Placental Chorangiosis: Increased Risk for Cesarean Section

We describe a patient with Class C diabetes who presented for nonstress testing at 36 weeks and 4 days of gestation with nonreassuring fetal heart tones (NRFHT) and oligohydramnios. Upon delivery, thrombosis of the umbilical cord was grossly noted. Pathological analysis of the placenta revealed chorangiosis, vascular congestion, and 40% occlusion of the umbilical vein. Chorangiosis is a vascular change of the placenta that involves the terminal chorionic villi. It has been proposed to result from longstanding, low-grade hypoxia in the placental tissue and has been associated with such conditions such as diabetes, intrauterine growth restriction (IUGR), and hypertensive conditions in pregnancy. To characterize chorangiosis and its associated obstetric outcomes we identified 61 cases of chorangiosis on placental pathology at Henry Ford Hospital from 2010 to 2015. Five of these cases were omitted due to lack of complete records. Among the 56 cases, the cesarean section rate was 51%, indicated in most cases for nonreassuring fetal status. Thus, we suggest that chorangiosis, a marker of chronic hypoxia, is associated with increased rates of cesarean sections for nonreassuring fetal status because of long standing hypoxia coupled with the stress of labor

Towards Sustained Monitoring of Subsidence at the Coast Using InSAR and GPS: An Application in Hampton Roads, Virginia

Hampton Roads is among the regions along the U.S. Atlantic Coast experiencing high rates of relative sea level rise. Partly to mitigate subsidence from aquifer compaction, Hampton Roads is injecting treated wastewater into the underlying aquifer. However, the GPS (Global Positioning System) station spacing (∼30 km) is too coarse to capture the spatial variability of subsidence and potential uplift from the injection. We present a cost‐effective workflow for generating an InSAR (interferometric synthetic aperture radar) and GPS combined displacement product. We leverage a live, open‐access archive of InSAR products generated from Sentinel‐1 data. We find an overall subsidence rate of −3.6 ± 2.3 mm/year with considerable spatial variability. The effects of groundwater injection are currently below detection. The workflow presented here is an asset for sustained monitoring of the injection effort and regional subsidence that is applicable along the U.S. coasts for assisting in mitigation and adaptation of relative sea level rise

A comparison of the epidemiology of ice hockey injuries between male and female youth in Canada

BACKGROUND: Hockey is played by youth across Canada, and its popularity has increased dramatically among females in the past decade. Despite this, there has been little epidemiological research comparing the injury patterns of young female and male hockey players. OBJECTIVE: To describe and compare injuries sustained by female and male youth hockey players using the Canadian Hospitals Injury Reporting and Prevention Program database. METHODS: In the present cross-sectional, retrospective comparison study, the Canadian Hospitals Injury Reporting and Prevention Program database was used to identify all hockey-related injuries sustained by children seven to 17.5 years of age over a 15-year period (January 1995 to December 2009). Exclusion criteria included paid professional players and children with injuries sustained while playing road hockey. RESULTS: Inclusion criteria were met by 33,233 children (2637 [7.9%] females and 30,596 [92.1%] males). Compared with males, females reported proportionately more soft tissue injuries (39.8% versus 32.6%; P\u3c0.01) and sprains/strains (21.1% versus 17.6%; P\u3c0.01). Males experienced more fractures (27.1% versus 18.2%; P\u3c0.01) and were most often injured through body checking (42.8% versus 25.7%; P\u3c0.01). Females showed a trend toward increased concussion with age, and were most often injured through collisions (28.6% versus 24.6%; P\u3c0.01). CONCLUSION: Compared with males, female hockey players sustained proportionately more soft tissue injures and sprains/strains, and showed a trend toward concussions in late adolecence. Males experienced more fractures, shoulder injuries and injuries due to body checking. Further research is required to identify risk factors for injury in female youth hockey players and to target injury prevention

The Toronto Extremity Salvage Score in unoperated controls: an age, gender, and country comparison

Extent: 5p.The Toronto Extremity Salvage Score (TESS) is widely used for the functional assessment of patients following surgery for musculoskeletal tumours. The aim of this study was to determine if there are gender and/or age-specific changes, unrelated to surgery, that may influence this score and the appropriateness of the questions. The TESS for lower limb was carried out in two different countries to see if there was variation between them. There were no statistically significant differences between the scores obtained between the respondents from Australia or Britain either in total or between the corresponding age groups. There were statistically significant differences in the TESS obtained between age groups with a lower score at older age groups but there was no difference between the sexes. Patients in the age group 70+ were more likely to record activities as “not applicable” and also have a lower score. This study has shown that age is the major factor in determining the TESS in both an Australian and British populations of otherwise healthy people. As there were no differences between the two populations, it supports the TESS as an international scoring system. There may be also an argument for age-specific questions.Mark Clayer, Simon Doyle, Nicole Sangha, and Robert Grime

Lower healthcare costs associated with the use of a single-pill ARV regimen in the UK, 2004-2008

Aim: Investigate the cost and effects of a single-pill versus two- or three pill first-line antiretroviral combinations in reducing viral load, increasing CD4 counts, and first-line failure rate associated with respective regimens at 6 and 12 months. Methods: Patients on first-line TDF+3TC+EFV, TDF+FTC+EFV, TruvadaH+EFV or AtriplaH between 1996–2008 were identified and viral load and CD4 counts measured at baseline, six and twelve months respectively. Factors that independently predicted treatment failure at six and twelve months were derived using multivariate Cox’s proportional hazard regression analyses. Use and cost of hospital services were calculated at six and twelve months respectively. Results: All regimens reduced viral load to below the limit of detection and CD4 counts increased to similar levels at six and twelve months for all treatment regimens. No statistically significant differences were observed for rate of treatment failure at six and twelve months. People on AtriplaH generated lower healthcare costs for non-AIDS patients at £5,340 (£5,254 to £5,426) per patient-semester and £9,821 (£9,719 to £9,924) per patient-year that was £1,344 (95%CI £1,222 to £1,465) less per patient-semester and £1,954 (95%CI £1,801 to £2,107) less per patient-year compared with TruvadaH+EFV; healthcare costs for AIDS patients were similar across all regimens. Conclusion: The single pill regimen is as effective as the two- and three-pill regimens of the same drugs, but if started as first-line induction therapy there would be a 20% savings on healthcare costs at six and 17% of costs at twelve months compared with TruvadaH+EFV, that generated the next lowest costs

Substorm onset latitude and the steadiness of magnetospheric convection

We study the role of substorms and steady magnetospheric convection (SMC) in magnetic flux transport in the magnetosphere, using observations of field-aligned currents by the Active Magnetosphere and Planetary Electrodynamics Response Experiment. We identify two classes of substorm, with onsets above and below 65° magnetic latitude, which display different nightside field-aligned current morphologies. We show that the low-latitude onsets develop a poleward-expanding auroral bulge, and identify these as substorms that manifest ionospheric convection-braking in the auroral bulge region as suggested by Grocott et al. (2009, https://doi.org/10.5194/angeo-27-591-2009). We show that the high-latitude substorms, which do not experience braking, can evolve into SMC events if the interplanetary magnetic field remains southward for a prolonged period following onset. We conclude that during periods of ongoing driving, the magnetosphere displays repeated substorm activity or SMC depending on the rate of driving and the open magnetic flux content of the magnetosphere prior to onset. We speculate that sawtooth events are an extreme case of repeated onsets and that substorms triggered by northward-turnings of the interplanetary magnetic field mark the cessation of periods of SMC. Our results provide a new explanation for the differing modes of response of the terrestrial system to solar wind-magnetosphere-ionosphere coupling by invoking friction between the ionosphere and atmosphere

Multi-instrument observations of the effects of a solar wind pressure pulse on the high latitude ionosphere : a detailed case study of a geomagnetic sudden impulse

Funding: ARF was supported by an STFC studentship, Science Foundation Ireland Grant 18/FRL/6199, and an Irish Research Council Government of Ireland Postdoctoral Fellowship GOIPD/2022/782. ML, TKY, and SEM acknowledge support from the Science and Technology Facilities Council, UKRI, grant no. ST/W00089X/1. JAC is supported by Royal Society grant DHF\R1\211068. HKS was supported by an STFC studentship. TE was supported by a Leverhulme Trust Early Career Fellowship (ECF-2019-155), the University of Leicester and the University of Glasgow. SJW was supported by NERC studentship NE/L002493/1. MKJ was supported by STFC Grant ST/W00089X/1. JML was supported by the Irish Research Council. LJP was supported by AFOSR MURI Award 26-0201-51-62.The effects of a solar wind pressure pulse on the terrestrial magnetosphere have been observed in detail across multiple datasets. The communication of these effects into the magnetosphere is known as a positive geomagnetic sudden impulse (+SI), and are observed across latitudes and different phenomena to characterise the propagation of +SI effects through the magnetosphere. A superposition of Alfvén and compressional propagation modes are observed in magnetometer signatures, with the dominance of these signatures varying with latitude. For the first time, collocated lobe reconnection convection vortices and region 0 field aligned currents are observed preceding the +SI onset, and an enhancement of these signatures is observed as a result of +SI effects. Finally, cusp auroral emission is observed collocated with the convection and current signatures. For the first time, simultaneous observations across multiple phenomena are presented to confirm models of +SI propagation presented previously.Publisher PDFPeer reviewe