Trusts Betrayed: The Absent Federal Partner in Immigration Policy

This Article develops a framework for analyzing claims brought by the states with large immigration populations against the federal government. The Article looks at the question of federal plenary power over immigration matters and examines state lawsuits seeking federal reimbursement for the costs of services for illegal immigrants. Illegal immigration problems are addressed in terms of trusts between the states and the federal government. The Author argues that the courts should draw from jurisprudence in other areas of government trust, such as trusts over coastal waters and Indian trusts, when deciding state claims for reimbursement of costs imposed by illegal immigration

Pregnancy outcome following spontaneous abortions

Background: The objective of the present study was to study pregnancy outcome in patients with history of previous spontaneous abortions.Methods: A prospective study included patients with history of previous spontaneous abortion admitted in the Department of Obstetrics and Gynaecology, GR Medical College and Kamla Raja Hospital, Gwalior between September 2008 and February 2009. The patients were either booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 70 patients with history of previous spontaneous abortion were admitted, out of which 40 (57.2%) patients were booked and 30 (42.8%) reported first time in emergency. Majority (57.1 %) of patients belong to the age group 21-29 years. Educational status of the patients showed 61.4% had no formal education or only up to primary level.  Anemia was found to be very severe in 4.3 %, severe in 10% and moderate in 30 % patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). Incidence of abortions after one, two, three and four abortions was 9.4, 14.8, 20 and 100 percent respectively. The final outcomes were term live birth (74.3%), abortion (14.3%), preterm delivery (8.6%), and still birth (2.8%).  In the present study 10 (14.3%) pregnancies ended with abortion, out of which 4 were in booked and 6 in emergency patients. Live babies were of 90% booked mothers whereas 70% in emergency patients. Caesarian section was done in 23.3% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care

Lightning phenomena and its effect on transmission line

As we know that Lightning is one of the most natural and serious cause of over voltage .So, my this paper describes about the lightning phenomena, the way it is caused and in the manner it effects the power equipments, building frames, transmission lines, etc It is matter of great surprise to know that over the whole world ,more than 40,000 lightning strokes per day and less than 100 lightning strokes per second takes place. Transmission lines functions as arteries that carry electricity from power stations to regions where the power is needed. Therefore, it is vital to control the construction and maintenance costs of these lines because while the frequency of transmission line faults resulting in power loss has decreased year by year yet the trouble due to natural cause lightning is not yet reduced The main object of this paper is to study the effect of lightning strokes on transmission lines which cause great damage due to traveling waves to the electrical equipments installed in open air and insulators, etc. Frequently lightning problems do not receive consideration during the design stage. It remains then for the lightning safety engineer to analyze the effect of thelightning during operations and to provide rational for safety  through modification to the Assets, Facilities and Structures

Investigation and Optimization of a Solvent / Anti-Solvent Crystallization Process for the Production of Inhalation Particles

Dry powder inhalers (DPIs) are commonly used to deliver drugs to the lungs. The drug particles used in these DPIs should possess a number of key properties. These include an aerodynamic particle size \u3c 5μm and particle crystallinity for long term formulation stability. The conventionally used micronization technique to produce inhalation particles offers limited opportunities to control and optimize the particle characteristics. It is also known to induce crystalline disorder in the particles leading to formulation instability. Hence, this research project investigates and optimizes a solvent/anti-solvent crystallization process capable of directly yielding inhalation particles using albuterol sulfate (AS) as a model drug. Further, the feasibility of the process to produce combination particles of AS and ipratropium bromide monohydrate (IB) in predictable proportions and in a size suitable for inhalation is also investigated. The solvent / anti-solvent systems employed were water / ethyl acetate (EA) and water / isopropanol (IPA). Investigation and optimization of the crystallization variables with the water / EA system revealed that particle crystallinity was significantly influenced by an interaction between the drug solution / anti-solvent ratio (Ra ratio), stirring speed and crystal maturation time. Inducing a temperature difference between the drug solution and anti-solvent (Tdrug solution \u3e Tanti-solvent) resulted in smaller particles being formed at a positive temperature difference of 65°C. IPA was shown to be the optimum anti-solvent for producing AS particles (IPA-AS) in a size range suitable for inhalation. In vitro aerosol performance of these IPA-AS particles was found to be superior compared to the conventionally used micronized particles when aerosolized from the Novolizer®. The solvent / anti-solvent systems investigated and optimized for combination particles were water / EA, water / IPA, and water / IPA:EA 1:10 (w/w). IPA was found to be the optimum anti-solvent for producing combination particles of AS and IB with the smallest size. These combination particles showed uniform co-deposition during in vitro aerosol performance testing from the Novolizer®. Pilot molecular modeling studies in conjunction with the analysis of particle interactions using HINT provided an improved understanding of the possible interactions between AS and IB within a combination particle matrix

Addressing Lower Segment Cesarean Section Hesitancy: A Patient-centered, Pragmatic Communication Guide

In women in whom a normal vaginal delivery is not possible or is not indicated, delayed acceptance of lower segment cesarean section (LSCS) or outright LSCS refusal, leads to complications that can easily be avoided. Hence, it makes sense for obstetricians and other health care professionals, to address LSCS hesitancy as an integral part of obstetric care. In this article, we discuss both the communication style and communication content, that is required to manage LSCS hesitancy in women in whom the intervention is indicated. We highlight the need to analyze the reasons for hesitancy, and address them in an appropriate and affable manner, using accurate information to buttress one’s points. We also encourage seeking assistance from colleagues in the health care team, utilizing audio-visual and social media aids, and offering alternatives if the patient so desires

Retrospective review of maternal deaths and maternal near misses due to major obstetric haemorrhage at a tertiary care centre in India

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani  Hospital over a period of 12 months (April 2016-March 2017), of  all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was  2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor  for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH.

Genetic variability of attachment (G) and Fusion (F) protein genes of human metapneumovirus strains circulating during 2006-2009 in Kolkata, Eastern India

<p>Abstract</p> <p>Background</p> <p>Human metapneumovirus (hMPV) is associated with the acute respiratory tract infection (ARTI) in all the age groups. However, there is limited information on prevalence and genetic diversity of human metapneumovirus (hMPV) strains circulating in India.</p> <p>Objective</p> <p>To study prevalence and genomic diversity of hMPV strains among ARTI patients reporting in outpatient departments of hospitals in Kolkata, Eastern India.</p> <p>Methods</p> <p>Nasal and/or throat swabs from 2309 patients during January 2006 to December 2009, were screened for the presence of hMPV by RT-PCR of nucleocapsid (N) gene. The G and F genes of representative hMPV positive samples were sequenced.</p> <p>Results</p> <p>118 of 2309 (5.11%) clinical samples were positive for hMPV. The majority (≈80%) of the positive cases were detected during July−November all through the study period. Genetic analysis revealed that 77% strains belong to A2 subgroup whereas rest clustered in B1 subgroup. G sequences showed higher diversity at the nucleotide and amino acid level. In contrast, less than 10% variation was observed in F gene of representative strains of all four years. Sequence analysis also revealed changes in the position of stop codon in G protein, which resulted in variable length (217-231 aa) polypeptides.</p> <p>Conclusion</p> <p>The study suggests that approximately 5% of ARTI in the region were caused by hMPV. This is the first report on the genetic variability of G and F gene of hMPV strains from India which clearly shows that the G protein of hMPV is continuously evolving. Though the study partially fulfills lacunae of information, further studies from other regions are necessary for better understanding of prevalence, epidemiology and virus evolution in Indian subcontinent.</p

Quinary Prevention and Lower Segment Cesarean Section

Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery

Impact of premenstrual syndrome and premenstrual dysphoric disorder on adolescent and young women’s quality of life in northern India

Background: Our aim was to study the effect of PMS and PMDD on quality of life in adolescent and young women.Methods: This was a cross-sectional questionnaire based study was conducted from 2019 to 2020 in Department of Obstetrics and Gynecology, King Georges Medical University, Lucknow. After getting informed consent 358 female participant was enrolment. All participants were screened first according to PMS ACOG guideline then further DSM IV based premenstrual symptom screening tool (PSST) was applied by enquiring detail about last 3 menstrual cycles. The subjects which are diagnosed were given WHO-QOL-BREF scale.Results: The work efficiency or productivity, relationship with co-workers, relationship with your family, social life activities and home responsibilities were 27.63%, 26.31%, 22.36%, 15.78% and 15.13% in no/mild PMS, 94.73%, 86.84%, 73.68%, 60.52% and 42.10% in moderate to severe PMS and 100.00%, 85.71%, 57.14%, 42.85%, and 2.85% PMDD. The mean percentages of physical health domain were 64.43±8.29, 58.47±6.91, and 52.86±6.20; psychological health domain was 66.39±9.39, 62.47±7.73 and 56.29±4.64; social relationship domain was 62.29±12.45, 60.61±11.67 and 56.00±5.32 and environmental health domain was 64.52±9.64, 61.13±9.39 and 58.86±3.72 in no/mild PMS, moderate to severe PMS and PMDD participants group, respectively.Conclusions: The changes of physical health domain, psychological health domain were significantly negative correlated with moderate to severe PMS that means participant with moderate and severe PMS have poor quality of physical and psychological health whereas, social relationship domain and environmental health domain were also negative correlated but not significantly associated with moderate to severe PMS