Johannesenboel3673

3%) vaginal and 30 (48.4%) laparoscopic. The algorithm sorted only 25 of the 62 abdominal cases (40.3%) to the abdominal approach. Conclusion Use of a hysterectomy route selection algorithm preoperatively improves identification of candidates for minimally invasive hysterectomy.Background Systemic lupus erythematosus (SLE) is an autoimmune disease commonly encountered during pregnancy. The use of hydroxychloroquine (HCQ) for SLE treatment in pregnancy has been supported by a few small studies performed in populations dissimilar from populations in the United States. this website Our objective was to compare maternal and neonatal outcomes in pregnant patients with SLE treated with and without HCQ at a tertiary care center in the United States. Methods We conducted a retrospective cohort study of patients with SLE and singleton gestations who delivered at the University of Alabama at Birmingham from 2006 to 2013. Patients treated with HCQ during pregnancy were compared with patients who did not receive HCQ. Key outcomes included maternal morbidities (hypertensive disorders, intrauterine growth restriction, preterm delivery, venous thromboembolism), disease-related morbidity, maternal death, and a composite of neonatal morbidity. Outcomes were compared using chi-square, Fisher exact, Wilcoxon rank sum, and t tests. Odds of adverse outcomes were modeled with logistic regression. Results Seventy-seven patients with SLE were included for analysis; 47 (61%) were treated with HCQ and 30 (39%) were not. We found no differences in the rates of maternal morbidities or death between groups. Patients taking HCQ had increased rates of disease-related hospitalizations (43% vs 7%, P less then 0.01) and inpatient rheumatology consultations (38% vs 10%, P less then 0.01), increases that persisted after multivariable adjustments (adjusted odds ratio [aOR] 8.09, 95% confidence interval [CI] 1.60-40.9; aOR 4.50, 95% CI 1.08-18.6, respectively). Neonatal morbidity did not differ between groups. Conclusion We found no differences in major maternal or neonatal outcomes in pregnant patients with SLE managed with HCQ.It is demonstrated that acoustic transmission through a phononic crystal with anisotropic solid scatterers becomes non-reciprocal if the background fluid is viscous. In an ideal (inviscid) fluid, the transmission along the direction of broken P symmetry is asymmetric. This asymmetry is compatible with reciprocity since time-reversal symmetry (T symmetry) holds. Viscous losses break T symmetry, adding a non-reciprocal contribution to the transmission coefficient. The non-reciprocal transmission spectra for a phononic crystal of metallic circular cylinders in water are experimentally obtained and analysed. The surfaces of the cylinders were specially processed in order to weakly break P symmetry and increase viscous losses through manipulation of surface features. Subsequently, the non-reciprocal part of transmission is separated from its asymmetric reciprocal part in numerically simulated transmission spectra. The level of non-reciprocity is in agreement with the measure of broken P symmetry. The reported study contradicts commonly accepted opinion that linear dissipation cannot be a reason leading to non-reciprocity. It also opens a way for engineering passive acoustic diodes exploring the natural viscosity of any fluid as a factor leading to non-reciprocity.Several biological materials are fibre networks infused with fluid, often referred to as fibrous gels. An important feature of these gels is that the fibres buckle under compression, causing a densification of the network that is accompanied by a reduction in volume and release of fluid. Displacement-controlled compression of fibrous gels has shown that the network can exist in a rarefied and a densified state over a range of stresses. Continuum chemo-elastic theories can be used to model the mechanical behaviour of these gels, but they suffer from the drawback that the stored energy function of the underlying network is based on neo-Hookean elasticity, which cannot account for the existence of multiple phases. Here we use a double-well stored energy function in a chemo-elastic model of gels to capture the existence of two phases of the network. We model cyclic compression/decompression experiments on fibrous gels and show that they exhibit propagating interfaces and hysteretic stress-strain curves that have been observed in experiments. We can capture features in the rate-dependent response of these fibrous gels without recourse to finite-element calculations. We also perform experiments to show that certain features in the stress-strain curves of fibrous gels predicted by our model can be found in the compression response of blood clots. Our methods may be extended to other tissues and synthetic gels that have a fibrous structure.This paper builds on the theory of nonlinear generalized functions begun in Nigsch & Vickers (Nigsch, Vickers 2021 Proc. R. Soc. A 20200640 (doi10.1098/rspa.2020.0640)) and extends this to a diffeomorphism-invariant nonlinear theory of generalized tensor fields with the sheaf property. The generalized Lie derivative is introduced and shown to commute with the embedding of distributional tensor fields and the generalized covariant derivative commutes with the embedding at the level of association. The concept of a generalized metric is introduced and used to develop a non-smooth theory of differential geometry. It is shown that the embedding of a continuous metric results in a generalized metric with well-defined connection and curvature and that for C2 metrics the embedding preserves the curvature at the level of association. Finally, we consider an example of a conical metric outside the Geroch-Traschen class and show that the curvature is associated to a delta function.In this work, we adopt a new approach to the construction of a global theory of algebras of generalized functions on manifolds based on the concept of smoothing operators. This produces a generalization of previous theories in a form which is suitable for applications to differential geometry. The generalized Lie derivative is introduced and shown to extend the Lie derivative of Schwartz distributions. A new feature of this theory is the ability to define a covariant derivative of generalized scalar fields which extends the covariant derivative of distributions at the level of association. We end by sketching some applications of the theory. This work also lays the foundations for a nonlinear theory of distributional geometry that is developed in a subsequent paper that is based on Colombeau algebras of tensor distributions on manifolds.