Basic newborn resuscitation for babies not breathing at birth is a highly effective intervention and its scale-up identified as a top research priority. However, tracking progress on the scale-up and coverage of this intervention is compromised by limitations in measuring both the number of newborns receiving the intervention and the number of newborns requiring the intervention. Using data from a facility and birth attendant survey in Gombe State, Nigeria, we aimed to advance the measurement agenda by developing a proxy indicator defined as the “percent of newborns born in a facility with the potential to provide newborn resuscitation”.The indicator’s denominator was defined as: the total number of births in facilities during a defined time period (facility records). The numerator was constructed from the number of those births that occurred in appropriately equipped facilities (facility inventory), where a birth attendant demonstrated basic resuscitation competence (assessed by a simulation exercise). The proportion of facility-births that took place in a setting with the potential to provide newborn resuscitation was then calculated.The analysis included 17 383 births that occurred during May-October 2015 in 117 primary and referral facilities surveyed in November 2015. Overall 81% of the facilities did not have all items of essential equipment required for resuscitation; the items of equipment least frequently present included a timing device and resuscitation bag with two sizes of neonatal face mask. Only 3% of 117 birth attendants interviewed demonstrated competence to undertake resuscitation, all of whom were classified as skilled attendants and worked in referral facilities. We found that 20% of the 17 383 births took place in a facility with the potential to provide lifesaving resuscitation care.The indicator definition of neonatal resuscitation presented here responds to the need to advance the measurement agenda for newborn care and importantly adjusts for the volume of births occurring in different facilities. Its application in this setting revealed substantial missed opportunities to providing lifesaving care and highlights the need for a greater focus on input as well as process quality in all levels of health facilities. To achieve greater progress in reducing under five mortality, more focus is needed on improving survival in the early neonatal period, especially on the day of birth. Intrapartum insults (leading to babies who are born gasping or not breathing at birth) is a leading cause of death at birth ,2. TreatThe scale-up of basic neonatal resuscitation has been identified as a key high impact intervention by the Every Newborn Action Plan . HoweverIn this manuscript we suggest that the measurement agenda for newborn resuscitation with a bag and mask can be advanced by defining an alternative actionable proxy indicator for facility based births. It is not anticipated that this intervention would be available for home births. This revised measurement approach could meet the needs of both continuous improvement efforts and for tracking progress.We argue that all babies born in a health facility have the right to expect that resuscitation is possible should the need arise, and therefore present an actionable alternative defined as the “percent of newborns delivered in a facility with the potential to provide newborn resuscitation”. To illustrate this, we analysed facility-level data from Nigeria on both the readiness of facilities and the competence of birth attendants in facilities to provide basic resuscitation care. We link this data to the volume of facility births in the same facilities to estimate the proportion of facility births that took place in a facility with the potential to provide newborn resuscitation care. Disaggregation of the resulting measure identifies the missed opportunities to providing lifesaving care, and therefore provides actionable evidence for improving health outcomes.A facility survey was carried out in November 2015 in Gombe state, Nigeria. Gombe state is located in northeastern Nigeria, and has poor maternal and neonatal health outcomes. The majority (68%) of women give birth at home and the neonatal mortality rate is high, estimated in 2016-17 to be 35 per 1000 live births . The majThe context for this study is described elsewhere . A stateAnalysis of the indicator “percent of newborns born in a facility with the potential to provide newborn resuscitation” was restricted to facilities that had recorded at least one delivery in the six months preceding the survey. Potential to provide resuscitation care was constructed from two measures  with the equipment available; (2) where a birth attendant had demonstrated competence; and (3) with the potential to provide resuscitation care, by dividing the number of births who satisfied the condition by the total number of births in the sample. Tabulations were carried out for both primary and referral levels, and for birth attendants classified as either skilled  or unskilled .Missed opportunities in readiness and competence were identified from the absolute attrition in proportion between the sample population and each of the measures  and were included in this analysis. The majority, 86% (101/117), were primary care facilities (Marked differences in the availability of equipment was observed between the different items surveyed (The proportion of birth attendants undertaking each stage of resuscitation was low and only 6% (7/117) of all birth attendants undertook stage 3 ‘initiates resuscitation with bag and mask’  were in the 16 referral facilities. Both the availability of functioning equipment and demonstrated birth attendants’ competence were found to contribute to missed opportunities to providing resuscitation care at birth , the WHO SARA and the emergency obstetric and neonatal care (EmONC) assessments . Whilst The proxy indicator definition of neonatal resuscitation presented here - that speaks to the potential of every newborn to receive life-saving care – responds to the need to advance the measurement agenda. Its application in this setting identified substantial missed opportunities to provide lifesaving care and highlighted the need to improve the availability of essential equipment and ensure that birth attendants acquire and maintain their skills to provide high quality newborn care.


Evidence suggests that both short and long birth intervals are associated with poor maternal and child health outcomes. However, current studies suggest that a number of births still occur at short intervals. The aim of this study was to document birth intervals and associated factors among women of reproductive age in rural Uganda.  This was a cross-sectional study conducted among 296 women aged 15-49 years attending young child clinic at Yumbe Hospital who had at least two successive live births. Data was collected using interviewer-administered questionnaire. Birth interval was categorized according to the WHO-recommended birth interval of ≥24 months and <24 months. P = 0.007), not planning to have another pregnancy , not deciding together with husband when to have the next child , not always using contraceptives before the next pregnancy , and lack of influence of husband on when to have the next child .  Of the 296 participants, 86.6% desired a birth interval ≥ 24 months with a desired median birth interval of 36 months. The actual median birth interval was 22 months. Slightly more than half of the women (52.4%) had short birth intervals. Factors which were likely to be associated with short birth intervals included being younger (15-24 years) , although majority (86.6%) of the women desire optimal birth intervals. Factors which were likely to be associated with short birth intervals included young maternal age, not using contraceptives, and lack of male involvement in child spacing activities. Therefore, to optimize birth intervals, focused child spacing strategies targeting young women and men are needed. World Health Organization (WHO) defines birth interval as the time period from live birth to a successive pregnancy and the recommended period is at least 24 months (2 years) . Short bGlobally, it was estimated that 25% of births still occur at intervals less than 24 months. Most of the cases of short birth intervals were observed in Central Asia at 33%. Sub-Saharan Africa had short birth intervals at 20% . Study oThough the sub-Saharan African picture shows optimal median birth intervals, individual countries were observed to be having differences in birth intervals. Demographic and Health Survey (DHS) reports show most of the countries having a significant number of births occurring at short intervals. Most countries in Africa including Uganda do not report about long birth intervals probably because it is not happening frequently. In Nigeria, short birth intervals were 23% , and in Studies have shown that short birth intervals contribute to poor maternal and child health , 13. In Authors have documented a number of factors associated with birth intervals. Some of these may be direct factors such as being sexually active, use of contraceptives, postpartum infecundability, abortion, and sterility while indirect factors may include sociocultural factors . In theiUganda like many sub-Saharan African countries still has high fertility, maternal mortality, and neonatal, infant, and under-five mortality rates. Recent estimates show the countries total fertility rate at 5.4, maternal mortality rate at 336/100,000 live births, neonatal mortality rate at 27/1,000 live births, infant mortality rate at 43/1,000 live births, and under-five mortality rate at 64/1,000 live births . HoweverTherefore, understanding birth intervals and its determinants is critical for a country like Uganda so as to improve and design child spacing programs which in turn will improve maternal and child health. This study therefore is aimed at filling this gap by assessing birth intervals and its determinants among women of reproductive age in rural Uganda.The study was aimed at identifying birth intervals and its determinants among women of reproductive age in Yumbe district in rural Uganda.The study employed a cross-sectional design and quantitative methods for data collection.The study was conducted in Yumbe Hospital at the maternal child health (MCH) unit, outpatient department. Yumbe Hospital is located in Yumbe district which is found in the West Nile subregion of Uganda, about 600 km from the capital Kampala. The hospital is located in a rural area in the southwestern part of the district about 10 kilometres away from Yumbe town. It is a grade V hospital, and services offered at the hospital include MCH, general medicine, surgery, and community health services. The hospital also serves as the district referral hospital. Mothers who come for MCH services are predominantly the indigenous people of the district, but a few clients are from the neighboring Koboko and Arua districts as well. Maternal child health services offered at the hospital at the outpatient department include antenatal care (ANC), postnatal care (PNC), young child clinic (YCC), and family planning services.The study participants were women aged 15-49 years who were attending YCC at Yumbe Hospital. A total of 296 women were selected using systematic sampling method. Women who had had two successive live births were included in the study. The study excluded women who had had two successive live births whose children were very sick and needed urgent treatment.Kth unit which is the sampling interval (K) = N/n, where N = population size and n = sample size .Systematic sampling method was used. Systematic sampling is a probability sampling technique in which the study population is arranged according to some ordering scheme and then selecting elements at regular intervals. Only the first element is selected randomly, the rest being selected according to predetermined pattern. The predetermined pattern is Kth woman in the register after the first one had been selected at random by blind folding one of the research assistants who was asked to put her index finger on any of the names which were recorded in the register on the first day of data collection. The count started with the name of the woman at the point where her index finger touched and the third person on the list being counted downwards from the random point was considered as the first participant, and the Kth interval of 3 continued throughout the data collection period. If the Kth woman did not meet the inclusion criteria, then the next woman on the list was selected and the interval continued. Once the list was completed for a data collection day, additional participants for the following day were sampled by looping the count to the beginning of the register for that day since women were being registered for the services on every working day at the clinic. This process was continued until all the required sample size was achieved. The selected participants were informed that the interview would be done as they exited the clinic so as not to interrupt their process of receiving health care.At the clinic, women and their children who were attending YCC were registered in the child health register. On data collection days, systematic sampling was achieved by sampling the N is the population sample size. n is the sample size. Time available for data collection was one month (20 working days). The average number of women received at YCC in a month was 1,020. Sampling interval (K) = 1,020/296 = 3.5. Therefore, the sampling interval was 3.The outcome variable for this study was birth interval. Birth interval was measured in months using interval scale. Actual birth interval, desired birth interval, and proportion of nonfirst births that occurred before 24 months and after 24 months were measured. For actual and desired birth intervals, the last birth interval was measured.a is the age in months of the second last born child when the last (current) baby was born and if b is the duration of pregnancy which resulted in the birth of the last (current) baby, then actual birth interval (c) would be a − b = c. Multiple births were treated as a single interval. Therefore, birth interval was categorized according to the WHO-recommended birth interval (24 months) and coded 1 if birth interval was ≥24 months and 2 if birth interval was <24 months.We defined actual birth interval as the time between a live birth and successive pregnancy. Only the last birth interval was measured. This was measured by assessing the length of time between the preceding birth and the current birth and then subtracting the length of pregnancy which resulted in the current birth, since women may not know their exact date of conception. Respondents were asked how old was your second last born child when your last baby (current baby) was born? They were then asked what was the duration of your pregnancy which resulted in the birth of the last (current) baby? Therefore, the difference between the age of the second last born child at the birth of the last born (current) child and the durations of pregnancy of the last born (current) child was considered as the actual birth interval. This was measured in months, e.g., if This is the birth interval a woman would wish to have if all factors were favorable. This was measured in months by asking the following: at the time you became pregnant with the current baby, did you want to become pregnant then? If the woman said yes, then that was considered as her desired birth interval. If she said no, she was then asked the following: how long would you have preferred to wait from the time you gave birth to your second last born child to conception of your current baby? The length of time she mentioned was recorded as her desired birth interval.This is the number of children a woman has excluding the first birth which occurred at an interval less than 24 months. This was measured by asking the following: how many of your children were born before 2 years of the preceding birth?This is the number of children a woman has excluding the first birth which occurred at an interval more than 24 months. This was measured by asking the following: how many of your children were born after 2 years of the preceding birth?In this study, independent variables are predisposing factors to birth intervals among women of reproductive age. This was measured by having precoded questions concerning factors that determine birth intervals ranked on an ordinal scale, and in some of the questions, the respondents were asked to choose response(s) of their choice.Demographic characteristics which were measured include age at first birth, current age of woman, education level, occupation, religion, marital status, residence, number of living children a woman has, and sex of the second last born child.Sociocultural factors were measured using an ordinal scale where the respondents were asked to indicate on a scale of 1 to 4 if she strongly agrees, agrees, disagrees, or strongly disagrees that the decision of her husband, mother-in-law, and significant others on when to have the next pregnancy matters a lot.Behavioral factors that were measured include plan of when to have the next child, family planning use, and couple communication about birth intervals. Plan of when to have the next child and couple communication about birth interval were measured on an ordinal scale of 1 to 3 if she never, sometimes, and always discusses with her husband and decides when to have the next child or if she makes the decision alone. Family planning use was measured by asking the respondent if she never, sometimes, or always used contraceptives between pregnancies.Knowledge about birth intervals was measured by asking the respondents to mention the recommended birth interval. Respondents were also asked to choose precoded responses. Questions included awareness about the recommended birth intervals, dangers of short birth intervals, and the benefits of optimal birth intervals.These are health facility-related factors that influence access and utilization of services that promote healthy birth intervals. Health system factors that were measured included the following: if health workers were giving information to the women about recommended birth intervals, contraceptive information, and provision of contraceptive services.We used a questionnaire as a data collection tool. The questionnaire was formulated by the authors according to the objectives of the study using literature as a source. The questionnaire contained a total number of 37 structured questions and was formulated in English and translated in the local dialect (Aringa). The questionnaire included demographic characteristics which had 12 questions, questions related to birth intervals were 6 and factors which affect birth intervals were 19 in total . Knowledge about birth intervals was measured by asking the respondents if they were aware about the recommended birth intervals and to mention the recommended birth interval, dangers of short birth intervals, and the benefits of optimal birth intervals. On average, the interview took approximately 20 minutes per participant. To ensure reliability of the questionnaire, questions were formulated according to the research objectives. The principal investigator pretested the questionnaire on 10 women attending YCC at Midigo HCIV in Yumbe district. Adjustments were made based on the results of the pretest by rephrasing questions which were not clear to the respondents and by removing questions which did not seem to be relevant. Reliability of the questionnaire was further ensured by selecting only respondents who met the inclusion. Furthermore, the research assistants were trained for half a day before data collection to ensure reliability of the data tool. All the filled questionnaires were checked every evening after a day's data collection by the principal investigator and the research assistants to ensure completeness and correctness of data collected. The respondents were identified from the child health register among mothers who were registered on data collection days. The principal investigator or the research assistant informed the participants of the purpose and objectives of the study, and consent was sought. The principal investigator or the research assistant read the questions on the questionnaire as the respondent listened. The respondents were required to select a precoded response. Responses were ticked or filled in accordingly by the principal investigator or research assistant.P value ≤ 0.1 at bivariate analysis and any other plausible variables were used to measure the association between dependent and predictive variables , median (interquartile range), and range for continuous variables and frequencies and proportion for categorical variables Tables –3. At biariables . VariablThe study was conducted in January 2018 among 296 women aged 15-49 years who had had at least two successive live births, attending young child clinic in rural Uganda.The women in the study were aged between 18 and 43 years, with a mean age of 26.82 (SD: ±5.14). Their mean age at first birth was 17.34 (SD ± 2.39). Slightly more than half of the women  were aged 25-34 years and 112 (37.8%) were aged 15-24 years. Most of the women  lived in rural areas, and only 53 (17.9%) have attended secondary education or plus. Two hundred and thirty-five (79.4%) of the women were housewives. Majority  of the women were Muslims. Two hundred and eighty-three (96%) were married, and among them, 162 (57.2%) were in monogamous marriage. Majority of the women  had had between 2 and 4 live births. One hundred and twenty-seven (42.9%) of the women wanted their pregnancy at the time of conception. Nearly half of the participants  had never used any contraceptive method before their next pregnancy. One hundred and sixteen (39.2%) of the women always decide together with their husband on when to have the next child. One hundred and forty-one (48%) of the women acknowledged that the influence of their husbands matters a lot on when to have the next child, as shown in As shown in As shown in At bivariate analysis, chi-square test was used to explore the association between birth intervals and independent related variables.P = 0.001) and women aged 25-34  compared to women aged 35-44. Other factors which were significantly associated with short birth intervals included not planning to have the next pregnancy, not deciding together with husband about when to have the next pregnancy, and not always using contraceptives before the next pregnancy. Women who planned to have their next pregnancy were 78% less likely to have short birth intervals  compared to those who did not plan to have the next pregnancy. Women who always decide together with their husbands when to have the next child were less likely to have short birth interval . The prevalence of short birth interval was 81% lower among women who always use contraceptive before the next pregnancy compared to those who never use contraceptives .As shown in P value ≤ 0.1 and other plausible variables were further analyzed using multivariate logistic regression to control for confounding. The OR was adjusted for the following variables: maternal age, sex of the second last born child, whether the last pregnancy was wanted, contraceptive use, deciding together with husband when to have the next baby, and influence of husband on when to have the next baby. Variables with P ≤ 0.05 were considered significantly associated with birth intervals.After bivariate logistic regression, variables with P = 0.007), and those aged 25-34 years were 3 times more likely to have short birth intervals  compared to women aged 35-44 years. The adjusted odds of short birth intervals were lower for women who wanted the pregnancy at the time of conception , women who always used contraceptive before the next pregnancy , those who always decide together with their husband on the time to have the next child , and those who were influenced by their husband on when to have the next baby .As shown in The aim of this study was to identify birth intervals and its determinants among women of reproductive age in rural Uganda. We measured the last birth interval for women who had had at least two live births. The study showed that slightly more than half of the study participants (52.4%) had short birth intervals. Many of the women in our study could not achieve their desired birth intervals probably because of low contraceptive prevalence where only 17.2% of the women always used contraceptives before the next pregnancy and 46.6% have never used a contraceptive method. Studies conducted in other parts of rural Uganda and Ethiopia reported similar results, where slightly more than half of the study population had short birth intervals , unlike Median birth interval in our study was 22 months which is lower than the one recommended by WHO, yet majority of the women 86.6%) desired a birth interval of ≥24 months. These findings were consistent with studies done in Asian and Latin American countries where median birth intervals at birth order two was 25 months. Our median birth intervals were much lower than those in Ethiopia , in othe6.6% desiLiterature suggests a number of factors associated with birth intervals. In our study, the age of the woman, plan to have the next pregnancy, deciding together with husband when to have the next child, always using contraceptives before the next pregnancy, and influence of husband on when to have the next pregnancy were significantly associated with birth intervals.Younger women were more likely to have short birth intervals compared to older women. This could probably be explained by the fact that fertility reduces with age above 35 years and older women could be having better ability to make independent decisions concerning their reproductive goals compared to the younger women. This may also be due to the fact that in this study, mean age at first birth was 17 years and older women might have been tending towards completing their family sizes. Our study findings are consistent with , 33, stuWomen who planned their pregnancy were less likely to have short birth intervals compared to those who did not want the pregnancy at the time of conception. This could probably be due to the fact that women/couples who plan their pregnancy may follow the recommendations for child spacing and therefore end up with optimal birth intervals. Limited access to reproductive health services in some settings may lead to unwanted or unplanned pregnancies for those women who wish to use contraceptives at present or in the future, leading to the notion of unmet need for family planning and therefore short birth intervals . Our stuOur study found that women who always decide together with their husband on when to have the next child were less likely to have short birth intervals. This could probably be argued that proper communication between couples about reproductive goals has a positive outcome on birth spacing. The level of reproductive health decision-making among couples such as when to have the next pregnancy, family size, and family planning use among others can result in benefits which impact positively on the family in general . These rWomen whose husbands have influence on when to have the next baby were less likely to have short birth intervals. This could probably be argued that these husbands supported interventions such as contraceptive use and other interventions which promote adequate birth intervals. These findings are consistent with studies done in rural Uganda, Saudi Arabia, and Egypt , 32, 39 Lack of contraceptive use has been documented in literature as one of the strongest predictors of short birth intervals . ContracThere was a universal awareness about recommended birth intervals in our study where all the respondents correctly mentioned the WHO-recommended birth intervals. All the respondents were able to mention at least one advantage of optimal birth intervals and one disadvantage of short birth intervals, but this knowledge was not translated into practice of optimal birth intervals by the majority of the respondents, where slightly more than half of the respondents had short birth intervals. This could probably be argued that factors other than knowledge might have resulted in this high proportion of short birth intervals. Similar results were found in Egypt where there was no significant difference in birth intervals with the control group even though the experimental group was given information about the recommended birth interval and advantages of healthy birth spacing .Although literature shows that mothers' education level , formal The following limitations should be considered when interpreting the results of this study. The source of data for this study was based on the self-report of mothers, and no validation of information was made with any objective sources such as health facility cards except for immunization card of the current baby. This could have introduced recall bias which was controlled by only asking the last birth interval. Respondents were also critically informed about the importance of giving accurate information by assuring the confidentiality of their responses, and it is logical to assume that biases are less likely in birth interval events than other more sensitive events. Finally, the sample size of this study may affect generalization of the results of factors to the whole population. However, a study involving a bigger sample size is necessary.In this study, we observed relatively high prevalence of short birth intervals among rural women in Uganda despite adequate knowledge about the recommended birth intervals and the majority desiring optimal birth intervals. Factors which were likely to influence short birth intervals included younger maternal age, not using contraceptives, not planning for pregnancies, not deciding together with their husbands about when to have the next child, and lack of influence of husband on when to have the next baby. We recommend that other than imparting knowledge on recommended birth interval, Ugandan ministry of health together with other stakeholders should strengthen the existing strategies of family planning as a comprehensive package in order to promote optimal birth intervals. Specific programs should be designed to deliberately target young women and men with family planning services. A study assessing how best men can be reached with reproductive health services could be conducted in order to improve their involvement in child spacing.


The squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat.To compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor.(ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve.Thirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal.Spontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat , feet flat on the ground is closer to optimal birth conditions than on tiptoes. At the beginning of the nineteenth century, Engelmann et al. observed that women not influenced by Western conventions mainly adopted the squatting birth position in the first and second phases of labor . At presAccording to Atwood, the squatting position is categorized among vertical positions . It is wFrom a biomechanical point of view, the squatting position is suffering of approximations about segmental positions  like other birth positions as we explained in a recent review . TherefoThese two kinds of foot position  on the biomechanical parameters (pelvic inlet plane and lordosis). This study answers the question: are all squatting positions equal in terms of obstetrical biomechanics?In this prospective comparative study, eligible participants were pregnant women older than 18 years and beyond 32 weeks of gestation, followed by physiological pregnancy consultation, with a body mass index under 40, and without inflammatory joint diseases or joint hypermobility syndrome, such as Marfan’s syndrome. In biomechanical studies, the number of subjects beyond 10 has an insignificant effect on statistical power . Taking The study protocol was approved by the Ethics Committee of Poitiers Hospital (Comité de Protection des Personnes: 2013-1203-42) and by the French National Agency of Drug Safety . All women provided written informed consent.A full protocol description about this innovative methodology is available in a recent publication . A tradiThe lumbar curve was assessed by measuring the lordosis according to the Epionics SPINE system . This system consists of two flexible sensor strips that use strain gauge sensors located alongside flexible circuit board strips. The positioning of the system is standardized. According to this measure, a lordosis of 0° corresponds to a back perfectly flattened. The data acquisition (50 Hz) was transmitted in real time via Bluetooth to a local personal computer . This biIn practice, women were asked to perform two types of squatting positions. We first asked the subjects to spontaneously squat without further instruction and to stay in this position. Data acquisition began when the subject was stabilized for at least 3 sec. Then we asked the subject to stand up to take the squatting position that was not spontaneously adopted at the time of the first acquisition. For all subjects, we had an acquisition of two different squatting positions (feet flat and on tiptoes). For the squatting position carried out with feet flat, which was often more difficult to maintain, we offered the women a stick to stabilize themselves.ANGec) was defined in the sagittal plane as the angle between the external conjugate and the line defined by the markers placed on the 7th cervical and the 10th thoracic vertebrae  was used to merge data from Epionics and VICON systems and to extract the required data. We defined a plane following the external conjugate diameter using the two markers placed on the posterosuperior iliac spines and the marker placed on the superior edge of the pubic symphysis. The hip joints angles (flexion and abduction) were obtained as defined by the conventional gait model. The flexion of the plane of the external conjugate on the spine .For each woman, conditions for optimal birth as defined above were assessed. As a reminder, we considered that the back was flat from − 3 ° of lumbar lordosis or in kyphosis when values were positive. The plane of the pelvic inlet plane is perpendicular to the rachis when p < 0.05.All values obtained for the two types of squatting position (feet flat vs on tiptoes) were compared using a Wilcoxon matched-pairs signed-ranks test. The significance level was defined as − 2. Seven participants (60%) were primiparous.As none of the 13 participants withdrew after giving informed consent, they have all been assessed. The mean age of the participants was 32.8 (Standard Deviation (SD) 2.8) years, and the mean of the term at the inclusion was 34.0 (SD 0.7) weeks of amenorrhea. The mean body mass index was 26.0 (SD 0.8) kg.mSpontaneously, 11 out of 13 women squatted on tiptoe at the first test. All the participants were able to squat whatever the initial posture (passing from tiptoe to feet flat and vice versa for two women).p = 0.02), whereas hip abduction was not significantly different (p = 0.28).According to Table ANGec angle (p = 0.003) was noticed for the position on tiptoes than feet flat.A lower p < 0.001).There was also a difference in the lumbar curve (lordosis), which was higher for the squatting position on tiptoes than for the position with feet flat (ANGec = 0°+/− 5°) and none had a flat back or kyphosis (lumbar curvature = 0 +/− 3 °). No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal  closer to the perpendicular than the squatting tiptoe position.The feet flat squatting position enabled an angle of the pelvic inlet plane significantly ANGec = 0°+/− 5°). Regarding lumbar curve, 9 out of 13 women had flat backs  or kyphosis   are more vertical. As a result, additional adjustments may occur, such as increasing hip flexions. This additional hip flexion, and the trunk adjustments necessary to maintain balance, had implications for pelvic position and lumbar curve. Our results showed that these adaptations resulted in a pelvic inlet plane closer to perpendicular and a correction of lumbar lordosis. These two conditions were considered as necessary to reach an “optimal” position.To the question “were all squatting positions equal?” we answered no. We highlighted the importance of controlling the position of the feet in order to make the squatting birth position as favorable as possible biomechanically. In another field of study, it has been shown that the squatting position, in particular in hyperflexion, was the most favorable to obtain a recto-anal canal close to rectitude during defecation. In this position lower abdominal pressure is necessary to defecate . WithoutAmong our population, three women in the squatting position with feet flat had beyond a flat back, a kyphosis (a round back). This posture is not problematic from a biomechanical point of view, because it did optimize the “obstetric chute” that we defined in a previous review . MoreoveIn this study, almost all of our subjects did not spontaneously adopt the squatting position with feet flat. The women’s natural choice of position was not the best biomechanically. Global position is nowadays an utter nonsense. All segmental positions must be defined and used to better assist women’s position choice. A better definition, “measuring” position is a necessity in all future works on birth position. A better birth definition will lead to a better assessment of the impact of position on obstetrical outcomes.A major limit is that this pilot study focused on women at the third trimester near term, but not in labor. The next step in our research should be to confirm our results during labor. In the future, the final step should be to confirm the impact of feet position during the squatting birth position correlated to an assessment of obstetrical outcomes .Our innovative biomechanical approach could have a real impact on supporting birth in alternative positions. Squatting birth position is one of the most common positions in countries with low medicalization . Simple In well-resourced countries the empowerment of the birthing experience for women who wish to give birth as naturally as possible and in security resulted in the introduction of the “natural birth space” in the classic labor ward, or birth center in maternity. In these units, women have the choice to give birth in the position that they wish. Supporting women in their choice and advising on an optimal position according to our research should be a new challenge for future birth-care providers.In squatting birth position, foot posture had a biomechanical impact on lumbar curve and on pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat is closer to the optimal birth condition than on tiptoes. The clinical impact of these new considerations has to be explored in future researches.


Recent observations of Jupiter's Great Red Spot indicate that the thermosphere above the storm is hotter than its surroundings by more than 700 K. Possible suggested sources for this heating have thus far included atmospheric gravity waves and lightning-driven acoustic waves. Here, we propose that Joule heating, driven by Great Red Spot vorticity penetrating up into the lower stratosphere and coupling to the thermosphere, may contribute to the large observed temperatures. The strength of Joule heating will depend on the local inclination angle of the magnetic field and thus the observed emissions and inferred temperatures should vary with planetary longitude as the Great Red Spot tracks across the planet.3+, H5+ and beyond’.This article is part of a discussion meeting issue ‘Advances in hydrogen molecular ions: H Centred at approximately 20° south latitude, the GRS is an anticyclonic feature with an approximate size of 22 000 km × 11 000 km in longitude and latitude, respectively [−1 in the northern portion of the storm ring [The majority of the GRS vorticity is contained in a ring approximately 75–80% of the storm's radius ,2. The vorm ring . A warm orm ring . The verorm ring –6.3+ observations of the GRS from 2012 using the SpeX spectrometer on the NASA Infrared Telescope Facility [3+ temperatures determined from the 2016 observations maximize at approximately 750 K, a reduction of approximately 50% from the 2012 observations, but are still significantly warmer than the surrounding atmosphere. Spatially, the centre of the GRS shifted in System III longitude from 246° to 270° between 2012 and 2016. Other hot spots are present in While the visible signatures of the GRS have been extensively studied over the years, the thermosphere above the storm has only recently been explored. An analysis of HFacility  showed t3+ temperatures above the GRS are distinct within Jupiter's mid-to-low latitudes and go beyond the giant planet ‘energy crisis’ [3+ observations range from 700 to 850 K [in situ temperatures measured by the Galileo probe maximize at approximately 900 K [The large observed H crisis’ ,9. In sh crisis’ . At sub-to 850 K . At nearly 900 K . In the ly 900 K ,13.In the auroral regions, magnetosphere–ionosphere–thermosphere coupling processes can generate heating through a plethora of mechanisms. Energetic precipitating electrons chemically heat the atmosphere through ionization and excitation ,15. ThisPotential atmospheric sources of heating include upward-propagating gravitational waves from the lower thermosphere and acoustic waves. As gravity waves dissipate, they deposit energy into the local atmosphere. However, there is also a cooling effect at altitudes above the peak wave amplitudes. The net heating on a column of air may only be approximately 200 K, which is not enough alone to explain the observed GRS or general mid-to-low latitude temperature enhancement .Acoustic waves can also propagate upwards and, through viscous dissipation, heat the atmosphere. Generated above thunderstorms, the GRS could be an ideal weather system to generate these waves. Models of acoustic waves at Jupiter suggest that they can heat the local atmosphere by tens to hundreds of Kelvin per day . HoweverAnother source of heating is electrodynamic coupling between Jupiter's thermosphere and stratosphere . Stratos2.The GRS is primarily a tropospheric storm, yet it extends vertically into the lower stratosphere. Thermal gradients result in the winds diminishing; however, infrared observations suggest that they persist into the lower stratosphere . Galileo+ and H3+. However, hydrocarbons become more important at lower altitudes. At Saturn, these hydrocarbon ions contribute strongly to the ionospheric conductivity [In the thermosphere, the dominant ions are Huctivity  and may j, can be related to the electric fields as follows:E⊥ is the electric field perpendicular to the magnetic field, E|| is the electric field component parallel to the magnetic field, v is the ionospheric bulk flow in the rest frame of the neutral atmosphere, B is the planetary magnetic field, and σP, σH, and σ|| are the local Pedersen, Hall and parallel conductivities, respectively.The strong wind shears generated by the GRS drive currents and electric fields in the ionosphere. The current density, Ion drag extracts kinetic energy from the local neutral winds through collisions. This can be expressed in terms of the local conductivities and electric fields as:qJH:Thermal energy is input into the atmosphere through Joule heating, Ion drag and Joule heating influence the energy balance in both the stratosphere and the thermosphere. The relative contribution of each process depends on the full conductivity tensor and the mechanisms driving the local electric fields. Any electric fields and currents generated by GRS winds are at sufficiently low magnetic latitudes that they should close within the local atmosphere or in the magnetically conjugate location of the northern hemisphere. This means that magnetospheric coupling can be ignored. In a steady-state system, in the absence of other sources of heating or cooling, energy conservation dictates that the Joule heating and ion drag terms must sum to 0 across all coupled regions.To consider the feasibility of the proposed heating mechanism, it is necessary to understand the electric fields generated by the GRS vorticity in the low-altitude ionosphere. In this study, we focus primarily on the electric field structure to determine whether electrodynamic coupling merits further investigation as a possible thermospheric heat source above the GRS and what potential observations could provide additional evidence.3.RJ × (1 − cos2θ/15.4), where 1RJ = 7.14 × 107 m and θ is colatitude. The solid line at −20° tracks the motion of the GRS in System III longitude as it drifts around the planet. The corresponding line in the northern hemisphere denotes the magnetically conjugate location of the GRS footprint, with the semi-vertical lines showing the trace of the magnetic field between the two footprints every 30° λIII longitude. The dashed and dotted lines track the southern and northern boundaries of the GRS at −27° and −13°, with their associated conjugate locations in the northern hemisphere.λIII to a near-vertical field when it passes through one of Jupiter's many magnetic anomalies near 90° λIII. The magnetic field magnitude at GRS latitudes ranges from approximately 4 to 6 Gauss [It is immediately clear from  6 Gauss , fig. 2.λIII. The magnitude of the stratospheric electric field, E, is given by E = v × B, where v is assumed to be in the rest frame of the neutral stratosphere and entirely in the horizontal plane, i.e. only azimuthal and meridional components to the velocity, and B is the planetary magnetic field vector [Owing to the decay in GRS flows with altitude , the wind vector .Figure The electric field magnitude maximizes on the northern edge of the GRS where the shear flows are strongest, with a minimum on the flanks. Since the velocity on the flanks is comparable to that on the southern boundary of the GRS, this minimum can be attributed to the reduction in the flow perpendicular to the magnetic field, i.e. the northward and southward flows have a larger component parallel to the magnetic field. Each electric field component exhibits a dichotomy driven by opposing flows. The radial and meridional electric fields reflect anticorotational flows along the equatorward edge of the GRS and corotational flows on the southern edge. Northward and southward flows on the flanks of the GRS generate anticorotational and corotational azimuthal electric fields, respectively.The electric field in (a)−1, the meridional flows capping at 6 m s−1 and the westward winds peaking at 5 m s−1.To investigate the variation in the electric field structure as the GRS drifts in System III longitude, we impose a simpler flow pattern  where onvθ’ and ‘+vθ’, respectively, are considered at all longitudes rather than imposing successive single vortexes with longitude. This approach allows a better investigation of the longitudinal variations present in the system; however, the true electric field signature of the vortex naturally has contributions from both northward and southward flow components similar to those in λIII, the radial component of the electric field dominates, pointing inwards on the northern vortex edge and outwards along the southern edge. A smaller radial component is driven by the meridional flows; the azimuthal component of the electric field dominates in the middle region of the vortex. The azimuthal winds also result in a meridional component to the electric field. Near the magnetic equator, approximately 225° λIII, a structure appears where oppositely directed meridional electric field components converge, which could result in currents diverging from the northern edge of the vortex along the magnetic field.From λIII, the magnetic field structure is such that the northward and southward winds drive radial electric fields of similar orientation. However, there would be a region of negligible electric field in the centre of the vortex where there is little vorticity. This discontinuity could again result in currents converging/diverging along the magnetic field into/out of the vortex.Between −18° and −22° latitude, the azimuthal electric fields at the eastward and westward flanks of the GRS are oppositely directed because of the northward and southward winds. Interestingly, near 90° 4.−1. Sharp gradients in the electric field at the edges of the GRS as well as those near the central non-rotating core region will drive field-aligned currents. Since the GRS is a long-lived storm system that drifts slowly with respect to System III longitude, temporal changes in the local magnetic field configuration are likely to be negligible compared with these strong spatial gradients.The electric fields generated by the assumed GRS vortex winds in the lower stratosphere are complex and strongly vary with planetary longitude. For a single vortex, e.g. a GRS centred at 274° as in While the electric fields are a critical component to electrodynamic coupling, we must also consider the nature of the currents in the stratosphere. A curl in the vorticity will drive Pedersen currents that must close along electric fields, while a divergence in the flow generates Hall currents. Thus, the non-uniform velocity around GRS leads to Hall currents, while gradients perpendicular to the flow produce Pedersen currents. In addition to the horizontal flows here, observations of the GRS indicate that it is tilted, with the northern edge shallower than the southern . This adSubstantial Hall and Pedersen conductivities are required for GRS flows to electrodynamically heat the thermosphere. The Hall conductivity will extract the kinetic energy from the storm winds, while the Pedersen conductivity, along with any parallel conductivity in the system, controls the resistive heating of the upper atmosphere. Therefore, to optimize thermospheric heating and energy extraction from the stratosphere, the peak in the Hall conductivity should occur at a lower altitude than the Pedersen conductivity.−6 and 2 × 10−7 bars, atmospheric models of the equatorial dayside conductivity profile show two peaks of 1 × 10−8 mho m−1 and 1 × 10−7 mho m−1 [There are currently few models of Jupiter's mid-to-low latitude ionosphere and the conductivity is not well understood. Typical values for the height-integrated conductivity generated by solar illumination at high latitudes are approximately 0.0006 mho , orders  mho m−1 . However−8 mho m−1 and 1 × 10−7 mho m−1, respectively, we can estimate the power deposited into the thermosphere by the GRS flows. Ignoring both externally imposed electric fields and magnetic field-aligned electric fields, the power deposited in the thermosphere for a vortex centred at ∼274° λIII longitude is approximately 0.1 μW m−2. This is three orders of magnitude smaller than auroral energy deposition near the poles. However, a more rigorous analysis is required to further quantify the heating.Assuming a simplified atmospheric structure consisting of a 100 km thick slab stratosphere and a 300 km thick slab thermosphere, with Pedersen conductivities of 1 × 103+. This could artificially inflate the temperatures inferred from ground-based observations as the increased density of H3+ at higher altitude could skew the intensity of the observed emission. This effect would decrease near the magnetic anomaly near 90° λ where the vertically directed magnetic field results in largely meridional electric fields. The radial electric fields are strongest near the magnetic equator and thus this effect could explain the much larger temperatures from the 2012 observations [The longitudinal shift in direction of the electric fields could lead to interesting effects. The radially outward-directed electric field associated with the corotational flows on the southern edge of the storm may lead to an electrostatic upwelling of Hrvations  relative3+ spot. There are indications of a conjugate spot in figure 1b; however, the robustness of this interpretation needs to be confirmed by further observations. Unfortunately, during the 2012 observations the GRS was on the magnetic equator and therefore we would not expect to see any conjugate emission.Another observational consequence of this heating mechanism is potential conjugate emission in the northern hemisphere. The conjugate traces shown in 5.3+ observations of Jupiter's thermosphere show enhanced heating above the GRS. This long-lived storm generates shear winds in the troposphere that extend into the stratosphere. Electrodynamic heating due to ionospheric vortexes driven by the GRS may contribute to the large observed thermospheric temperatures. These winds can generate electric fields of the order of mV m−1 with strong spatial variations along the vortex. Ion drag processes associated with these electric fields can extract kinetic energy from the stratosphere and deposit it in the thermosphere through resistive heating. Additionally, the complex planetary magnetic field structure leads to longitudinal variations in the electric fields that could lead to longitudinal System III variations in the heating. We have shown that this mechanism merits further investigation, which should include modelling of the mid-to-low latitude conductivity. Future H3+ observations could shed light on this heating mechanism by (i) providing longitudinal dependences of the heating and (ii) confirming the existence of conjugate emission.H3+ observations provide crucial evidence to test and constrain our theories.The complexity of Jupiter's atmosphere–ionosphere is such that multiple heating mechanisms are likely to be present. However, even a contribution of approximately 10–100 K could assist in our understanding of Jupiter's thermosphere. H


Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Physical examination revealed swollen areas in the posterolateral pharyngeal wall and on the external left side of the neck. Computed tomography imaging showed a left-sided mass that was filled with air and fluid. Eventually, the pyriform sinus cyst and the entire fistulous tract were excised. The postoperative course was uneventful. Follow-up after 18 months showed no recurrence. Branchial arch anomalies are the second most common congenital abnormality, representing 17% of congenital anomalies in the head and neck region in the pediatric population . Herein,The perinatal period of this patient was normal and delivered on 39 week 4 day through the vagina. The Apgar score was full marks. On day 9, the patient developed neck swelling with approximately 5 cm soft mass  and inspFor immediate relief of respiratory distress, puncture of the mass was performed under ultrasound guidance, enabling aspiration of 20 ml of exudate, which resulted in improvement of the respiratory conditions and feeding. Bacteriological examination with the aspirated sample showed no growth in any type of bacteria. However, recurrence of the symptoms a few days later prompted surgical treatment. On day 30, we performed PSF removal via a cervical approach. Though it was difficult to identify the opening of the pyriform fossa under rigid laryngopharyngoscopy, the pyriform sinus cyst and fistula could be visualized intraoperatively by open surgery. The pyriform sinus cyst adhered to the left lobe of the thyroid gland; therefore, both of them were resected. One postoperative complication was transient paralysis of the left recurrent laryngeal nerve, which resolved after 6 days. There was no recurrence of symptoms within 18 months after the operation.A lateral cervical cyst in a neonate has several differential diagnoses, including PSF, lateral cervical cyst, branchial cyst, bronchogenic cyst, vascular malformation and thymic cyst, foregut duplication cyst, and external laryngocele . Most thIncision and drainage are often selected for the initial treatment of infected branchial cleft cysts; however, these have been shown to have high recurrence rates . Total e


The cervix is the essential gatekeeper for birth. Incomplete cervix remodeling contributes to problems with delivery at or post-term while preterm birth is a major factor in perinatal morbidity and mortality in newborns. Lack of cervix biopsies from women during the period preceding term or preterm birth have led to use of rodent models to advanced understanding of the mechanism for prepartum cervix remodeling. The critical transition from a soft cervix to a compliant prepartum lower uterine segment has only recently been recognized to occur in various mammalian species when progesterone in circulation is at or near the peak of pregnancy in preparation for birth. In rodents, characterization of ripening resembles an inflammatory process with a temporal coincidence of decreased density of cell nuclei, decline in cross-linked extracellular collagen, and increased presence of macrophages in the cervix. Although a role for inflammation in parturition and cervix remodeling is not a new concept, a comprehensive examination of literature in this review reveals that many conclusions are drawn from comparisons before and after ripening has occurred, not during the process. The present review focuses on essential phenotypes and functions of resident myeloid and possibly other immune cells to bridge the gap with evidence that specific biomarkers may assess the progress of ripening both at term and with preterm birth. Moreover, use of endpoints to determine the effectiveness of various therapeutic approaches to forestall remodeling and reduce risks for preterm birth, or facilitate ripening to promote parturition will improve the postpartum well-being of mothers and newborns. The maternal immune system in mammals adapts to tolerate the differentiation of novel structures associated with the fetal allograft. Development of two interfaces protect the fetus from rejection and assault by the ecology of the external environment. The internal fetal-maternal interface, as represented by the fetal membranes, placenta, and decidua, is crucial for maintaining maternal inflammatory reactivity for surveillance and responses to pathogens. Discussion of the internal interface is elsewhere and in this special volume –3. HowevThe overall objective of this review is to advance appreciation that the cervix is a uniquely distinct structure and timing of remodeling occurs in advance of labor. Analogous to an inflammatory process, evidence suggests that cervix remodeling before term involves a coordination of immune cell activities for degradation of collagen structure in the extracellular matrix. Understanding cervix anatomy and heterogeneity is critical to appreciate the context of data and their interpretations in the literature. The goals of this review are to update the current perspective about characteristics associated with structural changes cervix functions that occur well before the shift in contractile activity by the uterus for labor. These characteristics with respect to phases of remodeling are conceived as the end result of activities by resident immune cells—effectors of the physiological inflammation that is a non-scarring reversible process for the next pregnancy. The importance of cross-linked collagen alignment and essential requirement for sufficient disintegration of cervix structure in the stroma to eliminate the barrier for birth before other reproductive organs of pregnancy is emphasized because if the gate does not open, delivery does not occur. Evidence indicates that a balance of endocrine and immune cells activities may sustain the barrier function of the cervix while increased presence and functional activities by resident immune cells appear critical to eliminate the barrier for birth. Insights about the remodeling mechanism at term and identification of gaps are useful considerations for understanding advanced remodeling or an incompetent barrier for the pathophysiology of preterm labor. What little is known about incomplete cervix remodeling that leads to medical intervention for delivery is also discussed. Literature indicates that an improved understanding of cervical remodeling and its timing may lead to the development of novel approaches to treat cervical insufficiency or lack of compliance. Identifying biomarkers for remodeling and the potential for non-invasive imaging to assess their change with the progress of pregnancy have promise, in the case of PTB, to serve as sentinels for women at risk of preterm cervix incompetence. Assessment of biomarkers for advanced or delayed loss of the barrier to birth would gauge the efficacy of novel approaches to treat women at risk for preterm birth or for insufficient remodeling at term to avert the necessity of medical intervention to protect newborn and maternal well-being.Among placental mammals, the gross anatomy of the reproductive tract has long been recognized to be diverse . In someWith appreciation that the cervix is a distinct component of the reproductive tract, do gross morphological commonalities extend to the cellular level among mammals? Compared to the uterus, the cervix is highly innervated, more so at term , 8. DuriTransformation of the barrier function of the cervix from a firm and relatively non-compliant structure before pregnancy occurs as pregnancy progresses and the contents of the uterus grows. Eventually, the barrier for birth must be removed. Evidence suggests that mechanical properties of the cervix dramatically change in direct relation to alterations in the dense network of cross-linked collagen from the mid-point of pregnancy to term compared to the non-pregnant state , 16, 17.For pregnant mice 4 days before birth, the cervix content of soluble collagen is increased as molecules associated with cross-linked collagen declined compared to that before pregnancy , 28. In Subregional heterogeneity of the cervix has been recognized. More than 60 years ago a study of serial cross-sections from the distal ectocervix through endocervix of the rat by Harkness et al. found that collagen content and cross-linking declined in from the external to internal os . This coBiomolecular studies of collagen in dispersed cervix are a common approach to study remodeling. The disintegration of structure to study cells and molecules present other challenges that do not take into consideration subregional tissue heterogeneity or changes in morphology as pregnancy progresses to term. As already mentioned above, biopsy tissue are unlikely to accurately characterize the entire human cervix. For animal models, studies rarely provide details about what defines an excised cervix. This is important, as exemplified in a study in mice, in which a wide range of cervix weights/day of pregnancy was reported and may reflect a varying presence of adherent vaginal and/or uterine tissue remnants . MoreoveAnother approach to assess collagen in the extracellular matrix is staining with the dye picrosirius red. Two reviews summarize the usefulness of this stain over the past 40 years and its application to quantify cross-linked collagen , 55. TheOther sentinels that reflect the transformation in cervix morphology characterize the process of inflammation, generally defined by swelling, increased presence of immune cells, and loss of function . Specifiin utero during softening and, after ripening, allowed for dilatation at birth. Though focus of these reviews were upon the mechanism to ripen the cervix, there was limited morphological, cellular, or biomolecular information to define the terms “softening” or “dilation” or to characterize what “ripening” actually was from start to finish. Rather, conclusions to suggest that ripening may result from increased IL-8 related to ingress of neutrophils and their release of collagenases, MMP-8, and MMP-9 were based, to a large part, upon analyses of the lower uterine segment from women at term after cesarean section  and migration (CD54) were found on the day prior to birth (day 18 postbreeding) than in mid/late gestation (day of pregnancy). These results suggest that activities by cervix macrophages are probably not related to migration, but remodeling and extracellular matrix degradation, which are important processes associated with increased biomechanical compliance in preparation for dilation and effective labor as previously described. Although tissue preparation and data analyses may account for differences in some findings  that respond to infection as part of the adaptive immune system, and cytotoxic T cells (CD8+) that surveil for virus-infected or damaged cells, are present in cervix biopsies throughout the menstrual cycle from non-pregnant women  to guide changes in extracellular matrix structure. Heterogeneity in cervix morphology within subregions may extend to distribution or density of immune cell phenotypes. As alluded to in a flow cytometry study of macrophages in the cervix of pregnant mice , analyseOverall, these findings raise the possibility that some balance of immune cell products guides extracellular remodeling to promote softening, ripening, and the capability to dilate. Retreating to a previous consideration, caution about current understandings of the remodeling process in women may be derived from comparisons of biomolecular data from biopsies without histological confirmation of cervix at unspecified periods at term, before or after labor, or from non-pregnant individuals. In rodents, more biomarkers are needed to fill gaps in understanding the transition from soft to ripening, as well as from ripe to dilation at term to understand pathological processes associated with models of preterm birth. Collectively, the transitions between phases of remodeling do not have sufficient time points to resolve the essential biomarkers to track ripening or its completion to predict the capability for the cervix to dilate whether at term or the premature loss of competency as occurs in some women at risk for preterm birth , 114. ThIn the path to birth at term, expression of key components of an inflammasome characterize the drive for spontaneous labor. Most women have no signs of infection in reproductive tract structures related to pregnancy, thus spontaneous term labor may be considered a physiologic sterile inflammation. This process appears driven by molecules that were the focus of an exquisite study of chorionic membranes from women at term, not in or after labor . The preFrom a restrictive and rigid barrier before pregnancy , the cerAs part of the stroma-immune cell cross talk during ripening, paracrine factors may include increased hyaluronic acid , nitric The role of T lymphocytes in remodeling has yet to be studied in the prepartum cervix. As described earlier, limited presence of lymphoid-derived cells in the cervix, as well as clustering in subepithelial and luminal regions, suggest a limited role in the stroma. Moreover, immunosuppression therapy that blocks adaptive immune responses in transplant patients does not interfere with pregnancy , 129. EfWorldwide, perinatal morbidity is most associated with preterm birth before 37 weeks of pregnancy. A classic review categorizes three major causes of preterm birth , (1) aboAlthough spontaneous term labor may be considered a state of physiologic sterile inflammation, most women at term have no signs of intra-amniotic or other infection. Key components of this process have been described as an inflammasome, a focus of an exquisite study of chorionic membranes from women at term, not in or after labor . AnotherBy contrast, comparison of preterm and term prepartum cervix remodeling has been studied in several rodent models and women. For regulation of the timing of birth in mice, effects of PR antagonists to induce preterm birth or agonists to block preterm birth are consistent with the working hypothesis in the Treatments to induce inflammation are a common model for preterm birth. Intrauterine or intraperitoneal injection with the bacterial endotoxin lipopolysaccharide (LPS) induces preterm prepartum cervix remodeling . In someThe common use of mice to investigate inflammation-induced preterm parturition has also served as a model to study the effects of a variety of agents to block preterm birth. By example, the effects of LPS to induce preterm birth can be blocked by systemic or intravaginal treatments with a variety of anti-inflammatory agents , 148. AlBeyond the scope of this review is the nuanced controversy about whether progesterone is effective for treatment of preterm birth or childhood consequences. Much has been written on this topic –153, thoThere is little to review about the status of immune cells or processes in the cervix of any species with when pregnancy extends beyond term. Whether remodeling is forestalled or inflammation suppressed in the cervix when birth does not occur at term is not known.5aR1−/−), up to two-thirds of pregnant females depending upon background strain fail to deliver at term  has increased more than 5-fold since Bishop first proposed a scoring system to predict successful induction of vaginal delivery for women at term with prior history of vaginal birth  and morein vivo assessment of biomechanical capabilities of the fetal membrane and cervix through application of a finite element model that was based upon MRI evaluation of a patient with a normal vs. short length (Multiphoton microscopy applies fluorescence technology to imaging structures in thick sections and live tissues. Second harmonic generation (SHG) is the most popular version of this technique with strength and challenges that limit usefulness to assess cervix remodeling during pregnancy , 167. Byt length . Thus, iin vivo throughout pregnancy. In a recent longitudinal study of women during pregnancy, this approach proved useful to identify many peaks that reflected extracellular matrix proteins, actin, and blood in the cervix that change throughout pregnancy and postpartum  and guidance by local paracrine signals, at a time much earlier than previously thought. This perspective needs to be expanded to understand phenotypic activities by macrophages and other immune cells of lymphoid lineage in the cervix. Moreover, the time course of critical cellular and biomolecular processes in fetal membranes of the so-called zone of altered morphology that overlays the internal os of the cervix , as wellSY conceived, wrote, and created the figures for this manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We report on a 21-year-old patient with a giant symptomatic hydatid cyst of the interventricular septum, to whom a staged management approach was employed. Induction medical therapy led to a reduction in the size of the cyst, which was then completely removed via surgical excision.A 21-year-old male Caucasian, with main complaints of fatigue and palpitations, was referred to our Centre due to a cystic formation in his left ventricle. The workup consisted of transthoracic echocardiography and cardiac magnetic resonance, which revealed a huge hydatid cyst in an active stage of disease, occupying the basal and mid part of the interventricular septum. Due to the size of the lesion and lack of viable myocardium in the affected area, the patient was declared inoperable and medical therapy was initiated. Serial echocardiography revealed a significant reduction in the size of the lesion and degradation to transitional and inactive stage, after which successful surgical excision of the cyst was performed. In the course of the medical treatment, the patient experienced sustained ventricular tachycardia causing loss of consciousness, which did not reoccur after surgical excision.Medical therapy can result in the degradation of a giant heart hydatid cyst, enabling surgical excision. Heart hydatid cyst can lead to potentially lethal arrhythmia irrespective of its size and stage, which does not reoccur after successful surgical excision.The online version of this article (10.1186/s12879-018-3599-2) contains supplementary material, which is available to authorized users. Echinococcosis is a protozoal infection usually affecting people living in rural, sheep-raising areas. Although it is currently rare in developed Western countries, globalization, increasing travel opportunities and migrations harbor the potential to raise its prevalence. Infection most commonly affects the liver and lungs . Cardiac involvement is observed in less than 2% of cases, with the primary infection of the heart being extremely rare (< 0.2%) . It can The aim of this case report is to present successful staged management approach in the treatment of a giant hydatid cyst, in which medical therapy led to cyst degradation, enabling surgical excision.A 21-year-old male Caucasian was referred to our Center due to a cystic formation in his LV. He is a student and lives in a house with his parents, in a rural area of the country, but they do not work in agriculture. He complained about fatigue and weakness with exertion, as well as palpitations and blurred vision. He was completely asymptomatic up until 6 months prior to his current presentation. His physical examination was unremarkable. His high sensitive troponin T and N-terminal -pro-brain natriuretic peptide were normal. His 24-h electrocardiogram was notable for non-sustained ventricular tachycardia and biphasic T waves.Transthoracic echocardiography (TTE) revealed a multivesicular, septated cystic formation with a thin outer wall, within the basal and mid part of the IVS. The largest daughter cyst measured 6.5 × 6 cm and protruded into LV cavity Fig. a. All thTechnical challenges from a surgical perspective included total removal of the cyst without disseminating its contents, as well as a potentially complex reconstruction of the IVS. Consequently, medical therapy with albendazole dose: 15 mg/kg) was initiated. Bisoprolol and amiodarone were administered due to ventricular arrhythmia. Over the next 8 weeks, the patient was monitored closely and serial TTE examinations revealed a great reduction in total cyst size . (DOCX 35 kb)


Epidermoid cyst is a common, cutaneous, benign lesion that is frequently seen on the face, neck and trunk. It is rarely seen in the perineal region. The differential diagnosis of perineal cystic lesions includes a wide range of lesions, with an epidermoid cyst being a rare entity to be considered, and only a few such cases have been reported in the literature. Our case was a young Asian female who presented with painless perineal swelling for the past 6 months and was diagnosed as having an epidermoid cyst on the basis of diffusion-weighted MRI and contrast enhancement pattern, which was later confirmed by histopathological findings. While they are located commonly on the face, neck and trunk, uncommon and rare sites of occurrence include perineum, extremities, bones and breast.3An epidermal inclusion cyst occurs as a result of implantation of epidermal elements in the dermis. Because most lesions originate from the follicular infundibulum, the more general term of epidermoid cyst is often used. They represent most common cutaneous cysts and are usually asymptomatic; however, they may become secondarily inflamed or infected, or rarely develop malignancy.A 27-year-old Asian female presented to the surgical outpatient department with complaints of perineal swelling. The swelling was noticed by the patient 6 months ago in the right perineal region; it was approximately the size of a lemon and did not show noticeable increase in size over this time period. It was painless and not associated with changes in the overlying skin colour or texture. The patient was referred for an MRI examination with the clinical query of a possible lipoma in the soft tissues.T1 weighted images  are other ultrasound patterns of epidermoid cysts. Increased blood flow may be seen on Doppler ultrasound at the periphery of the cyst in case of inflammation or rupture.8It may, however, be difficult to differentiate benign from malignant soft tissue masses and histological diagnosis is required in such cases. Histopathologically, epidermoid cysts are lined by stratified squamous epithelium containing a granular layer and filled with keratin.8Once the diagnosis of an epidermoid cyst is confirmed, the lesion should be excised with wide free margins. The entire cyst wall should be removed to reduce the risk of recurrence. Prognosis and outcome of these lesions is excellent, with a recurrence rate of only 3%.An epidermoid cyst is a common, cutaneous, benign lesion, frequently seen on the face, neck and trunk but rarely in the perineal region.They occur twice as commonly in males compared to females and can occur at any age, but are most commonly seen in the third and fourth decades of life.Differential diagnosis of a cystic lesion in the perineum includes abscess, pilonidal cyst, anal duct/gland cysts, tail gut cyst, benign teratomas and anal/skin cancer.MRI is the imaging modality of choice to narrow the differential of soft tissue lesions and can help in establishing a correct diagnosis.T1 weighted images and high signal intensity on T2 weighted/fluid-sensitive sequences with characteristic thin peripheral post-contrast enhancement and significant diffusion restriction.Epidermoid cysts typically are well-defined mass lesions with low signal intensity on Once the diagnosis of an epidermoid cyst is confirmed on histopathology, the lesion should be excised with wide free margins. The entire cyst wall should be removed to reduce the risk of recurrence.Informed consent was obtained from the patient to publish this article, including the images.


Preterm birth is a primary outcome of interest in maternal vaccination trials but determination of gestational age is challenging in limited-resource settings. This study compares the New Ballard Score and fundal height measurements with the current standard of early ultrasound for sensitivity of predicting preterm birth. A trial of maternal influenza vaccination was conducted in Bamako, Mali. The New Ballard Score and fundal height were collected on 4038 infants born in the trial, ultrasound data were available for 1893 of those infants. New Ballard Score and fundal height were compared, consecutively, to all ultrasound results, early ultrasound results from the first trimester, and the date of last menstrual period for estimation of gestational age. Sensitivity of the New Ballard Score for identifying preterm infants was 0.33 compared with early ultrasound and 0.1 compared with the last menstrual period based estimates of gestational age. Sensitivity of low birth weight alone was 0.43 compared with early ultrasound. New Ballard Score estimated gestational age within 1 week of ultrasound more frequently than fundal height  yet New Ballard Score identified few infants as preterm (1.8% vs 5.8% by early ultrasound), and was biased toward categorizing low birth weight infants and infants requiring hospitalization as preterm. New Ballard Score is not an ideal measure for identifying preterm births in low-resource settings. Despite the time and cost of training required for correct measurement of New Ballard Score, measurement of low birth weight alone performed better than New Ballard Score for identifying preterm infants. However, clinical issues differ between SGA and preterm infants and knowledge of GA is important to guide clinical decision making for newborn risk management.6 Low birth weight (LBW) is a common problem in low-resource settings and serves as a predictor of early-life morbidity and mortality due either to preterm birth or being SGA.7Maternal vaccination is a promising method for decreasing morbidity and mortality in young infants in low-resource settings.813 While an imperfect measure, an ultrasound (US) conducted early in pregnancy is considered the most accurate method for estimating GA and is the current standard.1416 In low-resource settings, US is not widely available and women commonly do not seek care until late in pregnancy. The date of the last menstrual period (LMP) is also used to estimate GA and is considered accurate when known. However, this information is often inaccurate due to poor recall, especially in women with lower education and socioeconomic status who are also more likely to delay seeking maternal care.1719 The simplest and most widely available estimate of GA is based on fundal height (FH) measurements—standard of care for estimating expected date of delivery when US and LMP are unavailable.20 While it can provide a rough estimate for date of delivery, the estimate is imprecise and thus the utility of FH for determining SGA or preterm birth is considered limited.21Prediction of GA is difficult in any setting and a topic of substantial debate.8 Despite relative ease of use, the assessment is complex, requiring trained staff to complete. In a large study in the United States, the Ballard method frequently overestimated the GA of preterm infants and underestimated the GA of postterm infants when compared with known LMP.22 Studies done in low-resource settings comparing GA based on the Ballard with LMP have yielded widely varying results and few studies have compared the Ballard method with US in a low-resource setting.2329The Ballard method estimates GA of a newborn infant based on neurological and physical developmental characteristics; it is the standard of care in many low-resource settings where US and accurate LMP are largely unavailable.We conducted a maternal influenza vaccine trial in 4193 pregnant Malian women from 2011 to 2014 and measured New Ballard Scores (NBS) and FH as well as recorded LMP and US results when available. The current study aims to evaluate the performance of the NBS and FH (standard of care) for estimating GA and identifying preterm infants in comparison with US and known LMP, in a low-resource setting under field conditions. Sensitivity, specificity, positive predictive value, and mean difference in GA estimations of clinical evaluations are estimated.30 According to the Demographic Health Surveys, 95% of births in the population take place within community health centers.31 Women were enrolled according to the inclusion and exclusion criteria for the vaccine trial . In brief, participants were included if they were in their third trimester of pregnancy, were able to understand and comply with study procedures, and intended to reside in the study area until newborn infants were 6 months old. Participants were excluded if another member of their household had already enrolled in the study, they had a history of severe reaction to vaccines, known active chronic infection , or known complications with the ongoing pregnancy.As previously described, women believed to be in their third trimester of pregnancy were recruited from among women receiving prenatal care at health centers in Bamako, Mali.32 Early US was defined as an US conducted at 15 weeks GA or earlier. Doctors and nurses were trained in conducting the Ballard scoring examination by an experienced neonatologist from the University of Maryland. Training was repeated 4 times throughout the study to reinforce understanding of the method and ensure consistency. NBS was obtained within the first 7 days of life using the new Ballard method.23 Study staff performing the NBS may have had knowledge of GA estimates obtained earlier in the pregnancy. Newborn weight, length, and head circumference were also measured at birth.All participants had uterine height measurements taken at enrollment to the study. US results were recorded from reports of US performed on women prior to enrollment or obtained after inclusion due to clinical indications. FH was measured at enrollment by study staff as described.t tests were used to compare the estimated GA (in days) from early US (conducted ≤15 weeks GA), any US and LMP to the GA estimated by NBS and FH. Twins were excluded from all analyses using FH measurements, and only one twin from any twin set (chosen at random) was included in correlation calculations in order to avoid over-estimation of correlation.All live-born infants from the study were included in descriptive analysis. A preterm infant was defined as any infant with an estimated GA less than 37 weeks by either US or LMP. A newborn was classified as preterm by NBS if the NBS score was 30 or less. Descriptive statistics were calculated for all newborns with GA measures. Among newborns with GA estimated by either US or LMP, estimates of sensitivity, specificity, and positive predictive value relative to US and LMP were calculated, and McNemar’s test for paired samples was used to compare the proportions defined as preterm between methods. Pearson correlation coefficients and matched-pair P < .05 were considered statistically significant.Analysis was done using SAS 9.3 . Results with Approval for the research was obtained from the University of Maryland, Baltimore Institutional Review Board ; the ethics committee of the Faculté de Médecine, Pharmacie et Odonto-Stomatologie of Mali; and the Ministry of Health of Mali. Community sensitization was achieved through community leaders, health center representatives, and community members who attended community-wide meetings. All participants provided written informed consent. If the participant was illiterate, consent was obtained in the presence of a literate witness after listening to the audiotaped version of the consent form in Bambara, the local language. Participants who were illiterate placed their mark on the signature line and an independent literate witness signed and dated the form.There were 4159 births in the maternal influenza vaccine trial, 54 of which were stillbirths, leaving 4105 live births to 4036 women for analyses. One individual was excluded due to data errors. Maternal characteristics of mothers of newborns included in the analysis are presented in The distribution of GA varied by the method used to estimate GA, with FH estimating a lower mean GA as well as a wider range than all other methods . FH clasThe primary aim of this article was to determine the accuracy of NBS for estimating GA in a low-resource setting. US and LMP are used as standards for comparison. Newborns were included in further analysis only if they had a GA calculated either from US or LMP. There were 1917 newborns with a GA calculated from US; among newborns with US results, 156 had LMP measured. An additional 107 newborns had GA calculated from LMP but not from US. One newborn was excluded due to data errors, leaving a final study population of 2023 newborns.Sensitivity of NBS for identifying preterm newborns was low, ranging from 10% to 33% depending on which comparator was used as the standard for comparison . The pror = 0.25) and FH had higher correlation overall . NBS estimated GA consistently closer to the standard than did FH. Over 50% of NBS estimates were within 1 week of US estimates and roughly 80% of all NBS estimates were within 2 weeks of US estimates  were classified as preterm by the NBS. Hospitalized newborns accounted for 70.0% of all newborns estimated as preterm by the NBS .28In this population, NBS showed limited efficacy for estimation of GA. NBS identified a significantly smaller proportion of the population as preterm compared with US and had low specificity for identifying preterm infants. NBS estimates of GA had low overall correlation with US and LMP estimates, despite 80% of NBS estimates falling within 2 weeks of the US estimates. This is consistent with previous findings indicating that NBS biases toward estimating newborns at term with a 21.4% sensitivity for identifying preterm infants.29 A study in 364 Zimbabwean women reported high correlation of GA estimates by NBS and LMP when Ballard scores were adjusted by infant birth weight.24 Despite high correlation, the average error of a single observation in the Zimbabwe study was 1.89 weeks, indicating less accuracy than we found in Mali. Studies in non-African populations have had similarly varied results, but multiple studies have found that the NBS overestimates GA for preterm infants and has low sensitivity for identification of preterm infants.2527 Extensive training of health care professionals on the use of NBS did not improve the performance of NBS in this population. In spite of repeated training in the use of the Ballard method conducted throughout the trial in order to improve the consistency, our study confirmed previous findings of low sensitivity for preterm infants.In a small study in Gambia including 80 women, estimates of GA from NBS were highly inaccurate when compared with estimates from first term US, and NBS overestimated the number of preterm infants.26 Clinical signs of illness appear to have influenced determination of GA by NBS, as newborns classified as preterm by NBS had a disproportionate number of hospitalizations compared with all other GA estimation methods. Similarly, LBW appears to bias NBS determination, as 90% of all newborns classified as preterm by NBS were LBW. LBW is sometimes used as a surrogate measure for preterm birth but can also be indicative of decreased fetal growth or SGA and is thus considered an inadequate marker for GA.7 In this study, LBW alone identified a greater proportion of newborns who were preterm by US than the proportion of newborns correctly identified as preterm by NBS. Our data suggest that the Ballard scoring system may do no better than birth weight alone for estimating GA.Although NBS had low sensitivity for identifying preterm infants overall, our results agree with previous findings that the NBS is more accurate at identifying unhealthy newborns than healthy newborns as preterm.20While FH has shown limited utility for estimating GA in previous studies, it is standard of care in many low-resource settings and was measured for over 99% of singleton pregnancies in our study. By most comparisons, estimates of GA by FH fared worse than NBS estimates. The distribution of GA estimated by FH had high variability and less than 50% of GA estimates by FH were within 2 weeks of US estimates. Estimates of GA by FH had low PPV for identifying preterm infants. Our results confirm previous findings that FH can be useful for roughly predicting expected date of delivery in low-resource settings; however, the accuracy of FH in identifying preterm infants is not sufficient.34 Women included in this study were provided with substantial monitoring and health education beyond the standard of care in Mali, which may have affected the rate of preterm births.The proportion of our study population classified as preterm was 5.8% by early US and 1.7% by NBS. Previous studies in West Africa and Mali have found rates of preterm birth from 5.3% to 13.3%.35 This bias does not change the interpretation of our results and confirms that NBS is underestimating the proportion of preterm infants in this population.This study was limited by the lack of early US available for comparison; US estimates were restricted to newborns born to women who could afford the procedure. The population available for comparison and analyses had higher socioeconomic status in comparison to the individuals who had GA measured by only NBS or FH. Women of lower socioeconomic status would likely have a higher rate of preterm births; thus, if any bias exists, the proportion of newborns estimated as preterm by US should be underestimated.Ideally, this study would be done in a population where all women received US, regardless of socioeconomic status. Maternal vaccination trials in the future may need to develop novel methods to identify women earlier in pregnancy and should prioritize provision of US to participants, as enrollment of women only with US results would result in a less representative study population. Although the proportion of our population who had US done was low, this was the largest study done to date comparing US estimates to NBS estimates of GA, with the number of ultrasounds 10-fold higher than previous studies conducted in low-resource populations. A large population, in combination with the fact that the vaccine trial inclusion criteria introduced limited selection bias , likely increases both the validity and generalizability of our findings concerning the accuracy of the NBS.The NBS had low sensitivity to identify preterm infants in a population of Malian newborns when compared with either US or LMP estimates of GA. The NBS preferentially detected preterm infants with LBW and clinical signs of illness related to preterm birth and overestimated the GA of preterm infants who appeared clinically healthy. Despite its low sensitivity for preterm births, NBS had much higher accuracy at predicting GA than FH, the current standard of care in low-resource settings. Measurements of FH had high variability between individuals and showed limited utility for estimating GA. Thus, while NBS may not be an ideal solution for the determination of GA in low-resource settings, it and other clinically determined methods of estimating GA may be preferable to reliance on FH. In circumstances where more precise estimates of GA are required, particularly in maternal vaccination trials where identification of preterm infants is an outcome of interest, substantial effort is needed to recruit women early in pregnancy and offer US in an unbiased fashion.


The magnetization, electric resistivity, and magnetoresistance properties of Pd X  are a family of functional materials showing shape memory effects (SMEs) and superelasticity (SE) via the diffusionless thermoelastic martensitic transformation. The history of SMA dates back to the discovery of SME in the Au–Cd alloy in 1951  in the 1X  with a Heusler-type structure have attracted much attention because of their potential applications in functional materials. The study of these Heusler alloys started in early pioneering works by Hames  and WebsAmong these MSMAs, Nireported ,50. The oup Pmma . Moreove44Sn0.56  undergo 44Sn0.56 .Recently, a new Pden found ,53. Chie0≤x≤0.5) , where t1+xSn1−x . HoweverPolycrystalline Pd results . The hysa and b are fitting parameters. The quadratic and linear terms are presumed to be related to the magnetic and electron–phonon scatterings, respectively. However, one should note that Equation  of Step A is identical to Step E, and Steps B and D are exactly identical. Thus, their magnetization curves should also be perfectly coincident if nothing distinct occurs during Step C. However, non-ergodic results are found for these measurements. As shown in the inset of This has been reported as the kinetic arrest phenomenon in Ni–Mn–In-based alloys ,71,72,73Thus, the following explanations can be applied to understand the measurements of Steps A to E in Step A.Under no magnetic field, the electric resistivity was measured starting from 300 K to 4 K and back to 300 K.Step B.The value of the electric resistivity was recorded at 4 K under no magnetic field.Step C.Under 90 kOe, the electric resistivity was measured starting from 300 K to 4 K.Step D.The value of the electric resistivity was recorded at 4 K under no magnetic field.Step E.Under no magnetic field, the electric resistivity was measured by heating from 4 K to 300 K.Second, the TTA phenomenon is also confirmed by the examination of the electric resistivity. By use of a strong magnetic field, the arrested parent phase is clearly confirmed. The following measurements were conducted:Steps B and D were not actually performed because Step B is the value of the electric resistivity at 4 K in Step A, and Step D is the first value of Step E. The results are shown MR (6Fe0.4Al , −1.7% fMn50In15 , and −2%d alloys . Howevern0.737Ga , over −1Fe17Ga25 , and aror Fe2VGa . The rea Pd2MnSn .Strong magnetic fields were also used to investigate the extrinsic MR caused by the occurrence of the MFIT. ver −90% .In conclusion, the electric resistivity and magnetoresistance properties were investigated for a Pd