Expectant management of a heterotopic interstitial pregnancy - a case report

Heterotopic pregnancy is the simultaneous occurrence of two pregnancies at two different implantation sites, mostly intrauterine and extrauterine sites. An interstitial ectopic pregnancy as part of a heterotopic pregnancy is very rare. This report highlights the case of a 40-year-old woman with heterotopic pregnancy who had conceived via assisted reproductive technology. The patient had an interstitial ectopic pregnancy and a viable intrauterine pregnancy. She was treated expectantly and had cesarean delivery of the intrauterine pregnancy at 38 weeks of gestation. Although management options for heterotopic pregnancies include surgical and medical, it may be reasonable to consider expectant management for select cases while weighing risks. In such cases, close monitoring of symptoms and serial ultrasound examinations should be standard

دراسة الموجات المنحرفة والدوامات في البلازما الممغنطة لشريحة في وجود بيتا منخفضة لطاقة الايونات المحددة

The derivation of reduced nonlinear fluid equations for the description of drift wave turbulence and vortices in low beta confinement, systems with magnetic shear is considered, where the effects associated with trapped particles could be neglected. In the present work, a set of reduced equations governing the slab-type ion temperature gradient driven mode in a shear magnetized plasma with low frequency, is derived which is generalization of the two fluid equations. With the use the model, equations are derived for the drift instabilities from the electrostatic two-fluid equations. The electrical resistivity included in the system that allows the dynamics of both the collisionless ion temperature gradient driven instability and the collisional drift wave instability of plasma. The model equations was used extensively in earlier nonlinear studies and the research developed it as appropriate limits of the model equations derived in the present work, where the effects of sheared velocity flows in the equilibrium plasma. The compressible two fluid equations are considered when fluctuation of magnetic field and electron temperature are ignored. It is also assumed that the mode is localized on a particular magnetic field line, typical frequency and growth rate of the model, which are much smaller than the ion cyclotron frequency. The dispersion relation of the slab-type ion temperature gradient driven mode is obtained for both collisionless and collisional drift waves in sheared magnetic fields of plasma. This illustrates that the strong magnetic shear has a stabilizing effect on the collisionless ion temperature gradient drift instability, which is not shown in collisional drift instability

Multi-staged conversion from intermittent to continuous water supply

This is the author accepted manuscript. The final version is available from Universitat Politécnica de València via the DOI in this record About 2.2 billion people worldwide lack access to safely managed drinking water. These include approximately 1.3 billion, mainly in South Asia, Latin America, and Africa, that receive water for domestic purposes through piped networks for only limited durations in a practice known as intermittent water supply (IWS). The complex interactions of demographic (social), technological, economic, environmental, and political factors are the primary causes of IWS. They lead to higher water demand and Non-Revenue Water (NRW) water than supply systems’ capacity. Under IWS, the limited water resources are distributed to various zones at different times. In this way, as many consumers as possible can access water and water losses through leakage can be reduced. However, IWS poses high operation costs and NRW to water utilities, coping costs for water storage and treatment facilities to consumers and inequitable water supply, health problems and effects on children’s school activities to society. As a result, there is a great interest worldwide in converting from IWS to Continuous Water Supply (CWS). Achieving CWS is challenging for systems that are significantly degraded and require huge investments. Consequently, the conversion to CWS should be gradual and staged. Using the given pilot network, this study proposes an approach for converting from intermittent to continuous water supply by improving the network infrastructure in a phased manner over a period of 5 years according to the limited available financial and water resources. For hydraulic simulations, EPANET 2.2 was used. First, the network input file was modified by placing the leaks to their exact locations. Before starting the rehabilitations, the network operation was assessed. Rehabilitation was phased in five years and the activities involved were leak fixing, pump upgrades, installation of flow control valves (FCVs) at sources, and pipe replacements. These activities were implemented both manually and using codes developed in R and python. Four major indicators were used to assess the effects of the rehabilitation activities each year. The indicators were the proportion of the number of effective hours a subscriber is served (I1), the volume of water leakage (I3), the proportion of volume of water supplied to users(I4) and the level of equity in supply (I9). Through the staged rehabilitation, I1, I4 and I9 increased from 0.907, 0.757 and 0.733 to 0.995, 0.965 and 0.96 respectively while I3 reduced from 0.504 to 0.302

Efficacy and Safety of Aspirin 162 mg Prophylaxis for Preeclampsia Prevention in High Risk Women

Objective: Numerous studies have evaluated the efficacy and safety of low dose aspirin for preeclampsia prevention in high risk women. Most studies were European based demonstrating efficacy and safety with aspirin 150 mg, with studies in the United States supporting aspirin 81 mg for preeclampsia prevention. There is limited data from the United States evaluating aspirin 162 mg; the aim of this study was to examine the efficacy and safety of aspirin 162 mg vs 81 mg vs no aspirin for preeclampsia prevention. Study Design: A retrospective cohort study was performed at Henry Ford Health System (HFHS) between 2013 and 2020. The ‘no aspirin’ group was composed of women who met high risk criteria prior to October 2015, when aspirin was implemented at HFHS. The ‘aspirin 81 mg’ and ‘aspirin 162 mg’ groups were composed of women who met high risk criteria prophylaxed with the respective aspirin doses after October 2015. Exclusion was made for women with bleeding disorders, sensitivity to aspirin, and covid-19 infection (as applicable). Results: A total of 2,266 women met high risk criteria prior to October 2015 and received no treatment. A total of 944 women received aspirin 81 mg and 387 women received aspirin 162 mg. 322 women (14.2%) without treatment developed preeclampsia, compared to 134 women (14.2%) in the aspirin 81 mg group and 39 (10.1%) in the aspirin 162 mg group. The difference in preeclampsia rates between aspirin 81 mg and aspirin 162 mg was statistically significant (p = 0.043). The risks for postpartum hemorrhage, postpartum hematoma, and intraventricular hemorrhage of the newborn were not statistically different between women in the aspirin 162 mg group compared to the aspirin 81 mg group (p \u3e0.05). Conclusion: We found a 29% reduction in the rate of preeclampsia for high risk women with aspirin 162 mg vs aspirin 81 mg without an increased risk for bleeding. Our study demonstrates that aspirin 162 mg should be recommended for preeclampsia prophylaxis in high risk women. Further studies by other groups are needed to confirm these findings

Provider Adherence to Aspirin Prophylaxis Prescription Guidelines for Preeclampsia Prevention - A Quality Improvement Project

Objective: Preeclampsia affects 2-8% of pregnancies leading to significant maternal and neonatal morbidity and mortality. The Society for Maternal-Fetal Medicine supports the use of low dose aspirin for the prevention of preeclampsia in women at risk. The aim of this study was to evaluate provider adherence to aspirin prophylaxis prescription guidelines for women at risk. Study Design: A retrospective chart review was performed at Henry Ford Health System (HFHS) between October 2015 and December 2020. In October 2015, aspirin 81 mg was recommended for women who met high risk criteria for preeclampsia at HFHS; in February 2019, aspirin 162 mg was recommended for women who met moderate or high risk criteria for preeclampsia. Providers prescribing aspirin included attending physicians, physician residents, and certified midwives. Results: A total of 46,016 pregnancies occurred between Oct 2015 and Dec 2020. 15,167 (33.0%) met high and moderate risk criteria and had no contraindication to aspirin administration. From the population at risk, 1,255 (8.3%) had a history of preeclampsia, 2,534 (16.7%) had a history of chronic hypertension, 1,418 (9.3%) had a history of diabetes, 7,470 (49.3%) were nulliparous, 4,038 (26.6%) were 35 years of age or older, 6,395 (42.2%) had a body mass index greater than 30 kg/m2, and 8,174 (53.9%) were African Americans. Only 630 out of 3,584 (17.6%) of women meeting the high risk criteria for preeclampsia between Oct 2015 and Jan 2019 received aspirin. Only 891 out of 5,874 (15.2%) of women meeting the high or moderate risk criteria for preeclampsia between Feb 2019 and Dec 2020 received aspirin. Conclusion: Adherence to aspirin prophylaxis guidelines for women at moderate or high risk for preeclampsia was low. Most urban healthcare systems serve diverse, high risk populations with multiple comorbidities rendering many women at moderate or high risk for preeclampsia. Educational efforts to improve provider knowledge regarding this important preventative measure are indicated