Using a smartphone app to identify signs of pre-eclampsia and/or worsening blood pressure

Background Hypertensive disorders of pregnancy complicate 10% of pregnancies and can have serious consequences. Aims To explore the experiences of pregnant women with a history of hypertension using an innovative home blood pressure monitoring device. Methods A qualitative study using a grounded theory approach was undertaken. Data were collected through semi-structured interviews. Women were given a blood pressure machine to monitor their blood pressure daily. They inserted their blood pressure results on a smartphone app and answered questions for signs of pre-eclampsia. Participants were followed up every 2 weeks. Findings The results suggested that women wanted a holistic care pathway for the management of hypertension in pregnancy. Three subcategories (‘empowerment’, ‘comparison of care pathways’ and ‘continuity of care’) were also identified. Conclusions The traditional management of hypertension in pregnancy is not holistic. The home blood pressure service was accepted by women and incorporated elements of holistic care but more is required to meet the standard of care that women need

Inflation in Supersymmetric SU(5)

We analyze the adjoint field inflation in supersymmetric (SUSY) SU(5) model. In minimal SUSY SU(5) hybrid inflation monopoles are produced at the end of inflation. We therefore explore the non-minimal model of inflation based on SUSY SU(5), like shifted hybrid, which provides a natural solution for the monopole problem. We find that the supergravity corrections with non-minimal Kahler potential are crucial to realize the central value of the scalar spectral index n_s ~ 0.96 consistent with the seven year WMAP data. The tensor to scalar ratio r is quite small, taking on values r < 10^{-5}. Due to R-symmetry massless SU(3) octet and SU(2) triplet Higgs bosons are present and could spoil for gauge coupling unification. To keep gauge coupling unification intact, light vector-like particles are added which are expected to be observed at LHC.Comment: 16 page

Clinical significance of cerebroplacental ratio.

PURPOSE OF REVIEW: Two-thirds of the pregnancies complicated by stillbirth demonstrate growth restriction. Identification of the foetus at risk of growth restriction is essential to reduce the risk of stillbirth. The aim of this review is to critically appraise the current evidence regarding clinical utility of cerebroplacental ratio (CPR) in antenatal surveillance. RECENT FINDINGS: The CPR has emerged as an assessment tool for foetuses at increased risk of growth disorders. CPR is a better predictor of adverse events compared with middle-cerebral artery or umbilical artery Doppler alone. The predictive value of CPR for adverse perinatal outcomes is better for suspected small-for-gestational age foetuses compared with appropriate-for-gestational age (AGA) foetuses. CPR could be useful for the risk stratification of small-for-gestational age foetuses to determine the timing of delivery and also to calculate the risk of intrapartum compromise or prolonged admission to the neonatal care unit. Although there are many proposed cut-offs for an abnormal CPR value, evidence is currently lacking to suggest the use of one cut-off over another. CPR appears to be associated with increased risk of intrapartum foetal compromise, abnormal growth velocity, and lower birthweight in AGA foetuses as well. Moreover, birthweight differences are better explained with CPR compared to other factors such as ethnicity. However, the role of CPR in predicting adverse perinatal outcomes such as acidosis or low Apgar scores in AGA foetuses is yet to be determined. SUMMARY: CPR appears to be a useful surrogate of suboptimal foetal growth and intrauterine hypoxia and it is associated with a variety of perinatal adverse events

Relic Neutralino Density in Scenarios with Intermediate Unification Scale

We analyse the relic neutralino density in supersymmetric models with an intermediate unification scale. In particular, we present concrete cosmological scenarios where the reheating temperature is as small as $\cal{O}$ $1 - 1000$ MeV). When this temperature is associated to the decay of moduli fields producing neutralinos, we show that the relic abundance increases considerably with respect to the standard thermal production. Thus the neutralino becomes a good dark matter candidate with 0.1\lsim \Omega h^2 \lsim 0.3, even for regions of the parameter space where large neutralino-nucleon cross sections, compatible with current dark matter experiments, are present. This is obtained for intermediate scales $M_I\sim 10^{11}-10^{14}$ GeV, and moduli masses $m_\phi\sim 100-1000$ GeV. On the other hand, when the above temperature is associated to the decay of an inflaton field, the relic abundance is too small.Comment: Latex, 11 pages, 2 figure

Evidence for uteroplacental malperfusion in fetuses with major congenital heart defects.

AIMS: Fetuses affected by congenital heart defects (CHD) are considered to be at increased risk of fetal growth restriction and intrauterine demise. Whether these risks are a direct consequence of fetal CHD or a result of associated uteroplacental dysfunction is not evident from the data of recent studies. The aim of this study was to investigate the prevalence of uteroplacental dysfunction reflected by abnormal uterine artery Doppler indices and reduced fetal growth in CHD pregnancies. METHODS: This is a retrospective case-control study including singleton pregnancies referred for detailed fetal cardiac assessment subsequently diagnosed with or without CHD. Mid-trimester uterine artery Doppler assessment at 20-24 weeks as well as third trimester fetal biometry and arterial Doppler pulsatility indices (PI) were performed. All fetal biometry were converted into centiles and Doppler values to multiples of median (MoM) to adjust for physiological changes with gestation. RESULTS: The study included 811 pregnancies including 153 cases where the fetus was diagnosed with CHD. Mid-pregnancy uterine artery PI was significantly higher in women with fetal CHD compared to controls (0.90MoM vs 0.83MoM; p = 0.006). In the third trimester, median centiles for fetal head circumference (45.4 vs 57.07; p<0.001), abdominal circumference (51.17 vs 55.71; p = 0.014), estimated fetal weight (33.6 vs 56.7; p<0.001) and cerebroplacental ratio (CPR: 0.84MoM vs 0.95MoM; p<0.001) were significantly lower in fetuses with CHD compared to controls. The percentage of small for gestational age births <10th centile (24.0% vs 10.7%; <0.001) and low CPR <0.6MoM (11.7% vs 2.5%; p<0.001) were significantly higher in the fetal CHD cohort. CONCLUSIONS: Mid-pregnancy uterine artery resistance is increased and subsequent fetal biometry reduced in pregnancies with CHD fetuses. These findings suggest that fetal CHD are associated with uteroplacental dysfunction, secondary to impaired maternal uteroplacental perfusion resulting in relative fetal hypoxaemia and reduced fetal growth

Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome.

This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention

Evaluation of the built environment performance in light of Sustainable and universal design: Criteria and Methods

Egypt\u27s Vision 2030 for Sustainable Development Strategy (SDS) emphasizes social inclusion and accessibility. The concept of Universal Design (UD) is crucial in achieving the goals of SDS by facilitating utilization and access to the built environment for all