A randomised controlled trial of blood pressure self-monitoring in the management of hypertensive pregnancy. OPTIMUM-BP:A feasibility trial

Objective: To assess the feasibility of a blood pressure self-monitoring intervention for managing pregnancy hypertension. Study design: OPTIMUM-BP was an unmasked randomised controlled trial comparing a self-monitoring of blood pressure (SMBP) intervention versus usual care for the management of pregnancy hypertension. Women with chronic (CH) or gestational hypertension (GH) from 4 UK centres were randomised (2:1) intervention to control. Self-monitoring involved daily home blood pressure (BP) measurements, with recording via study diary or telemonitoring. Clinicians were invited to use the home readings in clinical and antihypertensive titration decisions. Main outcomes: The primary outcomes were recruitment, retention, adherence and persistence with the intervention. Results: Women from four UK centres were randomised: 158/222 (71%) of those approached agreed, comprising: 86 women with chronic hypertension (55 SMBP, 31 control) and 72 with gestational hypertension (49 SMBP, 23 control) of whom outcome data were available from 154 (97%) and were included in the analysis. The median (IQR) number of days with home BP readings per week were 5.5 (3.1–6.5) for those with chronic hypertension and 6.1 (4.5–6.7) with gestational hypertension. Participants persisted with the intervention for 80% or more of their time from enrolment until delivery in 86% (43/50) and 76% (38/49) of those with chronic and gestational hypertension respectively. Recorded clinic and study BPs were similar for both groups. Conclusions: This is the first randomised investigation of BP self-monitoring for the management of pregnancy hypertension and indicates that a large RCT would be feasible.</p

Sentinel Case of Candida auris in the Western United States Following Prolonged Occult Colonization in a Returned Traveler from India.

Candida auris is an emerging multidrug-resistant yeast with high mortality. We report the sentinel C. auris case on the United States West Coast in a patient who relocated from India. We identified close phylogenetic relatedness to the South Asia clade and ERG11 Y132F and FKS1 S639Y mutations potentially explaining antifungal resistance

Simulation of Polymer Flow Using Smoothed Particle Hydrodynamics Method

Reactive rotational molding (RRM) is a process to manufacture hollow plastic articles. Comparing to rotational molding of thermoplastics, it decreases the process cycle time due to the reactivity of the system. However, the number of influent parameters is relatively high and optimization of the process is complex. During RRM, the viscosity is one of the key parameters and varies according to the polymer molecular weight due to chemical reactions. Simulation is a way to optimize this process. Prediction of the reactive flow is of great interest to optimize process conditions and wall thickness distribution of the molded part. We developed a solver based on smoothed particle hydrodynamics method. This Lagrangian meshfree method is well adapted to simulate free surface flows like those occurring in RRM. First, we validated the code comparing the simulation results to analytical Couette flow solution and experimental measurements of dam break problem. Then, we performed two-dimensional (2D) and 3D simulations to observe the influence of the change of viscosity on the flow, due to the chemical reactions. Adhesion of the polymer on the mold surface is modeled by new boundary conditions.Contract grant sponsor : RAIGI society for providing us the reactive materials and the Single Interministerial Fund (FUI)-SAGANE

Detection and control of pregnancy hypertension using self-monitoring of blood pressure with automated telemonitoring: cost analyses of the BUMP Randomized Trials

BACKGROUND: Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials’ integrated cost analyses. METHODS: Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately. RESULTS: In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (−£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (−£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (−£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2. CONCLUSIONS: SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149

‘Sons of athelings given to the earth’: Infant Mortality within Anglo-Saxon Mortuary Geography

FOR 20 OR MORE YEARS early Anglo-Saxon archaeologists have believed children are underrepresented in the cemetery evidence. They conclude that excavation misses small bones, that previous attitudes to reporting overlook the very young, or that infants and children were buried elsewhere. This is all well and good, but we must be careful of oversimplifying compound social and cultural responses to childhood and infant mortality. Previous approaches have offered methodological quandaries in the face of this under-representation. However, proportionally more infants were placed in large cemeteries and sometimes in specific zones. This trend is statistically significant and is therefore unlikely to result entirely from preservation or excavation problems. Early medieval cemeteries were part of regional mortuary geographies and provided places to stage events that promoted social cohesion across kinship systems extending over tribal territories. This paper argues that patterns in early Anglo-Saxon infant burial were the result of female mobility. Many women probably travelled locally to marry in a union which reinforced existing social networks. For an expectant mother, however, the safest place to give birth was with experience women in her maternal home. Infant identities were affected by personal and legal association with their mother’s parental kindred, so when an infant died in childbirth or months and years later, it was their mother’s identity which dictated burial location. As a result, cemeteries central to tribal identities became places to bury the sons and daughters of a regional tribal aristocracy

Local Partners’ Perspectives on Health Student Service-Learning Placements in Low- and Middle-Income Countries: A Pilot Qualitative Study with Partners from Vietnam and Timor-Leste

Service-learning programs can provide clinical assistance in low-resourced settings while providing students with intercultural learning opportunities in diverse health contexts; local partners’ perspectives on international service-learning (ISL) programs are integral to ethical, effective and sustainable university-community partnerships; yet the perspectives of local partners remain under-represented in research. Interpretive description methods guided data collection and thematic analysis of qualitative responses from written questionnaires. Four local partners from Vietnam and Timor-Leste responded to questionnaires in this pilot project. Three themes were identified regarding benefits, underpinning factors for program effectiveness, and a further three themes related to desired improvements. According to local partners, benefits of ISL include skill and knowledge exchange, enhanced assessment and intervention strategies, and increased service quality. Communication and relationships were seen as underpinning factors of effective partnerships. Areas for further improvement included drawing more strongly on local partner strengths and perspectives, further collaborative preparation for the placements, and more regular communication. These preliminary findings align with existing research regarding benefits to local partners. Modelling effective practices, formal training and meetings, and ongoing case discussions may be some useful methods for achieving knowledge and skill exchange in ISL