Extensive Pulmonary Embolism in late pregnancy associated with Anticardiolipin Antibodies

The leading cause of morbidity and mortality during pregnancy and the puerperium is venous thromboembolism. Though uncommon, the risk is five times higher in a pregnant woman than in a non-pregnant woman of similar age.1,2 In pregnancy, all three underlying factors for venous thrombosis are present: hypercoagulability, venous stasis and vascular damage (Virchow's triad). Of these, the most constant predisposing factor is increasing venous stasis due to the pressure of the gravid uterus on the pelvic vasculature. In addition the presence of a thrombophilia, (congenital or acquired) will increase this risk substantially. During pregnancy hypercoagulability is a physiological preparation for the haemostatic challenge of delivery. There are increases in procoagulant factors, such as von Willebrand factor, factor VIII, factor V, and fibrinogen together with an acquired resistance to activated protein C and a reduction in protein S. Increases in plasminogen activator inhibitors impair fibrinolysis. The third factor of this triad, vascular damage, is a possible complication of trophoblastic invasion of the uterine spiral arterioles or of delivery.peer-reviewe

Influence du couvert végétal sur l'hydrologie des crues, modélisation à validations multiples

La modélisation présentée ici a subi une double validation : expérimentale, par exploitation de bassins fortement contrastés en végétation, et méthodologique, par exploitation simultanée d'un modèle régional (descriptif synthétique) à démarche ascendante (QdF) et d'un modèle conceptuel global à démarche descendante (GR3J). Le bassin versant de l'Ardières à Beaujeu (54,5 km2) est un petit bassin versant montagneux, recouvert sur 90 % de sa superficie d'une forêt de sapins, de feuillus ainsi que de prairies et sur les 10 % restants de vignobles. A proximité de celui-ci, le bassin versant de la Vauxonne à Buyon (49,3 km2), dont 70 % de la superficie sont plantés en vigne et 30 % sont occupés par la forêt et les prairies, présente des crues bien différenciées, de celles de son voisin, en général plus rapides et deux fois plus intenses. Nous pouvons penser que cette différence de comportement hydrologique est liée au mode d'occupation des sols et plus précisément au système sol-végétation. Dans un premier temps, nous montrons que la paramétrisation des modèles, fortement différenciée d'un bassin versant à l'autre, est la "signature" (toutes choses égales par ailleurs) du rôle joué par l'entité végétale sur les crues observées. Dans un deuxième temps, l'exemple de simulation choisi permet de quantifier et de comparer, pour une même pluie "fictive" d'entrée, le comportement hydrologique en crue d'un petit bassin (environ 50 km2) forestier ou vignoble, dans un contexte pluviométrique bien différencié, de type océanique ou continental alpin. (Résumé d'auteur

Gas Purity effect on GEM Performance in He and Ne at Low Temperatures

The performance of Gas Electron Multipliers (GEMs) in gaseous He, Ne, He+H2 and Ne+H2 was studied at temperatures in the range of 3-293 K. This paper reports on previously published measurements and additional studies on the effects of the purity of the gases in which the GEM performance is evaluated. In He, at temperatures between 77 and 293 K, triple-GEM structures operate at rather high gains, exceeding 1000. There is an indication that this high gain is achieved through the Penning effect as a result of impurities in the gas. At lower temperatures the gain-voltage characteristics are significantly modified probably due to the freeze-out of these impurities. Double-GEM and single-GEM structures can operate down to 3 K at gains reaching only several tens at a gas density of about 0.5 g/l; at higher densities the maximum gain drops further. In Ne, the maximum gain also drops at cryogenic temperatures. The gain drop in Ne at low temperatures can be re-established in Penning mixtures of Ne+H2: very high gains, exceeding 104, have been obtained in these mixtures at 30-77 K, at a density of 9.2 g/l which corresponds to saturated Ne vapor density at 27 K. The addition of small amounts of H2 in He also re-establishes large GEM gains above 30 K but no gain was observed in He+H2 at 4 K and a density of 1.7 g/l (corresponding to roughly one-tenth of the saturated vapor density). These studies are, in part, being pursued in the development of two-phase He and Ne detectors for solar neutrino detection.Comment: 4 pages, 7 figure

Household decision-making about delivery in health facilities: evidence from Tanzania.

This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility

Fatigue Crack Growth And Piezoelectric Property Decay Induced By Cyclic Electric Fields For An Actuation Piezoceramic

Degradation of piezoelectric properties of piezomaterials has long been a concern in the applications of actuators and sensors. In this work, alternating electric field induced fatigue crack growth and effect of cyclic electric field on piezoelectric property decay were characterized for a polarized PZT-PIC151. The results show that a relatively high alternating electric field drives the pre-existing microcracks to grow very fast initially due to the superposition of electrostriction induced stress and residual stress at the crack tip, then slow down gradually to becoming dormant. The butterfly loop evolution shows that cyclic electric field strongly degrades the piezoelectric properties due to the frequent domain switching. The output strain decays more than 50% after 106 electric cycles at 0.9 Ec for PIC 151 pellet bonded on an aluminum beam

Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients:Observations From a Multicenter Data Set

Background and Purpose: The mortality and morbidity after aneurysmal subarachnoid hemorrhage has improved because of better diagnosis, early treatment to secure the aneurysm, and better management of disease-specific complications. With these improvements in care, it is not clear if the previously identified independent predictors of a negative outcome have changed. The aim of this study was to identify the independent predictors of an unfavorable outcome (Glasgow Outcome Score 1, 2, and 3) in aneurysmal subarachnoid hemorrhage patients.Methods: Univariate and multivariate analysis of prospectively collected data on patients presenting with an aneurysmal subarachnoid hemorrhage was performed. Outcome was assessed at discharge. Data were collected from 14 centers in the United Kingdom over a period of 4 years (September 2011-2015).Results: The median age (interquartile range) at presentation of 3341 patients with aneurysmal subarachnoid hemorrhage was 55 (18) years. Most patients were female (n=2288 [68.5%]), presented in good grade (2397 [70%]; World Federation of Neurological Surgeons grade 1 and 2), and were treated by endovascular coiling (n=2600; 75%). The independent predictors of an unfavorable outcome (95% confidence interval [CI]) were increasing age (odds ratio [OR], 1.04; 95% CI, 1.03-1.05; P&lt;0.001), World Federation of Neurological Surgeons grade (OR, 2.06; 95% CI, 1.91-2.22; P&lt;0.001), preoperative rebleeding (OR, 7.41; 95% CI, 4.48-12.30; P&lt;0.001), need for cerebrospinal fluid diversion (OR, 3.25; 95% CI, 2.58-4.09; P&lt;0.001), and delayed cerebral ischemia (OR, 2.21; 95% CI, 1.72-2.83; P&lt;0.001).Conclusions: These data suggest that potentially modifiable risk factors of preoperative rebleeding and delayed cerebral ischemia are associated with unfavorable outcomes. Understanding the reasons why patients requiring cerebrospinal fluid diversion have 3.25-fold higher adjusted odds of a poor outcome at discharge needs to be studied.</p