Perinatal and newborn care in a two years retrospective study in a first level peripheral hospital in Sicily (Italy)

BACKGROUND: Two hundred seventy-five thousand maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths have been estimated in 2015 worldwide, almost all in low-income countries (LICs). Moreover, more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. A significant decrease of mortality/morbidity rates could be achieved by providing effective perinatal and newborn care also in high-income countries (HICs), especially in peripheral hospitals and/or rural areas, where the number of childbirths per year is often under the minimal threshold recognized by the reference legislation. We report on a 2 years retrospective cohort study, conducted in a first level peripheral hospital in Cefalù, a small city in Sicily (Italy), to evaluate care provided and mortality/morbidity rates. The proposed goal is to improve the quality of care, and the services that peripheral centers can offer. METHODS: We collected data from maternity and neonatal records, over a 2-year period from January 2017 to December 2018. The informations analyzed were related to demographic features (age, ethnicity/origin area, residence, educational level, marital status), diagnosis at admission (attendance of birth training courses, parity, type of pregnancy, gestational age, fetal presentation), mode of delivery, obstetric complications, the weight of the newborns, their feeding and eventual transfer to II level hospitals, also through the Neonatal Emergency Transport Service, if the established criteria were present. RESULTS: Eight hundred sixteen women were included (age 18-48 years). 179 (22%) attended birth training courses. 763 (93%) were Italian, 53 foreign (7%). 175 (21%) came from outside the province of Palermo. Eight hundred ten were single pregnancies, 6 bigeminal; 783 were at term (96%), 33 preterm (4%, GA 30-41 WG); 434 vaginal deliveries (53%), 382 caesarean sections (47%). One maternal death and 28 (3%) obstetric complications occurred during the study period. The total number of children born to these women was 822, 3 of which stillbirths (3.6‰). 787 (96%) were born at term (>37WG), 35 preterm (4%), 31 of which late preterm. Twenty-one newborns (2.5%) were transferred to II level hospitals. Among them, 3 for moderate/severe prematurity, 18 for mild prematurity/other pathology. The outcome was favorable for all women (except 1 hysterectomy) and the newborns transferred, and no neonatal deaths occurred in the biennium under investigation. Of the remaining 798 newborns, 440 were breastfed at discharge (55%), 337 had a mixed feeding (breastfed/formula fed, 42%) and 21 were formula fed (3%). CONCLUSIONS: Although the minimal standard of adequate perinatal care in Italy is >500 childbirths/year, the aims of the Italian legislation concern the rationalization of birth centers as well as the structural, technological and organizational improvement of health facilities. Therefore, specific contexts and critical areas need to be identified and managed. Adequate resources and intervention strategies should be addressed not only to perinatal emergencies, but also to the management of mild prematurity/pathology, especially in vulnerable populations for social or orographic reasons. The increasing availability and spread of health care offers, even in HICs, cannot be separated from the goal of quality of care, which is an ethic and public health imperative

Hydrodynamic modelling of ejecta shrapnel in the Vela supernova remnant

Many supernova remnants (SNRs) are characterized by a knotty ejecta structure. The Vela SNR is an excellent example of remnant in which detached clumps of ejecta are visible as X-ray emitting bullets that have been observed and studied in great detail. We aim at modelling the evolution of ejecta shrapnel in the Vela SNR, investigating the role of their initial parameters (position and density) and addressing the effects of thermal conduction and radiative losses. We performed a set of 2-D hydrodynamic simulations describing the evolution of a density inhomogeneity in the ejecta profile. We explored different initial setups. We found that the final position of the shrapnel is very sensitive to its initial position within the ejecta, while the dependence on the initial density contrast is weaker. Our model also shows that moderately overdense knots can reproduce the detached features observed in the Vela SNR. Efficient thermal conduction produces detectable effects by determining an efficient mixing of the ejecta knot with the surrounding medium and shaping a characteristic elongated morphology in the clump.Comment: Accepted for publication in Monthly Notices of the Royal Astronomical Societ

Redshifted X-rays from the material accreting onto TW Hya: evidence of a low-latitude accretion spot

High resolution spectroscopy, providing constraints on plasma motions and temperatures, is a powerful means to investigate the structure of accretion streams in CTTS. In particular, the accretion shock region, where the accreting material is heated to temperatures of a few MK as it continues its inward bulk motion, can be probed by X-ray spectroscopy. To attempt to detect for the first time the motion of this X-ray-emitting post-shock material, we searched for a Doppler shift in the deep Chandra/HETGS observation of the CTTS TW Hya. This test should unveil the nature of this X-ray emitting plasma component in CTTS, and constrain the accretion stream geometry. We searched for a Doppler shift in the X-ray emission from TW Hya with two different methods, by measuring the position of a selected sample of emission lines, and by fitting the whole TW Hya X-ray spectrum, allowing the line-of-sight velocity to vary. We found that the plasma at T~2-4 MK has a line-of-sight velocity of 38.3+/-5.1 km/s with respect to the stellar photosphere. This result definitively confirms that this X-ray-emitting material originates in the post-shock region, at the base of the accretion stream, and not in coronal structures. The comparison of the observed velocity along the line of sight, 38.3+/-5.1 km/s, with the inferred intrinsic velocity of the post shock of TW Hya, v_post~110-120 km/s, indicates that the footpoints of the accretion streams on TW Hya are located at low latitudes on the stellar surface. Our results indicate that complex magnetic field geometries, such as that of TW Hya, permit low-latitude accretion spots. Moreover, since on TW Hya the redshift of the soft X-ray emission is very similar to that of the narrow component of the CIV resonance doublet at 1550 Ang, as found by Ardila et al. (2013), then the plasma at 2-4 MK and that at 0.1 MK likely originate in the same post-shock regions.Comment: Accepted for publication in Astronomy & Astrophysics; 2nd version after language editor corrections; 16 pages, 8 figures, 6 table

A General Mathematical Formulation for the Determination of Differential Leakage Factors in Electrical Machines with Symmetrical and Asymmetrical Full or Dead-Coil Multiphase Windings

This paper presents a simple and general mathematical formulation for the determination of the differential leakage factor for both symmetrical and asymmetrical full and dead-coil windings of electrical machines. The method can be applied to all multiphase windings and considers Görges polygons in conjunction with masses geometry in order to find an easy and affordable way to compute the differential leakage factor, avoiding the adoption of traditional methods that refer to the Ossanna's infinite series, which has to be obviously truncated under the bound of a predetermined accuracy. Moreover, the method described in this paper allows the easy determination of both the minimum and maximum values of the differential leakage factor, as well as its average value and the time trend. The proposed method, which does not require infinite series, is validated by means of several examples in order to practically demonstrate the effectiveness and the easiness of application of this procedure

Distribution of parallel vortices studied by spin-polarized neutron reflectivity and magnetization

We present the studies of non-uniformly distributed vortices in Nb/Al multilayers at applied field near parallel to film surface by using spin-polarized neutron reflectivity (SPNR) and DC magnetization measurements. We have observed peaks above the lower critical field, Hc1, in the M-H curves from the multilayers. Previous works with a model calculation of minimizing Gibbs free energy have suggested that the peaks could be ascribed to vortex line transitions for spatial commensuration in a thin film superconductor. In order to directly determine the distribution of vortices, we performed SPNR measurements on the multilayer and found that the distribution and density of vortices are different at ascending and descending fields. At ascending 2000 Oe which is just below the first peak in the M-H curve, SPNR shows that vortices are mostly localized near a middle line of the film meanwhile the vortices are distributed in broader region at the descending 2000 Oe. That is related to the observation of more vortices trapped at the descending field. As the applied field is sightly tilted (< 3.5degree), we observe another peak at a smaller field. The peak position is consistent with the parallel lower critical field (Hc1||). We discuss that the vortices run along the applied field below Hc1|| and rotate parallel to the surface at Hc1||.Comment: 17 pages, 9 figure

Association between one-hour post-load plasma glucose levels and vascular stiffness in essential hypertension

Objectives: Pulse wave velocity (PWV) is a surrogate end-point for cardiovascular morbidity and mortality. A plasma glucose value $155 mg/dl for the 1-hour post-load plasma glucose during an oral glucose tolerance test (OGTT) is able to identify subjects with normal glucose tolerance (NGT) at high-risk for type-2 diabetes (T2D) and for subclinical organ damage. Thus, we addressed the question if 1-hour post-load plasma glucose levels, affects PWV and its central hemodynamic correlates, as augmentation pressure (AP) and augmentation index (AI). Methods: We enrolled 584 newly diagnosed hypertensives. All patients underwent OGTT and measurements of PWV, AP and AI. Insulin sensitivity was assessed by Matsuda-index. Results: Among participants, 424 were NGT and 160 had impaired glucose tolerance (IGT). Of 424 NGT, 278 had 1-h postload plasma glucose ,155 mg/dl (NGT,155) and 146 had 1-h post-load plasma glucose$155 mg/dl (NGT$155). NGT$155 had a worse insulin sensitivity and higher hs-CRP than NGT,155, similar to IGT subjects. In addition, NGT $155 in comparison with NGT,155 had higher central systolic blood pressure (134612 vs 131610 mmHg), as well as PWV (8.463.7 vs 6.761.7 m/s), AP (12.567.1 vs 9.865.7 mmHg) and AI (29.4611.9 vs 25.1612.4 regression analysis, 1-h post-load plasma glucose resulted the major determinant of all indices of vascular stiffness. Conclusion: Hypertensive NGT$155 subjects, compared with NGT,155, have higher PWV and its hemodynamic correlates that increase their cardiovascular risk profile

Observability and diagnostics in the X-ray band of shock-cloud interactions in supernova remnants

X-ray emitting features originating from the interaction of supernova shock waves with small interstellar gas clouds are revealed in many X-ray observations of evolved supernova remnants (e.g. Cygnus Loop and Vela), but their interpretation is not straightforward. We develop a self-consistent method for the analysis and interpretation of shock-cloud interactions in middle-aged supernova remnants, which can provide the key parameters of the system and the role of relevant physical effects like the thermal conduction, without the need to run ad-hoc numerical simulations and to bother of morphology details. We explore all the possible values of the shock speed and cloud density contrast relevant to middle-aged SNRs with a set of hydrodynamic simulations of shock-cloud interaction, including the effects of thermal conduction and radiative cooling. From the simulations, we synthesize spatially and spectrally resolved focal-plane data as they would be collected with XMM-Newton/EPIC, an X-ray instrument commonly used in these studies. We devise and tune up two diagnostic tools, the first based on the mean-photon energy vs. count rate scatter plot and the second on the spectral analysis of the interaction region, that can be used to highlight the effects of thermal conduction and to derive the shock speed in case of efficient conduction at work. These tools can be used to ascertain information from X-ray observations, without the need to develop detailed and ad-hoc numerical models for the interpretation of the data.Comment: 9 pages, 7 Figures; accepted for publication on A&A. Version with full resolution images can be found at http://www.astropa.unipa.it/~orlando/PREPRINTS/sorlando_13801.pd

Coherence in Compton scattering at large angles

Compton scattering of laser light by an electron beam at large angles, in particular at 90°, produces coherent hard radiation if the density of the electron beam is high enough. In this case, the intensity of the scattered radiation is greatly enhanced in a small cone around the forward direction of propagation of the electron beam. As an example, the production of 1-KeV coherent X rays is discussed

Matter Mixing in Aspherical Core-collapse Supernovae: Three-dimensional Simulations with Single Star and Binary Merger Progenitor Models for SN 1987A

We perform three-dimensional hydrodynamic simulations of aspherical core-collapse supernovae focusing on the matter mixing in SN 1987A. The impacts of four progenitor (pre-supernova) models and parameterized aspherical explosions are investigated. The four pre-supernova models include a blue supergiant (BSG) model based on a slow merger scenario developed recently for the progenitor of SN 1987A (Urushibata et al. 2018). The others are a BSG model based on a single star evolution and two red supergiant (RSG) models. Among the investigated explosion (simulation) models, a model with the binary merger progenitor model and with an asymmetric bipolar-like explosion, which invokes a jetlike explosion, best reproduces constraints on the mass of high velocity $^{56}$Ni, as inferred from the observed [Fe II] line profiles. The advantage of the binary merger progenitor model for the matter mixing is the flat and less extended $\rho \,r^3$ profile of the C+O core and the helium layer, which may be characterized by the small helium core mass. From the best explosion model, the direction of the bipolar explosion axis (the strongest explosion direction), the neutron star (NS) kick velocity, and its direction are predicted. Other related implications and future prospects are also given