical varix complicated by placenta previa. Investigation by magnetic resonance imaging, serial ultrasonography, and speculum confirmed the diagnosis, and a healthy baby was successfully delivered at 36 weeks of gestation by cesarean section. An electronic search identified nine previous cases of cervical varix complicated by placenta previa in the literature. Clinicians should be aware of cervical varices when managing placenta previa to avoid iatrogenic rupture or misdiagnosis of placenta accreta by magnetic resonance imaging. © 2016 Japan Society of Obstetrics and Gynecology.

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa.

PubMed

Pei, Renguang; Wang, Guoxiang; Wang, Heping; Huang, Xinyu; Yan, Xiaoxing; Yang, Xiaohua

2017-03-01

To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. A cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed. Vaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed. Uterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.

[Risk factors of peripartum hysterectomy in placenta previa: a retrospective study of 3 840 cases].

PubMed

Lyu, B; Chen, M; Liu, X X

2016-07-25

To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section(OR=12.9,95% CI:6.3-26.3), two or more prior cesarean sections(OR=14.4, 95%CI:3.9-53.2), anterior placenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L(OR=1.7, 95%CI: 1.0-2.8)and delivery before 34 gestational weeks(OR=3.2, 95%CI: 1.6-6.3)were independent risk factors of peripartum hysterectomy in patients with placenta previa(P<0.05). Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa

A 5-year review of pattern of placenta previa in Ilorin, Nigeria

PubMed Central

Omokanye, L. O.; Olatinwo, A. W. O.; Salaudeen, A. G.; Ajiboye, A. D.; Durowade, K. A.

2017-01-01

Background: Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. Methodology: This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study. Results: There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a significant association between patients’ age, parity, booking status, and types of placenta previa (P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa (P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality. Conclusion: From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa. PMID:28539861

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pei, Renguang, E-mail: mediprg@bjmu.edu.cn; Wang, Guoxiang; Wang, Heping

PurposeTo appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa.MethodsA cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed.ResultsVaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery,more » and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed.ConclusionUterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.« less

Prevalence of placenta previa among deliveries in Mainland China: A PRISMA-compliant systematic review and meta-analysis.

PubMed

Fan, Dazhi; Wu, Song; Wang, Wen; Xin, Lihong; Tian, Guo; Liu, Li; Feng, Jinping; Guo, Xiaoling; Liu, Zhengping

2016-10-01

Placenta previa is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics. We aimed to obtain overall and regional estimates of placenta previa prevalence among deliveries in Mainland China. The research was performed a systematic review, following the Meta-analysis of observational studies in epidemiology (MOOSE) guidelines for systematic reviews of observational studies, and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement for reporting systematic reviews and meta-analysis. Electronic databases were searched and included hospital-based studies that reported placenta previa prevalence in Mainland China. Random-effects meta-analyses were used to pool prevalence estimates of placenta previa. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. For exploring the geographical distributions of placenta previa, the ArcGIS software (Esri) was used to construct the map of prevalence. A total of 80 articles and 86 datasets (including 1,298,548 subjects and 14,199 placenta previa cases) from 1965 through 2015 were included. The pooled overall prevalence of placenta previa among deliveries was 1.24% (95% confidence interval [CI], 1.12-1.36) in Mainland China during 1965 to 2015. And, the trend in the prevalence of placenta previa was steady. The occurrence rate of placenta previa in the region groups Northeast, North, Northwest, Central China, East, South, and Southwest was 1.20%, 1.01%, 1.10%, 1.15%, 0.93%, 1.42%, and 2.01%, respectively. The prevalence map based on a geographic information system showed an unequal geographic distribution. The results showed that placenta previa is currently a high-burden disease in Mainland China. This review would be useful for the design of placenta previa planning and implementation adequate health care systems and treatment

Placenta previa. A 13 years experience at a tertiary care center in Western Saudi Arabia.

PubMed

Abduljabbar, Hassan S; Bahkali, Nedaa M; Al-Basri, Samera F; Al Hachim, Estabrq; Shoudary, Ibrahim H; Dause, Wesam R; Mira, Mohammed Y; Khojah, Mohammed

2016-07-01

To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity.  A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013.    The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding.   Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of less than 36 weeks, and estimated blood loss more than 2000 ml.

Uterine artery embolization, not cesarean section, as an option for termination of pregnancy in placenta previa.

PubMed

Huang, Lingling; Awale, Reenu; Tang, Hui; Zeng, ZhiShan; Li, FuRong; Chen, Yue

2015-04-01

To summarize our experiences in the treatment of labor induction in placenta previa using uterine artery embolization. We retrospectively analyzed the clinical data of seven patients with placenta previa who underwent antepartum uterine artery embolization before vaginal delivery. After antepartum embolization, five patients with placenta previa had successful vaginal deliveries and two cases of placenta previa with accreta underwent emergency hysterectomy. Some complications were reported in this experience. The follow-up study showed that most patients resumed their normal menstruation and some of them were able to conceive. For the management of placenta previa, uterine artery embolization is a minimally invasive technique that helps to avoid cesarean section. The impact on menstruation and fertility is yet to be seen. Copyright © 2015. Published by Elsevier B.V.

Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum

PubMed Central

Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

2014-01-01

Objective To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. Material and Methods A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Results Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. Conclusion The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered. PMID:25584028

Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum.

PubMed

Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

2014-01-01

To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered.

Comparison of transabdominal and transvaginal sonography in the diagnosis of placenta previa.

PubMed

Petpichetchian, Chusana; Pranpanus, Savitree; Suntharasaj, Thitima; Kor-Anantakul, Ounjai; Hanprasertpong, Tharangrut

2018-07-01

To compare the accuracies of transabdominal sonography (TAS) and transvaginal sonography (TVS) in the diagnosis of placenta previa. A prospective, cross-sectional study was conducted at a university hospital. Both TAS and TVS were performed on 81 pregnant women with a suspicion of placenta previa in the third trimester. The final diagnosis was confirmed at delivery. The agreement between the two ultrasound methods and the parameters of each method were calculated. Fifty-eight percent of the women had a placenta previa. The sensitivities of TAS and TVS were 86% (95% CI 78-94%) and 95% (95% CI 91-100%), respectively (p= 0.2). The specificity of both methods was 93% (95 CI 88-99%), and the overall accuracies of TAS and TVS were 89% (95% CI 82-96%) and 94% (95% CI 89-100%), respectively. When TAS was followed by TVS, 23% of the previous diagnoses were changed. The agreement between both methods was good (Kappa value = 0.7, 95%CI 0.55-0.86). For the diagnosis of placenta previa, TAS showed a high sensitivity and specificity, which were comparable to those of TVS. © 2018 Wiley Periodicals, Inc.

Safety of cesarean delivery through placental incision in patients with anterior placenta previa.

PubMed

Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa; Jeong, Eun-Hwan

2016-03-01

To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique.

Safety of cesarean delivery through placental incision in patients with anterior placenta previa

PubMed Central

Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa

2016-01-01

Objective To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. Methods We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. Results There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Conclusion Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique. PMID:27004200

Acute and massive bleeding from placenta previa and infants' brain damage.

PubMed

Furuta, Ken; Tokunaga, Shuichi; Furukawa, Seishi; Sameshima, Hiroshi

2014-09-01

Among the causes of third trimester bleeding, the impact of placenta previa on cerebral palsy is not well known. To clarify the effect of maternal bleeding from placenta previa on cerebral palsy, and in particular when and how it occurs. A descriptive study. Sixty infants born to mothers with placenta previa in our regional population-based study of 160,000 deliveries from 1998 to 2012. Premature deliveries occurring at<26 weeks of gestation and placenta accreta were excluded. Prevalence of cystic periventricular leukomalacia (PVL) and cerebral palsy (CP). Five infants had PVL and 4 of these infants developed CP (1/40,000 deliveries). Acute and massive bleeding (>500g within 8h) occurred at around 30-31 weeks of gestation, and was severe enough to deliver the fetus. None of the 5 infants with PVL underwent antenatal corticosteroid treatment, and 1 infant had mild neonatal hypocapnia with a PaCO2 <25mmHg. However, none of the 5 PVL infants showed umbilical arterial acidemia with pH<7.2, an abnormal fetal heart rate monitoring pattern, or neonatal hypotension. Our descriptive study showed that acute and massive bleeding from placenta previa at around 30 weeks of gestation may be a risk factor for CP, and requires careful neonatal follow-up. The underlying process connecting massive placental bleeding and PVL requires further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis.

PubMed

Fan, Dazhi; Xia, Qing; Liu, Li; Wu, Shuzhen; Tian, Guo; Wang, Wen; Wu, Song; Guo, Xiaoling; Liu, Zhengping

2017-01-01

The global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them. The aim of this study was to calculate the average point incidence of PPH in women with placenta previa. A systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard. From 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8-28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0-41.6%), followed by the Asia (20.7%, 95%CI 12.8-28.6%), Australia (19.2%, 95% CI 17.2-21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%). The summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies.

Effect of placenta previa on neonatal respiratory disorders and amniotic lamellar body counts at 36-38weeks of gestation.

PubMed

Tsuda, Hiroyuki; Kotani, Tomomi; Sumigama, Seiji; Mano, Yukio; Hua, Li; Hayakawa, Hiromi; Hayakawa, Masahiro; Sato, Yoshiaki; Kikkawa, Fumitaka

2014-01-01

Pregnancies with placenta previa are significantly associated with preterm delivery and cesarean section. Therefore particular attention should be paid to the incidence of neonatal respiratory disorders in pregnancies with placenta previa. The purpose of this study is to examine the relationship between placenta previa and neonatal respiratory disorders, including respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN), and to evaluate the impact of placenta previa on the amniotic lamellar body count (LBC) values. We analyzed the data from 186 registered elective cesarean cases without fetal or maternal complications at 36-38weeks of gestation. Amniotic fluid samples were analyzed immediately without centrifugation, and the LBC was measured using a platelet channel on the Sysmex XE-2100. RDS was present in four neonates (2.2%) and TTN in 12 neonates (6.5%). The rate of TTN was significantly higher and the LBC values were significantly lower in the placenta previa group than in the control group (P=0.002 and P=0.024). The adjusted odds ratio for neonatal TTN was 7.20 (95% confidence interval: 6.58-7.88) among females with placenta previa. In placenta previa, warning bleeding was a significant factor protecting against neonatal respiratory disorders (P=0.046). Placenta previa in itself is a risk factor for neonatal TTN. When an elective cesarean section is performed in cases with uncomplicated placenta previa, special care should be taken to monitor for neonatal TTN even at 36-38weeks of gestation. © 2013.

The association of placenta previa and assisted reproductive techniques: a meta-analysis.

PubMed

Karami, Manoochehr; Jenabi, Ensiyeh; Fereidooni, Bita

2018-07-01

Several epidemiological studies have determined that assisted reproductive techniques (ART) can increase the risk of placenta previa. To date, only a meta-analysis has been performed for assessing the relationship between placenta previa and ART. This meta-analysis was conducted to estimate the association between placenta previa and ART in singleton and twin pregnancies. A literature search was performed in major databases PubMed, Web of Science, and Scopus from the earliest possible year to April 2017. The heterogeneity across studies was explored by Q-test and I 2 statistic. The publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) and relative risk (RR) estimates with its 95% confidence intervals (CI) using a random-effects model. The literature search yielded 1529 publications until September 2016 with 1,388,592 participants. The overall estimate of OR was 2.67 (95%CI: 2.01, 3.34) and RR was 3.62 (95%CI: 0.21, 7.03) based on singleton pregnancies. The overall estimate of OR was 1.50 (95%CI: 1.26, 1.74) based on twin pregnancies. We showed based on odds ratio reports in observational studies that ART procedures are a risk factor for placenta previa.

The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis

PubMed Central

Liu, Li; Wu, Shuzhen; Tian, Guo; Wang, Wen; Wu, Song; Guo, Xiaoling; Liu, Zhengping

2017-01-01

Background The global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them. Objective The aim of this study was to calculate the average point incidence of PPH in women with placenta previa. Methods A systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard. Results From 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8–28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%). Conclusions The summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies. PMID:28107460

[Severe Adverse Pregnancy Outcomes in Placenta Previa and Prior Cesarean Delivery].

PubMed

Zhou, Mi; Chen, Meng; Zhang, Li; He, Guo-Lin; He, Lei; Wei, Qiang; Li, Tao; Liu, Xing-Hui

2017-09-01

To investigate the severe adverse pregnancy outcomes in pregnancies with placenta previa and prior cesarean delivery and its risk factors. This retrospective casecontrol study reviewed all pregnancies with placenta previa and prior cesarean delivery delivered by repeat cesarean section in our institution between January 2005 and June 2015,and investigated the incidence of severe adverse pregnancy outcome. A composite of severe adverse pregnancy outcomes (including transfusion of 10 units or more red blood cells,maternal ICU admission,unanticipated injuries,repeat operation,hysterectomy,and maternal death) and other maternal and neonatal outcomes were described. Univariate and multivariable logistic regression analysis were used to quantify the effects of risk factors on severe adverse pregnancy outcomes. There were 478 women with placenta previa and prior cesarean delivery in our hospital over the last decade. The average age of them was 32.5±4.8 years old,most women were beyond 30 years old,the average gravidity and parity were 4 and 1,131 cases (27.4%) had severe adverse pregnancy outcomes. Transfusion of 10 units or more red blood cells happened in 75 cases (15.7%,75/478); 44 cases (9.2%,44/478) necessitated maternal ICU admission; unanticipated bladder injury occurred in 11 cases,but non ureter or bowel injury happened; All 4 repeat operations were due to delayed hemorrhage after conservative management during cesarean delivery,and an emergent hysterectomy was performed for all of the 4 cases. Hysterectomy (107 cases,22.4%) was the most common severe adverse pregnancy outcome. Among all 311 morbidly adherent placenta cases finally confirmed by pathological or surgical findings or both,only 172 (55.3%) were suspected before delivery. Multivariable logistic regression analysis showed that the risk of severe adverse pregnancy outcomes was significantly increased by pernicious placenta previa (i.e. anterior placenta overlying the prior cesarean scar),suspicion of

Increased expression of high mobility group box protein 1 and vascular endothelial growth factor in placenta previa.

PubMed

Xie, Han; Qiao, Ping; Lu, Yi; Li, Ying; Tang, Yuping; Huang, Yiying; Bao, Yirong; Ying, Hao

2017-12-01

Placenta previa is often associated with preterm delivery, reduced birth weight, a higher frequency of placental accreta and postpartum haemorrhage, and increased likelihood of blood transfusion. The present study aimed to examine the expression of high mobility group box protein 1 (HMGB1) in the placenta of women with or without placenta previa. The study group consisted of placental tissues obtained from women with or without placenta previa. The expression levels of HMGB1 and vascular endothelial growth factor (VEGF) were evaluated in the placental tissues using reverse transcription‑quantitative polymerase chain reaction, western blotting and immunohistochemistry. The mRNA expression levels of HMGB1 and VEGF were significantly increased in the placenta previa group compared with in the normal group. In addition, the placenta previa group exhibited increased HMGB1 and VEGF staining in vascular endothelial cells and trophoblasts. There were no significant differences in the expression of HMGB1 or VEGF between groups with or without placenta accreta or postpartum haemorrhage. The present study hypothesised that the increased expression of HMGB1 in the placenta may be associated with the pathogenesis of placenta previa by regulating the expression of the proangiogenic factor VEGF.

Development of the Preverbal Visual Assessment (PreViAs) questionnaire.

PubMed

Pueyo, Victoria; García-Ormaechea, Inés; González, Inmaculada; Ferrer, Concepción; de la Mata, Guillermo; Duplá, María; Orós, Pedro; Andres, Eva

2014-04-01

Visual cognitive functions of preverbal infants are evaluated by means of a behavioral assessment. Parents or primary caregivers may be appropriate to certify the acquisition of certain abilities. To develop the PreViAs (Preverbal Visual Assessment) questionnaire to assess visual behavior of infants under 24 months of age and to assess the normative outcomes for each item at each age. The process was divided into three phases: scale development (items and domains generation), pilot testing, and exploratory analysis. The final version of the PreViAs questionnaire consisted of 30 items, each related to one or more of four domains (visual attention, visual communication, visual-motor coordination, and visual processing). For the exploratory analysis, 298 children (159 boys and 139 girls) were recruited. Their ages ranged from 0.1 to 24 months (mean, 11.2 months). Internal consistency of the questionnaire was high for all domains (Cronbach's α coefficients of 0.85-0.94). The PreViAs questionnaire is a useful scale for assessing visual cognitive abilities of infants under 24 months of age. It is easy and feasible to complete by primary caregivers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa.

PubMed

Weiner, Eran; Miremberg, Hadas; Grinstein, Ehud; Schreiber, Letizia; Ginath, Shimon; Bar, Jacob; Kovo, Michal

2016-10-01

The mechanisms involved in bleeding in cases of placenta previa (PP) and the effect on pregnancy outcome is unclear. We aimed to compare pregnancy outcome and placental histopathology in pregnancies complicated with symptomatic (bleeding) vs. non-symptomatic PP, and to study the effects of the co-existence of histopathological retro-placental hemorrhage (RPH) in cases of symptomatic PP on neonatal and maternal outcomes. Labor and maternal characteristics, neonatal outcome and placental histopathology lesions of pregnancies with PP, delivered between 24 and 42weeks, during 2009-2015, were reviewed. Results were compared between PP who had elective cesarean delivery (CD) (previa group) and PP with bleeding necessitating emergent CD (symptomatic previa group). Placental lesions were classified to lesions consistent with maternal malperfusion or fetal thrombo-occlusive disease (vascular and villous changes), and inflammatory lesions. Compared to the previa group (n=63), the symptomatic previa group (n=74) was characterized by older patients (p<0.001), higher rate of smokers (p=0.005), thrombophilia (p=0.038), and preterm deliveries (p<0.001). Placentas within the symptomatic previa group were smaller, with higher rates of weight<10th% (p=0.02), RPH (p<0.001) and villous changes related to maternal malperfusion (p=0.023). As compared to symptomatic PP without RPH, co-existence of RPH was associated with higher rate of adverse neonatal outcome (p<0.001) and maternal blood transfusion (p=0.02). On multivariate regression analysis, composite adverse neonatal outcome was found to be dependent on coexisting RPH (OR=2.8, 95%CI 1.2-11.7, p=0.03), and low gestational age (OR=3.1, 95%CI 1.6-4.9, p=0.02). Symptomatic placenta previa is associated with increased placental malperfusion lesions suggesting an association of maternal malperfusion with abnormal placental separation. The coexisting finding of RPH with symptomatic placenta previa can be seen as a marker for more

Vasa previa screening strategies: a decision and cost-effectiveness analysis.

PubMed

Sinkey, R G; Odibo, A O

2018-05-22

The aim of this study is to perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa among singleton pregnancies. A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios which occurred at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening pregnancies conceived by in vitro fertilization (IVF), and universal screening. Ultrasound-indicated screening was defined as performing a transvaginal ultrasound at the time of routine anatomy ultrasound in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion, or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality adjusted life years (QALY) in U.S. dollars. The analysis was from a healthcare system perspective with a willingness to pay (WTP) threshold of $100,000 per QALY selected. One-way and multivariate sensitivity analyses (Monte-Carlo simulation) were performed. This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy with an incremental cost effectiveness ratio (ICER) of $29,186.50 / QALY. Ultrasound-indicated screening was the second most cost-effective with an ICER of $56,096.77 / QALY. These data were robust to all one-way and multivariate sensitivity analyses performed. Within our baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. This article is protected by copyright. All rights reserved. This

Resolution of a Low-Lying Placenta and Placenta Previa Diagnosed at the Midtrimester Anatomy Scan.

PubMed

Durst, Jennifer K; Tuuli, Methodius G; Temming, Lorene A; Hamilton, Owen; Dicke, Jeffrey M

2018-02-05

To identify the incidence and resolution rates of a low-lying placenta or placenta previa and to assess the optimal time to perform follow-up ultrasonography (US) to assess for resolution. We conducted a retrospective cohort study of women with a diagnosis of a low-lying placenta or placenta previa at routine anatomic screening. Follow-up US examinations were reviewed to estimate the proportion of women who had resolution. A Kaplan-Meier survival curve was generated to estimate the median time to resolution. The distance of the placental edge from the internal cervical os was used to categorize the placenta as previa or low-lying (0.1-10 or ≥ 10-20 mm). A time-to-event analysis was used to estimate predictive factors and the time to resolution by distance from the os. A total of 1663 (8.7%) women had a diagnosis of a low-lying placenta or placenta previa. The cumulative resolution for women who completed 1 or more additional US examinations was 91.9% (95% confidence interval, 90.2%-93.3%). The median time to resolution was 10 (interquartile range [IQR], 7-13) weeks. The distance from the internal cervical os was known for 658 (51.0%) women. The probability of resolution was inversely proportional to the distance from the internal os: 99.5% (≥10-20 mm), 95.4% (0.1-10 mm), and 72.3% (placenta previa; P < .001). The median times to resolution were 9 (IQR, 7-12) weeks for 10 to 20 mm, 10 (IQR, 7-13) weeks for 0.1 to 10 mm, and 12 (IQR, 9-15) weeks for placenta previa (P = .0003, log rank test). A low-lying placenta or placenta previa diagnosed at the midtrimester anatomy survey resolves in most patients. Resolution is near universal in patients with an initial distance from the internal os of 10 mm or greater. © 2018 by the American Institute of Ultrasound in Medicine.

Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging.

PubMed

Tanimura, Kenji; Yamasaki, Yui; Ebina, Yasuhiko; Deguchi, Masashi; Ueno, Yoshiko; Kitajima, Kazuhiro; Yamada, Hideto

2015-04-01

Adherent placenta is a life-threatening condition in pregnancy, and is often complicated by placenta previa. The aim of this prospective study was to determine prenatal imaging findings that predict the presence of adherent placenta in pregnancies with placenta previa. The study included 58 consecutive pregnant women with placenta previa who underwent both ultrasonography and magnetic resonance imaging prenatally. Ultrasonographic findings of anterior placental location, grade 2 or higher placental lacunae (PL≥G2), loss of retroplacental hypoechoic clear zone (LCZ) and the presence of turbulent blood flow in the arteries were evaluated, in addition to MRI findings. Forty-three women underwent cesarean section alone; 15 women with adherent placenta underwent cesarean section followed by hysterectomy with pathological examination. To determine imaging findings that predict adherent placenta, univariate and multivariate logistic regression analyses were performed. Univariate logistic regression analyses demonstrated that anterior placental location, PL≥G2, LCZ, and MRI were associated with the presence of adherent placenta. Multivariate analyses revealed that LCZ (p<0.01, odds ratio 15.6, 95%CI 2.1-114.6) was a single significant predictor of adherent placenta in women with placenta previa. This prospective study demonstrated for the first time that US findings, especially LCZ, might be useful for identifying patients at high risk for adherent placenta among pregnant women with placenta previa. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Placenta previa with early opening of the uterine isthmus is associated with high risk of bleeding during pregnancy, and massive haemorrhage during caesarean delivery.

PubMed

Goto, M; Hasegawa, J; Arakaki, T; Takita, H; Oba, T; Nakamura, M; Sekizawa, A

2016-06-01

To demonstrate the relationship between the timing of opening of the uterine isthmus and bleeding during pregnancy and caesarean section in patients with placenta previa. A prospective observational study was conducted at a single perinatal centre. All patients with placenta previa, diagnosed between 20 and 22 weeks of gestation, who were followed up at the study hospital and underwent caesarean section were enrolled. The condition of the uterine isthmus was examined every 2 weeks. The timing (in gestational weeks) of complete opening of the uterine isthmus was determined. Patients were divided into two groups: patients in whom the uterine isthmus opened before 25 weeks of gestation (EO-previa), and patients in whom the uterine isthmus opened after 25 weeks of gestation (LO-previa). The frequency of bleeding during pregnancy and the amount of intra-operative bleeding were compared between the two groups. Forty-four cases of EO-previa and 55 cases of LO-previa were analysed. Complete placenta previa at delivery was observed more frequently in the EO-previa group than in the LO-previa group (88.6% vs 47.3%, p<0.001). An emergency caesarean section due to active bleeding was performed more frequently in the EO-previa group (48%) than in the LO-previa group (25%) (p=0.021). The frequency of massive haemorrage (>2500ml) during caesarean section was higher in the EO-previa group than in the LO-previa group (25% vs 9%, p=0.033). Placenta previa was associated with a high risk of bleeding leading to emergency caesarean section during pregnancy, and massive haemorrhage during caesarean section in patients in whom the uterine isthmus opened before 25 weeks of gestation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa.

PubMed

Soyama, Hiroaki; Miyamoto, Morikazu; Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

2016-01-01

Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was -0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >-0.33 (odds ratio, 5.88; 95% confidence interval, 3.04-12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79-6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85-92.13) were independent risk of intraoperative massive hemorrhage. In patients with placenta previa, a birth weight >-0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether

Antenatal Sonographic Diagnosis and Clinical Significance of Placenta Previa Accreta after Cesarean Section.

PubMed

Liu, Zhen-Zhen; Wei, Yao; Wang, Ruo-Jiao; Xu, Wen; Shi, Zhi-Min; Dai, Qing

2017-10-30

Objective To investigate the clinical and antenatal sonographic characteristics of placenta previa accreta after cesarean section. Methods The data of 21 inpatients diagnosed as placenta previa accreta after cesarean section in PUMC Hospital from 2006 to 2016 were retrospectively reviewed. The clinical and ultrasound features were recorded and compared among three placental accreta groups,including placenta accrete group(n=5),increta group(n=12),and percreta group(n=4). The relationship between the placental thickness at the uterine anterior lower segment level and the blood loss of the following cesarean section was tested. Results Of 21 patients,placenta previa was diagnosed by ultrasound in 20 cases(95.2%) and placenta previa accreta was diagnosed in 9 cases(42.9%). Antenatal ultrasound findings included following signs:loss of "clear zone"(15/18,83.3%),myometrial thinning(12/18,66.7%),abnormal placental lacunae(12/19,63.2%),bladder wall interruption(2/18,11.1%),and uterovesical hypervascularity(4/9,44.4%). Myometrial thinning(J-T=64.000,P=0.036),abnormal placental lacunae(J-T=74.500,P=0.032) and the placental thickness at the uterine anterior lower segment level(U=83.000,P=0.010) showed significant difference among different placenta accreta groups. Placental thickness at the uterine anterior lower segment level showed linear correlation with the blood loss of the following cesarean section(r=0.669,P=0.002). The blood loss of the following cesarean section showed significant difference among different placenta accreta groups(U=118.500,P=0.000). Conclusions The clinical and sonographic manifestations of placenta previa accreta after cesarean section show a spectrum of demographic characteristics. The measurement of thickness of placenta at the anterior lower segment may help the evaluation of the clinical prognosis of this special pathology.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

PubMed

Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

2015-01-01

The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01). Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

PubMed Central

Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

2015-01-01

Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance. PMID:26263014

Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

PubMed Central

2012-01-01

Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p < .001). Among patients with placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended. PMID:22876799

The effect of advanced maternal age on maternal and neonatal outcomes of placenta previa: A register-based cohort study.

PubMed

Roustaei, Zahra; Vehviläinen-Julkunen, Katri; Tuomainen, Tomi-Pekka; Lamminpää, Reeta; Heinonen, Seppo

2018-05-19

Advanced maternal age (AMA) at the time of delivery generally worsens obstetric outcomes, but its effects on specific pregnancy problems, such as placenta previa, have not been adequately assessed. Therefore, the objective of the study was to explore the effect of AMA on adverse maternal and neonatal outcomes among pregnancies complicated by placenta previa. The study was a register-based cohort study using data of three Finnish health registries, including information of 283 324 women and their newborns. Separate multivariable logistic regression modeling was performed for women under age 35 and women aged 35 or older to assess the association between placenta previa and adverse maternal and neonatal outcomes. Furthermore, interactions between maternal age and placenta previa were tested. A total of 283 324 deliveries of which 714 (0.3%) were complicated by placenta previa. Adverse maternal and neonatal outcomes increased in women with placenta previa, with different patterns across age groups. The adjusted odds ratios and 95% confidence intervals for AMA and young women with previa were 7.3 (5.0-10.6) and 6.8 (5.2-8.9) in blood transfusion, 11.3 (5.4-23.3) and 10.9 (6.1-19.6) in placental abruption. In neonatal outcomes the adjusted odds ratios for AMA and young women with placenta previa were 8.8 (6.6-11.6) and 11.7 (9.7-14.1) in preterm birth <37 weeks, 4.0 (3.0-5.3) and 4.9 (4.1-5.9) in neonatal intensive care unit (NICU) admission, 4.0 (2.8-5.7) and 5.9 (4.7-7.4) low birth weight <2500 g, 2.7 (1.5-4.9) and 3.3 (2.2-5.0) in low Apgar score at 5 min. The joint effects of maternal age and placenta previa on the risk of adverse maternal and neonatal outcomes were non-significant. The risk of adverse maternal and neonatal outcomes for women with placenta previa was not substantially affected by maternal age if their different risk profiles were taken into account. Copyright © 2018 Elsevier B.V. All rights reserved.

Ultrasonographic findings of placenta lacunae and a lack of a clear zone in cases with placenta previa and normal placenta.

PubMed

Hamada, Shoko; Hasegawa, Junichi; Nakamura, Masamitsu; Matsuoka, Ryu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi

2011-11-01

To evaluate whether the frequencies of placenta lacunae and lack of a clear zone are higher in cases of placenta previa compared with those without it. Ultrasonographic findings just before delivery, including placenta lacunae and lack of a clear zone were prospectively evaluated in consecutive subjects. After collection, a case-control study with 1:5 matched pairs was conducted. The frequencies of ultrasonographic findings were analyzed in cases with placenta previa and normal placenta. Seventy cases with placenta previa and 350 cases with normal placentas were observed. Five and zero cases with abnormal placental adherence were observed in cases with placenta previa and normal placenta, respectively. Lack of a clear zone was observed in 60 and 1.5% of cases with and without the placental adherence (p = 0.001). Placenta lacunae and lack of a clear zone were observed in 31.4 and 9.7% of cases with and without placenta previa [odds ratio (OR) 4.2]. Lack of a clear zone was observed in 5.7 and 0.9% of cases with and without placenta previa (OR 7.0). Placenta lacunae and lack of a clear zone are frequently observed in placenta previa even when there is no adherence of the placenta. Copyright © 2011 John Wiley & Sons, Ltd.

A Case of Vaginal Stillbirth in the Presence of Placenta Previa at 33 Weeks of Gestation

PubMed Central

Chinen, Yukiko; Kinjo, Tadatsugu; Nitta, Hayase; Kinjo, Yui; Masamoto, Hitoshi

2016-01-01

It was demonstrated that second- and third-trimester therapeutic termination of pregnancy (TOP) is feasible in cases with placenta previa. We report a 34-year-old woman with complex fetal malformations associated with placenta previa. An ultrasound examination at 21 weeks of gestation revealed fetal growth restriction (FGR) and complex fetal malformations associated with a placenta previa. After extensive information, the parents opted for careful observation. Thereafter, FGR gradually progressed and we observed arrest of end-diastolic velocity of the umbilical artery. Finally, intrauterine fetal death (IUFD) was confirmed at 33 weeks of gestation. Two days after IUFD, the patient experienced labor pain. The placenta and dead fetus weighing 961 g were vaginally delivered, and total bleeding was 270 mL. Although further studies to confirm the dynamic change of the uteroplacental blood flow are necessary to avoid the risk of maternal hemorrhage, vaginal TOP with placenta previa after feticide or IUFD would be feasible. PMID:27579202

Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study.

PubMed

Mastrolia, Salvatore Andrea; Baumfeld, Yael; Loverro, Giuseppe; Yohai, David; Hershkovitz, Reli; Weintraub, Adi Yehuda

2016-11-01

The aim of our study was to compare maternal and neonatal outcomes in women with placenta previa complicated with severe bleeding leading to hospitalization until delivery versus those without severe bleeding episodes. This is a population-based retrospective cohort study including all pregnant women with placenta previa who delivered at our medical center in the study period, divided into the following groups: 1) women with severe bleeding leading to hospitalization resulting with delivery (n = 32); 2) patients with placenta previa without severe bleeding episodes (n = 1217). Out of all women with placenta previa who delivered at our medical center, 2.6% (32/1249) had an episode of severe bleeding leading to hospitalization and resulting with delivery. The rate of anemia was lower (43.8% versus 63.7%, p = 0.02) while the need for blood transfusion higher (37.5% versus 21.1%, p = 0.03) in the study group. The rate of cesarean sections was significantly different between the groups, and a logistic regression model was constructed in order to find independent risk factors for cesarean section in our patients. To the best of our knowledge, this is the first study to evaluate the impact of severe bleeding on the outcome of pregnancies complicated with placenta previa. Our study demonstrates that, in women with placenta previa, severe bleeding does not lead to increased adverse maternal or neonatal outcomes.

The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology.

PubMed

Weiner, E; Miremberg, H; Grinstein, E; Mizrachi, Y; Schreiber, L; Bar, J; Kovo, M

2016-12-01

To compare the clinical characteristics and placental histopathology between pregnancies complicated by placenta previa and controls. Between 2009 and 2015, cesarean deliveries (CDs) of 119 pregnancies with placenta previa were identified from which maternal outcomes, neonatal outcomes and placental pathology were reviewed. Results were compared with CDs matched for maternal age and pregnancy complications (control group, n=119). Placental lesions were classified into maternal and fetal vascular supply lesions and inflammatory response. Composite neonatal outcome was defined as one or more of early neonatal complications. Small-for-gestational age (SGA) was defined as birth weight ⩽10th percentile. Placentas from the previa group had higher rates of weights <10th percentile (P<0.001) and of maternal and fetal vascular supply lesions (P<0.001, for both). Higher rate of SGA (P=0.003) and worse composite neonatal outcome (P<0.001) were also observed in the previa group as compared with controls. After controlling for potential confounding bias using multivariable logistic regression models, placenta previa remained statistically significantly associated with placental maternal (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.2-4.9, P=0.009) and fetal (aOR 7.05, 95% CI 2.4-20.2, P<0.001) vascular supply lesions, SGA (aOR 10, 95% CI 2.3-44.2, P=0.002) and adverse neonatal outcome (aOR 6.87, 95% CI 2.9-11.8, P<0.001). More placental vascular supply lesions, higher rate of SGA and worse neonatal outcome characterized pregnancies with placenta previa in the current study. These findings may suggest that abnormal placentation is accompanied by suboptimal implantation that interferes with fetal growth.

Expression of nestin in embryonic tissues and its effects on clinicopathological characteristics of patients with placenta previa.

PubMed

Qiao, Yan-Yan; Chu, Ping

2018-02-01

In this study, we examined expression of nestin in the spinal cord, lung, kidney, stomach, colon, and intestine tissues at different stages of embryos in patients with placenta previa. Fetuses of 75 patients with placenta previa were assigned to case group and 80 fetuses from healthy pregnant women with normal placenta who voluntarily terminated pregnancy to control group. Clinical data of pregnant women were collected at the time of admission. Blood from elbow vein was collected to determine expression of serum nestin. Tissues from spinal cord, lung, kidney, stomach, colon, and intestine in 3-7 months fetuses of the two groups were extracted. Expression of nestin in tissues was detected by immunohistochemistry, Western blotting and RT-qPCR. The mRNA expression of nestin in the case group was increased. Nestin expression was correlated with the gestational age, age of foetus, and type of placenta previa in patients with placenta previa. Positive nestin expression was detected in the spinal cord, lung, kidney, stomach, intestine, and colon tissues in normal and placenta previa embryo at Stage I. The positive cell density and nestin expression decreased at Stage II, and further decreased at Stage III. The case group had higher nestin mRNA and protein levels throughout human fetal development. Findings of this study suggested that, nestin, as a specific marker of neural precursor cells, was expressed in various tissues of the embryo in patients with placenta previa and nestin expression was lower with increased maturation of the embryo. © 2017 Wiley Periodicals, Inc.

A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa.

PubMed

Yoon, So-Yeon; You, Ji Yeon; Choi, Suk-Joo; Oh, Soo-Young; Kim, Jong-Hwa; Roh, Cheong-Rae

2014-09-01

To generate a combined ultrasound and clinical model predictive for peripartum complications in pregnancies complicated by placenta previa. This study included 110 singleton pregnant women with placenta previa delivered by cesarean section (CS) from July 2011 to November 2013. We prospectively collected ultrasound and clinical data before CS and observed the occurrence of blood transfusion, uterine artery embolization and cesarean hysterectomy. We formulated a scoring model including type of previa (0: partials, 2: totalis), lacunae (0: none, 1: 1-3, 2: 4-6, 3: whole), uteroplacental hypervascularity (0: normal, 1: moderate, 2: severe), multiparity (0: no, 1: yes), history of CS (0: none, 1: once, 2: ≥ twice) and history of placenta previa (0: no, 1: yes) to predict the risk of peripartum complications. In our study population, the risk of perioperative transfusion, uterine artery embolization, and cesarean hysterectomy were 26.4, 1.8 and 6.4%, respectively. The type of previa, lacunae, uteroplacental hypervascularity, parity, history of CS, and history of placenta previa were associated with complications in univariable analysis. However, no factor was independently predictive for any complication in exact logistic regression analysis. Using the scoring model, we found that total score significantly correlated with perioperative transfusion, cesarean hysterectomy and composite complication (p<0.0001, Cochrane Armitage test). Notably, all patients with total score ≥7 needed cesarean hysterectomy. When total score was ≥6, three fourths of patients needed blood transfusion. This combined scoring model may provide useful information for prediction of peripartum complications in women with placenta previa. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa

PubMed Central

Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

2016-01-01

Background Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. Materials and Methods We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Results Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was −0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >−0.33 (odds ratio, 5.88; 95% confidence interval, 3.04–12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79–6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85–92.13) were independent risk of intraoperative massive hemorrhage. Conclusion In patients with placenta previa, a birth weight >−0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on

Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis

PubMed Central

Fan, Dazhi; Wu, Song; Liu, Li; Xia, Qing; Wang, Wen; Guo, Xiaoling; Liu, Zhengping

2017-01-01

Antepartum hemorrhage (APH) is an important cause of perinatal mortality and maternal morbidity in pregnant women with placenta previa in the world. However, the epidemiological characteristics are not completely understood. We performed an initial systematic review and meta-analysis to assess the prevalence of APH in pregnant women with placenta previa. It was totally performed following the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. PubMed, Elsevier Science Direct, and the Cochrane Library were searched before April 2016. A meta-analysis with a random-effects model based on a proportions approach was performed to determine the prevalence. Stratified analyses, meta-regression method, and sensitivity analysis were utilized to analyze the heterogeneity. A total of 29 articles were included. The pooled overall prevalence of APH among pregnant women with placenta previa was 51.6% (95% CI 42.7–60.6) in a heterogeneous set of studies (I2 = 97.9). Correlation analysis found that there was a positive correlation between prevalence and percentage of multiparous (r = 0.534, P = 0.027) and a negative correlation between prevalence and survey year (r = −0.400, P = 0.031). In conclusion, the prevalence of APH was a high condition among pregnant women with placenta previa. PMID:28067303

A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

PubMed Central

Matsuzaki, Satoko; Matsuzaki, Shinya; Ueda, Yutaka; Tanaka, Yusuke; Kakuda, Mamoru; Kanagawa, Takeshi; Kimura, Tadashi

2014-01-01

Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options. PMID:26199801

A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta.

PubMed

Matsuzaki, Satoko; Matsuzaki, Shinya; Ueda, Yutaka; Tanaka, Yusuke; Kakuda, Mamoru; Kanagawa, Takeshi; Kimura, Tadashi

2015-04-01

Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.

[Features of cytotrophoblast invasion in complete placenta previa and increta].

PubMed

Milovanov, A P; Bushtarev, A V; Fokina, T V

to investigate the characteristics of cytotrophoblast invasion in complete placenta previa and increta. Three groups of placentas and amputated uteri were examined. These were: 1) 10 placentas at 20-22 weeks' gestation after drug-induced abortion; 2) 4 uteri with typical placentation at 34-36 weeks and wall ruptures; 3) 12 uteri with ultrasound-confirmed complete placenta previa and subsequent hysterectomy (at 34-36 weeks.) due to massive bleeding. In all cases, the sections were stained with hematoxylin and eosin, azan by the Mallory's method; immunovisualization of invasive cells with the marker cytokeratin 8 was also used. In Groups 2 and 3, the uterine distribution density of invasive cells was compared in a standard slice area (×200) separately, within the endometrium and myometrium. Complete placenta previa was found to have the following characteristics: 1) all the uteri exhibited focal or diffuse friable, or thick scars after cesarean section; 2) multiple active anchor villi with villous cytotrophoblast layers, which were characteristic of Group 1 placentas and absent in the uteri women of Group 2; 3) bays diagnosed in the basal endometrium with ingrown villi (placenta increta); 4) a morphometrically significant increase in the distribution density of interstitial cytotrophoblast in the endometrium and only a similar trend in the myometrium. Invasive cells did not penetrate into the area of scars. Failure of the second wave of cytotrophoblast invasion was confirmed by incomplete gestational restructuring and partial obliteration of the myometrial radial arteries. Real risks for severe clinical forms of abnormal placentation declare more stringent indications for surgical delivery.

Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis

PubMed Central

2011-01-01

Background Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally. Methods Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980. Results The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76). In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46). Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65). Conclusions There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy. PMID:22103697

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

PubMed

Hossain, G A; Islam, S M; Mahmood, S; Chakraborty, R K; Akhter, N; Sultana, S

2004-07-01

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

[Management of placenta previa and accreta].

PubMed

Kayem, G; Keita, H

2014-12-01

Produce recommendations for the management of placenta previa and placenta accrete. A literature search was conducted using Medline and the Cochrane Library over a period from 1950 to 31/12/2013. Recommendations of the latest scientific societies have also been consulted. In cases of placenta previa, if bleeding episode before 34weeks gestation occurs, a short hospitalization and tocolysis may help stop bleeding (grade C). Vaginal delivery is preferable when the distance between the internal cervical os and the placental edge is greater than 20mm. When this distance is less than 20mm, vaginal delivery is possible (professional consensus). Caesarean section is recommended in cases of placenta overlapping the internal os (professional consensus). Antenatal screening placenta accreta could improve care (EL3). Upon discovery of a placenta accreta during childbirth, it is better to avoid a forced removal of the placenta (grade C). Conservative treatment or cesarean hysterectomy are possible (grade C). The management of placental abnormalities should be planned and managed with a multidisciplinary team (professional consensus). The use of blood-saving techniques such as "cell saver" is possible in situations where early intraoperative bleeding would be>1500mL (grade C). There are no studies that have sufficient methodological value to recommend an anesthetic technique [general anaesthesia (GA) or neuraxial anaesthesia] over another in the context of placental abnormalities (grade B). When a major bleeding risk is identified, GA can be chosen in order to avoid emergency conversions in difficult conditions (professional consensus). Placental insertion abnormalities require anesthetic and obstetric coordination. Delivery must be planned in a suitable structure. Copyright © 2014. Published by Elsevier Masson SAS.

Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery.

PubMed

Verspyck, Eric; Douysset, Xavier; Roman, Horace; Marret, Stephane; Marpeau, Loïc

2015-01-01

To compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery. In a retrospective study, records were reviewed for women who had anterior placenta previa and delivered by cesarean after 24 weeks of pregnancy at a tertiary center in Rouen, France. During period A (January 2000 to December 2006), the protocol was to systematically transect the placenta when it was unavoidable. During period B (January 2007 to December 2010), the technique was to avoid incision by circumventing the placenta and passing a hand around its margin. Logistic regression was used to identify independent risk factors associated with maternal transfusion of packed red blood cells. Eighty-four women were included (period A: n=43; period B: n=41). During period B, there was a reduction in frequency of intraoperative hemorrhage (>1000 mL) (P=0.02), intraoperative hemoglobin loss (P=0.005), and frequency of blood transfusion (P=0.02) as compared with period A. In multivariable analysis, period B was associated with a reduced risk of maternal transfusion (odds ratio 0.27; 95% confidence interval 0.09-0.82; P=0.02). Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa.

PubMed

Melcer, Yaakov; Jauniaux, Eric; Maymon, Shlomit; Tsviban, Anna; Pekar-Zlotin, Marina; Betser, Moshe; Maymon, Ron

2018-04-01

Placenta accreta spectrum and vasa previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes. The objective of the study was to compare perinatal outcome in women with placenta accreta spectrum or vasa previa before and after implementation of targeted scanning protocols. This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 vs 2013-2016 for placenta accreta spectrum and 1988-2007 vs 2008-2016 for vasa previa). Clinical reports of women diagnosed with placenta accreta spectrum and vasa previa during the study periods were reviewed and outcomes were compared. In total, there were 97 cases of placenta accreta spectrum and 51 cases with vasa previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P < .001, for placenta accreta spectrum and 9 of 18 cases [50%] vs 29 of 33 cases [87.9%], 87.9%, P < .01 for vasa previa). The perinatal outcome improved also significantly in both cohorts after implementation of the protocols. In the placenta accreta spectrum cohort, the estimated blood loss and the postoperative hospitalization stay decreased between periods (1520 ± 845 vs 1168 ± 707 mL, P < .01, and 10.9 ± 14.1 vs 5.7 ± 2.2 days, P < .05, respectively). In the vasa previa cohort, the number of 5 minute Apgar score ≤5 and umbilical cord pH <7 decreased between periods (5 of 18 cases [27.8%] vs 1 of 33 cases [3%]; P < .05, and 4 of 18 cases [22.2%] vs 1 of 33 cases [3%], P < .05, respectively). The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta

Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis.

PubMed

Jauniaux, Eric; Bhide, Amar

2017-07-01

Women with a history of previous cesarean delivery, presenting with a placenta previa, have become the largest group with the highest risk for placenta previa accreta. The objective of the study was to evaluate the accuracy of ultrasound imaging in the prenatal diagnosis of placenta accreta and the impact of the depth of villous invasion on management in women presenting with placenta previa or low-lying placenta and with 1 or more prior cesarean deliveries. We searched PubMed, Google Scholar, clinicalTrials.gov, and MEDLINE for studies published between 1982 and November 2016. Criteria for the study were cohort studies that provided data on previous mode of delivery, placenta previa, or low-lying placenta on prenatal ultrasound imaging and pregnancy outcome. The initial search identified 171 records, of which 5 retrospective and 9 prospective cohort studies were eligible for inclusion in the quantitative analysis. The studies were scored on methodological quality using the Quality Assessment of Diagnostic Accuracy Studies tool. The 14 cohort studies included 3889 pregnancies presenting with placenta previa or low-lying placenta and 1 or more prior cesarean deliveries screened for placenta accreta. There were 328 cases of placenta previa accreta (8.4%), of which 298 (90.9%) were diagnosed prenatally by ultrasound. The incidence of placenta previa accreta was 4.1% in women with 1 prior cesarean and 13.3% in women with ≥2 previous cesarean deliveries. The pooled performance of ultrasound for the antenatal detection of placenta previa accreta was higher in prospective than retrospective studies, with a diagnostic odds ratios of 228.5 (95% confidence interval, 67.2-776.9) and 80.8 (95% confidence interval, 13.0-501.4), respectively. Only 2 studies provided detailed data on the relationship between the depth of villous invasion and the number of previous cesarean deliveries, independently of the depth of the villous invasion. A cesarean hysterectomy was performed in

Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy

PubMed Central

Findeklee, S.; Costa, S. D.

2015-01-01

Placentation disorders are the result of impaired embedding of the placenta in the endometrium. The prevalence of these disorders is estimated to be around 0.3 %. A history of previous prior uterine surgery (especially cesarean section and curettage) is the most common risk factor. Impaired placentation is differentiated into deep placental attachment; marginal, partial and total placenta previa; and placenta accreta, increta and percreta. Treatment depends on the severity of presentation and ranges from expectant management to emergency hysterectomy. In most cases, preterm termination of pregnancy is necessary. We report here on the case of a 39-year-old woman with placenta accreta and total placenta previa who underwent hysterectomy in the 19th week of pregnancy. PMID:26366004

Cervical varicosities may predict placenta accreta in posterior placenta previa: a magnetic resonance imaging study.

PubMed

Ishibashi, Hiroki; Miyamoto, Morikazu; Shinnmoto, Hiroshi; Murakami, Wakana; Soyama, Hiroaki; Nakatsuka, Masaya; Natsuyama, Takahiro; Yoshida, Masashi; Takano, Masashi; Furuya, Kenichi

2017-10-01

The aim of this study was to prenatally predict placenta accreta in posterior placenta previa using magnetic resonance imaging (MRI). This retrospective study was approved by the Institutional Review Board of our hospital. We identified 81 patients with singleton pregnancy who had undergone cesarean section due to posterior placenta previa at our hospital between January 2012 and December 2016. We calculated the sensitivity and specificity of several well-known findings, and of cervical varicosities quantified using magnetic resonance imaging, in predicting placenta accreta in posterior placenta previa. To quantify cervical varicosities, we calculated the A/B ratio, where "A" was the minimum distance from the most dorsal cervical varicosity to the deciduous placenta, and "B" was the minimum distance from the most dorsal cervical varicosity to the amniotic placenta. The appropriate cut-off value of the A/B ratio was determined using a receiver operating characteristic (ROC) curve. Three patients (3.7%) were diagnosed as having placenta accreta. The sensitivity and specificity of the well-known findings were 0 and 97.4%, respectively. Furthermore, the A/B ratio ranged from 0.02 to 0.79. ROC curve analysis revealed that the area under the combined placenta accreta and A/B ratio curve was 0.96. When the cutoff value of the A/B ratio was set 0.18, the sensitivity and specificity were 100 and 91%, respectively. It was difficult to diagnose placenta accreta in the posterior placenta previa using the well-known findings. The quantification of cervical varicosities could effectively predict placenta accreta.

Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis.

PubMed

Gasparri, Maria Luisa; Nirgianakis, Konstantinos; Taghavi, Katayoun; Papadia, Andrea; Mueller, Michael D

2018-07-01

Recent evidence suggests that assisted reproductive technology (ART) increases the risk of adverse pregnancy outcomes, including placental disorders. Similarly, endometriosis resulted detrimental on placenta previa. However, up to 50% of women with endometriosis suffer from infertility, thus requiring ART. The aim of our metanalysis is to compare women with and without endometriosis undergoing ART in terms of placenta disorders events, to establish if ART itself or endometriosis, as an indication to ART, increases the risk of placenta previa. Literature searches were conducted in January 2018 using electronic databases (PubMed, Medline, Scopus, Embase, Science Direct, and the Cochrane Library Scopus). Series comparing pregnancy outcome after ART in women with and without endometriosis were screened and data on placenta previa and placental abruption were extracted. Five retrospective case-control studies met the inclusion criteria. The meta-analysis revealed that endometriosis is associated with an increased risk of placenta previa in pregnancies achieved through ART (OR 2.96 (95% CI 1.25-7.03); p = 0.01, I 2  =69%, random-effect model). No differences in placental abruption incidence were found (OR 0.44 (95% CI 0.10-1.87); p = 0.26, I 2  = 0%, fixed-effect model). Patients with endometriosis undergoing ART may have additional risk of placenta previa. Despite the inability to determine if endometriosis alone or endometriosis plus ART increase the risk, physicians should be aware of the potential additional risk that endometriosis patients undergoing ART harbor.

Diagnosis of Placenta Accreta by Uterine Artery Doppler Velocimetry in Patients With Placenta Previa.

PubMed

Cho, Hee Young; Hwang, Han Sung; Jung, Inkyung; Park, Yong Won; Kwon, Ja-Young; Kim, Young Han

2015-09-01

To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta. Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight. The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047). This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined. © 2015 by the American Institute of Ultrasound in Medicine.

Improving the Accuracy of Diagnosing Placenta Previa on Transvaginal Ultrasound by Distinguishing between the Uterine Isthmus and Cervix: A Prospective Multicenter Observational Study.

PubMed

Hasegawa, Junichi; Kawabata, Ikuno; Takeda, Yoshiharu; Aoki, Hiroaki; Fukami, Takehiko; Tajima, Atsushi; Miyakoshi, Kei; Otsuki, Katsufumi; Shinozuka, Norio; Matsuda, Yoshio; Iwashita, Mitsutoshi; Okai, Takashi; Nakai, Akihito

2017-01-01

To clarify whether distinguishing between the uterine isthmus and cervix can improve the accuracy of diagnosing placenta previa at term. A multicenter prospective observational study was conducted among pregnant women with suspected placenta previa at 20-24 weeks' gestation. Subjects were divided into the open isthmus group and closed isthmus group. The accuracy of diagnosing placenta previa at term was compared between the 2 groups. We screened 9,341 patients, and 53 (0.6%) met the inclusion criteria. Nineteen cases with an open isthmus and 34 with a closed isthmus were followed. The accuracy for diagnosing placenta previa or a low-lying placenta at term was 94.7% in the open isthmus group and 26.5% in the closed isthmus group (p < 0.001). Elective or emergency Cesarean section was required in 100% of cases in the open isthmus group and 20.6% in the closed isthmus group (p < 0.001). A high prediction rate of placenta previa was obtained by using transvaginal ultrasound at 20-24 weeks' gestation after the isthmus opened by carefully distinguishing between the cervix and isthmus. © 2016 S. Karger AG, Basel.

[The Application of Internal Iliac Artery Balloon Occlusion in Pernicious Placenta Previa].

PubMed

Qi, Xiao-Rong; Liu, Xing-Hui; You, Yong; Wang, Xiao-Dong; Zhou, Rong; Xing, Ai-Yun; Zhang, Li; Ning, Gang; Zhao, Fu-Min; Li, Kai-Ming

2016-07-01

To evaluate the clinical application value of internal iliac artery balloon occlusion in pernicious placenta previa. We retrospectively reviewed the medical records of the patients of pernicious placenta previa in a single center from Jan, 2010 to Jan, 2015. The patients were divided into two groups, internal iliac artery balloon occlusion group and the control group without endovascular intervention. Blood loss in operation, volume of transfused blood products, caesarean hysterectomy, operating time, hospital days after operation and postoperative morbidity were compared between the two groups. The balloon occlusion group had significantly less blood loss, the volume of transfused blood products, caesarean hysterectomy, hospital day after operation than the control group had. There was no statistical difference in operating time, intensive care units (ICU), hypotension, infection, hypoxemia, bladder injury, bowel obstruction, neonatal asphyxia between the two groups. The balloon occlusion group had significantly higher rate in coagulopathy, hypoalbuminemia, electrolyte imbalance. Among the patients whose uterus were preserved, the blood loss was not significantly difference between the two groups. Among the patients with the complication of placenta accreta, caesarean hysterectomy was less in balloon group, and blood loss between the two groups was not significantly different. Among the patients without placenta accrete, the blood loss was less in balloon group, and caesarean hysterectomy between the two groups was not significantly different. The risk of hysterectomy in balloon group was related to placenta accreta, uterine arteries engorgement, placental invasive serosa, taking placenta by hand, placental invasive bladder, barrel-shaped thickening of lower uterine segment, unable to remove placenta. Internal iliac artery balloon occlusion is an effective treatment for pernicious placenta previa.

Prophylactic temporary abdominal aorta balloon occlusion in women with placenta previa accretism during late gestation.

PubMed

Qiu, Zhongyuan; Hu, Jifen; Wu, Jianbo; Chen, Lihong

2017-11-01

To evaluate the clinical efficacy of prophylactic temporary balloon occlusion of the abdominal aorta in patients with placenta previa accretism during cesarean section. Twenty-three consecutive patients, prenatally confirmed with placenta previa accretism were retrospectively analyzed in our center from August 2012 to October 2014. All 23 subjects underwent cesarean section with prophylactic balloon occlusion of the abdominal aorta. All of the 23 subjects experienced singleton pregnancies leading to the birth of live infants. Of these subjects, the following problems were diagnosed: placenta accrete (n = 10), placenta increte (n = 10), and placenta precrete (n = 3). Mean intraoperative hemorrhage was 1170.0 mL. Fifteen patients received red blood cell transfusion with a mean transfusion volume of 2.3 units. The incidence of hysterectomy was 21.74% (5/23) with blood loss ranging from 2000 to 5000 mL (mean 3360.0 mL). One complication encountered in this retrospective study was lower extremity arterial thrombosis. Eighteen patients were followed-up by telephone to 14 months following discharge, all babies were noted to be healthy. Prophylactic abdominal aorta balloon occlusion (ABO) was relatively safe in the treatment of patients with placenta previa accretism. This approach could represent a key aspect in a multidisciplinary algorithm in reducing hemorrhage in abnormal placentation.

Intraoperative aortic balloon occlusion in patients with placenta previa and/or placenta accreta: a retrospective study.

PubMed

Luo, Fangyuan; Xie, Lan; Xie, Ping; Liu, Siwei; Zhu, Yue

2017-04-01

To introduce the primary experience of using aortic balloon catheters during cesarean section for placenta previa and/or placenta accreta. From January 2013 to May 2015, 43 patients who were preoperatively diagnosed with major placenta previa and/or placenta accreta and who underwent prophylactic aortic catheterization before caesarean section (CS) were included in the study. We analyzed the clinical data of the study population. Surgery- and catheterization-related complications were also reported. Major placenta previa or placenta accreta was surgically confirmed in 42 patients, 28 of whom had both conditions. The mean patient age was 32.3 ± 5.5 years, whereas the median gestational age at delivery was 260 (range, 153-280) days. Twenty-nine (67.4%) patients had previously undergone CS, and 13 (30%) patients had undergone emergency surgery for antenatal hemorrhage. The median estimated blood loss during surgery was 500 (range, 100-3,000) mL, and the median duration of occlusion was 20 (range, 5-32) minutes. Hysterectomy was performed in five (11.6%) patients and uterine artery embolization in two (4.6%) patients. Two patients with placenta percreta experienced surgery-related complications, and two patients required hospital readmission. No major catheterization-related complications were observed. Forty-two live births were recorded, and the Apgar score of the infants at 5 minutes was > 7. Intraoperative aortic balloon occlusion is a relatively safe method for treating placenta previa and/or placenta accreta during scheduled and emergency CS and might be helpful to prevent hysterectomy and embolization in women wishing to preserve fertility. Copyright © 2017. Published by Elsevier B.V.

Optimal timing of antenatal corticosteroids in women with bleeding placenta previa or low-lying placenta.

PubMed

Alsayegh, Eman; Barrett, Jon; Melamed, Nir

2018-01-11

Administrating a single course of antenatal corticosteroids to women at risk of preterm birth between 24 and 34 weeks of gestation has been shown to decrease neonatal morbidity and mortality. There is evidence that the optimal timing for the administration of antenatal corticosteroids is within 1-7 days before birth as the effect of antenatal corticosteroids has been shown to decline 7 days after administration. Therefore, given that antenatal corticosteroids are the single most effective intervention in cases of preterm birth, efforts should be made to optimize the timing of administration of antenatal corticosteroids. To test the hypothesis that the timing of antenatal corticosteroids in women with vaginal bleeding due to placenta previa or low-lying placenta can be optimized by identifying women at low risk of imminent delivery. This was a retrospective cohort study of all women admitted to a tertiary referral center at 24-34 weeks' gestation with vaginal bleeding due to placenta previa or low-lying placenta between 2003 and 2014. Multivariable logistic regression analysis was used to identify factors that are independently associated with delivery within 14 days from admission. A total of 202 women who met the inclusion criteria were admitted with vaginal bleeding in the presence of placenta previa or low-lying placenta during the study period, of whom 31 (15.3%) and 44 (21.8%) gave birth within 7 and 14 days from admission, respectively. The following factors were independently associated with delivery within 14 days from admission: complete placenta previa (odds (OR) 3.57, 95%CI 1.57-9.03), severe bleeding at presentation (OR 17.14, 95%CI 2.92-100.70), uterine contractions at presentation (OR 6.02, 95%CI 1.91-19.00), and cervical length <25 mm at presentation (OR 6.33, 95%CI 1.37-29.11). A predictive test based on the presence of ≥1 of these risk factors was associated with a sensitivity of 90.9% and a negative predictive value of 94.6% for delivery

The risk of placental abruption and placenta previa in pregnant women with chronic hepatitis B viral infection: a systematic review and meta-analysis.

PubMed

Huang, Q T; Chen, J H; Zhong, M; Xu, Y Y; Cai, C X; Wei, S S; Hang, L L; Liu, Q; Yu, Y H

2014-08-01

Several epidemiological studies have found a positive association between chronic hepatitis B virus (CHB) infection and the risk of placental abruption and placenta previa, but various studies have reported conflicting findings. The objective was to systematically review the literature to determine a possible association between CHB infection and these two placental complications. We conducted a computerized search in electronic database through March 1, 2014, supplemented with a manual search of reference lists, to identify original published research on placental abruption and placenta previa rates in women with CHB infection. Data were independently extracted, and relative risks were calculated. The meta-analysis was performed using Stata version 10.0 software. Five studies involving 9088 placenta previa cases were identified. No significant association between CHB infection and placenta previa was identified (OR = 0.98, 95% CI = 0.60-1.62). Five studies involving 15571 placental abruption cases were identified. No significant association between CHB infection and placental abruption was identified (OR = 1.42, 95% CI, 0.93-2.15). The immune response against the virus represents a key factor in determining infection outcomes. No observation of significant increased risk of the placental complications could be partially explained by the complex immune response during CHB infection. Our meta-analysis found no evidence of significant associations between CHB infection and increased risk of placental abruption as well as placenta previa. Further well-designed studies were warranted to assess any potential association between CHB infection and increased risk of placental abruption as well as placenta previa. Copyright © 2014 Elsevier Ltd. All rights reserved.

Nestin is highly expressed in fetal spinal cord isolated from placenta previa patients and promotes inflammation by enhancing NF-κB activity.

PubMed

Li, Ling; Zhang, Jing; Gao, Huahe; Ma, Yuyan

2018-04-26

Purpose Nestin is expressed in various tissues of the embryo in patients with placenta previa, while the regulatory mechanism still unknown. Materials and methods All participants terminated pregnancy. Among them, 75 patients with placenta previa were assigned to the case group and 80 healthy pregnant women with normal placenta were assigned to the control group. Expression of nestin and CDK5 in fetal spinal cord tissues was detected by Western Blot and RT-qPCR methods. The enzyme-linked immunosorbent assay (ELISA) was used to determine the serum expression of some pro-inflammatory cytokines in placenta previa patients. The interaction between nestin and CDK5 was evaluated by immunoprecipitation and siRNA inhibition of nestin was performed to estimate its effect on NF-κB activity in fetal spinal cord tissues. Results Along with increased expression of nestin and CDK5 in fetal spinal cord tissues in the case group, IL-1β, IL-6, TNF-α, and IFN-γ were increased in the serum of placenta previa patients. siRNA inhibition analysis indicated that nestin interacted with CDK5 and regulated NF-κB activity in fetal spinal cord tissues. Conclusions Nestin is highly expressed and the interaction between nestin and CDK5 might lead to the progress of placenta previa through its regulation on NF-κB.

Increased Levels of Cell-Free miR-517a and Decreased Levels of Cell-Free miR-518b in Maternal Plasma Samples From Placenta Previa Pregnancies at 32 Weeks of Gestation.

PubMed

Hasegawa, Yuri; Miura, Kiyonori; Higashijima, Ai; Abe, Shuhei; Miura, Shoko; Yoshiura, Koh-ichiro; Masuzaki, Hideaki

2015-12-01

The aim of this study was to clarify the association between placenta previa and circulating levels of cell-free pregnancy-associated placenta-specific microRNAs (miRNAs) in maternal plasma. Twenty singleton pregnancies with placenta previa (placenta previa group) and 26 uncomplicated pregnancies (control group) were recruited. Blood sampling was performed at 32 weeks of gestation, and cesarean delivery in all cases of placenta previa was performed at a mean gestational age of 37 weeks. The maternal plasma concentrations of cell-free pregnancy-associated placenta-specific miRNAs (miR-517a and miR-518b) were measured by absolute quantitative real-time reverse transcription-polymerase chain reaction. Plasma concentrations of cell-free miR-517a were significantly higher in the placenta previa group than that in the control group (P = .011), while the plasma concentration of cell-free miR-518b was significantly lower in the placenta previa group than that in the control group (P = .004). Plasma concentrations of cell-free miR-517a in placenta previa were significantly higher in placenta previa with alert bleeding later group than those in placenta previa without alert bleeding group or control group (P = .030 or .047, respectively) and correlated with the volume of hemorrhage at delivery (R and P value: .512 and .025). Plasma concentrations of cell-free miR-517a and miR-518b at 32 weeks of gestation were altered in pregnant women with placenta previa, and the circulating level of cell-free miR-517a in placenta previa may be a predictive marker for the risks of alert bleeding later and massive hemorrhage at delivery. © The Author(s) 2015.

[Risk factors of pregnancy termination at second and third trimester in women with scarred uterus and placenta previa].

PubMed

Tian, Ji-shun; Pan, Fei-xia; He, Sai-nan; Hu, Wen-sheng

2015-05-01

To investigate the risk factors of pregnancy termination at second and third trimester in women with scarred uterus and placenta previa. Clinical data of 24 pregnant women of second and third trimester with a scarred uterus and placenta previa,who requested termination in Women's Hospital Zhejiang University School of Medicine from July 2009 to June 2014, were retrospectively analyzed. The method of mifepristone combined with ethacridine lactate was adopted for all cases. Mifepristone combined with ethacridine lactate and uterine artery embolization were routinely given for patients with complete placenta previa. Cesarean section was performed for patients who failed to delivery or underwent massive vaginal bleeding before delivery. Age, gestational weeks, gravidity and parity, times of previous cesarean section, the interval from previous operation, the position and the type of placenta previa, placenta accretet, the indication and method of termination, postpartum hemorrhage, successful rate of labor induction, placental retention ratio and uterus rupture were documented. The successful rate of labor induction was 83.3%. The analysis showed that age, gestational weeks, gravidity and parity and times of previous cesarean section were not risk factors for failed labor induction, however the interval time from previous operation was related to induction failure (P<0.05). Patients with previous cesarean section ≥ 13 years were more likely to require cesarean section than those <13 years (P<0.05). The placenta adhered to the antetheca of the uterus or placenta accrete increased risk to have cesarean section. There were no significant differences in postpartum hemorrhage, the successful rate of labor induction, placental retention ratio and the rate of uterine rupture between patients with uterine artery embolization and those without. The labor induction would be feasible for women with a scarred uterus and placenta previa in second and third-trimester pregnancy

Prophylactic temporary abdominal aorta balloon occlusion in women with placenta previa accretism during late gestation

PubMed Central

Qiu, Zhongyuan; Hu, Jifen; Wu, Jianbo; Chen, Lihong

2017-01-01

Abstract Background: To evaluate the clinical efficacy of prophylactic temporary balloon occlusion of the abdominal aorta in patients with placenta previa accretism during cesarean section. Methods: Twenty-three consecutive patients, prenatally confirmed with placenta previa accretism were retrospectively analyzed in our center from August 2012 to October 2014. All 23 subjects underwent cesarean section with prophylactic balloon occlusion of the abdominal aorta. Results: All of the 23 subjects experienced singleton pregnancies leading to the birth of live infants. Of these subjects, the following problems were diagnosed: placenta accrete (n = 10), placenta increte (n = 10), and placenta precrete (n = 3). Mean intraoperative hemorrhage was 1170.0 mL. Fifteen patients received red blood cell transfusion with a mean transfusion volume of 2.3 units. The incidence of hysterectomy was 21.74% (5/23) with blood loss ranging from 2000 to 5000 mL (mean 3360.0 mL). One complication encountered in this retrospective study was lower extremity arterial thrombosis. Eighteen patients were followed-up by telephone to 14 months following discharge, all babies were noted to be healthy. Conclusion: Prophylactic abdominal aorta balloon occlusion (ABO) was relatively safe in the treatment of patients with placenta previa accretism. This approach could represent a key aspect in a multidisciplinary algorithm in reducing hemorrhage in abnormal placentation. PMID:29145299

ACCRETA COMPLICATING COMPLETE PLACENTA PREVIA IS CHARACTERIZED BY REDUCED SYSTEMIC LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND EPITHELIAL-TO-MESENCHYMAL TRANSITION OF THE INVASIVE TROPHOBLAST

PubMed Central

Wehrum, Mark J.; Buhimschi, Irina A.; Salafia, Carolyn; Thung, Stephen; Bahtiyar, Mert O.; Werner, Erica F.; Campbell, Katherine H.; Laky, Christine; Sfakianaki, Anna K.; Zhao, Guomao; Funai, Edmund F.; Buhimschi, Catalin S.

2011-01-01

OBJECTIVE To characterize serum angiogenic factor profile of women with complete placenta previa and determine if invasive trophoblast differentiation characteristic of accreta, increta or percreta shares features of epitehelial-mesenchymal-transition (EMT). STUDY DESIGN We analyzed gestational age matched serum samples from 90 pregnant women with either complete placenta previa (n=45) or uncomplicated pregnancies (n=45). Vascular-endothelial-growth-factor (VEGF), placental-growth-factor (PlGF) and soluble fms-like-tyrosine-kinase-1 (sFlt-1) were immunoassayed. VEGF and phosphotyrosine (P-Tyr) immunoreactivity was surveyed in histological specimens relative to expression of vimentin and cytokeratin-7. RESULTS Women with previa and invasive placentation [accreta (n=5); increta (n=6); percreta (n=2)] had lower systemic VEGF (invasive previa: median [IQR]: 0.8[0.02–3.4] vs. control: 6.5[2.7–10.5] pg/mL, P=0.02). VEGF and P-Tyr immunostaining predominated in the invasive extravillous trophoblasts (EVT) which co-expressed vimentin and cytokeratin-7, a EMT feature and tumor-like cell phenotype. CONCLUSIONS Lower systemic free VEGF and a switch of the interstitial EVT to a metastable cell phenotype characterize placenta previa with excessive myometrial invasion. PMID:21316642

Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa: A retrospective cohort study.

PubMed

Lee, Ji Yeon; Ahn, Eun Hee; Kang, Sukho; Moon, Myung Jin; Jung, Sang Hee; Chang, Sung Woon; Cho, Hee Young

2018-01-01

We aimed to identify factors associated with massive post-partum bleeding in pregnancies with placenta previa and to establish a scoring model to predict post-partum severe bleeding. A retrospective cohort study was performed in 506 healthy singleton pregnancies with placenta previa from 2006 to 2016. Cases with intraoperative blood loss (≥2000 mL), packed red blood cells transfusion (≥4), uterine artery embolization, or hysterectomy were defined as massive bleeding. After performing multivariable analysis, using the adjusted odds ratios (aOR), we formulated a scoring model. Seventy-three women experienced massive post-partum bleeding (14.4%). After multivariable analysis, seven variables were associated with massive bleeding: maternal old age (≥35 years; aOR 1.79, 95% confidence interval [CI] 1.00-3.20, P = 0.049), antepartum bleeding (aOR 4.76, 95%CI 2.01-11.02, P < 0.001), non-cephalic presentation (aOR 3.41, 95%CI 1.40-8.30, P = 0.007), complete placenta previa (aOR 1.93, 95%CI 1.05-3.54, P = 0.034), anterior placenta (aOR 2.74, 95%CI 1.54-4.89, P = 0.001), multiple lacunae (≥4; aOR 2.77, 95%CI 1.54-4.99, P = 0.001), and uteroplacental hypervascularity (aOR 4.51, 95%CI 2.30-8.83, P < 0.001). We formulated a scoring model including maternal old age (<35: 0, ≥35: 1), antepartum bleeding (no: 0, yes: 2), fetal non-cephalic presentation (no: 0, yes: 2), placenta previa type (incomplete: 0, complete: 1), placenta location (posterior: 0, anterior: 1), uteroplacental hypervascularity (no: 0, yes: 2), and multiple lacunae (no: 0, yes: 1) to predict post-partum massive bleeding. According to our scoring model, a score of 5/10 had a sensitivity of 81% and a specificity of 77% for predicting massive post-partum bleeding. The area under the receiver-operator curve was 0.856 (P < 0.001). The negative predictive value was 95.9%. Our scoring model might provide useful information for prediction of massive post-partum bleeding in pregnancies with placenta previa. �

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa

PubMed Central

Shin, Jae Eun; Shin, Jong Chul; Lee, Young; Kim, Sa Jin

2016-01-01

Purpose To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. Methods This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. Results A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm. Conclusions Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS. PMID:26863133

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

PubMed

Shin, Jae Eun; Shin, Jong Chul; Lee, Young; Kim, Sa Jin

2016-01-01

To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm. Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

Environmental impact of the MV CITA on the foreshore of Porth Hellick, Isles of Scilly.

PubMed

Smith, Nicola A

2004-12-01

The grounding of the container feeder vessel MV CITA on Newfoundland Rocks, Isles of Scilly, had an effect on the surrounding biota and benthic environment. Included in the CITA's cargo were five 40 ft containers holding pallets of polyester film used in the production of audio and visual recording tapes. The wreckage presented a minor but potentially chronic source of pollution through the delayed release of polythene film, which was left on the seabed as it was considered insufficiently valuable to warrant salvage. The polythene disintegrated and was washed upon the foreshore of Porth Hellick in minute shreds. The adjacent foreshore and two control sites within the islands were analysed using a 5-strand line and vegetation survey with 10 random quadrats within each line to determine the environmental impact of the polythene.

Increased Levels of Cell-Free Human Placental Lactogen mRNA at 28-32 Gestational Weeks in Plasma of Pregnant Women With Placenta Previa and Invasive Placenta

PubMed Central

Sekizawa, Akihiko; Ventura, Walter; Koide, Keiko; Hori, Kyouko; Okai, Takashi; Masashi, Yoshida; Furuya, Kenichi; Mizumoto, Yoshifumi

2014-01-01

We compared the levels of cell-free human placental lactogen (hPL) messenger RNA (mRNA) in maternal plasma at 28 to 32 weeks of gestation between women with diagnosis of placenta previa or invasive placenta and women with an uneventful pregnancy. Sensitivity and specificity of hPL mRNA for the prediction of invasive placenta were further explored. Plasma hPL mRNA were quantified by real-time reverse-transcriptase polymerase chain reaction in women with placenta previa (n = 13), invasive placenta (n = 5), and normal pregnancies (n = 92). Median (range) hPL mRNA was significantly higher in women with placenta previa, 782 (10-2301) copies/mL of plasma, and in those with invasive placenta, 615 (522-2102) copies/mL of plasma, when compared to normal pregnancies, 90 (4-4407) copies/mL of plasma, P < .01 and P < .05, respectively. We found a sensitivity of 100% and a specificity of 61.5% for the prediction of invasive placenta among women with placenta previa. In conclusion, expression of hPL mRNA is increased in plasma of women with placenta previa and invasive placenta at 28 to 32 weeks of gestation. PMID:23744883

Increased levels of cell-free human placental lactogen mRNA at 28-32 gestational weeks in plasma of pregnant women with placenta previa and invasive placenta.

PubMed

Kawashima, Akihiro; Sekizawa, Akihiko; Ventura, Walter; Koide, Keiko; Hori, Kyouko; Okai, Takashi; Masashi, Yoshida; Furuya, Kenichi; Mizumoto, Yoshifumi

2014-02-01

We compared the levels of cell-free human placental lactogen (hPL) messenger RNA (mRNA) in maternal plasma at 28 to 32 weeks of gestation between women with diagnosis of placenta previa or invasive placenta and women with an uneventful pregnancy. Sensitivity and specificity of hPL mRNA for the prediction of invasive placenta were further explored. Plasma hPL mRNA were quantified by real-time reverse-transcriptase polymerase chain reaction in women with placenta previa (n = 13), invasive placenta (n = 5), and normal pregnancies (n = 92). Median (range) hPL mRNA was significantly higher in women with placenta previa, 782 (10-2301) copies/mL of plasma, and in those with invasive placenta, 615 (522-2102) copies/mL of plasma, when compared to normal pregnancies, 90 (4-4407) copies/mL of plasma, P < .01 and P < .05, respectively. We found a sensitivity of 100% and a specificity of 61.5% for the prediction of invasive placenta among women with placenta previa. In conclusion, expression of hPL mRNA is increased in plasma of women with placenta previa and invasive placenta at 28 to 32 weeks of gestation.

The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation.

PubMed

Algebally, Ahmed M; Yousef, Reda Ramadan Hussein; Badr, Sanaa Sayed Hussein; Al Obeidly, Amal; Szmigielski, Wojciech; Al Ibrahim, Abdullah A

2014-01-01

The purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone. The study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients' files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature. US and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97-100% and 94-100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant. US and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient's morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI.

The Value of Ultrasound and Magnetic Resonance Imaging in Diagnostics and Prediction of Morbidity in Cases of Placenta Previa with Abnormal Placentation

PubMed Central

Algebally, Ahmed M.; Yousef, Reda Ramadan Hussein; Badr, Sanaa Sayed Hussein; Al Obeidly, Amal; Szmigielski, Wojciech; Al Ibrahim, Abdullah A.

2014-01-01

Summary Background The purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone. Material/Methods The study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients’ files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature. Results US and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97–100% and 94–100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant. Conclusions US and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient’s morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI. PMID:25411586

Mifepristone combined with ethacridine lactate for the second-trimester pregnancy termination in women with placenta previa and/or prior cesarean deliveries.

PubMed

Chen, Chunqin; Lin, Feikai; Wang, Xiaoyun; Jiang, Yaping; Wu, Sufang

2017-01-01

This study was aimed to evaluate the safety and efficacy of the second-trimester medical abortions using mifepristone and ethacridine lactate in women with placenta previa and/or prior cesarean deliveries. The patients who underwent a second-trimester pregnancy termination from January 2009 to December 2015 were retrospectively analyzed. The eligible patients were assigned to four groups based on placentation and cesarean history. The abortion interval (AI), blood loss, hospital stays, incidence of curettage, and transfusion were reviewed. Two women underwent cesarean sections for placenta increta. Finally, 443 patients were enrolled in this study, including 92 with placenta previa, 153 with prior cesarean deliveries, 36 with the both factors, and 236 with normal placentation and no cesarean delivery history. All the included cases had a successful vaginal delivery. There was no significant difference in AI, hospital stay, rate of hemorrhage, and transfusion among the four groups. Patients with prior cesarean section had higher blood loss than the normal group (P = 0.0017), as well as patients with both placenta previa and prior cesarean (P = 0.0018). However, there was no obvious blood loss in patients with placenta previa when compared with normal placetal patients (P = 0.23). No uterine rupture occurred in all patients. Mifepristone combined with ethacridine lactate is safe and effective for patients with low placentation or/and prior cesarean in the second-trimester pregnancy termination.

Intrauterine Inflated Foley's Catheter Balloon in the Management of Abnormally Invasive Placenta Previa: A Case-Control Study.

PubMed

Thabet, Mahmoud; Abdelhafez, Mohamed Sayed; Fyala, Emad Ahmed

2018-06-01

To describe the use of intrauterine inflated Foley's catheter balloon for control of postpartum hemorrhage (PPH) during cesarean section (CS) in cases of abnormally invasive placenta previa aiming to preserve the uterus. Retrospective case-control study of the data of women who underwent elective CS on abnormally adherent placenta previa was carried out. Women in whom inflated Foley's catheter balloon was used for control of PPH during CS ( n  = 40) were compared with a control group of women who underwent elective CS by the same technique but without use of intrauterine catheter balloon ( n  = 38). Use of intrauterine inflated Foley's catheter balloon significantly reduced the estimated amount of blood loss ( P  = 0.008), amounts of crystalloids, colloids and packed red blood cells transfusion ( P  = 0.025, 0.017 and 0.022, respectively), and the need for bilateral internal iliac artery (IIA) ligation ( P  = 0.016). No significant difference was observed between both groups regarding the use of massive transfusion protocol, performing cesarean hysterectomy, relaparotomy, and admission to the intensive care unit. Application of an intrauterine inflated Foley's catheter balloon during CS in cases of morbidly adherent placenta previa helps to control PPH with preservation of the uterus and decreases the need for the invasive IIA ligation.

Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture.

PubMed

Rauf, Melekoglu; Ebru, Celik; Sevil, Eraslan; Selim, Buyukkurt

2017-02-01

The aim of this study was to investigate maternal and neonatal outcomes of conservative management of post-partum hemorrhage due to placenta previa-accreta using hypogastric artery ligation and endo-uterine hemostatic suture to lower uterine segment. The records of 38 patients who were managed conservatively with hypogastric artery ligation and endo-uterine hemostatic suture to control post-partum hemorrhage secondary to placenta previa-accreta between April 2014 and January 2016, were reviewed retrospectively. Placenta previa-accreta was diagnosed according to gray-scale, color and 3-D power Doppler ultrasonography in addition to the intraoperative findings based on fragmentary or difficult separation of the placenta. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed. Of these patients, 55.2% were between 25 and 35 years old; 97.5% were multiparous; 71.2% had two or more previous cesarean section and 68.5% had preterm delivery. Women with placenta accreta had a median estimated blood loss of 450 mL; 57.8% of patients had blood transfusion (mean intraoperative transfusion, 2 units packed red blood cells; range, 0-9 units). Median duration of operation was 112.5 min (range, 45-305 min) and 32 patients (84.3%) with placenta accreta did not undergo cesarean hysterectomy. Conservative treatment of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic sutures to the lower segment of the uterus is associated with lower hysterectomy rate compared with the other conservative methods reported in the literature. © 2016 Japan Society of Obstetrics and Gynecology.

Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall

PubMed Central

Lee, Hyun Jung; Lee, Young Jai; Ahn, Eun Hee; Kim, Hyeon Chul; Jung, Sang Hee; Chang, Sung Woon

2017-01-01

Objective To identify factors associated with massive postpartum bleeding in pregnancies complicated by incomplete placenta previa located on the posterior uterine wall. Methods A retrospective case-control study was performed. We identified 210 healthy singleton pregnancies with incomplete placenta previa located on the posterior uterine wall, who underwent elective or emergency cesarean section after 24 weeks of gestation between January 2006 and April 2016. The cases with intraoperative blood loss (≥2,000 mL) or transfusion of packed red blood cells (≥4) or uterine artery embolization or hysterectomy were defined as massive bleeding. Results Twenty-three women experienced postpartum profuse bleeding (11.0%). After multivariable analysis, 4 variables were associated with massive postpartum hemorrhage (PPH): experience of 2 or more prior uterine curettage (adjusted odds ratio [aOR], 4.47; 95% confidence interval [CI], 1.29 to 15.48; P=0.018), short cervical length before delivery (<2.0 cm) (aOR, 7.13; 95% CI, 1.01 to 50.25; P=0.049), fetal non-cephalic presentation (aOR, 12.48; 95% CI, 1.29 to 121.24; P=0.030), and uteroplacental hypervascularity (aOR, 6.23; 95% CI, 2.30 to 8.83; P=0.001). Conclusion This is the first study of cases with incomplete placenta previa located on the posterior uterine wall, which were complicated by massive PPH. Our findings might be helpful to guide obstetric management and provide useful information for prediction of massive PPH in pregnancies with incomplete placenta previa located on the posterior uterine wall. PMID:29184859

Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall.

PubMed

Lee, Hyun Jung; Lee, Young Jai; Ahn, Eun Hee; Kim, Hyeon Chul; Jung, Sang Hee; Chang, Sung Woon; Lee, Ji Yeon

2017-11-01

To identify factors associated with massive postpartum bleeding in pregnancies complicated by incomplete placenta previa located on the posterior uterine wall. A retrospective case-control study was performed. We identified 210 healthy singleton pregnancies with incomplete placenta previa located on the posterior uterine wall, who underwent elective or emergency cesarean section after 24 weeks of gestation between January 2006 and April 2016. The cases with intraoperative blood loss (≥2,000 mL) or transfusion of packed red blood cells (≥4) or uterine artery embolization or hysterectomy were defined as massive bleeding. Twenty-three women experienced postpartum profuse bleeding (11.0%). After multivariable analysis, 4 variables were associated with massive postpartum hemorrhage (PPH): experience of 2 or more prior uterine curettage (adjusted odds ratio [aOR], 4.47; 95% confidence interval [CI], 1.29 to 15.48; P =0.018), short cervical length before delivery (<2.0 cm) (aOR, 7.13; 95% CI, 1.01 to 50.25; P =0.049), fetal non-cephalic presentation (aOR, 12.48; 95% CI, 1.29 to 121.24; P =0.030), and uteroplacental hypervascularity (aOR, 6.23; 95% CI, 2.30 to 8.83; P =0.001). This is the first study of cases with incomplete placenta previa located on the posterior uterine wall, which were complicated by massive PPH. Our findings might be helpful to guide obstetric management and provide useful information for prediction of massive PPH in pregnancies with incomplete placenta previa located on the posterior uterine wall.

Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center.

PubMed

Erfani, Hadi; Kassir, Elias; Fox, Karin A; Clark, Steven L; Karbasian, Niloofar; Salmanian, Bahram; Shamshirsaz, Amir A; Espinoza, Jimmy; Nassr, Ahmed A; Eppes, Catherine S; Belfort, Michael A; Shamshirsaz, Alireza A

2017-11-05

The objective of this study is to compare patient outcomes between planned and emergent cesarean deliveries for placenta previa without morbidly adherent placenta. All patients with confirmed, persistent placenta previa (without morbidly adherent placentation) who underwent the surgery between January 2010 and April 2016 were included in this retrospective study. Primary outcome was composite maternal morbidity defined as the presence of at least one of the followings: death, red blood cell (RBC) transfusion, hysterectomy, reoperation, hospital stay >7 d, ureteral injury, bowel injury, or cystotomy. Three hundred and four patients with placenta previa were identified during the study period, of whom 154 (50.65%) had an antenatal and 10 (3.28%) had an intraoperative diagnosis of morbidly adherent placenta. One hundred and forty patients met the inclusion criteria. Eighty (57.1%) underwent planned cesarean delivery (planned cesarean delivery (PCD) group), and 60 (42.8%) required emergent cesarean delivery due to uterine contractions and/or bleeding (emergent cesarean delivery (ECD) group). Baseline characteristics were similar between the two groups except for the gestational age at delivery (36.0 weeks (36.0, 37.0) in PCD versus 34.0 weeks (32.0, 36.0) in ECP, p < .001). Composite maternal morbidity was not significantly different between two groups: 11 (18.3%) in ECD and 10 (12.5%) in PCD (p = .35) Conclusions: In our referral tertiary centre, emergent and planned cesarean deliveries for placenta previa without morbidly adherent placenta have similar maternal outcomes. In patients without significant hemorrhage, delivery may be safely deferred until 36-37 weeks.

Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section.

PubMed

Soyama, Hiroaki; Miyamoto, Morikazu; Sasa, Hidenori; Ishibashi, Hiroki; Yoshida, Masashi; Nakatsuka, Masaya; Takano, Masashi; Furuya, Kenichi

2017-09-01

To evaluate the effectiveness of routine rapid insertion of a Bakri balloon during cesarean section for placenta previa based on a retrospective control study. Women with singleton pregnancies who underwent cesarean section for placenta previa at our institution between 2003 and 2016 were enrolled. Between 2015 and 2016, women who routinely underwent balloon tamponade during cesarean section were defined as the balloon group. Between 2003 and 2014, women who underwent no hemostatic procedures except balloon tamponade were defined as the non-balloon group. The clinical outcomes of the two groups were retrospectively analyzed. Of the 266 women with placenta previa, 50 were in the balloon group and 216 were in the non-balloon group. The bleeding amounts were significantly smaller in the balloon group than in the non-balloon group: intraoperative bleeding (991 vs. 1250 g, p < 0.01), postoperative bleeding (62 vs. 150 g, p < 0.01), and total bleeding (1066 vs. 1451 g, p < 0.01). Furthermore, the mean surgical duration was shorter in the balloon group than the non-balloon group (30 vs. 50 min, p < 0.01). In the balloon group, five patients suffered from increasing hemorrhage due to prolapse of the balloon from the uterus after the operation, but the hemorrhage was controlled by balloon re-insertion without additional hemostatic procedures. This study demonstrated that the routine rapid insertion of Bakri balloon tamponade during cesarean section significantly decreased intra- and postoperative hemorrhage and shortened the surgical duration in women with placenta previa.

Aortic balloon occlusion for controlling intraoperative hemorrhage in patients with placenta previa increta/percreta.

PubMed

Wang, Ying-Lan; Su, Fang-Ming; Zhang, Hai-Ying; Wang, Fang; Zhe, Rui-Lian; Shen, Xin-Ying

2017-11-01

To investigate whether abdominal aortic balloon occlusion (ABO) effectively reduces intraoperative hemorrhage in patents with placenta previa increta/increta. Forty-three women were diagnosed as placenta previa increta/percreta by ultrasound and MRI. These patients' assessments were taken by their chief physician, and they were under necessity of previous cesarean section as confirmed by the committee of experts during consultation. There was no significant difference in disease risk rating between them in whole process. Although our department provided a more appropriate method, 10 of 43 patients chose intraoperative aortic balloon occlusion (IABO). Other 33 patients who refused that suggestion were considered as control group. Fully informed consents were obtained from all patients in this study group. The intraoperative blood loss, blood transfusion, rate of hysterectomy and complications of mothers and fetus of IABO group and control group were analyzed. The median intraoperative blood loss was 1000 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). The median volume of transfused red blood cells was 1100 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). 33.3% (11/33) patients in the control group had hemorrhagic shock, and one of them suffered from cardiac arrest intraoperatively because of severe bleeding. However, none of these serious events occurred in the IABO group (p < 0.05). The hysterectomy rate was 70% (7/10) in the IABO group and 63.3% (21/33) in the control group (p > 0.05). No IABO-related complications were observed in the mother and fetus. IABO is an effective and safe method to control intraoperative blood loss and blood transfusion in patients with placenta previa increta/percreta.

Longitudinal parallel compression suture to control postopartum hemorrhage due to placenta previa and accrete.

PubMed

Li, Guang-Tai; Li, Xiao-Fan; Wu, Baoping; Li, Guangrui

2016-04-01

To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta. Fifteen women received a longitudinal parallel compression suture to stop life-threatening PPH due to placenta previa with or without accreta during cesarean section. The suture apposed the anterior and posterior walls of the lower uterine segment together using an absorbable thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ∼1-2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in the same way. The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal menstrual flow, and no postoperative anatomical or physiological abnormalities related to the suture were observed. Three women achieved further pregnancies after the procedure. Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta. Copyright © 2016. Published by Elsevier B.V.

Topical application of recombinant activated factor VII during cesarean delivery for placenta previa.

PubMed

Schjoldager, Birgit T B G; Mikkelsen, Emmeli; Lykke, Malene R; Præst, Jørgen; Hvas, Anne-Mette; Heslet, Lars; Secher, Niels J; Salvig, Jannie D; Uldbjerg, Niels

2017-06-01

During cesarean delivery in patients with placenta previa, hemorrhaging after removal of the placenta is often challenging. In this condition, the extraordinarily high concentration of tissue factor at the placenta site may constitute a principle of treatment as it activates coagulation very effectively. The presumption, however, is that tissue factor is bound to activated factor VII. We hypothesized that topical application of recombinant activated factor VII at the placenta site reduces bleeding without affecting intravascular coagulation. We included 5 cases with planned cesarean delivery for placenta previa. After removal of the placenta, the surgeon applied a swab soaked in recombinant activated factor VII containing saline (1 mg in 246 mL) to the placenta site for 2 minutes; this treatment was repeated once if the bleeding did not decrease sufficiently. We documented the treatment on video recordings and measured blood loss. Furthermore, we determined hemoglobin concentration, platelet count, international normalized ratio, activated partial thrombin time, fibrinogen (functional), factor VII:clot, and thrombin generation in peripheral blood prior to and 15 minutes after removal of the placenta. We also tested these blood coagulation variables in 5 women with cesarean delivery planned for other reasons. Mann-Whitney test was used for unpaired data. In all 5 cases, the uterotomy was closed under practically dry conditions and the median blood loss was 490 (range 300-800) mL. There were no adverse effects of recombinant activated factor VII and we did not measure factor VII to enter the circulation. Neither did we observe changes in thrombin generation, fibrinogen, activated partial thrombin time, international normalized ratio, and platelet count in the peripheral circulation (all P values >.20). This study indicates that in patients with placenta previa, topical recombinant activated factor VII may diminish bleeding from the placenta site without initiation

Nuevas observaciones de 3C10 con el VLA*: estudio de la expansión

NASA Astrophysics Data System (ADS)

Reynoso, E. M.; Moffett, D. A.:; Dubner, G. M.; Giacani, E. B.; Reynolds, S. P.; Goss, W. M.; Dickel, J.

Se presentan nuevos resultados sobre la expansión del remanente de la supernova de Tycho a lo largo de un intervalo de 10.9 años, comparando nuevas observaciones tomadas con el VLA a 1375 y 1635 MHz durante 1994 y 1995, con observaciones previas realizadas entre 1983 y 1984 (Dickel y col. ~1991 AJ 101, 2151), usando las mismas configuraciones, anchos de banda, calibradores y tiempos de integración. El coeficiente de expansión se calcula para sectores radiales de 4o de ancho cada uno, ajustando la correlación cruzada de las derivadas de los perfiles promedio para cada época. A partir de la expansión medida, se estima el índice (parámetro de expansión) de la ley potencial R∝ tm como m≡ d ln R/d ln t . Este valor se compara con coeficientes teóricos para diferentes fases evolutivas de remanentes de supernova.

Access to Information in Both CitaDel and FirstSearch: A Comparative Study of Dissertation Coverage.

ERIC Educational Resources Information Center

Perry, Stephen; Salisbury, Lutishoor

1995-01-01

Presents a comparative analysis of electronic access to theses and dissertations through CitaDel and FirstSearch. Highlights include the effectiveness and ease of use in providing enduser access; strengths and weaknesses of searching capabilities; coverage; pricing; and examples of direct retrieval comparison. (LRW)

Direct puncture embolization of the internal iliac artery during cesarean delivery for pernicious placenta previa coexisting with placenta accreta.

PubMed

Chen, Zhenyu; Li, Ju; Shen, Jian; Jin, Jiaxi; Zhang, Wei; Zhong, Wan

2016-12-01

To evaluate direct puncture embolization of the internal iliac artery with hemostatic gelatin sponge particles to treat pernicious placenta previa coexisting with placenta accreta during cesarean delivery. A retrospective study was conducted of data from women with pernicious placenta previa and placenta accreta who underwent direct puncture embolization of the internal iliac artery during cesarean delivery at a center in China between September 1, 2013, and February 28, 2015. Information regarding surgical procedures, operative data, and outcomes during hospitalization were obtained from medical records. The procedure was successful in all 16 cases included. Mean operative time was 78 minutes (range 65-90) and mean estimated blood loss was 1550 mL (range 1000-2500). Complications such as fever, buttock pain, or acute limb ischemia were not observed. The procedure was performed after partial cystectomy for two patients with bladder invasion. Postoperative Doppler imaging indicated uterine recovery and normalized uterine blood flow in all patients. Direct puncture embolization of the internal iliac artery during cesarean delivery was a safe, effective, simple, and rapid method to control hemorrhage among women with pernicious placenta previa and placenta accreta. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

PubMed Central

Yi, Kyong Wook; Seo, Tae-Seok; So, Kyeong A; Paek, Yu Chin; Kim, Hai-Joong

2010-01-01

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta. PMID:20358016

Frequency, Risk Factors, and Adverse Fetomaternal Outcomes of Placenta Previa in Northern Tanzania

PubMed Central

Senkoro, Elizabeth Eliet; Mwanamsangu, Amasha H.; Chuwa, Fransisca Seraphin; Msuya, Sia Emmanuel; Mnali, Oresta Peter

2017-01-01

Background and Objective. Placenta previa (PP) is a potential risk factor for obstetric hemorrhage, which is a major cause of fetomaternal morbidity and mortality in developing countries. This study aimed to determine frequency, risk factors, and adverse fetomaternal outcomes of placenta previa in Northern Tanzania. Methodology. A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre birth registry spanning 2000 to 2015. All women who gave birth to singleton infants were studied. Adjusted odds ratios (ORs) with 95% confidence intervals for risk factors and adverse fetomaternal outcomes associated with PP were estimated in multivariable logistic regression models. Result. A total of 47,686 singleton deliveries were analyzed. Of these, the frequency of PP was 0.6%. Notable significant risk factors for PP included gynecological diseases, alcohol consumption during pregnancy, malpresentation, and gravidity ≥5. Adverse maternal outcomes were postpartum haemorrhage, antepartum haemorrhage, and Caesarean delivery. PP increased odds of fetal Malpresentation and early neonatal death. Conclusion. The prevalence of PP was comparable to that found in past research. Multiple independent risk factors were identified. PP was found to have associations with several adverse fetomaternal outcomes. Early identification of women at risk of PP may help clinicians prevent such complications. PMID:28321338

Sonoembryological evaluations of the development of placenta previa and velamentous cord insertion.

PubMed

Hasegawa, Junichi

2015-01-01

Longitudinal and cross-sectional investigations using ultrasound examinations during pregnancy can be used to clarify the mechanisms and pathophysiology of abnormal fetal and placental development. Such sonoembryological assessments are useful as a method for clarifying the etiology of disease. In the present review, we describe current knowledge based on our experience with applying sonoembryological methods to determine the developmental mechanisms of placenta previa and velamentous cord insertion. © 2014 The Author. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Association of Placenta Previa with a History of Previous Cesarian Deliveries and Indications for a Possible Role of a Genetic Component

PubMed Central

M, Matalliotakis; A, Velegrakis; GN, Goulielmos; E, Niraki; AE, Patelarou; I, Matalliotakis

2017-01-01

Abstract A prior Cesaria section (C-section) is an important risk factor that leads to endometrial damage and abnormal implantation of the placenta. Our retrospective study aims to correlate the frequency of placenta previa to previous C-sections, to determine the effect of male gender in this condition and to evaluate further the maternal outcome. Seventy-six cases with placenta previa were selected out of 5200 live births. Diagnosis was confirmed by ultrasound and in the operating theater. In the 76 women examined, we found 50 cases with a history of a previous C-section (66.0%) and 49 male offspring (65.0%) (p <0.001), with a mean birth weight of 2635 ± 740 g. Of all these patients, six (8.0%) cases developed placenta percreta, seven (9.0%) were transferred to the intensive care unit (ICU), 14 (18.0%) women needed blood transfusion and eight (11.0%) underwent hysterectomy. The results of our series show a strong correlation of placenta previa to a history of previous C-sections and a predominance of male fetuses. Early recognition and proper monitoring could minimize the possibility of a poor outcome. PMID:29876227

Association of Placenta Previa with a History of Previous Cesarian Deliveries and Indications for a Possible Role of a Genetic Component.

PubMed

M, Matalliotakis; A, Velegrakis; Gn, Goulielmos; E, Niraki; Ae, Patelarou; I, Matalliotakis

2017-12-01

A prior Cesaria section (C-section) is an important risk factor that leads to endometrial damage and abnormal implantation of the placenta. Our retrospective study aims to correlate the frequency of placenta previa to previous C-sections, to determine the effect of male gender in this condition and to evaluate further the maternal outcome. Seventy-six cases with placenta previa were selected out of 5200 live births. Diagnosis was confirmed by ultrasound and in the operating theater. In the 76 women examined, we found 50 cases with a history of a previous C-section (66.0%) and 49 male offspring (65.0%) ( p <0.001), with a mean birth weight of 2635 ± 740 g. Of all these patients, six (8.0%) cases developed placenta percreta, seven (9.0%) were transferred to the intensive care unit (ICU), 14 (18.0%) women needed blood transfusion and eight (11.0%) underwent hysterectomy. The results of our series show a strong correlation of placenta previa to a history of previous C-sections and a predominance of male fetuses. Early recognition and proper monitoring could minimize the possibility of a poor outcome.

Asymptomatic "placental prolapse" with cervical funneling in a patient with complete placenta previa.

PubMed

Adekola, Henry; Lam-Rachlin, Jennifer; Bronshtein, Elena; Abramowicz, Jacques S

2015-02-01

We describe the transvaginal sonographic findings in a patient with complete placenta previa and increased risk of preterm birth owing to a prior history of mid-trimester pregnancy loss in whom we observed a short cervix and prolapse of the placenta and fetal membranes into the endocervical canal. We believe that this could lead to antepartum hemorrhage and mandate close observation when diagnosed. We introduced the term "placental prolapse" to describe our finding. © 2015 Wiley Periodicals, Inc.

Planificación Neuroquirúrgica con Software Osirix

PubMed Central

Jaimovich, Sebastián Gastón; Guevara, Martin; Pampin, Sergio; Jaimovich, Roberto; Gardella, Javier Luis

2014-01-01

Introducción: La individualidad anatómica es clave para reducir el trauma quirúrgico y obtener un mejor resultado. Actualmente, el avance en las neuroimágenes ha permitido objetivar esa individualidad anatómica, permitiendo planificar la intervención quirúrgica. Con este objetivo, presentamos nuestra experiencia con el software Osirix. Descripción de la técnica: Se presentan 3 casos ejemplificadores de 40 realizados. Caso 1: Paciente con meningioma de la convexidad parasagital izquierda en área premotora; Caso 2: Paciente con macroadenoma hipofisario, operada previamente por vía transeptoesfenoidal en otra institución con una resección parcial; Caso 3: Paciente con lesiones en pedúnculo cerebeloso medio bilateral. Se realizó la planificación prequirúrgica con el software OsiriX, fusionando y reconstruyendo en 3D las imágenes de TC e IRM, para analizar relaciones anatómicas, medir distancias, coordenadas y trayectorias, entre otras funciones. Discusión: El software OsiriX de acceso libre y gratuito permite al cirujano, mediante la fusión y reconstrucción en 3D de imágenes, analizar la anatomía individual del paciente y planificar de forma rápida, simple, segura y económica cirugías de alta complejidad. En el Caso 1 se pudo analizar las relaciones del tumor con las estructuras adyacentes para minimizar el abordaje. En el Caso 2 permitió comprender la anatomía post-operatoria previa del paciente, para determinar la trayectoria del abordaje transnasal endoscópico y la necesidad de ampliar su exposición, logrando la resección tumoral completa. En el Caso 3 permitió obtener las coordenadas estereotáxicas y trayectoria de una lesión sin representación tomográfica. Conclusión: En casos de no contar con costosos sistemas de neuronavegación o estereotáxia el software OsiriX es una alternativa a la hora de planificar la cirugía, con el objetivo de disminuir el trauma y la morbilidad operatoria. PMID:25165617

Effect of Placenta Previa on Preeclampsia

PubMed Central

Ying, Hao; Lu, Yi; Dong, Yi-Nuo; Wang, De-Fen

2016-01-01

Background The correlation between gestational hypertension-preeclampsia (GH-PE) and placenta previa (PP) is controversial. Specifically, it is unknown whether placenta previa has any effect on the various types of preeclampsia (PE), and the role PP with concurrent placenta accreta (PA) play in the occurrence of GH-PE are not well understood. Objective The aim of this study was to identify the effects of PP on GH, mild and severe preeclampsia (MPE and SPE), and early- and late-onset preeclampsia (EPE and LPE). Another aim of the study was to determine if concurrent PA impacts the relationship between PP and GH-PE. Methods A retrospective single-center study of 1,058 patients having singleton pregnancies with PP was performed, and 2,116 pregnant women were randomly included as controls. These cases were collected from a tertiary hospital and met the inclusion criteria for the study. Clinical information, including PP and the gestational age at the onset of GH-PE were collected. Binary and multiple logistic regression analyses were conducted after the confounding variables were controlled to assess the effects of PP on different types of GH-PE. Results There were 155 patients with GH-PE in the two groups. The incidences of GH-PE in the PP group and the control group were 2.5% (26/1058) and 6.1% (129/2116), respectively (P = 0.000). Binary and multiple regression analyses were conducted after controlling for confounding variables. Compared to the control group, in the PP group, the risk of GH-PE was reduced significantly by 78% (AOR: 0.216; 95% CI: 0.135–0.345); the risks of GH and PE were reduced by 55% (AOR: 0.451; 95% CI: 0.233–0.873) and 86% (AOR: 0.141; 95% CI: 0.073–0.271), respectively; the risks of MPE and SPE were reduced by 73% (AOR: 0.269; 95% CI: 0.087–0828) and 88% (AOR: 0.123; 95% CI: 0.055–0.279), respectively; and the risks of EPE and LPE were reduced by 95% (AOR: 0.047; 95% CI: 0.012–0.190) and 67% (AOR: 0.330; 95% CI: 0.153–0

A novel scoring system for predicting adherent placenta in women with placenta previa.

PubMed

Tanimura, Kenji; Morizane, Mayumi; Deguchi, Masashi; Ebina, Yasuhiko; Tanaka, Utaru; Ueno, Yoshiko; Kitajima, Kazuhiro; Maeda, Tetsuo; Sugimura, Kazuro; Yamada, Hideto

2018-04-01

Placenta previa (PP) is one of the most significant risk factors for adherent placenta (AP). The aim of this study was to evaluate the diagnostic efficacy of a novel scoring system for predicting AP in pregnant women with PP. This prospective cohort study enrolled 175 women with PP. The placenta previa with adherent placenta score (PPAP score) is composed of 2 categories: (1) past history of cesarean section (CS), surgical abortion, and/or uterine surgery; and (2) ultrasonography and magnetic resonance imaging findings. Each category is graded as 0, 1, 2, or 4 points, yielding a total score between 0 and 24. When women with PP had PPAP score ≥8, they were considered to be at a high risk for AP and received placement of preoperative internal iliac artery occlusion balloon catheters. If they were found to have AP during CS, they underwent hysterectomy or placenta removal using advanced bipolar with balloon catheter occlusion. The predictive accuracy of PPAP score was evaluated. In total, 23 of the 175 women with PP were diagnosed as having AP, histopathologically or clinically. Twenty-one of 24 women with PPAP score ≥8 had AP, whereas two of 151 women with PPAP score <8 had AP. The scoring system yielded 91.3% sensitivity, 98.0% specificity, 87.5% positive predictive value, and 98.7% negative predictive value for predicting AP in women with PP. This prospective study demonstrated that PPAP scoring system may be useful for predicting AP in women with PP. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Application of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa complicated with placenta accreta].

PubMed

Cui, S H; Zhi, Y X; Zhang, K; Zhang, L D; Shen, L N; Gao, Y N

2016-09-25

Objective: To investigate the value of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa with placenta accreta. Methods: From January 2015 to February 2016, 24 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the abdominal aorta(the study group)before cesarean, and 24 cases of complete placenta previa with placenta accreta did not receive balloon occlusion(the control group). The operation time, intraoperative blood loss, intraoperative blood transfusion volume, the perioperative hemoglobin level, the hysterectomy rate and the related complications were compared retrospectively.Also, the hospitalization time, the blood coagulation parameters after operation, including activated partial thromboplastin time(APTT), fibrinogen(FIB), D-Dimer and reperfusion injury parameters including creatine phosphokinase(CK), creatine phosphokinase isoenzyme(CK-MB), lactate dehydrogenase(LDH)and serum creatinine were compared between the 2 groups. Results: The blood loss[750 ml(400- 2 000 ml)vs 2 000 ml(1 500- 2 375 ml); Z =-3.214, P =0.001]and blood transfusion volume[200 ml(0-800 ml)vs 800 ml(0-1 200 ml); Z =- 2.173, P =0.030]in the study group were lower than in the control group. The hemoglobin difference between before and after operation in the study group was lower than the control group[(12.8±13.4)g/L vs(22.9±20.1)g/L; t =-2.041, P =0.047]. In the study group, there were still bleeding in 13 cases after releasing the balloon, 5 of them received uterine artery embolization, 5 cases received uterine artery ligation, and 3 cases received uterine packing. One case had venous thrombosis in the right lower limb. Two cases(8%,2/24)in the control group had hysterectomy, while none in the study group, there was no statistical significance( P = 0.489). Conclusions: Temporary balloon occlusion of the abdominal aorta can effectively reduce blood loss and blood transfusion in the

Pre-cesarean prophylactic balloon placement in the internal iliac artery to prevent postpartum hemorrhage among women with pernicious placenta previa.

PubMed

Meng-Jun, Dai; Guang-Xin, Jin; Jian-Hua, Lin; Yu, Zhang; Yun-Yan, Chen; Xue-Bin, Zhang

2018-06-07

To evaluate pre-cesarean prophylactic balloon placement (PBP) in the internal iliac artery among women with pernicious placenta previa. The present retrospective study included women with pernicious placenta previa who underwent cesarean delivery at Shanghai Renji Hospital, Shanghai, China, between March 1, 2011, and June 30, 2017. Data were compared between patients who did and did not undergo PBP. Among 42 patients included, 20 underwent PBP and 22 did not. Mean±SD estimated blood loss was 2900.00±2352.21 mL in the PBP group, and 4549.77±2366.67 mL in the non-PBP group (P=0.025). The amount of transfused red blood cells was 8.40±7.14 U and 13.00±7.93 U (P=0.018), respectively. No patients in the PBP group developed postoperative disseminated intravascular coagulopathy, compared with 3 (14%) in the non-PBP group (P=0.087). In the PBP and non-PBP groups, the hospital stay duration was 7.40±3.07 and 8.68±2.58 days (P=0.029), and there were 1 and 7 patients who had obstetric hysterectomies (P=0.027), respectively. Two patients experienced PBP-related adverse events, including thrombosis and re-bleeding. There were no deaths. Pre-cesarean PBP in the internal iliac artery was a safe and effective treatment that could reduce the incidence of both postpartum hemorrhage and hysterectomy among women with pernicious placenta previa. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Twin pregnancy with complete mole and coexisting fetus after in vitro fertilization and embryo transfer complicated with placenta previa accreta. A case report].

PubMed

Guzmán González, Eduardo; Gaviño Gaviño, Fernando; Valero Origel, Alberto; Deschamps Díaz, Horacio; Ramírez Fernández, María Antonieta; Miranda Lamadrid, Mario

2009-03-01

The double twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare event and perinatal treatment complex. Presents a significant case of this unusual partnership and describes their evolution. Patient of 33 years, secondary infertility factor-peritoneal tube and pregnancy achieved by in vitro fertilization and embryo transfer. An ultrasound early pregnancy reported twice, a sack was a complete mole, another bag was a fetus and placenta previa unchanged total. The case is carefully monitored and uterine inhibitors were administered at different stages of gestation. It settled the case by caesarean section at 37 weeks and obstetric hysterectomy for placenta previa percreta molar involution of the placenta and newborn health. The evolution of the mother and the child was appropriate.

[Application of uterine lower part breakwater-like suture operation in placenta previa].

PubMed

Zhao, Y; Zhu, J W; Wu, D; Wang, Q H; Lu, S S; Liu, X X; Zou, L

2018-04-25

Objective: To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods: From June 2016 to June 2017, 47 patients were diagnosed placenta previa in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Posterior wall breakwater-like suture technique was used preferentially, as for cases with poor myometrium layer, lower anterior wall stitch suture was used at the same time. Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results: Thirty cases (63.8, 30/47) were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively. Senventeen cases were diagnosed as placenta accreta (36.2%, 17/47) . Thirty-four cases had the previous history of cesarean section. The average cervical canal length of 47 patients was (2.8±0.9) cm. There were 19 cases (40.4%,19/47) with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47) with 2 or 3 times posterior wall breakwater-like sutured; 12 cases (25.5%,12/47) were treated with anterior wall stitch suture simultaneously.Ten cases (21.3%, 10/47) underwent uterine artery ligation, 17 cases (36.2%, 17/47) underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml, the percentiles 25 was 500 ml, and the percentiles 75 was 1 200 ml. The blood loss ≥1 000 ml in 18 (38.3%, 18/47) patients,and the most serious one was 2 500 ml. The median blood transfusion volume (including allogenetic transfusion and autotransfusion) was 450 ml, the percentiles 25 was 228 ml, and the percentiles 75 was 675 ml. The average vaginal bleeding volume was (150±63) ml first day after operation. The

Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country

PubMed Central

Berhan, Yifru

2014-01-01

A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12 gm/dL) with mean haemoglobin level of 9.0 ± 3.0 gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. PMID:25002975

Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar.

PubMed

Miyakoshi, Kei; Otani, Toshimitsu; Kondoh, Eiji; Makino, Shintaro; Tanaka, Mamoru; Takeda, Satoru

2018-03-01

To investigate maternal outcomes after leaving the placenta in situ for placenta accreta spectrum (PAS) disorders in patients with placenta previa on a cesarean delivery scar. The present retrospective study reviewed medical records from women with placenta previa on a cesarean scar underwent perinatal care at secondary- or tertiary-level perinatal centers in Japan between January 1, 2010, and December 31, 2014. Perinatal management was conducted based on each leading obstetrician's discretion. The primary outcome was success of the leaving the placenta in situ approach for PAS disorders (defined as preserving the uterus without hysterectomy). Of 178 eligible centers, 126 (71%) participated in this study; data from 613 patients were included. Of these, 41 had the placenta left in situ owing to PAS disorders and follow-up data were available for 36 women. Leaving the placenta in situ was successful in 25 (69%) patients, with placental resorption occurring postpartum (median 89 days; range 6-510). Hysterectomy was performed for 11 patients, primarily owing to hemorrhage and/or infection (median 30 days; range 0-95 days, postpartum). Leaving the placenta in situ, with close postpartum follow-up for at least several months, could be a uterus-preserving option for patient with PAS disorders. © 2017 International Federation of Gynecology and Obstetrics.

Which type of placenta previa requires blood transfusion more frequently? A new concept of indiscernible edge total previa.

PubMed

Baba, Yosuke; Takahashi, Hironori; Ohkuchi, Akihide; Usui, Rie; Matsubara, Shigeki

2016-11-01

During cesarean section (CS) for placenta previa (PP), the size/area/portion of the lower uterine segment occupied by the placenta may affect the bleeding amount and the subsequent need for a blood transfusion (BT). We propose a new concept, indiscernible edge total PP (IEPP), when vaginal ultrasound does not discern the lower placental edge because the placenta covers the visible lower segment. We characterized IEPP, focusing on its allogeneic BT requirement. We classified PP (n = 307) into four types: marginal, partial, discernible edge total PP (DEPP) and IEPP: internal ostium (os)-placental edge distance measurable or unmeasurable on vaginal ultrasound in DEPP or IEPP, respectively. We determined the clinical characteristics according to the four types; the relationship between the intraoperative blood loss and os-edge distance in DEPP; and risk factors for allogeneic BT. The following were significantly higher/larger in cases of IEPP: previous CS; anterior placentation; lacunae; elective cesarean hysterectomy; intraoperative blood loss; autologous BT; allogeneic BT; intensive care unit admission; and an abnormally invasive placenta (AIP). In DEPP, the os-edge distance was weakly correlated with the bleeding amount (r = 0.214). Multivariate logistic regression analysis showed that previous CS, lacunae, AIP and IEPP were independent risk factors for allogeneic BT (odds ratios 3.8, 3.1, 13.8 and 4.6, respectively). After excluding patients undergoing hemostatic procedures during CS, IEPP remained the only independent risk factor for allogeneic BT (odds ratio 5.2). The new concept of IEPP may be useful for predicting BT in CS for patients with PP. © 2016 Japan Society of Obstetrics and Gynecology.

[Application of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa].

PubMed

Wei, L C; Gong, G Y; Chen, J H; Hou, P Y; Li, Q Y; Zheng, Z Y; Su, Y M; Zheng, Y; Luo, C Z; Zhang, K; Xu, T F; Ye, Y H; Lan, Y J; Wei, X M

2018-03-27

Objective: To discuss the feasibility, effect and safety of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa. Methods: The clinical data of 40 patients with pernicious placenta previa complicated with placenta accreta from January 2015 to August 2017 in Liuzhou workers hospital were analyzed retrospectively. The study group included 20 cases, which were operated in the way of cesarean section combined lower abdominal aorta balloon occlusion technique by ultrasound guiding, while the control group also included 20 cases, which were operated in the way of the conventional cesarean section without balloon occlusion technique. The bleeding amount, blood transfusion volume, operative total time, hysterectomy and complications of the two groups were compared. Results: The bleeding amount and blood transfusion volume in study group were(850±100)ml and (400±50)ml, which were lower than that of the control group[(2 500±230)ml and (1 500±100)ml], the difference was statistically significant( t =35.624, 16.523, all P <0.05). In addition, the hysterectomy rate in study group was 5%, which was lower than that in the control group(30%), the difference was statistically significant(χ 2 =8.672, P <0.05). And the total time of operation was (2.0±0.5)h in the study group, which was shorter than that in the control group[(3.5±0.4)h]. The difference was statistically significant( t =11.362, P <0.05). No postoperative complications took place in the study group.The blood pressure, heart rate and blood oxygen fluctuated significantly, and the postoperative renal function was significantly reduced in the control group. Conclusions: The lower abdominal aorta balloon occlusion technique by ultrasound guiding during a caesarean section in patients with pernicious placenta previa can effectively control the bleeding during operation, and preserve reproductive function to the utmost degree

Matsubara-Takahashi cervix-holding technique for massive postpartum hemorrhage in patients with placenta previa with or without placenta accreta spectrum disorders.

PubMed

Takahashi, Hironori; Ohkuchi, Akihide; Usui, Rie; Suzuki, Hirotada; Baba, Yosuke; Matsubara, Shigeki

2018-03-01

To determine the efficacy and safety of the Matsubara-Takahashi cervix-holding technique (MT-holding) for achieving hemostasis for postpartum hemorrhage (PPH). The present retrospective observational study included data from deliveries that occurred between January 1, 2004, and December 31, 2014, at the Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan. Deliveries were included where patients experienced blood loss greater than 2500 mL and MT-holding was used. The success rates of the technique in patients with placenta accreta spectrum (PAS) disorders and PPH were determined; subsequent pregnancy outcomes were also examined. There were 53 deliveries included in the study; 29 patients had placenta previa and 8 of these patients also had PAS disorders. MT-holding achieved hemostasis in 15 (71%) and 4 (50%) patients with placenta previa without and with PAS disorders, respectively; the placenta was removed in the latter. Overall, MT-holding achieved hemostasis in 40 (75%) deliveries. Of nine patients who became pregnant after this procedure, six went on to have full-term deliveries. MT-holding achieved hemostasis in 50% of patients with PAS disorders and had an overall success rate of 75% for PPH, comparable to other uterus-sparing procedures. MT-holding is suggested as a simple, effective, safe technique available to less-experienced obstetrician; these findings require confirmation in larger studies. © 2017 International Federation of Gynecology and Obstetrics.

Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study.

PubMed

Aydogan, P; Kahyaoglu, S; Saygan, S; Kaymak, O; Mollamahmutoglu, L; Danisman, N

2014-08-01

The underlying inflammation of endometrium may impede normal implantation of placenta during pregnancy. Our objective is to show cervical colonization of ureaplasma and/or mycoplasma as a marker of endometritis in pregnancies complicated with placenta previa that can be a risk factor for placenta accreta and peripartum hemorrhage. Cervical cultures for ureaplasma urealyticum and mycoplasma genitalium have been taken from the endocervical region of the cervix of the patients. Subsequent uterine lower segment bleeding suggesting placenta implantation defects have been evaluated during cesarean section. Of 25 patients: ten (40%) had negative cervical cultures for cervical mycoplasma and/or ureaplasma, 9 (36%) were found to be culture positive for cervical ureaplasma, 1 (4%) was found to be culture positive for cervical mycoplasma. Half of the 10 patients with positive cervical cultures for ureaplasma or mycoplasma and 6 of (40%) 15 patients with negative results had experienced lower uterine segment bleeding during cesarean section. Bacterial colonization of cervix in particular with ureaplasma and/or mycoplasma is found to be strongly associated with placenta previa. Before a planned pregnancy, treatment of this infection with appropriate antibiotics is necessary to prevent underlying uterine endometritis that increases the risk for abnormal implantation of placenta.

Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy.

PubMed

Alchalabi, Haifa'a; Lataifeh, Isam; Obeidat, Basil; Zayed, Faheem; Khader, Yousef S; Obeidat, Nail

2014-11-01

To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used. This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search. A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group. MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study

PubMed Central

Ahmed, Salah Roshdy; Aitallah, Abdusaeed; Abdelghafar, Hazem M.

2015-01-01

Introduction Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. Aim To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). Materials and Methods A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. Results The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. Conclusion The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services. PMID:26674539

Evaluation of interobserver variability and diagnostic performance of developed MRI-based radiological scoring system for invasive placenta previa.

PubMed

Ueno, Yoshiko; Maeda, Tetsuo; Tanaka, Utaru; Tanimura, Kenji; Kitajima, Kazuhiro; Suenaga, Yuko; Takahashi, Satoru; Yamada, Hideto; Sugimura, Kazuro

2016-09-01

To evaluate the interobserver variability and diagnostic performance of a developed magnetic resonance imaging (MRI)-based scoring system for invasive placenta previa. Prenatal MR images of 70 women were retrospectively evaluated, 18 of whom were diagnosed with invasive placenta. The six MR features (dark band on T2 -weighted images, intraplacental abnormal vascularity, placental bulge, heterogeneous placenta, myometrial thinning, and placental protrusion sign) were scored on 5-point Likert scale separately, and the cumulative radiological score (CRS) was defined as the sum of each score. Two more experienced radiologists (readers A and B) and two less experienced residents (readers C and D) calculated the CRS. Interobserver variability was assessed by measuring the intraclass correlation coefficient. Diagnostic performance was evaluated by means of receiver operating characteristic (ROC) analysis. Interobserver variability for CRS was excellent for the more experienced radiologists (0.85), and good for all readers (0.72) and the less experienced residents (0.66). The area under the ROC curve (Az) and accuracy (Acc) for CRS were significantly higher or equivalent to those of other MR features for all readers (Az and Acc for reader A; CRS, 0.92, 91.4%; intraplacental T2 dark band, 0.83, P = 0.009, 81.4%, P = 0.03; intraplacental abnormal vascularity, 0.9, P = 0.3, 90.0%, P = 1.00; placental bulge, 0.81, P = 0.0008, 80.0%, P = 0.02; heterogeneous placenta, 0.85, P = 0.11, 74.3%, P = 0.002; myometrial thinning, 0.84, P = 0.06, 60.0%, P < 0.0001; placental protrusion sign, 0.81, P = 0.01, 81.4%, P = 0.26). This developed MRI-based scoring system demonstrated excellent or good interobserver variability, and good diagnostic performance for invasive placenta previa. J. Magn. Reson. Imaging 2016;44:573-583. © 2016 International Society for Magnetic Resonance in Medicine.

Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study.

PubMed

Fan, Dazhi; Wu, Shuzhen; Ye, Shaoxin; Wang, Wen; Wang, Lijuan; Fu, Yao; Zeng, Meng; Liu, Yan; Guo, Xiaoling; Liu, Zhengping

2018-04-03

Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women. A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069. Mean maternal age and gestational age at delivery were 32.26 ± 5.03 years old and 36.21 ± 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43-64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44-1092.86) ml. Total blood loss was 875.00 (604.50-1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was -0.33 (6.00-13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18-7.58) d. The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete

Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI - useful features for differentiating placenta percreta from placenta accreta.

PubMed

Chen, Xin; Shan, Ruiqin; Zhao, Lianxin; Song, Qingxu; Zuo, Changting; Zhang, Xinjuan; Wang, Shanshan; Shi, Honglu; Gao, Fei; Qian, Tianyi; Wang, Guangbin; Limperopoulos, Catherine

2018-02-01

To characterise MRI features of invasive placenta previa and to identify specific features for differentiating placenta percreta (PP) from placenta accreta (PA). Forty-five women with PP and 93 women with PA who underwent 1.5T placental MRI were included. Two radiologists independently evaluated the MRI features of invasive placenta previa, including our novel type of placental bulge (i.e. placental bulge type-II, characterized by placental bulge with distorted uterine outline). Pearson's chi-squared or Fisher's two-sided exact test was performed to compare the MRI features between PP and PA. Logistic stepwise regression analysis and the area under the receiver operating characteristic curve (AUC) were performed to select the optimal features for differentiating PP from PA. Significant differences were found in nine MRI features between women with PP and those with PA (P <0.05). Placental bulge type-II and uterine serosal hypervascularity were independently associated with PP (odds ratio = 48.618, P < 0.001; odds ratio = 4.165, P = 0.018 respectively), and the combination of the two MRI features to distinguish PP from PA yielded an AUC of 0.92 for its predictive performance. Placental bulge type-II and uterine serosal hypervascularity are useful MRI features for differentiating PP from PA. • Placental bulge type-II demonstrated the strongest independent association with PP. • Uterine serosal hypervascularity is a useful feature for differentiating PP from PA. • MRI features associated with abnormal vessels increase the risk of massive haemorrhage.

Assessment of total placenta previa by magnetic resonance imaging and ultrasonography to detect placenta accreta and its variants.

PubMed

Peker, Nuri; Turan, Volkan; Ergenoglu, Mete; Yeniel, Ozgur; Sever, Ahmet; Kazandi, Mert; Zekioglu, Osman

2013-03-01

To evaluate the importance of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting placental adherence defects. Patients diagnozed with total placenta previa (n = 40) in whom hysterectomy was performed due to placental adherence defects (n = 20) or in whom the placenta detached spontaneously after a Cesarean delivery (n = 20) were included into the study between June 2008 and January 2011, at the Department of Obstetrics and Gynecology Ege University (lzmir Turkey). Gray-scale US was used to check for any placental lacunae, sub-placental sonolucent spaces or a placental mass invading the vesicouterine plane and bladder Intra-placental lacunar turbulent blood flow and an increase in vascularization in the vesicouterine plane were evaluated with color Doppler mode. Subsequently all patients had MRI and the results were compared with the histopathologic examinations. The sensitivity of MRI for diagnosis of placental adherence defects before the operation was 95%, with a specificity of 95%. In the presence of at least one diagnostic criterion, the sensitivity and specificity of US were 87.5% and 100% respectively, while the sensitivity of color Doppler US was 62.5% with a specificity of 100%. Currently MRI appears to be the gold standard for the diagnosis of placenta accreta. None of the ultrasonographic criteria is solely sufficient to diagnose placental adherence defects, however they assist in the diagnostic process.

Omeprazole preferentially inhibits the metabolism of (+)-(S)-citalopram in healthy volunteers.

PubMed

Rocha, Adriana; Coelho, Eduardo B; Sampaio, Stefânia A; Lanchote, Vera L

2010-07-01

Citalopram (CITA) pharmacokinetics are enantioselective in healthy volunteers and the metabolism of (+)-(S)-CITA to (+)-(S)-DCITA is dependent on CYP2C19. Omeprazole is a potent CYP2C19 inhibitor. This study indicates that omeprazole induces a loss of enantioselectivity in the CITA pharmacokinetics because of the selective inhibition of (+)-(S)-CITA metabolism. The study assessed the influence of omeprazole on the kinetic disposition of the (+)-(S)-citalopram (CITA) and (-)-(R)-CITA enantiomers in healthy volunteers. In a cross-over study, healthy volunteers (n = 9) phenotyped as extensive metabolizers of CYP2C19 and CYP2D6 and with an oral midazolam clearance ranging from 10.9 to 149.3 ml min(-1) kg(-1) received a single dose of racemic CITA (20 mg orally) in combination or not with omeprazole (20 mg day(-1) for 18 days). Serial blood samples were collected up to 240 h after CITA administration. CITA and demethylcitalopram (DCITA) enantiomers were analyzed by LC-MS/MS using a Chiralcel OD-R column. The kinetic disposition of CITA was enantioselective in the absence of treatment with omeprazole, with the observation of a greater proportion of plasma (-)-(R)-CITA [AUC S:R ratio of 0.53 (95% CI 0.41, 0.66) for CITA and 1.08 (95% CI 0.80, 1.76) for DCITA] than (+)-(S)-CITA. Racemic CITA administration to healthy volunteers in combination with omeprazole showed a loss of enantioselectivity in CITA pharmacokinetics with an increase of approximately 120% in plasma (+)-(S)-CITA concentrations [AUC S:R ratio of 0.95 (95% CI 0.72, 1.10) for CITA and 0.95 (95% CI 0.44, 1.72) for DCITA]. The administration of multiple doses of omeprazole preferentially inhibited (+)-(S)-CITA metabolism in healthy volunteers. Although omeprazole increased plasma concentrations of (+)-(S)-CITA by approximately 120%, it is difficult to evaluate the clinical outcome because the range of plasma CITA concentrations related to maximum efficacy and minimum risk of adverse effects has not been

Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey.

PubMed

Coskun, Bora; Akkurt, Iltac; Dur, Rıza; Akkurt, Mehmet O; Ergani, Seval Y; Turan, Ozerk T; Coskun, Bugra

2018-02-01

To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP). We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features. Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n = 5), bladder injury (n = 4), pelvic abscess (n = 1), and uterine rupture (n = 1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8-75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24-43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32-26.69), and (4) transvaginal cervical length (CL) measurement <10th percentile (aOR 5.5, 95% CI 2.1-15.4). Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.

Omeprazole preferentially inhibits the metabolism of (+)-(S)-citalopram in healthy volunteers

PubMed Central

Rocha, Adriana; Coelho, Eduardo B; Sampaio, Stefânia A; Lanchote, Vera L

2010-01-01

AIM The study assessed the influence of omeprazole on the kinetic disposition of the (+)-(S)-citalopram (CITA) and (−)-(R)-CITA enantiomers in healthy volunteers. METHODS In a cross-over study, healthy volunteers (n = 9) phenotyped as extensive metabolizers of CYP2C19 and CYP2D6 and with an oral midazolam clearance ranging from 10.9 to 149.3 ml min−1 kg−1 received a single dose of racemic CITA (20 mg orally) in combination or not with omeprazole (20 mg day−1 for 18 days). Serial blood samples were collected up to 240 h after CITA administration. CITA and demethylcitalopram (DCITA) enantiomers were analyzed by LC-MS/MS using a Chiralcel® OD-R column. RESULTS The kinetic disposition of CITA was enantioselective in the absence of treatment with omeprazole, with the observation of a greater proportion of plasma (−)-(R)-CITA [AUC S : R ratio of 0.53 (95% CI 0.41, 0.66) for CITA and 1.08 (95% CI 0.80, 1.76) for DCITA] than (+)-(S)-CITA. Racemic CITA administration to healthy volunteers in combination with omeprazole showed a loss of enantioselectivity in CITA pharmacokinetics with an increase of approximately 120% in plasma (+)-(S)-CITA concentrations [AUC S : R ratio of 0.95 (95% CI 0.72, 1.10) for CITA and 0.95 (95% CI 0.44, 1.72) for DCITA]. CONCLUSIONS The administration of multiple doses of omeprazole preferentially inhibited (+)-(S)-CITA metabolism in healthy volunteers. Although omeprazole increased plasma concentrations of (+)-(S)-CITA by approximately 120%, it is difficult to evaluate the clinical outcome because the range of plasma CITA concentrations related to maximum efficacy and minimum risk of adverse effects has not been established. PMID:20642546

Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa?

PubMed

Haidar, Ziad A; Papanna, Ramesha; Sibai, Baha M; Tatevian, Nina; Viteri, Oscar A; Vowels, Patricia C; Blackwell, Sean C; Moise, Kenneth J

2017-08-01

Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ 2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index

PubMed

Damián-Bastidas, Narda; Chala-Florencio, Roni J; Chávez-Blanco, Ricardo; Mayta-Tristán, Percy

2016-11-29

Introducción: el etiquetado nutricional ayuda a los consumidores a realizar elecciones más saludables. Sin embargo, este es poco leído, mal interpretado o no usado.Objetivos: evaluar la frecuencia y los factores asociados a la lectura, el uso y la interpretación de etiquetas nutricionales en usuarios de gimnasios en la ciudad de Huancayo, Perú.Materiales y métodos: estudio de corte transversal en 385 usuarios de una cadena de gimnasios. Se midió la interpretación con un test a partir de dos etiquetas, lectura reportada (frecuentemente o no) y el uso reportado para elegir un producto (frecuentemente o no), así como variables demográficas, dietéticas y relacionadas con el gimnasio. Se evaluó la asociación calculando las razones de prevalencias ajustadas en base a las variables significativas del modelo bivariado.Resultados: los participantes tuvieron una edad media de 27,8 ± 9,3 años, 44,7% fueron varones, 49,4% contaron con educación universitaria. El 27,5% reporta leer frecuentemente y dentro de estos el 55,7% reporta usarlas frecuentemente, asimismo el 17,4% sabe interpretar. La lectura se asoció con factores dietéticos y de uso de gimnasio y la interpretación con capacitación previa de lectura de la etiqueta. El uso fue principalmente para seleccionar productos bajos en grasa total (65,1%), alto en proteínas (64,2%) y en menor proporción, productos bajos en sodio (47,2%).Conclusiones: la frecuencia de lectura, el uso y la interpretación de etiquetas nutricionales en usuarios de gimnasio de Huancayo es baja. La capacitación previa de lectura es un factor necesario para una elección saludable. Es necesario establecer estrategias educativas para enseñar a interpretar de forma adecuada las etiquetas nutricionales.

The Pros and Cons of Army Automation

DTIC Science & Technology

2007-11-13

The Pros and Cons of Army Automation 1 Running Head: THE PROS AND CONS OF ARMY AUTOMATION The Pros and Cons of Army Automation SGM...TITLE AND SUBTITLE The Pros and Cons of Army Automation 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...Prescribed by ANSI Std Z39-18 The Pros and Cons of Army Automation 2 Outline I. Introduction (MSG (P) Dostie) II. Manual skills (MSG (P

Experimental and Computational Studies of Carbonyl Diazide (CON6) as a Precursor to Diazirinone (CON2)

NASA Astrophysics Data System (ADS)

Esselman, Brian J.; Amberger, Brent K.; Nolan, Alex M.; Woods, R. Claude; McMahon, R. J.

2011-10-01

Intrigued by the reported 2005 synthesis of diazirinone (1), we carried out further experimental and theoretical studies aimed at the detailed matrix-isolation and millimeter-wave spectroscopic characterizations of 1. Diazirinone (1) is a peculiar isoconjugate of two very stable molecules and may be of astrochemical interest. Unfortunately, the original reported methods of diazirinone (1) generation did not yield this species, rather its decomposition products. Inspired by a more recent gas phase pyrolysis of CON6 (2) to yield CON2 (1), we proposed a new method of generating CON6 (2) in solution as a precursor of diazirinone (1). This new synthesis may allow us to generate larger quantities of both CON6 and CON2 for investigation by millimeter-wave spectroscopy. We are able to safely generate carbonyl diazide (2) in sufficient yield from the reaction of triphosgene (3) and tetrabutylammonium azide in diethyl ether. This has allowed us to obtain both matrix-isolation and gas phase IR spectra of carbonyl diazide (2). After purification, it has a gas-phase lifetime that allows samples to be useable for up to several weeks. However, it is a shock-sensitive material that must be handled with care to prevent violent decomposition. In order to provide better mechanistic insight into the decomposition of carbonyl diazide (2) to diazirinone (1), we have engaged in a DFT and ab initio computational study. We have found a pathway between the two species via the triplet acylnitrene, CON4, and an oxaziridine CON2 species, but not at sufficiently low energies to allow for the trapping and detection of diazirinone (1). Preliminary millimeter-wave spectra have been obtained from several synthesized and purified samples of CON6 (2). However, the assignment of the spectra lines has been unexpectedly problematic. We have placed several CON6 (2) samples, confirmed by IR spectroscopy at the time of sample loading, into our instrument and obtained two different sets of rotational lines

Placenta previa

MedlinePlus

... bleeding. This can be deadly to both the mother and baby. If the placenta is near or covering part of the cervix, your provider may recommend: Reducing your activities Bed rest Pelvic rest, which means no sex, no tampons, and no douching Nothing should be ...

Discussion on the Timing of Balloon Occlusion of the Abdominal Aorta during a Caesarean Section in Patients with Pernicious Placenta Previa Complicated with Placenta Accreta

PubMed Central

Yang, Kaili; Cai, Lina

2017-01-01

Objective This paper is aimed at investigating the role and value of the timing of balloon occlusion of the abdominal aorta during caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Methods 79 cases admitted to the Second Affiliated Hospital of Zhengzhou University from September 2015 to December 2016 were treated with ultrasound mediated abdominal aortic balloon occlusion. Among them, 42 cases, whose balloon occlusion time was selected before the delivery and transverse incision was taken, were group A. The other 37 cases were group B, whose timing of balloon occlusion was selected after the delivery and the uterine incision made trying to avoid the placenta or double incisions. The intraoperative blood loss, utilization of blood, and other indicators were compared between the two groups. Results The intraoperative blood loss in groups A and B was 413.8 ± 105.9 ml and 810.3 ± 180.3 ml, and the utilization of blood products in groups A and B was 30.23% and 89.2%. The total hysterectomy rate was 2.53% (2/79), with no hysterectomies in groups A and 2 cases in group B. Conclusion The balloon occlusion of the abdominal aorta before the delivery combined with a transverse incision is more effective. PMID:29230417

9 CFR 319.300 - Chili con carne.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Chili con carne. 319.300 Section 319.300 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY... Products § 319.300 Chili con carne. “Chili con carne” shall contain not less than 40 percent of meat...

Mincle Signaling Promotes Con-A Hepatitis

PubMed Central

Greco, Stephanie H.; Torres-Hernandez, Alejandro; Kalabin, Aleksandr; Whiteman, Clint; Rokosh, Rae; Ravirala, Sushma; Ochi, Atsuo; Gutierrez, Johana; Salyana, Muhammad Atif; Mani, Vishnu R.; Nagaraj, Savitha V.; Deutsch, Michael; Seifert, Lena; Daley, Donnele; Barilla, Rocky; Hundeyin, Mautin; Nikifrov, Yuriy; Tejada, Karla; Gelb, Bruce E.; Katz, Steven C.; Miller, George

2016-01-01

Concanavalin-A (Con-A) hepatitis is regarded as a T cell-mediated model of acute liver injury. Mincle is a C-type lectin receptor (CLR) that is critical in the immune response to mycobacteria and fungi, but does not have a well-defined role in pre-clinical models of non-pathogen mediated inflammation. Since Mincle can ligate the cell death ligand SAP130, we postulated that Mincle signaling drives intrahepatic inflammation and liver injury in Con-A hepatitis. Acute liver injury was assessed in the murine Con-A hepatitis model using C57BL/6, Mincle−/−, and Dectin-1−/− mice. The role of C/EBPβ and HIF-1α signaling was assessed using selective inhibitors. We found that Mincle was highly expressed in hepatic innate inflammatory cells and endothelial cells in both mice and humans. Furthermore, sterile Mincle ligands and Mincle signaling intermediates were increased in the murine liver in Con-A hepatitis. Most significantly, Mincle deletion or blockade protected against Con-A hepatitis whereas Mincle ligation exacerbated disease. Bone marrow chimeric and adoptive transfer experiments suggested that Mincle signaling in infiltrating myeloid cells dictates disease phenotype. Conversely, signaling via other CLRs did not alter disease course. Mechanistically, we found that Mincle blockade decreased the NF-κβ related signaling intermediates, C/EBPβ and HIF-1α, both of which are necessary in macrophage-mediated inflammatory responses. Accordingly, Mincle deletion lowered production of nitrites in Con-A hepatitis and inhibition of both C/EBPβ and HIF1-α reduced the severity of liver disease. Our work implicates a novel innate immune driver of Con-A hepatitis and, more broadly, suggests a potential role for Mincle in diseases governed by sterile inflammation. PMID:27559045

Mincle Signaling Promotes Con A Hepatitis.

PubMed

Greco, Stephanie H; Torres-Hernandez, Alejandro; Kalabin, Aleksandr; Whiteman, Clint; Rokosh, Rae; Ravirala, Sushma; Ochi, Atsuo; Gutierrez, Johana; Salyana, Muhammad Atif; Mani, Vishnu R; Nagaraj, Savitha V; Deutsch, Michael; Seifert, Lena; Daley, Donnele; Barilla, Rocky; Hundeyin, Mautin; Nikifrov, Yuriy; Tejada, Karla; Gelb, Bruce E; Katz, Steven C; Miller, George

2016-10-01

Con A hepatitis is regarded as a T cell-mediated model of acute liver injury. Mincle is a C-type lectin receptor that is critical in the immune response to mycobacteria and fungi but does not have a well-defined role in preclinical models of non-pathogen-mediated inflammation. Because Mincle can ligate the cell death ligand SAP130, we postulated that Mincle signaling drives intrahepatic inflammation and liver injury in Con A hepatitis. Acute liver injury was assessed in the murine Con A hepatitis model using C57BL/6, Mincle(-/-), and Dectin-1(-/-) mice. The role of C/EBPβ and hypoxia-inducible factor-1α (HIF-1α) signaling was assessed using selective inhibitors. We found that Mincle was highly expressed in hepatic innate inflammatory cells and endothelial cells in both mice and humans. Furthermore, sterile Mincle ligands and Mincle signaling intermediates were increased in the murine liver in Con A hepatitis. Most significantly, Mincle deletion or blockade protected against Con A hepatitis, whereas Mincle ligation exacerbated disease. Bone marrow chimeric and adoptive transfer experiments suggested that Mincle signaling in infiltrating myeloid cells dictates disease phenotype. Conversely, signaling via other C-type lectin receptors did not alter disease course. Mechanistically, we found that Mincle blockade decreased the NF-κβ-related signaling intermediates C/EBPβ and HIF-1α, both of which are necessary in macrophage-mediated inflammatory responses. Accordingly, Mincle deletion lowered production of nitrites in Con A hepatitis and inhibition of both C/EBPβ and HIF-1α reduced the severity of liver disease. Our work implicates a novel innate immune driver of Con A hepatitis and, more broadly, suggests a potential role for Mincle in diseases governed by sterile inflammation. Copyright © 2016 by The American Association of Immunologists, Inc.

Women in Combat Pros and Cons

DTIC Science & Technology

1988-04-01

and Cons . Major Thomas H. Cecil 88-0490 "--"insights into tomorrou,"’ ..v- A A 0 PtY-i f(.> i’I,-:::x:’~ --pcr~ j.~ ~~* --. -- iiV • DISCLAIMER The...k. r- r,’ I’. REPORT NUMBER 88-0490 TITLE WOMEN IN COMBAT-PROS AND CONS AUTHOR(S) MAJOR THOMAS H. CEC-IL, USAF -% FACULTY ADVISOR CH, LT COL DAVID W...NUMBERS 11 TITLE (include Security Classification) WOMEN IN COMBAT--PROS AND CONS 12. PERSON4AL AUTHOR(S) Cecil, Thomas H1., Major, USAF 9a YýOF REPORT

Ependimoma myxopapilar sacro gigante con osteolisis

PubMed Central

Ajler, Pablo; Landriel, Federico; Goldschmidt, Ezequiel; Campero, Álvaro; Yampolsky, Claudio

2014-01-01

Objetivo: la presentación de un caso de una paciente con un ependimoma sacro con extensa infiltración y destrucción ósea local. Descripción del caso: una mujer de 53 años acudió a la consulta por dolor lumbosacro y alteraciones sensitivas perineales y esfinterianas. La imágenes por Resonancia Magnética (IRM) y la Tomografía Axial Computada (TAC) mostraron una lesión expansiva gigante a nivel S2-S4 con extensa osteólisis e invasión de tejidos adyacentes. Se realizó una exéresis tumoral completa con mejoría del estatus funcional. La anatomía patológica informó ependimoma mixopapilar. Discusión: la extensión de la resección quirúrgica es el mejor predictor de buen pronóstico. El tratamiento radiante se reserva como opción adyuvante para las resecciones incompletas y recidiva tumoral. La quimioterapia sólo debería utilizarse en casos en que la cirugía y la radioterapia estén contraindicadas. Conclusión: Los ependimomas mixopapilares sacros con destrucción ósea y presentación intra y extradural son muy infrecuentes y deben ser tenidos en cuenta entre los diagnósticos diferenciales preoperatorios. Su resección total, siempre que sea posible, es la mejor alternativa terapéutica. PMID:25165615

Pros and Cons of International Weapons Procurement Collaboration.

DTIC Science & Technology

1995-01-01

ad- vanced U.S. industry. Greater risk of cost growth and schedule slippage. Pro: U.S. and partners share common equip- ment. Con : U.S. require...Mark A., 1947- Pros and cons of international weapons procurement collaboration / Mark Lorell, Julia Lowell, p. cm "Prepared for the Office...one/ Cons of International Weapons Procurement Collaboration Mark Lorell Julia Lowell National Defense Research Institute Prepared for the

Who Seeks Cita Con El Doctor? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos.

PubMed

Ramirez, A Susana; Graff, Kaitlin; Nelson, David; Galica, Kasia; Leyva, Bryan; Banegas, Mateo; Huerta, Elmer

2015-10-01

Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique, low-cost health information source: the longest-running U.S.-based Spanish-language call-in radio health education program. From the universe of all calls 1999 to 2011, stratified random sampling yielded 1,237 analyzed calls, which were manually coded for caller sex, age, proxy status, and health concern. Descriptive statistics were used to examine basic demographics of callers and call topics overall and by sex and proxy caller status. Among all calls, the top three call-generating health topics were specific symptoms/conditions, sexual/reproductive health, and gastrointestinal concerns. The top nine topics were consistent among women, men, and proxy callers; however, relative frequency of topics varied across groups. Nearly one quarter of calls were initiated on behalf of someone, generally a child, spouse or sibling, or parent. Sixty percent of callers were women; women made 70% of proxy calls. Understanding the differences in information seeking behaviors, information needs, and source preferences is important for determining where and how to disseminate health information and may help explain disparities in knowledge and health outcomes. The radio talk show format provides a uniquely personal, culturally sensitive channel for meeting health information needs of a vulnerable population while leveraging the cost-effectiveness and wide reach of a mass medium. © 2014 Society for Public Health Education.

Who Seeks "Cita Con El Doctor"? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos

ERIC Educational Resources Information Center

Ramirez, A. Susana; Graff, Kaitlin; Nelson, David; Galica, Kasia; Leyva, Bryan; Banegas, Mateo; Huerta, Elmer

2015-01-01

Purpose: Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique,…

9 CFR 319.301 - Chili con carne with beans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Chili con carne with beans. 319.301 Section 319.301 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Dehydrated Meat Food Products § 319.301 Chili con carne with beans. Chili con carne with beans shall contain...

9 CFR 319.301 - Chili con carne with beans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Chili con carne with beans. 319.301 Section 319.301 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Dehydrated Meat Food Products § 319.301 Chili con carne with beans. Chili con carne with beans shall contain...

9 CFR 319.301 - Chili con carne with beans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Chili con carne with beans. 319.301 Section 319.301 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Dehydrated Meat Food Products § 319.301 Chili con carne with beans. Chili con carne with beans shall contain...

9 CFR 319.301 - Chili con carne with beans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Chili con carne with beans. 319.301 Section 319.301 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Dehydrated Meat Food Products § 319.301 Chili con carne with beans. Chili con carne with beans shall contain...

9 CFR 319.301 - Chili con carne with beans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Chili con carne with beans. 319.301 Section 319.301 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Dehydrated Meat Food Products § 319.301 Chili con carne with beans. Chili con carne with beans shall contain...

PubMed

Fumis, María Agustina; Bidabehere, María Belén; Moyano, Yohana; Sardoy, Agustina; Gubiani, María Laura; Boldrini, María Pía; Pinardi, Beatriz Alicia

2017-09-08

La fascitis necrotizante por estrepotococo del grupo A es una infección infrecuente del tejido subcutáneo  y de la fascia, con una tasa de mortalidad elevada debido a su rápida progresión a shock y fallo multiorgánico. Se desarrolla generalmente en extremidades tras un traumatismo o lesión previa. El diagnóstico temprano es esencial así como también el manejo rápido y agresivo. Presentamos un caso de fascitis necrotizante de evolución rápida a pesar del diagnóstico precoz y tratamiento específico instaurado.

Galaxias australes con núcleo doble

NASA Astrophysics Data System (ADS)

Gimeno, G.; Díaz, R.; Carranza, G.

Se estudia una muestra de galaxias australes con núcleo doble a partir de una búsqueda extensiva en la literatura. Se analizan las características morfológicas, fotométricas y espectroscópicas de la muestra. Para algunas galaxias se han realizado observaciones con el espectrógrafo multifunción (EMF) de la Estación Astrofísica de Bosque Alegre a partir de las cuales se determinaron parámetros cinemáticos.

Low Birth Weight: A Descriptive Study of Risk Factors

DTIC Science & Technology

1999-01-07

abruption Dx on admit MT Placenta previa Yes Placenta previa Dx complete/partial MT Smoking Yes Tobacco use this pregnancy MT Heavy alcohol use Yes...Multiple Gestation MT Urinary tract infection MT *Anemia MT Fetal anomalies MT Abruptio placentae MT Placenta previa MT Smoking MT Alcohol use...categories: (a) problems with the placenta , (b) problems with the pregnant woman herself, (c) problems with the fetus itself, or (d) any

Comparación de la efectividad de ranibizumab intravítreo para el tratamiento del edema macular diabético en ojos vitrectomizados y no vitrectomizados.

PubMed

Koyanagi, Yoshito; Yoshida, Shigeo; Kobayashi, Yoshiyuki; Kubo, Yuki; Yamaguchi, Muneo; Nakama, Takahito; Nakao, Shintaro; Ikeda, Yasuhiro; Ohshima, Yuji; Ishibashi, Tatsuro; Sonoda, Kohhei

2017-07-11

Objetivo: Comparar la efectividad de ranibizumab intravítreo (RIV) para el tratamiento del edema macular diabético (EMD) en ojos con y sin vitrectomía previa. Procedimientos: Evaluamos de manera prospectiva la mejor agudeza visual corregida (MAVC) y el grosor macular central (GMC) tras el tratamiento con RIV durante 6 meses. Resultados: No se observaron diferencias significativas en la MAVC o GMC inicial en ninguno de los dos grupos. En el grupo no vitrectomizado (n = 15), los cambios medios en la MAVC y GMC hasta el sexto mes de tratamiento con respecto al valor inicial resultaron significativos (p < 0,01). En el grupo vitrectomizado (n = 10), se observó una mejora más lenta, y la mejora media en la MAVC no resultó significativa (p = 0,5), aunque la media en la disminución del GMC sí que lo fue (p < 0,05). No se observaron diferencias significativas en los cambios medios en la MAVC y el GMC entre ambos grupos a los 6 meses del tratamiento. Conclusiones: La diferencia en la efectividad de RIV entre ambos grupos no resultó significativa. Ranibizumab intravítreo puede ser una opción de tratamiento incluso en pacientes vitrectomizados con EMD. © 2017 S. Karger AG, Basel.

The Procurement of Non Developmental Items: Pros and Cons

DTIC Science & Technology

1994-09-01

commercial way of procurement will bring more advantages than disadvantages to DOD. The list of the pros greatly outweighs the cons . There is practically...AD-A285 009 MH PROCUREMENT OF NON DEVELOPMENTAL ITEMS: PROS AND CONS THES IS Giorgio Scappaticci. Lt. Col., Italian Air Force AFIT/GLMILALj94S-3 I...PROS AND CONS U;narmou,.ced 0 Justification THESIS Giorgio Scappaticci, Lt. Col., Italian Air Force Dist’ibution f Availability Codes AFIT/GLM/LAL

ConKit: a python interface to contact predictions.

PubMed

Simkovic, Felix; Thomas, Jens M H; Rigden, Daniel J

2017-07-15

Recent advances in protein residue contact prediction algorithms have led to the emergence of many new methods and a variety of file formats. We present ConKit , an open source, modular and extensible Python interface which allows facile conversion between formats and provides an interface to analyses of sequence alignments and sets of contact predictions. ConKit is available via the Python Package Index. The documentation can be found at http://www.conkit.org . ConKit is licensed under the BSD 3-Clause. hlfsimko@liverpool.ac.uk or drigden@liverpool.ac.uk. Supplementary data are available at Bioinformatics online. © The Author(s) 2017. Published by Oxford University Press.

ComSciCon: The Communicating Science Workshop for Graduate Students

NASA Astrophysics Data System (ADS)

Sanders, Nathan; Drout, Maria; Kohler, Susanna; Cook, Ben; ComSciCon Leadership Team

2018-01-01

ComSciCon (comscicon.com) is a national workshop series organized by graduate students, for graduate students, focused on leadership and training in science communication. Our goal is to empower young scientists to become leaders in their field, propagating appreciation and understanding of research results to broad and diverse audiences. ComSciCon attendees meet and interact with professional communicators, build lasting networks with graduate students in all fields of science and engineering from around the country, and write and publish original works. ComSciCon consists of both a flagship national conference series run annually for future leaders in science communication, and a series of regional and specialized workshops organized by ComSciCon alumni nationwide. We routinely receive over 1000 applications for 50 spots in our national workshop. Since its founding in 2012, over 300 STEM graduate students have participated in the national workshop, and 23 local spin-off workshops have been organized in 10 different locations throughout the country. This year, ComSciCon is working to grow as a self-sustaining organization by launching as an independent 501(c)(3) non-profit. In this poster we will discuss the ComSciCon program and methods, our results to date, potential future collaborations between ComSciCon and AAS, and how you can become involved.

Trazando la materia oscura con cúmulos globulares

NASA Astrophysics Data System (ADS)

Forte, J. C.

Se describe la estrategia adoptada para mapear la distribución de materia oscura y bariónica en galaxias elípticas cuyos cúmulos globulares están siendo observados con los telescopios VLT y Gemini. Se ejemplifican los resultados con los datos obtenidos en el cúmulo de Fornax.

Protein Supplements: Pros and Cons.

PubMed

Samal, Jay Rabindra Kumar; Samal, Indira R

2018-05-04

To provide a comprehensive analysis of the literature examining the pros and cons of protein supplementation, various articles on protein supplementation were obtained from Google Scholar, PubMed, and National Center for Biotechnology Information. Over the past few years, protein supplementation has become commonplace for gym-goers as well as for the public. A large segment of the general population relies on protein supplementation for meal replacement, weight reduction, and purported health benefits. These protein supplements have varying pros and cons associated with them, which are often overlooked by the public. This review aims to assimilate existing studies and form a consensus regarding the benefits and disadvantages of protein supplementation. The purported health benefits of protein supplementation have led to overuse by both adults and adolescents. Although the pros and cons of protein supplementation is a widely debated topic, not many studies have been conducted regarding the same. The few studies that exist either provide insufficient evidence or have not employed proper conditions for the conduct of the tests. It should be considered that protein supplements are processed materials and often do not contain other essential nutrients required for the sustenance of a healthy lifestyle. It is suggested that the required protein intake should be obtained from natural food sources and protein supplementation should be resorted to only if sufficient protein is not available in the normal diet.

ConSpeciFix: Classifying prokaryotic species based on gene flow.

PubMed

Bobay, Louis-Marie; Ellis, Brian Shin-Hua; Ochman, Howard

2018-05-16

Classification of prokaryotic species is usually based on sequence similarity thresholds, which are easy to apply but lack a biologically-relevant foundation. Here, we present ConSpeciFix, a program that classifies prokaryotes into species using criteria set forth by the Biological Species Concept, thereby unifying species definition in all domains of life. ConSpeciFix's webserver is freely available at www.conspecifix.com. The local version of the program can be freely downloaded from https://github.com/Bobay-Ochman/ConSpeciFix. ConSpeciFix is written in Python 2.7 and requires the following dependencies: Usearch, MCL, MAFFT and RAxML. ljbobay@uncg.edu.

Games Con Men Play: The Semiosis of Deceptive Interaction.

ERIC Educational Resources Information Center

Hankiss, Agnes

1980-01-01

Analyzes some of the most frequent deceptive interactions as rendered through case histories of male con artists and their victims taken from police records. Discusses the recurrent elements in both the con-games strategies and victims' way of interpreting those strategies. (JMF)

Breath Analysis Science at PittCon 2012, Orlando, Florida

EPA Science Inventory

Breath analysis science was featured in three organized sessions at this year’s Pittsburgh Conference and Exposition, or ‘PittCon 2012’ (http://www.pittcon.org/). As described in previous meeting reports, PittCon is one of the largest international conferences for analytical chem...

C-section

MedlinePlus

... part of the opening to the birth canal ( placenta previa ) Placenta separates from the uterine wall ( placenta abruptio ) ... future pregnancies. This includes a higher risk for: Placenta previa Placenta growing into the muscle of the uterus ...

78 FR 52907 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-27

... polyester/nylon cut corduroy fabric, as specified below, is not available in commercial quantities in a... cut corduroy fabric, as specified below. On July 29, 2013, in accordance with CITA's procedures, CITA...: Certain Polyester/Nylon Cut Corduroy Fabric. HTS: 5801.32.0000. Fiber Content: 80-95% polyester, 5-20...

Maternal plasma levels of cell-free β-HCG mRNA as a prenatal diagnostic indicator of placenta accrete.

PubMed

Zhou, J; Li, J; Yan, P; Ye, Y H; Peng, W; Wang, S; Wang, X Tong

2014-09-01

Several biomarkers, including maternal serum creatinine kinase and α-fetoprotein, have been described as potential tools for the diagnosis of placental abnormalities. This study aimed to determine whether maternal plasma mRNA levels of the β subunit of human chorionic gonadotropin (β-HCG) could predict placenta accreta prenatally. Sixty-eight singleton pregnant women with prior cesarean deliveries (CDs) were classified into three groups: normal placentation (35 women, control group); placenta previa alone (21 women, placenta previa group); and both placenta previa and placenta accreta (12 women, placenta previa/accreta group). Maternal plasma concentrations of cell-free β-HCG mRNA were measured by real-time reverse-transcription polymerase chain reaction and were expressed as multiples of the median (MoM). Cell-free β-HCG mRNA concentrations (MoM, range) were significantly higher in women with placenta accreta (3.65, 2.78-7.19) than in women with placenta previa (0.94, 0.00-2.97) or normal placentation (1.00, 0.00-2.69) (Steel-Dwass test, P < 0.01 and P < 0.01, respectively). In the placenta previa/accreta group, the concentration of cell-free β-HCG mRNA was significantly higher among women who underwent CDs with hysterectomy (4.41, 3.49-7.19) than among women whose CDs did not result in hysterectomy (3.20, 2.78-3.70) (Mann-Whitney U test, P = 0.012). An increased level of cell-free β-HCG mRNA in the maternal plasma of women with placenta accreta may arise from direct uteroplacental transfer of cell-free placental mRNA molecules. The concentration of cell-free β-HCG mRNA in maternal plasma may be applicable to the prenatal diagnosis of placenta accreta, especially to identify women with placenta accreta likely to require hysterectomy. Copyright © 2014 Elsevier Ltd. All rights reserved.

ConsPred: a rule-based (re-)annotation framework for prokaryotic genomes.

PubMed

Weinmaier, Thomas; Platzer, Alexander; Frank, Jeroen; Hellinger, Hans-Jörg; Tischler, Patrick; Rattei, Thomas

2016-11-01

The rapidly growing number of available prokaryotic genome sequences requires fully automated and high-quality software solutions for their initial and re-annotation. Here we present ConsPred, a prokaryotic genome annotation framework that performs intrinsic gene predictions, homology searches, predictions of non-coding genes as well as CRISPR repeats and integrates all evidence into a consensus annotation. ConsPred achieves comprehensive, high-quality annotations based on rules and priorities, similar to decision-making in manual curation and avoids conflicting predictions. Parameters controlling the annotation process are configurable by the user. ConsPred has been used in the institutions of the authors for longer than 5 years and can easily be extended and adapted to specific needs. The ConsPred algorithm for producing a consensus from the varying scores of multiple gene prediction programs approaches manual curation in accuracy. Its rule-based approach for choosing final predictions avoids overriding previous manual curations. ConsPred is implemented in Java, Perl and Shell and is freely available under the Creative Commons license as a stand-alone in-house pipeline or as an Amazon Machine Image for cloud computing, see https://sourceforge.net/projects/conspred/. thomas.rattei@univie.ac.atSupplementary information: Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

InterCon Travel Health: Case B

ERIC Educational Resources Information Center

Truman, Gregory E.; Pachamanova, Dessislava A.; Goldstein, Michael A.

2010-01-01

InterCon provides services to health insurers of foreign tourists who travel to the United States and Canada. Management wants to implement a new information system that will deal with several operational problems, but it is having difficulty securing the capital resources to fund the system's development. After an initial failure, the chief…

Impact of the ConRed program on different cyberbulling roles.

PubMed

Del Rey, Rosario; Casas, José A; Ortega, Rosario

2016-01-01

This article presents results from an evaluation of the ConRed cyberbullying intervention program. The program's impacts were separately determined for the different roles within cyberbullying that students can take, i.e., cyber-victims, cyber-bullies, cyber-bully/victims, and bystanders. The ConRed program is a theory-driven program designed to prevent cyberbullying and improve cyberbullying coping skills. It involves students, teachers, and families. During a 3-month period, external experts conducted eight training sessions with students, two with teachers and one with families. ConRed was evaluated through a quasi-experimental design, in which students from three secondary schools were separated into experimental and control groups. The sample comprised 875 students, aged between 11 and 19 years. More students (n = 586) were allocated to the experimental groups at the specific insistence of the management of all schools; the remainder (n = 289) formed the control. Repeated measures MANOVA showed that cyber victims, cyber aggressors and cyberbully/victims reduced their involvement in cyberbullying. Moreover, cyber-victims and bystanders adjusted their perceptions about their control of personal information on the Internet, and cyber aggressors and bystanders reduced their Internet dependence. The ConRed program had stronger effects on male participants, especially in heightening their affective empathy. © 2015 Wiley Periodicals, Inc.

El efecto de la panfotocoagulación con láser en edema macular diabético con el fotocoagulador Pascal® versus el láser de argón convencional.

PubMed

Mahgoub, Mohamed M; Macky, Tamer A

2017-07-11

Objetivo: El objetivo de este estudio fue comparar el efecto de la panfotocoagulación (PFC) en el edema macular diabético (EMD) en pacientes con retinopatía diabética proliferativa (RDP) con el fotocoagulador Pascal® (FP) vs. un fotocoagulador con láser de argón convencional (FLAC). Métodos: Se aleatorizó el uso de FP o FLAC en ochenta ojos con RDP y EMD con afectación central de la mácula. Ambos grupos tuvieron una evaluación de base de mejor agudeza visual corregida y fueron examinados con tomografía de coherencia óptica y angiografía con fluoresceína. Resultados: El número medio de disparos de láser en los grupos de FP y FLAC fue 1.726,10 y 752,00 en la sesión 1 y 1.589,00 y 830,00 (p < 0,001) en la sesión 2, respectivamente. El grosor foveal central (GFC) medio antes de comenzar el estudio fue 306 ± 100 y 314 ± 98 en los grupos de FP y FLAC, respectivamente. A las 8 semanas, el GFC medio fue 332 ± 116 y 347 ± 111 en los grupos de FP y FLAC, respectivamente (p > 0,05). La MAVC media fue similar durante el periodo de estudio y no hubo ninguna diferencia significativa entre los grupos (p > 0,05). Conclusiones: El FP y el FLAC mostraron efectos similares en el EMD en ojos con RDP y fueron igualmente seguros sin un aumento significativo del GFC. © 2017 S. Karger AG, Basel.

Meeting Report: Breath Biomarkers Networking Sessions at PittCon 2010, Orlando, Florida

EPA Science Inventory

The Pittsburgh Conference and Exposition, or "PittCon" (www.pittcon.org/), is one of the largest international conferences for analytical chemistry and instrumentation typically attracting about 25,000 attendees and 1,000 commercial exhibitors. PittCon began in 1950 as a small sp...

Hemangioblastomas de fosa posterior: Reporte de 16 casos y revisión de la literatura

PubMed Central

Campero, Alvaro; Ajler, Pablo; Fernandez, Julio; Isolan, Gustavo; Paiz, Martin; Rivadeneira, Conrado

2016-01-01

Resumen Objetivo: El propósito del presente trabajo es presentar los resultados de 16 pacientes con diagnóstico de hemangioblastoma de fosa posterior (HBFP), operados con técnicas microquirúrgicas. Método: Desde junio de 2005 a diciembre de 2015, 16 pacientes con diagnóstico de HBFP fueron intervenidos quirúrgicamente. Se evaluó: sexo, edad, tipo de lesión (quística con nódulo, quística sin nódulo, sólida y sólida-quística), sintomatología y resultados postoperatorios. Resultados: De los 16 pacientes intervenidos, 11 fueron varones y 5 mujeres. La edad promedio fue de 44 años. La forma más frecuente fue quística con nódulo (57%), seguida por forma sólida (31%). Un solo caso presentó la forma quística sin nódulo (6%), y uno solo la forma sólido-quística (6%). La sintomatología más frecuente fue cefalea acompañada de síndrome cerebeloso (43%), seguido de síndrome de hipertensión endocraneana (25%). En todos los casos la resección fue completa, siendo necesario en un caso una embolización previa. Como complicaciones postoperatorias, 2 pacientes presentaron ataxia (mejoró al cabo de 3 meses), y 1 paciente presentó una fístula de LCR (se solucionó con un drenaje espinal externo). Se registró un óbito por complicaciones postoperatorias. Conclusión: Lo más frecuente de ver en pacientes con HBFP es la forma quística con nódulo, siendo su sintomatología predominante la cefalea acompañada de síndrome cerebeloso. La resección quirúrgica completa es posible, con una baja tasa de morbimortalidad. PMID:27999708

ConA-based glucose sensing using the long-lifetime azadioxatriangulenium fluorophore

NASA Astrophysics Data System (ADS)

Cummins, Brian; Simpson, Jonathan; Gryczynski, Zygmunt; Sørensen, Thomas Just; Laursen, Bo W.; Graham, Duncan; Birch, David; Coté, Gerard

2014-02-01

Fluorescent glucose sensing technologies have been identified as possible alternatives to current continuous glucose monitoring approaches. We have recently introduced a new, smart fluorescent ligand to overcome the traditional problems of ConA-based glucose sensors. For this assay to be translated into a continuous glucose monitoring device where both components are free in solution, the molecular weight of the smart fluorescent ligand must be increased. We have identified ovalbumin as a naturally-occurring glycoprotein that could serve as the core-component of a 2nd generation smart fluorescent ligand. It has a single asparagine residue that is capable of displaying an N-linked glycan and a similar isoelectric point to ConA. Thus, binding between ConA and ovalbumin can potentially be monovalent and sugar specific. This work is the preliminary implementation of fluorescently-labeled ovalbumin in the ConA-based assay. We conjugate the red-emitting, long-lifetime azadioxatriangulenium (ADOTA+) dye to ovalbumin, as ADOTA have many advantageous properties to track the equilibrium binding of the assay. The ADOTA-labeled ovalbumin is paired with Alexa Fluor 647-labeled ConA to create a Förster Resonance Energy Transfer (FRET) assay that is glucose dependent. The assay responds across the physiologically relevant glucose range (0-500 mg/dL) with increasing intensity from the ADOTA-ovalbumin, showing that the strategy may allow for the translation of the smart fluorescent ligand concept into a continuous glucose monitoring device.

ConTour: Data-Driven Exploration of Multi-Relational Datasets for Drug Discovery.

PubMed

Partl, Christian; Lex, Alexander; Streit, Marc; Strobelt, Hendrik; Wassermann, Anne-Mai; Pfister, Hanspeter; Schmalstieg, Dieter

2014-12-01

Large scale data analysis is nowadays a crucial part of drug discovery. Biologists and chemists need to quickly explore and evaluate potentially effective yet safe compounds based on many datasets that are in relationship with each other. However, there is a lack of tools that support them in these processes. To remedy this, we developed ConTour, an interactive visual analytics technique that enables the exploration of these complex, multi-relational datasets. At its core ConTour lists all items of each dataset in a column. Relationships between the columns are revealed through interaction: selecting one or multiple items in one column highlights and re-sorts the items in other columns. Filters based on relationships enable drilling down into the large data space. To identify interesting items in the first place, ConTour employs advanced sorting strategies, including strategies based on connectivity strength and uniqueness, as well as sorting based on item attributes. ConTour also introduces interactive nesting of columns, a powerful method to show the related items of a child column for each item in the parent column. Within the columns, ConTour shows rich attribute data about the items as well as information about the connection strengths to other datasets. Finally, ConTour provides a number of detail views, which can show items from multiple datasets and their associated data at the same time. We demonstrate the utility of our system in case studies conducted with a team of chemical biologists, who investigate the effects of chemical compounds on cells and need to understand the underlying mechanisms.

SLUDGE PARTICLE SEPAPATION EFFICIENCIES DURING SETTLER TANK RETRIEVAL INTO SCS-CON-230

DOE Office of Scientific and Technical Information (OSTI.GOV)

DEARING JI; EPSTEIN M; PLYS MG

2009-07-16

The purpose of this document is to release, into the Hanford Document Control System, FA1/0991, Sludge Particle Separation Efficiencies for the Rectangular SCS-CON-230 Container, by M. Epstein and M. G. Plys, Fauske & Associates, LLC, June 2009. The Sludge Treatment Project (STP) will retrieve sludge from the 105-K West Integrated Water Treatment System (IWTS) Settler Tanks and transfer it to container SCS-CON-230 using the Settler Tank Retrieval System (STRS). The sludge will enter the container through two distributors. The container will have a filtration system that is designed to minimize the overflow of sludge fines from the container to themore » basin. FAI/09-91 was performed to quantify the effect of the STRS on sludge distribution inside of and overflow out of SCS-CON-230. Selected results of the analysis and a system description are discussed. The principal result of the analysis is that the STRS filtration system reduces the overflow of sludge from SCS-CON-230 to the basin by roughly a factor of 10. Some turbidity can be expected in the center bay where the container is located. The exact amount of overflow and subsequent turbidity is dependent on the density of the sludge (which will vary with location in the Settler Tanks) and the thermal gradient between the SCS-CON-230 and the basin. Attachment A presents the full analytical results. These results are applicable specifically to SCS-CON-230 and the STRS filtration system's expected operating duty cycles.« less

Virulence, Speciation and Antibiotic Susceptibility of Ocular Coagualase Negative Staphylococci (CoNS)

PubMed Central

Priya, Ravindran; Mythili, Arumugam; Singh, Yendremban Randhir Babu; Sreekumar, Haridas; Manikandan, Palanisamy; Panneerselvam, Kanesan

2014-01-01

Background: Coagulase negative Staphylococci (CoNS) are common inhabitants of human skin and mucous membranes. With the emergence of these organisms as prominent pathogens in patients with ocular infections, investigation has intensified in an effort to identify important virulence factors and to inform new approaches to treatment and prevention. Aim: To isolate CoNS from ocular specimens; to study the possible virulence factors; speciation of coagulase negative staphylococci (CoNS) which were isolated from ocular complications; antibiotic susceptibility testing of ocular CoNS. Materials and Methods: The specimens were collected from the target patients who attended the Microbiology Laboratory of a tertiary care eye hospital in Coimbatore, Tamilnadu state, India. The isolates were subjected to tube and slide coagulase tests for the identification of CoNS. All the isolates were subjected to screening for lipase and protease activities. Screening for other virulence factors viz., slime production on Congo red agar medium and haemagglutination assay with use of 96-well microtitre plates. These isolates were identified upto species level by performing biochemical tests such as phosphatase test, arginine test, maltose and trehalose fermentation tests and novobiocin sensitivity test. The isolates were subjected to antibiotic susceptibility studies, based on the revised standards of Clinical and Laboratory Standards Institutes (CLSI). Results: During the one year of study, among the total 260 individuals who were screened, 100 isolates of CoNS were obtained. Lipolytic activity was seen in all the isolates, whereas 38 isolates showed a positive result for protease. A total of 63 isolates showed slime production. Of 100 isolates, 30 isolates were analyzed for haemagglutination, where 4 isolates showed the capacity to agglutinate the erythrocytes. The results of the biochemical analysis revealed that of the 100 isolates of CoNS, 43% were Staphylococcus epidermidis. The other

Placenta accreta and balloon catheterization: the experience of a single center and an update of latest evidence of literature.

PubMed

Gulino, Ferdinando Antonio; Guardo, F Di; Zambrotta, E; Di Gregorio, L M; Miranda, Andrea; Capriglione, Stella; Palumbo, M A

2018-05-18

We studied the efficacy of using pre-cesarean delivery (CD) temporary occlusion of internal iliac arteries with balloon catheters in case of placenta previa-accreta in terms of maternal and neonatal outcomes and to test accuracy of ultrasound (US) and magnetic resonance imaging (MRI) for prenatal diagnosis. From March 2014 to January 2018, women with an US and/or MRI diagnosis of placenta previa-accreta and a planned delivery were enrolled and divided into two groups: balloon catheterization group (women treated with preoperative catheters and CD) and control group (women candidates to elective CD). 37 patients were enrolled: 16 in balloon catheterization group and 21 in control group. Significant differences were detected in estimated blood loss. Prophylactic balloon catheterization could reduce intraoperative red blood cell transfusion. The incidence of hysterectomy was lower in balloon group. No statistical difference was found for neonatal outcomes. Both US and MRI have showed to be useful and complementary to diagnose placenta previa-accreta. Temporal, perioperative, and prophylactic positioning of balloon vascular catheters is an effective method for managing severe hemorrhage caused by placenta previa-accreta as it reduced intraoperative blood loss, lessened perioperative hemostatic measures and intraoperative red cell transfusions, and reduced hysterectomies.

Enrichment of Glycoproteins using Nano-scale Chelating Con A Monolithic Capillary Chromatography

PubMed Central

Feng, Shun; Yang, Na; Pennathur, Subramaniam; Goodison, Steve; Lubman, David M.

2009-01-01

Immobilized lectin chromatography can be employed for glycoprotein enrichment, but commonly used columns have limitations of yield and resolution. In order to improve efficiency and to make the technique applicable to minimal sample material, we have developed a nano-scale chelating Concanavalin A (Con A) monolithic capillary prepared using GMA-EDMA (glycidyl methacrylate–co-ethylene dimethacrylate) as polymeric support. Con A was immobilized on Cu(II)-charged iminodiacetic acid (IDA) regenerable sorbents by forming a IDA:Cu(II):Con A sandwich affinity structure that has high column capacity as well as stability. When compared with conventional Con A lectin chromatography, the monolithic capillary enabled the better reproducible detection of over double the number of unique N-glycoproteins in human urine samples. Utility for analysis of minimal biological samples was confirmed by the successful elucidation of glycoprotein profiles in mouse urine samples at the microliter scale. The improved efficiency of the nano-scale monolithic capillary will impact the analysis of glycoproteins in complex biological samples, especially where only limited material may be available. PMID:19366252

9 CFR 319.300 - Chili con carne.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CERTIFICATION DEFINITIONS AND STANDARDS OF IDENTITY OR COMPOSITION Canned, Frozen, or Dehydrated Meat Food... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Chili con carne. 319.300 Section 319.300 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY...

9 CFR 319.300 - Chili con carne.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CERTIFICATION DEFINITIONS AND STANDARDS OF IDENTITY OR COMPOSITION Canned, Frozen, or Dehydrated Meat Food... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Chili con carne. 319.300 Section 319.300 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY...

Optimizing Electrospray Interfaces Using Slowly Diverging Conical Duct (ConDuct) Electrodes

PubMed Central

Krutchinsky, Andrew N.; Padovan, Júlio C.; Cohen, Herbert; Chait, Brian T.

2015-01-01

We demonstrate that the efficiency of ion transmission from atmosphere to vacuum through stainless steel electrodes that contain slowly divergent conical duct (ConDuct) channels can be close to 100%. Here, we explore the properties of 2.5 cm long electrodes with angles of divergence of 0°, 1°, 2°, 3°, 5°, 8°, 13°, and 21°, respectively. The ion transmission efficiency was observed to jump from 10–20% for the 0° (straight) channels to 90–95% for channels with an angle of divergence as small as 1°. Furthermore, the 2–3° ConDuct electrodes produced extraordinarily low divergence ion beams that propagated in a laser-like fashion over long distances in vacuum. To take advantage of these newly discovered properties, we constructed a novel atmosphere-to-vacuum ion interface utilizing a 2° ConDuct as an inlet electrode and compared its ion transmission efficiency with that of the interface used in the commercial (Thermo) Velos Orbitrap and Q Exactive mass spectrometers. We observed that the ConDuct interface transmitted up to 17 times more ions than the commercial reference interface and also yielded improved signal-to-noise mass spectra of peptides. We infer from these results that the performance of many current atmosphere-tovacuum interfaces utilizing metal capillaries can be substantially improved by replacing them with 1° or 2° metal ConDuct electrodes, which should preserve the convenience of supplying ion desolvation energy by heating the electrode while greatly increasing the efficiency of ion transmission into the mass spectrometer. PMID:25667060

Optimizing Electrospray Interfaces Using Slowly Diverging Conical Duct (ConDuct) Electrodes

NASA Astrophysics Data System (ADS)

Krutchinsky, Andrew N.; Padovan, Júlio C.; Cohen, Herbert; Chait, Brian T.

2015-04-01

We demonstrate that the efficiency of ion transmission from atmosphere to vacuum through stainless steel electrodes that contain slowly divergent conical duct (ConDuct) channels can be close to 100%. Here, we explore the properties of 2.5-cm-long electrodes with angles of divergence of 0°, 1°, 2°, 3°, 5°, 8°, 13°, and 21°, respectively. The ion transmission efficiency was observed to jump from 10-20% for the 0° (straight) channels to 90-95% for channels with an angle of divergence as small as 1°. Furthermore, the 2-3° ConDuct electrodes produced extraordinarily low divergence ion beams that propagated in a laser-like fashion over long distances in vacuum. To take advantage of these newly discovered properties, we constructed a novel atmosphere-to-vacuum ion interface utilizing a 2° ConDuct as an inlet electrode and compared its ion transmission efficiency with that of the interface used in the commercial (Thermo Fisher Scientific, San Jose, CA, USA) Velos Orbitrap and Q Exactive mass spectrometers. We observed that the ConDuct interface transmitted up to 17 times more ions than the commercial reference interface and also yielded improved signal-to-noise mass spectra of peptides. We infer from these results that the performance of many current atmosphere-to-vacuum interfaces utilizing metal capillaries can be substantially improved by replacing them with 1° or 2° metal ConDuct electrodes, which should preserve the convenience of supplying ion desolvation energy by heating the electrode while greatly increasing the efficiency of ion transmission into the mass spectrometer.

SeleCon: Scalable IoT Device Selection and Control Using Hand Gestures.

PubMed

Alanwar, Amr; Alzantot, Moustafa; Ho, Bo-Jhang; Martin, Paul; Srivastava, Mani

2017-04-01

Although different interaction modalities have been proposed in the field of human-computer interface (HCI), only a few of these techniques could reach the end users because of scalability and usability issues. Given the popularity and the growing number of IoT devices, selecting one out of many devices becomes a hurdle in a typical smarthome environment. Therefore, an easy-to-learn, scalable, and non-intrusive interaction modality has to be explored. In this paper, we propose a pointing approach to interact with devices, as pointing is arguably a natural way for device selection. We introduce SeleCon for device selection and control which uses an ultra-wideband (UWB) equipped smartwatch. To interact with a device in our system, people can point to the device to select it then draw a hand gesture in the air to specify a control action. To this end, SeleCon employs inertial sensors for pointing gesture detection and a UWB transceiver for identifying the selected device from ranging measurements. Furthermore, SeleCon supports an alphabet of gestures that can be used for controlling the selected devices. We performed our experiment in a 9 m -by-10 m lab space with eight deployed devices. The results demonstrate that SeleCon can achieve 84.5% accuracy for device selection and 97% accuracy for hand gesture recognition. We also show that SeleCon is power efficient to sustain daily use by turning off the UWB transceiver, when a user's wrist is stationary.

Development of a Selective Culture Medium for Primary Isolation of the Main Brucella Species▿

PubMed Central

De Miguel, M. J.; Marín, C. M.; Muñoz, P. M.; Dieste, L.; Grilló, M. J.; Blasco, J. M.

2011-01-01

Bacteriological diagnosis of brucellosis is performed by culturing animal samples directly on both Farrell medium (FM) and modified Thayer-Martin medium (mTM). However, despite inhibiting most contaminating microorganisms, FM also inhibits the growth of Brucella ovis and some B. melitensis and B. abortus strains. In contrast, mTM is adequate for growth of all Brucella species but only partially inhibitory for contaminants. Moreover, the performance of both culture media for isolating B. suis has never been established properly. We first determined the performance of both media for B. suis isolation, proving that FM significantly inhibits B. suis growth. We also determined the susceptibility of B. suis to the antibiotics contained in both selective media, proving that nalidixic acid and bacitracin are highly inhibitory, thus explaining the reduced performance of FM for B. suis isolation. Based on these results, a new selective medium (CITA) containing vancomycin, colistin, nystatin, nitrofurantoin, and amphotericin B was tested for isolation of the main Brucella species, including B. suis. CITA's performance was evaluated using reference contaminant strains but also field samples taken from brucella-infected animals or animals suspected of infection. CITA inhibited most contaminant microorganisms but allowed the growth of all Brucella species, to levels similar to those for both the control medium without antibiotics and mTM. Moreover, CITA medium was more sensitive than both mTM and FM for isolating all Brucella species from field samples. Altogether, these results demonstrate the adequate performance of CITA medium for the primary isolation of the main Brucella species, including B. suis. PMID:21270216

Propiedades biomecánicas de la membrana limitante interna tras recibir tratamiento intravítreo con ocriplasmina.

PubMed

Vielmuth, Franziska; Schumann, Ricarda G; Spindler, Volker; Wolf, Armin; Scheler, Renate; Mayer, Wolfgang J; Henrich, Paul B; Haritoglou, Christos

2017-01-01

Objetivo: Evaluar la rigidez de la membrana limitante interna (MLI) humana y evaluar los posibles cambios de las propiedades mecánicas tras administrar una inyección intravítrea de ocriplasmina para tratar la tracción vitreomacular. Métodos: Este estudio se compone de una serie de casos intervencionales y comparativos de 12 muestras de MLI extraídas mediante cirugía y obtenidas de forma consecutiva de 9 ojos de 9 pacientes después de someterse sin éxito a vitreólisis farmacológica con ocriplasmina. Durante el mismo periodo de tiempo, 16 muestras de otros 13 ojos sin tratamiento con ocriplasmina se obtuvieron mediante vitrectomía y sirvieron como controles. Todos los pacientes presentaron agujeros maculares o tracción vitreomacular y se sometieron a vitrectomía con disección de la MLI tanto con tinción con azul brillante (AB) como sin ella. Todas las muestras se analizaron con un microscopio de fuerza atómica con imágenes de las regiones de 25 × 25 μm. En todas las muestras, se analizaron tanto la parte de la retina como la del vítreo de la MLI. Resultados: La microscopia de fuerza atómica no reveló diferencias significativas en cuanto a elasticidad de las muestras de MLI extraídas de ojos con o sin tratamiento con ocriplasmina. Las áreas onduladas de la parte de la retina presentaron una mayor rigidez que la parte del vítreo de la MLI. La cartografía topográfica tanto de la parte del vítreo como de la retina de la MLI no mostró ninguna alteración aparente de la morfología en ojos tratados con ocriplasmina en comparación con los ojos no tratados. La tinción con azul brillante conllevó un aumento de la rigidez tisular. Conclusiones: Las inyecciones intravítreas de ocriplasmina no varían las propiedades biomecánicas de la MLI humana. No existen pruebas de un posible efecto enzimático que interfiera con la rigidez de esta membrana basal. © 2017 S. Karger AG, Basel.

B cells as accessory cells in a Con A response of a T cell clone.

PubMed

Takeuchi, M; Kakiuchi, T; Taira, S; Nariuchi, H

1987-12-01

Accessory cell (AC) function of B cells was examined in Con A response of a cloned T cell line, 22-9D, which is Thy 1+,L3T4+,Lyt2-,H-2KbDb+ and I-Ab-.22-9D cells produced IL 2 in the presence of Con A without participation of AC. For the initiation of a proliferative response to Con A, the addition of spleen cells or spleen adherent cells was required. B cells as AC were unable to induce the proliferative response. In the presence of culture supernatant of spleen cells stimulated with Con A (CAS), 22-9D cells showed proliferative response to Con A with B cell AC. The response was inhibited by a relevant monoclonal anti-I-A antibody. Although irradiated spleen cells as AC induced IL 2 receptor expression of 22-9D cells in the presence of Con A, B cells were shown to require the addition of unknown factor(s) in CAS, which was suggested to be different from IL 1, IL 2, IL 3, or IFN-gamma, for the induction of the receptor expression on 22-9D cells.

Wildland Fire Induced Heating of Dome 375 Perma-Con®

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flores, Eugene Michael

AET-1 was tasked by ADEM with determining the temperature rise in the drum contents of drums stored in the Dome 375 Perma-Con® at TA-54 given a wildland fire. The wildland fire causes radiative and convective heating on the Perma-Con® exterior. The wildland fire time histories for the radiative and convective heating environment were provided to AET-1 by EES-16. If the calculated temperature rise results in a drum content temperature over 40 °C, then ADEM desires a design solution to ensure the peak temperature remains below 40 °C. An axi-symmetric FE simulation was completed to determine the peak temperature of themore » contents of a drum stored in the Dome 375 Perma-Con® during a wildland fire event. Three wildland fire time histories for the radiative and convective heat transfer were provided by EES-16 and were inputs for the FE simulation. The maximum drum content temperature reached was found to be 110 °C while using inputs from the SiteG_2ms_4ign_wind_from_west.xlsx time history input and not including the SWB in the model. Including the SWB in the results in a peak drum content temperature of 61 °C for the SiteG_2ms_4ign_wind_from_west.xlsx inputs. EES-16 decided that by using fuel mitigation efforts, such as mowing the grass and shrubs near the Perma-Con® they could reduce the shrub/grass fuel loading near the Perma-Con® from 1.46 kg/m 2 to 0.146 kg/m 2 and by using a less conservative fuel loading for the debris field inside the Dome 375 perimeter, reducing it from 0.58 kg/m2 to 0.058 kg/m 2 in their model. They also greatly increased the resolution of their radiation model and increased the accuracy of their model’s required convergence value. Using this refined input the maximum drum content temperature was found to be 28 °C with no SWB present in the model. Additionally, this refined input model was modified to include worst case emissivity values for the concrete, drum and Perma-Con® interior, along with adding a 91 second long

La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II

PubMed Central

Martínez-Leal, Rafael; Salvador-Carulla, Luis; Gutiérrez-Colosía, Mencía Ruiz; Nadal, Margarida; Novell-Alsina, Ramón; Martorell, Almudena; González-Gordón, Rodrigo G.; Mérida-Gutiérrez, M. Reyes; Ángel, Silvia; Milagrosa-Tejonero, Luisa; Rodríguez, Alicia; García-Gutiérrez, Juan C.; Pérez-Vicente, Amado; García-Ibáñez, José; Aguilera-Inés, Francisco

2011-01-01

Introducción Estudios internacionales demuestran que existe un patrón diferenciado de salud y una disparidad en la atención sanitaria entre personas con discapacidad intelectual (DI) y población general. Objetivo Obtener datos sobre el estado de salud de las personas con DI y compararlos con datos de población general. Pacientes y métodos Se utilizó el conjunto de indicadores de salud P15 en una muestra de 111 sujetos con DI. Los datos de salud encontrados se compararon según el tipo de residencia de los sujetos y se utilizó la Encuesta Nacional de Salud 2006 para comparar estos datos con los de la población general. Resultados La muestra con DI presentó 25 veces más casos de epilepsia y el doble de obesidad. Un 20% presentó dolor bucal, y existió una alta presencia de problemas sensoriales, de movilidad y psicosis. Sin embargo, encontramos una baja presencia de patologías como la diabetes, la hipertensión, la osteoartritis y la osteoporosis. También presentaron una menor participación en programas de prevención y promoción de la salud, un mayor número de ingresos hospitalarios y un uso menor de los servicios de urgencia. Conclusiones El patrón de salud de las personas con DI difiere del de la población general, y éstas realizan un uso distinto de los servicios sanitarios. Es importante el desarrollo de programas de promoción de salud y de formación profesional específicamente diseñados para la atención de personas con DI, así como la implementación de encuestas de salud que incluyan datos sobre esta población. PMID:21948011

Energy Star program benefits Con Edison

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Impressed with savings in energy costs achieved after upgrading the lighting and air conditioning systems at its Manhattan headquarters, Home Box Office (HBO) wanted to do more, James Flock, vice president for computer and office systems, contacted Con Edison Co. of New York in March 1991 to determine what the company could do to save money by reducing energy consumed by personal computers. Arthur Kressner, Con Edison Research and Development manager contacted industry organizations and manufacturers for advice, but was told only to shut off computers at night and on weekends. Kressner arranged a series of meetings with IBM andmore » the Electric Power Research Institute (EPRI) to discuss the issue, then approached the U.S. Environmental Protection Agency (EPA), which was designing a program to promote the introduction and use of energy-efficient office equipment. In 1992, the EPA announced the Energy Star program for PCs, enabling manufacturers to display the Energy Star logo on machines meeting program criteria, including the ability to enter a sleep mode in which neither the computer nor monitor consume more than 30 W or electricity. Industry experts estimate national energy consumption by office equipment could double by the year 2000, but Energy Star equipment is expected to improve efficiency and help maintain electric loads.« less

SeleCon: Scalable IoT Device Selection and Control Using Hand Gestures

PubMed Central

Alanwar, Amr; Alzantot, Moustafa; Ho, Bo-Jhang; Martin, Paul; Srivastava, Mani

2018-01-01

Although different interaction modalities have been proposed in the field of human-computer interface (HCI), only a few of these techniques could reach the end users because of scalability and usability issues. Given the popularity and the growing number of IoT devices, selecting one out of many devices becomes a hurdle in a typical smarthome environment. Therefore, an easy-to-learn, scalable, and non-intrusive interaction modality has to be explored. In this paper, we propose a pointing approach to interact with devices, as pointing is arguably a natural way for device selection. We introduce SeleCon for device selection and control which uses an ultra-wideband (UWB) equipped smartwatch. To interact with a device in our system, people can point to the device to select it then draw a hand gesture in the air to specify a control action. To this end, SeleCon employs inertial sensors for pointing gesture detection and a UWB transceiver for identifying the selected device from ranging measurements. Furthermore, SeleCon supports an alphabet of gestures that can be used for controlling the selected devices. We performed our experiment in a 9m-by-10m lab space with eight deployed devices. The results demonstrate that SeleCon can achieve 84.5% accuracy for device selection and 97% accuracy for hand gesture recognition. We also show that SeleCon is power efficient to sustain daily use by turning off the UWB transceiver, when a user’s wrist is stationary. PMID:29683151

Sport Concussion Management Using Facebook: A Feasibility Study of an Innovative Adjunct "iCon".

PubMed

Ahmed, Osman Hassan; Schneiders, Anthony G; McCrory, Paul R; Sullivan, S John

2017-04-01

  Sport concussion is currently the focus of much international attention. Innovative methods to assist athletic trainers in facilitating management after this injury need to be investigated.   To investigate the feasibility of using a Facebook concussion-management program termed iCon (interactive concussion management) to facilitate the safe return to play (RTP) of young persons after sport concussion.   Observational study.   Facebook group containing interactive elements, with moderation and support from trained health care professionals.   Eleven participants (n = 9 men, n = 2 women; range, 18 to 28 years old) completed the study.   The study was conducted over a 3-month period, with participant questionnaires administered preintervention and postintervention. The primary focus was on the qualitative experiences of the participants and the effect of iCon on their RTP. Usage data were also collected.   At the completion of the study, all participants (100%) stated that they would recommend an intervention such as iCon to others. Their supporting quotes all indicated that iCon has the potential to improve the management of concussion among this cohort. Most participants (n = 9, 82%) stated they were better informed with regard to their RTP due to participating in iCon.   This interactive adjunct to traditional concussion management was appreciated among this participant group, which indicates the feasibility of a future, larger study of iCon. Athletic trainers should consider the role that multimedia technologies may play in assisting with the management of sport concussion.

Influence of protic ionic liquids on the structure and stability of succinylated Con A.

PubMed

Attri, Pankaj; Venkatesu, Pannuru

2012-01-01

We report the synthesis of a series of ionic liquids (ILs) from various ions having different kosmotropicity including dihydrogen phosphate (H(2)PO(4)(-)), hydrogen sulfate (HSO(4)(-)) and acetate (CH(3)COO(-)) as anions and chaotropic cation such as trialkylammonium cation. To characterize the biomolecular interactions of ILs with protein, we have explored the stability of succinylated Con A (S Con A) in the presence of these aqueous ILs, which are varied combinations of kosmotropic anion with chaotropic cation such as triethylammonium dihydrogen phosphate [(CH(3)CH(2))(3)NH][H(2)PO(4)] (TEAP), trimethylammonium acetate [(CH(3))(3)NH][CH(3)COO] (TMAA), trimethylammonium dihydrogen phosphate [(CH(3))(3)NH][H(2)PO(4)] (TMAP) and trimethylammonium hydrogen sulfate [(CH(3))(3)NH][HSO(4)] (TMAS). Circular dichroism (CD) and fluorescence experiments have been used to characterize the stability of S Con A by ILs. Our data distinctly demonstrate that the long alkyl chain IL TEAP is a strong stabilizer for S Con A. Further, our experimental results reveal that TEAP is an effective refolding enhancer for S Con A from a thermally denatured protein structure. Copyright © 2012 Elsevier B.V. All rights reserved.

Apoyo a Estudios Geodinamicos con GPS en Guatemala

NASA Astrophysics Data System (ADS)

Robles, V. R.

2013-05-01

El Instituto Geografico Nacional de Guatemala implemento 17 estaciones GNSS en el año 2009, como un proyecto de credito mixto de donacion de equipamiento del Gobierno de Suiza, el cual, este equipamiento de estaciones CORS GNSS es un sistema de recepción y transmisión de datos crudos GPS RInex que utiliza la tecnologia Spider Web de Leica, asi mismo este sistema esta sirviendo para el espablecimiento de un marco geodesico nacional de coordenadas geodesicas oficiales, el cual se calculan u obtienen las velocidades en tiempos temporales programados de las 17 Estaciones CORS. La infraestructura del marco geodesico de Guatemala esta sirviendo de base para las aplicaciones de estudios geodinamicos como el monitoreo de del desplazamiento de las placas tectonicas por medio de un estudio que se inicio en el año de 1999, llamado medicion con GPS el sistema de Fallas de los rios Polochic Motagua de Guatemala, tambien para un estudio que se implemento para deformación de corteza terrestre local en un Volcan Activo de Guatemala llamado Pacaya. Para el estudio de medicion con GPS en el sistema de falla de los Rios del polochic Motagua se implementaron 16 puntos para medir con GPS de dos frecuencias en el año de 1999, el cual, tres puntos son estaciones geodesicas CORS IGS llamados GUAT, ELEN y HUEH, despues en el año de 2003 se hizo otra medicion en un total de 20 puntos, que permitió calcular las velocidades de desplazamieinto de los puntos en mención, usando como referencia el modelo NUVEL 1A de DeMets de la placa de Norteamerica. Este estudio fue en cooperación internacional por la universidad de Nice de Francia y el IGNde Francia. Para el estudio del monitoreo con GPS del volcan activo de Guatemala, se implementaron cuatro puntos al rededor del volcan, el cual, se realizan cuatro mediciones al año, que permiten determinar axialmente la distancias entre los puntos, y rebisar estadisticamente cual es el comportamiento de las distancias en funcion del tiempo, si

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study.

PubMed

Shi, Xiao-Ming; Wang, Yan; Zhang, Yan; Wei, Yuan; Chen, Lian; Zhao, Yang-Yu

2018-03-20

Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa. A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups. The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68-6.58). Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study

PubMed Central

Shi, Xiao-Ming; Wang, Yan; Zhang, Yan; Wei, Yuan; Chen, Lian; Zhao, Yang-Yu

2018-01-01

Background: Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa. Methods: A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups. Results: The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68–6.58). Conclusion: Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa. PMID:29521289

Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities.

PubMed

Trindade-Suedam, Ivy Kiemle; Kostrisch, Lília Maria von; Pimenta, Luiz André Freire; Negrato, Carlos Antônio; Franzolin, Solange Braga; Trindade, Alceu Sergio

2016-08-08

to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized. esta investigación estableció la prevalencia de diabetes mellitus (DM) y el abuso de drogas en madres de niños con malformaciones creaneofaciales (MCF). 325 mujeres que tuvieron hijos (0-3 años) con malformaciones fueron entrevistadas. Se obtuvieron datos referentes a: tipo de diabetes; uso de drogas lícitas o ilícitas durante el embarazo; circunferencia de la cintura; y, glucemia en ayunas en la primera consulta prenatal. el veintisiete por ciento de las mujeres tenían DM. Entre estas, el 89% tuvieron DM gestacional, el 5,5% DM tipo 1 y el 5,5% DM tipo 2. La prevalencia de DM en madres de hijos con MCF fue de 27%. Esto es significativamente más alto que el promedio de la población brasileña afectada por esa enfermedad, que es de 7,6% (p<0.01) (OR=4,5, 95%IC=3,5-5,8). Observando el abuso de drogas durante el embarazo, el 32% de las madres había utilizado drogas y una correlación positiva significativa fue

Workload and associated factors: a study in maritime port in Brazil.

PubMed

Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Almeida, Marlise Capa Verde de; Sant'Anna, Cynthia Fontella; Cardoso, Leticia Silveira

2016-11-28

ísica e esforço total apresentaram maior efeito sobre a carga global de trabalho, indicando elevada carga global no trabalho portuário (134 trabalhadores - 58,8%). Permaneceram associados, estatisticamente, com níveis elevados da carga de trabalho: idade (p = 0,044), ser trabalhador da capatazia (p = 0,006), trabalhar somente no período noturno (p = 0,025), tabagismo (p = 0,037) e uso de drogas ilícitas (p = 0,029). a carga de trabalho, nesse tipo de atividade, foi alta, sendo a categoria profissional e o turno de trabalho os fatores que contribuíram para o aumento, enquanto a idade mostrou-se fator associado à sua diminuição. identificar el efecto de las demandas mentales, físicas de tiempo y de desempeño, el esfuerzo total y la frustración en la carga de trabajo global, al mismo tiempo que se analizan la carga global de trabajo portuario y los factores asociados que contribuyen principalmente a su disminución o aumento. estudio transversal cuantitativo desarrollado con 232 trabajadores portuarios. Para la recolección de datos se aplicó un cuestionario estructurado con variables de caracterización, ocupacionales, tabaquismo y uso de drogas ilícitas así como también variables sobre la carga en las tareas desarrolladas en el trabajo, en base en el cuestionario NASA Task Load Index. Para el análisis de los datos se utilizó análisis de regresión de Poisson. las demandas exigencia física y esfuerzo total presentaron mayor efecto sobre la carga global de trabajo, indicando una elevada carga global en el trabajo portuario (134 trabajadores 58,8%). Estaban asociados estadísticamente con niveles elevados de la carga de trabajo: la edad (p = 0,044); ser trabajador de la capatacía (p = 0,006); trabajar solamente en el periodo nocturno (p = 0,025); tabaquismo (p = 0,037); y uso de drogas ilícitas (p = 0,029). la carga de trabajo en este tipo de actividad fue alta, siendo la categoría profesional y el turno de trabajo los factores que contribuyeron para

A Review of Staphylococcal Cassette Chromosome mec (SCCmec) Types in Coagulase-Negative Staphylococci (CoNS) Species.

PubMed

Saber, Huda; Jasni, Azmiza Syawani; Jamaluddin, Tengku Zetty Maztura Tengku; Ibrahim, Rosni

2017-10-01

Coagulase-negative staphylococci (CoNS) are considered low pathogenic organisms. However, they are progressively causing more serious infections with time because they have adapted well to various antibiotics owing to their ability to form biofilms. Few studies have been conducted on CoNS in both, hospital and community-acquired settings, especially in Malaysia. Thus, it is important to study their species and gene distributions. A mobile genetic element, staphylococcal cassette chromosome mec (SCC mec ), plays an important role in staphylococci pathogenesis. Among CoNS, SCC mec has been studied less frequently than Staphylococcus aureus (coagulase-positive staphylococci). A recent study (8) conducted in Malaysia successfully detected SCC mec type I to VIII as well as several new combination patterns in CoNS species, particularly Staphylococcus epidermidis . However, data are still limited, and further research is warranted. This paper provides a review on SCC mec types among CoNS species.

Connected vehicle pilot deployment program phase 1, concept of operations (ConOps) – Tampa (THEA).

DOT National Transportation Integrated Search

2016-02-01

This document describes the Concept of Operations (ConOps) for the Tampa Hillsborough Expressway Authority (THEA) Connected Vehicle (CV) Pilot Deployment. This ConOps describes the current state of operations, establishes the reasons for change, and ...

Connected vehicle pilot deployment program phase 1, concept of operations (ConOps) - New York City.

DOT National Transportation Integrated Search

2016-04-08

This document describes the Concept of Operations (ConOps) for the New York City Department of Transportation (NYC) Connected Vehicle Pilot Deployment (CVPD) Project. This ConOps describes the current state of operations, establishes the reasons for ...

Inclusion: The Pros and Cons--A Critical Review

ERIC Educational Resources Information Center

Savich, Carl

2008-01-01

The purpose of this paper was to review, analyze, and critique the pros and cons, the advantages and disadvantages, of inclusion. The methodology consisted in analyzing and comparing research findings on the benefits and costs of inclusion. Federal legislation and regulations on inclusion were examined, analyzed, and discussed. The results showed…

Precisión de las velocidades radiales obtenidas con el REOSC

NASA Astrophysics Data System (ADS)

González, J. F.; Lapasset, E.

Complementando una línea de trabajo iniciada con anterioridad discutimos la estabilidad del espectrógrafo REOSC de CASLEO en DC para la medición de velocidades radiales en base al análisis de observaciones realizadas en enero y abril de 1997. En esas oportunidades obtuvimos 26 espectros de estrellas patrones y 27 espectros de 3 estrellas usadas como estrellas de referencia en nuestro programa de cúmulos abiertos. Además tomamos 26 espectros de crepúsculo con el telescopio en posiciones cubriendo el rango H=-4,+4 y δ =-90,+30. Mediante correlaciones cruzadas derivamos la velocidad de 19 órdenes en cada uno de estos espectros. En base a un análisis estadístico de los datos obtenidos discutimos la contribución de los distintos factores que afectan a la dispersión de lectura observada. En particular, la flexión del instrumento no introduciría errores significativos cuando se observa con masas de aire menores que 2.0. La dispersión de los valores de velocidad medidos para espectros de alta relación S/N de una misma estrella resultó del orden de 0.5 km/s. La comparación con los valores de velocidad publicados por distintos autores para las estrellas patrones no permite distinguir ninguna diferencia sistemática apreciable de las velocidades de CASLEO, siendo la media cuadrática de los residuos del orden de 1.0 km/s.

Tailoring a ConOps for NASA LSP Integrated Operations

NASA Technical Reports Server (NTRS)

Owens, Skip Clark V., III

2017-01-01

An integral part of the Systems Engineering process is the creation of a Concept of Operations (ConOps) for a given system, with the ConOps initially established early in the system design process and evolved as the system definition and design matures. As Integration Engineers in NASA's Launch Services Program (LSP) at Kennedy Space Center (KSC), our job is to manage the interface requirements for all the robotic space missions that come to our Program for a Launch Service. LSP procures and manages a launch service from one of our many commercial Launch Vehicle Contractors (LVCs) and these commercial companies are then responsible for developing the Interface Control Document (ICD), the verification of the requirements in that document, and all the services pertaining to integrating the spacecraft and launching it into orbit. However, one of the systems engineering tools that have not been employed within LSP to date is a Concept of Operations. The goal of this paper is to research the format and content that goes into these various aerospace industry ConOps and tailor the format and content into template form, so the template may be used as an engineering tool for spacecraft integration with future LSP procured launch services. This tailoring effort was performed as the authors final Masters Project in the Spring of 2016 for the Stevens Institute of Technology and modified for publication with INCOSE (Owens, 2016).

Soluble FLT-1 rules placental destiny.

PubMed

Yamashita, Michiko; Kumasawa, Keiichi; Nakamura, Hitomi; Kimura, Tadashi

2018-02-19

Placenta previa is an abnormality in which the placenta covers the internal uterine os, and it can cause serious morbidity and mortality in both mother and fetus due to catastrophic hemorrhage. Some pregnant women recover from placenta previa due to a phenomenon called "migration." However, the mechanism of "migration" of the placenta has not been elucidated. Human placentas were collected from patients with placenta previa and those with no abnormal placentation (control). A microarray analysis was performed to detect the genes up- or down-regulated only in the caudal part in the previa group. Specific mRNA expression was evaluated using real-time quantitative reverse transcription PCR (qRT-PCR). Unilateral uterine artery ablation of 8.5 dpc mice was performed to reproduce the reduction of placental blood supply, and weights of the placentas and fetuses were evaluated in 18.5 dpc. Specific mRNA expression was also evaluated in mice placentas. According to the result of the microarray analysis, we focused on soluble fms-like tyrosine kinase-1 (sFLT-1) and hypoxia-inducible factor-1 (HIF-1) alpha. The sFLT-1 expression level is locally high in the caudal part of the human placenta in patients with placenta previa. In mice experiments, the weights of the placentas and fetuses were significantly smaller in the ablation side than those in the control side, and the sFlt-1 expression level was significantly higher in the ablation side than in the control side. Our study suggests that "migration" of the placenta is derived from placental degeneration at the caudal part of the placenta, and sFlt-1 plays a role in this placental degeneration. Copyright © 2018 Elsevier Inc. All rights reserved.

Canceling Some d-CON Mouse and Rat Control Products

EPA Pesticide Factsheets

EPA has reached agreement with the manufacturer, to cancel 12 d-CON products that do not meet our testing protocols that better protect children, pets and non-target wildlife from accidental exposure to the pesticide. These products will be phased out.

The ConSurf-DB: pre-calculated evolutionary conservation profiles of protein structures.

PubMed

Goldenberg, Ofir; Erez, Elana; Nimrod, Guy; Ben-Tal, Nir

2009-01-01

ConSurf-DB is a repository for evolutionary conservation analysis of the proteins of known structures in the Protein Data Bank (PDB). Sequence homologues of each of the PDB entries were collected and aligned using standard methods. The evolutionary conservation of each amino acid position in the alignment was calculated using the Rate4Site algorithm, implemented in the ConSurf web server. The algorithm takes into account the phylogenetic relations between the aligned proteins and the stochastic nature of the evolutionary process explicitly. Rate4Site assigns a conservation level for each position in the multiple sequence alignment using an empirical Bayesian inference. Visual inspection of the conservation patterns on the 3D structure often enables the identification of key residues that comprise the functionally important regions of the protein. The repository is updated with the latest PDB entries on a monthly basis and will be rebuilt annually. ConSurf-DB is available online at http://consurfdb.tau.ac.il/

The ConSurf-DB: pre-calculated evolutionary conservation profiles of protein structures

PubMed Central

Goldenberg, Ofir; Erez, Elana; Nimrod, Guy; Ben-Tal, Nir

2009-01-01

ConSurf-DB is a repository for evolutionary conservation analysis of the proteins of known structures in the Protein Data Bank (PDB). Sequence homologues of each of the PDB entries were collected and aligned using standard methods. The evolutionary conservation of each amino acid position in the alignment was calculated using the Rate4Site algorithm, implemented in the ConSurf web server. The algorithm takes into account the phylogenetic relations between the aligned proteins and the stochastic nature of the evolutionary process explicitly. Rate4Site assigns a conservation level for each position in the multiple sequence alignment using an empirical Bayesian inference. Visual inspection of the conservation patterns on the 3D structure often enables the identification of key residues that comprise the functionally important regions of the protein. The repository is updated with the latest PDB entries on a monthly basis and will be rebuilt annually. ConSurf-DB is available online at http://consurfdb.tau.ac.il/ PMID:18971256

A Randomized Phase 2 Study of Long-Acting TransCon GH vs Daily GH in Childhood GH Deficiency.

PubMed

Chatelain, Pierre; Malievskiy, Oleg; Radziuk, Klaudziya; Senatorova, Ganna; Abdou, Magdy O; Vlachopapadopoulou, Elpis; Skorodok, Yulia; Peterkova, Valentina; Leff, Jonathan A; Beckert, Michael

2017-05-01

TransCon Growth Hormone (GH) (Ascendis Pharma) is a long-acting recombinant sustained-release human GH prodrug in development for children with GH deficiency (GHD). To compare the pharmacokinetics, pharmacodynamics, safety, and efficacy of weekly TransCon GH to that of daily GH in prepubertal children with GHD. Randomized, open-label, active-controlled study of three doses of weekly TransCon GH versus daily Genotropin (Pfizer). Thirty-eight centers in 14 European countries and Egypt. Prepubertal male and female treatment-naïve children with GHD (n = 53). Subjects received one of three TransCon GH doses (0.14, 0.21, or 0.30 mg GH/kg/wk) or Genotropin 0.03 mg GH/kg/d for 26 weeks. GH and insulinlike growth factor-1 (IGF-1) levels, growth, adverse events, and immunogenicity. Both GH maximum concentration and area under the curve were similar following TransCon GH or Genotropin administration at comparable doses. A dose response was observed, with IGF-1 standard deviation scores increasing into the normal range for all three TransCon GH doses. Annualized mean height velocity for the three TransCon GH doses ranged from 11.9 cm to 13.9 cm, which was not statistically different from 11.6 cm for Genotropin. Adverse events were mild to moderate, and most were unrelated to the study drug. Injection site tolerance was good. One TransCon GH subject developed a low-titer, nonneutralizing antibody response to GH. The results suggest that long-acting TransCon GH is comparable to daily Genotropin for GH (pharmacokinetics) and IGF-1 (pharmacodynamics) levels, safety, and efficacy and support advancement into phase 3 development. Copyright © 2017 Endocrine Society

Teaching after Retirement: The Pros and the Cons

ERIC Educational Resources Information Center

Sommer, Robert

2014-01-01

Having enjoyed teaching during my active career, I continued to teach summer school following retirement. Self-observed sensory and cognitive impairments, although not mentioned by students in their evaluations, induced me to consider the pros and cons of continuing to teach. My hope is that this list of benefits and problems will be of assistance…

40 CFR 180.1213 - Coniothyrium minitans strain CON/M/91-08; exemption from the requirement of a tolerance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Coniothyrium minitans strain CON/M/91... PESTICIDE CHEMICAL RESIDUES IN FOOD Exemptions From Tolerances § 180.1213 Coniothyrium minitans strain CON/M... tolerance is established for residues of the microbial pesticide Coniothyrium minitans strain CON/M/91-08...

40 CFR 180.1213 - Coniothyrium minitans strain CON/M/91-08; exemption from the requirement of a tolerance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Coniothyrium minitans strain CON/M/91... PESTICIDE CHEMICAL RESIDUES IN FOOD Exemptions From Tolerances § 180.1213 Coniothyrium minitans strain CON/M... tolerance is established for residues of the microbial pesticide Coniothyrium minitans strain CON/M/91-08...

The SubCons webserver: A user friendly web interface for state-of-the-art subcellular localization prediction.

PubMed

Salvatore, M; Shu, N; Elofsson, A

2018-01-01

SubCons is a recently developed method that predicts the subcellular localization of a protein. It combines predictions from four predictors using a Random Forest classifier. Here, we present the user-friendly web-interface implementation of SubCons. Starting from a protein sequence, the server rapidly predicts the subcellular localizations of an individual protein. In addition, the server accepts the submission of sets of proteins either by uploading the files or programmatically by using command line WSDL API scripts. This makes SubCons ideal for proteome wide analyses allowing the user to scan a whole proteome in few days. From the web page, it is also possible to download precalculated predictions for several eukaryotic organisms. To evaluate the performance of SubCons we present a benchmark of LocTree3 and SubCons using two recent mass-spectrometry based datasets of mouse and drosophila proteins. The server is available at http://subcons.bioinfo.se/. © 2017 The Protein Society.

Somatic cell nuclear transfer: pros and cons.

PubMed

Sumer, Huseyin; Liu, Jun; Tat, Pollyanna; Heffernan, Corey; Jones, Karen L; Verma, Paul J

2009-01-01

Even though the technique of mammalian SCNT is just over a decade old it has already resulted in numerous significant advances. Despite the recent advances in the reprogramming field, SCNT remains the bench-mark for the generation of both genetically unmodified autologous pluripotent stem cells for transplantation and for the production of cloned animals. In this review we will discuss the pros and cons of SCNT, drawing comparisons with other reprogramming methods.

Conserva a Puerto Rico con bosques maderables

Treesearch

Frank H. Wadsworth

2009-01-01

[article in Spanish] Puerto Rico consume muchos productos forestales costosos de importar. También tiene bosques extensos con maderas explotables. Además, existen condiciones físicas favorables para la producción de madera útil. No obstante, hoy día no se utiliza la madera de los bosques actuales ocurre la deforestación para cualquier fin. Los Bosques productivos de...

DESAFÍOS ÉTICOS DE LA INVESTIGACIÓN CON ANIMALES, MANIPULACIÓN GENÉTICA

PubMed Central

Yunta, Eduardo Rodríguez

2012-01-01

En la investigación con animales existen cuestionamientos éticos tanto en el uso como modelos de enfermedades humanas y requisito previo para ensayos en humanos como en la introducción de modificaciones genéticas. Algunos de estos cuestionamientos son: no representar exactamente la condición humana como modelos, realizar pruebas de toxicidad con grave daño para los animales, alterar su naturaleza mediante modificaciones genéticas, riesgos de la introducción de organismos genéticamente modificados. El uso de animales en investigación para beneficio humano, impone al ser humano la responsabilidad moral de respetarlo, no haciéndoles sufrir innecesariamente, al estar trabajando con seres vivientes y sentientes. PMID:23338641

Órbitas caóticas en satelites galácticos

NASA Astrophysics Data System (ADS)

Carpintero, D. D.; Muzzio, J. C.; Vergne, M. M.; Wachlin, F. C.

En trabajos anteriores investigamos las órbitas de estrellas que forman los satelites galácticos utilizando análisis de frecuencias. Su uso estaba plenamente justificado por su velocidad y la gran información que brinda, amén de haber dado resultados muy concordantes con los exponentes de Liapunov. Sin embargo, más recientemente, encontramos algunos problemas en la utilización del análisis de frecuencias en sistemas de referencia rotantes (como se utilizan para los satélites), por lo que en este trabajo rehicimos nuestras investigaciones previas utilizando exclusivamente exponentes de Liapunov. Algunas conclusiones anteriores se han confirmado, en tanto que otras deben modificarse. Además, los nuevos resultados muestran que las escalas de tiempo de los procesos caóticos en los satélites galácticos son comparables a, o más cortas que, las escalas de tiempo de otros procesos dinámicos característicos de estos objetos.

Con Edison power failure of July 13 and 14, 1977. Final staff report

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

1978-06-01

On July 13, 1977 the entire electric load of the Con Edison system was lost, plunging New York City and Westchester County into darkness. The collapse resulted from a combination of natural events, equipment malfunctions, questionable system-design features, and operating errors. An attempt is made in this report to answer the following: what were the specific causes of the failure; if equipment malfunctions and operator errors contributed, could they have been prevented; to what extent was Con Edison prepared to handle such an emergency; and did Con Edison plan prudently reserve generation, for reserve transmission capability, for automatic equipment tomore » protect its system, and for proper operator response to a critical situation. Following the introductory and summary section, additional sections include: the Consolidated Edison system; prevention of bulk power-supply interruptions; the sequence of failure and restoration; analysis of the July 1977 power failure; restoration sequence and equipment damage assessment; and other investigations of the blackout. (MCW)« less

Providers debate pros and cons of pneumonia vaccination at discharge.

PubMed

2001-02-01

When to vaccinate against pneumonia? Does it makes sense when patients are in the hospital? Or should patients wait for the first post-op visit with the PCP? Office-based and hospital-based physicians weigh the pros and cons of each.

Cue-based assertion classification for Swedish clinical text – developing a lexicon for pyConTextSwe

PubMed Central

Velupillai, Sumithra; Skeppstedt, Maria; Kvist, Maria; Mowery, Danielle; Chapman, Brian E.; Dalianis, Hercules; Chapman, Wendy W.

2014-01-01

Objective The ability of a cue-based system to accurately assert whether a disorder is affirmed, negated, or uncertain is dependent, in part, on its cue lexicon. In this paper, we continue our study of porting an assertion system (pyConTextNLP) from English to Swedish (pyConTextSwe) by creating an optimized assertion lexicon for clinical Swedish. Methods and material We integrated cues from four external lexicons, along with generated inflections and combinations. We used subsets of a clinical corpus in Swedish. We applied four assertion classes (definite existence, probable existence, probable negated existence and definite negated existence) and two binary classes (existence yes/no and uncertainty yes/no) to pyConTextSwe. We compared pyConTextSwe’s performance with and without the added cues on a development set, and improved the lexicon further after an error analysis. On a separate evaluation set, we calculated the system’s final performance. Results Following integration steps, we added 454 cues to pyConTextSwe. The optimized lexicon developed after an error analysis resulted in statistically significant improvements on the development set (83% F-score, overall). The system’s final F-scores on an evaluation set were 81% (overall). For the individual assertion classes, F-score results were 88% (definite existence), 81% (probable existence), 55% (probable negated existence), and 63% (definite negated existence). For the binary classifications existence yes/no and uncertainty yes/no, final system performance was 97%/87% and 78%/86% F-score, respectively. Conclusions We have successfully ported pyConTextNLP to Swedish (pyConTextSwe). We have created an extensive and useful assertion lexicon for Swedish clinical text, which could form a valuable resource for similar studies, and which is publicly available. PMID:24556644

An Application of Con-Resistant Trust to Improve the Reliability of Special Protection Systems within the Smart Grid

DTIC Science & Technology

2012-06-01

in an effort to be more reliable and efficient. However, with the benefits of this new technology comes added risk . This research utilizes a con ...AN APPLICATION OF CON -RESISTANT TRUST TO IMPROVE THE RELIABILITY OF SPECIAL PROTECTION SYSTEMS WITHIN THE SMART GRID THESIS Crystal M. Shipman...Government and is not subject to copyright protection in the United States AFIT/GCO/ENG/12-22 AN APPLICATION OF CON -RESISTANT TRUST TO IMPROVE THE

Gestational surrogacy: could be a way to be a way to reproduction? Pros and cons.

PubMed

Clementina, Peris

2011-06-01

The aim of this article was to address pros and cons of gestational surrogacy, the social and psychological issues involved in surrogate motherhood triads. Pros and cons of surrogacy, the possible insurgence of a hematologic disease in the fetus, hemolytic disease of the newborn, naturally acquired microchimerism in surrogacy cases, ethical, medical, psychologic, legal and religious issues of a problem are discussed.

Young women's perspective of the pros and cons to seeking screening for chlamydia and gonorrhea: an exploratory study.

PubMed

Chacko, Mariam R; von Sternberg, Kirk; Velasquez, Mary M; Wiemann, Constance M; Smith, Peggy B; DiClemente, Ralph

2008-08-01

To identify young women's pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening. Prospective, cross sectional study Community-based reproductive health clinic 192 young women (66% African American; mean age 18.9 years). Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated. Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner trust issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness of the body, being healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic factors. A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young woman's decision-making to seek screening.

Utilice en forma segura los productos con cebo para roedores

EPA Pesticide Factsheets

Si se usan de manera inadecuada, los productos con veneno para ratas y ratones podrían hacerle daño a usted, a sus hijos o a sus mascotas. Siempre que use pesticidas lea la etiqueta del producto y siga todas las indicaciones.

Single step purification of concanavalin A (Con A) and bio-sugar production from jack bean using glucosylated magnetic nano matrix.

PubMed

Kim, Ho Myeong; Cho, Eun Jin; Bae, Hyeun-Jong

2016-08-01

Jack bean (JB, Canavalia ensiformis) is the source of bio-based products, such as proteins and bio-sugars that contribute to modern molecular biology and biomedical research. In this study, the use of jack bean was evaluated as a source for concanavalin A (Con A) and bio-sugar production. A novel method for purifying Con A from JBs was successfully developed using a glucosylated magnetic nano matrix (GMNM) as a physical support, which facilitated easy separation and purification of Con A. In addition, the enzymatic conversion rate of 2% (w/v) Con A extracted residue to bio-sugar was 98.4%. Therefore, this new approach for the production of Con A and bio-sugar is potentially useful for obtaining bio-based products from jack bean. Copyright © 2016 Elsevier Ltd. All rights reserved.

The role of the 2H4 molecule in the generation of suppressor function in Con A-activated T cells.

PubMed

Morimoto, C; Letvin, N L; Rudd, C E; Hagan, M; Takeuchi, T; Schlossman, S F

1986-11-15

The molecular basis for the suppression generated in a concanavalin A (Con A)-activated T cell culture remains unknown. In this study, we have attempted to determine whether the 2H4 and 4B4 molecules on Con A-activated T cells play some role in the generation of suppression by such cells. We have shown that Con A-activated suppressor cells belong to the 2H4+ subset of T cells but not the 4B4+ (2H4-) subset. Con A-activated T cells exerted their optimal suppressor function on day 2 in culture, a time at which the expression of 2H4 on such cells was maximal and 4B4 was minimal. Furthermore, the stimulation of T cells with the higher concentration of Con A generated the stronger suppressor function. At the same time, both 2H4 expression and density were increased and 4B4 expression and density were decreased on such Con A-activated T cells. More importantly, the treatment of Con A-activated T cells with anti-2H4 antibody but not with anti-4B4, anti-TQ1, or anti-T4 antibodies can block the suppressor function of such cells. Taken together, the above results strongly suggest that the 2H4 molecule itself may be involved in the generation of suppressor function in Con A-activated T cells. The 2H4 antigen on such cells was shown to be comprised of 220,000 and 200,000 m.w. glycoproteins. Thus this study indicates that the 220,000 and 200,000 m.w. structure of the 2H4 molecule may itself play a crucial role in the generation of suppressor signals of Con A-activated cells.

Hacia el consumo informado de tabaco en México: efecto de las advertencias con pictogramas en población fumadora

PubMed Central

Thrasher, James F; Pérez-Hernández, Rosaura; Arillo-Santillán, Edna; Barrientos-Gutiérrez, Inti

2015-01-01

Resumen Objetivo Evaluar el efecto de las advertencias sanitarias (AS) con pictogramas en las cajetillas de tabaco en adultos fumadores. Material y métodos Cohorte de fumadores con representatividad poblacional de siete ciudades mexi canas, antes (2010) y después (2011) de la implementación de AS con pictogramas (ASP). Para determinar el cambio en las variables sobre el impacto cognitivo y conductual de las advertencias, se estimaron modelos bivariados y ajustados de ecuaciones de estimación generalizada. En el Segundo levantamiento (2011), se estimaron modelos para determiner los factores que se asocian con el reporte de recordar cada advertencia que había entrado al mercado, además de los factores asociados con el autorreporte del impacto de cada advertencia vigente. Resultados Se observaron incrementos importantes de 2010 a 2011 en los conocimientos sobre los riesgos de fumar, los componentes tóxicos del tabaco y el número telefónico para recibir consejos sobre dejar de fumar. La recordación e impacto de las primeras advertencias con pictogramas parecen ser amplios y equitativos a través de la población fumadora. En comparación con 2010, un mayor nivel de ex fumadores entrevistados en 2011 reportaron que las advertencias habían influido mucho en dejar de fumar (RM=2.44, 95% IC 1.27–4.72). Conclusiones Las AS con pictogramas han logrado un impacto importante en el conocimiento y conducta, información relevante para la población y en tomadores de decisiones. PMID:22689162

Self-efficacy, pros, and cons as variables associated with adjacent stages of change for regular exercise in Japanese college students.

PubMed

Horiuchi, Satoshi; Tsuda, Akira; Kobayashi, Hisanori; Fallon, Elizabeth A; Sakano, Yuji

2017-07-01

This study examined self-efficacy (confidence to exercise), pros (exercise's advantages), and cons (exercise's disadvantages) as variables associated across the transtheoretical model's six stages of change in 403 Japanese college students. A series of logistic regression analyses were conducted. Results showed that higher pros and lower cons were associated with being in contemplation compared to precontemplation. Lower cons were associated with being in preparation compared to contemplation. Higher self-efficacy was associated with being in action compared to preparation as well as being in maintenance compared to action. Lower cons were associated with being in termination compared to maintenance.

Changes to perceptions of the pros and cons of genetic susceptibility testing after APOE genotyping for Alzheimer disease risk

PubMed Central

Christensen, Kurt D.; Roberts, J. Scott; Uhlmann, Wendy R.; Green, Robert C.

2011-01-01

Purpose Perceptions about the pros and cons of genetic susceptibility testing are among the best predictors of test utilization. How actual testing changes such perceptions has yet to be examined. Methods In a clinical trial, first-degree relatives of patients with Alzheimer disease received genetic risk assessments for Alzheimer disease including APOE disclosure. Participants rated 11 possible benefits associated with genetic testing (pros) and 10 risks or limitations (cons) before genetic risk disclosure and again 12 months afterward. Results Pros were rated higher than cons at baseline (3.53 vs. 1.83, P < 0.001) and at 12 months after risk disclosure (3.33 vs. 1.88, P < 0.001). Ratings of pros decreased during the 12-month period (3.33 vs. 3.53, P < 0.001). Ratings of cons did not change (1.88 vs. 1.83, P = 0.199) except for a three-item discrimination subscale which increased (2.07 vs. 1.92, P = 0.012). Among specific pros and cons, three items related to prevention and treatment changed the most. Conclusion The process of APOE genetic risk assessment for Alzheimer disease sensitizes some to its limitations and the risks of discrimination; however, 1-year after disclosure, test recipients still consider the pros to strongly outweigh the cons. PMID:21270636

Effects of a 12-hour shift on mood states and sleepiness of Neonatal Intensive Care Unit nurses.

PubMed

Ferreira, Tadeu Sartini; Moreira, Clarice Zinato; Guo, James; Noce, Franco

2017-03-09

To assess the effect of a 12-hour shift on mood states and sleepiness at the beginning and end of the shift. Quantitative, cross-sectional and descriptive study.It was conducted with 70 neonatal intensive care unit nurses. The Brunel Mood Scale (BRUMS), Karolinska Sleepiness Scale (KSS), and a socio-demographic profile questionnaire were administered. When the KSS and BRUMS scores were compared at the beginning of the shift associations were found with previous sleep quality (p ≤ 0.01), and quality of life (p ≤ 0.05). Statistical significant effects on BRUMS scores were also associated with previous sleep quality, quality of life, liquid ingestion, healthy diet, marital status, and shift work stress. When the beginning and end of the shift were compared, different KSS scores were seen in the group of all nurses and in the night shift one. Significant vigor and fatigue scores were observed within shift groups. A good night's sleep has positive effects on the individual`s mood states both at the beginning and the end of the shift. The self-perception of a good quality of life also positively influenced KSS and BRUMS scores at the beginning and end of the shift. Proper liquid ingestion led to better KSS and BRUMS scores. Evaluar el efecto de un turno de 12 horas en estados de ánimo y somnolencia al principio y al final del turno. Estudio cuantitativo, transversal y descriptivo.Se realizó con 70 enfermeras de unidades de cuidados intensivos neonatales. Se administró la Escala de Humor Brunel (BRUMS), la Escala de Somnolencia de Karolinska (KSS) y un cuestionario de perfil sociodemográfico. Cuando se compararon las puntuaciones de KSS y BRUMS al comienzo del turno se encontraron asociaciones con calidad de sueño previa (p ≤ 0,01) y calidad de vida (p ≤ 0,05). Los efectos estadísticos significativos en las puntuaciones de BRUMS también se asociaron con la calidad previa del sueño, la calidad de vida, la ingestión de líquidos, la dieta saludable, el

Perceived pros and cons of smoking and quitting in hard-core smokers: a focus group study

PubMed Central

2014-01-01

Background In the last decade, so-called hard-core smokers have received increasing interest in research literature. For smokers in general, the study of perceived costs and benefits (or ‘pros and cons’) of smoking and quitting is of particular importance in predicting motivation to quit and actual quitting attempts. Therefore, this study aims to gain insight into the perceived pros and cons of smoking and quitting in hard-core smokers. Methods We conducted 11 focus group interviews among current hard-core smokers (n = 32) and former hard-core smokers (n = 31) in the Netherlands. Subsequently, each participant listed his or her main pros and cons in a questionnaire. We used a structural procedure to analyse the data obtained from the group interviews and from the questionnaires. Results Using the qualitative data of both the questionnaires and the transcripts, the perceived pros and cons of smoking and smoking cessation were grouped into 6 main categories: Finance, Health, Intrapersonal Processes, Social Environment, Physical Environment and Food and Weight. Conclusions Although the perceived pros and cons of smoking in hard-core smokers largely mirror the perceived pros and cons of quitting, there are some major differences with respect to weight, social integration, health of children and stress reduction, that should be taken into account in clinical settings and when developing interventions. Based on these findings we propose the ‘Distorted Mirror Hypothesis’. PMID:24548463

YOUNG WOMEN’S PERSPECTIVE OF THE PROS AND CONS TO SEEKING SCREENING FOR CHLAMYDIA AND GONORRHEA: AN EXPLORATORY STUDY

PubMed Central

Chacko, Mariam R.; von Sternberg, Kirk; Velasquez, Mary M.; Wiemann, Constance M.; Smith, Peggy B.; DiClemente, Ralph

2008-01-01

Study Objective To identify young women’s pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening. Design Prospective, cross sectional study Setting Community-based reproductive health clinic Participants 192 young women (66% African American; mean age 18.9 years). Main Outcome Measure(s) Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated. Results Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of knowing the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner relationship issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness, healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic issues. Conclusions A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young woman’s decision-making to seek screening. PMID:18656072

CHILES Con Pol: An ultra-deep JVLA survey probing galaxy evolution and cosmic magnetism

NASA Astrophysics Data System (ADS)

Hales, Christopher A.; Momjian, Emmanuel; van Gorkom, Jacqueline; Rupen, Michael P.; Greiner, Maksim; Ensslin, Torsten A.; Bonzini, Margherita; Padovani, Paolo; Harrison, Ian; Brown, Michael L.; Gim, Hansung; Yun, Min S.; Maddox, Natasha; Stewart, Adam; Fender, Rob P.; Tremou, Evangelia; Chomiuk, Laura; Peters, Charee; Wilcots, Eric M.; Lazio, Joseph

2015-08-01

We are undertaking a 1000 hour campaign with the Karl G. Jansky VLA to survey 0.2 square degrees of the COSMOS field in full polarization continuum at 1.4 GHz. Our observations are part of a joint program with the spectral line COSMOS HI Large Extragalactic Survey (CHILES). When complete, we expect our CHILES Continuum Polarization (CHILES Con Pol) survey to reach an SKA-era sensitivity of 500 nJy per 4 arcsecond resolving beam, the deepest view of the radio sky yet. CHILES Con Pol will open new and fertile parameter space, with sensitivity to star formation rates of 10 Msun per year out to an unprecedented redshift of z=2, and ultra-luminous infrared galaxies and sub-millimeter galaxies out to redshifts of z=8 and beyond. This rich resource will extend the utility of radio band studies beyond the usual radio quasar and radio galaxy populations, opening sensitivity to the starforming and radio-quiet AGN populations that form the bulk of extragalactic sources detected in the optical, X-ray, and infrared bands. In this talk I will outline the key science of CHILES Con Pol, including galaxy evolution and novel measurements of intergalactic magnetic fields. I will present initial results from the first 180 hours of the survey and describe our forthcoming Data Release 1. I invite the astronomical community to consider unique science that can be pursued with CHILES Con Pol radio data.

NREL, NYSERDA, and Con Edison Partner on Home Energy Management Systems |

Science.gov Websites

at large scale, the overall impact could be a win-win for both homeowners and utilities, which could sources. Founded in 1823, Con Edison provides electric, gas, and steam service to 10 million people who

Angio-OCT de la zona avascular foveal en ojos con oclusión venosa de la retina.

PubMed

Wons, Juliana; Pfau, Maximilian; Wirth, Magdalena A; Freiberg, Florentina J; Becker, Matthias D; Michels, Stephan

2017-07-11

Objetivo: El objetivo del estudio comprendía visualizar y cuantificar las alteraciones patológicas de la zona avascular foveal (ZAF) mediante angio-OCT en ojos con oclusión venosa de la retina (OVR) en comparación con el ojo contralateral sano. Procedimientos: La angio-OCT se llevó a cabo mediante el sistema Avanti® RTVue 100 XR (Optovue Inc., Fremont, Calif., EE. UU.). Los bordes de la capa vascular superficial (CVS) se definieron como 3 μm por debajo de la membrana limitante interna y 15 μm por debajo de la capa plexiforme interna y, para la capa vascular profunda (CVP), como 15 y 70 μm por debajo de la membrana limitante interna y de la capa plexiforme interna, respectivamente. La longitud de la ZAF horizontal, vertical y máxima de la CVS y la CVP en cada ojo se midió de forma manual. Además, se midió el ángulo entre el diámetro máximo de la ZAF y el plano papilomacular. Resultados: La angio-OCT representó los defectos dentro de la vasculatura en el área perifoveal en ojos con oclusión de rama venosa de la retina (ORVR; n = 11) y con oclusión de la vena central de la retina (OVCR; n = 8). Esto resultó en un crecimiento del diámetro máximo de la ZAF en ojos con OVR (n = 19) en comparación con el ojo contralateral (n = 19; 921 ± 213 frente a 724 ± 145 µm; p = 0,008). Además, se observó una correlación significativa entre la mejor agudeza visual corregida (MAVC) y el diámetro máximo de la ZAF en la CVP (ρ de Spearman = -0,423, p < 0,01). Por último, en los ojos con OVR, el ángulo entre el plano papilomacular y el diámetro máximo de la ZAF se dio tan solo en el 21,05% (CVS) y en el 15,79% (CVP) de los casos a 0 ± 15 ó 90 ± 15°, respectivamente. En ojos sanos, estos ángulos (que supuestamente representan una configuración de la ZAF regular) fueron más prevalentes (CVS 68,42 frente a 21,05%, p = 0,003; CVP 73,68 frente a 15,79%, p < 0,001). Conclusiones: La angio-OCT muestra alteraciones morfológicas de la ZAF en ojos con

The International Consortium for the Investigation of Renal Malignancies (I-ConFIRM)

Cancer.gov

The International Consortium for the Investigation of Renal Malignancies (I-ConFIRM) was formed to promote international, multidisciplinary collaborations to advance our understanding of the etiology and outcomes of kidney cancer.

Detail of conning tower atop the submarine. Note the wire ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Detail of conning tower atop the submarine. Note the wire rope wrapped around the base of the tower, which may have been used in an attempt to pull the submarine offshore. - Sub Marine Explorer, Located along the beach of Isla San Telmo, Pearl Islands, Isla San Telmo, Former Panama Canal Zone, CZ

End-User Use of Data Base Query Language: Pros and Cons.

ERIC Educational Resources Information Center

Nicholes, Walter

1988-01-01

Man-machine interface, the concept of a computer "query," a review of database technology, and a description of the use of query languages at Brigham Young University are discussed. The pros and cons of end-user use of database query languages are explored. (Author/MLW)

Papiloma invertido sinunasal con invasión intracraneal: Reporte de caso y revisión bibliográfica

PubMed Central

Di Pietrantonio, Andrés; Asmus, Humberto; Ingratta, Christian; Brennan, Walter; Schulz, Javier; Carballo, Leandro

2018-01-01

Resumen IntroducciÓn: El papiloma invertido es una neoplasia benigna de los senos paranasales localmente agresiva con alto potencial de recurrencia y de malignización. La extensión intracraneal es infrecuente y más aún, la penetración dural, asociándose a menudo a la recurrencia de la enfermedad o a su degeneración en carcinoma de células escamosas. Caso clínico: Presentamos el caso de una paciente de 32 años que consultó por lesión exofítica en fosa nasal derecha y exoftalmos, asociada a cefalea, anosmia y disgeusia. Se estudió con TC cerebro, macizo facial y RM de encéfalo que evidencian lesión en fosa nasal derecha con ocupación de senos aéreos, osteólisis de pared medial orbitaria y base de cráneo anterior e invasión intracraneal frontal derecha, con efecto de masa y compresión del parénquima encefálico adyacente. Intervención: Se realizó una nasofibroscopía en primer tiempo con diagnóstico anatomopatológico de papiloma invertido y posteriormente resección de la lesión mediante doble abordaje más reconstrucción de la fosa craneal anterior. Se obtuvo diagnóstico definitivo de papiloma invertido de tipo Schneideriano con áreas de transformación atípica in situ. La paciente evolucionó de forma favorable y sin complicaciones, con permeabilidad de vía aérea superior, sin signos de recidiva lesional luego de 4 años de seguimiento. Conclusión: La invasión intracraneal de esta patología es sumamente infrecuente. Cuando existe, es indicador de agresividad y potencial recidiva, por lo que la exéresis completa de la misma define el pronóstico de la enfermedad. PMID:29430328

Prevalencia y tamizaje del Trastorno por Déficit de Atención con Hiperactividad en Costa Rica

PubMed Central

Weiss, Nicholas T.; Schuler, Jovita; Monge, Silvia; McGough, James J.; Chavira, Denise; Bagnarello, Monica; Herrera, Luis Diego; Mathews, Carol A.

2015-01-01

Resumen La investigación tuvo como propósito estimar la prevalencia del Trastorno por Déficit de Atención con Hiperactividad (TDAH) en Costa Rica y determinar si la versión en español del cuestionario Swanson Nolan and Pelham Scale IV (SNAP-IV) es un instrumento de tamizaje útil en una población de niños y niñas escolares costarricenses. El instrumento fue entregado a padres y maestros de 425 niños entre 5 y 13 años de edad (promedio = 8.8). Todos fueron evaluados con el instrumento Swanson, Kotkin, Agler, M-Flynn and Pelham Scale (SKAMP). Su diagnóstico fue confirmado con una entrevista clínica. La sensibilidad y la especificidad del SNAP-IV fueron evaluadas como predictores de criterios de diagnóstico según el DSM-IV. La prevalencia puntual en la muestra del TDAH fue del 5%. El tamizaje más preciso lo hizo el SNAP-IV completado por el maestro en un corte de 20%, con una sensibilidad de 96% y una especificidad de un 82%. La sensibilidad de los instrumentos completados por los padres fue más baja que aquella de los maestros. El SNAP-IV completado por las maestras con un corte aislando el 20% de los mayores puntajes categorizó correctamente a un 87% de los sujetos. PMID:22432094

Soluciones analiticas AL problema de jets con velocidad de eyeccion variable EN EL tiempo.

NASA Astrophysics Data System (ADS)

Canto, J.; Raga, A. C.; D'Alessio, P.

1998-11-01

Se presenta un nuevo metodo que permite resolver de manera exacta y analitica las ecuaciones que describen un jet hipersonico con velocidad de eyeccion variable en el tiempo. El metodo se basa en consideraciones sencillas de conservacion de momento para las superficies de trabajo que se forman en el interior del jet. Como ejemplo, se presentan soluciones para jets con variacion sinusoidal en la velocidad de eyeccion, y tambien para el caso de un incremento lineal en el tiempo. Estas soluciones analiticas tienen una clara aplicacion en la interpretacion de las observaciones de jets asociados a objetos Herbig-Haro.

Air Traffic Management Technology Demonstration-1 Concept of Operations (ATD-1 ConOps)

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Johnson, William C.; Swenson, Harry; Robinson, John E.; Prevot, Thomas; Callantine, Todd; Scardina, John; Greene, Michael

2012-01-01

The operational goal of the ATD-1 ConOps is to enable aircraft, using their onboard FMS capabilities, to fly Optimized Profile Descents (OPDs) from cruise to the runway threshold at a high-density airport, at a high throughput rate, using primarily speed control to maintain in-trail separation and the arrival schedule. The three technologies in the ATD-1 ConOps achieve this by calculating a precise arrival schedule, using controller decision support tools to provide terminal controllers with speeds for aircraft to fly to meet times at a particular meter points, and onboard software providing flight crews with speeds for the aircraft to fly to achieve a particular spacing behind preceding aircraft.

Existing con el Lobo, Traversing la Frontera con Mis Nepantla Coyotes, y Buscando la Vida del Zorro: An Autoethnographic Exploration of a Chicano in Academia

ERIC Educational Resources Information Center

Ramirez, Ernesto Fidel

2017-01-01

This dissertation is the experience of my life, an evolution of platicas I have had con mis coyotes, my Nepantlero guides. I am one Chicano navigating through the mechanisms of a coercive and hegemonic system which limits our advancement in the academy. My ontology, epistemology, and axiology stem from my cultural and family foundations which I…

Relationship between first trimester aneuploidy screening test serum analytes and placenta accreta.

PubMed

Büke, Barış; Akkaya, Hatice; Demir, Sibel; Sağol, Sermet; Şimşek, Deniz; Başol, Güneş; Barutçuoğlu, Burcu

2018-01-01

The aim of this study is to determine whether there is a relationship between first trimester serum pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fβhCG) MoM values and placenta accreta in women who had placenta previa. A total of 88 patients with placenta previa who had first trimester aneuploidy screening test results were enrolled in the study. Nineteen of these patients were also diagnosed with placenta accreta. As probable markers of excessive placental invasion, serum PAPP-A and fβhCG MoM values were compared in two groups with and without placenta accreta. Patients with placenta accreta had higher statistically significant serum PAPP-A (1.20 versus 0.865, respectively, p = 0.045) and fβhCG MoM (1.42 versus 0.93, respectively, p = 0.042) values than patients without accreta. Higher first trimester serum PAPP-A and fβhCG MoM values seem to be associated with placenta accreta in women with placenta previa. Further studies are needed to use these promising additional tools for early detection of placenta accreta.

Thymic lymphocytes. III. Cooperative phenomenon in the proliferation of thymocytes under Con A stimulation.

PubMed

Papiernik, M; Jacobson, J B

1986-01-01

In the present paper, the response of thymocytes to Con A is analyzed in terms of a cooperative phenomenon between medullary thymocytes, cortical thymocytes, thymic accessory cells, and interleukin 2. Medullary thymocytes respond spontaneously to Con A and produce IL-2. The addition of exogenously produced IL-2 enhances their proliferation. Small numbers of cortical (PNA+) thymocytes do not respond to Con A, even in the presence of IL-2-containing supernatant. By increasing the number of PNA+ cells per well, sensitivity to Con A and IL-2 appears. This response may be linked either to the increase in a minor PNA+-responding population and/or to the enhanced contamination by medullary thymocytes and macrophages in non-responding PNA+ thymocyte population. In this hypothesis, either the contaminating cells respond by themselves and/or cooperate with PNA+ cells to induce their proliferation. Coculture of non-responding low numbers of PNA+ thymocytes with Con A- and IL-2-containing supernatant in the presence of PNA- cells containing thymic medullary thymocytes and macrophages always produces a higher response than that of each individual population. These results show that a cooperative phenomenon occurs in the cocultures of PNA+ and PNA- thymic cells. We can show using PNA+ and PNA- thymocytes with different Thy 1 alleles, that indeed both PNA+ and populations participate PNA-thymocytes with different Thy 1 alleles, that indeed both PNA+ and PNA- populations participate in the generation of proliferating cells. We can demonstrate, by lysis experiments with monoclonal antibodies and complement that at the end of coculture, most of the proliferating cells are Lyt 1+, and part are Lyt 2+ or L3T4+. We discuss the fact that the phenotype of the cells after activation does not allow us to deduce the phenotype of their precursors. Lysis of Ia+ cells prior to coculture, reduces the level of the proliferative response but does not modify the percentage of cooperation produced

Ultrasound pregnancy

MedlinePlus

Pregnancy sonogram; Obstetric ultrasonography; Obstetric sonogram; Ultrasound - pregnancy; IUGR - ultrasound; Intrauterine growth - ultrasound; Polyhydramnios - ultrasound; Oligohydramnios - ultrasound; Placenta previa - ultrasound; Multiple pregnancy - ultrasound; ...

Oxacilin-resistant Coagulase-negative staphylococci (CoNS) bacteremia in a general hospital at São Paulo city, Brasil

PubMed Central

d’Azevedo, P.A.; Secchi, C.; Antunes, A.L.S.; Sales, T.; Silva, F.M.; Tranchesi, R.; Pignatari, A.C.C.

2008-01-01

In the last decades, coagulase-negative staphylococci (CoNS), especially Staphylococcus epidermidis have become an important cause of bloodstream infections. In addition, rates of methicillin-resistance among CoNS have increased substantially, leading to the use of glicopeptides for therapy. The objective of this study was to evaluate eleven consecutives clinically relevant cases of oxacillin-resistant CoNS bacteremia in a general hospital localized in São Paulo city, Brazil. Five different species were identified by different phenotypic methods, including S. epidermidis (5), S. haemolyticus (3), S. hominis (1), S. warneri (1) and S. cohnii subsp urealyticus (1). A variety of Pulsed Field Gel Electrophoresis profiles was observed by macrorestriction DNA analysis in S. epidermidis isolates, but two of three S. haemolyticus isolates presented the same profile. These data indicated the heterogeneity of the CoNS isolates, suggesting that horizontal dissemination of these microorganisms in the investigated hospital was not frequent. One S. epidermidis and one S. haemolyticus isolates were resistant to teicoplanin and susceptible to vancomycin. The selective pressure due to the use of teicoplanin in this hospital is relevant. PMID:24031279

40 CFR 227.27 - Limiting permissible con-cen-tra-tion (LPC).

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Limiting permissible con-cen-tra-tion... scientific literature or accepted by EPA as being reliable test organisms to determine the anticipated impact... for each type they represent, and that are documented in the scientific literature and accepted by EPA...

Salud mental en desastres naturales: estrategias interventivas con adultos mayores en sectores rurales de Chile.

PubMed

Osorio-Parraguez, Paulina; Espinoza, Adriana

2016-06-01

En el presente artículo se da a conocer una estrategia de intervención llevada a cabo con adultos mayores en la comuna de Paredones, sexta región de Chile, con posterioridad al terremoto y tsunami del 27 de febrero 2010 en Chile, en el contexto de una investigación sobre fortalezas y vulnerabilidades desplegadas por este grupo etario, con posterioridad a un desastre natural. Se presenta una descripción del desarrollo metodológico de la intervención y de los sustentos teóricos y conceptuales en los que se basa. Como resultado de este proceso, se propone una estrategia que trabaje a través de la identificación de las propias experiencias y fortalezas de los sujetos. De tal forma se minimizan los efectos negativos de los determinantes sociales de la salud (como la edad y el lugar de residencia) en contexto de crisis; permitiendo a los adultos mayores fortalecer sus recursos individuales y colectivos, en pro de su bienestar psicosocial. © The Author(s) 2015.

Catálogo de Radio-Fuentes Opticas con Astrolabio Fotoeléctrico PAII

NASA Astrophysics Data System (ADS)

Manrique, W. T.; Podestá, R. C.; Alonso, E.; Actis, E. V.; Pacheco, A. M.; Bustos, G.; Lizhi, L.; Zezhi, W.; Fanmiao, Z.; Hongqi, W.; Perdomo, R.

Usando los datos observados en San Juan con el Astrolabio Fotoeléctrico PAII desde Febrero de 1992 hasta Marzo de 1997, se ha realizado el Catálogo de Radio-Fuentes Opticas de San Juan conteniendo 69 estrellas. Las observaciones de las posiciones de las radio-fuentes están realizadas para la época y equinoccio J2000,0 y en un sistema cercano al del FK5. Las precisiones medias son ± 2,2 ms y ± 0,"035 en ascensión recta y declinación respectivamente. Las magnitudes de las estrellas son desde 0,9 a 10,7 . Las declinaciones son desde --2,5 grados a --60 grados. La época media es 1995,1. Se muestran también los resultados comparados con el Catálogo Hiparcos.

ConSurf 2016: an improved methodology to estimate and visualize evolutionary conservation in macromolecules

PubMed Central

Ashkenazy, Haim; Abadi, Shiran; Martz, Eric; Chay, Ofer; Mayrose, Itay; Pupko, Tal; Ben-Tal, Nir

2016-01-01

The degree of evolutionary conservation of an amino acid in a protein or a nucleic acid in DNA/RNA reflects a balance between its natural tendency to mutate and the overall need to retain the structural integrity and function of the macromolecule. The ConSurf web server (http://consurf.tau.ac.il), established over 15 years ago, analyses the evolutionary pattern of the amino/nucleic acids of the macromolecule to reveal regions that are important for structure and/or function. Starting from a query sequence or structure, the server automatically collects homologues, infers their multiple sequence alignment and reconstructs a phylogenetic tree that reflects their evolutionary relations. These data are then used, within a probabilistic framework, to estimate the evolutionary rates of each sequence position. Here we introduce several new features into ConSurf, including automatic selection of the best evolutionary model used to infer the rates, the ability to homology-model query proteins, prediction of the secondary structure of query RNA molecules from sequence, the ability to view the biological assembly of a query (in addition to the single chain), mapping of the conservation grades onto 2D RNA models and an advanced view of the phylogenetic tree that enables interactively rerunning ConSurf with the taxa of a sub-tree. PMID:27166375

A National Look at Postmodernism's Pros and Cons in Educational Leadership

ERIC Educational Resources Information Center

Townsell, Rhodena

2007-01-01

The purpose of this article is to take a look at the pros and cons of postmodernism. It is imperative for administrators to closely examine educational theories and practices prior to instituting changes. The ability to read and digest challenging material keeps one informed and prepared to lead effectively. This paper will list the pros and cons…

Cervical disc arthroplasty: Pros and cons

PubMed Central

Moatz, Bradley; Tortolani, P. Justin

2012-01-01

Background: Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. Methods: This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Results: Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Conclusion: Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing. PMID:22905327

Cervical disc arthroplasty: Pros and cons.

PubMed

Moatz, Bradley; Tortolani, P Justin

2012-01-01

Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

Conning the conmen: Intelligence and female desire in Dedh Ishqiya.

PubMed

Singh, Shailendra Kumar

2018-01-02

This article investigates the ostensibly paradoxical relationship that exists between the theme of excessive love, as suggested by the title of Abhishek Chaubey's film Dedh Ishqiya (2014), and the actual representation of it in the movie, which is not only restrained and disproportionate, but is also looked at with suspicion and contempt. It examines the logic of this seeming contradiction through the other two related themes that Chaubey's chef-d'œuvre foregrounds, namely that of intelligence and female desire. The quest for financial autonomy that the female protagonists of the movie are involved in-a necessary pre-condition for leading independent lives-is so inextricably intertwined with manipulation, dexterity, and subterfuge, that any overt expression of homoerotic female desire can only jeopardize their existing possibilities of self-aggrandizement. The heteronormative arrangements of Begum Para's palace thus constitute the elaborate mise en scène, behind which female desire is enacted through a politics of intelligence, resourcefulness, discretion, and anonymity. Through this strategic negotiation, which is also a tactical necessity, the female protagonists are not only able to con the con men in the movie, but also imagine alternative subject positions that recognize the need for both pragmatism and expediency as well as deconstructing heteropatriarchal economies of desire.

Pros and cons of prognostic disclosure to Japanese cancer patients and their families from the family's point of view.

PubMed

Yoshida, Saran; Shiozaki, Mariko; Sanjo, Makiko; Morita, Tatsuya; Hirai, Kei; Tsuneto, Satoru; Shima, Yasuo

2012-12-01

The primary goals of this analysis were to explore the pros and cons of prognostic disclosure to patients and their families from the bereaved family's point of view. Semistructured interviews were conducted with 60 bereaved family members of patients with cancer in Japan. There were eight categories of influence related to the disclosure of prognosis to the family, including pros (e.g., "Enabling mental preparedness for the patient's death") and cons (e.g., "Being distressed by acknowledging the patient's prognosis"); and seven categories of influence of not disclosing the prognosis to family, including pros (e.g., "Being able to maintain hope") and cons (e.g., "Being prevented from providing adequate care for the patient"). There were also nine categories of influence related to the disclosure of prognosis to patients (e.g., "Enabling various discussions regarding death with the patient"), and eight categories of influence related to not disclosing the prognosis to patients (e.g., "Maintaining the patient's hope"). Although prognostic disclosure to family members can contribute to psychological distress and hopelessness, at the same time, it has the potential to prepare them for the future both emotionally and practically, and also to make the time until the patient's death as meaningful as possible. It is useful for physicians to introduce pros and cons of prognostic disclosure to family members at the time of decision making, to understand the family members' psychological state, and to provide support considering pros and cons whether or not they disclosed prognosis.

Public mental hospital work: pros and cons for psychiatrists.

PubMed

Miller, R D

1984-09-01

The extensive literature concerning public mental hospitals has largely been written from the perspective of administrators and systems analysts; most of the reports emphasize the frustrations and problems of working in public mental hospitals and the continued exodus of psychiatrists from these facilities. The author addresses the pros and cons of such a career choice from the viewpoint of one who has been an "Indian" rather than a "chief" for a decade. He suggests that the current financial situation in both private practice and academia makes work in public mental hospitals increasingly attractive.

Silence, Metaperformance, and Communication in Pedro Almodóvar's "Hable con ella"

ERIC Educational Resources Information Center

Fellie, Maria C.

2016-01-01

Many scenes in Pedro Almodóvar's "Hable con ella" (2002) include shots of metaperformances such as silent films, dances, television shows, concerts, and bullfights. Spectators often observe passive characters who are in turn observing. By presenting these performances within cinematic performance, Almodóvar highlights our role as viewers…

U.S. Exploration EVA: ConOps, Interfaces and Test Objectives for Airlocks

NASA Technical Reports Server (NTRS)

Buffington, J.

2017-01-01

NASA is moving forward on defining the xEVA System Architecture and its implications to the spacecraft that host exploration EVA systems. This presentation provides an overview of the latest information for NASA's Concept of Operations (ConOps), Interfaces and corresponding Test Objectives for Airlocks hosting the xEVA System.

Trayectoria de los tornillos pediculares lumbares y sacros: Comparación entre el abordaje por linea media versus el abordaje posterolateral tipo wiltse

PubMed Central

Gagliardi, Martín; Guiroy, Alfredo; Molina, Federico Fernández; Fasano, Francisco; Ciancio, Alejandro Morales; Mezzadri, Juan José; Jalón, Pablo

2017-01-01

Resumen Objetivos: El objetivo de este estudio fue comparar, en fusiones lumbosacras cortas, el ángulo de convergencia de los tornillos pediculares entre el abordaje posterolateral tipo Wiltse y el abordaje mediano convencional. Método: Se revisaron en forma retrospectiva los controles en tomografía axial computada (TAC) de 76 tornillos pediculares lumbares y sacros colocados por vía posterior, mediante un abordaje mediano convencional (n: 38) o por vía posterolateral transmuscular tipo Wiltse (n: 38). Se incluyeron fusiones lumbosacras cortas desde L3 a S1, en pacientes adultos, con patología degenerativa. Se excluyeron los tornillos con una brecha ósea >4 mm en cualquier dirección, los casos con instrumentaciones pediculares previas y aquellos con curvas en el plano coronal mayores de 20°. Resultados: Considerando la totalidad de los implantes, el ángulo de convergencia fue de 23,3° (+/- 15,82). La angulación promedio, en el grupo AW, fue de 29,3° (+/- 9,72). En el grupo AC, el grado de convergencia de los implantes fue de 17,2° (+/- 10,58). Esta diferencia fue estadísticamente significativa (P < 0,0001). Para el grupo AW, el grado de convergencia según nivel fue el siguiente: L3: 31,2° (+/- 1,9); L4: 31,4° (+/- 2,76); L5: 31,1° (+/- 5,62); S1: 24,2° (+/- 12,16). El promedio del ángulo del tornillo según nivel para el grupo AC fue: L3: 16° (+/- 7,16); L4: 20,3° (+/- 6,9) L5: 15,9° (+/- 13,38); S1: 15,2° (+/- 14,32). Los implantes del grupo AW tuvieron ángulos significativamente más convergentes que el grupo AC en todos los segmentos explorados. Conclusión: En las fusiones lumbosacras cortas, la utilización del abordaje tipo Wiltse permitió la colocación de tornillos pediculares con más convergencia que en el abordaje mediano convencional. La relevancia clínica de este hecho es desconocida y se requerirían trabajos prospectivos randomizados para determinar la misma. PMID:29142777

Evaluation of ConPrim: A three-part model for continuing education in primary health care.

PubMed

Berggren, Erika; Strang, Peter; Orrevall, Ylva; Ödlund Olin, Ann; Sandelowsky, Hanna; Törnkvist, Lena

2016-11-01

To overcome the gap between existing knowledge and the application of this knowledge in practice, a three-part continuing educational model for primary health care professionals (ConPrim) was developed. It includes a web-based program, a practical exercise and a case seminar. To evaluate professionals' perceptions of the design, pedagogy and adaptation to primary health care of the ConPrim continuing educational model as applied in a subject-specific intervention. A total of 67 professionals (nurses and physicians) completed a computer-based questionnaire evaluating the model's design, pedagogy and adaptation to primary health care one week after the intervention. Descriptive statistics were used. Over 90% found the design of the web-based program and case seminar attractive; 86% found the design of the practical exercise attractive. The professionals agreed that the time spent on two of the three parts was acceptable. The exception was the practical exercise: 32% did not fully agree. Approximately 90% agreed that the contents of all parts were relevant to their work and promoted interactive and interprofessional learning. In response to the statements about the intervention as whole, approximately 90% agreed that the intervention was suitable to primary health care, that it had increased their competence in the subject area, and that they would be able to use what they had learned in their work. ConPrim is a promising model for continuing educational interventions in primary health care. However, the time spent on the practical exercise should be adjusted and the instructions for the exercise clarified. ConPrim should be tested in other subject-specific interventions and its influence on clinical practice should be evaluated. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Advocacy in the Public Forum: The Pro/Con Program at Ohio State.

ERIC Educational Resources Information Center

Stegman, John D.

The Pro/Con Campus Debate and Community Forum program at The Ohio State University serves the educational mission of the department of communication and contributes to the intellectual life of the student body and the larger community by emphasizing the needs of the audience. Eschewing jargon and rhetorical tricks, the program encourages the…

Evaluation of a new automated microscopy urine sediment analyser - sediMAX conTRUST®.

PubMed

Bogaert, Laura; Peeters, Bart; Billen, Jaak

2017-04-01

This study evaluated the performance of the stand-alone sediMAX conTRUST (77Elektronika, Budapest, Hungary) analyser as an alternative to microscopic analysis of urine. The validation included a precision, carry-over, categorical correlation and diagnostic performance study with manual phase-contrast microscopy as reference method. A total of 260 routine urine samples were assessed. The within-run precision was much better at higher concentrations than at very low concentrations. The precision met our predefined limits for all the elements at the different concentrations, with the exception of the lowest RBC, the WBC, pathological casts and crystals count. There was no sample carry-over. The analyser showed good categorical agreement with manual microscopy for RBC and WBC counts, moderate agreement for yeast cells, crystals and squamous epithelial cells and bad agreement for non-squamous epithelial cells, bacteria and casts. Diagnostic performance was satisfying only for RBC, WBC and yeast cells. The number of false negative results was acceptable (≤4%) for all elements after connecting the sediMAX conTRUST with an automatic strip reader (AutionMAX) and after implementation of review rules. We conclude that the sediMAX conTRUST should be used as a screening tool in combination with an automatic strip reader, for the identification of normal samples. Therefore, adequate review rules should be defined. Manual microscopy is still required in 'flagged' pathological samples. Despite the poor analytical performance on pathological samples, the images on the screen can be used for interpretation without the microscope and can be stored as PDF-documents for archiving the results.

The global regulator of pathogenesis PnCon7 positively regulates Tox3 effector gene expression through direct interaction in the wheat pathogen Parastagonospora nodorum.

PubMed

Lin, Shao-Yu; Chooi, Yit-Heng; Solomon, Peter S

2018-05-03

To investigate effector gene regulation in the wheat pathogenic fungus Parastagonospora nodorum, the promoter and expression of Tox3 was characterised through a series of complementary approaches. Promoter deletion and DNase I footprinting experiments identified a 25 bp region in the Tox3 promoter as being required for transcription. Subsequent yeast one-hybrid analysis using the DNA sequence as bait identified that interacting partner as the C2H2 zinc finger transcription factor PnCon7, a putative master regulator of pathogenesis. Silencing of PnCon7 resulted in the down-regulation of Tox3 demonstrating that the transcription factor has a positive regulatory role on gene expression. Analysis of Tox3 expression in the PnCon7 silenced strains revealed a strong correlation with PnCon7 transcript levels, supportive of a direct regulatory role. Subsequent pathogenicity assays using PnCon7-silenced isolates revealed that the transcription factor was required for Tox3-mediated disease. The expression of two other necrotrophic effectors (ToxA and Tox1) was also affected but in a non-dose dependent manner suggesting that the regulatory role of PnCon7 on these genes was indirect. Collectively, these data have advanced our fundamental understanding of the Con7 master regulator of pathogenesis by demonstrating its positive regulatory role on the Tox3 effector in P. nodorum through direct interaction. This article is protected by copyright. All rights reserved. © 2018 John Wiley & Sons Ltd.

Pro/con a precessional geodynamo

NASA Astrophysics Data System (ADS)

Vanyo, J.

2003-04-01

The modest amount of research that exists on the ability, or lack of ability, of mantle precession to power a geodynamo developed mostly during the last half of the 1900s. Papers by Roberts and Stewartson (1965) and by Busse (1968) studied precession generally without a pro/con conclusion. Malkus in the late 1960s attempted to advance a positive role for precession through experiments and analysis. His experiments have survived criticism, but his analyses were discounted, especially by Rochester, Jacobs, Smylie, and Chong (1975) and by Loper (1975). Rochester, et al. critiqued existing analyses of precession, including those of Malkus, but did not reach a strong position either pro or con a precessional geodynamo. Loper argued emphatically that precession was not capable of powering the geodynamo. Explicit analyses that either critique or support Loper’s arguments have yet to appear in the literature. During the 1970s, Vanyo and associates studied energy dissipation during precession of satellite liquid fuels and its effect on satellite attitude stability. Engineers and scientists in every country that has launched satellites completed similar research. Some is published in the aerospace literature, more is available in company and government reports. Beginning in 1981, Vanyo and associates applied this knowledge to the very similar problem of energy dissipation and flow patterns in precessing mechanical models scaled geometrically and dynamically to the Earth’s liquid core. Energy experiments indicate massive amounts of mechanical energy are dissipated at the CMB, and flow experiments show complex motions within the boundary layer and axial flows with helicity throughout the interior. Analysis of Earth core precession also advanced, especially in several papers by Kerswell and by Tilgner in the late 1990s. Detail numerical models have yet to appear. Although progress in understanding the role of precession in Earth core motions has advanced, there remains a

Modelo de accesibilidad de conceptos matematicos aplicados en el curso de Astronomia Descriptiva para estudiantes con impedimentos visuales en la UPR

NASA Astrophysics Data System (ADS)

Isidro Villamizar, Gloria Maria

Este estudio utiliza metodologia de investigacion cualitativa, con el proposito de describir, analizar y evaluar los procesos de diseno y desarrollo de un modelo de accesibilidad que consiste en estrategias de ensenanza de las matematicas para estudiantes con impedimentos visuales matriculados en el curso de Astronomia Descriptiva en la UPR. Se utilizaron las siguientes estrategias para recopilar la informacion, 1) reflexiones de la investigadora en el proceso de diseno y desarrollo de las lecciones adaptadas, que se registraron en un diario reflexivo. 2) entrevista semiestructurada luego de haber trabajado las lecciones de aprendizaje adaptadas con los participantes. 3) observaciones y notas de la investigadora del trabajo de los participantes. Para obtener la informacion de los participantes se obtuvo los permisos institucionales necesarios; se seleccionaron los participantes y se validaron los instrumentos; se realizo el desarrollo de las lecciones adaptadas con los participantes; y finalmente, se analizo la informacion obtenida. El diseno de las lecciones de aprendizaje adaptadas se hizo siguiendo las recomendaciones curriculares de los temas de matematicas aplicados en el curso de Astronomia Descriptiva realizado por la investigadora durante su semestre de internado. El testimonio de las voces de los participantes se obtuvo del proceso de desarrollo de las lecciones de aprendizaje adaptadas de temas seleccionados de conceptos matematicos requeridos en el curso de Astronomia Descriptiva y de la entrevista semiestructurada con los participantes, luego de haber trabajado las lecciones de aprendizaje. Para el desarrollo de las lecciones de aprendizaje, se utilizaron materiales tactiles adaptados, materiales tactiles disenados y materiales disponibles comercialmente. Los textos de las lecciones se imprimieron en tinta y en Braille. Se exhorta a disenar y desarrollar estrategias de ensenanza accesibles, considerando como recursos para evaluar su efectividad a

Accurate macromolecular crystallographic refinement: incorporation of the linear scaling, semiempirical quantum-mechanics program DivCon into the PHENIX refinement package

DOE Office of Scientific and Technical Information (OSTI.GOV)

Borbulevych, Oleg Y.; Plumley, Joshua A.; Martin, Roger I.

2014-05-01

Semiempirical quantum-chemical X-ray macromolecular refinement using the program DivCon integrated with PHENIX is described. Macromolecular crystallographic refinement relies on sometimes dubious stereochemical restraints and rudimentary energy functionals to ensure the correct geometry of the model of the macromolecule and any covalently bound ligand(s). The ligand stereochemical restraint file (CIF) requires a priori understanding of the ligand geometry within the active site, and creation of the CIF is often an error-prone process owing to the great variety of potential ligand chemistry and structure. Stereochemical restraints have been replaced with more robust functionals through the integration of the linear-scaling, semiempirical quantum-mechanics (SE-QM)more » program DivCon with the PHENIX X-ray refinement engine. The PHENIX/DivCon package has been thoroughly validated on a population of 50 protein–ligand Protein Data Bank (PDB) structures with a range of resolutions and chemistry. The PDB structures used for the validation were originally refined utilizing various refinement packages and were published within the past five years. PHENIX/DivCon does not utilize CIF(s), link restraints and other parameters for refinement and hence it does not make as many a priori assumptions about the model. Across the entire population, the method results in reasonable ligand geometries and low ligand strains, even when the original refinement exhibited difficulties, indicating that PHENIX/DivCon is applicable to both single-structure and high-throughput crystallography.« less

Topical Oxygen for Chronic Wounds: A PRO/CON Debate

PubMed Central

Mutluoglu, Mesut; Cakkalkurt, Aslican; Uzun, Gunalp; Aktas, Samil

2014-01-01

The role of oxygen in wound healing is universally accepted and does not require any further evidence; however the controversy as to whether oxygen delivery systems have the potential to improve wound healing remains to be concluded. Topical oxygen treatment (TOT) involves the delivery of 100% oxygen for a mean of 90 min, once a day at an atmospheric pressure slightly above 1 atm abs. The use of TOT gained increasing interest recently. The current manuscript will summarize the pros and cons of TOT in the view of the available literature. PMID:26199891

Non Invasive Biomedical Analysis - Breath Networking Session at PittCon 2011, Atlanta, Georgia

EPA Science Inventory

This was the second year that our breath colleagues organized a networking session at the Pittsburgh Conference and Exposition or ''PittCon'' (http://www.pincon.org/).This time it was called "Non-invasive Biomedical Analysis" to broaden the scope a bit, but the primary focus rema...

Gradient Optimization for Analytic conTrols - GOAT

NASA Astrophysics Data System (ADS)

Assémat, Elie; Machnes, Shai; Tannor, David; Wilhelm-Mauch, Frank

Quantum optimal control becomes a necessary step in a number of studies in the quantum realm. Recent experimental advances showed that superconducting qubits can be controlled with an impressive accuracy. However, most of the standard optimal control algorithms are not designed to manage such high accuracy. To tackle this issue, a novel quantum optimal control algorithm have been introduced: the Gradient Optimization for Analytic conTrols (GOAT). It avoids the piecewise constant approximation of the control pulse used by standard algorithms. This allows an efficient implementation of very high accuracy optimization. It also includes a novel method to compute the gradient that provides many advantages, e.g. the absence of backpropagation or the natural route to optimize the robustness of the control pulses. This talk will present the GOAT algorithm and a few applications to transmons systems.

Segundo Catálogo Estelar del Hemisferio Sur con Astrolabio Fotoeléctrico PAII

NASA Astrophysics Data System (ADS)

Manrique, W. T.; Podestá, R. C.; Alonso, E.; Actis, E. V.; Pacheco, A. M.; Bustos, G.; Lizhi, L.; Zezhi, W.; Fanmiao, Z.; Hongqi, W.; Perdomo, R.

Recordamos que entre el Observatorio Astronómico ``Félix Aguilar'', el Observatorio Astronómico de Beijing y el Observatorio Astronómico de La Plata, se ha convenido en desarrollar un Proyecto de Investigación conjunto, para la observación sistemática de estrellas en el Hemisferio Sur, con el objeto de la elaboración de un Catálogo Estelar Global utilizando un Astrolabio Fotoeléctrico PAII del Observatorio de Beijing, que ha sido usado con éxito en la República de China. En este trabajo se presenta el Segundo Catálogo Estelar del Hemisferio Sur, derivado de las observaciones realizadas con el PAII instalado en el OAFA, durante el períiodo Febrero de 1992 a Marzo de 1997. En este lapso se han observado mas de 400000 pasajes estelares, obteniéndose las correcciones Δ α y Δ δ de 5241 estrellas del FK4, FK5, FK5 Ext., SRS, CAMC y GC. Las precisiones medias son del orden de ± 3,2 ms en ascensión recta y ±0."057 en declinación. Rango de magnitudes : 2,0 a 11,5 Rango de declinaciones : -3o a -60o Epoca Media : 1994.9 Se analizan los residuos en función de la magnitud y tipo espectral, correcciones de grupo y frecuencia de distribución Δ α y Δ δ.

Wilderness for science: pros and cons of using wilderness areas for biological research

Treesearch

Diana L. Six; Paul Alaback; Robert A. Winfree; Delia Snyder; Anne Hagele

2000-01-01

Research is one of the intended purposes of wilderness. The Wilderness Act states that “wilderness may contain ecological, geological, or other features of scientific, educational, scenic, or historical value.” This session specifically focuses on the pros and cons of conducting research in wilderness.

ConsDock: A new program for the consensus analysis of protein-ligand interactions.

PubMed

Paul, Nicodème; Rognan, Didier

2002-06-01

Protein-based virtual screening of chemical libraries is a powerful technique for identifying new molecules that may interact with a macromolecular target of interest. Because of docking and scoring limitations, it is more difficult to apply as a lead optimization method because it requires that the docking/scoring tool is able to propose as few solutions as possible and all of them with a very good accuracy for both the protein-bound orientation and the conformation of the ligand. In the present study, we present a consensus docking approach (ConsDock) that takes advantage of three widely used docking tools (Dock, FlexX, and Gold). The consensus analysis of all possible poses generated by several docking tools is performed sequentially in four steps: (i) hierarchical clustering of all poses generated by a docking tool into families represented by a leader; (ii) definition of all consensus pairs from leaders generated by different docking programs; (iii) clustering of consensus pairs into classes, represented by a mean structure; and (iv) ranking the different means starting from the most populated class of consensus pairs. When applied to a test set of 100 protein-ligand complexes from the Protein Data Bank, ConsDock significantly outperforms single docking with respect to the docking accuracy of the top-ranked pose. In 60% of the cases investigated here, ConsDock was able to rank as top solution a pose within 2 A RMSD of the X-ray structure. It can be applied as a postprocessing filter to either single- or multiple-docking programs to prioritize three-dimensional guided lead optimization from the most likely docking solution. Copyright 2002 Wiley-Liss, Inc.

Change in Brooklyn and Queens: How New York?s Reforming the Energy Vision Program and Con Edison Are Reshaping Electric Distribution Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coddington, Michael; Sciano, Damian; Fuller, Jason

In response to this tremendous growth in both population and electricity demand, Con Edison estimates that its cost to expand the “traditional” Brooklyn-Queens grid will be in the neighborhood of US$1.2 billion—a relatively high number, even for New York City and Con Edison. The complexity of the city’s underground electrical system along with the difficulties of construction in a highly congested urban environment with infrastructure both above and below ground mean that the costs for transmission, substations, and secondary networks are significantly higher than those of a typical electric utility. The New York State Public Service Commission (PSC) is inmore » the process revising its approach to acquiring and serving energy throughout the state of New York, and traditional expansion for this rather costly project was not likely to be approved. Instead, the PSC asked Con Edison to evaluate numerous alternatives. The PSC and Con Edison are now considering and adopting strategies that include renewable energy generation, demand response (DR), battery energy storage systems, fuel-cell distributed generation, combined heat and power, volt-volt ampere reactive (VAR) optimization (VVO), and a host of other innovative solutions that would both reduce electricity demand and transform how and when Con Edison’s consumers use electricity.« less

Conventional MRI features for predicting the clinical outcome of patients with invasive placenta

PubMed Central

Chen, Ting; Xu, Xiao-Quan; Shi, Hai-Bin; Yang, Zheng-Qiang; Zhou, Xin; Pan, Yi

2017-01-01

PURPOSE We aimed to evaluate whether morphologic magnetic resonance imaging (MRI) features could help to predict the maternal outcome after uterine artery embolization (UAE)-assisted cesarean section (CS) in patients with invasive placenta previa. METHODS We retrospectively reviewed the MRI data of 40 pregnant women who have undergone UAE-assisted cesarean section due to suspected high risk of massive hemorrhage caused by invasive placenta previa. Patients were divided into two groups based on the maternal outcome (good-outcome group: minor hemorrhage and uterus preserved; poor-outcome group: significant hemorrhage or emergency hysterectomy). Morphologic MRI features were compared between the two groups. Multivariate logistic regression analysis was used to identify the most valuable variables, and predictive value of the identified risk factor was determined. RESULTS Low signal intensity bands on T2-weighted imaging (P < 0.001), placenta percreta (P = 0.011), and placental cervical protrusion sign (P = 0.002) were more frequently observed in patients with poor outcome. Low signal intensity bands on T2-weighted imaging was the only significant predictor of poor maternal outcome in multivariate analysis (P = 0.020; odds ratio, 14.79), with 81.3% sensitivity and 84.3% specificity. CONCLUSION Low signal intensity bands on T2-weighted imaging might be a predictor of poor maternal outcome after UAE-assisted cesarean section in patients with invasive placenta previa. PMID:28345524

Neogene sequence stratigraphy, Nam Con Son Basin, offshore Vietnam

DOE Office of Scientific and Technical Information (OSTI.GOV)

McMillen, K.J.; Do Van Luu; Lee, E.K.

1996-12-31

An integrated well log, biostratigraphic, and seismic stratigraphic study of Miocene to Recent deltaic sediments deposited in the Nam Con Son Basin offshore from southern Vietnam shows the influence of eustacy and tectonics on sequence development. Sediments consist of Oligocene non-marine rift-basin fill (Cau Formation), early to middle Miocene tide-dominated delta plain to delta front sediments (TB 1.5 to TB 2.5, Due and Thong Formations), and late Miocene to Recent marine shelf sediments (TB. 2.6 to TB 3.1 0, Mang Cau, Nam Con Son, and Bien Dong Formations). Eustacy controlled the timing of key surfaces and sand distribution in themore » tectonically-quiet early Miocene. Tectonic effects on middle to late Miocene sequence development consist of thick transgressive systems tracts due to basin-wide subsidence and transgression, sand distribution in the basin center, and carbonate sedimentation on isolated fault blocks within the basin. Third-order sequence boundaries (SB) are identified by spore peaks, sand stacking patterns, and channel incision. In the basin center, widespread shale beds with coal occur above sequence boundaries followed by transgressive sandstone units. These TST sandstones merge toward the basin margin where they lie on older HST sandstones. Maximum flooding surfaces (MFS) have abundant marine microfossils and mangrove pollen, a change in sand stacking pattern, and often a strong seismic reflection with downlap. Fourth-order genetic-type sequences are also interpreted. The MFS is the easiest marker to identify and correlate on well logs. Fourth-order SB occur within these genetic units but are harder to identify and correlate.« less

Neogene sequence stratigraphy, Nam Con Son Basin, offshore Vietnam

DOE Office of Scientific and Technical Information (OSTI.GOV)

McMillen, K.J.; Do Van Luu; Lee, E.K.

1996-01-01

An integrated well log, biostratigraphic, and seismic stratigraphic study of Miocene to Recent deltaic sediments deposited in the Nam Con Son Basin offshore from southern Vietnam shows the influence of eustacy and tectonics on sequence development. Sediments consist of Oligocene non-marine rift-basin fill (Cau Formation), early to middle Miocene tide-dominated delta plain to delta front sediments (TB 1.5 to TB 2.5, Due and Thong Formations), and late Miocene to Recent marine shelf sediments (TB. 2.6 to TB 3.1 0, Mang Cau, Nam Con Son, and Bien Dong Formations). Eustacy controlled the timing of key surfaces and sand distribution in themore » tectonically-quiet early Miocene. Tectonic effects on middle to late Miocene sequence development consist of thick transgressive systems tracts due to basin-wide subsidence and transgression, sand distribution in the basin center, and carbonate sedimentation on isolated fault blocks within the basin. Third-order sequence boundaries (SB) are identified by spore peaks, sand stacking patterns, and channel incision. In the basin center, widespread shale beds with coal occur above sequence boundaries followed by transgressive sandstone units. These TST sandstones merge toward the basin margin where they lie on older HST sandstones. Maximum flooding surfaces (MFS) have abundant marine microfossils and mangrove pollen, a change in sand stacking pattern, and often a strong seismic reflection with downlap. Fourth-order genetic-type sequences are also interpreted. The MFS is the easiest marker to identify and correlate on well logs. Fourth-order SB occur within these genetic units but are harder to identify and correlate.« less

Clinical and epidemiological aspects of cornea transplant patients of a reference hospital.

PubMed

Cruz, Giovanna Karinny Pereira; Azevedo, Isabelle Campos de; Carvalho, Diana Paula de Souza Rego Pinto; Vitor, Allyne Fortes; Santos, Viviane Euzébia Pereira; Ferreira, Marcos Antonio

2017-06-08

clinically characterizing cornea transplant patients and their distribution according to indicated and post-operative conditions of cornea transplantation, as well as estimating the average waiting time. a cross-sectional, descriptive and analytical study performed for all cornea transplants performed at a reference service (n=258). Data were analyzed using Statistical Package for the Social Sciences, version 20.0. the main indicator for cornea transplant was keratoconus. The mean waiting time for the transplant was approximately 5 months and 3 weeks for elective transplants and 9 days for urgent cases. An association between the type of corneal disorder with gender, age, previous surgery, eye classification, glaucoma and anterior graft failure were found. keratoconus was the main indicator for cornea transplant. Factors such as age, previous corneal graft failure (retransplantation), glaucoma, cases of surgeries prior to cornea transplant (especially cataract surgery) may be related to the onset corneal endothelium disorders. caracterizar clínicamente los pacientes trasplantados y su distribución, con descripción de las condiciones indicadoras y posoperatorias de los trasplantes de córneas, así como estimar el tiempo promedio en la fila de espera. estudio epidemiológico, transversal, descriptivo y analítico, realizado con todos los trasplantes de córnea realizados en un servicio de referencia (n=258). Los datos fueron analizados con el software Statistical Package for the Social Sciences, versión 20.0. la principal condición indicadora para el trasplante de córnea fue el queratocono. El tiempo promedio en fila de espera para realización del trasplante fue de aproximadamente 5 meses y tres semanas, para trasplantes electivos y de 9 días para los casos de urgencia. Existió asociación entre el tipo de disturbio de la córnea con: sexo, intervalo etario, cirugía previa, clasificación del ojo, glaucoma y rechazo del injerto anterior. el queratocono fue

Are You Ready to Go Digital?: The Pros and Cons of Electronic Portfolio Development

ERIC Educational Resources Information Center

Heath, Marilyn

2005-01-01

There is an increasing need for educators to have professional portfolios, which are considered to be authentic tools for evaluating the knowledge, skill, beliefs and attitudes of prospective educators. Electronic portfolios are gaining in popularity and their relative pros and cons are examined.

RETOS EN LA INTERVENCIÓN CON ADOLESCENTES PUERTORRIQUEÑOS/AS QUE MANIFIESTAN COMPORTAMIENTO SUICIDA*

PubMed Central

Vélez, Yovanska Duarté; Dávila, Paloma Torres; Hernández, Samariz Laboy

2015-01-01

Presentamos un estudio de caso de una adolescente puertorriqueña con comportamiento suicida. Esta comenzó una Terapia Socio Cognitivo-Conductual para el Comportamiento Suicida (TSCC-CS) de tipo ambulatorio luego de una hospitalización por intento suicida. La TSCC-CS incorpora una perspectiva ecológica y de desarrollo a la terapia cognitivo-conductual. Inicialmente mostró baja autoestima y severos síntomas depresivos y de ansiedad. Al finalizar el tratamiento, manifestó un cambio significativo en su sintomatología clínica y evidenció una mejoría en sus destrezas de manejo. No presentó ideas suicidas durante meses previos, ni durante el seguimiento. El análisis de este caso permitió realizar cambios en el protocolo de tratamiento, particularmente en las sesiones de familia y de comunicación con el fin de aumentar la viabilidad del tratamiento. PMID:26702337

Use of a GnRH vaccine, GonaCon, for prevention and treatment of adrenocortical disease (ACD) in domestic ferrets.

PubMed

Miller, Lowell A; Fagerstone, Kathleen A; Wagner, Robert A; Finkler, Mark

2013-09-23

Adrenocortical disease (ACD) is a common problem in surgically sterilized, middle-aged to old ferrets (Mustela putorius furo). The adrenal tissues of these ferrets develop hyperplasia, adenomas, or adenocarcinomas, which produce steroid hormones including estradiol, 17-hydroxyprogesterone, and androstenedione. Major clinical signs attributable to overproduction of these hormones are alopecia (hair loss) in both sexes and a swollen vulva in females. Pruritus, muscle atrophy, hind limb weakness, and sexual activity or aggression are also observed in both sexes. Males can develop prostatic cysts, prostatitis, and urethral obstruction. ACD is thought to be linked to continuous and increased LH secretion, due to lack of gonadal hormone feedback in neutered ferrets. This continuous elevated LH acts on adrenal cortex LH receptors, resulting in adrenal hyperplasia or adrenal tumor. This study investigated whether the immunocontraceptive vaccine GonaCon, a GnRH vaccine developed to reduce the fertility of wildlife species and the spread of disease, could prevent or delay onset of ACD and treat alopecia in ferrets with existing ACD. Results showed that GonaCon provided relief from ACD by causing production of antibodies to GnRH, probably suppressing production and/or release of LH. Treatment caused many ACD symptoms to disappear, allowing the ferrets to return to a normal life. The study also found that the probability of developing ACD was significantly reduced in ferrets treated with GonaCon when young (1-3 years old) compared to untreated control animals. GonaCon caused injection site reaction in some animals when administered as an intramuscular injection but caused few side effects when administered subcutaneously. Both intramuscular and subcutaneous vaccination resulted in similar levels of GnRH antibody titers. Subcutaneous vaccination with GonaCon is thus recommended to prevent the onset of ACD and as a possible treatment for ACD-signs in domestic ferrets. Published

Anabaena sp. strain PCC 7120 conR contains a LytR-CpsA-Psr domain, is developmentally regulated, and is essential for diazotrophic growth and heterocyst morphogenesis.

PubMed

Mella-Herrera, Rodrigo A; Neunuebel, M Ramona; Golden, James W

2011-03-01

The conR (all0187) gene of the filamentous cyanobacterium Anabaena (Nostoc) sp. strain PCC 7120 is predicted to be part of a family of proteins that contain the LytR-CpsA-Psr domain associated with septum formation and cell wall maintenance. The conR gene was originally misannotated as a transcription regulator. Northern RNA blot analysis showed that conR expression was upregulated 8 h after nitrogen step-down. Fluorescence microscopy of a P(conR)-gfp reporter strain revealed increased GFP fluorescence in proheterocysts and heterocysts beginning 9 h after nitrogen step-down. Insertional inactivation of conR caused a septum-formation defect of vegetative cells grown in nitrate-containing medium. In nitrate-free medium, mutant filaments formed abnormally long heterocysts and were defective for diazotrophic growth. Septum formation between heterocysts and adjacent vegetative cells was abnormal, often with one or both poles of the heterocysts appearing partially open. In a conR mutant, expression of nifH was delayed after nitrogen step-down and nitrogenase activity was approximately 70 % of wild-type activity, indicating that heterocysts of the conR mutant strain are partially functional. We hypothesize that the diazotrophic growth defect is caused by an inability of the heterocysts to transport fixed nitrogen to the neighbouring vegetative cells.

"Con todo mi corazón": Mentoring Latinas in Educational Leadership Doctoral Programs

ERIC Educational Resources Information Center

Rodríguez, Mariela A.

2016-01-01

Personal narrative essays were used to analyze the experiences of four Latina doctoral students who completed their first year in an educational leadership doctoral program in a Hispanic-Serving Institution (HSI) in the southwestern U.S. Four themes emerged from their "testimonios" 1) "Con todo el corazón"; 2) "Somos como…

Contaminación por mercurio de leche materna de madres lactantes de municipios de Antioquia con explotación minera de oro.

PubMed

Molina, Carlos Federico; Arango, Catalina María; Sepúlveda, Hernán

2018-05-01

Introducción. La leche materna es esencial para el desarrollo del ser humano, pero puede contener sustancias tóxicas provenientes de la contaminación ambiental, especialmente en las áreas mineras.Objetivo. Determinar la prevalencia de la contaminación con mercurio de la leche materna de mujeres lactantes residentes en los municipios con explotación minera de oro.Materiales y métodos. Se hizo un estudio transversal de 150 madres lactantes de cuatro municipios mineros de Antioquia (El Bagre, Segovia, Remedios y Zaragoza), a quienes se les hizo una encuesta sobre factores sociodemográficos, ocupacionales y ambientales relacionados con el mercurio, y se les tomaron muestras de leche materna, de orina y de cabello. Se calculó el promedio de la concentración de mercurio y las prevalencias municipales de contaminación.Resultados. El promedio de la concentración de mercurio en la leche materna fue de 2,5 (± desviación estándar 9,2) μg/L. La prevalencia de muestras de leche materna con niveles altos de mercurio fue de 11,7 %.Conclusión. En este estudio se evidencia un grave problema en las regiones mineras auríferas de Antioquia por el efecto de la contaminación con mercurio en sectores de la población más vulnerable.

The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.

ERIC Educational Resources Information Center

Consolidated Edison Co., Brooklyn, NY.

This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…

Pros & Cons of Using Blackboard Collaborate for Blended Learning on Students' Learning Outcomes

ERIC Educational Resources Information Center

Hamad, Mona M.

2017-01-01

Blackboard Collaborate was introduced to King Khalid University recently in the last decade; instructors and students were trained to use it in an effective way. The objective of this study is to find pros and cons of using Blackboard Collaborate for Blended Learning and its effect on students' learning outcomes. The researcher used the…

Aspergilosis cervical con diseminación al sistema nervioso central. Presentación de un caso y revisión de bibliografía

PubMed Central

Vergara, Guillermo Enrique; Roura, Natalia; del Castillo, Marcelo; Mora, Andrea; Alcorta, Santiago Condomi; Mormandi, Rubén; Cervio, Andrés; Salvat, Jorge

2015-01-01

Introducción: la Aspergilosis Invasiva (AI) del Sistema Nervioso Central (SNC) es infrecuente y ocurre generalmente en pacientes inmunocomprometidos. Puede presentarse con cuadros de meningitis, aneurismas micóticos, infartos o abscesos. Es una infección con pronóstico reservado y puede afectar el SNC de forma primaria o secundaria a partir de un foco que se disemina por vía hematógena. Presentamos el caso de un paciente con AI con invasión primaria a nivel óseo y diseminación posterior al cerebro. Caso clínico: Paciente masculino de 25 años con diagnóstico de leucemia linfática aguda en tratamiento quimioterápico que presentó neumonitis por metotrexate por lo que inicia tratamiento con corticoides. Posteriormente agregó cervicalgia y con el diagnóstico de osteomielitis cervical se realiza punción bajo tomografía computada (TC) sin aislarse gérmenes. Se colocó Halo Vest e inició tratamiento antibiótico empírico. Posteriormente presentó afasia de expresión secundaria a lesión frontal izquierda. Se realizó evacuación de absceso cerebral aislando A. fumigatus. El tratamiento antibiótico específico posterior permitió una buena respuesta clínica y radiológica. Conclusión: La presencia de lesiones en el SNC de pacientes inmunocomprometidos debe incluir a las micosis como diagnóstico diferencial. La evacuación quirúrgica permite llegar rápidamente al diagnóstico mejorando la respuesta posterior al tratamiento antibiótico. Para evaluar la respuesta terapéutica y posibles recaídas se debe realizar un seguimiento periódico clínico radiológico. Palabras clave: Aspergilosis cerebral; Aspergilosis cervical; Aspergilosis invasiva; Voriconazol. PMID:26600985

Structure, stratigraphy and petroleum geology of the south east Nam Con Son Basin, offshore Vietnam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fraser, A.J.; Matthews, S.J.; Lowe, S.

1996-12-31

Recent exploration of the south east Nam Con Son Basin, offshore Vietnam, by BP in alliance with Statoil has involved acquisition of new seismic and well data. These new data have allowed re-evaluation of the tectono-stratigraphic development and petroleum geology, and have provided additional constraints on the regional tectonic evolution. The offshore Vietnamese basins have evolved in response to the complex relative motions of Indochina, Peninsular Malaysia, Borneo and the South China Sea during the Cenozoic. On the regional scale these motions have been accommodated by strike-slip fault development, rifting and contraction. In the Nam Con Son Basin these motionsmore » have interacted in different ways from the Palaeogene to recent. Two rifting episodes are recognized; a Palaeogene phase dominated by E-W trending extensional faults, and a Miocene phase dominated by N-S to NE-SW trending faults. The structural evolution is complicated by a pulse of mild contraction during the Middle Miocene. The sedimentary fill of the basin evolves from continental fluvio-lacustrine in the Palaeogene through to fully marine following the second phase of rifting in the Miocene. This pulsed structural and stratigraphic evolution has resulted in basinwide deposition of source, reservoir and seal facies, and produced a variety of potential trapping styles. This paper describes the hydrocarbon habitat of the south east Nam Con Son Basin within the context of the regional tectono-stratigraphic model.« less

Structure, stratigraphy and petroleum geology of the south east Nam Con Son Basin, offshore Vietnam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fraser, A.J.; Matthews, S.J.; Lowe, S.

1996-01-01

Recent exploration of the south east Nam Con Son Basin, offshore Vietnam, by BP in alliance with Statoil has involved acquisition of new seismic and well data. These new data have allowed re-evaluation of the tectono-stratigraphic development and petroleum geology, and have provided additional constraints on the regional tectonic evolution. The offshore Vietnamese basins have evolved in response to the complex relative motions of Indochina, Peninsular Malaysia, Borneo and the South China Sea during the Cenozoic. On the regional scale these motions have been accommodated by strike-slip fault development, rifting and contraction. In the Nam Con Son Basin these motionsmore » have interacted in different ways from the Palaeogene to recent. Two rifting episodes are recognized; a Palaeogene phase dominated by E-W trending extensional faults, and a Miocene phase dominated by N-S to NE-SW trending faults. The structural evolution is complicated by a pulse of mild contraction during the Middle Miocene. The sedimentary fill of the basin evolves from continental fluvio-lacustrine in the Palaeogene through to fully marine following the second phase of rifting in the Miocene. This pulsed structural and stratigraphic evolution has resulted in basinwide deposition of source, reservoir and seal facies, and produced a variety of potential trapping styles. This paper describes the hydrocarbon habitat of the south east Nam Con Son Basin within the context of the regional tectono-stratigraphic model.« less

NASA KSC/AFRL Reusable Booster System (RBS) Concept of Operations (ConOps)

NASA Technical Reports Server (NTRS)

Zeno, Dnany; Mosteller, Ted; McCleskey, Carey; Jhnson, Robert; Hopkins, Jason; Miller, Thomas

2010-01-01

This slide presentation reviews the study and findings of the study on the Concept of Operations (ConOps) for Reusable Booster System (RBS) centering on rapid turnaround and launch of a two-stage partially reusable payload delivery system (i.e., 8 hours between launches). The study was to develop rapid ground processing (aircraft like concepts) and identify areas for follow-on study, technology needs, and proof-of-concept demonstrations.

Pros and cons of phage therapy

PubMed Central

Loc-Carrillo, Catherine

2011-01-01

Many publications list advantages and disadvantages associated with phage therapy, which is the use of bacterial viruses to combat populations of nuisance or pathogenic bacteria. The goal of this commentary is to discuss many of those issues in a single location. In terms of “Pros,” for example, phages can be bactericidal, can increase in number over the course of treatment, tend to only minimally disrupt normal flora, are equally effective against antibiotic-sensitive and antibiotic-resistant bacteria, often are easily discovered, seem to be capable of disrupting bacterial biofilms, and can have low inherent toxicities. In addition to these assets, we consider aspects of phage therapy that can contribute to its safety, economics, or convenience, but in ways that are perhaps less essential to the phage potential to combat bacteria. For example, autonomous phage transfer between animals during veterinary application could provide convenience or economic advantages by decreasing the need for repeated phage application, but is not necessarily crucial to therapeutic success. We also consider possible disadvantages to phage use as antibacterial agents. These “Cons,” however, tend to be relatively minor. PMID:22334867

Genes del receptor variable beta de células T en células circulantes de pacientes con lupus eritematoso generalizado y sus familiares sanos.

PubMed

Jakez-Ocampo, Juan; Paulín-Vera, Carmen María; Rivadeneyra-Espinoza, Liliana; Gómez-Martín, Diana; Carrillo-Maravilla, Eduardo; Lima, Guadalupe; Vargas-Rojas, María Inés; Pérez-Romano, Beatriz; Calva-Cevenini, Gabriella; García-Carrasco, Mario; Ruiz-Argüelles, Alejandro; Llorente, Luis

Se investigó la proporción de la expresión génica del receptor variable beta de células T (Vβ TCR) en linfocitos periféricos CD3+ en pacientes con lupus eritematoso generalizado (LEG) familiar y no familiar. El repertorio de Vβ TCR se estudió en 14 familias que presentaban más de un miembro con LEG. El uso de Vβ TCR en pacientes con LEG (n = 27) se comparó con el de los miembros sanos de estas familias (n = 47), con 37 pacientes con LEG esporádico y con 15 controles sanos. La expresión del repertorio de Vβ TCR se estudió por citometría de flujo multiparamétrica utilizando un arreglo de 24 diferentes anticuerpos monoclonales específicos de genes familiares para Vβ TCR. Se encontró el mismo perfil de expresión en las comparaciones entre los casos de LEG esporádico y familiar, así como en los consanguíneos sanos de las familias multicasos, que incluía una expresión incrementada de Vβ 5.2, Vβ 11 y Vβ 16, y una menor expresión de Vβ 3, Vβ4, Vβ 7.1 y Vβ 7. De manera interesante, solo Vβ 17 se expresó de modo diferente entre casos familiares y esporádicos de LEG. Igualmente, la expresión incrementada de Vβ 9 fue el distintivo entre los casos de LEG familiar (casos y consanguíneos sanos) y los controles sanos. Estos resultados refuerzan la noción de que el perfil final del repertorio Vβ TCR observado en LEG familiar y no familiar parece surgir de la interacción de factores genéticos, ambientales e inmunorreguladores, además de que pueden explicar las alteraciones inmunitarias que se observan en los consanguíneos sanos de pacientes con LEG. Copyright: © 2018 SecretarÍa de Salud

[Modern tribology in total hip arthroplasty: pros and cons].

PubMed

Gómez-García, F

2014-01-01

The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.

ConMap: Investigating New Computer-Based Approaches to Assessing Conceptual Knowledge Structure in Physics.

ERIC Educational Resources Information Center

Beatty, Ian D.

There is a growing consensus among educational researchers that traditional problem-based assessments are not effective tools for diagnosing a student's knowledge state and for guiding pedagogical intervention, and that new tools grounded in the results of cognitive science research are needed. The ConMap ("Conceptual Mapping") project, described…

Protective Effects of Astaxanthin on ConA-Induced Autoimmune Hepatitis by the JNK/p-JNK Pathway-Mediated Inhibition of Autophagy and Apoptosis

PubMed Central

Liu, Tong; Wang, Junshan; Dai, Weiqi; Wang, Fan; Zheng, Yuanyuan; Chen, Kan; Li, Sainan; Abudumijiti, Huerxidan; Zhou, Zheng; Wang, Jianrong; Lu, Wenxia; Zhu, Rong; Yang, Jing; Zhang, Huawei; Yin, Qin; Wang, Chengfen; Zhou, Yuqing; Lu, Jie; Zhou, Yingqun; Guo, Chuanyong

2015-01-01

Objective Astaxanthin, a potent antioxidant, exhibits a wide range of biological activities, including antioxidant, atherosclerosis and antitumor activities. However, its effect on concanavalin A (ConA)-induced autoimmune hepatitis remains unclear. The aim of this study was to investigate the protective effects of astaxanthin on ConA-induced hepatitis in mice, and to elucidate the mechanisms of regulation. Materials and Methods Autoimmune hepatitis was induced in in Balb/C mice using ConA (25 mg/kg), and astaxanthin was orally administered daily at two doses (20 mg/kg and 40 mg/kg) for 14 days before ConA injection. Levels of serum liver enzymes and the histopathology of inflammatory cytokines and other maker proteins were determined at three time points (2, 8 and 24 h). Primary hepatocytes were pretreated with astaxanthin (80 μM) in vitro 24 h before stimulation with TNF-α (10 ng/ml). The apoptosis rate and related protein expression were determined 24 h after the administration of TNF-α. Results Astaxanthin attenuated serum liver enzymes and pathological damage by reducing the release of inflammatory factors. It performed anti-apoptotic effects via the descending phosphorylation of Bcl-2 through the down-regulation of the JNK/p-JNK pathway. Conclusion This research firstly expounded that astaxanthin reduced immune liver injury in ConA-induced autoimmune hepatitis. The mode of action appears to be downregulation of JNK/p-JNK-mediated apoptosis and autophagy. PMID:25761053

Analysis of citalopram and desmethylcitalopram in postmortem fluids and tissues using liquid chromatography-mass spectrometry.

DOT National Transportation Integrated Search

2011-10-01

"Citalopram is a selective serotonin reuptake inhibitor that is a commonly prescribed drug for the treatment of : depression, obsessive-compulsive disorder, panic disorder, anxiety disorder, and post-traumatic stress disorder. : While the use of cita...

Integrated Concentration in Science (iCons): Undergraduate Education Through Interdisciplinary, Team-Based, Real-World Problem Solving

NASA Astrophysics Data System (ADS)

Tuominen, Mark

2013-03-01

Attitude, Skills, Knowledge (ASK) - In this order, these are fundamental characteristics of scientific innovators. Through first-hand practice in using science to unpack and solve complex real-world problems, students can become self-motivated scientific leaders. This presentation describes the pedagogy of a recently developed interdisciplinary undergraduate science education program at the University of Massachusetts Amherst focused on addressing global challenges with scientific solutions. Integrated Concentration in Science (iCons) is an overarching concentration program that supplements the curricula provided within each student's chosen major. iCons is a platform for students to perform student-led research in interdisciplinary collaborative teams. With a schedule of one course per year over four years, the cohort of students move through case studies, analysis of real-world problems, development of potential solutions, integrative communication, laboratory practice, and capstone research projects. In this presentation, a track emphasizing renewable energy science is used to illustrate the iCons pedagogical methods. This includes discussion of a third-year laboratory course in renewable energy that is educationally scaffolded: beginning with a boot camp in laboratory techniques and culminating with student-designed research projects. Among other objectives, this course emphasizes the practice of using reflection and redesign, as a means of generating better solutions and embedding learning for the long term. This work is supported in part by NSF grant DUE-1140805.

Accurate macromolecular crystallographic refinement: incorporation of the linear scaling, semiempirical quantum-mechanics program DivCon into the PHENIX refinement package.

PubMed

Borbulevych, Oleg Y; Plumley, Joshua A; Martin, Roger I; Merz, Kenneth M; Westerhoff, Lance M

2014-05-01

Macromolecular crystallographic refinement relies on sometimes dubious stereochemical restraints and rudimentary energy functionals to ensure the correct geometry of the model of the macromolecule and any covalently bound ligand(s). The ligand stereochemical restraint file (CIF) requires a priori understanding of the ligand geometry within the active site, and creation of the CIF is often an error-prone process owing to the great variety of potential ligand chemistry and structure. Stereochemical restraints have been replaced with more robust functionals through the integration of the linear-scaling, semiempirical quantum-mechanics (SE-QM) program DivCon with the PHENIX X-ray refinement engine. The PHENIX/DivCon package has been thoroughly validated on a population of 50 protein-ligand Protein Data Bank (PDB) structures with a range of resolutions and chemistry. The PDB structures used for the validation were originally refined utilizing various refinement packages and were published within the past five years. PHENIX/DivCon does not utilize CIF(s), link restraints and other parameters for refinement and hence it does not make as many a priori assumptions about the model. Across the entire population, the method results in reasonable ligand geometries and low ligand strains, even when the original refinement exhibited difficulties, indicating that PHENIX/DivCon is applicable to both single-structure and high-throughput crystallography.

Infertility treatment use in relation to selected adverse birth outcomes.

PubMed

Welmerink, Diana B; Voigt, Lynda F; Daling, Janet R; Mueller, Beth A

2010-12-01

To determine whether maternal infertility treatment is associated with adverse outcomes. Population-based cohort study using linked birth certificate-hospital discharge data. Washington State. Live-born singleton infants conceived with infertility treatment between 2003 and 2006 (n = 2,182) and a random sample of live-born singleton infants conceived spontaneously, frequency matched by birth year (n = 10,989). None. Mantel-Haenszel adjusted relative risks (RRs) and 95% confidence intervals (CIs) were computed for low birth weight, delivery at <37 weeks, small for gestational age infants, any malformation, placenta previa, and placenta abruptio. Women with infertility treatment were at increased risk of placental abnormalities, including placenta abruptio (RR, 1.6; 95% CI, 1.1-2.5) and placenta previa (RR, 3.0; 95% CI, 2.0-4.7). Their infants were more likely to be delivered at <37 weeks (RR, 1.7; 95% CI, 1.4-1.9) or weigh <2500 g (RR, 1.4; 95% CI, 1.1-1.7); however, they were not at increased risk of being small for gestational age. An increased risk of malformations was observed in infants born to older women with infertility treatment, but not to younger women. Women using infertility treatment are at increased risk for delivering preterm, placenta previa, and placenta abruptio. Studies with measurement of specific infertility treatments will help identify the mechanisms. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

ProCon - PROteomics CONversion tool.

PubMed

Mayer, Gerhard; Stephan, Christian; Meyer, Helmut E; Kohl, Michael; Marcus, Katrin; Eisenacher, Martin

2015-11-03

With the growing amount of experimental data produced in proteomics experiments and the requirements/recommendations of journals in the proteomics field to publicly make available data described in papers, a need for long-term storage of proteomics data in public repositories arises. For such an upload one needs proteomics data in a standardized format. Therefore, it is desirable, that the proprietary vendor's software will integrate in the future such an export functionality using the standard formats for proteomics results defined by the HUPO-PSI group. Currently not all search engines and analysis tools support these standard formats. In the meantime there is a need to provide user-friendly free-to-use conversion tools that can convert the data into such standard formats in order to support wet-lab scientists in creating proteomics data files ready for upload into the public repositories. ProCon is such a conversion tool written in Java for conversion of proteomics identification data into standard formats mzIdentML and Pride XML. It allows the conversion of Sequest™/Comet .out files, of search results from the popular and often used ProteomeDiscoverer® 1.x (x=versions 1.1 to1.4) software and search results stored in the LIMS systems ProteinScape® 1.3 and 2.1 into mzIdentML and PRIDE XML. This article is part of a Special Issue entitled: Computational Proteomics. Copyright © 2015. Published by Elsevier B.V.

Desarrollo de la Escala sobre el Estigma Relacionado con el VIH/SIDA para Profesionales de la Salud mediante el uso de métodos mixtos123

PubMed Central

Varas-Díaz, Nelson; Neilands, Torsten B.; Guilamo-Ramos, Vincent; Cintrón Bou, Francheska N.

2009-01-01

El estigma relacionado con el VIH/SIDA continúa siendo un obstáculo para la prevención primaria y secundaria del VIH. Las consecuencias para las personas que viven con la enfermedad han sido muy documentadas y continúan siendo una gran preocupación para las personas que proveen servicios de salud y para aquellas que investigan el tema. Estas consecuencias son preocupantes cuando el estigma emana de profesionales de la salud porque se puede limitar el acceso a los servicios. Uno de los principales obstáculos para la investigación del estigma relacionado con el VIH en Puerto Rico es la falta de instrumentos cuantitativos para evaluar las manifestaciones del estigma entre profesionales de la salud. El objetivo principal de este estudio fue desarrollar y probar las propiedades psicométricas de una escala sobre el estigma relacionado con el VIH/SIDA culturalmente apropiada para personas que proveen servicios de salud puertorriqueñas y desarrollar una versión corta de la escala que pudiera usarse en escenarios clínicos con tiempo limitado. El instrumento desarrollado estuvo basado en evidencia cualitativa recopilada entre profesionales y estudiantes de profesiones de la salud puertorriqueños/as (n=80) y administrado a una muestra de 421 profesionales de la salud en adiestramiento. La escala contenía 12 dimensiones del estigma relacionado con el VIH/SIDA. El análisis cuantitativo corroboró 11 de ellas, teniendo como resultado un instrumento con validez y confiabilidad satisfactoria. Estas dimensiones, a su vez, fueron subcomponentes de un factor de estigma general superior. PMID:20333258

Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más

PubMed Central

de León González, Enrique Díaz; Pérez, Héctor Eloy Tamez; Hermosillo, Hugo Gutiérrez; Rodríguez, Javier Armando Cedillo; Torres, Gabriela

2016-01-01

Fundamento y objetivo Determinar la asociación entre fragilidad y mortalidad, dependencia funcional, caídas y hospitalizaciones en el Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Sujetos y métodos Estudio prospectivo poblacional en México en el que se seleccionaron sujetos de 60 años o más, que fueron evaluados en las variables de fragilidad durante la primera vuelta del estudio en el año 2001 y que incluyó: dificultad para levantarse de una silla después de haber estado sentado(a) durante largo tiempo, pérdida de peso de 5 kilogramos o más en los últimos dos años y falta de energía. Los sujetos fueron catalogados como robustos, prefrágiles y frágiles cuando tenían cero, una o dos de las características anteriores, respectivamente. La mortalidad, hospitalizaciones, caídas y dependencia funcional fueron evaluadas en la segunda vuelta del estudio en el año 2003. Se calculó el riesgo relativo para cada una de las complicaciones, así como análisis multivariado con regresión de Cox para el caso de mortalidad y regresión logística para el resto. Resultados Los estados de prefragilidad y fragilidad se asociaron independientemente con mortalidad, con índices de riesgo ajustados de 1,61 (intervalo de confianza del 95% [IC 95%] 1,01-2,55) y 1,94 (IC 95% 1,20-3,13), respectivamente. Sólo el estado de fragilidad se asoció independientemente con hospitalización y dependencia funcional, con una razón de momios ajustada de 1,53 (IC 95% 1,13-2,07) y 3,07 (IC 95% 1,76-5,34), respectivamente. No hubo asociación entre los estados de prefragilidad y fragilidad con caídas. Conclusión El estado de fragilidad se asocia independientemente con mortalidad, hospitalizaciones y disfuncionalidad en actividades básicas de la vida diaria en los siguientes dos años en población mexicana. PMID:21612803

La interacción de estrellas WN con el medio circundante

NASA Astrophysics Data System (ADS)

Arnal, M.; Cappa, C.; Rizzo, J. R.; Cichovolski, S.

Se presentan resultados preliminares de un estudio de la distribución del hidrógeno neutro en los alrededores de estrellas WR de la serie del nitrógeno. Los datos observacionales de la línea de 21 cm provienen de un relevamineto de baja resolución angular (36'), así como de observaciones de resolución angular intermedia (9') tomadas con el radiotelescopio de Effelsberg. Este análisis ha permitido detectar cavidades y envolturas de H I en expansión vinculadas a las estrellas que componen la muestra.

Impacto metabólico e inflamatorio de una comida rica en grasas saturadas y su relación con la obesidad abdominal.

PubMed

Alayón, Alicia Norma; Rivadeneira, Ana Patricia; Herrera, Carlos; Guzmán, Heidy; Arellano, Dioneris; Echeverri, Isabella

2018-05-01

Introducción. La etapa posprandial se asocia con el incremento de marcadores relacionados con el riesgo cardiovascular, cuya intensidad depende del estado metabólico.Objetivo. Determinar el impacto de la ingestión de una comida rica en grasas saturadas sobre el perfil metabólico e inflamatorio y su relación con la obesidad abdominal.Materiales y métodos. Se hizo un ensayo clínico en 42 individuos (21 con obesidad abdominal). Se midieron, en sangre, la glucosa, la insulina, el perfil lipídico, la proteína C reactiva, los lipopolisacáridos y la interleucina 6, en ayunas y después de la ingestión.Resultados. Además de la obesidad, se registró la presencia de resistencia a la insulina y de niveles elevados de triacilglicéridos y proteína C reactiva en ayunas. Asimismo, se detectaron niveles posprandiales más elevados de glucosa, insulina y triacilglicéridos. La interleucina 6 disminuyó en el grupo de personas sin obesidad y los lipopolisacáridos aumentaron en ambos grupos.Conclusión. La ingestión de una comida rica en grasas saturadas produjo un mayor impacto en las variables glucémicas en el grupo con obesidad y, aunque afectó de forma similar los lípidos en ambos grupos, el incremento de triacilglicéridos fue mayor en presencia de una concentración basal elevada y promovió el aumento de lipopolisacáridos. El estado inflamatorio basal y posprandial afectó en mayor medida al grupo con obesidad. El momento posprandial reflejó el estado más frecuente de los individuos en un día normal y permitió evidenciar la capacidad de respuesta metabólica frente a la ingestión de alimentos, así como los estados tempranos de riesgo metabólico.

A con-focal setup for micro-XRF experiments using diamond anvil cells

NASA Astrophysics Data System (ADS)

Wilke, Max; Rickers, Karen; Vincze, Laszlo; Schmidt, Christian; Borchert, Manuela; Pascarelli, Sakura

2010-05-01

In this contribution we introduce an experimental setup to perform con-focal micro X-ray fluorescence measurements in situ in samples at high temperatures and pressures in diamond anvil cells (DAC) (e.g. Schmidt et al. 2007). The con-focal arrangement is used to suppress the background in X-ray fluorescence (XRF) spectra that stems from elastic and inelastic scattering of the diamond anvils. The setup is based on a focusing optic in the incident beam that reaches a spot of 5-10 μm and a focusing poly-capillary in front of an energy-dispersive solid-state detector. The detector poly-capillary is designed to work at a very long working distance of 50 mm in order to collect the radiation from the center of the DAC at 90° to the incident beam. The probing volume is defined by the two foci and has a size of ca. 300 μm at 8 keV and 150 μm at 19 keV as measured by scans through thin metal foils. Comparison of XRF spectra acquired with a usual detector collimator and spectra recorded with the detector capillary shows a strong suppression of XRF signal generated outside the probed volume, i.e. XRF from the gasket material and signal from elastic and Compton scattering by the diamond anvils. The ratio of the Zr K-alpha fluorescence peak to the peak of the Compton scattering changes from 0.5 (collimator) to 1.26 (detector capillary) for a ca. 1000 ppm Zr standard solution and an incident beam energy of 20 keV. For a standard solution containing ca. 1000 ppm Hf, the ratio of the L-alpha to the Compton signal increases to 6 using the detector capillary and an incident beam energy of 9.7 keV. Thus, the con-focal setup substantially improves the fluorescence to background ratio. This will result in higher sensitivities for dilute elements in the sample chamber of the DAC. Furthermore, the possibilities of interference of the sample's signal with signal from the sample environment are greatly reduced. In a broader sense, the setup can also be applied to other confined samples

Caffe con Troll: Shallow Ideas to Speed Up Deep Learning

PubMed Central

Hadjis, Stefan; Abuzaid, Firas; Zhang, Ce; Ré, Christopher

2016-01-01

We present Caffe con Troll (CcT), a fully compatible end-to-end version of the popular framework Caffe with rebuilt internals. We built CcT to examine the performance characteristics of training and deploying general-purpose convolutional neural networks across different hardware architectures. We find that, by employing standard batching optimizations for CPU training, we achieve a 4.5× throughput improvement over Caffe on popular networks like CaffeNet. Moreover, with these improvements, the end-to-end training time for CNNs is directly proportional to the FLOPS delivered by the CPU, which enables us to efficiently train hybrid CPU-GPU systems for CNNs. PMID:27314106

Caffe con Troll: Shallow Ideas to Speed Up Deep Learning.

PubMed

Hadjis, Stefan; Abuzaid, Firas; Zhang, Ce; Ré, Christopher

2015-01-01

We present Caffe con Troll (CcT), a fully compatible end-to-end version of the popular framework Caffe with rebuilt internals. We built CcT to examine the performance characteristics of training and deploying general-purpose convolutional neural networks across different hardware architectures. We find that, by employing standard batching optimizations for CPU training, we achieve a 4.5× throughput improvement over Caffe on popular networks like CaffeNet. Moreover, with these improvements, the end-to-end training time for CNNs is directly proportional to the FLOPS delivered by the CPU, which enables us to efficiently train hybrid CPU-GPU systems for CNNs.

Moderator's view: High-volume plasma exchange: pro, con and consensus.

PubMed

Kaplan, Andre A

2017-09-01

I have been asked to comment on the pro and con opinions regarding high-volume plasma exchange. The authors of both positions have provided cogent arguments and a reasonable approach to choosing the exchange volume for any given therapeutic plasma exchange. The major issue of relevance in this discussion is the nature of the toxins targeted for removal. These parameters include molecular weight, the apparent volume of distribution, the degree of protein binding, the biologic and chemical half-life, and the severity and rapidity of its toxicity. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Nano anti-cancer drugs: pros and cons and future perspectives.

PubMed

Ali, Imran

2011-02-01

For last one decade, scientists are working for developing nano anti-cancer drugs with claim of ideal ones due to their targeted chemotherapic nature. These drugs have many beneficial properties such as targeted drug delivery and gene therapy modalities with minimum side effects. This article describes pros and cons and future perspectives of nano anti-cancer drugs. Efforts have been made to address importance, special features, toxicities (general, blood identities, immune system and environmental) and future perspectives of nano anti-cancer drugs. It was concluded that nano anti-cancer drugs may be magic bullet drugs for cancer treatment leading to bright future of the whole world.

Balancing Ethical Pros and Cons of Stem Cell Derived Gametes.

PubMed

Segers, Seppe; Mertes, Heidi; de Wert, Guido; Dondorp, Wybo; Pennings, Guido

2017-07-01

In this review we aim to provide an overview of the most important ethical pros and cons of stem cell derived gametes (SCD-gametes), as a contribution to the debate about reproductive tissue engineering. Derivation of gametes from stem cells holds promising applications both for research and for clinical use in assisted reproduction. We explore the ethical issues connected to gametes derived from embryonic stem cells (both patient specific and non-patient specific) as well as those related to gametes derived from induced pluripotent stem cells. The technology of SCD-gametes raises moral concerns of how reproductive autonomy relates to issues of embryo destruction, safety, access, and applications beyond clinical infertility.

What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective.

PubMed

Howard, Sam; Lang, Alexandra; Sharples, Sarah; Shaw, Dominick

2016-01-01

Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process. Three rounds of surveys in a Delphi format were used to assess the most important pros and cons of EMDs for asthma care in a sample of 31 stakeholders which included healthcare professionals and members of clinical commissioning groups. The respondents identified 29 pros and 32 cons. Pros that were rated as most important included new visual evidence to aid clinical discussions with a patient and an increase in patient involvement and motivation. The cons that were rated as most important included a need for more clinical evidence of the effectiveness of EMDs, as well as better clarity over who has responsibilities in managing, interpreting and discussing data with a patient. The research provides a guide for EMD developers by highlighting where these devices may provide the most benefit as well as prioritising the key issues that need addressing if they are to be used effectively in everyday asthma care.

What are the pros and cons of electronically monitoring inhaler use in asthma? A multistakeholder perspective

PubMed Central

Howard, Sam; Lang, Alexandra; Sharples, Sarah; Shaw, Dominick

2016-01-01

Introduction Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process. Methods Three rounds of surveys in a Delphi format were used to assess the most important pros and cons of EMDs for asthma care in a sample of 31 stakeholders which included healthcare professionals and members of clinical commissioning groups. Results The respondents identified 29 pros and 32 cons. Pros that were rated as most important included new visual evidence to aid clinical discussions with a patient and an increase in patient involvement and motivation. The cons that were rated as most important included a need for more clinical evidence of the effectiveness of EMDs, as well as better clarity over who has responsibilities in managing, interpreting and discussing data with a patient. Conclusions The research provides a guide for EMD developers by highlighting where these devices may provide the most benefit as well as prioritising the key issues that need addressing if they are to be used effectively in everyday asthma care. PMID:27933181

Placenta: How It Works, What's Normal

MedlinePlus

... toward placentophagy: A brief report. Health Care for Women International. 2015;35:113. Ananth CV, et al. Placental abruption: Clinical features and diagnosis. https://www.uptodate.com/contents/search. Accessed March 20, 2018. Lockwood CJ, et al. Placenta previa: ...

First observations of tracking clouds using scanning ARM cloud radars

DOE PAGES

Borque, Paloma; Giangrande, Scott; Kollias, Pavlos

2014-12-01

Tracking clouds using scanning cloud radars can help to document the temporal evolution of cloud properties well before large drop formation (‘‘first echo’’). These measurements complement cloud and precipitation tracking using geostationary satellites and weather radars. Here, two-dimensional (2-D) Along-Wind Range Height Indicator (AW-RHI) observations of a population of shallow cumuli (with and without precipitation) from the 35-GHz scanning ARM cloud radar (SACR) at the DOE Atmospheric Radiation Measurements (ARM) program Southern Great Plains (SGP) site are presented. Observations from the ARM SGP network of scanning precipitation radars are used to provide the larger scale context of the cloud fieldmore » and to highlight the advantages of the SACR to detect the numerous, small, non-precipitating cloud elements. A new Cloud Identification and Tracking Algorithm (CITA) is developed to track cloud elements. In CITA, a cloud element is identified as a region having a contiguous set of pixels exceeding a preset reflectivity and size threshold. The high temporal resolution of the SACR 2-D observations (30 sec) allows for an area superposition criteria algorithm to match cloud elements at consecutive times. Following CITA, the temporal evolution of cloud element properties (number, size, and maximum reflectivity) is presented. The vast majority of the designated elements during this cumulus event were short-lived non-precipitating clouds having an apparent life cycle shorter than 15 minutes. The advantages and disadvantages of cloud tracking using an SACR are discussed.« less

First observations of tracking clouds using scanning ARM cloud radars

DOE Office of Scientific and Technical Information (OSTI.GOV)

Borque, Paloma; Giangrande, Scott; Kollias, Pavlos

Tracking clouds using scanning cloud radars can help to document the temporal evolution of cloud properties well before large drop formation (‘‘first echo’’). These measurements complement cloud and precipitation tracking using geostationary satellites and weather radars. Here, two-dimensional (2-D) Along-Wind Range Height Indicator (AW-RHI) observations of a population of shallow cumuli (with and without precipitation) from the 35-GHz scanning ARM cloud radar (SACR) at the DOE Atmospheric Radiation Measurements (ARM) program Southern Great Plains (SGP) site are presented. Observations from the ARM SGP network of scanning precipitation radars are used to provide the larger scale context of the cloud fieldmore » and to highlight the advantages of the SACR to detect the numerous, small, non-precipitating cloud elements. A new Cloud Identification and Tracking Algorithm (CITA) is developed to track cloud elements. In CITA, a cloud element is identified as a region having a contiguous set of pixels exceeding a preset reflectivity and size threshold. The high temporal resolution of the SACR 2-D observations (30 sec) allows for an area superposition criteria algorithm to match cloud elements at consecutive times. Following CITA, the temporal evolution of cloud element properties (number, size, and maximum reflectivity) is presented. The vast majority of the designated elements during this cumulus event were short-lived non-precipitating clouds having an apparent life cycle shorter than 15 minutes. The advantages and disadvantages of cloud tracking using an SACR are discussed.« less

Magnetic Phase Transition in Ion-Irradiated Ultrathin CoN Films via Magneto-Optic Faraday Effect.

PubMed

Su, Chiung-Wu; Chang, Yen-Chu; Chang, Sheng-Chi

2013-11-15

The magnetic properties of 1 nm thick in-plane anisotropic Co ultrathin film on ZnO(0001) were investigated through successive 500 eV nitrogen-ion sputtering. Magneto-optical Faraday effects were used to observe the evolution of the ion-irradiated sample in longitudinal and perpendicular magnetic fields. The ferromagnetic phase of the initial in-plane anisotropic fcc β-Co phase transformation to β-Co(N) phase was terminated at paramagnetic CoN x phase. In-plane anisotropy with weak out-of-plane anisotropy of the Co/ZnO sample was initially observed in the as-grown condition. In the sputtering process, the N⁺ ions induced simultaneous sputtering and doping. An abrupt spin reorientation behavior from in-plane to out-of-plane was found under prolonged sputtering condition. The existence of perpendicular anisotropy measured from the out-of-plane Faraday effect may be attributed to the co-existence of residual β-Co and Co₄N exchange bonding force by the gradual depletion of Co-N thickness.

Mandated Mental Health Insurance: A Complex Case of Pros and Cons. Human Resources Series.

ERIC Educational Resources Information Center

Paterson, Andrea

1986-01-01

The pros and cons of state laws mandating mental health insurance are discussed in this report. The history of a 1985 Supreme Court case which held that states could mandate mental health benefits introduces the report. In an overview of the issue, the long-standing argument between the insurance industry and the mental health establishment is…

Repeat C-Sections: Is There a Limit?

MedlinePlus

... or completely covering the opening of the cervix (placenta previa). If you've had a prior C-section, your health care provider might recommend an ultrasound to determine the location of your placenta during subsequent pregnancies. Both vaginal and cesarean deliveries ...

Air Traffic Management Technology Demonstration-1 Concept of Operations (ATD-1 ConOps), Version 3.0

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Johnson, William C.; Scardina, John; Shay, Richard F.

2016-01-01

This document describes the goals, benefits, technologies, and procedures of the Concept of Operations (ConOps) for the Air Traffic Management (ATM) Technology Demonstration #1 (ATD-1), and provides an update to the previous versions of the document [ref 1 and ref 2].

Understanding the pros and cons of organ donation decision-making: Decisional balance and expressing donation intentions among African Americans.

PubMed

Flemming, Shauna St Clair; Redmond, Nakeva; Williamson, Dana Hz; Thompson, Nancy J; Perryman, Jennie P; Patzer, Rachel E; Arriola, Kimberly Jacob

2018-04-01

Increasing public commitment to organ donation is critical to improving donor kidney availability for end-stage renal disease patients desiring transplant. This study surveyed ( N = 1339) African Americans, measuring perceived pros relative to cons of organ donation, to evaluate an existing Transtheoretical Model decisional balance scale and associations between decisional balance and expressing donation intentions. Findings supported the existing scale structure. More positive decisional balance ratios were associated with 1.76 times the odds of expressing intentions (95% confidence interval = 1.52-2.04). Pros were more strongly linked to donation intentions than cons. Greater understanding of organ donation decision-making is valuable for informing interventions that encourage donation.

Cannabinoids and cancer: pros and cons of an antitumour strategy

PubMed Central

Bifulco, Maurizio; Laezza, Chiara; Pisanti, Simona; Gazzerro, Patrizia

2006-01-01

In the last two decades, research has dramatically increased the knowledge of cannabinoids biology and pharmacology. In mammals, compounds with properties similar to active components of Cannabis sativa, the so called ‘endocannabinoids', have been shown to modulate key cell-signalling pathways involved in cancer cell growth, invasion and metastasis. To date, cannabinoids have been licensed for clinical use as palliative treatment of chemotherapy, but increased evidences showed direct antiproliferative actions of cannabinoid agonists on several tumour cells in vitro and in animal models. In this article, we will review the principal molecular pathways modulated by cannabinoids on cancer and summarize pros and cons evidence on the possible future use of endocannabinoid-based drugs in cancer therapy. PMID:16501583

[Perioperative management of abdominal aortic balloon occlusion in patients complicated with placenta percteta: a case report].

PubMed

Zeng, Hong; Wang, Yan; Wang, Yang; Guo, Xiang-yang

2015-12-18

When placenta previa complicated with placenta percreta, the exposure of operative field is difficult and the routine methods are difficult to effectively control the bleeding, even causing life-threatening results. A 31-year-old woman, who had been diagnosed with a complete type of placenta previa and placenta percreta with bladder invasion at 34 weeks gestation. Her ultrasound results showed a complete type of placenta previa and there was a loss of the decidual interface between the placenta and the myometrium on the lower part of the uterus, suggestive of placenta increta. For further evaluation of the placenta, pelvis magnetic resonance imaging was performed, which revealed findings suspicious of a placenta percreta. She underwent elective cecarean section at 36 weeks of gestation. Firstly, two ureteral stents were placed into the bilateral ureter through the cystoscope. After the infrarenal abdominal aorta catheter was inserted via the femoral artery (9 F sheath ), subarachnoid anesthesia had been established. A healthy 2 510 g infant was delivered, with Apgar scores of 10 at 1 min and 10 at 5 min. Immediately after the baby was delivered, following which there was massive haemorrhage and general anaesthesia was induced. The balloon catheter was immediately inflated until the wave of dorsal artery disappeared. With the placenta retained within the uterus, a total hysterectomy was performed. The occluding time was 30 min. The intraoperative blood loss was 2 500 mL. The occluding balloon was deflated at the end of the operation. The patient had stable vital signs and normal laboratory findings during the recovery period and the hemoglobin was 116 g/L. She was discharged six days after delivery without intervention-related complications. This case illustrates that temporary occlusion of the infrarenal abdominal aorta using balloon might be a safe and effective treatment option for patients with placenta previa complicated with placenta percreta, who were at high

La mortalidad en adolescentes con cáncer: características clinicoepidemiológicas de muerte y aspectos éticos emergentes.

PubMed

Cicero-Oneto, Carlo Egysto; Mata-Valderrama, Guadalupe; Valdez-Martínez, Edith

Describir los aspectos epidemiológicos, clínicos y éticos de la mortalidad de los adolescentes con cáncer en -México. Se revisaron 63 expedientes clínicos de adolescentes (de 14 a 18 años de edad) con cáncer, fallecidos entre 2011 y 2014, para obtener información clínica y epidemiológica de su muerte. Los sitios de estudio fueron tres hospitales de concentración en la Ciudad de México. De los 40 adolescentes con criterios de fase terminal, 16 (40%) continuaron recibiendo tratamiento con fines curativos. De los 51 cuyo lugar de muerte era conocido, 45 (88%) murieron en hospital. De los 41 que murieron dentro de los 30 días de su última hospitalización, las muertes fueron principalmente debidas a complicaciones (51%), a progresión de la enfermedad (41%) o bien fueron muertes en tratamiento paliativo (7%, 3/41). La práctica oncológica descansa en lo que es conocido como modelo biomédico. Los resultados del estudio sugieren y apoyan la urgente necesidad de implementar verdaderos servicios de cuidados paliativos, pero más importante que eso, está el ímpetu de poner la ética de la práctica clínica en acción, y de ese modo reforzar la buena práctica de la medicina. Copyright: © 2018 SecretarÍa de Salud

Quick fix or long-term cure? Pros and cons of bariatric surgery

PubMed Central

Madura, James A.

2012-01-01

The past decade has seen an enormous increase in the number of bariatric, or weight loss, operations performed. This trend is likely to continue, mirroring the epidemic of obesity around the world and its rising prevalence among children. Bariatric surgery is considered by many to be the most effective treatment for obesity in terms of maintenance of long-term weight loss and improvement in obesity-related comorbid conditions. Although overly simplified, the primary mechanisms of the surgical interventions currently utilized to treat obesity are the creation of a restrictive or malabsorptive bowel anatomy. Operations based on these mechanisms include the laparoscopic adjustable gastric band and laparoscopic vertical sleeve gastrectomy (considered primarily restrictive operations), the laparoscopic biliopancreatic diversion with or without a duodenal switch (primarily malabsorptive operation), and the laparoscopic Roux-en-Y gastric bypass (considered a combination restrictive and selective malabsorptive procedure). Each operation has pros and cons. Important considerations, for the patient and surgeon alike, in the decision to proceed with bariatric surgery include the technical aspects of the operation, postoperative complications including long-term nutritional problems, magnitude of initial and sustained weight loss desired, and correction of obesity-related comorbidities. Herein, the pros and cons of the contemporary laparoscopic bariatric operations are reviewed and ongoing controversies relating to bariatric surgery are discussed: appropriate patient selection, appropriate operation selection for an individual patient, surgeon selection, and how to measure success after surgery. PMID:23091563

76 FR 1137 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

76 FR 66915 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

77 FR 59913 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-month cap...

The Research Libraries Group: Making a Difference.

ERIC Educational Resources Information Center

Michalko, James; Haeger, John

1994-01-01

This overview of the Research Libraries Group (RLG) discusses historical background, collaboration, new needs and expectations, the Research Libraries Information Network (RLIN), the CitaDel service, the ARIEL service, the Eureka service, the Zephyr server, and JACKPHY-Plus Script Development, and preservation. (JLB)

76 FR 78249 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... Agreements (``CITA'') has determined that certain cotton/nylon/spandex raschel knit, open work crepe, piece... cotton/ nylon/spandex raschel knit, open crepe, piece dyed fabric, as specified below. On November 15... site for CAFTA-DR Commercial Availability proceedings. Specifications Certain Cotton/Nylon/Spandex...

76 FR 79166 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... (``CITA'') has determined that certain cotton/nylon/spandex raschel knit open work crepe printed fabric... determination (``Request'') from Sorini Samet & Associates on behalf of Hansoll Textile Ltd. for certain cotton... site for CAFTA-DR Commercial Availability proceedings. SPECIFICATIONS: Certain Cotton/Nylon/Spandex...

Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology.

PubMed

Wennberg, Anna Lena; Opdahl, Signe; Bergh, Christina; Aaris Henningsen, Anna-Karina; Gissler, Mika; Romundstad, Liv Bente; Pinborg, Anja; Tiitinen, Aila; Skjærven, Rolv; Wennerholm, Ulla-Britt

2016-10-01

To compare the effect of maternal age on assisted reproductive technology (ART) and spontaneous conception (SC) pregnancies regarding maternal and neonatal complications. Nordic retrospective population-based cohort study. Data from national ART registries were cross-linked with national medical birth registries. Not applicable. A total of 300,085 singleton deliveries: 39,919 after ART and 260,166 after SC. None. Hypertensive disorders in pregnancy (HDP), placenta previa, cesarean delivery, preterm birth (PTB; <37 weeks), low birth weight (LBW; <2,500 g), small for gestational age (SGA), and perinatal mortality (≥28 weeks). Adjusted odds ratios (AORs) were calculated. Associations between maternal age and outcomes were analyzed. The risk of placenta previa (AOR 4.11-6.05), cesarean delivery (AOR 1.18-1.50), PTB (AOR 1.23-2.19), and LBW (AOR 1.44-2.35) was significantly higher in ART than in SC pregnancies for most maternal ages. In both ART and SC pregnancies, the risk of HDP, placenta previa, cesarean delivery, PTB, LBW, and SGA changed significantly with age. The AORs for adverse neonatal outcomes at advanced maternal age (>35 years) showed a greater increase in SC than in ART. The change in risk with age did not differ between ART and SC for maternal outcomes at advanced maternal age. Having singleton conceptions after ART results in higher maternal and neonatal outcome risks overall, but the impact of age seems to be more pronounced in couples conceiving spontaneously. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Pros and cons of transcatheter aortic valve implantation (TAVI).

PubMed

Terré, Juan A; George, Isaac; Smith, Craig R

2017-09-01

Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.

Encefalitis por anticuerpos contra el receptor de NMDA: experiencia con seis pacientes pediátricos. Potencial eficacia del metotrexato

PubMed Central

Bravo-Oro, Antonio; Abud-Mendoza, Carlos; Quezada-Corona, Arturo; Dalmau, Josep; Campos-Guevara, Verónica

2016-01-01

Introducción La encefalitis por anticuerpos contra el receptor de N-metil-D-aspartato (NMDA) es una entidad cada vez más diagnosticada en edad pediátrica. A diferencia de los adultos, en muchos casos no se asocia a tumores y las manifestaciones iniciales en niños más frecuentes son crisis convulsivas y trastornos del movimiento, mientras que en los adultos predominan las alteraciones psiquiátricas. Casos clínicos Presentamos seis casos pediátricos confirmados con anticuerpos contra la subunidad NR1 del receptor de NMDA en suero y líquido cefalorraquídeo. Cinco de los casos comenzaron con crisis convulsivas como manifestación clínica inicial antes de desarrollar el cuadro clásico de esta entidad. En todos los casos se utilizaron esteroides como primera línea de tratamiento, con los que sólo se observó control de las manifestaciones en uno, por lo que el resto de los pacientes requirió inmunomoduladores de segunda línea. Todos los pacientes recibieron metotrexato como tratamiento inmunomodulador para evitar recaídas y la evolución fue a la mejoría en todos ellos. Conclusiones En nuestra serie de pacientes con encefalitis por anticuerpos contra el receptor de NMDA, ninguno se asoció a tumores. Todos los casos recibieron metotrexato por lo menos durante un año, no observamos eventos adversos clínicos ni por laboratorio, ni hubo secuelas neurológicas ni recaídas durante el tratamiento. Aunque es una serie pequeña y es deseable incrementar el número y tiempo de evolución, consideramos el metotrexato una excelente alternativa como tratamiento inmunomodulador para esta patología. PMID:24150952

Confrontando teorías físicas con la Cosmología

NASA Astrophysics Data System (ADS)

Vucetich, H.

Hay numerosas teorías físicas que no pueden contrastarse con el experimento en laboratorio y eso las hace poco interesantes como descripción de la naturaleza. Sin embargo, algunas de estas teorías tienen consecuencias cosmológicas observables y se abre la posibilidad de contrastación a través de la observación. Se discuten las observaciones capaces de poner a prueba tales teorías y se examinan ejemplos de teorías limitadas por la observación.

Hable con Ella (Talk to Her) through the lens of gender.

PubMed

Yanof, Judith A

2008-04-01

In the 2002 film Hable con Ella (Talk to Her), Spanish writer-director Pedro Almodóvar plays with the ambiguity of gender, transcending conventional assumptions about "masculinity" and "femininity." Each of the four main characters holds complex, varied, and, in some cases, gender-bending gender identifications. The theme of gender plasticity is a prominent motif in this film. However, underlying the narrative, there is also a perverse subtext that relies on rigidly binary gender stereotypes to define relationships between men and women. Both these views of gender which operate dialectically, create a complex tapestry through which Almodóvar explores his characters' problems in attaining intimacy.

Fairfax County and the Commonwealth of Virginia Public Safety and Transportation Operations Center : concept of cooperation (ConCoop)

DOT National Transportation Integrated Search

2005-01-01

The Public Safety and Transportation Operations Centers (PSTOCs) Concept of Cooperation (ConCoop) enables partner agencies to lay out and reach consensus on: : their intentions in co-locating; : joint functions and systems needed to mee...

To Bind or Not To Bind: Pros & Cons of Maintaining Paper Periodicals in the Library's Collection.

ERIC Educational Resources Information Center

Anderson, Iris W.

1999-01-01

Explores controversial questions related to libraries' decision-making on paper journals and electronic journals. Notes that the critical mass of scholarly publishing is still in print. Discusses benefits and drawbacks of electronic journals and paper journals. Presents comments on the pros and cons to binding paper periodicals gathered from an…

78 FR 17642 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... Agreements (``CITA'') has determined that certain piece dyed three-thread fleece fabric, as specified below... behalf of Garan Manufacturing, Inc. for certain piece dyed three-thread fleece fabric, as specified below... Commercial Availability proceedings. SPECIFICATIONS: Certain Piece Dyed Three-thread Fleece Fabric HTS: 6001...

78 FR 17923 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... Agreements (``CITA'') has determined that certain three-thread fleece fabric with soft hand pigment, as... behalf of Garan Manufacturing, Inc. for certain three-thread fleece fabric with soft hand pigment, as... dedicated Web site for CAFTA-DR Commercial Availability proceedings. Specifications: Certain Three-Thread...

78 FR 7414 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... Agreements (``CITA'') has determined that certain cotton/polyester three-thread circular knit fleece fabric... behalf of Intradeco Apparel, Inc. for certain cotton/polyester three-thread circular knit fleece fabric.... Specifications: Certain Cotton/Polyester Three-Thread Circular Knit Fleece Fabric HTS: 6001.21 Fiber content...

78 FR 11159 - Determination under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-15

... Agreements (``CITA'') has determined that certain three-layered composite fabric, as specified below, is not.... on behalf of VF Corp. for certain three- layered composite fabric, as specified below. On January 18... Availability proceedings. Specifications: Certain 3-layered Composite Fabric Fabric type: Composite fabric...

Pros and Cons of the Acceleration Scheme (NF-IDS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bogacz, Alex; Bogacz, Slawomir

The overall goal of the acceleration systems: large acceptance acceleration to 25 GeV and beam shaping can be accomplished by various fixed field accelerators at different stages. They involve three superconducting linacs: a single pass linear Pre-accelerator followed by a pair of multi-pass Recirculating Linear Accelerators (RLA) and finally a nonâ scaling FFAG ring. The present baseline acceleration scenario has been optimized to take maximum advantage of appropriate acceleration scheme at a given stage. Pros and cons of various stages are discussed here in detail. The solenoid based Pre-accelerator offers very large acceptance and facilitates correction of energy gain acrossmore » the bunch and significant longitudinal compression trough induced synchrotron motion. However, far off-crest acceleration reduces the effective acceleration gradient and adds complexity through the requirement of individual RF phase control for each cavity. Close proximity of strong solenoids and superc« less

Pros and cons of transcatheter aortic valve implantation (TAVI)

PubMed Central

Terré, Juan A.; George, Isaac

2017-01-01

Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement. PMID:29062739

Pros and cons of healthcare information technology implementation: the pros win.

PubMed

Maffei, Roxana

2006-01-01

Countless studies and investigations have been performed siding either for or against the implementation of technology in the healthcare setting. This article presents both sides of this debate, with an obvious conclusion that the pros of this debate win. The practice of information technology in the medical domain lags behind its knowledge and discovery by at least 7 years. The key to closing this gap is to show, through various studies, how information technology systems provide decision support to users at the point in time when decisions are needed. What the reader will obtain from this article is that the pros for information technology implementation in healthcare settings weigh much more and have a greater effect than the cons.

76 FR 67424 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

... Agreements (``CITA'') has determined that certain cotton/nylon/spandex raschel knit open work crepe fabric..., Travis & Rosenberg, P.A., on behalf of Hansae Co. Ltd., for certain cotton/nylon/spandex raschel knit... Availability proceedings. Specifications: Certain Cotton/Nylon/Spandex Raschel Knit Open Work Crepe Fabric HTS...

76 FR 52640 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... (``CITA'') has determined that an acceptable substitute for certain compacted, plied, ring spun cotton... to remove or restrict (``Request'') certain compacted, plied, ring spun cotton yarns, currently on... Spun Cotton Yarns Compacted, plied, ring spun cotton yarns, with yarn counts in the range from 42 to...

Scientific publications: now a marketing decision?

USDA-ARS?s Scientific Manuscript database

Scientists have been publishing in journals related to their disciplines. Now with the advent of the internet, many more options are now available and scientific publication has become a marketing decision. Scientific journals are rated by "impact factor" which is based on the average number of cita...

78 FR 28198 - Interim Procedures for Considering Requests Under the Commercial Availability Provision of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

..., Response, Rebuttal, and Request to Remove or Restrict) must be in English. If any attachments are in a language other than English, then a complete translation must be provided. Each submission must be... that lacks the applicable certifications will be considered an incomplete submission that CITA will...

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity

PubMed Central

Alcaraz, Kassandra I.; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C.; Lu, Qian; Meade, Cathy D.; Menon, Usha; Gwede, Clement K.

2017-01-01

Health disparities persist despite ongoing efforts. Given the United States’ rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the Con-NECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT’s five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice. PMID:27509892

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity.

PubMed

Alcaraz, Kassandra I; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C; Lu, Qian; Meade, Cathy D; Menon, Usha; Gwede, Clement K

2017-02-01

Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.

The Protective Effect of Intrasplenic Transplantation of Ad-IL-18BP/IL-4 Gene-Modified Fetal Hepatocytes on ConA-Induced Hepatitis in Mice

PubMed Central

Xu, Chenhuai; Hong, Bo; Xu, Wanhong; Shen, Ling; Jin, Changzhong; Wu, Zhigang; Tong, Xiangmin; Yao, Hangping

2013-01-01

Background Concanavalin A (ConA)-induced hepatitis is an experimental murine model mirroring the pathology of human autoimmune hepatitis. Aim To investigate the effects of intrasplenically transplanted fetal hepatocytes (BNL.CL2) transfected with recombinant adenovirus vector expressing the IL-18 binding protein (IL-18BP) and IL-4 fusion protein on ConA-induced hepatitis in mice. Methods Ad-IL-18BP/IL-4 was used to infect BNL.CL2 cells. IL-4 and IL-18BP fusion protein expression were detected by ELISA and Western blotting. BNL.CL2 cells infected with Ad-IL-18BP/IL-4 were intrasplenically transplanted into mice. After 10 days, mice were injected with ConA (15 mg/kg), and sacrificed 18 hours later. Liver injury was assessed by serum transaminase and liver histology. TNF-α, IL-18, IL-4, IL-10, IL-12p70 and monocyte-chemoattracting protein (MCP)-1 levels in serum and liver homogenates were detected by ELISA. Signaling molecules in liver homogenates were analyzed by Western blotting. Results Ad-IL-18BP/IL-4 effectively expressed the IL-18BP/IL-4 fusion protein for more than 14 days in BNL.CL12 cells. Treatment of mice with Ad-IL-18BP/IL-4-BNL.CL2 before ConA injection significantly reduced the elevated plasma levels of transaminases compared with ConA control groups. TNF-α, IL-18, IL-12p70 and MCP-1 levels in serum and liver homogenates from mice transplanted with Ad-IL-18BP/IL-4-BNL.CL2 were lower and IL-4 and IL-10 levels were higher than control groups. Phosphorylation levels of NF-κB p65, AKT, p38 and JNK1/2 in liver homogenates were markedly suppressed by Ad-IL-18BP/IL-4. Conclusions Ad-IL-18BP/IL-4 was effectively transfected into mouse BNL.CL2 cells. Intrasplenic transplantation of Ad-IL-18BP/IL-4-BNL.CL12 cells alleviated the severity of inflammation in ConA-induced experimental hepatitis and provides a useful basis for the targeted gene therapy of liver disease. PMID:23516562

The protective effect of intrasplenic transplantation of Ad-IL-18BP/IL-4 gene-modified fetal hepatocytes on ConA-induced hepatitis in mice.

PubMed

Shao, Xueting; Qian, Yun; Xu, Chenhuai; Hong, Bo; Xu, Wanhong; Shen, Ling; Jin, Changzhong; Wu, Zhigang; Tong, Xiangmin; Yao, Hangping

2013-01-01

Concanavalin A (ConA)-induced hepatitis is an experimental murine model mirroring the pathology of human autoimmune hepatitis. To investigate the effects of intrasplenically transplanted fetal hepatocytes (BNL.CL2) transfected with recombinant adenovirus vector expressing the IL-18 binding protein (IL-18BP) and IL-4 fusion protein on ConA-induced hepatitis in mice. Ad-IL-18BP/IL-4 was used to infect BNL.CL2 cells. IL-4 and IL-18BP fusion protein expression were detected by ELISA and Western blotting. BNL.CL2 cells infected with Ad-IL-18BP/IL-4 were intrasplenically transplanted into mice. After 10 days, mice were injected with ConA (15 mg/kg), and sacrificed 18 hours later. Liver injury was assessed by serum transaminase and liver histology. TNF-α, IL-18, IL-4, IL-10, IL-12p70 and monocyte-chemoattracting protein (MCP)-1 levels in serum and liver homogenates were detected by ELISA. Signaling molecules in liver homogenates were analyzed by Western blotting. Ad-IL-18BP/IL-4 effectively expressed the IL-18BP/IL-4 fusion protein for more than 14 days in BNL.CL12 cells. Treatment of mice with Ad-IL-18BP/IL-4-BNL.CL2 before ConA injection significantly reduced the elevated plasma levels of transaminases compared with ConA control groups. TNF-α, IL-18, IL-12p70 and MCP-1 levels in serum and liver homogenates from mice transplanted with Ad-IL-18BP/IL-4-BNL.CL2 were lower and IL-4 and IL-10 levels were higher than control groups. Phosphorylation levels of NF-κB p65, AKT, p38 and JNK1/2 in liver homogenates were markedly suppressed by Ad-IL-18BP/IL-4. Ad-IL-18BP/IL-4 was effectively transfected into mouse BNL.CL2 cells. Intrasplenic transplantation of Ad-IL-18BP/IL-4-BNL.CL12 cells alleviated the severity of inflammation in ConA-induced experimental hepatitis and provides a useful basis for the targeted gene therapy of liver disease.

Nanoparticulas basadas en complejos de Fe(II) con transicion de espin: sintesis, caracterizacion y aplicaciones en electronica molecular

NASA Astrophysics Data System (ADS)

Monrabal Capilla, Maria

Esta tesis doctoral esta organizada en 5 capitulos y esta destinada al estudio de sistemas de Fe (II) que presentan el fenomeno de la transicion de espin a escala nanometrica. El capitulo 1 contiene una introduccion general sobre materiales moleculares multifuncionales, destacando aquellos ejemplos mas importantes. Por otro lado, se explicara el fenomeno de la transicion de espin, tratando aspectos conceptuales, los antecedentes mas importantes y la situacion actual. En el capitulo 2 se describen los diferentes procesos existentes para la obtencion de diferentes tipos de nanoparticulas. Ademas, se presenta la sintesis y caracterizacion de nanoparticulas del polimero de coordinacion unidimensional [Fe(Htrz)2(trz)]BF4, obtenidas mediante el metodo de micelas inversas. Estas nanoparticulas, con una estrecha distribucion de tamanos centrada alrededor de los 11 nm, presentan una transicion de espin muy abrupta, con un ancho ciclo de histeresis termica de unos 40K. En el capitulo 3 se describe el proceso de modificacion del tamano de las nanoparticulas descritas en el capitulo anterior, llevado a cabo variando la proporcion de surfactante/H2O en el medio. Ademas, con el objetivo de modificar las propiedades magneticas de las nanoparticulas obtenidas en el capitulo 2, se lleva a cabo la sintesis de nanoparticulas de polimeros de la misma familia del [Fe(Htrz)2(trz)]BF4. En concreto se sintetizaron 3 nuevos tipos de nanoparticulas basadas en el polimero [Fe(Htrz)1-x(NH2trz)x](ClO4)2, siendo x = 0.05, 0.15 y 0.3, en cada caso. Estas nanoparticulas siguen presentando una estrecha distribucion de tamanos y una transicion de espin muy abrupta y con un ancho ciclo de histeresis. Ademas, se observa que este ciclo se desplaza a temperaturas mas proximas a la temperatura ambiente a medida que se aumenta el porcentaje de 4-amino-1, 2, 4- triazol en la muestra. Pero al mismo tiempo se produce una disminucion de la anchura de este ciclo. Por ultimo, en este capitulo se presenta la

Men's health: non-communicable chronic diseases and social vulnerability.

PubMed

Bidinotto, Daniele Natália Pacharone Bertolini; Simonetti, Janete Pessuto; Bocchi, Silvia Cristina Mangini

2016-08-15

Doenças em homens solteiros. Obtiveram-se 21 casos geoestatisticamente significantes de intolerância à glicose na zona urbana. Desses, 62% moravam em região com a classificação de vulnerabilidade social Muito Baixa, 19% Média, 14% Baixa e 5% Alta. observou-se que quanto mais velhos os homens, maior é o número de doenças crônicas instaladas e menos eles faltam em consultas agendadas. Quanto ao uso do geoprocessamento, obteve-se número de casos significantes de intolerância à glicose na zona urbana, sendo a maioria classificada como vulnerabilidade social Muito Baixa. Pôde-se relacionar a distribuição espacial dessas doenças com a classificação de vulnerabilidade social, porém, não foi possível perceber uma relação delas com índices mais elevados de vulnerabilidade social. evaluar la relación entre las faltas en las citas programadas y el número de enfermedades crónicas y para investigar la relación entre la distribución espacial de estas enfermedades y la vulnerabilidad social, utilizando geoprocesamiento. estudio cuantitativo de enfoque mixto secuencial y siendo analizadas 158 historias clínicas de los usuarios masculinos para relacionar las faltas y 1250 registros de geoprocesamiento. cuanto mayor eran el número de ausencias en las citas médicas programadas, menores fueron el número, para los hombres solteiros, de enfermedades crónicas y de las incluídas en la Clasificación Internacional de Enfermedades. Se obtuvieron 21 casos de intolerancia a la glucosa geoestadísticamente significativos en el área urbana. De éstos, el 62% viven en una región con calificación de vulnerabilidad social muy baja 19%, media, 14% baja y 5% Alta. se observó que cuanta mayor la edad de los hombres, mayor es el número de enfermedades crónicas instaladas y menos faltas en las citas programadas. Respecto al uso de geoprocesamiento, obtuvimos número significativo de casos de intolerancia a la glucosa en las zonas urbanas, la mayoría clasificada

Establishing confidence in the output of qualitative research synthesis: the ConQual approach.

PubMed

Munn, Zachary; Porritt, Kylie; Lockwood, Craig; Aromataris, Edoardo; Pearson, Alan

2014-09-20

The importance of findings derived from syntheses of qualitative research has been increasingly acknowledged. Findings that arise from qualitative syntheses inform questions of practice and policy in their own right and are commonly used to complement findings from quantitative research syntheses. The GRADE approach has been widely adopted by international organisations to rate the quality and confidence of the findings of quantitative systematic reviews. To date, there has been no widely accepted corresponding approach to assist health care professionals and policy makers in establishing confidence in the synthesised findings of qualitative systematic reviews. A methodological group was formed develop a process to assess the confidence in synthesised qualitative research findings and develop a Summary of Findings tables for meta-aggregative qualitative systematic reviews. Dependability and credibility are two elements considered by the methodological group to influence the confidence of qualitative synthesised findings. A set of critical appraisal questions are proposed to establish dependability, whilst credibility can be ranked according to the goodness of fit between the author's interpretation and the original data. By following the processes outlined in this article, an overall ranking can be assigned to rate the confidence of synthesised qualitative findings, a system we have labelled ConQual. The development and use of the ConQual approach will assist users of qualitative systematic reviews to establish confidence in the evidence produced in these types of reviews and can serve as a practical tool to assist in decision making.

Electronic Document Delivery: New Options for Libraries.

ERIC Educational Resources Information Center

Leach, Ronald G.; Tribble, Judith E.

1993-01-01

Examines commercial electronic document delivery services that are available to academic libraries. Highlights include collection development issues; criteria for selection and evaluation; remote access systems, including CARL UnCover 2, Faxon Finder and Faxon Xpress, ContentsFirst and ArticleFirst, and CitaDel; and on-site access systems,…

Soy-Based Therapeutic Baby Formulas: Testable Hypotheses Regarding the Pros and Cons.

PubMed

Westmark, Cara J

2016-01-01

Soy-based infant formulas have been consumed in the United States since 1909, and currently constitute a significant portion of the infant formula market. There are efforts underway to generate genetically modified soybeans that produce therapeutic agents of interest with the intent to deliver those agents in a soy-based infant formula platform. The threefold purpose of this review article is to first discuss the pros and cons of soy-based infant formulas, then present testable hypotheses to discern the suitability of a soy platform for drug delivery in babies, and finally start a discussion to inform public policy on this important area of infant nutrition.

Soy-Based Therapeutic Baby Formulas: Testable Hypotheses Regarding the Pros and Cons

PubMed Central

Westmark, Cara J.

2017-01-01

Soy-based infant formulas have been consumed in the United States since 1909, and currently constitute a significant portion of the infant formula market. There are efforts underway to generate genetically modified soybeans that produce therapeutic agents of interest with the intent to deliver those agents in a soy-based infant formula platform. The threefold purpose of this review article is to first discuss the pros and cons of soy-based infant formulas, then present testable hypotheses to discern the suitability of a soy platform for drug delivery in babies, and finally start a discussion to inform public policy on this important area of infant nutrition. PMID:28149839

PubMed

Martínez Carrión, José Miguel; Cámara, Antonio D; Pérez-Castroviejo, Pedro María

2016-12-12

Objetivo: analizar la geografía del estado nutricional en España y su evolución entre mediados del siglo xixy comienzos del siglo xx, etapa previa a la transición nutricional con alta prevalencia de malnutrición.Métodos: se utilizan datos antropométricos agregados (promedios provinciales de estatura) del reclutamiento militar en 1858 y 1913, así como promedios provinciales de estatura y peso procedentes de una revisión realizada entre 119.571 soldados en 1903-1906. Con estos datos se elaboran cartografía y estadísticos descriptivos.Resultados: los parámetros antropométricos de los españoles se situaban entre los valores de complexión más bajos de Europa antes de la transición nutricional. Entre 1858 y 1913, la altura media creció solo 1,43 cm. En ese periodo hubo cambios significativos en la geografía antropométrica marcados por la configuración de una polaridad nutricional a las puertas de la I Guerra Mundial: las provincias del centro y del sur de país exhiben mayor incidencia de la malnutrición crónica que las provincias del arco Noreste, que disfrutan de ventaja relativa en términos nutricionales.Conclusión:las desigualdades territoriales que configuraron una geografía polarizada del estado nutricional en España pueden asociarse en parte a los cambios ambientales del periodo, caracterizados por el inicio de la modernización y la industrialización y, asimismo, por la privación derivada de las crisis agrarias, las enfermedades y el relativo atraso tecnológico. Se destaca la relevancia de la historia antropométrica para el estudio de los niveles de vida en poblaciones del pasado y del proceso de transición nutricional.

CHILES Con Pol: Probing galaxy evolution, the dark Universe, and cosmic magnetism with a deep 1000 hour Jansky VLA survey

NASA Astrophysics Data System (ADS)

Hales, Christopher A.; Chiles Con Pol Collaboration

2014-04-01

We recently started a 1000 hour campaign to observe 0.2 square degrees of the COSMOS field in full polarization continuum at 1.4 GHz with the Jansky VLA, as part of a joint program with the spectral line COSMOS HI Large Extragalactic Survey (CHILES). When complete, we expect our CHILES Continuum Polarization (CHILES Con Pol) survey to reach an unprecedented SKA-era sensitivity of 0.7 uJy per 4 arcsecond FWHM beam. Here we present the key goals of CHILES Con Pol, which are to (i) produce a source catalog of legacy value to the astronomical community, (ii) measure differential source counts in total intensity, linear polarization, and circular polarization in order to constrain the redshift and luminosity distributions of source populations, (iii) perform a novel weak lensing study using radio polarization as an indicator of intrinsic alignment to better study dark energy and dark matter, and (iv) probe the unknown origin of cosmic magnetism by measuring the strength and structure of intergalactic magnetic fields in the filaments of large scale structure. The CHILES Con Pol source catalog will be a useful resource for upcoming wide-field surveys by acting as a training set for machine learning algorithms, which can then be used to identify and classify radio sources in regions lacking deep multiwavelength coverage.

Binge drinking and illicit drug use among adolescent students.

PubMed

Raposo, Jakelline Cipriano Dos Santos; Costa, Ana Carolina de Queiroz; Valença, Paula Andréa de Melo; Zarzar, Patrícia Maria; Diniz, Alcides da Silva; Colares, Viviane; Franca, Carolina da

2017-09-04

To estimate the prevalence of illicit drug use and its association with binge drinking and sociodemographic factors among adolescent students. This is a cross-sectional study with probabilistic conglomerate sampling, involving 1,154 students, aged 13 to 19 years old, from the public school system, in the city of Olinda, State of Pernambuco, Brazil, carried out in 2014. We used the Youth Risk Behavior Survey questionnaire, validated for use with Brazilian adolescents. The Chi-square test (≤ 0.05) and Poisson regression analysis were used to estimate the prevalence ratios, with 95% confidence intervals. Use in life of illicit drugs was four times more prevalent among students who reported binge drinking (95%CI 3.19-5.45). Being in the age group of 16 to 19 years, being male, and having no religion were also significantly associated with illicit drug use. The prevalence of use in life of illicit drugs was higher in this study than in other studies carried out in Brazil and it was strongly associated with binge drinking. This factor was associated with gender, age, and religion. Estimar a prevalência do uso de drogas ilícitas e sua associação com binge drinking e fatores sociodemográficos entre estudantes adolescentes. Estudo transversal com amostra probabilística por conglomerado, envolvendo 1.154 estudantes, de 13 a 19 anos de idade, da rede pública de ensino, no município de Olinda, PE, 2014. Foi utilizado o questionário Youth Risk Behavior Survey, validado para uso com adolescentes brasileiros. Para análise dos dados foi utilizado o teste do Qui-quadrado (≤ 0,05) e análise de regressão de Poisson, para estimar razões de prevalência, com intervalos com 95% de confiança. O uso na vida de drogas ilícitas foi quatro vezes mais prevalente entre os estudantes que relataram o binge drinking (IC95% 3,19-5,45). Estar na faixa etária de 16 a 19 anos, ser do sexo masculino e não ter religião também foram significativamente associados ao uso de drogas

Redefining Information Access to Serials Information.

ERIC Educational Resources Information Center

Chen, Ching-chih

1992-01-01

Describes full-text document delivery services that have been introduced in conjunction with available databases in response to economic and technological changes affecting libraries: (1) CARL System's UnCover database and UnCover2 service; (2) Research Libraries Group's CitaDel delivery service; and (3) Faxon Research Service's Faxon Finder and…

75 FR 48931 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... Agreements (``CITA'') has determined that certain woven yarn-dyed fabrics of lyocell and cotton, as specified...'') for BWA, Inc. (``BWA'') Corporation for certain woven yarn-dyed fabrics of lyocell and cotton. On July... Fabrics of Lyocell and Cotton HTS Subheading: 5516.13.0000, 5516.43.00 Fiber Content: 55-85% standard...

Flight Deck Surface Trajectory-based Operations (STBO): Results of Piloted Simulations and Implications for Concepts of Operation (ConOps)

NASA Technical Reports Server (NTRS)

Foyle, David C.; Hooey, Becky L.; Bakowski, Deborah L.

2013-01-01

The results offour piloted medium-fidelity simulations investigating flight deck surface trajectory-based operations (STBO) will be reviewed. In these flight deck STBO simulations, commercial transport pilots were given taxi clearances with time and/or speed components and required to taxi to the departing runway or an intermediate traffic intersection. Under a variety of concept of operations (ConOps) and flight deck information conditions, pilots' ability to taxi in compliance with the required time of arrival (RTA) at the designated airport location was measured. ConOps and flight deck information conditions explored included: Availability of taxi clearance speed and elapsed time information; Intermediate RTAs at intermediate time constraint points (e.g., intersection traffic flow points); STBO taxi clearances via ATC voice speed commands or datal ink; and, Availability of flight deck display algorithms to reduce STBO RTA error. Flight Deck Implications. Pilot RTA conformance for STBO clearances, in the form of ATC taxi clearances with associated speed requirements, was found to be relatively poor, unless the pilot is required to follow a precise speed and acceleration/deceleration profile. However, following such a precise speed profile results in inordinate head-down tracking of current ground speed, leading to potentially unsafe operations. Mitigating these results, and providing good taxi RTA performance without the associated safety issues, is a flight deck avionics or electronic flight bag (EFB) solution. Such a solution enables pilots to meet the taxi route RTA without moment-by-moment tracking of ground speed. An avionics or EFB "error-nulling" algorithm allows the pilot to view the STBO information when the pilot determines it is necessary and when workload alloys, thus enabling the pilot to spread his/her attention appropriately and strategically on aircraft separation airport navigation, and the many other flight deck tasks concurrently required

Ontogeny of con A and PHA responses of chicken blood cells in MHC-compatible lines 6(3) and 7(2).

PubMed

Fredericksen, T L; Gilmour, D G

1983-06-01

The development of T cell responsiveness to Con A and PHA was examined in two MHC-compatible inbred chicken lines, RPRL 6(3) and 7(2), at ages 2 to 118 days posthatching. These lines are respectively resistant or susceptible to Marek's disease, a naturally occurring, virally induced T cell lymphoma. Between-line comparisons were made of optimal in vitro responses of diluted serum-free blood cells to each mitogen in two groups of chicks tested over ages 2 to 63 and 41 to 118 days. Over 2 to 63 days, Con A responses increased with age at the same rate in each line, but 7(2) responses averaged 2.3 times higher than 6(3). The increase with age was dependent on blood lymphocyte counts, which also increased with age in parallel in both lines. In contrast, the between-line difference in responsiveness was dependent on intrinsic reactivity of cells as well as lymphocyte counts. Covariance analysis was used to estimate that line 7(2) was 1.4 times higher than 6(3) in intrinsic cell reactivity, after accounting for the effect of the twofold higher blood lymphocyte counts in 7(2), and that this intrinsic difference contributed almost one-half the total difference. Over 41 to 118 days Con A responses no longer increased with age, although lymphocyte counts were still increasing, and the line difference (2.6 times) was now almost entirely contributed by a 2.3-fold superiority of 7(2) blood cells in intrinsic reactivity. The line difference in PHA responses was the reverse of the above in young chicks, with 6(3) responses greater than 7(2) in spite of lower lymphocyte counts. In additional chicks tested over 5 to 26 days, intrinsic reactivity of 6(3) cells to PHA averaged 4.5 times higher than 7(2). There was an abrupt decline in intrinsic reactivity of line 6(3) blood cells between 26 and 41 days to a level equal with 7(2). After this age, line 7(2) responses were 1.8 times greater than those of 6(3), and this difference was dependent solely on lymphocyte count differences. The

The InterCon network: a program for education partnerships at the University of Texas-Houston Health Science Center.

PubMed

Castro, G A; Bouldin, P A; Farver, D W; Maugans, L A; Sanders, L C; Booker, J

1999-04-01

The University of Texas-Houston Health Science Center (UT-Houston) has created programs and activities to address the state's pressing needs in minority education. Through InterCon, a network of universities and K-12 schools, UT-Houston works with its partners to identify competitive candidates in the current pool of minority graduates with bachelor's degrees and to help them--along with their non-minority counterparts--progress in their education. Another objective is to expand the pool of minorities underrepresented in medicine who complete high school and go to college. In 1994 UT-Houston and Prairie View A&M University created a collaborative venture to provide new educational opportunities at UT-Houston for Prairie View's predominantly African American students. A three-track summer internship program--a result of that collaboration--has since been expanded to partnerships with other minority and majority universities throughout Texas. In 1998, for example, 108 undergraduate students from these universities (and 40 other universities nationwide) participated in research, professional, and administrative summer internships at UT-Houston. The InterCon network also has partnerships with K-12 schools. UT-Houston works with inner-city, suburban, and rural school districts to develop education models that can be transferred throughout the state. The partnerships deal with helping to teach basic academic skills and computer literacy, improve science-related instruction, meet demands for health promotion materials and information for school-initiated health and wellness programs, and develop distance-learning paradigms. UT-Houston views InterCon as a program helping Texas institutions to engage and adapt to the socioeconomic factors, demographic changes, and technology explosion that currently challenge public education.

Minimizing blood loss at cesarean-hysterectomy for placenta previa percreta.

PubMed

Belfort, Michael A; Shamshiraz, Alireza A; Fox, Karin

2017-01-01

Preventing blood loss at the time of a cesarean delivery during a scheduled, nonemergent cesarean hysterectomy for placenta percreta may reduce the need for crystalloid and blood product transfusion. Commonly a classical hysterotomy is created and this can result in as much as a 500-800 mL blood loss before the hysterotomy is closed. Our technique involves placement of 4 full-thickness interrupted sutures in a box pattern to create an unperfused area of upper uterine segment. Diathermy is used to open the uterus to the membranes in the center of the "box" without blood loss. A finger is then inserted between the membranes and uterus to create a space into which 1 side of an 80-mm linear cutting stapler is introduced. The other side of the stapler is then attached and clamped closed, and the stapler is activated. Forward motion of the lever lays down 2 rows of staples, and backward movement of the lever divides the uterine muscle between the 2 staple lines. The stapler is removed and reloaded and reintroduced 1 or 2 times as needed to create an avascular hysterotomy large enough to atraumatically deliver the baby. The membranes are then opened and the baby is delivered. Following this the umbilical cord is clamped and cut without any attempt to remove the placenta, replaced in the uterine cavity, and the hysterotomy is closed with a running locked suture that incorporates the membrane edges. The hysterectomy then proceeds. In most cases there is minimal blood loss (usually <20 mL) from the cesarean delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

"Estudio tribologico de aceros para moldes. Aplicacion al moldeo por inyeccion de polibutilentereftalato reforzado con fibra de vidrio"

NASA Astrophysics Data System (ADS)

Martinez Mateo, Isidoro Jose

fabricacion del molde, tienen una gran influencia sobre su comportamiento en servicio a lo largo de la vida util del molde. En la primera parte del presente estudio, a partir de ensayos punzon sobre disco, se ha determinado la relacion entre la resistencia al desgaste y la dureza de aceros para moldes obtenidos a partir de bloques de gran espesor, estudiando los principales mecanismos de desgaste que tienen lugar. A continuacion, con el fin de determinar el dano superficial que sufren los aceros para moldes en condiciones reales de inyeccion, se han estudiado distintos tipos de aceros utilizados comercialmente en moldes de inyeccion de polimeros y materiales compuestos, seleccionando las condiciones de operacion para determinar la variacion de la rugosidad superficial del acero en funcion del material inyectado, del numero de operaciones sucesivas de inyeccion y de la orientacion del flujo de inyeccion, mediante tecnicas de perfilometria optica y microscopia electronica de barrido. Ademas del dano superficial sufrido por el acero con el numero de piezas inyectadas, tambien se ha determinado la evolucion de la rugosidad superficial de los materiales inyectados, polibutilentereftalato (PBT) puro y materiales compuestos derivados de PBT por adicion de un 20 o un 50% en peso de fibra de vidrio. En el caso de las piezas inyectadas, se ha caracterizado su microestructura en funcion del flujo de inyeccion y de la densidad de fibra, se han determinado sus propiedades termicas y dinamico-mecanicas, asi como la variacion de la rugosidad superficial de las piezas inyectadas con el numero de operaciones de inyeccion y con la geometria de las distintas secciones de las piezas. Finalmente, se ha evaluado la resistencia a la abrasion de PBT reforzado con un 50% de fibra, en funcion del numero de piezas inyectadas y de la direccion de rayado con respecto a la orientacion del flujo de inyeccion.

Laparoscopy for inflammatory bowel disease: pros and cons.

PubMed

Sardinha, T C; Wexner, S D

1998-04-01

The role of laparoscopic surgery in the treatment of colorectal malignancies is still under investigation, although it can offer significant benefits to many patients with inflammatory bowel disease (IBD). The aim of this study was to assess the pros and cons of the laparoscopic management of IBD. Data were obtained from a review of the literature published since 1992, when the first report of laparoscopic surgery for IBD appeared in print. From 1992 to 1997 several series of laparoscopic colorectal surgery for the management of IBD have been reported. A close evaluation of these studies revealed that laparoscopy in patients with terminal ileal Crohn's disease or anal Crohn's disease in need of fecal diversion offers significant advantages compared to laparotomy, including decreased pain, length of hospitalization, and disability. An additional bonus is improved cosmesis and a reduction in symptomatic postoperative adhesions. These many benefits can be achieved without any increase in morbidity or expense. Conversely, the use of this technology for restorative proctocolectomy in patients with mucosal ulcerative colitis is associated with a longer operative time and an increased incidence of both intra- and postoperative complications compared to laparotomy. Laparoscopic colorectal surgery can thus be advantageous for treatment of terminal ileal Crohn's disease but cannot be routinely justified for the treatment of mucosal ulcerative colitis.

Interbirth Interval and Pregnancy Complications and Outcomes: Findings from the Pregnancy Risk Assessment Monitoring System.

PubMed

Brunner Huber, Larissa R; Smith, Kenesha; Sha, Wei; Vick, Tara

2018-05-25

Although the definition of a short interbirth interval has been inconsistent in the literature, Healthy People 2020 recommends that women wait at least 18 months after a live birth before attempting their next pregnancy. In the United States, approximately 33% of pregnancies are conceived within 18 months of a previous birth. Pregnancies that result from short interbirth intervals can pose serious risks. The objective of this study was to determine the association between interbirth interval and understudied pregnancy complications and outcomes, including small for gestational age (SGA) infants, premature rupture of membranes (PROM), preterm PROM (PPROM), placenta previa, and gestational diabetes, using Pregnancy Risk Assessment and Monitoring System data from Mississippi and Tennessee. This study collected self-reported information from 2212 women on interbirth interval (≤18 months, ie, short; 19-35 months, ie, intermediate; and ≥36 months, ie, long; referent), PPROM, placenta previa, and gestational diabetes. SGA and PROM data were obtained from birth certificates. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs. After adjustment, there were no strong associations between interbirth interval and PPROM, gestational diabetes, or SGA infants. However, women with shorter intervals had increased odds of PROM (short: OR, 3.54; 95% CI, 1.22-10.23 and intermediate: OR, 4.09; 95% CI, 1.28-13.03) and placenta previa (short: OR, 2.58; 95% CI, 1.10-6.05 and intermediate: OR, 1.69; 95% CI, 0.94-3.05). The study's findings provide further support for encouraging women to space their pregnancies appropriately. Moreover, findings underscore the need to provide women with family planning services so that closely spaced pregnancies and unintended pregnancies can be avoided. Additional studies of the role of interbirth interval on these understudied pregnancy complications and outcomes are warranted. © 2018 by the American College of Nurse-Midwives.

Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta.

PubMed

Oztas, Efser; Ozler, Sibel; Ersoy, Ali Ozgur; Ersoy, Ebru; Caglar, Ali Turhan; Uygur, Dilek; Yucel, Aykan; Ergin, Merve; Danisman, Nuri

2016-03-01

TNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections. A total of 82 pregnant women were enrolled in this case-control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated. Both placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883-0.987, p = 0.016 and OR:7.725 95% CI: 2.717-21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated. Decreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion. Copyright © 2016 Elsevier Ltd. All rights reserved.

The peripartum management of a patient with glutaric aciduria type 1.

PubMed

Ituk, Unyime S; Allen, Terrence K; Habib, Ashraf S

2013-03-01

The management of cesarean delivery for a parturient with placenta previa at 36 weeks' gestation and glutaric aciduria type 1 is presented. The management goal was to prevent encephalopathic crisis by ensuring adequate caloric intake with dextrose infusion and to provide carnitine supplementation and adequate anesthesia. Copyright © 2013 Elsevier Inc. All rights reserved.

Uso de Sustancias en Mujeres con Desventaja Social: Riesgo para el Contagio de VIH/SIDA

PubMed Central

Cianelli, R.; Ferrer, L; Bernales, M.; Miner, S.; Irarrázabal, L.; Molina, Y.

2009-01-01

Antecedentes La caracterización epidemiológica en Chile apunta a feminización, pauperización y heterosexualización de la epidemia del VIH, lo que implica un mayor riesgo para las mujeres en desventaja social. Si a esto se suma la utilización de sustancias, la vulnerabilidad de este grupo frente al VIH/SIDA aumenta. Objetivo Describir el uso de sustancias en mujeres con desventaja social e identificar factores de riesgo de contagio de VIH, asociados a este consumo. Material y Método 52 mujeres fueron entrevistadas como parte del proyecto “Testeando una intervención en prevención de VIH/SIDA en mujeres chilenas” GRANT # RO1 TW 006977. Se describen variables sociodemográficas y de consumo de sustancias a través de estadísticas descriptivas y se analiza la relación entre variables a través de pruebas de correlación. Resultados Los resultados indican un perfil sociodemográfico que sitúa a las mujeres en situación de vulnerabilidad frente al contagio de VIH/SIDA, con alto índice de uso de sustancias que acentúa el riesgo. Conclusiones Los hallazgos apuntan a la necesidad de considerar intervenciones que se enfoquen en la prevención de VIH en mujeres, abordando los riesgos asociados al consumo de sustancias. PMID:21197380

HOW TO EVALUATE SCIENTIFIC PRODUCTION.

PubMed

Antunes, Alberto Azoubel

2015-01-01

To conduct a critical analysis of the two main bibliometric indexes used by science: the impact factor and the H index. Research was conducted on PubMed using the keywords: impact factor, Bibliometrics and H index. The citations of articles tend to follow a curve in which the articles published in a given year increase sharply to a peak occurring between two and six years after its publication. From this peak citations decline over time. The analysis of the scientific merit should not be based on only in bibliometric measure, but in the association of various parameters. The impact factor and the H index is mainly based on the number of citations of scientific papers, and this parameter, although important, should not be used alone, nor overvalued in the evaluation of teaching merit. Realizar análise crítica dos dois principais índices bibliométricos utilizados pela ciência: o fator de impacto e o índice H. Foi realizada pesquisa no Pubmed utilizando as palavras-chave: impact factor, bibliometrics, H index. As citações dos artigos tendem a seguir uma curva em que os artigos publicados em determinado ano aumentam agudamente para um pico que ocorre entre dois e seis anos após sua publicação. A partir deste pico, as citações declinam ao longo do tempo. A análise do mérito científico não deve ser baseada em apenas uma medida bibliométrica, mas em associação de medidas. O FI e o índice H se baseiam fundamentalmente no número de citações dos artigos científicos, e este parâmetro, apesar de importante, não deve ser utilizado sozinho e tampouco supervalorizado na avaliação do mérito docente.

Medición de placas astrométricas obtenidas con el telescopio Astrográfico de La Plata

NASA Astrophysics Data System (ADS)

di Sisto, R. P.; Orellana, R.

El Observatorio de La Plata cuenta con un gran número de placas de asteroides y cometas obtenidas con el telescopio astrográfico, que cubren gran parte del cielo del hemisferio sur. En 1996 se recopilaron y clasificaron 2187 placas (Beca para estudiantes de la AAA 1996) de las cuales 2031 corresponden a asteroides. Los datos de cada placa se volcaron en una base de datos creada para facilitar su manejo y preservar la información. A partir de este trabajo se revisaron los MPC electrónicos y se identificaron aquellas placas de asteroides pertenecientes a nuestra base de datos cuyos resultados no fueron publicados en los mismos. De un total de 400 placas que no aparecían publicadas sobresalía un paquete constituído por 40 placas obtenidas en 1977. Estas últimas fueron reducidas utilizando las posiciones y movimientos propios de las estrellas de referencia obtenidas del catálogo SAO 2000 dadas para el sistema FK5. Las posiciones calculadas fueron enviadas y publicadas en los Minor Planet Circulars (MPC).

Violación del Principio de Equivalencia en Teorías con Dilatón de Cuerdas

NASA Astrophysics Data System (ADS)

Landau, S. J.; Sisterna, P. D.; Vucetich, H.

Se estudian las violaciones al Principio de Equivalencia en Teorías con Dilatón de Cuerdas. En estos modelos, algunas de las constantes fundamentales dependen del espacio y del tiempo. Se muestra que los experimentos de caída libre no tienen aún precisión como para poner límites a los parámetros de la teoría.

Presentación del estudio "Links" de hombres que tienes sexo con hombres en Buenos Aires, Argentina.

PubMed

Carballo-Diéguez, Alex; Avila, María M; Balán, Iván C; Marone, Rubén; Pando, María A; Barreda, Victoria

2011-03-01

Estudios previos en Buenos Aires reportaron altas prevalencias de HIV entre HSH, con valores que oscilan entre 9 y 14% durante casi 10 años de continuo testeo. El objetivo principal de este estudio fue la evaluación de factores relacionados al comportamiento de alto riesgo para transmisión del HIV entre HSH entre los que se incluyen el conocimiento y factores emocionales, socioculturales y ambientales. Por otro lado se realizó la estimación de prevalencia e incidencia de HIV utilizando RDS (Respondent Driven Sampling), así como la presencia de otras infecciones de transmisión sexual. Por último se evaluaron los hábitos de testeo para HIV indagando que factores facilitan o impiden su realización. El estudio constó de dos fases, en primer lugar una fase cualitativa y posteriormente una fase cuantitativa con una duración total de 4 años y medio. Durante la fase cualitativa se realizaron 44 entrevistas individuales en profundidad, 8 grupos focales y 10 observaciones etnográficas (hoteles, baños públicos ("teteras"), cines pornográficos, fiestas privadas, dark rooms y discotecas). Durante la fase cuantitativa del estudio se realizó el reclutamiento de 500 participantes que provinieron de la Ciudad Autónoma de Buenos Aires, así como del Gran Buenos Aires. El reclutamiento se comenzó con 16 participantes llamados semillas. Se realizó el diagnóstico de infección por HIV, hepatitis B y C (HBV y HCV), Treponema pallidum, Virus Papiloma Humano (HPV) y Chlamidias. La colaboración establecida entre los grupos de trabajo enfocados en áreas diversas posibilitó el abordaje conjunto de nuevas estrategias de investigación antes no exploradas en nuestro país. Los resultados más relevantes de esta investigación serán progresivamente publicados en sucesivos números de Actualizaciones en SIDA.

Identification of nucleotides in the 5'UTR and amino acids substitutions that are essential for the infectivity of 5'UTR-NS5A recombinant of hepatitis C virus genotype 1b (strain Con1).

PubMed

Li, Jinqian; Feng, Shengjun; Liu, Xi; Guo, Mingzhe; Chen, Mingxiao; Chen, Yiyi; Rong, Liang; Xia, Jinyu; Zhou, Yuanping; Zhong, Jin; Li, Yi-Ping

2018-05-01

Genotype 1b strain Con1 represents an important reference in the study of hepatitis C virus (HCV). Here, we aimed to develop an advanced infectious Con1 recombinant. We found that previously identified mutations A1226G/F1464L/A1672S/Q1773H permitted culture adaption of Con1 Core-NS5A (C-5A) recombinant containing 5'UTR and NS5B-3'UTR from JFH1 (genotype 2a), thus acquired additional mutations L725H/F886L/D2415G. C-5A containing all seven mutations (C-5A_7m) replicated efficiently in Huh7.5 and Huh7.5.1 cells and had an increased infectivity in SEC14L2-expressing Huh7.5.1 cells. Incorporation of Con1 NS5B was deleterious to C-5A_7m, however Con1 5'UTR was permissive but attenuated the virus. Nucleotides G1, A4, and G35 primarily accounted for the viral attenuation without affecting RNA translation. C-5A_7m was inhibited dose-dependently by simeprevir and daclatasvir, and substitutions at A4, A29, A34, and G35 conferred resistance to miR-122 antagonism. The novel Con1 5'UTR-NS5A recombinant, adaptive mutations, and critical nucleotides described here will facilitate future studies of HCV culture systems and virus-host interaction. Copyright © 2018 Elsevier Inc. All rights reserved.

Preparation of stimulus responsive multiple emulsions by membrane emulsification using con a as biochemical sensor.

PubMed

Piacentini, Emma; Drioli, Enrico; Giorno, Lidietta

2011-04-01

In this work, a novel strategy for the controlled fabrication of biomolecular stimulus responsive water-in-oil-in-water (W/O/W) multiple emulsion using the membrane emulsification process was investigated. The emulsions interface was functionalized with a biomolecule able to function as a receptor for a target compound. The interaction between the biomolecular receptor and target stimulus activated the release of bioactive molecules contained within the structured emulsion. A glucose sensitive emulsion was investigated as a model study case. Concanavalin A (Con A) was used as the biomolecular glucose sensor. Various physicochemical strategies for stimulus responsive materials formulation are available in literature, but the preparation of biomolecule-responsive emulsions has been explored for the first time in this paper. The development of novel drug delivery systems requires advanced and highly precise techniques to obtain their particular properties and targeting requirements. The present study has proven the flexibility and suitability of membrane emulsification for the preparation of stable and functional multiple emulsions containing Con A as interfacial biomolecular receptor able to activate the release of a bioactive molecule as a consequence of interaction with the glucose target molecule. The influence of emulsion interfacial composition and membrane emulsification operating conditions on droplets stability and functional properties have been investigated. The release of the bioactive molecule as a function of glucose stimulus and its concentration has been demonstrated. Copyright © 2010 Wiley Periodicals, Inc.

Is ACPA positivity the main driver for rheumatoid arthritis treatment? Pros and cons.

PubMed

Alivernini, Stefano; Galeazzi, Mauro; Peleg, Hagit; Tolusso, Barbara; Gremese, Elisa; Ferraccioli, Gianfranco; Naparstek, Yaakov

2017-11-01

Rheumatoid Arthritis (RA) is an autoimmune chronic disease that is characterized by the positivity of various antibodies, the most specific being autoantibodies against citrullinated antigens (ACPA). Despite ACPA are not arthritogenic by themselves, ACPA positive individuals have high risk of RA development and ACPA positivity is associated with severe erosive phenotype and higher mortality rate compared to seronegative RA. Moreover, ACPA status is associated with favorable response to biologics targeting pathways involving autoantibody producing cells as B lymphocytes. In the current review we have discussed the pros and cons on the available scientific evidences, regarding the diagnostic, prognostic and management implications of ACPAs in RA. Copyright © 2017 Elsevier B.V. All rights reserved.

What to consider when regulating electronic cigarettes: Pros, cons and unintended consequences.

PubMed

Caponnetto, Pasquale; Saitta, Daniela; Sweanor, David; Polosa, Riccardo

2015-06-01

Many public health experts, medical research societies, large health organizations and policy makers have expressed concerns about the increased popularity of electronic cigarettes and have pushed for more restrictive measures ranging from complete bans to tight regulations of these products either as medicines or as tobacco products. But these concerns have never been adequately qualified nor quantified. Without judicious assessment and thorough evaluation, regulations may have unintended consequences that can do more damage than good in public health terms. In this article, we will appraise the existing prominent regulatory frameworks for e-cigarettes, namely, general consumer product, medicinal product and tobacco product regulation, to highlight their pros and cons. Moreover, we provide concrete examples of the unintended consequences which may arise from inappropriate regulatory action. Copyright © 2015 Elsevier B.V. All rights reserved.

The pros and cons about the digital recording of Intangible Cultural Heritage and some strategies

NASA Astrophysics Data System (ADS)

Yang, H.

2015-08-01

Intangible Cultural Heritage (referred to as ICH), whose fundamental nature different from the tangible cultural heritage is "Intangible", and the related physical presence of the heritage is not the core content. Digital means have irreplaceable advantages in recording intangible and dynamic ICH resources, while it also needs flexible and rigorous recording means as a support, thus striving to maximize resources recording and protection. This article will focus on the pros and cons about the digital recording of ICH, and preliminarily discuss some strategies used in the process of recording.

Lesiones subcutáneas dolorosas en paciente con melanoma metastásico: un caso de paniculitis linfocítica asociado a vemurafenib.

PubMed

Benavente-Villegas, Felipe; Ferrando-Roca, Francisco; Dolz-Gaitón, Raquel; Royo-Peiró, María

2017-10-15

Vemurafenib ha probado ser una herramienta útil en el tratamiento de melanoma metastásico con mutación BRAF-V600E. Los efectos adversos incluyen artralgias, fatiga y toxicidad cutánea, siendo infrecuente la paniculitis. Presentamos el caso de una paciente de 43 años con melanoma metastásico que desarrolla lesiones subcutáneas dolorosas en miembros inferiores y superiores, asociadas a clínica sistémica después de 2 semanas de inicio de tratamiento con Vemurafenib + Cobimetinib. La histología demostró paniculitis linfocitaria septal y lobulillar. La paciente tuvo mala tolerancia al tratamiento anti diana a dosis plenas, requiriendo su ajuste, generando una corticodependencia para controlar sintomatología, y que finalmente obligó a la descontinuación de la terapia dirigida contra melanoma.  A la fecha, se han descrito 29 casos en la literatura de paniculitis asociada a vemurafenib, siendo la mayoría paniculitis neutrofílicas con adecuado control de sintomatología asociando antiinflamatorios no esteroidales y/o corticoides orales sin requerir en su mayoría modificación de la terapia contra melanoma; sin embargo hay que tener presente que pueden haber casos con mala evolución que obligan a la reducción de dosis de vemurafenib y descontinuar el tratamiento, como ha ocurrido en nuestro reporte.Vemurafenib has proven to be a useful tool in the treatment of metastatic melanoma with BRAF-V600E mutation. Adverse effects include arthralgia, fatigue, and skin toxicity; panniculitis is a rare complication. We present the case of a 43-year-old patient with metastatic melanoma who developed painful subcutaneous nodules of the lower and upper limbs and associated systemic clinical symptoms after 2 weeks of treatment with vemurafenib plus cobimetinib. Histology showed a septal and lobular lymphocytic panniculitis.The patient had poor tolerance of the full-dose treatment, requiring its adjustment. Systemic corticosteroids were required to control symptomatology

To share or not to share? Expected pros and cons of data sharing in radiological research.

PubMed

Sardanelli, Francesco; Alì, Marco; Hunink, Myriam G; Houssami, Nehmat; Sconfienza, Luca M; Di Leo, Giovanni

2018-06-01

The aims of this paper are to illustrate the trend towards data sharing, i.e. the regulated availability of the original patient-level data obtained during a study, and to discuss the expected advantages (pros) and disadvantages (cons) of data sharing in radiological research. Expected pros include the potential for verification of original results with alternative or supplementary analyses (including estimation of reproducibility), advancement of knowledge by providing new results by testing new hypotheses (not explored by the original authors) on pre-existing databases, larger scale analyses based on individual-patient data, enhanced multidisciplinary cooperation, reduced publication of false studies, improved clinical practice, and reduced cost and time for clinical research. Expected cons are outlined as the risk that the original authors could not exploit the entire potential of the data they obtained, possible failures in patients' privacy protection, technical barriers such as the lack of standard formats, and possible data misinterpretation. Finally, open issues regarding data ownership, the role of individual patients, advocacy groups and funding institutions in decision making about sharing of data and images are discussed. • Regulated availability of patient-level data of published clinical studies (data-sharing) is expected. • Expected benefits include verification/advancement of knowledge, reduced cost/time of research, clinical improvement. • Potential drawbacks include faults in patients' identity protection and data misinterpretation.

Pros and cons of vaccination against serogroup B meningococcal disease.

PubMed

Delgado Rodríguez, Miguel; Domínguez García, Ángela

2018-02-09

A vaccine has recently been approved in the EU against meningococcal serogroup B, the main cause of meningococcal disease. There is a fierce debate about the decision regarding a universal vaccination in infants older than 2 months, as recommended by the majority of scientific societies. In western Europe the only country to have included the universal vaccination is the United Kingdom, with a lower incidence of the disease than Ireland. Other countries have also adopted it, such as the Czech Republic, Cuba and certain regions of Italy. Numerous cost-effectiveness studies have been published regarding the vaccination with different assumptions, which have supported the decision not to implant the universal vaccination because it exceeds the will to pay for a health benefit. We discuss the pros and cons of the universal vaccination against meningococcal B, recommended by the Sociedad Española de Pediatría (Spanish Society of Paediatrics), which as yet has not been implemented. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report

PubMed Central

Manchia, Mirko; Adli, Mazda; Akula, Nirmala; Ardau, Raffaella; Aubry, Jean-Michel; Backlund, Lena; Banzato, Claudio EM.; Baune, Bernhard T.; Bellivier, Frank; Bengesser, Susanne; Biernacka, Joanna M.; Brichant-Petitjean, Clara; Bui, Elise; Calkin, Cynthia V.; Cheng, Andrew Tai Ann; Chillotti, Caterina; Cichon, Sven; Clark, Scott; Czerski, Piotr M.; Dantas, Clarissa; Zompo, Maria Del; DePaulo, J. Raymond; Detera-Wadleigh, Sevilla D.; Etain, Bruno; Falkai, Peter; Frisén, Louise; Frye, Mark A.; Fullerton, Jan; Gard, Sébastien; Garnham, Julie; Goes, Fernando S.; Grof, Paul; Gruber, Oliver; Hashimoto, Ryota; Hauser, Joanna; Heilbronner, Urs; Hoban, Rebecca; Hou, Liping; Jamain, Stéphane; Kahn, Jean-Pierre; Kassem, Layla; Kato, Tadafumi; Kelsoe, John R.; Kittel-Schneider, Sarah; Kliwicki, Sebastian; Kuo, Po-Hsiu; Kusumi, Ichiro; Laje, Gonzalo; Lavebratt, Catharina; Leboyer, Marion; Leckband, Susan G.; López Jaramillo, Carlos A.; Maj, Mario; Malafosse, Alain; Martinsson, Lina; Masui, Takuya; Mitchell, Philip B.; Mondimore, Frank; Monteleone, Palmiero; Nallet, Audrey; Neuner, Maria; Novák, Tomás; O’Donovan, Claire; Ösby, Urban; Ozaki, Norio; Perlis, Roy H.; Pfennig, Andrea; Potash, James B.; Reich-Erkelenz, Daniela; Reif, Andreas; Reininghaus, Eva; Richardson, Sara; Rouleau, Guy A.; Rybakowski, Janusz K.; Schalling, Martin; Schofield, Peter R.; Schubert, Oliver K.; Schweizer, Barbara; Seemüller, Florian; Grigoroiu-Serbanescu, Maria; Severino, Giovanni; Seymour, Lisa R.; Slaney, Claire; Smoller, Jordan W.; Squassina, Alessio; Stamm, Thomas; Steele, Jo; Stopkova, Pavla; Tighe, Sarah K.; Tortorella, Alfonso; Turecki, Gustavo; Wray, Naomi R.; Wright, Adam; Zandi, Peter P.; Zilles, David; Bauer, Michael; Rietschel, Marcella; McMahon, Francis J.

2013-01-01

Objective The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the “Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder” scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. Materials and Methods Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. Results Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). Conclusions We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study. PMID:23840348

Actitudes Éticas de los estudiantes y egresados en carrera de medicina con metodologías activas

PubMed Central

Novaes, Maria Rita Carvalho Garbi; Novaes, Luiz Carlos Garcez; Guilhem, Dirce; Stepke, Fernando Lolas; Silveira, Carla Cristina Costa; Komatsu, Ricardo Shoiti; Trindade, Eliane Mendonça Vilar; Guiotti, Murilo Galvão

2010-01-01

El presente estudio tiene por objeto desarrollar un diagnostico de la inserción integrada de la ética en la carrera de medicina brasileña con una metodología de aprendizaje basada en problemas y describir las percepciones de actitudes éticas de los estudiantes y egresados. El diseño metodológico es un estudio de caso, descriptivo y documental, con abordaje cualitativo y cuantitativo. La muestra de esta investigación ha sido constituida por 120 estudiantes y 40 egresados de dos promociones del Curso de Medicina de la ESCS. Este proyecto fue aprobado por el Comité de Ética en Investigación - SES/DF. Los estudiantes y egresados de la ESCS demostraron un buen manejo en el abordaje de los conflictos éticos y respeto a los pacientes. Sin embargo, el análisis de sensibilidad ética mostró una fragilidad en las percepciones y aptitudes inapropiadas de los estudiantes de la carrera de medicina, identificada básicamente en los años iniciales, que necesitan más discusiones sistematizadas sobre los aspectos éticos y bioéticos integrados a las actividades prácticas para estimular y fortalecer la reflexión ética de los estudiantes. PMID:20981242

JPRS Report, West Europe, Reference Aid, Acronyms and Abbreviations of Portugal

DTIC Science & Technology

1988-09-02

Internacional, Ltd. AML Auto Metralhadora Ligeira AN Assembleia Nacional ANA Aeroportos e Navegacao Aerea ANASD ^ Associacao Nacional dos...de Informacoes ANIC ^ Associacao Nacional dos Industriais de Conservas ANIMEE Associac’ao Nacional dos Industriais de Material Electrico e...Produtos Electricos SIPIP ^ Servico de Informacao Previa ao Investidor Potencial SIRP ^ Sistema de Informac’oes da Repüblica Portuguesa SIS

Presentación del estudio “Links” de hombres que tienes sexo con hombres en Buenos Aires, Argentina

PubMed Central

Carballo-Diéguez, Alex; Ávila, María M; Balán, Iván C.; Marone, Rubén; Pando, María A.; Barreda, Victoria

2011-01-01

Resumen Estudios previos en Buenos Aires reportaron altas prevalencias de HIV entre HSH, con valores que oscilan entre 9 y 14% durante casi 10 años de continuo testeo. El objetivo principal de este estudio fue la evaluación de factores relacionados al comportamiento de alto riesgo para transmisión del HIV entre HSH entre los que se incluyen el conocimiento y factores emocionales, socioculturales y ambientales. Por otro lado se realizó la estimación de prevalencia e incidencia de HIV utilizando RDS (Respondent Driven Sampling), así como la presencia de otras infecciones de transmisión sexual. Por último se evaluaron los hábitos de testeo para HIV indagando que factores facilitan o impiden su realización. El estudio constó de dos fases, en primer lugar una fase cualitativa y posteriormente una fase cuantitativa con una duración total de 4 años y medio. Durante la fase cualitativa se realizaron 44 entrevistas individuales en profundidad, 8 grupos focales y 10 observaciones etnográficas (hoteles, baños públicos (“teteras”), cines pornográficos, fiestas privadas, dark rooms y discotecas). Durante la fase cuantitativa del estudio se realizó el reclutamiento de 500 participantes que provinieron de la Ciudad Autónoma de Buenos Aires, así como del Gran Buenos Aires. El reclutamiento se comenzó con 16 participantes llamados semillas. Se realizó el diagnóstico de infección por HIV, hepatitis B y C (HBV y HCV), Treponema pallidum, Virus Papiloma Humano (HPV) y Chlamidias. La colaboración establecida entre los grupos de trabajo enfocados en áreas diversas posibilitó el abordaje conjunto de nuevas estrategias de investigación antes no exploradas en nuestro país. Los resultados más relevantes de esta investigación serán progresivamente publicados en sucesivos números de Actualizaciones en SIDA. PMID:25264397

U.S. Navy In-House Cost Estimates for CITA: Operations Overhead

DTIC Science & Technology

1980-06-01

sector as it specifically relates t o Government contractors using the Cost Accounting Standar ds Board ’s criteria, and DD " 0 ".. 1~73 I JAN 71...34’-• • • • • a.AII l as required by the OMB Circular A-76. The Navy’s accounting systems, as they relate to the collection of expenses for cost ...used by other nonprofit organizations, by the private sector as it specifically relates to Government contractors using the Cost Accounting

SSRI Effects on Psychomotor Performance: Assessment of Citalopram and Escitalopram on Normal Subjects

DTIC Science & Technology

2007-07-01

RESEARCH ARTICLE SSRI Effects on Pyschomotor Performance: Assessment of Citalopram and Escitalopram on Normal Subjects MICHEL A. PAUL, GARY W... escitalopram 011 nomral subjects. Aviat Space Environ Med 2007; 78:693-7. Introduction: Standard aeromedical doctrine dictates that aircrew...noradrenaline and dopamine reuptake inhibi- tor). This study was undertaken to determine whether or not cita lopram or escitalopram affect psychomotor

Overlap corrections for emissivity calculations of H2O-CO2-CO-N2 mixtures

NASA Astrophysics Data System (ADS)

Alberti, Michael; Weber, Roman; Mancini, Marco

2018-01-01

Calculations of total gas emissivities of gas mixtures containing several radiatively active species require corrections for band overlapping. In this paper, we generate such overlap correction charts for H2O-CO2-N2, H2O-CO-N2, and CO2-CO-N2 mixtures. These charts are applicable in the 0.1-40 bar total pressure range and in the 500 K-2500 K temperature range. For H2O-CO2-N2 mixtures, differences between our charts and Hottel's graphs as well as models of Leckner and Modak are highlighted and analyzed.

Lesbian (in)visibility in Italian Renaissance culture: Diana and other cases of donna con donna.

PubMed

Simons, P

1994-01-01

Current conceptualizations of sexual identity in the West are not necessarily useful to an historian investigating "lesbianism" in the social history and visual representations of different periods. After an overview of Renaissance documents treating donna con donna relations which examines the potentially positive effects of condemnation and silence, the paper focuses on Diana, the goddess of chastity, who bathed with her nymphs as an exemplar of female bodies preserved for heterosexual, reproductive pleasures. Yet the self-sufficiency and bodily contact sometimes represented in images of this secluded all-female gathering might suggest "deviant" responses from their viewers.

[Obstetric hysterectomy. Incidence, indications and complications].

PubMed

Vázquez, Juan A Reveles; Rivera, Geannyne Villegas; Higareda, Salvador Hernández; Páez, Fernando Grover; Vega, Carmen C Hernández; Segura, Agustin Patiño

2008-03-01

Obstetric hysterectomy is indicated when patient's life is at risk, and it is a procedure that requires a highly experienced and skilled medical team to solve any complication. To identify incidence, indications, and complications of obstetric hysterectomy within a high-risk population. Transversal, retrospective study from July 1st 2004 to June 30 2006 at Unidad Medica de Alta Especialidad, Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, IMSS. There were reviewed 103 patient' files with obstetric hysterectomy. Incidence was calculated, and clinical and socio-demographic characteristics, indications, and complications of obstetric hysterectomy identified and expressed in frequency, percentages, and central tendency measurements. Incidence of obstetric hysterectomy was 8 cases within every 1,000 obstetric consultation. Age average was 31.1 +/- 5.1 years. 72.8% had cesarean surgery history. Main indication was placenta previa associated with placenta accreta (33%), followed by uterine hypotony (22.3%). Complications were hypovolemic shock (56.3%), and vesical injuries (5.8%). There were no maternal deaths. Cesarean history induces higher obstetric hysterectomy incidence in women with high-risk pregnancy, due to its relation to placentation disorders, as placenta previa that increases hemorrhage possibility, and thus, maternal morbidity and mortality.

Can venous ProBNP levels predict placenta accreta?

PubMed

Ersoy, Ali Ozgur; Oztas, Efser; Ozler, Sibel; Ersoy, Ebru; Erkenekli, Kudret; Uygur, Dilek; Caglar, Ali Turhan; Danisman, Nuri

2016-12-01

Placenta previa (PP) is a potential life-threatening pregnancy complication. Pro-brain natriuretic peptide (ProBNP), creatine kinase (CK), cardiac form of CK (CK-MB) and Troponin I are circulatory biomarkers related to cardiac functions. We aimed to determine whether these biomarkers are related to PP and placenta accreta. In this case-control study, fifty-four pregnant women who attended our tertiary care center for perinatology with the diagnosis of PP totalis, and of them, 14 patients with placenta accreta were recruited as the study groups. Forty-six uncomplicated control patients who were matched for age, BMI were also included. Maternal venous ProBNP, CK, CK-MB and Troponin I levels were compared between the three groups. Obstetric history characteristics were comparable among groups, generally. CK and CK-MB levels were similar among three groups. Troponin I levels in the previa and accreta groups were significantly higher than the controls. ProBNP levels in the accreta group were significantly higher than other two groups. The multivariate regression model revealed that ProBNP could predict placental adhesion anomalies. Troponin I and ProBNP levels in PP cases were higher than controls and ProBNP could predict placenta accreta.

Obstetric hysterectomy: a 14-year experience of Rajavithi Hospital 1989-2002.

PubMed

Kovavisarach, Ekachai

2006-11-01

To review and compare the incidence rate of obstetric hysterectomised patients between two seven-year periods. Theperiods were from October 1, 1988 to September 30, 1995 andfrom October P', 1995 to September 30th, 2002. The data included demographic characteristics, indications, possible risk factors, complications, and operative managements. Retrospective analysis of the data that was collected from medical and labor records of the obstetric hysterectomised patientsfrom October 1, 1995 to September 30, 2002, the second seven-year period, compared with those in Pratumthong and Wattanaruangkowit's study from October 1, 1988 to September 30, 1995, the first seven-year period. Between 1998 and 2002, there were 201, 696 total deliveries with 111 obstetric hysterectomies. A significant increase in the average incidence rate of hysterectomy from 0.42 to 0.76/1000 deliveries and maternal age, placenta previa and blood transfusion in the second period compared with the first period (p < 0.05). Postoperative complications and the other risk factors of obstetric hysterectomy were not significant difference. The present study of obstetric hysterectomy demonstrates a significant increase in the incidence of hysterectomised rate, maternal age, blood transfusion, and placenta previa in the second period compared with the first period.

Synthesis, growth, structural, spectral, thermal, chemical etching, linear and nonlinear optical and mechanical studies of an organic single crystal 4-chloro 4-nitrostilbene (CONS): a potential NLO material.

PubMed

Dinakaran, Paul M; Kalainathan, S

2013-07-01

4-Chloro 4-nitrostilbene (CONS) a new organic nonlinear optical material has been synthesized. Employing slow evaporation method, good optical quality single crystals (dimensions up to 6×2×3 mm(3)) have been grown using ethyl methyl ketone (EMK) as a solvent. The grown crystals have been subjected to various characterizations such as single crystal X-ray diffraction, powder XRD, Fourier Transform Infrared spectroscopy (FTIR), proton NMR, solid UV absorption, SHG studies. Single crystal X-ray diffraction reveals that the crystal system belongs to monoclinic with noncentrosymmetric space group P21. The UV-Vis absorption spectrum has been recorded and found that the cut off wavelength is 380 nm. Functional groups and the structure of the title compound have been confirmed by FTIR and (1)H NMR spectroscopic analyses respectively. Molecular mass of the CONS confirmed by the high resolution mass spectral analysis .The thermal behavior of the grown crystal has been studied by TG/DTA analysis and it shows the melting point is at 188.66 °C. Dislocations and growth pattern present in the grown crystal revealed by the etching study. The mechanical strength of the CONS crystal has been studied by Vicker's hardness measurement. The SHG efficiency of the grown crystal has been determined by Kurtz and Perry powder test which revealed that the CONS crystal (327 mV) has 15 times greater efficiency than that of KDP (21.7 mV). Copyright © 2013 Elsevier B.V. All rights reserved.

CON4EI: Selection of the reference chemicals for hazard identification and labelling of eye irritating chemicals.

PubMed

Adriaens, E; Alépée, N; Kandarova, H; Drzewieckac, A; Gruszka, K; Guest, R; Willoughby, J A; Verstraelen, S; Van Rompay, A R

2017-10-01

Assessment of the acute eye irritation potential is part of the international regulatory requirements for testing of chemicals. In the past, several prospective and retrospective validation studies have taken place in the area of serious eye damage/eye irritation testing. Success in terms of complete replacement of the regulatory in vivo Draize rabbit eye test has not yet been achieved. A very important aspect to ensure development of successful alternative test methods and/or strategies for serious eye damage/eye irritation testing is the selection of appropriate reference chemicals. A set of 80 reference chemicals was selected for the CEFIC-LRI-AIMT6-VITO CON4EI (CONsortium for in vitro Eye Irritation testing strategy) project, in collaboration with Cosmetics Europe, from the Draize Reference Database published by Cosmetics Europe based on key criteria that were set in their paper (e.g. balanced by important driver of classification and physical state). The most important goals of the CON4EI project were to identify the performance of eight in vitro alternative tests in terms of driver of classification and to identify similarities/differences between the methods in order the build a successful testing strategy that can discriminate between all UN GHS categories. This paper provides background on selection of the test chemicals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cervical Length in Patients at Risk for Placenta Accreta.

PubMed

Rac, Martha W F; McIntire, Donald D; Wells, C Edward; Moschos, Elysia; Twickler, Diane D

2017-07-01

To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth. We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used. A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n = 43 [34%]) and without (n = 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32- to 34-week ultrasound examinations (mean ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P = .001). However, these findings did not correlate with the degree of invasion (P = .3), or higher rates of vaginal bleeding and preterm labor (P = .19) resulting in preterm birth before 36 weeks (P = .64). Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks. © 2017 by the American Institute of Ultrasound in Medicine.

Pros, Cons, and Alternatives to Weight Based Cost Estimating

NASA Technical Reports Server (NTRS)

Joyner, Claude R.; Lauriem, Jonathan R.; Levack, Daniel H.; Zapata, Edgar

2011-01-01

Many cost estimating tools use weight as a major parameter in projecting the cost. This is often combined with modifying factors such as complexity, technical maturity of design, environment of operation, etc. to increase the fidelity of the estimate. For a set of conceptual designs, all meeting the same requirements, increased weight can be a major driver in increased cost. However, once a design is fixed, increased weight generally decreases cost, while decreased weight generally increases cost - and the relationship is not linear. Alternative approaches to estimating cost without using weight (except perhaps for materials costs) have been attempted to try to produce a tool usable throughout the design process - from concept studies through development. This paper will address the pros and cons of using weight based models for cost estimating, using liquid rocket engines as the example. It will then examine approaches that minimize the impct of weight based cost estimating. The Rocket Engine- Cost Model (RECM) is an attribute based model developed internally by Pratt & Whitney Rocketdyne for NASA. RECM will be presented primarily to show a successful method to use design and programmatic parameters instead of weight to estimate both design and development costs and production costs. An operations model developed by KSC, the Launch and Landing Effects Ground Operations model (LLEGO), will also be discussed.

Con-Text: Text Detection for Fine-grained Object Classification.

PubMed

Karaoglu, Sezer; Tao, Ran; van Gemert, Jan C; Gevers, Theo

2017-05-24

This work focuses on fine-grained object classification using recognized scene text in natural images. While the state-of-the-art relies on visual cues only, this paper is the first work which proposes to combine textual and visual cues. Another novelty is the textual cue extraction. Unlike the state-of-the-art text detection methods, we focus more on the background instead of text regions. Once text regions are detected, they are further processed by two methods to perform text recognition i.e. ABBYY commercial OCR engine and a state-of-the-art character recognition algorithm. Then, to perform textual cue encoding, bi- and trigrams are formed between the recognized characters by considering the proposed spatial pairwise constraints. Finally, extracted visual and textual cues are combined for fine-grained classification. The proposed method is validated on four publicly available datasets: ICDAR03, ICDAR13, Con-Text and Flickr-logo. We improve the state-of-the-art end-to-end character recognition by a large margin of 15% on ICDAR03. We show that textual cues are useful in addition to visual cues for fine-grained classification. We show that textual cues are also useful for logo retrieval. Adding textual cues outperforms visual- and textual-only in fine-grained classification (70.7% to 60.3%) and logo retrieval (57.4% to 54.8%).

Development of a heptaplex PCR assay for identification of Staphylococcus aureus and CoNS with simultaneous detection of virulence and antibiotic resistance genes.

PubMed

Okolie, Charles Emeka; Wooldridge, Karl G; Turner, David P J; Cockayne, Alan; James, Richard

2015-08-05

Staphylococcal toxicity and antibiotic resistance (STAAR) have been menacing public health. Although vancomycin-resistant Staphylococcus aureus (VRSA) is currently not as widespread as methicillin-resistant S. aureus (MRSA), genome evolution of MRSA into VRSA, including strains engineered within the same patient under anti-staphylococcal therapy, may build up to future public health concern. To further complicate diagnosis, infection control and anti-microbial chemotherapy, non-sterile sites such as the nares and the skin could contain both S. aureus and coagulase-negative staphylococci (CoNS), either of which could harbour mecA the gene driving staphylococcal methicillin-resistance and required for MRSA-VRSA evolution. A new heptaplex PCR assay has been developed which simultaneously detects seven markers for: i) eubacteria (16S rRNA), ii) Staphylococcus genus (tuf), iii) Staphylococcus aureus (spa), iv) CoNS (cns), v) Panton-Valentine leukocidin (pvl), vi) methicillin resistance (mecA), and vii) vancomycin resistance (vanA). Following successful validation using 255 reference bacterial strains, applicability to analyse clinical samples was evaluated by direct amplification in spiked blood cultures (n = 89) which returned 100 % specificity, negative and positive predictive values. The new assay has LoD of 1.0x10(3) CFU/mL for the 16S rRNA marker and 1.0x10(4) CFU/mL for six other markers and completes cycling in less than one hour. The speed, sensitivity (100 %), NPV (100 %) and PPV (100 %) suggest the new heptaplex PCR assay could be easily integrated into a routine diagnostic microbiology workflow. Detection of the cns marker allows for unique identification of CoNS in mono-microbial and in poly-microbial samples containing mixtures of CoNS and S. aureus without recourse to the conventional elimination approach which is ambiguous. In addition to the SA-CoNS differential diagnostic essence of the new assay, inclusion of vanA primers will allow

The new human papillomavirus (HPV) vaccine: pros and cons for pediatric and adolescent health.

PubMed

Thomas, Tami L

2008-01-01

The new human papillomavirus (HPV) vaccine is a research breakthrough for pediatric/adolescent health to prevent cervical cancer and related morbidity. The annual heath care cost for the treatment of cervical cancer and genital warts is estimated to be more than three billion dollars a year. The new HPV vaccine has incredible potential to improve reproductive health promotion, reduce health care costs, and close health care disparity gaps. However, issues both for and against the new HPV vaccine, including mandating vaccination, high cost of the vaccine, the short duration of protection offered, and the perceived promotion of sexual activity, cause confusion. Pediatric nurses, including those in advanced practice, benefit by understanding the pros and cons of these issues in advocating for their patients.

Maternal Factors Influencing Perinatal Transmission of HIV Infection

DTIC Science & Technology

1990-01-01

PET Chronic hypertension Eclampsia 17. IUGR 17. 18. Preterm Labor 18. 19. 3rd Trimester Bleeding 19. a) Placenta Previa b) Abruptio Placenta 20...Obstetrics/Gynecology, and laboratory procedures including those for maternal/neonatal drug screening and for handling and processing tissue ( placenta ...amniocentesis Is n done as a part of this study. After delivery, the placenta (afterbirth) will be examined for evidence of HIV infection (AIDS virus). Blood

Probabilidad de colisión de cometas periódicos con partículas interplanetarias

NASA Astrophysics Data System (ADS)

Gil Hutton, R.

Se presentan resultados sobre la probabilidad de colisión de cometas de corto período con la población de partículas interplanetarias presentes en la región del cinturón de asteroides. Se encuentra que este proceso colisional afecta la evolución física de los cometas de manera no despreciable y puede ser el responsable de variaciones de brillo de tipo ``outburst". Se presentan resultados para algunos cometas en particular y se obtiene un límite inferior para el tamaño de los núcleos en función de la distribución de radios del cinturón de asteroides.

Economic and Ethical Consequences of Natural Hazards in Alpine Valleys (EE-Con)

NASA Astrophysics Data System (ADS)

Ortner, Florian; Brantl, Dirk; Meyer, Lukas; Steininger, Karl; Sass, Oliver

2015-04-01

The Alps and their population are particularly vulnerable to geomorphological and hydrological hazards and this problem might be amplified by ongoing climate change. Natural disasters cause severe monetary damage which often leads to the difficult question whether it socially pays to protect settlements at high costs or whether alternatively settlement areas should better be abandoned. By investigations in the Johnsbachtal and the Kleinsölktal (Styria), the interdisciplinary project "Economic and Ethical Consequences of Natural Hazards in Alpine Valleys" (EE-Con), funded by the Austrian Academy of Sciences, seeks to answer the following questions: (1) Are natural hazards and associated damages in fact increasing, and is this due to meteorological triggers, to anthropogenic factors or to internal process dynamics? (2) What is the perception and knowledge of local people, how is risk and risk prevention communicated? (3) What is the respective cost ratio between protection infrastructure, soft measures of adaptation and other options (e.g. reduction of settlement area)? (4) What legitimate claims to compensation do people have, how far does societal responsibility go and where does individual responsibility start if parts of the settlement area had to be abandoned? These questions will be tackled in an interdisciplinary cooperation between geography, economics and normative theory (philosophy). EE-Con will follow broadly the path of risk analysis and risk assessment, focusing on the temporal dimension (past - present - future) with the aim to unravel the history of natural hazards in the areas and to analyse the economic values involved. In the following, natural hazard scenarios for the future (2050 and 2100) will be developed considering the economic consequences. Besides this, the project deals with local knowledge, risk perception and risk communication, which will be investigated via group interviews and stakeholder workshops and be integrated into a human

Future of clip-on weapon sights: pros and cons from an applications perspective

NASA Astrophysics Data System (ADS)

Knight, C. Reed; Greenslade, Ken; Francisco, Glen

2015-05-01

US Domestic, International, allied Foreign National Warfighters and Para-Military First Responders (Police, SWAT, Special Operations, Law Enforcement, Government, Security and more) are put in harm's way all the time. To successfully complete their missions and return home safely are the primary goals of these professionals. Tactical product improvements that affect mission effectiveness and solider survivability are pivotal to understanding the past, present and future of Clip-On in-line weapon sights. Clip-On Weapon Sight (WS) technology was deemed an interim solution by the US Government for use until integrated and fused (day/night multi-sensor) Weapon Sights (WSs) were developed/fielded. Clip-On has now become the solution of choice by Users, Warriors, Soldiers and the US Government. SWaP-C (size, weight and power -cost) has been improved through progressive advances in Clip-On Image Intensified (I2), passive thermal, LL-CMOS and fused technology. Clip-On Weapon Sights are now no longer mounting position sensitive. Now they maintain aim point boresight, so they can be used for longer ranges with increased capabilities while utilizing the existing zeroed weapon and daysight optic. Active illuminated low-light level (both analog I2 and digital LL-CMOS) imaging is rightfully a real-world technology, proven to deliver daytime and low-light level identification confidence. Passive thermal imaging is also a real-world technology, proven to deliver daytime, nighttime and all-weather (including dirty battlefield) target detection confidence. Image processing detection algorithms with intelligent analytics provide documented promise to improve confidence by reducing Users, Warriors and Soldiers' work-loads and improving overall system engagement solution outcomes. In order to understand the future of Clip-On in-line weapon sights, addressing pros and cons, this paper starts with an overview of historical weapon sight applications, technologies and stakeholder decisions

Fuentes de variabilidad en el diagnóstico de gastritis atrófica multifocal asociada con la infección por Helicobacter pylori1

PubMed Central

Bravo, Luis Eduardo; Bravo, Juan Carlos; Realpe, José Luis; Zarama, Guillermo; Piazuelo, MarÍa Blanca; Correa, Pelayo

2014-01-01

RESUMEN Introducción El mapeo de las diferentes regiones del estómago y el número de fragmentos de mucosa gástrica disponibles para evaluación histopatológica son fuentes importantes de variación en el momento de clasificar y hacer la gradación de la gastritis crónica. Objetivos Estimar la sensibilidad del número de fragmentos de mucosa gástrica necesarios para establecer los diagnósticos de gastritis atrófica con metaplasia intestinal (MI), displasia y estado de infección por Helicobacter pylori. Además evaluar la variabilidad intra-observador en la clasificación de estas lesiones precursoras del cáncer gástrico. Materiales y métodos En una cohorte de 6 años de seguimiento se evaluaron 1,958 procedimientos de endoscopia realizados por dos gastroenterólogos. En cada procedimiento y de cada participante se obtuvieron 5 biopsias de mucosa gástrica que representaban antro, incisura angularis y cuerpo. Un único patólogo hizo la interpretación histológica de las 5 biopsias y proporcionó un diagnóstico definitivo global que se utilizó como patrón de referencia. Cada fragmento de mucosa gástrica examinado condujo a un diagnóstico individual para cada biopsia que se comparó con el patrón de referencia. La variabilidad intra-observador se evaluó en 127 personas que corresponden a una muestra aleatoria de 20% del total de endoscopias hechas a los 72 meses de seguimiento. Resultados La sensibilidad del diagnóstico de MI y displasia gástrica aumentó de manera significativa con el número de fragmentos de mucosa gástrica evaluados El sitio anatómico de mayor sensibilidad para el diagnóstico de MI y displasia fue la incisura angularis. Para descubrir H. pylori se logró alta sensibilidad con el estudio de un solo fragmento de mucosa gástrica (95.9%) y fue independiente del sitio de obtención de la biopsia. El acuerdo intra-observador para el diagnóstico de gastritis crónica fue 86.1% con valor kappa de 0.79 IC 95% (0.76-0.85). Las

Nest destruction elicits indiscriminate con- versus heterospecific brood parasitism in a captive bird.

PubMed

Shaw, Rachael C; Feeney, William E; Hauber, Mark E

2014-12-01

Following nest destruction, the laying of physiologically committed eggs (eggs that are ovulated, yolked, and making their way through the oviduct) in the nests of other birds is considered a viable pathway for the evolution of obligate interspecific brood parasitism. While intraspecific brood parasitism in response to nest predation has been experimentally demonstrated, this pathway has yet to be evaluated in an interspecific context. We studied patterns of egg laying following experimental nest destruction in captive zebra finches, Taeniopygia guttata, a frequent intraspecific brood parasite. We found that zebra finches laid physiologically committed eggs indiscriminately between nests containing conspecific eggs and nests containing heterospecific eggs (of Bengalese finches, Lonchura striata vars. domestica), despite the con- and heterospecific eggs differing in both size and coloration. This is the first experimental evidence that nest destruction may provide a pathway for the evolution of interspecific brood parasitism in birds.

ACR appropriateness Criteria® second and third trimester bleeding.

PubMed

Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

2013-12-01

Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Grey-scale and colour Doppler ultrasound versus magnetic resonance imaging for the prenatal diagnosis of placenta accreta.

PubMed

Rezk, Mohamed Abd-Allah; Shawky, Mohamed

2016-01-01

To assess the effectiveness of grey-scale and colour Doppler ultrasound (US) versus magnetic resonance imaging (MRI) for the prenatal diagnosis of placenta accreta. A prospective observational study including a total of 74 patients with placenta previa and previous uterine scar (n = 74). Grey-scale and colour Doppler US was done followed by MRI by different observers to diagnose adherent placenta. Test validity of US and MRI were calculated. Maternal morbidity and mortality were also assessed. A total of 53 patients confirmed to have placenta accreta at operation. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US was 94.34, 91.67, 96.15 and 88% compared to 96.08, 87.50, 94.23 and 91.3% for MRI, respectively. The most relevant US sign was turbulent blood flow by colour Doppler, while dark intra-placental band was the most sensitive MRI sign. Venous thromboembolism (1.3%), bladder injury (29.7%), ureteric injury (18.9%), postoperative fever (10.8%), admission to ICU (50%) and re-operation (31.1%). Placenta accreta can be successfully diagnosed by grey-scale and colour Doppler US. MRI would be more likely suggested for either posteriorly or laterally situated placenta previa in order to exclude placental invasion.

Cámara CCD Directa con el Telescopio de 2.15 m del CASLEO: algunos diagnósticos

NASA Astrophysics Data System (ADS)

Cellone, S. A.

Se efectuaron algunas pruebas con la cámara CCD (+ Reductor Focal) instalada en el foco Cassegrain del Telescopio de 2.15 m del Complejo Astronómico El Leoncito (CASLEO). Las conclusiones más significativas son: Los tiempos de exposición efectivos difieren de los nominales en una fracción apreciable de segundo. En exposiciones de menos de 3 segundos, la iluminación no es pareja en todo el detector. En consecuencia, se recomiendan los pasos a seguir por los astrónomos tanto durante la observación como en la reducción de sus datos.

Inversor Resonante de Tres Elementos L-LC con Caracteristica Cortocircuitable para Aplicaciones de Calentamiento por Induccion

NASA Astrophysics Data System (ADS)

Espi Huerta, Jose Miguel

Los generadores de calentamiento por induccion son puentes inversores con carga resonante, cuya mision es basicamente crear una corriente sinusoidal de gran amplitud sobre la "bobina de caldeo", que forma parte del tanque resonante. En el interior de esta bobina se introduce la pieza que se desea calentar. EI campo magnetico creado induce corrientes superficiales (corrientes de Foucault) sobre la pieza, que producen su calentamiento. Los tanques resonantes (tambien llamados osciladores) utilizados en la actualidad son el resonante serie y el resonante paralelo. Aunque ya desde hace algun tiempo se vienen construyendo generadores de alta potencia basados en estos dos osciladores, el exito nunca ha. sido completo en ninguno de los dos casos. Tal y como se explica en la introduccion de esta memoria, los puentes inversores utilizados deben operar sobre una carga inductiva (corriente retrasada) para evitar el fenomeno de la recuperacion inversa de sus diodos y la consiguiente ruptura de los transistores. De la restriccion topologica anterior se deduce que el generador paralelo debe conmutar a frecuencias inferiores a la resonancia, y el serie a frecuencias superiores. A esta restriccion topologica hay que unir otra que es exclusiva del calentamiento por induccion: La corriente por la bobina de caldeo debe ser sinusoidal. De no ser asi, resultaria imposible disponer toda la potencia de calentamiento sobre la pieza en el espesor requerido por la aplicacion. Como consecuencia, los inversores no pueden operar por debajo de la frecuencia de resonancia del oscilador, pues en ese caso se amplifican los armonicos de orden superior de la tension/corriente de entrada situados sobre la resonancia, con la consiguiente distorsion de la corriente de salida. La conjuncion de las dos restricciones anteriores obligan al inversor paralelo a funcionar a la frecuencia de resonancia del oscilador. Esto imposibilita un control por variacion de frecuencia, regulandose la potencia desde la

Potential pros and cons of external healthcare performance evaluation systems: real-life perspectives on Iranian hospital evaluation and accreditation program

PubMed Central

Jaafaripooyan, Ebrahim

2014-01-01

Background: Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. Methods: A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Results: Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs’ over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Conclusion: Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs. PMID:25279381

Potential pros and cons of external healthcare performance evaluation systems: real-life perspectives on Iranian hospital evaluation and accreditation program.

PubMed

Jaafaripooyan, Ebrahim

2014-09-01

Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs' over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs.

Reprint of "CON4EI: Selection of the reference chemicals for hazard identification and labelling of eye irritating chemicals".

PubMed

Adriaens, E; Alépée, N; Kandarova, H; Drzewieckac, A; Gruszka, K; Guest, R; Willoughby, J A; Verstraelen, S; Van Rompay, A R

2018-06-01

Assessment of the acute eye irritation potential is part of the international regulatory requirements for testing of chemicals. In the past, several prospective and retrospective validation studies have taken place in the area of serious eye damage/eye irritation testing. Success in terms of complete replacement of the regulatory in vivo Draize rabbit eye test has not yet been achieved. A very important aspect to ensure development of successful alternative test methods and/or strategies for serious eye damage/eye irritation testing is the selection of appropriate reference chemicals. A set of 80 reference chemicals was selected for the CEFIC-LRI-AIMT6-VITO CON4EI (CONsortium for in vitro Eye Irritation testing strategy) project, in collaboration with Cosmetics Europe, from the Draize Reference Database published by Cosmetics Europe based on key criteria that were set in their paper (e.g. balanced by important driver of classification and physical state). The most important goals of the CON4EI project were to identify the performance of eight in vitro alternative tests in terms of driver of classification and to identify similarities/differences between the methods in order the build a successful testing strategy that can discriminate between all UN GHS categories. This paper provides background on selection of the test chemicals. Copyright © 2018. Published by Elsevier Ltd.

International Criminal Court Cases in Africa: Status and Policy Issues

DTIC Science & Technology

2009-07-14

court, such as the one established for Sierra Leone.31 These courts and tribunals are distinct from the ICC. International Court of Justice The...African International Courts and Tribunals” website, at http://www.aict-cita.org. 31 The Special Court for Sierra Leone (SCSL), a hybrid international...domestic court based in Sierra Leone’s capital, Freetown, was set up jointly by the Government of Sierra Leone and the United Nations under Security

OMB A-76: Full Costing and Its Impact at Installation Level within the U.S. Army.

DTIC Science & Technology

1980-09-01

United States Army B.S., United States Military Academy, 1972 Submitted in partial fulfillment of the requirements for the degree of -- MASTER OF SCIENCE...65 F. PRIVATE INDUSTRY AND GOVERNMENT CONTRACTS ----- 67 G. FULL COSTING AND THE OMB CCH OVERHEAD POOLS --- 69 H. OMB A-76 ELEMENTS OF COST...analysis prepared in accordance with OMB A-76 and the supplementing Cost Comparison Handbook (OMB CCH ) prior to in-house performance of a CITA function

The beliefs about pros and cons of drinking and intention to change among hazardous and moderate alcohol users: a population-based cross-sectional study.

PubMed

Ansker, Fredrik G; Helgason, Asgeir R; Ahacic, Kozma

2014-08-01

Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users. Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05). Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships. Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

Pros and cons of the liposome platform in cancer drug targeting.

PubMed

Gabizon, Alberto A; Shmeeda, Hilary; Zalipsky, Samuel

2006-01-01

Coating of liposomes with polyethylene-glycol (PEG) by incorporation in the liposome bilayer of PEG-derivatized lipids results in inhibition of liposome uptake by the reticulo-endothelial system and significant prolongation of liposome residence time in the blood stream. Parallel developments in drug loading technology have improved the efficiency and stability of drug entrapment in liposomes, particularly with regard to cationic amphiphiles such as anthracyclines. An example of this new generation of liposomes is a formulation of pegylated liposomal doxorubicin known as Doxil or Caelyx, whose clinical pharmacokinetic profile is characterized by slow plasma clearance and small volume of distribution. A hallmark of these long-circulating liposomal drug carriers is their enhanced accumulation in tumors. The mechanism underlying this passive targeting effect is the phenomenon known as enhanced permeability and retention (EPR) which has been described in a broad variety of experimental tumor types. Further to the passive targeting effect, the liposome drug delivery platform offers the possibility of grafting tumor-specific ligands on the liposome membrane for active targeting to tumor cells, and potentially intracellular drug delivery. The pros and cons of the liposome platform in cancer targeting are discussed vis-à-vis nontargeted drugs, using as an example a liposome drug delivery system targeted to the folate receptor.

Surgical animal models of neuropathic pain: Pros and Cons.

PubMed

Challa, Siva Reddy

2015-03-01

One of the biggest challenges for discovering more efficacious drugs for the control of neuropathic pain has been the diversity of chronic pain states in humans. It is now acceptable that different mechanisms contribute to normal physiologic pain, pain arising from tissue damage and pain arising from injury to the nervous system. To study pain transmission, spot novel pain targets and characterize the potential analgesic profile of new chemical entities, numerous experimental animal pain models have been developed that attempt to simulate the many human pain conditions. Among the neuropathic pain models, surgical models have paramount importance in the induction of pain states. Many surgical animal models exist, like the chronic constriction injury (CCI) to the sciatic nerve, partial sciatic nerve ligation (pSNL), spinal nerve ligation (SNL), spared nerve injury (SNI), brachial plexus avulsion (BPA), sciatic nerve transaction (SNT) and sciatic nerve trisection. Most of these models induce responses similar to those found in causalgia, a syndrome of sustained burning pain often seen in the distal extremity after partial peripheral nerve injury in humans. Researchers most commonly use these surgical models in both rats and mice during drug discovery to screen new chemical entities for efficacy in the area of neuropathic pain. However, there is scant literature that provides a comparative discussion of all these surgical models. Each surgical model has its own benefits and limitations. It is very difficult for a researcher to choose a suitable surgical animal model to suit their experimental set-up. Therefore, particular attention has been given in this review to comparatively provide the pros and cons of each model of surgically induced neuropathic pain.

Pros and cons of circumcision: an evidence-based overview.

PubMed

Friedman, B; Khoury, J; Petersiel, N; Yahalomi, T; Paul, M; Neuberger, A

2016-09-01

Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Arab-American Hookah Smokers: Initiation, and Pros and Cons of Hookah Use.

PubMed

Kassem, Nada O F; Kassem, Noura O; Jackson, Sheila R; Daffa, Reem M; Liles, Sandy; Hovell, Melbourne F

2015-09-01

To examine initiation, pros and cons of hookah tobacco smoking among Arab Americans. In this descriptive cross-sectional study, we recruited a community-based convenience sample of 458 adult Arab-American hookah smokers, mean age 28.4 years, who completed self-administered questionnaires. Irrespective of sex, most participants initiated hookah tobacco use by young adulthood in private homes or hookah lounges influenced by friends and family. Women initiated hookah use later than men. Ever dual smokers (hookah smokers who ever smoked a cigarette) initiated hookah use later than cigarettes; however, early hookah initiators < 18 years initiated hookah and cigarettes concurrently. Participants enjoyed the flavors of hookah tobacco, and complained about coughing, dizziness, and headaches. Early and late initiation of hookah tobacco use warrant prevention programs targeting the youth and older adults in communities, colleges, and middle and high schools that include health education campaigns, and encouragement of voluntary smokefree home rules. Tobacco control policies aimed to prevent initiation of hookah use should include regulation of hookah tobacco flavors, and should target the physical environments in neighborhoods, especially around schools and colleges, to reduce the proliferation of hookah lounges. Dual hookah tobacco and cigarette use warrant continuous monitoring.

In vitro evolution of chemically-modified nucleic acid aptamers: Pros and cons, and comprehensive selection strategies.

PubMed

Lipi, Farhana; Chen, Suxiang; Chakravarthy, Madhuri; Rakesh, Shilpa; Veedu, Rakesh N

2016-12-01

Nucleic acid aptamers are single-stranded DNA or RNA oligonucleotide sequences that bind to a specific target molecule with high affinity and specificity through their ability to adopt 3-dimensional structure in solution. Aptamers have huge potential as targeted therapeutics, diagnostics, delivery agents and as biosensors. However, aptamers composed of natural nucleotide monomers are quickly degraded in vivo and show poor pharmacodynamic properties. To overcome this, chemically-modified nucleic acid aptamers are developed by incorporating modified nucleotides after or during the selection process by Systematic Evolution of Ligands by EXponential enrichment (SELEX). This review will discuss the development of chemically-modified aptamers and provide the pros and cons, and new insights on in vitro aptamer selection strategies by using chemically-modified nucleic acid libraries.

In vitro evolution of chemically-modified nucleic acid aptamers: Pros and cons, and comprehensive selection strategies

PubMed Central

Chen, Suxiang; Chakravarthy, Madhuri; Rakesh, Shilpa; Veedu, Rakesh N.

2016-01-01

ABSTRACT Nucleic acid aptamers are single-stranded DNA or RNA oligonucleotide sequences that bind to a specific target molecule with high affinity and specificity through their ability to adopt 3-dimensional structure in solution. Aptamers have huge potential as targeted therapeutics, diagnostics, delivery agents and as biosensors. However, aptamers composed of natural nucleotide monomers are quickly degraded in vivo and show poor pharmacodynamic properties. To overcome this, chemically-modified nucleic acid aptamers are developed by incorporating modified nucleotides after or during the selection process by Systematic Evolution of Ligands by EXponential enrichment (SELEX). This review will discuss the development of chemically-modified aptamers and provide the pros and cons, and new insights on in vitro aptamer selection strategies by using chemically-modified nucleic acid libraries. PMID:27715478

Pros and cons of BCG vaccination in countries with low incidence of tuberculosis.

PubMed

Tala, E O; Tala-Heikkilä, M M

1994-07-01

Preventive bacille Calmette-Guérin (BCG) vaccination, together with case finding and effective chemotherapy, has formed an integral part of the tuberculosis (TB) control program in most countries. In some low-incidence countries the balance of prevention has been more on the side of chemoprophylaxis than of BCG vaccination. The time clearly has come when the strategy of mass BCG vaccination no longer is indicated medically, nor is it cost-effective. The pros and cons of the programs need to be critically evaluated against the present epidemiological background, taking into account the facts that TB, the killer disease, is recovering strength, human immunodeficiency virus infection is on the increase, and multidrug-resistant TB has changed the outcome of this previously fully curable disease. Although no longer appropriate for mass programs, BCG vaccination still should be considered for the protection of selected risk groups in low-incidence countries. The overall efficacy may be of the order 50% to 80%, but the variation is great. Therefore, further research urgently is needed on the effectiveness of BCG as an intervention in local TB programs.

Anxiety and coping in women with breast cancer in chemotherapy.

PubMed

Silva, Araceli Vicente da; Zandonade, Eliana; Amorim, Maria Helena Costa

2017-06-05

com o enfrentamento com foco no problema (p=0,001) e com o foco na emoção (p=0,004). Os resultados demonstram fracas associações entre as diferentes estratégias de enfrentamento. a estratégia de enfrentamento eleita pelas mulheres com câncer de mama tem relação direta com a ansiedade. As pacientes que possuem ansiedade com nível baixo tendem a utilizar como estratégia a resolução dos problemas e quando o nível é médio a alto o enfrentamento com foco na emoção. identificar las estrategias de enfrentamiento utilizadas por las mujeres con cáncer de mama sometidas a quimioterapia y la asociación con el perfil de la ansiedad que presentan. estudio transversal de tipo analítico. Utilizamos muestra aleatoria de 307 mujeres con cáncer con quimioterapia previa, adyuvante o paliativa. Se recogieron los datos con entrevistas registradas en un formulario y búsqueda activa en los registros médicos, Escala de Modo de Enfrentamiento de Problemas e Inventario de Ansiedad y Estado. Se utilizó para análisis el Paquete Estadístico para Ciencias Sociales 19.0, coeficiente de correlación Pearson y la prueba de Mann-Whitney. hubo una asociación significativa del rasgo ansiedad y las estrategias de enfrentamiento centradas en el problema y en la emoción (p<0,000) y el estado de ansiedad con el enfrentamiento centrado en el problema (p=0,001) y con el foco en emoción (p=0,004). Los resultados muestran asociaciones débiles entre diferentes estrategias de enfrentamiento. la estrategia de enfrentamiento elegida por las mujeres con cáncer de mama está directamente relacionada con la ansiedad. Las pacientes que tienen ansiedad con niveles bajos tienden a utilizar una estrategia de solución de problemas y cuando el nivel es medio a alto utilizan el enfrentamiento centrado en la emoción.

Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders.

PubMed

Riveros-Perez, Efrain; Wood, Cristina

2018-03-01

To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23-42). Median blood loss was 1500 mL (interquartile range 1000-2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200-6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal-epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal-epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Placenta previa and accreta coexist in many patients, leading to substantial bleeding related to the degree of myometrial invasion. An interdisciplinary team approach plus the use of combined spinal-epidural anesthesia, transitioning to general anesthesia, were advisable and safe. © 2017 International Federation of Gynecology and Obstetrics.

Estudio de la influencia de la refrigeracion con aire de forma natural e inducida en el comportamiento de instalaciones fotovoltaicas

NASA Astrophysics Data System (ADS)

Mazon Hernandez, Rocio

panels are analysed to compare and select the best configuration. The presented research provides a deep knowledge of how they work as well as information and results for an improvement in future designs of building integrated photovoltaic systems. Este estudio se centra en analizar la influencia negativa de la temperatura en la produccion electrica de paneles fotovoltaicos al estar emplazados sobre cubierta de acero, como sucede en naves industriales y sobre un invernadero. Se estudian diferentes configuraciones que permitan refrigerar los paneles, reduciendo su temperatura y mejorar su rendimiento. Para abordar este problema, se han construido dos instalaciones experimentales, fieles a plantas solares en funcionamiento. Una instalacion engloba dos paneles fotovoltaicos sobre estructura fija al suelo. Uno de los paneles esta integrado sobre una superficie paralela y metalica. Entre ambas superficies existe un espacio que posibilita circular aire, permitiendo refrigerar el panel por conveccion natural, o conveccion forzada impulsando el aire con un ventilador. El otro panel, libre por su cara posterior y se ha considerado de referencia. Se ha estudiado el comportamiento del panel integrado sobre cubierta para diferentes secciones de aire y velocidades inducidas, comparandolo con el panel de referencia. Se ha desarrollado un modelo experimental que nos permite determinar la temperatura del panel en funcion de las variables que influyen en su refrigeracion. Adicionalmente, se han analizado los datos de una planta solar en funcionamiento, con paneles de igual caracteristicas, obteniendo correlaciones entre la temperatura del panel y las variables electricas y comparandolos con las obtenidas en la instalacion experimental. La segunda instalacion experimental reproduce parte de una instalacion solar sobre un invernadero, formada por cuatro paneles fotovoltaicos colocados sobre el plastico del invernadero, existiendo un canal divergente entre ambas superficies. Se estudia la

The soil-water balance simulations of a grassland in response to CO2, rainfall, and biodiversity manipulations at BioCON

NASA Astrophysics Data System (ADS)

Flinker, R. H.; Cardenas, M.; Caldwell, T. G.; Rich, R.; Reich, P.

2013-12-01

The BioCON (Biodiversity, CO2 and N) experiment has been continuously running since 1997. Operated by the University of Minnesota and located within the Cedar Creek Ecosystem Science Reserve in Minnesota, USA, BioCON is a Free-Air CO2 Enrichment (FACE) experiment that investigates plant community response to three key environmental variables: nitrogen, atmospheric CO2 and biodiversity. More recently rainfall exclusion and temperature manipulation were added to the experiment which amounts to 371 plots. The site attempts to replicate predicted average temperature increases and a northern shift of plant species and any associated consequences. FACE experiments have been conducted for a number of years in different countries, but the focus has generally been on how plant communities, soil respiration and microbes respond. Minimal work has been focused on the hydrologic aspects of these experiments which are potentially valuable for investigating global warming effects on local and plot-scale ecohydrology. Thus, the objective of this work is to characterize and model unsaturated flow for different CO2 and rainfall treatments in order to see how they affect soil moisture dynamics and groundwater recharge on grasslands of central Minnesota. Our study focuses on simulating soil moisture dynamics in eighteen of the BioCON plots: six bare plots with regular rainfall regimes (zero plant species, three plots with elevated atmospheric CO2 levels), six regular rainfall regimes (nine plant species, three plots with elevated atmospheric CO2 levels) and six reduced rainfall regimes (nine plant species, three plots with elevated atmospheric CO2 levels). The Simultaneous Heat and Water (SHAW) model, which solves the Richards equation for unsaturated zone water flow coupled to a comprehensive energy balance model, was parameterized with a combination of field and lab estimates of soil properties. Field estimates of saturated hydraulic conductivity using tension infiltrometers ranged

Draft genome sequence for virulent and avirulent strains of Xanthomonas arboricola isolated from Prunus spp. in Spain.

PubMed

Garita-Cambronero, Jerson; Palacio-Bielsa, Ana; López, María M; Cubero, Jaime

2016-01-01

Xanthomonas arboricola is a species in genus Xanthomonas which is mainly comprised of plant pathogens. Among the members of this taxon, X. arboricola pv. pruni, the causal agent of bacterial spot disease of stone fruits and almond, is distributed worldwide although it is considered a quarantine pathogen in the European Union. Herein, we report the draft genome sequence, the classification, the annotation and the sequence analyses of a virulent strain, IVIA 2626.1, and an avirulent strain, CITA 44, of X. arboricola associated with Prunus spp. The draft genome sequence of IVIA 2626.1 consists of 5,027,671 bp, 4,720 protein coding genes and 50 RNA encoding genes. The draft genome sequence of strain CITA 44 consists of 4,760,482 bp, 4,250 protein coding genes and 56 RNA coding genes. Initial comparative analyses reveals differences in the presence of structural and regulatory components of the type IV pilus, the type III secretion system, the type III effectors as well as variations in the number of the type IV secretion systems. The genome sequence data for these strains will facilitate the development of molecular diagnostics protocols that differentiate virulent and avirulent strains. In addition, comparative genome analysis will provide insights into the plant-pathogen interaction during the bacterial spot disease process.

NLRC5/MHC class I transactivator is a target for immune evasion in cancer

PubMed Central

Yoshihama, Sayuri; Roszik, Jason; Downs, Isaac; Meissner, Torsten B.; Vijayan, Saptha; Chapuy, Bjoern; Sidiq, Tabasum; Shipp, Margaret A.; Lizee, Gregory A.; Kobayashi, Koichi S.

2016-01-01

Cancer cells develop under immune surveillance, thus necessitating immune escape for successful growth. Loss of MHC class I expression provides a key immune evasion strategy in many cancers, although the molecular mechanisms remain elusive. MHC class I transactivator (CITA), known as “NLRC5” [NOD-like receptor (NLR) family, caspase recruitment (CARD) domain containing 5], has recently been identified as a critical transcriptional coactivator of MHC class I gene expression. Here we show that the MHC class I transactivation pathway mediated by CITA/NLRC5 constitutes a target for cancer immune evasion. In all the 21 tumor types we examined, NLRC5 expression was highly correlated with the expression of MHC class I, with cytotoxic T-cell markers, and with genes in the MHC class I antigen-presentation pathway, including LMP2/LMP7, TAP1, and β2-microglobulin. Epigenetic and genetic alterations in cancers, including promoter methylation, copy number loss, and somatic mutations, were most prevalent in NLRC5 among all MHC class I-related genes and were associated with the impaired expression of components of the MHC class I pathway. Strikingly, NLRC5 expression was significantly associated with the activation of CD8+ cytotoxic T cells and patient survival in multiple cancer types. Thus, NLRC5 constitutes a novel prognostic biomarker and potential therapeutic target of cancers. PMID:27162338

NLRC5/MHC class I transactivator is a target for immune evasion in cancer.

PubMed

Yoshihama, Sayuri; Roszik, Jason; Downs, Isaac; Meissner, Torsten B; Vijayan, Saptha; Chapuy, Bjoern; Sidiq, Tabasum; Shipp, Margaret A; Lizee, Gregory A; Kobayashi, Koichi S

2016-05-24

Cancer cells develop under immune surveillance, thus necessitating immune escape for successful growth. Loss of MHC class I expression provides a key immune evasion strategy in many cancers, although the molecular mechanisms remain elusive. MHC class I transactivator (CITA), known as "NLRC5" [NOD-like receptor (NLR) family, caspase recruitment (CARD) domain containing 5], has recently been identified as a critical transcriptional coactivator of MHC class I gene expression. Here we show that the MHC class I transactivation pathway mediated by CITA/NLRC5 constitutes a target for cancer immune evasion. In all the 21 tumor types we examined, NLRC5 expression was highly correlated with the expression of MHC class I, with cytotoxic T-cell markers, and with genes in the MHC class I antigen-presentation pathway, including LMP2/LMP7, TAP1, and β2-microglobulin. Epigenetic and genetic alterations in cancers, including promoter methylation, copy number loss, and somatic mutations, were most prevalent in NLRC5 among all MHC class I-related genes and were associated with the impaired expression of components of the MHC class I pathway. Strikingly, NLRC5 expression was significantly associated with the activation of CD8(+) cytotoxic T cells and patient survival in multiple cancer types. Thus, NLRC5 constitutes a novel prognostic biomarker and potential therapeutic target of cancers.

Responses of urban crows to con- and hetero-specific alarm calls in predator and non-predator zoo enclosures.

PubMed

Bílá, Kateřina; Beránková, Jana; Veselý, Petr; Bugnyar, Thomas; Schwab, Christine

2017-01-01

Urban animals and birds in particular are able to cope with diverse novel threats in a city environment such as avoiding novel, unfamiliar predators. Predator avoidance often includes alarm signals that can be used also by hetero-specifics, which is mainly the case in mixed-species flocks. It can also occur when species do not form flocks but co-occur together. In this study we tested whether urban crows use alarm calls of conspecifics and hetero-specifics (jackdaws, Corvus monedula) differently in a predator and a non-predator context with partly novel and unfamiliar zoo animal species. Birds were tested at the Tiergarten Schönbrunn in the city of Vienna by playing back con- and hetero-specific alarm calls and control stimuli (great tit song and no stimuli) at predator (wolf, polar bear) and non-predator (eland antelope and cranes, peccaries) enclosures. We recorded responses of crows as the percentage of birds flying away after hearing the playback (out of those present before the playback) and as the number of vocalizations given by the present birds. A significantly higher percentage of crows flew away after hearing either con- or hetero-specific alarm calls, but it did not significantly differ between the predator and the non-predator context. Crows treated jackdaw calls just as crow calls, indicating that they make proper use of hetero-specific alarm calls. Responding similarly in both contexts may suggest that the crows were uncertain about the threat a particular zoo animal represents and were generally cautious. In the predator context, however, a high percentage of crows also flew away upon hearing the great tit control song which suggests that they may still evaluate those species which occasionally killed crows as more dangerous and respond to any conspicuous sound.

The Pros And Cons Of Various Optical Media For The Soldier's Interfacility Radiographic Record (SIRR) In The Combat Casualty Care System

NASA Astrophysics Data System (ADS)

Kerlin, Barbara D.; Johnson, William P.

1989-05-01

Ongoing research and evaluation projects sponsored by the Army Medical Research and Development Command are leading towards filmless radiography in the combat casualty care system of the 1990s. With the elimination of film, the question arises as to the most appropriate medium for archiving and transporting x-ray images and related patient data with the wounded between facilities. This paper considers the pros and cons of the various candidate media in relation to their specifications, availability, and appropriateness under simulated combat casualty care conditions.

Project "Convective Wind Gusts" (ConWinG)

NASA Astrophysics Data System (ADS)

Mohr, Susanna; Richter, Alexandra; Kunz, Michael; Ruck, Bodo

2017-04-01

Convectively-driven strong winds usually associated with thunderstorms frequently cause substantial damage to buildings and other structures in many parts of the world. Decisive for the high damage potential are the short-term wind speed maxima with duration of a few seconds, termed as gusts. Several studies have shown that convectively-driven gusts can reach even higher wind speeds compared to turbulent gusts associated with synoptic-scale weather systems. Due to the small-scale and non-stationary nature of convective wind gusts, there is a considerable lack of knowledge regarding their characteristics and statistics. Furthermore, their interaction with urban structures and their influence on buildings is not yet fully understood. For these two reasons, convective wind events are not included in the present wind load standards of buildings and structures, which so far have been based solely on the characteristics of synoptically-driven wind gusts in the near-surface boundary layer (e. g., DIN EN 1991-1-4:2010-12; ASCE7). However, convective and turbulent gusts differ considerably, e.g. concerning vertical wind-speed profiles, gust factors (i.e., maximum to mean wind speed), or exceedance probability curves. In an effort to remedy this situation, the overarching objective of the DFG-project "Convective Wind Gusts" (ConWinG) is to investigate the characteristics and statistics of convective gusts as well as their interaction with urban structures. Based on a set of 110 climate stations of the German Weather Service (DWD) between 1992 and 2014, we analyzed the temporal and spatial distribution, intensity, and occurrence probability of convective gusts. Similar to thunderstorm activity, the frequency of convective gusts decreases gradually from South to North Germany. A relation between gust intensity/probability to orography or climate conditions cannot be identified. Rather, high wind speeds, e.g., above 30 m/s, can be expected everywhere in Germany with almost

Food for thought: a pilot study of the pros and cons of changing eating patterns within cognitive-behavioural therapy for the eating disorders.

PubMed

Waller, Glenn; Evans, Jane; Pugh, Matthew

2013-09-01

Evidence-based cognitive-behavioural therapy (CBT) for the eating disorders has an early focus on behavioural changes around food intake. However, patients' anxiety around such change might account for why they often seem unmotivated in treatment. In order to determine the impact of changing intake, this pilot study of patients with bulimic disorders (N = 19) or anorexia nervosa (N = 9) used a mixed quantitative and qualitative design to retrospectively examine their perspectives of the short- and long-term pros and cons of such change. As expected, change was seen negatively in the short-term (with particularly high numbers reporting anxiety), but there were few reports of long-term negative outcomes. In contrast, there were both short- and long-term benefits of changing eating. The patients described what was helpful in making changes and what they had learned as a result. In both cases, their descriptions mapped closely onto the content and process of evidence-based CBT for the eating disorders. Although there is a need for more extensive research, these findings suggest that patients (and therapists) might benefit from being aware of the contrast between the short- and the long-term pros and cons of changing eating within CBT for the eating disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

FACTORES SOCIO-ESTRUCTURALES Y EL ESTIGMA HACIA EL VIH/SIDA: EXPERIENCIAS DE PUERTORRIQUEÑOS/AS CON VIH/SIDA AL ACCEDER SERVICIOS DE SALUD

PubMed Central

RIVERA-DIAZ, MARINILDA; VARAS-DIAZ, NELSON; REYES-ESTRADA, MARCOS; SURO, BEATRIZ; CORIANO, DORALIS

2013-01-01

RESUMEN El estigma relacionado al VIH/SIDA continúa afectando la prestación de servicios de salud y el bienestar físico y mental de las personas con VIH/SIDA (PVS). Recientemente la literatura científica ha señalado la importancia de comprender las manifestaciones de estigma más allá de las interacciones individuales. Por tal razón, investigaciones recientes en y fuera de Puerto Rico enfatizan la importancia de entender cómo factores socio-estructurales (FSE) influyen en los procesos de estigmatización social. Con el propósito de examinar los FSE que influyen en las manifestaciones de estigma relacionado al VIH/SIDA, realizamos y analizamos nueve grupos focales compuestos por hombres y mujeres en tratamiento para el VIH/SIDA que habían tenido experiencias estigmatizantes. Los participantes identificaron FSE relacionados a las manifestaciones de estigma, tales como el uso de viviendas especializadas, descentralización de los servicios de salud y el desarrollo de protocolos administrativos excluyentes en los servicios de salud. Los resultados demuestran la importancia de considerar los FSE en el desarrollo e implementación de intervenciones dirigidas a la población. PMID:24639599

Sequías Hidrológicas en la República Argentina y su relación con Variables Macroclimáticas

NASA Astrophysics Data System (ADS)

Díaz, Erica Betiana

2016-07-01

Una adecuada planificación y gestión requiere un conocimiento de la distribución temporal y espacial de los recursos hídricos. Una amenaza que afecta al desarrollo y aprovechamiento de los recursos hídricos, y para las cuales la ingeniería debe dar soluciones, son las situaciones de extremos hidrológicos como inundaciones o sequías. Siendo estas últimas un fenómeno hidrológico extremo de gran complejidad del cual aún se conoce poco. Con el objetivo de identificar y caracterizar temporal y espacialmente las sequías hidrológicas en Argentina, esta tesis abordó en primera instancia, la identificación y caracterización de sequías desde el punto de vista hidrológico, abarcando el mayor período de tiempo y espacio, en función de los datos de caudales disponibles. Con el fin de predecir eventos plurianuales de sequías hidrológicas en el mediano y largo plazo se generaron, a través del análisis espectral y armónico de las series históricas de caudales observados, series sintéticas que reproducen las componentes periódicas plurianuales más significativas de las series observadas. Además, para lograr un avance en el conocimiento de los fenómenos climáticos que conducen a las sequías hidrológicas, se identificaron las variables macroclimáticas que tienen una mayor correlación con los caudales escurridos en las distintas cuencas. Esta tesis comprende el estudio de 14 cuencas hidrográficas argentinas, pertenecientes a los ríos Colorado, Mendoza, San Juan, Atuel, Ctalamochita, Anizacate, Xanaes, Suquía, Dulce, Juramento, Salado, Paraná, Bermejo y Pilcomayo. Los resultados a los que se abordaron en esta tesis son de relevancia para la gestión de los recursos hídricos ya que usos tales como el abastecimiento humano, el riego y la producción energética, entre otros, pueden ser seriamente afectados por la ocurrencia de manera simultánea de sequías severas en cuencas que aportan a una región y zonas vecinas.

Information technology as a tool for the Italian Institute of Social Security (INPS) in the management of social security and civil disability: Pro and cons.

PubMed

Sammicheli, Michele; Scaglione, Marcella

2018-01-01

We examine, from a medical-legal perspective, the pro and cons of the information technology procedures that the Italian Institute of Social Security (INPS) has implemented to manage the provision of social disability assistance, meaning that separate from the payment of pension contributions, being welfare, anchored to an administrative requirement by way of the compulsory payment of a minimum social security contribution.

Scale of attitudes toward alcohol - Spanish version: evidences of validity and reliability.

PubMed

Ramírez, Erika Gisseth León; Vargas, Divane de

2017-08-03

espanhol, apresentou qualidades psicométricas robustas, afirmando que se trata de um instrumento com estrutura fatorial e confiabilidade sólidas, capaz de medir com precisão as atitudes dos enfermeiros frente ao fenômeno proposto. validar la Escala de actitudes frente al alcohol, al alcoholismo y a la persona con trastornos relacionados al uso de alcohol en su versión española. estudio de tipo metodológico, realizado con 303 enfermeros colombianos. Siguiendo la teoría clásica, se utilizó análisis factorial confirmatoria sin exploración previa, con base en la fuerte evidencia histórica de la estructura factorial del instrumento original para determinar la validez de constructo de esta versión en español. La confiabilidad se evaluó por los coeficientes de Alfa de Cronbach y Omega de Mc Donald. el análisis factorial confirmatorio indicó buen ajuste del modelo de la escala en la distribución de cuatro factores, comportando 48 ítems en su versión en español. Los índices de confiabilidad fueron satisfactorios, con un punto de corte observado en 3,2, mostrando sensibilidad del 66,7%. la Escala de actitudes frente al alcohol, al alcoholismo y a la persona con trastornos relacionados al uso de alcohol en idioma español presentó cualidades psicométricas robustas, afirmando que se trata de un instrumento con estructura factorial y confiabilidad sólidas, capaz de medir con precisión las actitudes de los enfermeros frente al fenómeno propuesto.

Shared governance: time to consider the cons as well as the pros.

PubMed

Gavin, M; Ash, D; Wakefield, S; Wroe, C

1999-07-01

This paper aims to provide a critical appraisal of an approach to the management and organization of nursing work known as shared governance (SG). This approach has its origins in the USA, where, during the past 20 years it has become increasingly influential. The advocates of SG claim that it can, inter alia, improve recruitment and retention rates, boost morale, and help raise clinical skills. Little wonder that SG in now beginning to make significant inroads into the NHS. ORIGIN OF INFORMATION: However, a trawl through the extensive US literature, using printed and online (e.g. BIDS, CINHAL, MEDLINE, etc.) bibliographical sources, suggests that the claimed benefits of SG should be treated with caution. Much of the existing published research appears to be both methodologically flawed and lacking in any critical edge. While many researchers and commentators appear only too willing to highlight what they see as the promise of SG, they shy away from exploring any potential pitfalls. One consequence of this is that many of the putative benefits SG is said to confer, may in fact be more apparent than real. Nurses and nurse managers need to be apprised of and consider seriously, the possible cons as well as the potential pros of SG, if any promise it may have is to be realized.

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion.

PubMed

Cho, Yoon Jin; Oh, Yong Taek; Kim, Suk Young; Kim, Ju Young; Jung, Sun Young; Chon, Seung Joo; Kim, Jeong Ho; Byun, Sung Su

2017-01-01

Prophylactic trans-catheter arterial balloon occlusion (PTABO) before cesarean section of placenta previa totalis has been introduced to prevent massive hemorrhage. The purpose of this study is to evaluate the clinical usefulness of PTABO in cases of suspected placental adhesion and to examine antepartal risk factors and perinatal outcomes in women with placental adhesion. Between January 2012 and December 2015, 77 patients who had undergone ultrasonography for evaluation of placenta previa were enrolled in this study. Seventeen of these patients with suspected placental adhesion by ultrasonography and Pelvic MRI underwent PTABO before cesarean section and another 59 patients underwent cesarean section without PTABO. Antepartal risk factors and peripartum maternal and neonatal outcomes were compared between patients with PTABO and those without PTABO. More advanced maternal age, longer in gestational weeks at delivery, and more common previous cesarean section history were observed in the PTABO group. Placenta adhesion, abnormal Doppler findings, and frequency of transfusion were more common in the PTABO group. However there was no significant difference in estimated blood loss, hospital days, and neonatal outcome. It had occurred 3 cases of hysterectomy and 1 case of uterine artery embolization after cesarean section in the PTABO group. Close surveillance of antepartum risk factors for placental adhesion using ultrasonography and pelvic magnetic resonance imaging is important to prevention of massive hemorrhage during cesarean section. PTABO before cesarean section might result in reduced blood loss and requirement for transfusion during the operation.

Accuracy of Home-Based Ultrasonographic Diagnosis of Obstetric Risk Factors by Primary-Level Health Workers in Rural Nepal

PubMed Central

Kozuki, Naoko; Mullany, Luke C.; Khatry, Subarna K.; Ghimire, Ram K.; Paudel, Sharma; Blakemore, Karin; Bird, Christine; Tielsch, James M.; LeClerq, Steven C.; Katz, Joanne

2016-01-01

Objective To assess the feasibility of task shifting by estimating the accuracy at which primary-level health care workers can perform community-based third trimester ultrasound diagnosis for selected obstetric risk factors in rural Nepal. Methods Three auxiliary nurse midwives received two one-week ultrasound trainings at Tribhuvan University Teaching Hospital in Kathmandu. In our study site in rural Nepal, women who were ≥32 weeks in gestational age were enrolled and received ultrasound examinations from the auxiliary nurse midwives during home visits. Each auxiliary nurse midwife screened for non-cephalic presentation, multiple gestation, and placenta previa. All de-identified images were stored and uploaded onto an online server, where certified sonologists and sonographers reviewed the images and made their own diagnoses for the three conditions. Accuracy of auxiliary nurse midwife diagnoses was then calculated. Results We enrolled 804 women in the study. Each auxiliary nurse midwife’s kappa statistic for diagnosis of non-cephalic presentation was above 0.90 compared with the sonogram reviewers. Sensitivity, specificity, positive and negative predictive values were between 90–100% for all auxiliary nurse midwives For multiple gestation, the auxiliary nurse midwives were in perfect agreement with both the sonogram reviewers and maternal postpartum self-report. Two placenta previa cases were detected, and the sonogram reviewers agreed with both. Conclusion With limited training, primary-level health care workers in rural Nepal can accurately diagnose selected third trimester obstetric risk factors using ultrasonography. PMID:27500343

Endometriosis and obstetrics complications: a systematic review and meta-analysis.

PubMed

Zullo, Fabrizio; Spagnolo, Emanuela; Saccone, Gabriele; Acunzo, Miriam; Xodo, Serena; Ceccaroni, Marcello; Berghella, Vincenzo

2017-10-01

To evaluate the effect of endometriosis on pregnancy outcomes. Systematic review and meta-analysis. Not applicable. Women with or without endometriosis. Electronic databases searched from their inception until February 2017 with no limit for language and with all cohort studies reporting the incidence of obstetric complications in women with a diagnosis of endometriosis compared with a control group (women without a diagnosis of endometriosis) included. Primary outcome of incidence of preterm birth at <37 weeks with meta-analysis performed using the random effects model of DerSimonian and Laird to produce an odds ratio (OR) with 95% confidence interval (CI). Twenty-four studies were analyzed comprising 1,924,114 women. In most of them, the diagnosis of endometriosis was made histologically after surgery. Women with endometriosis had a statistically significantly higher risk of preterm birth (OR 1.63; 95% CI, 1.32-2.01), miscarriage (OR 1.75; 95% CI, 1.29-2.37), placenta previa (OR 3.03; 95% CI, 1.50-6.13), small for gestational age (OR 1.27; 95% CI, 1.03-1.57), and cesarean delivery (OR 1.57; 95% CI, 1.39-1.78) compared with the healthy controls. No differences were found in the incidence of gestational hypertension and preeclampsia. Women with endometriosis have a statistically significantly higher risk of preterm birth, miscarriage, placenta previa, small for gestational age infants, and cesarean delivery. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Autophagic Mechanism in Anti-Cancer Immunity: Its Pros and Cons for Cancer Therapy

PubMed Central

Li, Ying-Ying; Feun, Lynn G.; Thongkum, Angkana; Tu, Chiao-Hui; Chen, Shu-Mei; Wangpaichitr, Medhi; Wu, Chunjing; Kuo, Macus T.; Savaraj, Niramol

2017-01-01

Autophagy, a self-eating machinery, has been reported as an adaptive response to maintain metabolic homeostasis when cancer cells encounter stress. It has been appreciated that autophagy acts as a double-edge sword to decide the fate of cancer cells upon stress factors, molecular subtypes, and microenvironmental conditions. Currently, the majority of evidence support that autophagy in cancer cells is a vital mechanism bringing on resistance to current and prospective treatments, yet whether autophagy affects the anticancer immune response remains unclear and controversial. Accumulated studies have demonstrated that triggering autophagy is able to facilitate anticancer immunity due to an increase in immunogenicity, whereas other studies suggested that autophagy is likely to disarm anticancer immunity mediated by cytotoxic T cells and nature killer (NK) cells. Hence, this contradiction needs to be elucidated. In this review, we discuss the role of autophagy in cancer cells per se and in cancer microenvironment as well as its dual regulatory roles in immune surveillance through modulating presentation of tumor antigens, development of immune cells, and expression of immune checkpoints. We further focus on emerging roles of autophagy induced by current treatments and its impact on anticancer immune response, and illustrate the pros and cons of utilizing autophagy in cancer immunotherapy based on preclinical references. PMID:28629173

Effect of PGE2 on thymocyte proliferation induced by Con A or IL-4 + PMA.

PubMed

Daculsi, R; Vaillier, D; Bezian, J H; Gualde, N

1993-02-01

Prostaglandin E2 (PGE2) is known to inhibit peripheral T-lymphocyte and thymocyte proliferation activated by antigens, mitogens or anti-CD3 antibodies. In this study, we have investigated, the effect of PGE2 on thymocyte proliferation induced by the combination of IL-4 plus PMA. PGE2 inhibits the proliferation of thymocytes activated by ConA, whatever the culture period; in contrast PGE2 shifts the kinetics of thymocyte proliferation after stimulation by IL-4 plus PMA, but does not sustain the proliferation beyond day 3. This effect depends upon cell density, IL-4 concentration and on the time that PGE2 is added to the culture. By use of the cAMP inducer, forskolin, or a cAMP analog, db-cAMP, we observed the same results, PGE2 increases the proliferation of CD8+ corticoresistant thymocytes (CRT) activated by IL-4 plus PMA, but inhibits that of CD4+ CRT. These results suggest that PGE2 can regulate thymocyte proliferation differently according to the activation pathway and the thymic subpopulations.

NLRC5: a key regulator of MHC class I-dependent immune responses.

PubMed

Kobayashi, Koichi S; van den Elsen, Peter J

2012-12-01

The expression of MHC class I molecules is crucial for the initiation and regulation of adaptive immune responses against pathogens. NOD-, LRR- and CARD-containing 5 (NLRC5) was recently identified as a specific transactivator of MHC class I genes (CITA). NLRC5 and the master regulator for MHC class II genes, class II transactivator (CIITA), interact with similar MHC promoter-bound factors. Here, we provide a broad overview of the molecular mechanisms behind MHC class I transcription and the role of the class I transactivator NLRC5 in MHC class I-dependent immune responses.

Halving the Volume of AnaConDa: Evaluation of a New Small-Volume Anesthetic Reflector in a Test Lung Model.

PubMed

Bomberg, Hagen; Meiser, Franziska; Daume, Philipp; Bellgardt, Martin; Volk, Thomas; Sessler, Daniel I; Groesdonk, Heinrich V; Meiser, Andreas

2018-05-21

Volatile anesthetics are increasingly used for sedation in intensive care units. The most common administration system is AnaConDa-100 mL (ACD-100; Sedana Medical, Uppsala, Sweden), which reflects volatile anesthetics in open ventilation circuits. AnaConDa-50 mL (ACD-50) is a new device with half the volumetric dead space. Carbon dioxide (CO2) can be retained with both devices. We therefore compared the CO2 elimination and isoflurane reflection efficiency of both devices. A test lung constantly insufflated with CO2 was ventilated with a tidal volume of 500 mL at 10 breaths/min. End-tidal CO2 (EtCO2) partial pressure was measured using 3 different devices: a heat-and-moisture exchanger (HME, 35 mL), ACD-100, and ACD-50 under 4 different experimental conditions: ambient temperature pressure (ATP), body temperature pressure saturated (BTPS) conditions, BTPS with 0.4 Vol% isoflurane (ISO-0.4), and BTPS with 1.2 Vol% isoflurane. Fifty breaths were recorded at 3 time points (n = 150) for each device and each condition. To determine device dead space, we adjusted the tidal volume to maintain normocapnia (n = 3), for each device. Thereafter, we determined reflection efficiency by measuring isoflurane concentrations at infusion rates varying from 0.5 to 20 mL/h (n = 3), for each device. EtCO2 was consistently greater with ACD-100 than with ACD-50 and HME (ISO-0.4, mean ± standard deviations: ACD-100, 52.4 ± 0.8; ACD-50, 44.4 ± 0.8; HME, 40.1 ± 0.4 mm Hg; differences of means of EtCO2 [respective 95% confidence intervals]: ACD-100 - ACD-50, 8.0 [7.9-8.1] mm Hg, P < .001; ACD-100 - HME, 12.3 [12.2-12.4] mm Hg, P < .001; ACD-50 - HME, 4.3 [4.2-4.3] mm Hg, P < .001). It was greatest under ATP, less under BTPS, and least with ISO-0.4 and BTPS with 1.2 Vol% isoflurane. In addition to the 100 or 50 mL "volumetric dead space" of each AnaConDa, "reflective dead space" was 40 mL with ACD-100 and 25 mL with ACD-50 when using isoflurane. Isoflurane reflection was highest under ATP

Cálculos ab initio con correlación electrónica

NASA Astrophysics Data System (ADS)

Merchán Bonete, M.

Estamos entrando en una era donde la ortogonalidad entre las investigaciones de carácter experimental y de naturaleza teórica se irá difuminando progresivamente y la problemática a resolver quedará en escena como el único actor principal de la obra. Como premisa para una cooperación teórico-experimental de igual a igual, la metodología químico-cuántica utilizada debe ser capaz de ofrecer resultados de carácter predictivo. Sin duda, esta madurez en la metodología químico-cuántica ya la hemos alcanzado hace algunos años, tal y como muestra entre otras muchas, la labor que nuestro grupo ha realizado en el transcurso de la última década, dentro del campo de la Espectroscopía Teórica. Los estudios realizados comprenden una amplia gama de sistemas, variando tanto en tamaño como en complejidad, abordando problemáticas espectroscópicas consideradas tradicionalmente como especialmente controvertidas. Nuestra contribución científica más relevante reside en el carácter cuantitativo de las asignaciones espectroscópicas que hemos propuesto en base a resultados ab initio. Recordemos que en los años noventa los resultados ab initio solían presentar para las energías de excitación de sistemas de tamaño molecular moderado, como el benceno, errores de más de 1 eV. En comparación con el éxito relativo de los métodos semiempíricos, la frustración de la metodología ab initio quedaba todavía más patente. Los estudios que hemos presentado representan una comprensión profunda de los espectros electrónicos en sistemas orgánicos claves, mostrando el camino a seguir para obtener asignaciones espectroscópicas precisas (entre 0.1-0.2 eV). La naturaleza del método CASPT2 junto al diseño de estrategias computacionales nos ha permitido alcanzar el carácter cuantitativo con el que se caracterizan nuestras contribuciones[1,2]. Por todo ello, algunos de los trabajos publicados se consideran clásicos dentro del campo, pues en cierto modo definen el

Engaging Community With Promotores de Salud to Support Infant Nutrition and Breastfeeding Among Latinas Residing in Los Angeles County: Salud con Hyland's.

PubMed

Rios-Ellis, Britt; Nguyen-Rodriguez, Selena T; Espinoza, Lilia; Galvez, Gino; Garcia-Vega, Melawhy

2015-01-01

The Salud con Hyland's Project: Comienzo Saludable, Familia Sana [Health With Hyland's Project: Healthy Start, Healthy Family],was developed to provide education and support to Latina mothers regarding healthy infant feeding practices and maternal health. The promotora-delivered intervention was comprised of two charlas (educational sessions) and a supplemental, culturally and linguistically relevant infant feeding and care rolling calendar. Results indicate that the intervention increased intention to breastfeed exclusively, as well as to delay infant initiation of solids by 5 to 6 months. Qualitative feedback identified barriers to maternal and child health education as well as highlighted several benefits of the intervention.

Evaluation of the Arthritis Foundation's Camine Con Gusto Program for Hispanic Adults With Arthritis

PubMed Central

Callahan, Leigh F.; Rivadeneira, Alfredo; Altpeter, Mary; Vilen, Leigha; Cleveland, Rebecca J.; Sepulveda, Victoria E.; Hackney, Betsy; Reuland, Daniel S.; Rojas, Claudia

2017-01-01

Introduction Camine Con Gusto (CCG) is the Hispanic version of an evidence-based walking program for people with arthritis. This study examined CCG outcomes, feasibility, tolerability, safety, and acceptability and potential tailoring. Method A pre and post 6-week evaluation was conducted in Hispanic people with arthritis. Outcomes included pain, stiffness, fatigue, functional capacity, helplessness, and self-efficacy. A formative evaluation with program participants and key stakeholders explored program tailoring. Results Participants' mean age was 46.9 years, 44.4% had a high school degree or less, 2.5% were born in United States, 60.1% spoke only Spanish, and 74.7% were female. Moderate effect sizes were found: 0.50 for pain, 0.75 for fatigue, 0.49 for stiffness, 0.33 for function, 0.26 for helplessness, and 0.24 for self-efficacy. There were 285 participants recruited with an 82% 6-week retention (feasibility), no adverse events were reported (safety), and 98% reported program satisfaction (acceptability). Recommended adaptations included simpler language, more pictures and content addressing nutrition and chronic conditions, shortened materials, and inclusion of motivational strategies. Conclusion CCG showed improvement in outcomes in Hispanic individuals comparable to those noted in non-Hispanic White and Black individuals with arthritis. PMID:27553228

Outreach Opportunities for Early Career Scientists at the Phoenix ComiCon

NASA Astrophysics Data System (ADS)

Horodyskyj, L.; Walker, S. I.; Forrester, J. H.

2014-12-01

The Phoenix ComiCon (PCC) is a rapidly growing annual four-day pop culture event, featuring guests, costuming, exhibits, and discussion panels for popular sci-fi, fantasy, horror, and anime franchises. In 2013, PCC began experimenting with science discussion panels. The popularity of the science programming resulted in an expansion of the track for 2014, which Horodyskyj was responsible for coordinating. Thirty hours of programming were scheduled, including 25 discussion panels, NASA's FameLab, and a Mars room. Panelists included industry specialists, established scientists, STEM outreach enthusiasts, and early career scientists. The majority of the panelists were early career scientists recruited from planetary sciences and biology departments at ASU and UA. Panel topics included cosmology, biotechnology, artificial intelligence, space exploration, astrobiology, and the cross-linkages of each with pop culture. Formats consisted of Q&A, presentations, and interactive game shows. Although most panels were aimed at the general audience, some panels were more specialized. PCC 2014 attracted 77,818 attendees. The science programming received rave reviews from the audience, the PCC management, and the panelists themselves. Many panel rooms were filled to capacity and required crowd control to limit attendance. We observed the formation of science "groupies" who sought out the science panels exclusively and requested more information on other science public events in the Phoenix area. We distributed surveys to several select sessions to evaluate audience reasons for attending the science panels and their opinion of the scientists they observed. We will present the results of these surveys. As the PCC continues to grow at an exponential rate, the science programming will continue to expand. We will discuss ideas for continued expansion of the PCC science programming both to serve the public and as a unique public outreach opportunity for early career scientists.

Perfiles de luminosidad en galaxias con núcleo tipo Seyfert 1

NASA Astrophysics Data System (ADS)

Boris, N.; Rodriguez-Ardilla, A. A.; Pastoriza, M. G.

Presentamos imágenes CCD en los filtros BVI y Hα de una muestra de 10 galaxias Seyfert 1 y Narrow Line Seyfert 1. Recientes observaciones muestran que hay una diferencia significante en el índice espectral óptico entre NLS1s y Sy1 normales, siendo para las primeras del orden de 2. Otra característica importante es que la mayor parte de las NLS1s muestran tasas de FeII/Hβ mayores que las observadas en otras Sy1s. Desde el punto de vista fotométrico, estas galaxias no tienenningún tipo de estudio previo. Presentamos magnitudes totales, perfiles de luminosidad y mapas de color junto con un detallado análisis de la formación estelar en estos objetos. Encontramos que la descomposición en bulbo + disco representa adecuadamente los perfiles de luminosidad de las galaxias de la muestra. Sin embargo, en todos los casos es necesario que el disco tenga un agujero en su centro. El radio de este agujero va desde los 3 a los 9 kpc. Si bien no tenemos aún una explicación para este hecho, los agujeros parecen estar asociados a anillos circumnucleares de alto oscurecimiento E(B-V) ~1. Los perfiles presentan también un fuerte gradiente de color, siendo notablemente más azules hacia la región nuclear. Los objetos de la muestra cubren todo el rango de tipos morfológicos, no obstante, no encontramos regiones de formación estelar en las regiones exteriores de las galaxias. La formación estelar está confinada a la región nuclear y se data en alrededor de 5 x 107 años.

Patterns of evolution of research strands in the hydrologic sciences

NASA Astrophysics Data System (ADS)

Schwartz, F. W.; Fang, Y. C.; Parthasarathy, S.

2005-03-01

première contribution dans leur domaine et qui ont beaucoup influencé la recherche sont en général les plus cités. Il semble que la diminution de l'importance d'un domaine de recherche est aussi reflétée par le nombre de citations. Le modèle des citations des quelques articles classiques montre que l'activité dans le domaine ainsi que l'impact sur les articles suivantes déclinent progressivement pendant le temps ce qui présente une analogie avec les idées de Kuhn sur la science normale et révolutionnaire. Le résultat de l'étude renforce une fois de plus l'importance d'être un pionnier dans un domaine, en faisant avancer la recherche dans le domaine respectif, en adoptant des stratégies qui peuvent créer des percées majeures dans la recherche. Este artículo examina los temas de impacto e innovación en la investigación de las aguas subterráneas, mediante el uso de datos bibliométricos y del análisis de las referencias bibliográficas. El análisis se basó en 3120 artículos de la revista Water Resources Research, con el contenido completo y sus datos de referencias bibliográficas obtenidos de la Red de Ciencia ISI. La investigación se diseñó para desarrollar un entendimiento mayor de la forma en que la cantidad de citas bibliográficas puede ser interpretada por los científicos. No es sorprendente que los artículos más citados, parecen ser los pioneros en el campo, siendo artículos que divergen significativamente de lo que se ha hecho anteriormente, los cuales son efectivos creando de manera similar otros artículos "seguidores". Los artículos que son contribuciones iniciales en una línea de investigación nueva, la cual es de alta influencia, serán en promedio citados muy frecuentemente. Sin embargo, la importancia de una línea de investigación, de acuerdo a su medida por las veces que es citada, parece disminuir con el tiempo. Las tendencias en cuanto a hacer citas bibliográficas de algunos artículos clásicos, muestran que la

Synthesis of colloidal metal nanocrystals in droplet reactors: the pros and cons of interfacial adsorption.

PubMed

Zhang, Lei; Wang, Yi; Tong, Limin; Xia, Younan

2014-07-09

Droplet reactors have received considerable attention in recent years as an alternative route to the synthesis and potentially high-volume production of colloidal metal nanocrystals. Interfacial adsorption will immediately become an important issue to address when one seeks to translate a nanocrystal synthesis from batch reactors to droplet reactors due to the involvement of higher surface-to-volume ratios for the droplets and the fact that nanocrystals tend to be concentrated at the water-oil interface. Here we report a systematic study to compare the pros and cons of interfacial adsorption of metal nanocrystals during their synthesis in droplet reactors. On the one hand, interfacial adsorption can be used to generate nanocrystals with asymmetric shapes or structures, including one-sixth-truncated Ag octahedra and Au-Ag nanocups. On the other hand, interfacial adsorption has to be mitigated to obtain nanocrystals with uniform sizes and controlled shapes. We confirmed that Triton X-100, a nonionic surfactant, could effectively alleviate interfacial adsorption while imposing no impact on the capping agent typically needed for a shape-controlled synthesis. With the introduction of a proper surfactant, droplet reactors offer an attractive platform for the continuous production of colloidal metal nanocrystals.

[Birth and pregnancy outcomes of drug addicted women].

PubMed

Tzur, Tamar; Aslanov, Lili; Sheiner, Eyal; Levy, Amalia

2012-03-01

Illegal drug abuse causes significant health problems with consequences to the mother and the neonate, and an economic burden to the health system. The present study aimed to investigate pregnancy and perinatal outcome in women using illegal drugs prior to and during pregnancy. A retrospective cohort study comparing pregnancy and neonatal outcomes of drug addicted women to the outcomes of other Jewish women. The study population includes all women who gave birth between the years 1989-2008 at the Soroka University Medical Center. From a total of 106,000 deliveries, 119 women were known to be drug addicted. No significant differences were found between the groups regarding maternal age and origin, but more women in the addicted group smoked, and tacked prenatal care. More women in the addicted group had obstetrics complications such as: recurrent abortions, placenta previa, pLacental abruption and preterm labor. Illegal drug abuse was significantly associated with adverse perinatal outcomes such as low birth weight, congenital anomalies, peripartum death and prolonged hospitalizations. Illegal drug abuse is an independent risk factor for adverse obstetric and perinatal outcomes. This study investigated a significant problem that may be underestimated in our population. The higher incidence of pLacental abruption, placenta previa, preterm tabor and low birth weight could be a sign for placentaL insult. Illegal drug abuse is an independent risk factor for adverse perinatal outcomes and causes an economic burden. Further national studies are needed to characterize the problem, and to develop appropriate intervention programs.

Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study.

PubMed

Belachew, Johanna; Eurenius, Karin; Mulic-Lutvica, Ajlana; Axelsson, Ove

2017-08-01

Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women. We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28-30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta. The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta. The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.

MRI in the diagnosis and surgical management of abnormal placentation.

PubMed

Palacios-Jaraquemada, José Miguel; Bruno, Claudio Hernán; Martín, Eduardo

2013-04-01

To determine the usefulness of placental magnetic resonance imaging (MRI) in the diagnosis and surgical management of abnormal placentation. Retrospective follow-up. Buenos Aires, Argentina. 547 pregnant women. In all cases, a direct and reliable description of abnormal placentation features was obtained by the operating surgeon. Placental MRI was analyzed according to: (1) primary description, (2) invasion topography, (3) modification required to the surgical tactics or techniques and (4) by positive and negative predictive values. Ultrasound and MRI findings were compared with surgical results, which were considered a final diagnosis in relation to primary diagnostic indications. Placental MRI was obtained because of diagnostic doubt in 78 cases, for deep invasion diagnosis in 148 cases and to define the invasion area in 346 cases. Placental MRI allowed accurate demarcation and assessment of the degree of placental invasion, parametrial involvement and cervico-trigonal vascular hyperplasia, permitting changes in the surgical tactical approach. Ultrasound and MRI differences were associated with placenta previa, uterine scar thinning and use of different criteria for placental invasion through definitions or terminology. Six cases of false-negative and 11 of false-positive findings were reported. Placental MRI provides excellent characterization of the degree and extension of placental invasion. Its usefulness in cases of adherent placentation is directly associated to the therapeutic measures, especially where dissection maneuvers are needed. Diagnostic differences between ultrasound and MRI related to the presence or not of placenta previa and uterine scar thinning. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Bedside risk estimation of morbidly adherent placenta using simple calculator.

PubMed

Maymon, R; Melcer, Y; Pekar-Zlotin, M; Shaked, O; Cuckle, H; Tovbin, J

2018-03-01

To construct a calculator for 'bedside' estimation of morbidly adherent placenta (MAP) risk based on ultrasound (US) findings. This retrospective study included all pregnant women with at least one previous cesarean delivery attending in our US unit between December 2013 and January 2017. The examination was based on a scoring system which determines the probability for MAP. The study population included 471 pregnant women, and 41 of whom (8.7%) were diagnosed with MAP. Based on ROC curve, the most effective US criteria for detection of MAP were the presence of the placental lacunae, obliteration of the utero-placental demarcation, and placenta previa. On the multivariate logistic regression analysis, US findings of placental lacunae (OR = 3.5; 95% CI, 1.2-9.5; P = 0.01), obliteration of the utero-placental demarcation (OR = 12.4; 95% CI, 3.7-41.6; P < 0.0001), and placenta previa (OR = 10.5; 95% CI, 3.5-31.3; P < 0.0001) were associated with MAP. By combining these three parameters, the receiver operating characteristic curve was calculated, yielding an area under the curve of 0.93 (95% CI, 0.87-0.97). Accordingly, we have constructed a simple calculator for 'bedside' estimation of MAP risk. The calculator is mounted on the hospital's internet website ( http://www.assafh.org/Pages/PPCalc/index.html ). The risk estimation of MAP varies between 1.5 and 87%. The present calculator enables a simple 'bedside' MAP estimation, facilitating accurate and adequate antenatal risk assessment.

Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study

PubMed Central

Belachew, Johanna; Eurenius, Karin; Mulic-Lutvica, Ajlana; Axelsson, Ove

2017-01-01

Objective Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women. Materials and methods We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28–30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta. Results The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta. Conclusions The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta. PMID:28826360

Circulating microRNA Biomarkers as Liquid Biopsy for Cancer Patients: Pros and Cons of Current Assays

PubMed Central

Ono, Shigeshi; Lam, Stella; Nagahara, Makoto; Hoon, Dave S. B.

2015-01-01

An increasing number of studies have focused on circulating microRNAs (cmiRNA) in cancer patients’ blood for their potential as minimally-invasive biomarkers. Studies have reported the utility of assessing specific miRNAs in blood as diagnostic/prognostic biomarkers; however, the methodologies are not validated or standardized across laboratories. Unfortunately, there is often minimum limited overlap in techniques between results reported even in similar type studies on the same cancer. This hampers interpretation and reliability of cmiRNA as potential cancer biomarkers. Blood collection and processing, cmiRNA extractions, quality and quantity control of assays, defined patient population assessment, reproducibility, and reference standards all affect the cmiRNA assay results. To date, there is no reported definitive method to assess cmiRNAs. Therefore, appropriate and reliable methodologies are highly necessary in order for cmiRNAs to be used in regulated clinical diagnostic laboratories. In this review, we summarize the developments made over the past decade towards cmiRNA detection and discuss the pros and cons of the assays. PMID:26512704

Evaluation of clinical information modeling tools.

PubMed

Moreno-Conde, Alberto; Austin, Tony; Moreno-Conde, Jesús; Parra-Calderón, Carlos L; Kalra, Dipak

2016-11-01

un marco para la evaluación de herramientas informáticas diseñadas para dar soporte en la en los procesos de definición, gestión e implementación de estos modelos. El marco de evaluación propuesto se basa en una investigación previa para obtener consenso en la definición de requisitos esenciales en esta área. A partir de los 20 requisitos funcionales acordados, un conjunto de 50 criterios de conformidad fueron definidos y aplicados en la evaluación de las herramientas existentes. Un total de 9 de las 11 iniciativas identificadas desarrollando herramientas para el modelado de información clínica fueron evaluadas. Los resultados muestran que las funcionalidades relacionadas con la gestión de tipos de datos, especificaciones, metadatos y mapeo con terminologías u ontologías tienen un buen nivel de adopción. Se identifican posibles mejoras en áreas relacionadas con los procesos de modelado de información. Otros criterios relacionados con presentar las relaciones semánticas entre conceptos y la comunicación con servidores de terminología tienen un bajo nivel de adopción. El marco de evaluación propuesto fue probado y validado satisfactoriamente contra un conjunto representativo de las herramientas existentes. Los resultados identifican la necesidad de mejorar el soporte de herramientas a los procesos de modelado de información y desarrollo de software, especialmente en las áreas relacionadas con gobernanza, participación de profesionales clínicos y la optimización de la validación técnica en los procesos de pruebas técnicas. Esta investigación ha confirmado el potencial de este marco de evaluación para dar soporte a los usuarios en la toma de decisiones sobre que herramienta es más apropiadas para su organización. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address the use of evidence to inform judgements about the balance between the pros and cons of policy and programme options. We suggest five questions that can be considered when making these judgements. These are: 1. What are the options that are being compared? 2. What are the most important potential outcomes of the options being compared? 3. What is the best estimate of the impact of the options being compared for each important outcome? 4. How confident can policymakers and others be in the estimated impacts? 5. Is a formal economic model likely to facilitate decision making? PMID:20018106

Balancing the pros and cons of GMOs: socio-scientific argumentation in pre-service teacher education

NASA Astrophysics Data System (ADS)

Cinici, Ayhan

2016-07-01

This study investigates the role of the discursive process in the act of scientific knowledge building. Specifically, it links scientific knowledge building to risk perception of Genetically Modified Organisms (GMOs). To this end, this study designed and implemented a three-stage argumentation programme giving pre-service teachers (PSTs) the opportunity to consider, discuss and construct shared decisions about GMOs. The study involved 101 third-year PSTs from two different classes, randomly divided into control and experimental groups. The study utilised both quantitative and qualitative methods. During the quantitative phase, researchers administered a pre- and post-intervention scale to measure both groups' risk perception of GMOs. During the qualitative phase, data were collected from the experimental group alone through individual and group reports and an open-ended questionnaire. T-test results showed a statistically significant difference between the experimental and control groups' risk perception of GMOs. Qualitative analysis also revealed differences, for example, in PSTs' weighing of the pros and cons of scientific research demonstrating positive results of GMOs. In addition, PSTs' acceptance of GMOs increased. Consequently, this study suggests that developing familiarity with scientific enterprise may play an effective role in adopting a scientific perspective as well as a more balanced risk perception of GMOs.

[Reconstrucción ósea de defectos craneales secundarios a traumatismo con implantes personalizados].

PubMed

Cienfuegos, Ricardo; Fernández, Gerardo; Cruz, Aída; Sierra, Eduardo

2018-01-01

Los defectos craneales secundarios a traumatismos son frecuentes. Por lo común se reparan de forma secundaria por sintomatología como el síndrome del paciente trepanado, por protección cerebral y por el aspecto cosmético. Históricamente se han utilizado diversos materiales para la reconstrucción. Se presentan cinco casos de pacientes reconstruidos con implantes personalizados de polieteretercetona (PEEK) o polimetilmetacrilato poroso (PMMA). Las localizaciones afectaron el frontal, el borde orbitario superior y el techo orbitario en cuatro casos, y la porción lateral del frontal, la zona temporoparietal y el borde del occipital en un caso. La reconstrucción en cuatro pacientes fue entre 6 y 12 meses después de la lesión, y en un caso después de 25 años. En dos casos se requirió expansión tisular antes de colocar el implante. Cuatro pacientes evolucionaron favorablemente, con mejoría de los síntomas neurológicos, forma y contorno adecuados, así como un proceso de cicatrización adecuada de los colgajos de piel cabelluda. Un paciente presentó infección por Staphylococcus aureus, atribuida a la presencia de un mucocele y una fístula de la vía aérea a la cavidad craneal, lo que hizo necesario retirar el implante. Los implantes personalizados son un recurso útil para defectos óseos craneales. Brindan resultados satisfactorios desde el punto de vista funcional y cosmético. Deben tomarse precauciones respecto al tratamiento de las lesiones que afecten el seno frontal, para evitar la comunicación entre la vía aérea y la cavidad craneal. Cranial defects due to trauma are frequent. They are usually repaired in a secondary fashion due to features such as syndrome of the trephined, for brain protection and for cosmetic purposes. Historically, various materials have been used for reconstruction. Five cases of patients reconstructed with customized polyetheretherketone (PEEK) o polymethyl methacrylate (PMMA) implants are presented. Defects involved

Exploring the pros and cons of mechanistic case diagrams for problem-based learning

PubMed Central

2017-01-01

Purpose Mechanistic case diagram (MCD) was recommended for increasing the depth of understanding of disease, but with few articles on its specific methods. We address the experience of making MCD in the fullest depth to identify the pros and cons of using MCDs in such ways. Methods During problem-based learning, we gave guidelines of MCD for its mechanistic exploration from subcellular processes to clinical features, being laid out in as much detail as possible. To understand the students’ attitudes and depth of study using MCDs, we analyzed the results of a questionnaire in an open format about experiencing MCDs and examined the resulting products. Results Through the responses to questionnaire, we found several favorable outcomes, major of which was deeper insight and comprehensive understanding of disease facilitated by the process of making well-organized diagram. The main disadvantages of these guidelines were the feeling of too much workload and difficulty of finding mechanisms. Students gave suggestions to overcome these problems: cautious reading of comprehensive texts, additional guidance from staff about depth and focus of mechanisms, and cooperative group work. From the analysis of maps, we recognized there should be allowance of diversities in the appearance of maps and many hypothetical connections, which could be related to an insufficient understanding of mechanisms in nature. Conclusion The more detailed an MCD task is, the better students can become acquainted with deep knowledges. However, this advantage should be balanced by the results that there are many ensuing difficulties for the work and deliberate help plans should be prepared. PMID:28870018

Conversation with Lara about the Earth and Land. (Spanish Title: Conversando con Lara sobre la Tierra y la Teirra.) Conversando com Lara sobre a Terra e a Terra

NASA Astrophysics Data System (ADS)

da Conceição Barbosa-Lima, Maria

2010-12-01

The present article is the analysis of a conversation between the author and Lara, a four-yearold- girl, enrolled in nursery school, while she makes a drawing of the Earth. It took place outside school environment and without any other person around to avoid interference during the interview. According to Ferreira & Silva (2004), a researcher can only comprehend a child's drawing, or form, by listening to him/her while he/she is creating it. Lara presented the traditional flat drawing, picturing the sky parallel to the ground, as reported by Nardi & Carvalho (1996). However, when asked to draw the World - term used by Butterworth et al. (2002), in order to avoid unnecessary confusion - she represented it by a circle, with herself on the surface. Her drawings led to the conclusion that such girl does not know yet the World in which she lives is the Earth, and probably because of that, within her age and consequent maturity, she accurately differentiates the concepts of land and Earth. El presente artículo analiza una entrevista libre, mientras una niña de 4 años y 4 meses, matriculada en el pregrado, dibuja la Tierra. Esta entrevista se realizó fuera del ambiente escolar y sin otra persona alrededor que pudiera interferir. De acuerdo con Ferreira Silva (2004), para quien investiga es posible conocer realmente lo que un niño o una niña pone en el papel a través de grafismos y/o dibujos si se lo escucha durante el proceso de creación de la escritura con imágenes. La niña, en este caso, representa la Tierra con el tradicional dibujo plano y el "cielo" paralelo al suelo, conforme analizaron Nardi & Carvalho (1996). Pero, cuando se Le solicita dibujar el "Mundo" - palabra empleada en un trabajo de Butterworth et al. (2002), con intención de no provocar "confusiones" innecesarias a sus sujetos de investigación- lo representa de forma circular, poniéndose sobre su superficie. Sus dibujos llevan a concluir que esta niña aún no tiene conocimiento que el mundo

Obstetric outcomes after fresh versus frozen-thawed embryo transfers: A systematic review and meta-analysis.

PubMed

Roque, Matheus; Valle, Marcello; Sampaio, Marcos; Geber, Selmo

2018-05-21

To evaluate if there are differences in the risks of obstetric outcomes in IVF/ICSI singleton pregnancies when compared fresh to frozen-thawed embryo transfers (FET). This was a systematic review and meta-analysis evaluating the obstetric outcomes in singleton pregnancies after FET and fresh embryo transfer. The outcomes included in this study were pregnancy-induced hypertension (PIH), pre-eclampsia, placenta previa, and placenta accreta. The search yielded 654 papers, 6 of which met the inclusion criteria and reported on obstetric outcomes. When comparing pregnancies that arose from FET or fresh embryo transfer, there was an increase in the risk of obstetric complications in pregnancies resulting from FET when compared to those emerging from fresh embryo transfers in PIH (aOR 1.82; 95% CI 1.24-2.68), pre-eclampsia (aOR 1.32, 95% CI 1.07, 1.63), and placenta accreta (aOR 3.51, 95% CI 2.04-6.05). There were no significant differences in the risk between the FET and fresh embryo transfer groups when evaluating placenta previa (aOR 0.70; 95% CI 0.46-1.08). The obstetric outcomes observed in pregnancies arising from ART may differ among fresh and FET cycles. Thus, when evaluating to perform a fresh embryo transfer or a freeze-all cycle, these differences found in obstetric outcomes between fresh and FET should be taken into account. The adverse obstetric outcomes after FET found in this study emphasize that the freeze-all policy should not be offered to all the patients, but should be offered to those with a clear indication of the benefit of this strategy.

Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects.

PubMed

Woo, Irene; Hindoyan, Rita; Landay, Melanie; Ho, Jacqueline; Ingles, Sue Ann; McGinnis, Lynda K; Paulson, Richard J; Chung, Karine

2017-12-01

To study the perinatal outcomes between singleton live births achieved with the use of commissioned versus spontaneously conceived embryos carried by the same gestational surrogate. Retrospective cohort study. Academic in vitro fertilization center. Gestational surrogate. None. Pregnancy outcome, gestational age at birth, birth weight, perinatal complications. We identified 124 gestational surrogates who achieved a total of 494 pregnancies. Pregnancy outcomes for surrogate and spontaneous pregnancies were significantly different (P<.001), with surrogate pregnancies more likely to result in twin pregnancies: 33% vs. 1%. Miscarriage and ectopic rates were similar. Of these pregnancies, there were 352 singleton live births: 103 achieved from commissioned embryos and 249 conceived spontaneously. Surrogate births had lower mean gestational age at delivery (38.8 ± 2.1 vs. 39.7 ± 1.4), higher rates of preterm birth (10.7% vs. 3.1%), and higher rates of low birth weight (7.8% vs. 2.4%). Neonates from surrogacy had birth weights that were, on average, 105 g lower. Surrogate births had significantly higher obstetrical complications, including gestational diabetes, hypertension, use of amniocentesis, placenta previa, antibiotic requirement during labor, and cesarean section. Neonates born from commissioned embryos and carried by gestational surrogates have increased adverse perinatal outcomes, including preterm birth, low birth weight, hypertension, maternal gestational diabetes, and placenta previa, compared with singletons conceived spontaneously and carried by the same woman. Our data suggest that assisted reproductive procedures may potentially affect embryo quality and that its negative impact can not be overcome even with a proven healthy uterine environment. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Ab initio study of the CO-N2 complex: a new highly accurate intermolecular potential energy surface and rovibrational spectrum.

PubMed

Cybulski, Hubert; Henriksen, Christian; Dawes, Richard; Wang, Xiao-Gang; Bora, Neha; Avila, Gustavo; Carrington, Tucker; Fernández, Berta

2018-05-09

A new, highly accurate ab initio ground-state intermolecular potential-energy surface (IPES) for the CO-N2 complex is presented. Thousands of interaction energies calculated with the CCSD(T) method and Dunning's aug-cc-pVQZ basis set extended with midbond functions were fitted to an analytical function. The global minimum of the potential is characterized by an almost T-shaped structure and has an energy of -118.2 cm-1. The symmetry-adapted Lanczos algorithm was used to compute rovibrational energies (up to J = 20) on the new IPES. The RMSE with respect to experiment was found to be on the order of 0.038 cm-1 which confirms the very high accuracy of the potential. This level of agreement is among the best reported in the literature for weakly bound systems and considerably improves on those of previously published potentials.

Leveling data in geochemical mapping: scope of application, pros and cons of existing methods

NASA Astrophysics Data System (ADS)

Pereira, Benoît; Vandeuren, Aubry; Sonnet, Philippe

2017-04-01

Geochemical mapping successfully met a range of needs from mineral exploration to environmental management. In Europe and around the world numerous geochemical datasets already exist. These datasets may originate from geochemical mapping projects or from the collection of sample analyses requested by environmental protection regulatory bodies. Combining datasets can be highly beneficial for establishing geochemical maps with increased resolution and/or coverage area. However this practice requires assessing the equivalence between datasets and, if needed, applying data leveling to remove possible biases between datasets. In the literature, several procedures for assessing dataset equivalence and leveling data are proposed. Daneshfar & Cameron (1998) proposed a method for the leveling of two adjacent datasets while Pereira et al. (2016) proposed two methods for the leveling of datasets that contain records located within the same geographical area. Each discussed method requires its own set of assumptions (underlying populations of data, spatial distribution of data, etc.). Here we propose to discuss the scope of application, pros, cons and practical recommendations for each method. This work is illustrated with several case studies in Wallonia (Southern Belgium) and in Europe involving trace element geochemical datasets. References: Daneshfar, B. & Cameron, E. (1998), Leveling geochemical data between map sheets, Journal of Geochemical Exploration 63(3), 189-201. Pereira, B.; Vandeuren, A.; Govaerts, B. B. & Sonnet, P. (2016), Assessing dataset equivalence and leveling data in geochemical mapping, Journal of Geochemical Exploration 168, 36-48.

El Administrador Regional de la EPA Pete López se reúne con el Gobernador de las Islas Vírgenes Estadounidenses, Kenneth Mapp, comprometiéndose a restablecer las comunidades de Puerto Rico y las USVI

EPA Pesticide Factsheets

Comunicado de prensa de la EPA: El Administrador Regional de la EPA Pete López se reúne con el Gobernador de las Islas Vírgenes Estadounidenses, Kenneth Mapp, comprometiéndose a restablecer las comunidades de Puerto Rico y las USVI

Placenta accreta spectrum: accreta, increta, and percreta.

PubMed

Silver, Robert M; Barbour, Kelli D

2015-06-01

Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta. Copyright © 2015 Elsevier Inc. All rights reserved.

Molecular detection of pathogens in water--the pros and cons of molecular techniques.

PubMed

Girones, Rosina; Ferrús, Maria Antonia; Alonso, José Luis; Rodriguez-Manzano, Jesus; Calgua, Byron; Corrêa, Adriana de Abreu; Hundesa, Ayalkibet; Carratala, Anna; Bofill-Mas, Sílvia

2010-08-01

Pollution of water by sewage and run-off from farms produces a serious public health problem in many countries. Viruses, along with bacteria and protozoa in the intestine or in urine are shed and transported through the sewer system. Even in highly industrialized countries, pathogens, including viruses, are prevalent throughout the environment. Molecular methods are used to monitor viral, bacterial, and protozoan pathogens, and to track pathogen- and source-specific markers in the environment. Molecular techniques, specifically polymerase chain reaction-based methods, provide sensitive, rapid, and quantitative analytical tools with which to study such pathogens, including new or emerging strains. These techniques are used to evaluate the microbiological quality of food and water, and to assess the efficiency of virus removal in drinking and wastewater treatment plants. The range of methods available for the application of molecular techniques has increased, and the costs involved have fallen. These developments have allowed the potential standardization and automation of certain techniques. In some cases they facilitate the identification, genotyping, enumeration, viability assessment, and source-tracking of human and animal contamination. Additionally, recent improvements in detection technologies have allowed the simultaneous detection of multiple targets in a single assay. However, the molecular techniques available today and those under development require further refinement in order to be standardized and applicable to a diversity of matrices. Water disinfection treatments may have an effect on the viability of pathogens and the numbers obtained by molecular techniques may overestimate the quantification of infectious microorganisms. The pros and cons of molecular techniques for the detection and quantification of pathogens in water are discussed. (c) 2010 Elsevier Ltd. All rights reserved.

Linking innovative measurement technologies (ConMon and Dataflow© systems) for high-resolution temporal and spatial dissolved oxygen criteria assessment.

PubMed

O'Leary, C A; Perry, E; Bayard, A; Wainger, L; Boynton, W R

2015-10-01

One consequence of nutrient-induced eutrophication in shallow estuarine waters is the occurrence of hypoxia and anoxia that has serious impacts on biota, habitats, and biogeochemical cycles of important elements. Because of the important role of dissolved oxygen (DO) on these ecosystem features, a variety of DO criteria have been established as indicators of system condition. However, DO dynamics are complex and vary on time scales ranging from diel to decadal and spatial scales from meters to multiple kilometers. Because of these complexities, determining DO criteria attainment or failure remains difficult. We propose a method for linking two common measurement technologies for shallow water DO criteria assessment using a Chesapeake Bay tributary as a test case. Dataflow© is a spatially intensive (30-60-m collection intervals) system used to map surface water conditions at the whole estuary scale, and ConMon is a high-frequency (15-min collection intervals) fixed station approach. The former technology is effective with spatial descriptions but poor regarding temporal resolution, while the latter provides excellent temporal but very limited spatial resolution. Our methodology for combining the strengths of these measurement technologies involved a sequence of steps. First, a statistical model of surface water DO dynamics, based on temporally intense ConMon data, was developed. The results of this model were used to calculate daily DO minimum concentrations. Second, this model was then inserted into Dataflow©-generated spatial maps of DO conditions and used to adjust measured DO concentrations to daily minimum concentrations. This information was used to assess DO criteria compliance at the full tributary scale. Model results indicated that it is vital to consider the short-term time scale DO criteria across both space and time concurrently. Large fluctuations in DO occurred within a 24-h time period, and DO dynamics varied across the length and width of the

Air Traffic Management Technology Demonstration-1 Concept of Operations (ATD-1 ConOps), Version 2.0

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Johnson, William C.; Swenson, Harry N.; Robinson, John E.; Prevot, Tom; Callantine, Todd J.; Scardina, John; Greene, Michael

2013-01-01

This document is an update to the operations and procedures envisioned for NASA s Air Traffic Management (ATM) Technology Demonstration #1 (ATD-1). The ATD-1 Concept of Operations (ConOps) integrates three NASA technologies to achieve high throughput, fuel-efficient arrival operations into busy terminal airspace. They are Traffic Management Advisor with Terminal Metering (TMA-TM) for precise time-based schedules to the runway and points within the terminal area, Controller-Managed Spacing (CMS) decision support tools for terminal controllers to better manage aircraft delay using speed control, and Flight deck Interval Management (FIM) avionics and flight crew procedures to conduct airborne spacing operations. The ATD-1 concept provides de-conflicted and efficient operations of multiple arrival streams of aircraft, passing through multiple merge points, from top-of-descent (TOD) to the Final Approach Fix. These arrival streams are Optimized Profile Descents (OPDs) from en route altitude to the runway, using primarily speed control to maintain separation and schedule. The ATD-1 project is currently addressing the challenges of integrating the three technologies, and their implantation into an operational environment. The ATD-1 goals include increasing the throughput of high-density airports, reducing controller workload, increasing efficiency of arrival operations and the frequency of trajectory-based operations, and promoting aircraft ADS-B equipage.

Pros and cons of condom use among gay and bisexual men as explored via the Internet.

PubMed

Gullette, Donna L; Turner, Joan G

2003-01-01

The purpose of this study was to conduct a survey utilizing Internet technology related to gay and bisexual men's condom use behavior as an expression of safer sexual practices. A total of 241 self-identified gay and bisexual men responded to the questionnaire in a 3-month period of time. Confidentiality was assured by utilizing an electronic system whereby the respondents e-mail address was eliminated. The study was conceptually guided by the use of the Transtheoretical Model of Behavioral Change (TMC) and the pros and cons of condom of use were explored. Fifty-six percent of the participants reported that one advantage (pro) of using condoms with casual partners was that it would make them safer from disease. About half of the respondents (n = 119, 49%) reported a history of one or more sexually transmitted diseases. There were 14 variables found to be significantly associated with using a condom with primary and casual partners among gay and bisexual men. Essentially, findings from this study corresponded to results obtained by more traditional data collection methods. Therefore, the authors conclude that electronic data collection may well be an alternative means for collecting sensitive data such as those collected in this study.

Obtención de perfiles teóricos de elementos metálicos con velocidades macroscópicas

NASA Astrophysics Data System (ADS)

Cirigliano, D.; Costa, A.; Rovira, M.

El propósito de este trabajo es poder establecer -a partir de la modelización de perfiles de distintas especies- patrones de comparación observacional que permitan caracterizar los fenómenos físicos que están presentes en las estructuras que se observan. Para ello se resuelven las ecuaciones de equilibrio de ionización para un determinado átomo y una atmósfera de parámetros determinados. A partir de ello se definen las poblaciones para los distintos grados de ionización. Considerando distintas configuraciones e intensidades de flujos de masa se deducen la función fuente, el espesor óptico y se calculan los perfiles de las distintas líneas. Se obtuvieron perfiles teóricos de líneas del CII, CIV y del OIV para flujos entrante, saliente y pasante. La forma del perfil, las intensidades relativas entre los distintos flujos y el corrimiento Doppler da cuenta de una caracterización teórica a partir de la cual se comparará con observaciones.

Con-forming bodies: the interplay of machines and bodies and the implications of agency in medical imaging.

PubMed

Wood, Lisa A

2016-06-01

Attending to the material discursive constructions of the patient body within cone beam computed tomography (CBCT) imaging in radiotherapy treatments, in this paper I describe how bodies and machines co-create images. Using an analytical framework inspired by Science and Technology Studies and Feminist Technoscience, I describe the interplay between machines and bodies and the implications of materialities and agency. I argue that patients' bodies play a part in producing scans within acceptable limits of machines as set out through organisational arrangements. In doing so I argue that bodies are fabricated into the order of work prescribed and embedded within and around the CBCT system, becoming, not only the subject of resulting images, but part of that image. The scan is not therefore a representation of a passive subject (a body) but co-produced by the work of practitioners and patients who actively control (and contort) and discipline their body according to protocols and instructions and the CBCT system. In this way I suggest they are 'con-forming' the CBCT image. A Virtual Abstract of this paper can be found at: https://youtu.be/qysCcBGuNSM. © 2015 Foundation for the Sociology of Health & Illness.

MAÑANA: U.S. EPA, National Econ Corporation demostrarán prácticas seguras de trabajo con plomo para contratistas, se anunciará compromiso para reducir la exposición al plomo en la región

EPA Pesticide Factsheets

EPA News Release: MAÑANA: U.S. EPA, National Econ Corporation demostrarán prácticas seguras de trabajo con plomo para contratistas, se anunciará compromiso para reducir la exposición al plomo en la región