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With an estimated 8,000 deaths per year in the United States from complications of UCA, an initial goal of 50% reduction of loss is possible. To achieve this goal requires the recognition by the obstetrical community of the issue. Recent research into circadian rhythms may help explain why UCA stillbirth is an event between 2:00 a.m. and 4:00 a.m. Melatonin has been described as stimulating uterine contractions through the M2 receptor. Melatonin secretion from the pineal gland begins around 10:00 p.m. and peaks to 60 pg at 3:00 a.m. Serum levels decline to below 10 pg by 6:00 a.m. Uterine stimulation intensifies during maternal sleep, which can be overwhelming to a compromised fetus, especially one experiencing intermittent umbilical cord compression due to UCA. It is now time for the focus to be on screening for UCA, managing UCA prenatally, and delivery of the baby in distress defined by the American College of Obstetricians and Gynecologists as a heart rate of 90 beats per minute for 1 minute on a recorded nonstress test. The ability of ultrasound and magnetic resonance imaging (MRI) to visualize UCA is well documented. The 18 20 week ultrasound review should include the umbilical cord, its characteristics, and description of its placental and fetal attachment. The American Association of Ultrasound Technologists has defined these parameters for umbilical cord abnormalities: B.1.4 Abnormal insertion B.1.5 Vasa previa B.1.6 Abnormal composition B.1.7 Cysts, hematomas, and masses B.1.8 Umbilical cord thrombosis B.1.9 Coiling, collapse, knotting, and prolapse B.1.10 Umbilical cord evaluation with sonography includes the appearance, composition, location, and size of the cord Cord Events: Although many stillbirths are attributed to a cord accident, this diagnosis should be made with caution. Cord abnormalities, including a Nuchal Cord, are found in approximately 30% of normal births and may be an incidental finding. (American College of Obstetrics and Gynecology Practice Bulletin 2009) According to NICHD's recent stillbirth study, UCA is a significant cause of mortality (10%). This finding is in agreement with other international UCA studies. (Bukowski et al. 2011) These histologic criteria identify cases of cord accident as a cause of stillbirth with very high specificity. (Dilated fetal vessels, thrombosis in fetal vessels, avascular placental villi.) (Pediatr Dev Pathol 2012) Finally, defining the morbidity (injury) of cord compression, such as fetal neurologic injury or heart injury identified with umbilical cord blood troponin T levels or pulmonary injury, is the next major area of investigation.
In Roads to Health, G. Geltner demonstrates that urban dwellers in medieval Italy had a keen sense of the dangers to their health posed by conditions of overcrowding, shortages of food and clean water, air pollution, and the improper disposal of human and animal waste. He consults scientific, narrative, and normative sources that detailed and consistently denounced the physical and environmental hazards urban communities faced: latrines improperly installed and sewers blocked; animals left to roam free and carcasses left rotting on public byways; and thoroughfares congested by artisanal and commercial activities that impeded circulation, polluted waterways, and raised miasmas. However, as Geltner shows, numerous administrative records also offer ample evidence of the concrete measures cities took to ameliorate unhealthy conditions. Toiling on the frontlines were public functionaries generally known as viarii, or "road-masters," appointed to maintain their community's infrastructures and police pertinent human and animal behavior. Operating on a parallel track were the camparii, or "field-masters," charged with protecting the city's hinterlands and thereby the quality of what would reach urban markets, taverns, ovens, and mills. Roads to Health provides a critical overview of the mandates and activities of the viarii and camparii as enforcers of preventive health and safety policies between roughly 1250 and 1500, and offers three extended case studies, for Lucca, Bologna, and the smaller Piedmont town of Pinerolo. In telling their stories, Geltner contends that preventive health practices, while scientifically informed, emerged neither solely from a centralized regime nor as a reaction to the onset of the Black Death. Instead, they were typically negotiated by diverse stakeholders, including neighborhood residents, officials, artisans, and clergymen, and fostered throughout the centuries by a steady concern for people's greater health.
Histopathologists all over the world have to report cytopathology during the course of their work and it is then that they find themselves facing diagnostic dilemmas. This practical, well-illustrated book, explicitly dedicated to this readership will serve their needs and meets their requirements in daily practice.
In "The Complete Guide to Running", the secrets of Earl Fee, a world master's champion, are revealed that helped him achieve over 30 world records in running. This material is supported by hundreds of references. Fifteen chapters explain how to improve general physical and mental fitness with major emphasis on mental training, nutrition, physiology, inspiration, and motivation. Ten chapters reveal the how and why of running training for sprinting, middle and long distance, hurdles, and running in the pool. Athletes from 9 to 90 will benefit from this information since all are bound by the same training principles. Precautions and training are explained for the extreme young and old.
An account of the distribution of 28 cetacean species that are known to have occurred in the waters off north-west Europe. Individual chapters cover particular species in detail, spanning identification, behaviour and social organisation, diet and habitat preferences, worldwide distribution and population status.
Recoge: 1. Introduction -- 2. Organisation -- Guiding principles for organising a colorectal cancer screening programme -- 3. Evaluation and interpretation of screening outcomes -- 4. Faecal occult blood testing -- 5. Quality assurance in endoscopy in colorectal cancer screening and diagnosis -- 6. Professional requirements and training -- 7. Quality assurance in pathology in colorectal cancer screening and diagnosis -- 8. Management of lesions detected in colorectal cancer screening -- 9. Colonoscopic surveillance following adenoma removal --10. Communication -- Appendices.