Final Evaluation Report: Pilot for New Model of Midwifery Supervision

The focus of the evaluation was a bridging programme to prepare existing supervisors of midwives (SOMs) to become professional midwifery advocates (PMAs) in order to deliver a new model of supervision (A-EQUIP). It set out to assess the bridging programme and the A-EQUIP model. This report documents the following stages of the evaluation: 1. Establish baseline data, prior to the adoption of the A-EQUIP pilot a. Development and completion of a site pro-forma to provide contextual organisational data 2. Evaluation of the preparation of the A-EQUIP practitioner and assessment of the A-EQUIP model through the following mechanisms: a. Documentary analysis b. Supervisor/PMA survey c. Supervisee survey d. Supervisor/PMA interview

Clinicopathological study of benign ovarian tumuors

Background: The incidence of ovarian tumor amongst gynecological admissions have been reported to vary from 1-3 %. About 75% of these tumors have been found to be benign. Ovarian malignancies represent the greatest clinical challenge of all the gynecological malignancies. During the reproductive years most of the ovarian tumors encountered are benign. About 2/3 of the ovarian tumors are encountered in this group only. The chance that an ovarian tumor is malignant in a patient younger than 45 years is 1 in 15. The differentiation of the benign from malignant tumors can go wrong even with imaging modalities.CA125 along with ultrasound are useful in differentiating benign from malignant tumors. Histopathological examination is gold standard for diagnosis of ovarian neoplasm.Methods: The present study includes consecutive cases of histopathologically proven ovarian tumors of 3 years from June 2010 to May 2013 reported by the Department of Pathology of our tertiary care center. It includes total 150 cases. After careful study of gross findings, appropriate bits were taken from received ovarian specimen, followed by routine paraffin processing to make H and E stained slides. Special stains were used wherever needed.Results: Majority of the cases 91 (60.67%) were benign, 53 (35.33%) were malignant and 6 (4.0%) were borderline. Surface epithelial tumours were the most common type (68.13%) of ovarian neoplasm in this study. Most of tumours in our study occurred in the age group of 21-40 years. Mucinous cystadenomas were most common benign surface epithelial tumour and most common benign tumors overall. There were 22 cases of benign germ cell tumor, all were mature teratoma. All the sex-cord stromal tumours were diagnosed in women older than 40 years. Most common benign lesion in our study is surface epithelial tumour and in age group of 21-40 years. 84% patients studied had symptoms at presentation, out of which 26% of patient presented with dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.Conclusions: Most of ovarian neoplasm are benign with mucinous cystadenoma being commonest entity. Commonest age group is 21-40 years. Commonest benign germ cell tumor is Mature cystic teratoma. Commonest clinical symptom is dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.

Neuron class-specific responses govern adaptive myelin remodeling in the neocortex

© 2020 American Association for the Advancement of Science. All rights reserved. Myelin plasticity is critical for neurological function, including learning and memory. However, it is unknown whether this plasticity reflects uniform changes across all neuronal subtypes, or whether myelin dynamics vary between neuronal classes to enable fine-tuning of adaptive circuit responses. We performed in vivo two-photon imaging of myelin sheaths along single axons of excitatory callosal neurons and inhibitory parvalbumin-expressing interneurons in adult mouse visual cortex. We found that both neuron types show homeostatic myelin remodeling under normal vision. However, monocular deprivation results in adaptive myelin remodeling only in parvalbumin-expressing interneurons. An initial increase in elongation of myelin segments is followed by contraction of a separate cohort of segments. This data indicates that distinct classes of neurons individualize remodeling of their myelination profiles to diversify circuit tuning in response to sensory experience

Idiopathic eosinophilic cholecystitis with Cholelithiasis- a rare histopathological variant

Eosinophilic cholecystitis is a rare form of cholecystitis presented with classical symptoms of cholecystitis and diagnosed on histopathology in presence of more than 90% eosinophilic infiltrate with in wall of gallbladder . We report case in a 55 year old male presented to surgical department having complaints of upper right abdominal pain, tenderness, associated with vomiting since 8 days. On ultrasonography abdomen-pelvis show distended gallbladder with calculus of size 1.7 cm at fundic region .The wall of gallbladder thickened and edematous .Mild heterogenous intraluminal debris was noted. Open cholecystectomy was performed . Gallbladder specimen on histopathologically diagnosed as eosinophilic cholecystitis with cholelithiasis. We are presenting this case for its rarity , its clinical and histopathological findings

Genome-wide expression profile of first trimester villous and extravillous human trophoblast cells

We have examined the transcriptional changes associated with differentiation from villous to extravillous trophoblast using a whole genome microarray. Villous trophoblast (VT) is in contact with maternal blood and mediates nutrient exchange whereas extravillous trophoblast (EVT) invades the decidua and remodels uterine arteries. Using highly purified first trimester trophoblast we identified over 3000 transcripts that are differentially expressed. Many of these transcripts represent novel functions and pathways that show co-ordinated up-regulation in VT or EVT. In addition we identify new players in established functions such as migration, immune modulation and cytokine or angiogenic factor secretion by EVT. The transition from VT to EVT is also characterised by alterations in transcription factors such as STAT4 and IRF9, which may co-ordinate these changes. Transcripts encoding several members of the immunoglobulin-superfamily, which are normally expressed on leukocytes, were highly transcribed in EVT but not expressed as protein, indicating specific control of translation in EVT. Interactions of trophoblast with decidual leukocytes are involved in regulating EVT invasion. We show that decidual T-cells, macrophages and NK cells express the inhibitory collagen receptor LAIR-1 and that EVT secrete LAIR-2, which can block this interaction. This represents a new mechanism by which EVT can modulate leukocyte function in the decidua. Since LAIR-2 is detectable in the urine of pregnant, but not non-pregnant women, trophoblast-derived LAIR-2 may also have systemic effects during pregnancy

The Performance of Financial Institutions in 1999

Part of the Lecture Notes in Computer Science book series (LNCS, volume 12266)Fetal MRI is heavily constrained by unpredictable and substantial fetal motion that causes image artifacts and limits the set of viable diagnostic image contrasts. Current mitigation of motion artifacts is predominantly performed by fast, single-shot MRI and retrospective motion correction. Estimation of fetal pose in real time during MRI stands to benefit prospective methods to detect and mitigate fetal motion artifacts where inferred fetal motion is combined with online slice prescription with low-latency decision making. Current developments of deep reinforcement learning (DRL), offer a novel approach for fetal landmarks detection. In this task 15 agents are deployed to detect 15 landmarks simultaneously by DRL. The optimization is challenging, and here we propose an improved DRL that incorporates priors on physical structure of the fetal body. First, we use graph communication layers to improve the communication among agents based on a graph where each node represents a fetal-body landmark. Further, additional reward based on the distance between agents and physical structures such as the fetal limbs is used to fully exploit physical structure. Evaluation of this method on a repository of 3-mm resolution in vivo data demonstrates a mean accuracy of landmark estimation 10 mm of ground truth as 87.3%, and a mean error of 6.9 mm. The proposed DRL for fetal pose landmark search demonstrates a potential clinical utility for online detection of fetal motion that guides real-time mitigation of motion artifacts as well as health diagnosis during MRI of the pregnant mother.NIH (Grant U01HD087211, R01EB01733 and NIBIB NAC P41EB015902