Ectopic Pregnancy in a Woman with T9 AIS A Paraplegia Secondary to High-Grade Spinal Cord Pilocytic Astrocytoma

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma Background In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy. Methods This is a case report on a female Veteran who initially presented to the McGuire VA Medical Center’s (VAMC) Spinal Cord Injuries & Disorder (SCI&D) service for a comprehensive evaluation, who’s diagnosed pregnancy warranted coordination of medical care with the VCU Health System. Case Presentation A 37-year-old female with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord astrocytoma presented to the VAMC SCI&D service. She was evaluated by the interdisciplinary team to assess her functional status and equipment needs, as well as to receive SCI-specific education. During her evaluation, the patient brought to medical attention her recent missed menstrual period and sexual activity. Labs revealed an elevated and appropriately increasing serum beta-HCG consistent with pregnancy. The VAMC’s Women’s Health Center coordinated for the patient to receive further evaluation by VCU’s Maternal Fetal Medicine team. The patient’s transvaginal ultrasound revealed an ectopic pregnancy, so she underwent a laparoscopic salpingectomy. Prior to diagnosing the pregnancy’s ectopic nature, she was counseled on antepartum medication management and anticipated SCI complications exacerbated by pregnancy. Conclusion 14-18% of women with SCI have children after injury. There are unique matters related to ante-partum, intra-partum, and post-partum care to consider in injured women whose pregnancy progresses. Our patient’s pregnancy was high-risk, given her advanced maternal age and SCI. Her case raises the importance of coordinated care amongst the physiatry, obstetrics, and anesthesiology teams, as adverse pregnancy and neonatal-related outcomes can occur

War as exit from exclusion?: the formation of Mayi-Mayi militias in Eastern Congo

In eastern Congo scores of young and marginalized people have been increasingly attracted to the mobilising efforts of new local actors. The inquiry into this phenomenon traces the emergence of the first militias to the end of the eighties. These first generation militias were a result of the growing willingness of marginalized youngsters and school drop-outs to form groups of under-aged combatants acting against eveiy representative of modern political authority and against their desperate feelings of exclusion, for which both their political and social environment were held responsible. As they had nothing more to lose than their marginalisation, rebellion became an option, both as a survival strategy and as a strategy of self-defence against a predatory political and social order. The shiftiness of their ideological basis and allies only further proved what these first militias were about: a search for alternatives to a situation of acute deprivation. This article reveals that the present RCD rebellion that rages through the eastern parts of the Democratic Republic of Congo has had an escalating effect on the proliferation of new militias. Before, the Kabila-led AFDL rebellion had already offered the already existing militias a new cause: that of an anti-Tutsi force fighting against foreign occupation. In resistance to the effects of state collapse and armed foreign interventions, rural and urban youth today have combined former traditions and newly developed patterns of mobility in an interpretation of customary and national defence. This has not meant that they link up with the traditional emanations of authority. Rather, a crisis in the social fabric has meant a shift in authority towards these combatants and the use of violence. In addition, shared feelings of antipathy towards the 'Tutsi-aggressors ' have facilitated the creation of links between these diverse local groupings and other, foreign, factions of armed militia roaming the local countryside. Consolidation, however, remains unlikely as this shared ideology does not run very deep and alliances continuously change. The question remains what the future impact of these militias might be on the local social order. On the one hand, for several years now in some remote areas these armed groupings have become the only representatives of any authority structure, even if this structure is based on violence. Contrary to other cases, these militias in South Kivu are still closely linked to the rural population and have not turned against them. On the other hand, the dynamic of the Inter-Congolese Dialogue has forced their leaders to present their grievances to the outside world

Spectral analysis of the background in ground-based, long-slit spectroscopy

This paper examines the variations, because of atmospheric extinction, of broad-band visible spectra, obtained from long-slit spectroscopy, in the vicinity of some stars, nebulae, and one faint galaxy.Comment: 12 figure

ADEPT2 - Next Generation Process Management Technology

If current process management systems shall be applied to a broad spectrum of applications, they will have to be significantly improved with respect to their technological capabilities. In particular, in dynamic environments it must be possible to quickly implement and deploy new processes, to enable ad-hoc modifications of single process instances at runtime (e.g., to add, delete or shift process steps), and to support process schema evolution with instance migration, i.e., to propagate process schema changes to already running instances. These requirements must be met without affecting process consistency and by preserving the robustness of the process management system. In this paper we describe how these challenges have been addressed and solved in the ADEPT2 Process Management System. Our overall vision is to provide a next generation process management technology which can be used in a variety of application domains

Estimating the economic benefits of wind energy projects using NREL's JEDI model with Monte Carlo simulation: Coconino and Navajo County, Arizona: Working paper series--06-04

A process was developed to evaluate the county-level economic benefits from constructing and operating a wind energy project. Specifically, an economic input/output analysis was used in conjunction with Monte Carlo simulation to determine the economic impacts. Two northern-Arizona counties, Coconino County and Navajo County, were analyzed to demonstrate the process. The National Renewable Energy Laboratory's Jobs, Economic Development, and Impacts (JEDI) model is used to estimate the economic benefits generated by both the construction phase and the operations and maintenance (O&M) phase of a wind energy project. As there is uncertainty in some of the required input parameters, Monte Carlo simulation allows the input parameters to be entered as a range. The results of the JEDI model with Monte Carlo simulation analysis produce a distribution for: Jobs during construction; Jobs during the O&M phase; Earnings during the construction phase; Annual Earnings during the O&M phase; Economic activity during the construction phase; Annual Economic Activity during the O&M phase. In addition to these results, a sensitivity analysis was performed and indicated that the input parameters of construction cost, annual operating cost, local share percentage for construction, and local share percentage for high-voltage substation/interconnection affect the results from the JEDI model most significantly and effort should be spent carefully estimating these input parameters

Evaluating the most promising sites for wind energy development in Arizona USA: Working paper series--05-09

During the summer of 2003, the state of Arizona took delivery of a set of high-resolution wind energy maps. After applying various exclusions, the developable wind energy potential is 23,290 MW of class 3 or higher, 2,630 MW of class 4 or higher, and 775 MW of class 5 or higher winds. Having determined the potential wind resource, the geographical information system data supplied with the wind maps was used to create a wind resource inventory and to systematically identify the most promising sites for wind energy development. In addition to wind energy potential, proximity to transmission lines and roads, and land ownership were considered in this analysis. Following that, the cost of energy was estimated at a few geographically diverse sites, including class 3, 4, and 5 wind resource areas, at a hub height of 70 m. These estimates revealed that the real levelized cost of energy in 2005 dollars ranged from 4.21 to 5.04 cents per kWh, as the wind class varies from 5 to 3. This paper documents the findings of the wind mapping process, describes the method and results of evaluating the most promising sites for wind development, and presents the cost of energy results

A Common Explanation for the Atmospheric, Solar-Neutrino and Double Beta Decay Anomalies

We make a number of small changes, including correcting an error in our heavy-neutrino decay rate. None of our analysis is changed, either in substance or detail.Comment: 25 pages, 6 Figures, McGill-93/1

Photoemission investigation of the electronic structure of Fe-Pd and Fe-Pt alloys

A photoemission investigation of Fe-Pd and Fe-Pt transition-metal alloys, using ∼50–150-eV synchrotron radiation, is presented. We consider in particular the spectral distribution of Fe states when approaching the dilute limit. By means of the Cooper minimum in the 4d and 5d photoionization cross section, we identify structures that have mainly Fe minority- or Fe majority-spin character. The relative position of these peaks is discussed in terms of the covalent interaction between Fe 3d and Pd or Pt d states. Also, the strong resemblance between the distribution of Fe states in the Pd-based and in the Pt-based alloys is demonstrated. We find a consistent behavior of interacting d states towards the dilute limit. It is concluded that the Fe states that are observed in the photoemission spectra of the dilute alloys have mainly majority-spin character and are, because of the covalent interaction with host states, widely distributed over the energy range of the host d band. The Fe minority-spin band, which is centered near the Fermi level, gradually empties with increasing Fe dilution

MSW mediated neutrino decay and the solar neutrino problem

We investigate the solar neutrino problem assuming simultaneous presence of MSW transitions in the sun and neutrino decay on the way from sun to earth. We do a global $\chi^2$-analysis of the data on total rates in Cl, Ga and Superkamiokande (SK) experiments and the SK day-night spectrum data and determine the changes in the allowed region in the \dm - \tan^2\theta plane in presence of decay. We also discuss the implications for unstable neutrinos in the SNO experiment.Comment: Final version to appear in Phys. Rev.