Cornual pregnancy as a complicaton of the use of a levonorgestrel intrauterine device: a case report

<p>Abstract</p> <p>Introduction</p> <p>Complications of copper load intrauterine devices, including ectopic pregnancies are well reported. Rates of ectopic pregnancy are 0.6 to 1.1% per year. However, the levonorgestrel intrauterine device has been described as more protective against ectopic pregnancies due to the addition of the hormone levonorgestrel. The hormone released from the intrauterine device causes some systemic effects, but local effects such as glandular atrophy and stromal decidualization, in addition to foreign body reaction, are dominant. Few case reports have described ampullary ectopic pregnancies. However, we report, for the first time, a major complication of levonorgestrel intrauterine device: a cornual pregnancy.</p> <p>Case presentation</p> <p>A 36-year-old Caucasian nulliparous woman presented with complaints of progressive nausea, abdominal pain and irregular vaginal bleeding for 2 months. For 3 years, she had been using a levonorgestrel intrauterine device. A two-dimensional transvaginal sonogram noted a sac situated external to the endometrial cavity in the right cornua of the uterus with an empty uterus. She was successfully treated with chemotherapy.</p> <p>Conclusion</p> <p>Many complications have been described, including ectopic pregnancies, using copper intrauterine devices. The levonorgestrel-releasing intrauterine system is a particularly good choice for adolescents because of associated non-contraceptive benefits such as decreased menstrual bleeding, dysmenorrhea and pain associated with endometriosis <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. Yet a cornual pregnancy following the use of a levonorgestrel intrauterine device is a complication which, to our knowledge, has not been described before. Physicians prescribing this type of intrauterine device should be aware of this rare event.</p

Action versus Result-Oriented Schemes in a Grassland Agroecosystem: A Dynamic Modelling Approach

Effects of agri-environment schemes (AES) on biodiversity remain controversial. While most AES are action-oriented, result-oriented and habitat-oriented schemes have recently been proposed as a solution to improve AES efficiency. The objective of this study was to compare action-oriented, habitat-oriented and result-oriented schemes in terms of ecological and productive performance as well as in terms of management flexibility. We developed a dynamic modelling approach based on the viable control framework to carry out a long term assessment of the three schemes in a grassland agroecosystem. The model explicitly links grazed grassland dynamics to bird population dynamics. It is applied to lapwing conservation in wet grasslands in France. We ran the model to assess the three AES scenarios. The model revealed the grazing strategies respecting ecological and productive constraints specific to each scheme. Grazing strategies were assessed by both their ecological and productive performance. The viable control approach made it possible to obtain the whole set of viable grazing strategies and therefore to quantify the management flexibility of the grassland agroecosystem. Our results showed that habitat and result-oriented scenarios led to much higher ecological performance than the action-oriented one. Differences in both ecological and productive performance between the habitat and result-oriented scenarios were limited. Flexibility of the grassland agroecosystem in the result-oriented scenario was much higher than in that of habitat-oriented scenario. Our model confirms the higher flexibility as well as the better ecological and productive performance of result-oriented schemes. A larger use of result-oriented schemes in conservation may also allow farmers to adapt their management to local conditions and to climatic variations

Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study

BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. METHODS: This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. RESULTS: Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. CONCLUSIONS: Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers. (aut. ref.

Erratum to: Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: individual patient data (IPD) meta-analysis and health economic evaluation.

Erratum to: Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: individual patient data (IPD) meta-analysis and health economic evaluatio

A Multi-Platform Flow Device for Microbial (Co-) Cultivation and Microscopic Analysis

Novel microbial cultivation platforms are of increasing interest to researchers in academia and industry. The development of materials with specialized chemical and geometric properties has opened up new possibilities in the study of previously unculturable microorganisms and has facilitated the design of elegant, high-throughput experimental set-ups. Within the context of the international Genetically Engineered Machine (iGEM) competition, we set out to design, manufacture, and implement a flow device that can accommodate multiple growth platforms, that is, a silicon nitride based microsieve and a porous aluminium oxide based microdish. It provides control over (co-)culturing conditions similar to a chemostat, while allowing organisms to be observed microscopically. The device was designed to be affordable, reusable, and above all, versatile. To test its functionality and general utility, we performed multiple experiments with Escherichia coli cells harboring synthetic gene circuits and were able to quantitatively study emerging expression dynamics in real-time via fluorescence microscopy. Furthermore, we demonstrated that the device provides a unique environment for the cultivation of nematodes, suggesting that the device could also prove useful in microscopy studies of multicellular microorganisms

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: Individual participant data meta-Analysis

Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design Individual participant data meta-Analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources Major electronic databases, from inception to February 2017. Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education ( 65tertiary) or lower education ( 64secondary). Risk of bias Cochrane risk of bias tool was used. Data synthesis Principle measures of effect were OR and regression coefficient. Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B-0.055; 95% CI-0.098 to-0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B-0.053; 95% CI-0.069 to-0.037,p&lt;0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial

Одноколейные тракторно-ледяные дороги: учебное пособие для лесотехнических вузов

Книга содержит описание конструкций однополозных тракторных саней, расчет основных деталей саней, краткие технические условия проектирования одноколейных тракторно-ледяных дорог, правила постройки и эксплуатации ледяных дорог и основы организации тракторного хозяйства на базе одноколейных ледяных дорог. Книга предназначена в качестве учебного пособия для лесотехнических вузов, но может также служить практическим пособием и для высшего технического персонала лесозаготовительных предприятий Наркомлеса СССР.0|7|Предисловие [c. 7]0|8|Введение [c. 8]0|11|Возникновение и развитие конструкции однополозных саней [c. 11]1|11|Первые опыты [c. 11]1|12|Принцип работы одноколейной ледяной дороги и теоретические основания проектирования однополозных саней [c. 12]1|17|Конструкция первых однополозных саней [c. 17]1|17|Однополозные сани Востокостальлеса [c. 17]1|19|Одкополозные сани ЦНИИМЭ, модель Б [c. 19]1|21|Однополозные сани на базе поковок тракторных двухполозных саней модели Д [c. 21]1|22|Однополозные сани Я. И. Гинзбурга модели 1939 г. [c. 22]1|33|Однополозные сани ГЗЯ-2 [c. 33]1|39|Варианты соединения коника с полозом [c. 39]1|39|Модернизированные однополозные сани на базе поковок саней модели Свердлеса и Востокостальлеса [c. 39]1|44|Бескониковые однополозные сани конструкции СибНИИЛХЭ [c. 44]1|46|Буферно-прицепные устройства трактора конструкции УЛТИ, Сотринского мехлесопункта и Стройлеспроекта [c. 46]1|48|Автоматическая сцепка тракторных саней [c. 48]1|49|Рама для перевозки коротья на однополозных санях [c. 49]1|51|Расчет саней [c. 51]1|51|Расчет полоза [c. 51]1|58|О форме подрезов [c. 58]0|61|Постройка одноколейных ледяных дорог [c. 61]1|61|Условия применения, сырьевая база и порядок оформления строительства [c. 61]1|62|Технические условия проектирования одноколейных ледяных дорог [c. 62]1|72|Изыскания трасс одноколейных ледяных дорог [c. 72]1|73|Строительные работы на одноколейных ледяных дорогах [c. 73]1|85|Дорожные орудия для строительства одноколейных ледяных дорог [c. 85]1|91|Цистерны для поливки ледяной дороги [c. 91]1|91|Насосные станции [c. 91]0|95|Эксплуатация ледяных дорог [c. 95]1|95|Техническая характеристика тяговых машин [c. 95]1|107|Эксплуатация газогенераторных тракторов на лесовывозке по ледяным дорогам [c. 107]1|115|Правила вождения поездов [c. 115]1|117|Формирование состава и маневры [c. 117]1|117|Содержание и ремонт пути ледяной дороги [c. 117]1|119|Техника безопасности при вывозке леса по тракторным ледяным дорогам [c. 119]1|121|Основные правила по технике безопасности для тракторного лесотранспорта [c. 121]0|123|Приложения [c. 123]1|123|Детали однополозных саней ГЗЯ-1 [c. 123]1|136|Детали модернизированных однополозных саней на базе поковок саней Свердллеса [c. 136]1|141|Краткая техническая характеристика гусеничных тракторов Челябинского тракторного завода [c. 141]0|143|Оглавление [c. 143