Search

Introduction: A cornual pregnancy describes a rare ectopic location positioned within the myometrium next to the fallopian tube, which can be difficult to find on traditional ultrasound imaging. Given its location and the stretch within the uterine wall, cornual pregnancies can progress for weeks prior to diagnosis. Ruptures can, therefore, be catastrophic with disproportionally high maternal mortality rates compared to other ectopic pregnancies.Case Report: A 34-year-old female recently treated with methotrexate for ectopic pregnancy presented to the emergency department (ED) for acute onset of lower abdominal cramping without vaginal bleeding. She arrived clinically stable and quickly decompensated with witnessed syncope in the ED, prompting point-of-care ultrasound showing free fluid in the abdomen. The patient was taken for emergent surgery by obstetrics while receiving transfusion of blood products for suspected ruptured ectopic pregnancy. A fetus estimated to be 10 weeks of age was discovered in the left cornual region. Approximately two liters of intraperitoneal blood were drained without complication.Conclusion: Cornual pregnancy is a difficult to diagnose but potentially disastrous type of ectopic pregnancy due to massive hemorrhage. Emergency clinicians should be aware of this condition given its rare occurrence but potentially catastrophic outcomes.

Background: Left ventricular assist device (LVAD) recipients report symptom improvement but find adjusting to life with the LVAD challenging. These challenges are unique, and existing patient‐reported outcome measures (PROMs) do not reflect their experiences. This study aimed to develop a culturally relevant quality of life PROM for use with LVAD recipients in future research, design evolutions and clinical practice. Methods: A three‐stage mixed‐methods approach was used to develop a PROM: stage 1 included group concept mapping (GCM); stage 2 semi‐structured qualitative interviews were conducted with 11 LVAD recipients and 10 clinicians, and a questionnaire was developed using a conceptual framework; and stage 3 used exploratory psychometric analysis of the PROM data using Rasch measurement theory. This paper presents stages 2 and 3. Results: The conceptual framework consisted of four key concepts, including general health, life with the LVAD, equipment and clothing and emotional impact. Statements from interviews and GCM were used to create items for the LVAD quality of life (LVAD‐QoL). Cognitive interviews tested face validity and participant comprehension. Forty‐nine participants were recruited from three UK transplant centres. PROM data were collected and analysed using Rasch analysis. Four items displayed misfit; dependency between item sets was the biggest issue (57/485 pairwise differences). After restructuring and dealing with item misfit, the LVAD‐QoL conformed to the Rasch model, supporting the psychometric properties and quality of the LVAD‐QoL. Conclusions: Using a mixed‐methods approach ensured the development of a robust and psychometrically sound tool for research, design evolution and clinical practice with LVAD recipients. [ABSTRACT FROM AUTHOR]

Fog processing has a significant impact on sulfur chemistry in the atmosphere. This study analyzed three winter fog events in Hong Kong using single‐particle aerosol mass spectrometry (SPAMS) and a Monitor for AeRosols and GAses in ambient air (MARGA). Black carbon (BC)‐related carbonaceous particles with substantial sulfate amounts comprised the largest particle number fraction (56.7%). Sulfate mass concentration decreased during fog due to the cloud's effective scavenging, but fog processing notably promoted sulfate formation at the single‐particle level (average peak area increases of 31.2%). Hydroxymethanesulfonate (HMS), an important S(IV) compound and fog tracer, was identified accounting for up to 12% by particle number fraction. Although pH showed a positive correlation (r = 0.53–0.69) with HMS particles in each fog scenario, a negative overall correlation (r = −0.51) was observed. Further analysis revealed that the higher aerosol acidity (pH 0.65–3.11), promoted Fe dissolution, leading to 49% of HMS particles being mixed with Fe, which potentially facilitated sulfate formation via the Fenton reaction. Additionally, around 40% of HMS‐Fe particles are mixed with oxalate, thereby warranting further attention for their potential to cause more intricate sulfur oxidation processes. This study reveals the initial identification of a high mixed‐state of HMS‐Fe, which could potentially serve as a crucial avenue for the formation of sulfate on individual particulate matter. Considering the persistent augmentation of aerosol acidity in the Asian region, this phenomenon necessitates further investigation and attention. Plain Language Summary: Cloud and fog processes are crucial for atmospheric chemistry and important pathways in sulfate formation. However, current models often underestimate sulfate production in the atmosphere. While several potential pathways have been proposed, the influence of organic compounds on hydroxymethanesulfonate (HMS) formation and its subsequent sulfate generation is yet to be fully explored. This study, utilizing a single‐particle perspective, reveals that higher aerosol acidity in coastal areas can lead to the dissolution of iron (Fe) in coastal aerosols, thereby promoting the formation of HMS‐Fe. Additionally, as a transition metal, Fe has the potential to catalyze the conversion of HMS to sulfates. This finding challenges the prevailing notion that HMS hinders sulfate production by being less susceptible to oxidation by hydrogen peroxide (H2O2) and other radicals. The significance of this process is particularly pronounced in coastal or remote marine atmospheres, where cloud and fog processes exhibit higher aerosol acidity and limited ammonia sources. Furthermore, considering the current global scenario of increased aerosol acidity, the impact of transition metals on sulfate formation in HMS is likely to be more prominent. Consequently, this phenomenon necessitates further investigation and attention. [ABSTRACT FROM AUTHOR]

Dust models are widely applied over the East Asian region for the simulation of dust emission, transport, and deposition. However, due to the uncertainties in estimates of dust transport, these methods still lack the necessary precision to capture the complexity of transboundary dust events. This study demonstrates an improvement in the Community Multiscale Air Quality (CMAQ) model dust treatment during long-range transport of dust from northwestern China to the South China Sea (SCS). To accomplish this, we considered a super dust storm (SDS) event in March 2010 and evaluated the dust scheme by including adjustments to the recent calibration (Dust_Refined_1) and bulk density (Dust_Refined_2) refinements individually and in combination (Dust_Refined_3). The Dust_Refined_3 normalized mean bias of PM10 was - 30.65 % for the 2010 SDS event, which was lower in magnitude compared to Dust_Refined_1 (- 41.18 %) and Dust_Refined_2 (- 49.88 %). Indeed, Dust_Refined_3 improved the simulated aerosol optical depth (AOD) value during significant dust cases, e.g., in March 2005, March 2006, and April 2009. Dust_Refined_3 also showed more clearly that, in March 2010, a "double plume" (i.e., one plume originating from the Taiwan Strait and the other from the western Pacific) separated by the Central Mountain Range (CMR) of Taiwan affected dust transport on the island of Dongsha in the SCS. On 15–21 April 2021, both CMAQ simulations and satellite data highlighted the influence of Typhoon Surigae on dust transport to downwind Taiwan and the western Pacific Ocean (WPO). The CMAQ Dust_Refined_3 simulations further revealed that many dust aerosols were removed over the WPO due to Typhoon Surigae. Hence, the model indicated a near-zero dust particle concentration over the WPO, which was significantly different from previous dust transport episodes over the Taiwan region. Therefore, our study suggested an effective method to improve dust management of CMAQ under unique topographical and meteorological conditions. [ABSTRACT FROM AUTHOR]

Dust models are widely applied over the East Asian region for the simulation of dust emission, transport and deposition. However, due to the uncertainties in estimates of dust flux, these methods still lack the necessary precision to capture the complexity of transboundary dust events. This study demonstrates an improvement in the Community Multiscale Air Quality (CMAQ) model dust treatment during long-range transport of dust from northwest China to the South China Sea (SCS). To accomplish this, we considered a super dust storm (SDS) event in March 2010, and evaluated the dust scheme by including adjustments to the recent calibration (Dust_Refined_1) and bulk density (Dust_Refined_2) refinements individually and in combination (Dust_Refined_3). The Dust_Refined_3 normalized mean bias of PM10 was -30.73 % for the 2010 SDS event, which was lower compared to Dust_Refined_1 (-41.34 %) and Dust_Refined_2 (-50.09 %). Indeed, the Dust_Refined_3 improved the simulated AOD value during significant dust cases, for instance, in March 2005, March 2006 and April 2009. Dust_Refined_3 also showed more clearly that in March 2010, a 'double plume' (i.e., one plume originated from the Taiwan Strait and the other from the Western Pacific) separated by the Central Mountain Range (CMR) of Taiwan Island affected dust transport on Dongsha Island in the SCS. On 15–21 April 2021, both CMAQ simulations and satellite data highlighted the influence of typhoon 'Surigae' on dust transport to downwind Taiwan and the Western Pacific Ocean (WPO). The CMAQ Dust_Refined_3 simulations further revealed a large fraction of dust aerosols were removed over WPO due to typhoon 'Surigae'. Hence, the model indicated near-zero dust particle concentration over the WPO, which was significantly different from previous dust transport episodes over the Taiwan region. Therefore, our study suggested an effective method to improve dust management of CMAQ under unique topographical and meteorological conditions. [ABSTRACT FROM AUTHOR]