Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support.

AIMS: To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. POPULATION: Low risk singleton, term, pregnant women in labour. SETTING: Institutional births in low- and middle-income countries. SEARCH STRATEGY: A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. CASE SCENARIOS: Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. CONCLUSIONS: Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. TWEETABLE ABSTRACT: Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications.

Dynamics of coreless defects during winding up transitions in confined chiral nematic liquid crystals.

Twist-coupled elastic deformations are ubiquitous and in the limelight of interest for next-generation self-shaping materials. Here, we describe how twist dynamics under fixed anchoring lead to bend deformation and defect dynamics in a field-unwound chiral liquid crystal material. We use the Q-tensor dynamics under the Landau-de Gennes formalism in a finite-element mesh to explore the texture pathways from the unwound (homeotropic) to the helical planar structure. Our simulations describe well previously reported experiments and confirm that the process occurs by forming pairs of coreless defects that interact with each other and create quadrupolar structures called Lehmann clusters. The dynamics and coarsening of dipoles and quadrupoles of defects are described. This numerical study describes the full dynamics, which has been sought for several years.

Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health.

This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.

Estimating physical properties from liquid crystal textures via machine learning and complexity-entropy methods.

Imaging techniques are essential tools for inquiring a number of properties from different materials. Liquid crystals are often investigated via optical and image processing methods. In spite of that, considerably less attention has been paid to the problem of extracting physical properties of liquid crystals directly from textures images of these materials. Here we present an approach that combines two physics-inspired image quantifiers (permutation entropy and statistical complexity) with machine learning techniques for extracting physical properties of nematic and cholesteric liquid crystals directly from their textures images. We demonstrate the usefulness and accuracy of our approach in a series of applications involving simulated and experimental textures, in which physical properties of these materials (namely: average order parameter, sample temperature, and cholesteric pitch length) are predicted with significant precision. Finally, we believe our approach can be useful in more complex liquid crystal experiments as well as for probing physical properties of other materials that are investigated via imaging techniques.

Ultrasound Measurements of Fetal Thyroid: Reference Ranges from a Cohort of Low-Risk Pregnant Women.

BACKGROUND: Adequate thyroid function is essential for normal growth and development of the fetus. Sonographic recognition of alterations in fetal thyroid dimensions may be the first sign of thyroid dysfunction, permitting early diagnosis and intervention. The main goal of this study was to build curves with reference values for ultrasound measurements of the fetal thyroid from 14 to 40 weeks of gestation. METHODS: This is a prospective longitudinal study of 90 Brazilian pregnant women, complementary to a cohort multicentre study named "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component." Pregnant women without any pre-existing conditions that might affect fetal growth received antenatal care from the first trimester until childbirth, undergoing serial ultrasound evaluations of the fetus, including the thyroid. Longitudinal, anteroposterior, and transverse diameters of both thyroid lobes were measured in the fetus. Fetal thyroid lobe volume was also estimated. By quantile regression analysis, reference curves of measurements were fitted according to the gestational age. RESULTS: A reference standard of thyroid growth was defined during pregnancy by fitting curves of its measurements. Reference values for the 10th, 50th, and 90th centiles of fetal thyroid measurements (longitudinal, anteroposterior, transverse diameters, and lobe volume) were defined, from 14 to 40 weeks of gestation. CONCLUSION: We provided a reference curve of optimal thyroid development in a low-risk population that can be used as a standard of comparison to diagnose deviations from the norm. In addition, we demonstrated an alternative and simplified method for early recognition of thyroid morphological alterations by an individualized technique to evaluate the thyroid lobes.

Nematic liquid crystal in a cylindrical sample: Theoretical analysis of the electrical response.

The electrical responses of a nematic liquid crystal sample confined between two cylindrical surfaces are investigated in the framework of elastic continuum theory. The responses are the result of the molecular reorientation induced by both the applied electric field and the cylindrical geometry of the sample. The nematic medium is considered as a parallel RC circuit since the capacitance and the resistance are under the same difference of potential. The electrical properties, including the total electric current, are determined from the molecular reorientation of the director. The elastic anisotropy has been shown to influence substantially the profile of the electrical current, capacitance, and resistance characterizing the equivalent circuit for the medium.

Surface induced twist in nematic and chiral nematic liquid crystals: stick-slip-like and constrained motion.

Surface driven pattern formation is an intriguing phenomenon in the liquid crystal field. Owing to its ability to transmit torque, one can generate different patterns by propagating distortions on the optical wavelength scale in the sample from the surface. Here, we theoretically investigate (from the elasticity point of view) twist deformations induced by a rotating easy axis at one surface, by considering the anchoring energy and surface viscosity of nematic and chiral nematic samples. The model is solved analytically in the limit of strong anchoring and numerically for a low anchoring strength situation. Such rotation could be induced, in principle, by light-controlling the orientation of an azobenzene monolayer coated at one of the glass substrates or by an in-plane rotating field. We discuss the role of the surface parameters and the different distortions, and calculate light transmission using the Jones method. Three different regimes are identified: free twist, stick-slip twist, and constrained twist. The results obtained here may be relevant for liquid crystal active waveplates and for determining surface viscosity and the azimuthal anchoring energy.

Elastic anisotropy effects on the electrical responses of a thin sample of nematic liquid crystal.

The electrical responses of a nematic liquid crystal cell are investigated by means of the elastic continuum theory. The nematic medium is considered as a parallel circuit of a resistance and a capacitance and the electric current profile across the sample is determined as a function of the elastic constants. In the reorientation process of the nematic director, the resistance and capacitance of the sample are determined by taking into account the elastic anisotropy. A nonmonotonic profile for the current is observed in which a minimum value of the current may be used to estimate the elastic constants values. This scenario suggests a theoretical method to determine the values of the bulk elastic constants in a single planar aligned cell just by changing the direction of applied electrical field and measuring the resulting electrical current.

Nematic liquid crystals in planar and cylindrical hybrid cells: Role of elastic anisotropy on the director deformations.

Nematic samples filling a flat cell or the annular region between two concentric cylinders with hybrid anchoring conditions at the boundaries are investigated by setting up and minimizing their Frank elastic free energy. The coupling with the surfaces is taken to be strong on one side and weak on the other. The equations are numerically solved and the conditions for which the molecular organization inside the cell becomes uniform are analyzed. The classical calculation performed by G. Barbero and R. Barberi [J. Phys. 44, 609 (1983)] is reproduced and investigated from a different point of view, in order to compare the results of planar and cylindrical geometries. The results suggest that the cylindrical cell presents some unusual features deserving a more complete investigation. Although most part of the transitional phenomena are found for K(11)>K(33), a case not common for ordinary (lyotropic and thermotropic) liquid crystals, it is possible to find a completely uniform cell even for K(11)

Molecular organization of nematic liquid crystals between concentric cylinders: role of the elastic anisotropy.

The orientational order in a nematic liquid crystal sample confined to an annular region between two concentric cylinders is investigated by means of lattice Monte Carlo simulations. Strong anchoring and homeotropic orientations, parallel to the radial direction, are implemented at the confining surfaces. The elastic anisotropy is taken into account in the bulk interactions by using the pair potential introduced by Gruhn and Hess [T. Gruhn and S. Hess, Z. Naturforsch. A 51, 1 (1996)] and parametrized by Romano and Luckhurst [S. Romano, Int. J. Mod. Phys. B 12, 2305 (1998); Phys. Lett. A 302, 203 (2002); G. R. Luckhurst and S. Romano, Liq. Cryst. 26, 871 (1999)], i.e., the so-called GHRL potential. In the case of equal elastic constants, a small but appreciable deformation along the cylinder axis direction is observed, whereas when the values of K(11)/K(33) if K(22)=K(33) are low enough, all the spins in the bulk follow the orientation imposed by the surfaces. For larger values of K(11)/K(33), spontaneous deformations, perpendicular to the polar plane, increase significantly. Our findings indicate that the onset of these deformations also depends on the ratio K(22)/K(33) and on the radius of the cylindrical surfaces. Although expected from the elastic theory, no tangential component of the deformations was observed in the simulations for the set of parameters analyzed.

Antipersistent behavior of defects in a lyotropic liquid crystal during annihilation.

We report on the dynamical behavior of defects of strength s=±1/2 in a lyotropic liquid crystal during the annihilation process. By following their positions using time-resolved polarizing microscopy technique, we present statistically significant evidence that the relative velocity between defect pairs is Gaussian distributed, antipersistent, and long-range correlated. We further show that simulations of the Lebwohl-Lasher model reproduce quite well our experimental findings.

Ground-state proton decay of 69Br and implications for the 68Se astrophysical rapid proton-capture process waiting point.

We report on the first direct measurement of the proton separation energy for the proton-unbound nucleus (69)Br. Bypassing the (68)Se waiting point in the rp process is directly related to the 2p-capture rate through (69)Br, which depends exponentially on the proton separation energy. We find a proton separation energy for (69)Br of Sp((69)Br )= -785(-40)(+34) keV; this is less bound compared to previous predictions which have relied on uncertain theoretical calculations. The influence of the extracted proton separation energy on the rp process occurring in type I x-ray bursts is examined within the context of a one-zone burst model.

Mechanisms in knockout reactions.

We report the first detailed study of the relative importance of the stripping and diffraction mechanisms involved in nucleon knockout reactions, by the use of a coincidence measurement of the residue and fast proton following one-proton knockout reactions. The measurements used the S800 spectrograph in combination with the HiRA detector array at the NSCL. Results for the reactions 9Be(9C,8B+X)Y and 9Be(8B,7Be+X)Y are presented and compared with theoretical predictions for the two reaction mechanisms calculated using the eikonal model. The data show a clear distinction between the stripping and diffraction mechanisms and the measured relative proportions are very well reproduced by the reaction theory. This agreement adds support to the results of knockout reaction analyses and their applications to the spectroscopy of rare isotopes.

Tidal effects and the proximity decay of nuclei.

We examine the decay of the 3.03 MeV state of (8)Be evaporated from an excited projectilelike fragment following a peripheral heavy-ion collision. The relative energy of the daughter alpha particles exhibits a dependence on the decay angle of the (8)Be(*), indicative of a tidal effect. A comparison of the measured tidal effect with a model suggests a measurable nuclear proximity interaction.

Measurement of Neutron Decay Parameters-The abBA Experiment.

We are developing an experiment to measure the correlations a, A, and B, and the Fierz interference term b in neutron decay, with a precision of approximately 10(-4). The experiment uses an electromagnetic spectrometer in combination with two large-area segmented silicon detectors to detect the proton and electron from the decay in coincidence, with 4π acceptance for both particles. For the neutron-polarization-dependent observables A and B, precision neutron polarimetry is achieved through the combination of a pulsed neutron beam, under construction at the SNS, and a polarized (3)He neutron polarizer. Measuring a and A in the same apparatus provides a redundant determination of λ = gA/gV . Uncertainty in λ dominates the uncertainty of CKM unitarity tests.

Isospin diffusion and the nuclear symmetry energy in heavy ion reactions.

Using symmetric 112Sn+112Sn, 124Sn+124Sn collisions as references, we probe isospin diffusion in peripheral asymmetric 112Sn+124Sn, 124Sn+112Sn systems at an incident energy of E/A=50 MeV. Isoscaling analyses imply that the quasiprojectile and quasitarget in these collisions do not achieve isospin equilibrium, permitting an assessment of isospin transport rates. We find that comparisons between isospin sensitive experimental and theoretical observables, using suitably chosen scaled ratios, permit investigation of the density dependence of the asymmetry term of the nuclear equation of state.

Signals for a transition from surface to bulk emission in thermal multifragmentation.

Excitation-energy-gated two-fragment correlation functions have been studied between E(*)/A = (2-9)A MeV for equilibriumlike sources formed in 8-10 GeV/c pi(-) and p+197Au reactions. Comparison with an N-body Coulomb-trajectory code shows an order of magnitude decrease in the fragment emission time in the interval E(*)/A = (2-5)A MeV, followed by a nearly constant breakup time at higher excitation energy. The decrease in emission time is strongly correlated with the onset of multifragmentation and thermally induced radial expansion, consistent with a transition from surface-dominated to bulk emission expected for spinodal decomposition.