Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of Strategies and Outcomes in Maternal and Child Health

Maternal and child mortality, particularly during the neonatal period, are among the most challenging global health issues of this era. This burden disproportionately affects the poorest populations, across and within countries. And although many of these deaths would be avertable, improvements in most countries have been slow. This dissertation explores three main research questions: (1) what is the effect of maternal health on infant outcomes? ; (2) what survival gains could be attained through improved interventions, across the continuum of care? ; and (3) how do health system characteristics affect the potential impact and cost-effectiveness of such interventions? The first paper uses decision modeling to evaluate how increased use of family planning and of improved intrapartum care could reduce maternal deaths in Nepal—as well as the cost-effectiveness of doing so, and of accompanying interventions to achieve these targets. The second paper estimates the potential impact of administering interventions from the Safe Childbirth Checklist at health facilities in India, and how “real world” implementation might see different results due to health system characteristics. Lastly, the third paper examines child survival outcomes following a maternal death in Ethiopia, using a long-term household-level longitudinal dataset. Together, these papers aim to provide new insights on approaches to reducing the high level of mortality among women and children.
The GlobalEd Project: Problem-solving and decision making in a web-based PBL

The GlobalEd Project is a problem-based learning simulation delivered via the web for middle and high school students as their classes are assigned the role of a specific country with the goal of negotiating a treaty with one of the other participating classes/countries during a five-week period. A repeated measures ANOVA conducted on a Knowledge scale indicated a significant preto post-test increase; that females were more interested in school than males; and females reported an increase in behaviors over the simulation, while males reported a decrease. The results are discussed within the PBL framework.
Robust outer volume suppression utilizing elliptical pulsed second order fields (ECLIPSE) for human brain proton MRSI

The robust and reliable utilization of proton magnetic resonance spectroscopic imaging (MRSI) at high fields is hampered by several key technical difficulties, including contamination from extracranial lipids. To that end, this work presents novel lipid suppression sequences for proton MRSI in the human brain utilizing elliptical localization with pulsed second‐order fields (ECLIPSE).
Association between severe periodontitis and chronic kidney disease severity in pre-dialytic patients: A cross-sectional study.

OBJECTIVE The aim of this cross-sectional study was to evaluate the association between periodontitis and different severities of Chronic Kidney Disease(CKD) in pre-dialytic patients. MATERIALS AND METHODS Demographic, socioeconomic and medical data of 139 patients from the nephrology service of one university hospital in Porto Alegre, Brazil were obtained through interview and clinical records. Full-mouth six-sites-per-tooth periodontal examinations were performed. Associations between periodontitis, stages of CKD and estimated glomerular filtration rate(eGFR) were estimated by multivariable models adjusted for sex, smoking, vitamin-D supplementation, physical activity and renal treatment duration. CKD was classified based on eGFR(<60 ml/min/1.73m2 ) estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS Patients with severe periodontitis, compared to those without severe periodontitis, had 2.8(CI95%1.25-6.62) and 3.4(CI95%1.27-9.09) times higher risk of being in stages 4 and 5 of CKD, respectively. Having ≥ 2 teeth with clinical attachment loss(CAL) ≥6mm increased 3.9 times the risk of being in stage 5 of CKD. Patients with severe periodontitis and ≥ 2 teeth with CAL ≥ 6mm had 4.4ml/min/1.732 and 5.2 ml/min/1.732 lower eGFR(p-values < 0.05), respectively. CONCLUSION Severe periodontitis was associated with poor renal conditions in pre-dialytic CKD patients, strengthening the importance of periodontal evaluation in such patient population.
Weights of Fetal Membranes and Umbilical Cords: Correlation With Placental Pathology

Introduction Proper placental gross examination requires weighing the placental disc trimmed of fetal membranes and the umbilical cord. However, untrimmed placental weights are often reported, both in cases submitted for consultation and in publications. Thus, determining the contribution of membranes and cords to untrimmed placental weights would be helpful in estimating the true trimmed weight of placentas. We sought to report the average weights of membranes and cord in term placentas and to correlate these weights with common placental pathologies. Methods A total of 500 consecutive placentas delivered between 36 and 42 weeks gestational age were subjected to a modified grossing protocol, in which the weight of the trimmed and untrimmed placentas, fetal membranes, and umbilical cords were recorded. Acute chorioamnionitis, meconium, maternal vascular malperfusion, and fetal vascular malperfusion were included as pathologic correlates. Clinical data such as the presence of fetal hydrops, intrauterine growth restriction, intrauterine fetal demise, and maternal diabetes were also recorded. Results The mean weights of the trimmed placenta, fetal membranes, and umbilical cords were 442 g (180–805 g), 47.2 g (16–108 g), and 37.9 g (9–126 g), respectively. The fetal membranes and umbilical cord weights contributed a mean of 16% to the total untrimmed placental weight. Meconium was associated with heavier fetal membranes. Fetal vascular malperfusion was associated with longer umbilical cord and thus also with heavier umbilical cords. Maternal vascular malperfusion and intrauterine growth restriction were associated with lighter placentas. Discussion The trimmed placental disc weight may be estimated by subtracting 16% (ie, weight of the fetal membranes and umbilical cord) from the untrimmed placental weight, or alternatively by subtracting the mean weight of the membranes and umbilical cord. It is important to consider the effects of meconium, fetal and maternal vascular malperfusion, and intrauterine growth restriction on membrane and cord weights when estimating the trimmed placental disc weight.
Long-Term Objective Adherence to Mandibular Advancement Device Therapy Versus Continuous Positive Airway Pressure in Patients With Moderate Obstructive Sleep Apnea.

STUDY OBJECTIVES Comparable health effects of mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy have been attributed to higher adherence with MAD compared with CPAP therapy. The objective of this study was to make a direct comparison of the objective adherence between MAD and CPAP in patients with moderate obstructive sleep apnea (OSA). METHODS Adherence was monitored for 12 months in 59 patients with moderate OSA (apnea-hypopnea index 15-30 events/h) as part of a randomized controlled trial. Objective adherence with MAD was assessed using the TheraMon microsensor. Objective adherence with CPAP was assessed using the built-in registration software with readout on SD card. Self-reported adherence with both therapies was assessed using a questionnaire. RESULTS Forty patients (68%) completed the study with the therapy to which they were randomly assigned. Median (interquartile range) objective adherence (h/night) in the 3rd month was 7.4 (5.2-8.2) for MAD and 6.8 (5.7-7.6) for CPAP (P = .41), compared to 6.9 (3.5-7.9) with MAD and 6.8 (5.2-7.6) with CPAP (P = .85) in the 12th month. There were no significant changes between the 3rd and 12th month for both MAD (P = .21) and CPAP (P = .46). Changes in adherence were not significantly different between MAD and CPAP (P = .51). Self-reported adherence was significantly higher with MAD than CPAP at all follow-ups. Self-reported adherence with CPAP was lower than objective CPAP adherence at the 6th and 12th month (P = .02). CONCLUSIONS Objective adherence with MAD and CPAP is comparable and consistent over time. Self-reported adherence is higher with MAD than with CPAP giving rise to interesting discrepancy between objective and self-reported adherence with CPAP. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT01588275.
Policies to Create Healthier Food Environments in Canada: Experts’ Evaluation and Prioritized Actions Using the Healthy Food Environment Policy Index (Food-EPI)

Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored ‘high’ compared to best practices for 3 indicators, ‘moderate’ for 14 indicators, ‘low’ for 25 indicators, and ‘very little or none’ for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.
Effects of depression on the condition of older inpatients with fracture and preexisting cognitive impairment

Abstract Aim Few studies of depression have examined older inpatients with fracture and preexisting cognitive impairment. The current study sought to confirm whether depression affects the condition of older inpatients with fracture who also have cognitive impairment, and to investigate the extent to which depression affects activities of daily living. Methods This was a retrospective cross-sectional study. The subjects were older inpatients with fracture and preexisting cognitive impairment. We examined data within 1 week of hospitalization, obtained from medical records. The data included demographic information, the motor Functional Independence Measure, Charlson Comorbidity Index, Mini-Mental State Examination, Geriatric Depression Scale 15, Geriatric Nutritional Risk Index, Skeletal Muscle Index and maximum grip strength test. These variables were compared between the two groups (with and without depression), and multiple regression analysis was performed with the motor Functional Independence Measure as the dependent variable. Results The subjects were 68 patients. Only the motor Functional Independence Measure was significantly lower in the depression group than the non-depression group. Multiple regression analysis confirmed that depression strongly affected activities of daily living. Conclusions In considering the recovery of older inpatients with fracture and preexisting cognitive impairment, it is important to take the effects of depression into account. Implications for rehabilitation The number of older fracture inpatients with cognitive impairment is predicted to increase, and such patients have a high prevalence of depression. Depression strongly affected Activities of Daily Living in older inpatients with fracture and pre-existing cognitive impairment. Focusing on depression assessment and intervention is important for rehabilitation of older fracture inpatients with cognitive impairment.
Comparison of anti-inflammatory effects of intense pulsed light with tobramycin/dexamethasone plus warm compress on dry eye associated meibomian gland dysfunction.

AIM To compare the anti-inflammatory effects of intense pulsed light (IPL) with tobramycin/dexamethasone plus warm compress through clinical signs and cytokines in tears. METHODS Eighty-two patients with dry eye disease (DED) associated meibomian gland dysfunction (MGD) were divided into two groups. Group A was treated with IPL, and Group B was treated with tobramycin/dexamethasone plus warm compress. Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), corneal fluorescein staining (CFS), meibomian gland expressibility (MGE), meibum quality, gland dropout and tear cytokine levels were evaluated before treatment, 1wk and 1mo after treatment. RESULTS TBUT in Group A was higher (P=0.035), and MGE score was lower than Group B at 1mo (P=0.001). The changes of interleukin (IL)-17A and IL-1β levels in tears were lower in Group A compared with that in Group B at 1wk after treatment (P=0.05, P=0.005). CONCLUSION Treatment with IPL can improve TBUT and MGE and downregulate levels of IL-17A and IL-1β in tears of patients with DED associated MGD better than treatment with tobramycin/dexamethasone plus warm compress in one-month treatment period.
Influence of Cooking and Ingredients on the Antioxidant Activity, Phenolic Content and Volatile Profile of Different Variants of the Mediterranean Typical Tomato Sofrito

In this study, six different sofrito formulations were compared with the raw recipe for total phenolic content (TPC), antioxidant activity tested by 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric-reducing antioxidant power (FRAP) and 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) methods. The volatile profile was also obtained by the headspace solid-phase microextraction-gas chromatography mass spectrometry (HS-SPME-GC–MS) procedure. The cooking process and the addition of herbs, and garlic improved the final content of antioxidant compounds compared to the basic recipe and the raw ingredients. The total volatile content was higher in the samples that contained rosemary and thymus. Some of the volatiles had proven antioxidant properties and for that reason the sofrito with rosemary with the higher volatile content was also the one with the higher antioxidant capacity and TPC. In conclusion, as well as the processing technique, the addition of selected typical Mediterranean herbs apart from given flavour can contribute to improving the nutritional antioxidant profile of dishes and be used as a natural method to increase the shelf-life of preparation.
Capecitabine and Temozolomide versus FOLFIRI in RAS-Mutated, MGMT-Methylated Metastatic Colorectal Cancer

Purpose: To determine whether second-line therapy with capecitabine and temozolomide was superior to irinotecan, leucovorin, and fluorouracil (FOLFIRI) in patients with RAS-mutated, methyl-guanine methyltransferase (MGMT)-methylated metastatic colorectal cancer (mCRC). Patients and Methods: In this randomized, phase II trial, we enrolled patients with RAS-mutated, MGMT-methylated mCRC after failure of oxaliplatin-based regimen. Patients with centrally confirmed MGMT methylation were stratified by first-line progression-free survival (PFS) and prior bevacizumab and randomized to either capecitabine plus temozolomide (arm A, CAPTEM) or FOLFIRI (arm B). The primary endpoint was PFS analyzed on intention-to-treat basis, with 90% power and one-sided significance level of 0.05 to detect an increase of median time from 2 months in arm B to 4 months in arm A. Results: Between November 2014 and May 2019, 86 patients were randomly assigned to arm A (n = 43) or arm B (n = 43). After a median follow-up of 30.5 months (interquartile range, 12.2–36.3), 79 disease progression or death events occurred. Superiority of arm A was not demonstrated (one-sided P = 0.223). Progression-free survival and overall survival were 3.5 (2.0–5.0) and 9.5 (8.2–25.8) in arm A versus 3.5 (2.3–6.1) and 10.6 (8.5–20.8) in arm B [HR = 1.19 (0.82–1.72) and HR = 0.97 (0.58–1.61)], respectively. Grade ≥3 treatment-related adverse events had higher incidence in arm B versus A (47.6% vs 16.3%), and quality of life was significantly worse in arm B. Patients with positive MGMT expression by IHC did not benefit from CAPTEM. Conclusions: Temozolomide-based therapy warrants further investigation in molecularly hyperselected subgroups.
MERS-CoV in Camels but Not Camel Handlers, Sudan, 2015 and 2017

We tested samples collected from camels, camel workers, and other animals in Sudan and Qatar in 2015 and 2017 for evidence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. MERS-CoV antibodies were abundant in Sudan camels, but we found no evidence of MERS-CoV infection in camel workers, other livestock, or bats.
THE ROLE OF THE ENVIRONMENTAL CONTEXT IN ADVANCE CARE PLANNING AMONG OLDER ADULTS

Abstract Little is known about how environmental context shapes individuals’ advance care planning (ACP). We combined ACP information from the Wisconsin Longitudinal Study with county-level characteristics from the Area Health Resource File, Dartmouth Atlas, and US Census. Multilevel logistic regression models showed that local sociodemographic characteristics (e.g., rurality, racial/ethnic makeup, age composition, and prevalence of one-person households) and healthcare characteristics (e.g., number of hospice agencies, Medicare reimbursement rates) were related to rates of ACP. Additionally, the following environmental factors were moderated by both individual household income and educational attainment, Medicare physician reimbursement rate, racial/ethnic makeup, age composition, median household income, rurality, and the number of hospice agencies. These findings suggest that the environmental context of an individual’s residence can impact their engagement in ACP. Evidence from this study may be used to target areas for, and guide the design of, effective intervention strategies to help increase ACP at an environmental level.
Avian Influenza A Viruses among Occupationally Exposed Populations, China, 2014–2016

To determine the seroprevalence and seroconversion of avian influenza virus (AIV) antibodies in poultry workers, we conducted a seroepidemiologic study in 7 areas of China during December 2014–April 2016. We used viral isolation and reverse transcription PCR to detect AIVs in specimens from live poultry markets. We analyzed 2,124 serum samples obtained from 1,407 poultry workers by using hemagglutination inhibition and microneutralization assays. We noted seroprevalence of AIV antibodies for subtypes H9N2, H7N9, H6N1, H5N1-SC29, H5N6, H5N1-SH199, and H6N6. In serum from participants with longitudinal samples, we noted seroconversion, with >4-fold rise in titers, for H9N2, H7N9, H6N1, H5N1-SC29, H6N6, H5N6, and H5N1-SH199 subtypes. We found no evidence of H10N8 subtype. The distribution of AIV antibodies provided evidence of asymptomatic infection. We found that AIV antibody prevalence in live poultry markets correlated with increased risk for H7N9 and H9N2 infection among poultry workers.
Highly Pathogenic Avian Influenza A(H5N8) Virus in Gray Seals, Baltic Sea

We detected a highly pathogenic avian influenza A(H5N8) virus in lung samples of 2 gray seals (Halichoerus grypus) stranded on the Baltic coast of Poland in 2016 and 2017. This virus, clade 2.3. 4.4 B, was closely related to avian H5N8 viruses circulating in Europe at the time.
Non-Polar Organic Dispersion of 2D Ti3C2Tx MXene Flakes via Simultaneous Interfacial Chemical Grafting and Phase Transfer Method.

Herein, we demonstrate a simple and versatile way for preparing stable Ti3C2Tx MXene dispersions in non-polar organic solvents through a simultaneous interfacial chemical grafting reaction and phase transfer method. Alkylphosphonic acid ligands were chemically grafted on the hydroxyl terminal groups of Ti3C2Tx flakes at the liquid-liquid interface between water and water-immiscible organic medium to form a covalent Ti-O-P bond via interfacial nucleophilic addition and sequential condensation reaction at room temperature; the surface-functionalized Ti3C2Tx flakes concurrently migrated from the aqueous phase to the organic phase. Unlike conventional surface chemical modification methods that require many complex and tedious steps, this is a simple and easy process for fabricating a Ti3C2Tx organic dispersion in various organic solvents, from highly polar to non-polar solvent. The non-polar Ti3C2Tx dispersion in chloroform exhibits strong oxidation resistance and stable long-term storage. This approach provides an opportunity for preparing MXene nanocomposites with non-polar polymeric matrices that are soluble in organic media for future applications such as stretchable electrode.
Sleep Difficulties in Preschoolers with Psychiatric Diagnoses

Background: Sleep problems among preschoolers are highly prevalent. Given the impact of poor sleep quality on development, this relationship is particularly relevant in vulnerable populations but is less documented. This study aims to document parental perception of sleep problems in preschoolers assessed in a psychiatric clinic, as a function of diagnosis type. Methods: Children (14–71 months, n = 228) were evaluated by a psychiatrist, and diagnoses were pooled into four categories: behavioral disorders, relational disorders/psychosocial problems, developmental coordination disorder (DCD), and communication disorders. Sleep problems were measured using the Child Behavior Checklist (CBCL). Results: In this clinical sample of preschoolers, 21.6% of children were identified as having a sleep problem by their parents. Behavioral disorders and communication disorders were associated with increased parental report of sleep problems (respectively, trouble falling asleep and nighttime awakenings), while DCD was associated with lower parental report of sleep problems (fewer nighttime awakenings and less difficulty falling asleep) (p < 0.05). Relational disorders were not associated with parental reports of sleep difficulties (p > 0.05). Moreover, some psychiatric categories were associated with specific sleep symptoms (such as difficulty falling asleep and night awakenings). Conclusion: Parents of preschoolers with behavioral disorders and communication disorders are more likely to report sleep problems in their children than parents of preschoolers with DCD and relational disorders. Since different categories of psychiatric disorders are associated with specific types of sleep complaints, screening, and treatment should be adapted accordingly.