Risk factors for progression from severe maternal morbidity to death: a national cohort study.

Women continue to die unnecessarily during or after pregnancy in the developed world. The aim of this analysis was to compare women with severe maternal morbidities who survived with those who died, to quantify the risk associated with identified factors to inform policy and practice to improve survival

1960

Recent Developments Affecting Golf Course Design (page 1) From the Editor (3) Five Year Results (3) Turf Management Club News (4) Quotes from 1960 Seniors (5) Poa annua - - Friend or Foe (6) The Horticulture Show (7) Cartoons (8) Message from the Winter School President of 1960 (10) The Most Outstanding Turf Senior for 1959 (10) The Value of the Proper Use of Lime (11) Summer Placement (12) A Greenhouse on the Golf Course (13) More Opportunities in the Future for the Aggressive Superintendent at Country Clubs (14) Soil, Sawdust and Turfgrass (15) Picture - Senior Stockbridge Turf majors (16) Picture - Freshman Stockbridge Turf majors (17) Susceptibility of Merion Bluegrass to Stripe Smut (18) Bents in the South (19) Picture - Honorary Members of Turf Management Club (20) Picture - Graduates of Winter School for Turf mangers- 1960 (21) Weather - We are Going to Have Weather, Whether or Not - What Should we Expect by O. Tennebaum & R. E. Lautzenheiser (A-1) The Nature of Winter Injury to Plants by Dr. Johnson Parker (A-1) Turf Problems: You Name it and We\u27ve Had It in \u2759 by Alexander Radko ad T.T. Taylor (A-3) Topdressing Experiences with Greens at Century by James Fulwider (A-5) Poa annua - Fairway Rennovation at winged Foot by Sherwood A. Moore (A-6) Winter Problems at Ekwanaok by Paul O\u27Leary (A-8) Progress Through Drainage by Kayem Ovian (A-10) Winter Injury on Home Lawns by Orlando Capizzi (A-12) The Status of Pre-emergence Chemicals for the Control of Crabgrass by Dr. E. Engel (A-12) Turf Nurseries - Establishment, Maintenance & Utilization by Robert Grant (A-14) Soil Compaction by Dr. R. B. Alderfer (A-16) Water Management Practices on Turf Areas by Dr. J.R. Watson (A-18) Getting to Know Your Members by Owen Griffith (A-23) New Trends in Clubhouse Landscaping by Alfred Boicourt (A-26) General Lawn Management (Alternate Session) Conserving Soil for a good Lawn by Dr. William G. Colby (A-27) Fertilizting and Liming by Dr. Joseph Steckel (A-28) Grasses and Grass Mixtures for New England Lawns by Dr. Robert Schery (A-29) The Care and Maintenance of Establishment Lawns by Dr. John R. Davi

Association of peripartum management and high maternal blood loss at cesarean delivery for placenta accreta spectrum (PAS): A multinational database study

Introduction: Placenta accreta spectrum (PAS) carries a high burden of adverse maternal outcomes, especially significant blood loss, which can be life-threatening. Different management strategies have been proposed but the association of clinical risk factors and surgical management options during cesarean delivery with high blood loss is not clear. Material and methods: In this international multicenter study, 338 women with PAS undergoing cesarean delivery were included. Fourteen European and one non-European center (USA) provided cases treated retrospectively between 2008 and 2014 and prospectively from 2014 to 2019. Peripartum blood loss was estimated visually and/or by weighing and measuring of volume. Participants were grouped based on blood loss above or below the 75th percentile (>3500 ml) and the 90th percentile (>5500 ml). Results: Placenta percreta was found in 58% of cases. Median blood loss was 2000 ml (range: 150-20 000 ml). Unplanned hysterectomy was associated with an increased risk of blood loss >3500 ml when compared with planned hysterectomy (adjusted OR [aOR] 3.7 [1.5-9.4], p = 0.01). Focal resection was associated with blood loss comparable to that of planned hysterectomy (crude OR 0.7 [0.2-2.1], p = 0.49). Blood loss >3500 ml was less common in patients undergoing successful conservative management (placenta left in situ, aOR 0.1 [0.0-0.6], p = 0.02) but was more common in patients who required delayed hysterectomy (aOR 6.5 [1.7-24.4], p = 0.001). Arterial occlusion methods (uterine or iliac artery ligation, embolization or intravascular balloons), application of uterotonic medication or tranexamic acid showed no significant effect on blood loss >3500 ml. Patients delivered by surgeons without experience in PAS were more likely to experience blood loss >3500 ml (aOR 3.0 [1.4-6.4], p = 0.01). Conclusions: In pregnant women with PAS, the likelihood of blood loss >3500 ml was reduced in planned vs unplanned cesarean delivery, and when the surgery was performed by a specialist experienced in the management of PAS. This reinforces the necessity of delivery by an expert team. Conservative management was also associated with less blood loss, but only if successful. Therefore, careful patient selection is of great importance. Our study showed no consistent benefit of other adjunct measures such as arterial occlusion techniques, uterotonics or tranexamic acid

Symphysis-fundal height curve in the diagnosis of fetal growth deviations

OBJECTIVE: To validate a new symphysis-fundal curve for screening fetal growth deviations and to compare its performance with the standard curve adopted by the Brazilian Ministry of Health. METHODS: Observational study including a total of 753 low-risk pregnant women with gestational age above 27 weeks between March to October 2006 in the city of João Pessoa, Northeastern Brazil. Symphisys-fundal was measured using a standard technique recommended by the Brazilian Ministry of Health. Estimated fetal weight assessed through ultrasound using the Brazilian fetal weight chart for gestational age was the gold standard. A subsample of 122 women with neonatal weight measurements was taken up to seven days after estimated fetal weight measurements and symphisys-fundal classification was compared with Lubchenco growth reference curve as gold standard. Sensitivity, specificity, positive and negative predictive values were calculated. The McNemar χ2 test was used for comparing sensitivity of both symphisys-fundal curves studied. RESULTS: The sensitivity of the new curve for detecting small for gestational age fetuses was 51.6% while that of the Brazilian Ministry of Health reference curve was significantly lower (12.5%). In the subsample using neonatal weight as gold standard, the sensitivity of the new reference curve was 85.7% while that of the Brazilian Ministry of Health was 42.9% for detecting small for gestational age. CONCLUSIONS: The diagnostic performance of the new curve for detecting small for gestational age fetuses was significantly higher than that of the Brazilian Ministry of Health reference curve

On Monitoring Information Flow of Outsourced Data

Data outsourcing is an Internet-based paradigm that allows organizations to share data cost-effectively by transferring data to a third-party service provider for management. Enforcing outsourced data privacy in untrustworthy environments is challenging because the data needs to be kept secret both from unauthorized users and the service provider (SP). Existing approaches propose that the data owner(s) encrypt the data before it is transferred to the service provider to preserve confidentiality. Access is only granted to a user initiated program if the key presented can decrypt the data into a readable format. Therefore the data owner can control access to the data without having to worry about the management costs. However, this approach fails to monitor the data once it has been retrieved from the SP’s end. So, a user can retrieve information from the SP’s end and share it with unauthorized users or even the SP. We propose a conceptual framework, based on the concept of dependence graphs, for monitoring data exchanges between programs in order to prevent unauthorized access. The framework has a distributed architecture which is suitable for data outsourcing environments and the web in general. Each data object contains a cryptographic tag (like an invisible digital watermark) that is computed by using a cryptographic hash function to combine the checksum of the data and the encryption key. In order to execute an operation with a data object the key presented for decryption must match the one associated with the user’s role and generate a cryptographic tag that matches the one embedded into the data. Tracing data exchanges, in this way, can leverage data privacy for organizations that transfer data management to third party service providers

Thermodynamic properties of tripalmitin and trilinolein and their mixtures

Specific enthalpy and heat capacity of the tripalmitin and trilinolein as well as their mixtures have been determined by differential scanning calorimetry between 300 K and 363 K. The tripalmitin melts at 340 k. The specific enthalpy of trilinolein varies linearly with the temperature between 300 k and 363 k. The mean heat capacity of the trilinolein is equal to 2.09 Jg-1K-1 in this temperature range. Addition of trilinolein to tripalmitin decreases melting point of the tripalmitin.This study supplies further information on the phase diagram of the tripalmitin- trilinolein binary system, and so contributes towards a better understanding of the thermodynamic behaviour of complex mixtures such as vegetable oils

Polymers blends and their effects on the mechanical behavior and physical properties of prolonged release tablets prepared by direct compression

MastersAt present, all the matrix forming polymers being studied are used extensively in pharmaceuticals to control the release of drug. The approach of the present study was to make a comparative evaluation among these polymers and to assess the effect of physicochemical nature of the active ingredient on drug release profile. The study reveals that, the release of water soluble drug as higher than the drug with lower solubility and the extent of release rate was changed with the nature and content of polymer in the matrix. The type of polymers used imparts a conspicuous effect on release mechanism. The data generated in this study also shows that, the drug release from formula based on combination of plastic and elastic matrices was different upon changing the weight ratio of both. The release was more extended by increasing the plastic polymer weight ratio. In addition, different profiles were recorded by combining the plastic polymers with a brittle one, in which the more the plastic content, the higher the release percentage observed. Consequently, the drug aqueous solubility has markedly affected drug release pattern from the tablet formulations. However, a number of critical parameters such as tabletting conditions, compression forces, upper and lower punch compression forces, hardness, tensile strength and friability will affect the physicho-mechanical behavior of the tablets from different matrices. Those parameters should be taken into consideration during formulation design. A confirmatory analytical technique, namely DSC, IR and X-ray diffractometery, were used to prove the physicochemical stability of the used drug and the absence of any chemical interaction with the matrix forming polymers used. In addition, the incorporation of EC resulted in the manufacture of tablets of sufficient hardness. It can, therefore, be concluded that EC is a good direct compression matrix forming polymer that increased the duration of diclofenac sodium 2.5 folds compared to the commercial product

Maternal and obstetric factors associated with delayed postpartum eclampsia: a national study population.

OBJECTIVE: To estimate the incidence of delayed postpartum eclampsia and to investigate whether maternal characteristics and outcomes were different between women with delayed or early postpartum eclampsia. DESIGN: Prospective population-based study. SETTING: All 229 UK hospitals with consultant-led maternity units in the UK. POPULATION: All women delivering between February 2005 and February 2006. METHODS: Maternal characteristics and outcomes were compared between women with delayed (≥ 12 hours between delivery and eclampsia) and early postpartum eclampsia. MAIN OUTCOME MEASURES: Rates with 95% confidence intervals (CIs). Adjusted odds ratio estimates. RESULTS: Seventy-six women had postpartum eclampsia, representing an incidence of 1.0/10 000 (95% CI 0.7-1.2/10 000) maternities. Among the women having postpartum eclampsia, 53 (70%; 95% CI 59-79) occurred in the first 12 hours following delivery, eight (11%; 95% CI 3-20) during hours 12-24, four (5%; 95% CI 2-13) during the 24-48 hours after delivery and 11 (14%; 95% CI 7-24) more than 48 hours after delivery. Maternal characteristics, biological and clinical symptoms in the week preceding eclampsia and neonatal outcomes were not significantly different in the delayed eclampsia group in comparison with the early postpartum eclampsia group. However, the cesarean delivery rate was higher in women with delayed eclampsia in comparison with earlier postpartum eclampsia [13 (57%) vs. 6 (11%); odds ratio 10.1, 95% CI 3.12-33.3]. CONCLUSIONS: Close follow-up should be performed in the 12 hours following delivery in women with hypertensive disorders of pregnancy. Beyond this, the risk of eclampsia is very low, and eclampsia occurs mainly among women who have had a cesarean delivery