Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers

Impact of counselling on selecting a hormonal contraceptive method

Background: Unmet need for family planning is an important indicator for assessing the demand for family planning services. As per NFHS-4, the contraceptive prevalence rate in women age 15-49 years was 53.5 % and the unmet need for family planning among married women was 12.9%. Counselling provides the Health care professionals (HCPs) an opportunity to understand the individual need of a contraceptive seeker.Methods: This was a cross-sectional, observational study conducted at GMERS hospital, Valsad during June 2017 to October 2017. Sexually active women of 18 to 40 years who consulted HCPs for contraception and who interested in starting hormonal contraceptive method or expressed interest in switching (changing) to hormonal methods were included in the study. Total 213 women were enrolled in the study.  Questionnaires with information on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled both by the HCP and the participating women. The completed questionnaires were collected and analyzed.Results: During pre-counseling, most common hormonal contraceptive method selected by women was combined hormonal contraceptive pills followed by DMPA, LNG-IUS and POPs. In present study, structured contraception counseling helped most women (97.2 %) to choose a contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling except COCs. Among hormonal contraceptive methods, maximum difference was observed for choice of the COCs after counseling as compared to pre-counseling. Counseling helped more than 90% of the women who were indecisive to choose any contraceptive method. More than three fourth of them opted for hormonal methods with a maximum selection of COCs. The most common reasons for selecting COCs was ease of use for COC, breast feeding for POP and the most common reasons for not choosing other available contraceptive methods was discussion with partner.Conclusions: The combined hormonal contraceptive pills were reported to be the most commonly used contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling with maximum difference in COCs. Counseling helped most of the women who were indecisive to choose any contraceptive method

Clinical profile and predictors of mortality in neonates born with non-immune hydrops fetalis: Experience from a lower-middle-income country

Introduction: Hydrops fetalis (HF) is a life-threatening condition in which a fetus has an abnormal collection of fluid in the tissue around the lungs, heart, abdomen, or under the skin. Based on its pathophysiology, it is classified into immune and non-immune types. With the widespread use of anti-D immunoglobulin, non-immune HF has become more common, with an incidence of one in 1,700-3,000 live births. A multitude of fetal diseases with various causes can lead to non-immune HF. Due to the recent advances in prenatal diagnostic and therapeutic interventions together with improved neonatal intensive care, the diagnosis and subsequent management of HF have been refined. However, HF is still associated with a high mortality rate. A recent assessment of the literature found that there is a lack of data on prognostic variables in neonates with HF from low- and middle-income countries. In light of this, we sought to establish the etiologic causes, predictors of mortality, and eventual fate of newborns born non-immune HF at the Aga Khan University Hospital, Karachi during the 10-year period spanning January 2009-December 2019 in this retrospective analysis.Methodology: For this study, we collected data from the computerized database and patient record files at the hospital on all infants with non-immune HF. Demographic data, postnatal interventions, clinical and laboratory findings, outcomes, and the results of comparison between HF patients who died and those who survived were analyzed.Results: The incidence of non-immune HF at our hospital was 0.62/1,000 live births during the period under study, with 33 newborn babies diagnosed with non-immune HF from a total of 53,033 live-born deliveries. An etiologic factor was discovered in 17 (51.5%) neonates with non-immune HF while 16 (48.4%) were classified as those with unidentified etiology. The most common causes were cardiovascular and genetic syndromes, which resulted in 100% mortality. The overall mortality rate was 67%. The need for mechanical ventilation, surfactant therapy, and prolonged hospitalization were identified as independent risk factors of mortality.Conclusion: Our study proves that the need for mechanical ventilation [moderate to severe hypoxic respiratory failure (HRF)] and prolonged hospitalization are strong predictors of poor outcomes in neonates with non-immune HF. Therefore, severe hydrops causing significant mortality can be anticipated based on the patients\u27 respiratory status and the need for escalated oxygen support

Uncovering inequality through multifractality of land prices: 1912 and contemporary Kyoto

Multifractal analysis offers a number of advantages to measure spatial economic segregation and inequality, as it is free of categories and boundaries definition problems and is insensitive to some shape-preserving changes in the variable distribution. We use two datasets describing Kyoto land prices in 1912 and 2012 and derive city models from this data to show that multifractal analysis is suitable to describe the heterogeneity of land prices. We found in particular a sharp decrease in multifractality, characteristic of homogenisation, between older Kyoto and present Kyoto, and similarities both between present Kyoto and present London, and between Kyoto and Manhattan as they were a century ago. In addition, we enlighten the preponderance of spatial distribution over variable distribution in shaping the multifractal spectrum. The results were tested against the classical segregation and inequality indicators, and found to offer an improvement over those

Persistent, depth-intensified mixing during the Western Mediterranean Transition's initial stages

Piñeiro, S., González-Pola, C., Fernández-Díaz, J. M., Naveira-Garabato, A. C., Sánchez-Leal, R., Puig, P., et al. (2021). Persistent, depth-intensified mixing during the Western Mediterranean Transition's initial stages. Journal of Geophysical Research: Oceans, 126, e2020JC016535. https://doi.org/10.1029/2020JC016535. © 2020. American Geophysical Union. All Rights Reserved.© 2020. American Geophysical Union. All Rights Reserved. Major deep-convection activity in the northwestern Mediterranean during winter 2005 triggered the formation of a complex anomalous deep-water structure that substantially modified the properties of the Western Mediterranean deep layers. Since then, evolution of this thermohaline structure, the so-called Western Mediterranean Transition (WMT), has been traced through a regularly sampled hydrographic deep station located on the outer continental slope of Minorca Island. A rapid erosion of the WMT's near-bottom thermohaline signal was observed during 2005–2007. The plausible interpretation of this as local bottom-intensified mixing motivates this study. Here, the evolution of the WMT structure through 2005–2007 is reproduced by means of a one-dimensional diffusion model including double-diffusive mixing that allows vertical variation of the background mixing coefficient and includes a source term to represent the lateral advection of deep-water injections from the convection area. Using an optimization algorithm, a best guess for the depth-dependent background mixing coefficient is obtained for the study period. WMT evolution during its initial stages is satisfactorily reproduced using this simple conceptual model, indicating that strong depth-intensified mixing (K ∞ (z) ≈ 22 × 10−4 m2 s−1; z ⪆ 1,400 dbar) is a valid explanation for the observations. Extensive hydrographic and current observations gathered over the continental slope of Minorca during winter 2018, the first deep-convective winter intensively sampled in the region, provide evidence of topographically localized enhanced mixing concurrent with newly formed dense waters flowing along-slope toward the Algerian sub-basin. This transport-related boundary mixing mechanism is suggested to be a plausible source of the water-mass transformations observed during the initial stages of the WMT off Minorca.CTM2014-54374-R. BES-2015-074316.Versión del editor3,17

Fluid intelligence and brain functional organization in aging yoga and meditation practitioners

Numerous studies have documented the normal age-related decline of neural structure, function, and cognitive performance. Preliminary evidence suggests that meditation may reduce decline in specific cognitive domains and in brain structure. Here we extended this research by investigating the relation between age and fluid intelligence and resting state brain functional network architecture using graph theory, in middle-aged yoga and meditation practitioners, and matched controls. Fluid intelligence declined slower in yoga practitioners and meditators combined than in controls. Resting state functional networks of yoga practitioners and meditators combined were more integrated and more resilient to damage than those of controls. Furthermore, mindfulness was positively correlated with fluid intelligence, resilience, and global network efficiency. These findings reveal the possibility to increase resilience and to slow the decline of fluid intelligence and brain functional architecture and suggest that mindfulness plays a mechanistic role in this preservation

Review of existing and operable observing systems and sensors

Deliverable 1.4 is aimed at identification of existing and operable observing systems and sensors which are relevant to COMMON SENSE objectives. Report aggregates information on existing observing initiatives, programmes, systems, platforms and sensors. The Report includes: • inventory of previous and current EU funded projects. Some of the them, even if started before 2007, were aimed at activities which are relevant or in line with those stemming from MSFD in 2008. The ‘granulation’ of the contents and objectives of the projects varies from sensors development through observation methodologies to monitoring strategies, • inventory of research infrastructure in Europe. It starts from an attempt to define of Marine Research Infrastructure, as there is not a single definition of Research Infrastructure (RI) or of Marine Research Infrastructure (MRI), and there are different ways to categorise them. The chapter gives the categorization of the MRI, together with detailed description and examples of MRI – research platforms, marine data systems, research sites and laboratories with respect of four MSFD descriptors relevant to COMMON SENSE project, • two chapters on Research Programs and Infrastructure Networks; the pan-European initiatives aimed at cooperation and efficient use of infrastructural resources for marine observation and monitoring and data exchange are analysed. The detailed description of observing sensors and system are presented as well as frameworks for cooperation, • information on platforms (research vessels) available to the Project for testing developed sensors and systems. Platforms are available and operating in all three regions of interest to the project (Mediterranean, North Sea, Baltic), • annexed detailed description of two world-wide observation networks and systems. These systems are excellent examples of added value offered by integrated systems of ocean observation (from data to knowledge) and how they work in practice. Report concludes that it is seen a shortage of new classes of sensors to fulfil the emerging monitoring needs. Sensors proposed to be developed by COMMON SENSE project shall answer to the needs stemmed from introduction of MSFD and GES descriptors

Adolescent brain maturation and cortical folding: evidence for reductions in gyrification

Evidence from anatomical and functional imaging studies have highlighted major modifications of cortical circuits during adolescence. These include reductions of gray matter (GM), increases in the myelination of cortico-cortical connections and changes in the architecture of large-scale cortical networks. It is currently unclear, however, how the ongoing developmental processes impact upon the folding of the cerebral cortex and how changes in gyrification relate to maturation of GM/WM-volume, thickness and surface area. In the current study, we acquired high-resolution (3 Tesla) magnetic resonance imaging (MRI) data from 79 healthy subjects (34 males and 45 females) between the ages of 12 and 23 years and performed whole brain analysis of cortical folding patterns with the gyrification index (GI). In addition to GI-values, we obtained estimates of cortical thickness, surface area, GM and white matter (WM) volume which permitted correlations with changes in gyrification. Our data show pronounced and widespread reductions in GI-values during adolescence in several cortical regions which include precentral, temporal and frontal areas. Decreases in gyrification overlap only partially with changes in the thickness, volume and surface of GM and were characterized overall by a linear developmental trajectory. Our data suggest that the observed reductions in GI-values represent an additional, important modification of the cerebral cortex during late brain maturation which may be related to cognitive development

Recurrence properties of hypercyclic operators

[EN] We generalize the notions of hypercyclic operators, U-frequently hypercyclic operators and frequently hypercyclic operators by introducing a new concept in linear dynamics, namely A-hypercyclicity. We then state an A-hypercyclicity criterion, inspired by the hypercyclicity criterion and the frequent hypercyclicity criterion, and we show that this criterion characterizes the A-hypercyclicity for weighted shifts. We also investigate which density properties can the sets N(x, U) = {n is an element of N; T-n x is an element of U} have for a given hypercyclic operator, and we study the new notion of reiteratively hypercyclic operators.This work is supported in part by MEC and FEDER, Project MTM2013-47093-P, and by GVA, Projects PROMETEOII/2013/013 and ACOMP/2015/005. The second author was a postdoctoral researcher of the Belgian FNRS.Bès, JP.; Menet, Q.; Peris Manguillot, A.; Puig-De Dios, Y. (2016). Recurrence properties of hypercyclic operators. Mathematische Annalen. 366(1):545-572. https://doi.org/10.1007/s00208-015-1336-3S5455723661Badea, C., Grivaux, S.: Unimodular eigenvalues, uniformly distributed sequences and linear dynamics. Adv. Math. 211, 766–793 (2007)Bayart, F., Grivaux, S.: Frequently hypercyclic operators. Trans. Amer. Math. Soc. 358, 5083–5117 (2006)Bayart, F., Grivaux, S.: Invariant Gaussian measures for operators on Banach spaces and linear dynamics. Proc. Lond. Math. Soc. 94, 181–210 (2007)Bayart, F., Matheron, É.: Dynamics of linear operators, Cambridge Tracts in Mathematics, 179. Cambridge University Press, Cambridge (2009)Bayart, F., Matheron, É.: (Non-)weakly mixing operators and hypercyclicity sets. Ann. Inst. Fourier 59, 1–35 (2009)Bayart, F., Ruzsa, I.: Difference sets and frequently hypercyclic weighted shifts. Ergodic Theory Dynam. Syst. 35, 691–709 (2015)Bergelson, V.: Ergodic Ramsey Theory- an update, Ergodic Theory of $$\mathbb{Z}^d$$ Z d -actions. Lond. Math. Soc. Lecture Note Ser. 28, 1–61 (1996)Bernal-González, L., Grosse-Erdmann, K.-G.: The Hypercyclicity Criterion for sequences of operators. Studia Math. 157, 17–32 (2003)Bès, J., Peris, A.: Hereditarily hypercyclic operators. J. Funct. Anal. 167, 94–112 (1999)Bonilla, A., Grosse-Erdmann, K.-G.: Frequently hypercyclic operators and vectors. Ergodic Theory Dynam. Syst. 27, 383–404 (2007)Bonilla, A., Grosse-Erdmann, K.-G.: Erratum: Ergodic Theory Dynam. Systems 29, 1993–1994 (2009)Chan, K., Seceleanu, I.: Hypercyclicity of shifts as a zero-one law of orbital limit points. J. Oper. Theory 67, 257–277 (2012)Costakis, G., Sambarino, M.: Topologically mixing hypercyclic operators. Proc. Amer. Math. Soc. 132, 385–389 (2004)Furstenberg, H.: Recurrence in ergodic theory and combinatorial number theory. Princeton University Press, Princeton (1981)Giuliano, R., Grekos, G., Mišík, L.: Open problems on densities II, Diophantine Analysis and Related Fields 2010. AIP Conf. Proc. 1264, 114–128 (2010)Grosse-Erdmann, K.-G.: Hypercyclic and chaotic weighted shifts. Studia Math. 139, 47–68 (2000)Grosse-Erdmann, K.-G., Peris, A.: Frequently dense orbits. C. R. Math. Acad. Sci. Paris 341, 123–128 (2005)Grosse-Erdmann, K.G., Peris, A.: Weakly mixing operators on topological vector spaces, Rev. R. Acad. Cienc. Exactas Fís. Nat. Ser. A Math. RACSAM, 104, 413–426 (2010)Grosse-Erdmann, K.G., Peris Manguillot, A.: Linear chaos, Universitext. Springer, London (2011)Menet, Q.: Linear chaos and frequent hypercyclicity. Trans. Amer. Math. Soc. arXiv:1410.7173Puig, Y.: Linear dynamics and recurrence properties defined via essential idempotents of $$\beta {\mathbb{N}}$$ β N (2014) arXiv:1411.7729 (preprint)Salas, H.N.: Hypercyclic weighted shifts. Trans. Amer. Math. Soc. 347, 993–1004 (1995)Salat, T., Toma, V.: A classical Olivier’s theorem and statistical convergence. Ann. Math. Blaise Pascal 10, 305–313 (2003)Shkarin, S.: On the spectrum of frequently hypercyclic operators. Proc. Am. Math. Soc. 137, 123–134 (2009