Extensive hyperpigmentation during pregnancy: a case report

Abstract Introduction Skin hyperpigmentation is common during pregnancy and often is due to endocrinological changes. Usual patterns include linea nigra, darkening of areola and melasma. We report a rare diffused hyperpigmentation condition in a pregnant woman of dark colored skin. Case presentation A 19-year-old Tanzanian primigravida at 32 weeks gestation presented at our antenatal clinic concerned about an insidious but progressive onset of unusual darkening of her abdominal skin and both breasts. Her antenatal record was unremarkable except for this unusual onset of abnormal skin color. Findings from her physical examination were unremarkable, and she had a normal blood pressure of 120/70 mmHg. Her abdomen was distended with a uterine fundus of 34 weeks. Almost her entire abdominal skin had darkly colored diffuse deep hyperpigmentation extending cephalad from both iliac fossae to involve both breasts to 2-3 cm beyond the areolae circumferentially. She had a fetus in longitudinal lie and cephalic presentation, with a normal fetal heart rate of 140 beats per minute. Other examination findings were unremarkable. The impression at this stage was exaggerated pigmentation of pregnancy. No medical treatment was offered but she was counseled that she might need medical treatment after delivery. She progressed well and had spontaneous labor and normal delivery at 38 weeks gestation. She was lost to follow up. Conclusion Unusual pregnancy-related skin hyperpigmentation can occur with no adverse consequences to pregnancy, although may worry a pregnant woman. Reassurance and conservative management may be all that is required to allay a patient's concerns.</p

A system design for distributed energy generation in low temperature district heating (LTDH) networks

Project SCENIC (Smart Controlled Energy Networks Integrated in Communities) involves connecting properties at the University of Nottingham’s Creative Energy Homes test site in a community scale, integrated heat and power network. Controls will be developed to allow for the most effective heat load allocation and power distribution scenarios. Furthermore, the system will develop the prosumer concept, where consumers are both buyers and sellers of energy in both heat and power systems. This paper describes the initial phase of project SCENIC, achieving truly distributed generation within a heat network. The first of its kind, the system has a four pipe network configuration, consisting of a network flow loop to supply heat to homes, and a generation loop to collect energy from residential heating systems and supply it to a centralised thermal store. To achieve the design, IES-VE steady state heat load and dynamic building modelling have been used. A pre-insulated Rehau Rauthermex piping diameter was sized using flow rate calculations. Pipe diameter is reduced in line with distance from the central pump and associated pressure losses. The diameter ranges from 40 to 25mm, with a heat loss as low as 7.0 W/m. In addition, flow rates will fluctuate below a maximum of 1.99 l/s. Danfoss – 7 Series BS flatstations have been selected as the network-building heat interface units (HIU), to satisfy a calculated peak design heating loads of between 36.74 and 44.06 kW. Furthermore, to enable the prosumer concept and associated business models an adapted Danfoss Flatstations – 3 Series BS was selected to interface the distributed heat sources with the network. This paper gives details of the novel system configuration and concept, energy flows, as well as calculation and modelling results for the heat network. A premise is given to maintaining low temperatures in the network to ensure system efficiency in line with the latest research thinking

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes. Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Results: Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91) and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: Incomplete advance care planning understanding and confidence; Limited congruence for attitude and documentation; Advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants’ attitudes and their written document congruence was limited, but advance care planning was seen as helpful. Conclusions: This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation

Alcune note sull'articolazione interna di Grotta Manaccora durante l'età del Bronzo

Il contributo offre una sintesi delle evidenze archeologiche dell'età del Bronzo nela grotta di Manaccora (FG) e delle modalità di frequentazione della grotta stessa