Management Of Discharge Research Articles

ThP1.1 - Unilateral Nipple Discharge: Contemporary Approaches to Investigation and Management across a Multi-site Trust

Abstract Nipple discharge, in the absence of a palpable breast lump, constitutes 3-9% of referrals to breast services[i],[ii]. While the ABS released updated guidelines on nipple discharge in 2019, a standardised management protocol is yet to be established. This study aims to scrutinize the efficacy of imaging (mammogram, USS, MRI) and nipple discharge cytology in predicting malignancy outcomes in patients with unilateral nipple discharge. Aims Determine the incidence of malignancy in women presenting with unilateral nipple discharge. Assess sensitivity, specificity, and positive predictive value of imaging modalities (mammogram, USS, MRI) and cytology. Methodology 110 patients presenting with unilateral nipple discharge between 11/2022-12/2023 were retrospectively analysed. Data encompassing patient demographics, diagnostic procedures, and outcomes were systematically collected. Results 31.6% underwent surgical intervention, revealing a malignancy rate of 5.6%. Positive predictive values for detecting malignancy were 75% for mammogram, 50% for ultrasound, and 66% for nipple discharge cytology. No patients underwent MRI or ductoscopy as part of investigations. Conclusion This study highlights variable diagnostic accuracy of imaging and cytology and the necessity for large-scale collaborative data to draw substantive conclusions. The National Unilateral Discharge Study is anticipated to provide comprehensive insights and contribute to the establishment of a national investigative framework for patients presenting with unilateral nipple discharge. [i] Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol 2002; 3: 157–161. [ii] Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10: 111–117.

The advantages of inhouse testing to manage vaginitis treatment.

Vaginal discharge is a common presenting complaint in ambulatory care medicine, emergency medicine, primary care, and gynecology, accounting for nearly 10 million office visits annually in the United States. This article discusses management of abnormal vaginal discharge among women of childbearing age and the clinical significance of inhouse diagnostic tools. Provider-performed microscopy is an invaluable clinical skill that allows for immediate diagnosis, treatment, and management of infections and coinfections and should be strongly considered when evaluating a patient.

Impacts of salinity stress induced by ballast water discharge on the ecosystem of shanghai port, China

Large quantities of marine ballast water discharged by ocean-going vessels can cause salinity increases in freshwater ports, which in turn negatively affects indigenous plankton in the ports. In this study, we investigated the impacts of marine ballast water discharge on the plankton community in a freshwater wharf through field surveys. It was found that salinity stress caused reductions in community indicators such as plankton community composition, abundance and diversity, thus threatening the structure and function of the plankton community in the wharf. In terms of the impact range, the salinity stress had a significant effect on all plankton in the waters near the discharge point and the phytoplankton in the waters 50 m from the discharge point, but had no significant effect on the plankton in the waters further away. Ballast water discharge also caused a significant decrease in the alpha diversity and richness of the plankton community but had no significant effect on the evenness of the plankton community. Moreover, phytoplankton were more tolerant of salinity changes than zooplankton in our study. This study provides an ecological reference for the scientific management of marine ballast water discharge and the risk of exogenous nutrient inputs to freshwater ecosystems.

Dokumentationsqualität der Medikation in Entlassbriefen – eine Bestandsaufnahme nach Einführung des Rahmenvertrags Entlassmanagement

IntroductionDischarge from hospital is a risk to drug continuity and medication safety. In Germany, new legal requirements concerning the management of patient discharge from the hospital came into force in 2017. They set minimum requirements for the documentation of medications in patient discharge summaries, which are the primary means of communication at transitions of care. Six years later, data on their practical implementation in routine care are lacking. MethodsWithin the scope of an explorative retrospective observational study, the minimum requirements were operationalized and a second set of assessment criteria was derived from the recommendation “Good Prescribing Practice in Drug Therapy” published by the Aktionsbündnis Patientensicherheit e.V. as a comparative quality standard. A sample of discharge summaries was drawn from routine care at the University Hospital Heidelberg and assessed according to their fulfilment of the criteria sets. In addition, the potential influence of certain context factors (e. g., involvement of clinical pharmacists or software usage) was evaluated. ResultsIn total, 11 quality criteria were derived from the minimum requirements. According to the eligibility criteria (i. e., three or more discharge medications) 352 discharge summaries (42 wards; issued in May–July 2021), containing in total 3,051 medications, were included. The practical implementation of the minimum requirements for documenting medications in patient discharge summaries differed considerably depending on the criterion and defined context factors. Core elements (i. e., drug name, strength, and dosage at discharge) were fulfilled in 82.8 %, while further minimum requirements were rarely met or completely lacking (e. g., explanations for special pharmaceutical forms). Involvement of clinical pharmacists and usage of software were shown to be a facilitator of documentation quality, while on-demand medication (compared to long-term medication) as well as newly prescribed medication (compared to home medication or medication changed during hospitalisation) showed poorer documentation quality. In addition, the documentation quality seemed to depend on the department and the day of discharge. ConclusionTo date, the wording of the German legal requirements allows for different interpretations without considering the respective clinical setting and the medication actually prescribed. For future clarification of the requirements, implications of the wording for the clinical setting should be considered.

IMPACT OF DISCHARGE FROM A CARDIOLOGY UNIT ON OUTCOMES IN NON–ST ELEVATION MYOCARDIAL INFARCTION: AN ANALYSIS OF A NATIONWIDE ADMINISTRATIVE DATABASE

Abstract Background Current data on the prognostic impact of a specialist management of patients with acute coronary syndromes are scarce. Aim To evaluate the impact of the discharge of revascularized patients with Non–ST elevation myocardial infarction (NSTEMI) from a cardiology unit on their 1–year prognosis and to evaluate the differences in terms of effectiveness between discharge from a cardiology and non–cardiology unit and the whole management of the index hospitalization in a cardiology unit. Methods Retrospective nationwide cohort study enrolling consecutive patients older than 18 years admitted in 2019–2020 in Italy for a NSTEMI and undergoing percutaneous coronary intervention (PCI) within 48 hours from the index admission. Patients died within 30 days from the index admission were excluded from the analysis. Enrolled patients were classified based on the management department into: patients not discharged from a cardiology unit (group 1); patients not admitted but discharged from a cardiology unit (group 2); patients completely managed (admitted and discharged) in a cardiology unit (group 3). The outcome of interest was 1–year all–cause mortality. A Cox multivariate regression model was used to evaluate the impact of the management department on 1–year mortality. Results The study cohort consisted of 31950 NSTEMI events. Among them, 534 (1.6%) were allocated in group 1, 1160 (3.6%) in group 2 and 30256 (94.7%) in group 3. Patients completely managed by a cardiology unit were younger and less likely to be female than patients in other groups. The 1–year mortality was 14.4%, 8.4% and 3.8% (p<0.001) for group 1, group 2 and group 3, respectively (Figure). After adjustment for age, sex, and comorbidities, the hazard ratio (HR) for 1–year mortality was 2.4 (p<0.0001) and 1.7 (p<0.0001), in patients in group 1 and group 2, respectively, as compared with patients completely managed in a cardiology unit (group 3). Conclusion Complete management of index hospitalization or hospital discharge from a specialist unit alone improves the one–year prognosis of patients hospitalized with a diagnosis of NSTEMI in Italy.

Various Clinical Manifestation of Omphalomesenteric Duct Remnant in a Child: A Case Report

Omphalomesenteric duct (OMD) remnant is a condition in which the omphalomesenteric duct fails to obliterate completely or partially. Failure in this step can produce various patterns, such as a vitelline cyst, umbilical sinus, polyp, Meckel’s diverticulum, and patent OMD. Various clinical manifestations of OMD rarely occur in one patient. We present the case of omphalomesenteric duct remnant, manifested as anterior wall abdominal mass, intraperitoneal hemorrhage, and obstructive ileus. Case report: A four-year-old girl was referred to our hospital with obstructive ileus and abdominal wall mass on the left lower quadrant. Contrast-enhanced abdominal computed tomography (CT) scan found an irregular cystic mass in the abdominal cavity that adheres to the anterior wall of the abdomen and bowel structure with a fluid-solid level without enhancement. Further medical history was taken and found a history of intermittent watery umbilical discharge that appears three times in 2 years after birth. Omphalomesenteric duct remnant was suspected, then proceed to exploratory laparotomy. We found intraperitoneal hemorrhage and 5x4 centimeters frail mass adhering to the anterior wall of the abdomen on the left side of the umbilicus. Histopathological examination confirmed intestinal tissue, suggesting remnants of the omphalomesenteric duct and pancreatic tissue with a chronic inflammatory pattern. Diagnosing omphalomesenteric duct remnant could be challenging and should be considered a differential diagnosis of obstructive ileus, particularly if persistent umbilical discharges are also present. On the other hand, early diagnosis and appropriate management of persistent umbilical discharge could prevent a greater outcome.

Surgical outcomes of total duct excision in the diagnosis and management of nipple discharge.

Total duct excision (TDE) is performed for the diagnosis and management of nipple discharge. The Association of Breast Surgery's recent guidelines recommend considering diagnostic surgery for single-duct, blood-stained or clear nipple discharge, and for symptomatic management. We retrospectively reviewed the diagnostic and surgical outcomes of all cases of TDE between January 2013 and November 2019. In total, 259 TDEs were carried out: 219 for nipple discharge, 29 for recurrent mastitis, 3 for screening abnormalities and 8 for breast lumps. Of the nipple discharge group, 121 had blood-stained discharge. Mean patient age was 52 years (range 19-81). Median follow-up time was 45 months (interquartile range 24-63). The following cases were identified on histopathology: 236 benign breast changes, 10 atypical ductal hyperplasia, 4 lobular carcinoma in situ, 2 low-grade ductal carcinoma in situ (DCIS), 3 intermediate-grade DCIS, 2 high-grade DCIS and 2 invasive ductal carcinomas. In total, 3.5% of patients who underwent TDE had a diagnosis of DCIS or invasive carcinoma. Blood-stained discharge was associated with a significant increase in risk of DCIS or carcinoma compared with other nipple discharge colours (p = 0.043). The most common complications of TDE were infection, poor wound healing and haematoma. Nipple discharge recurred in 14.2% of cases. TDE can be considered for the diagnostics and management of nipple discharge. Blood-stained nipple discharge increases the risk of DCIS or malignancy, but the majority of the time TDE reveals benign breast pathology.

Antimicrobial Properties of Shrevestakadi Yoni Dhoopan for Management of Abnormal Vaginal Discharge

Ayurveda, an ancient system of medicine adopts a holistic approach, focusing on both curing diseases and enhancing the overall well-being of individuals. It emphasizes the importance of maintaining a balance between the individual (body, mind, soul, spirit) and the environment. It includes a range of pharmaceutical preparations and therapeutic techniques. However, in the contemporary era, only a limited number of these procedures are actively employed, leading to the loss of significance and recognition for numerous valuable formulations and techniques, Dhoopan karma being one of them. "Dhoopana" is a procedure involving the use of herbal, herbo-mineral, or animal-origin substances for fumigation. Dhoopan has been actively used as a preventive measure during pre and post-operative care and as a therapeutic procedure due to its antimicrobial, analgesic, anti-inflammatory properties. Yoni Dhoopan is effectively utilized in addressing diverse Yonivyapad conditions. Medicinal properties of Dhoopan drugs includes Kashaya and Tikta in Rasa, Katu in Vipaka, and Laghu and Ruksha in Guna, rendering them to be a potent Kledashoshaka, Shodhaka (detoxifier), and ropaka (wound-healer). Furthermore, it exhibits Yoni doshhara, Kledashoshaka, and Jantughana (anti-microbial) properties.

Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique.

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.

A Clinical Study to Assess the Effectiveness of Oral Combination Kit Therapy in Syndromic Management of Abnormal Vaginal Discharge (FEMINE Study) in Kinshasa, Democratic Republic of Congo

A Clinical Study to Assess the Effectiveness of Oral Combination Kit Therapy in Syndromic Management of Abnormal Vaginal Discharge (FEMINE Study) in Kinshasa, Democratic Republic of Congo

Estimation of the riverine input of organic ultraviolet filters (OUVFs) from the Pearl River Estuary to the South China Sea during the early Covid-19 pandemic

Organic ultraviolet filters (OUVFs) are functional ingredients used in cosmetics to protect skin from the harmful effects of ultraviolet (UV) radiation. This study presents recent findings on the distribution of OUVFs in the Pearl River Estuary (PRE), located in southern China. This investigation was conducted during the early stages of the Covid-19 pandemic when the stay-at-home policy was implemented. Analysis revealed the presence of OUVFs in both the surface and bottom water samples collected from eight major outlets of the Pearl River. The OUVFs were detected in both the dissolved phase and suspended particulate matter, with a total concentration ranging from 7.19 ± 6.54 to 20.5 ± 9.62 ng/L. Notably, OUVFs' concentrations in the study period were significantly lower compared to those reported before the pandemic. This implies that effective reduction of OUVF emissions can be achieved through usage reduction combined with the management of direct discharge and appropriate treatment by urban wastewater treatment facilities. During the study period, the annual release of OUVFs was approximately 12.6 kg/1000 people/year, with the greatest contribution from the Hu Men outlet. Consequently, it is imperative to consider the potential ecological risks associated with the release of OUVFs from the PRE into the marine environment, particularly with the potential for an accompanying rebound in risk upon the lifting of restrictions on outdoor activities in the post Covid-19 time.

A Clinical Study to Evaluate the Efficacy of Kasisadi Vaginal Pessary and Udumbaradi Tail Pichu in Management of Shweta Pradar (Abnormal Vaginal Discharge): A Double Arm Random Control Study

Shwetapradara, a symptom of many gynaecologic disorders, develop due to vitiation of Kapha predominant Doshas. Laghutriya described Shwetapradar. In Charak Samhita management of Shwetpradar is described under the description of Pandurasrigdara. Chakrapani has explained Pandura-Asrigdara as Shwetapradar in his commentary. Objectives: To draw Ayurvedic management to the disease with effective cure and no or minimal side effects, that can be easily administered and accepted by the patient. Materials & Methods: After obtaining Ethics Committee approval and informed consent, 210 patients were randomized into two groups. In one group, Kasisadi vaginal pessary in the night followed by Udumbaradi Taila Pichu for 2 hours in the morning was given while in another a vaginal pessary (clotrimazole+ tinidazole+ clindamycin) was given for 7 days. From baseline to 7th day on the bases of assessment criteria per-speculum examination was done. A comparison of categorical variables was done using an appropriate statistical test. Results: Uduambaradi Taila and Kasisadi vaginal pessary exhibited potentially comparable effects to the conventional treatment but the recurrence rate was found more in conventional treatment. Conclusion: Uduambaradi Taila pichu and Kasisadi vaginal pessary combination is an effective, side effects-free, patient-compliant herbal alternative for the management of abnormal vaginal discharge.

Effective Government Management of Flood Discharge in Drainage Channels using HEC-RAS 6.3.1 Application

Flooding remains one of the most significant natural disasters affecting communities around the world. Proper management of flood discharge in drainage channels is essential to mitigate its impacts on public safety, infrastructure, and the environment. In recent years, advancements in hydrodynamic modeling tools, such as the Hydraulic Engineering Center's River Analysis System (HEC-RAS) 6.3.1, have provided governments with powerful tools to analyze and manage flood discharges effectively. This research aims to investigate the role of government-led management strategies in handling flood discharge within drainage channels using the HEC-RAS 6.3.1 application. The study assesses how the application's features and capabilities can be harnessed by governmental agencies to make informed decisions and implement effective flood management plans. The research methodology involves a combination of field surveys, data collection, and computer simulations using the HEC-RAS 6.3.1 software. Geographic information systems (GIS) data, topographical surveys, and historical flood records are utilized to calibrate and validate the model's accuracy. Various flood scenarios are simulated to assess the performance of different government-led management strategies. The findings of this study reveal that the integration of HEC-RAS 6.3.1 with government-led management approaches enhances the understanding of flood dynamics within drainage channels. The application facilitates the identification of critical flood-prone areas, prediction of potential flood events, and evaluation of flood mitigation measures. The government can utilize this valuable information to formulate more effective flood management policies and allocate resources efficiently.

O FLUXO DE ALTA HOSPITALAR PEDIÁTRICA: ANÁLISE DE UM MUNICÍPIO DO SUL DO BRASIL

INTRODUCTION: Pediatric hospital discharge is an extremely important issue in the public health sector in Brazil. This is due to the fact that when this measure is not performed correctly, future challenges may be encountered in the management of these patients. OBJECTIVE: The final objective is to analyze the flow of events that are related to pediatric hospital discharge in the city of Pelotas-RS, as well as the factors that interfere and predict changes in this scenario. METHOD: Originating from a case study, a qualitative exploratory research was carried out with data collection on the flow of pediatric discharge in the city of Pelotas in the year 2022. RESULT: As a result, it was noticed that the management of discharge happens very similarly between the two hospitals studied and that they still need to seek adjustments for a fully reliable discharge plan. DISCUSSION: Analyzing the results against the literature, there are points that prevent the discharge flow from being entirely satisfactory. CONCLUSION: Thus, it can be concluded that there is a need to make improvements in the system and analysis of the flow of events for hospital discharge of children in the city of Pelotas.

Research on environmental management of domestic wasteincineration fly ash and high salt water discharge into the sea

In our comprehensive management proposal for fly ash washing wastewater discharge into the sea, we establishstringent control measures across four categories: general elements, nutrients, heavy metals, and organic pollutants. Ourapproach is rooted in respect for and compliance with national and international pollution control standards. We definethe acceptable parameters for pH, salinity, and the content of Chemical Oxygen Demand (COD), suspended solids, totalnitrogen, ammonia nitrogen, phosphates, various heavy metals, and organic pollutants. Our plan includes thoroughlytreating wastewater, emphasizing the removal of lead, desalination, effective precipitation, and filtering processes beforethe wastewater is discharged into the sea. We advocate for constant surveillance and stringent management practicesto maintain a healthy marine ecosystem. Moreover, we acknowledge the need for additional biological testing in actualwork to more scientifically and comprehensively understand the potential impact of the discharged wastewater onmarine ecology. Our overall goal is to ensure that the potential environmental effects of fly ash washing wastewater areminimized while adhering to the highest environmental management standards.

Environmental concentrations of anionic surfactants in lake surface microlayers enhance the toxicity of Microcystis blooms: Insight from photosynthesis, interspecies competition, and MC production

Anionic surfactants represented by linear alkylbenzene sulfonate (LAS) exhibit vertical heterogeneity of concentrations in aquatic environments owing to their amphiphilic structure. Field investigations showed that the concentration of anionic surfactants (mainly LAS) in the water surface microlayer (SML) of Lake Taihu reached 580 μg/L, higher than that in the lower layer. Floating Microcystis blooms overlap in space with the high concentration of anionic surfactants in SML. However, few studies have focused on the effects of anionic surfactants (e.g., LAS) on the interspecies competition between toxic and nontoxic Microcystis. In this study, coculture and monoculture experiments were conducted with both toxic and nontoxic Microcystis species to explore how the environmental concentration of LAS regulates the dominance of toxic Microcystis and toxicity from the perspective of photosynthesis, species dominance, and MC production. The results showed that LAS concentrations above 0.267 or 0.431 mg/L (depending on light conditions) selectively promoted the photosynthetic competitive advantage of toxic Microcystis, leading to its higher population proportion in the community. Additionally, LAS concentrations above 0.5 mg/L induced the synthesis and release of microcystins (MCs). The results of chlorophyll fluorescence analysis, electron microscopy and transcriptome sequencing suggested that compared with nontoxic Microcystis, toxic Microcystis can better resist LAS stress by dissipating excess light, maintaining an intact membrane structure and maintaining cellular homeostasis. Transcriptome sequencing revealed that the photosynthetic damage of nontoxic Microcystis might be attributed to the impacts of LAS on the absorption and assimilation of nitrogen, which finally resulted in the degradation of phycobilisomes. This study can provide novel insight for establishing standards and safety management of wastewater discharge.

Impacts of salinity stress caused by ballast water discharge on freshwater ecosystems

Global commodity trade and the transportation of goods rely heavily on shipping. But the discharge of large quantities of hypersaline ballast water carried by maritime vessels into freshwater ports, lakes, rivers and other water bodies cause salinity stress, which can be detrimental to native freshwater organisms. In this study, the effects of marine hypersaline ballast water discharge and the rate of discharge (abrupt vs. gradual) on inland freshwater lakes were assessed by observing changes in freshwater plankton communities under salinity stress. The findings indicate that increasing salinity has a negative impact on plankton community composition, density and biodiversity. Zooplankton were more sensitive to changes in salinity than phytoplankton through 10 consecutive days of experiments. Moreover, the plankton community showed some ability to recover itself at low salinities (S≤6.5 PSU). In terms of the rate of ballast water discharge, plankton were more likely to survive in aquatic environments with gradual changes in salinity than with abrupt changes. This research is of great significance for the scientific management of ballast water discharge in freshwater ports and the conservation of freshwater ecosystems.

Benefits and limitations of clinical assessment of abnormal vaginal discharge etiology

Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”.A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination.This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicineto prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.

Study on the Prediction of Runoff Usability in Kaihua County

Small hydropower is an important infrastructure for people's livelihoods and clean renewable energy, but there are still many weak links in the planning, design, construction, operation, and management of small hydropower in some regions. Kaihua County is located at the source of the Qianjiang River, and the rational development and utilization of its water resources are of great significance for protecting the water ecological environment at the source of the Qianjiang River and achieving the development strategy goal of "ecological county and characteristic county" in Kaihua County. To alleviate the water reduction caused by the development and utilization of watershed hydropower and rural hydropower interception and diversion, and further provide data support for the assessment of small hydropower cleaning and rectification in Kaihua County, At the same time, it also provides data basis for the ecological flow management of small hydropower discharge. This article conducted a study on the available amount of runoff in Kaihua County. This article uses the ANFIS model to predict the runoff at Misai Station in Kaihua County. The simulation and prediction relative errors of this model can meet the error requirements, and this model can be applied to predict the runoff at Misai Station in Kaihua County. Using the simulated model for prediction, the runoff depth of Misai Station in Kaihua County in 2022 is approximately 2450.420. In 2023, the runoff depth of Misai Station in Kaihua County is approximately 2146. In 2024, the runoff depth of Misai Station in Kaihua County is approximately 771.16. The predicted results can provide a reference basis for the development of hydropower resources in Kaihua County and the regulation of discharge flow of the hydropower station in Kaihua County.

Spawning Locations of Pallid Sturgeon in the Missouri River Corroborate the Mechanism for Recruitment Failure

Conservation propagation of pallid sturgeon (Scaphirhynchus albus) upstream of Fort Peck Reservoir, MT, USA, has successfully recruited a new generation of spawning-capable pallid sturgeon where there would otherwise be fewer than 30 remaining wild reproductively mature pallid sturgeon. Successful recovery of pallid sturgeon will now rely on the behavior of pallid sturgeon (e.g., successful spawning in locations that provide adequate drift distance for larvae to recruit). We used location data of pallid sturgeon during four putative spawning seasons to answer the following questions: Where do pallid sturgeon spawn? Are spawning locations related to discharge? Are substrate characteristics at the spawning locations similar to other river reaches? Do spawning-capable females, spawning-capable males, and female pallid sturgeon undergoing mass ovarian follicular atresia use the river similarly? Additionally, we considered if spawning locations are far enough from the river–reservoir transition zone to provide adequate drift distance for larvae to recruit. Spawning-capable pallid sturgeon did explore upstream locations, and four spawning-capable pallid sturgeon were located in the Marias River during the spawning season in 2018 when discharge was at an unprecedented high. Pallid sturgeon exited the Marias River and moved downstream prior to spawning, and when spawning occurred, it was not far enough upstream to prevent larvae from entering the transition zone of Fort Peck Reservoir. Thus, management of discharge and water temperature to mimic 2018 conditions may increase use of the Marias River by pallid sturgeon during the spawning season, which would increase drift distance available to larvae and increase the probability of successful recruitment.