bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial properties of cotton fabrics coated with silicone rubber/ZnO nanocomposites under the effect of UV irradiation
Authors: Hassan Mahmoud S , Attia Mona K , Attia RM
Published: September 2022

In order to enhancement the antimicrobial properties and the thermal stability of the cotton fabrics for outdoor uses, they were coated with formulations of room-temperature vulcanizing silicone rubber (RTVSR)/synthesized zinc oxide nanoparticles (ZnO NPs). The coated fabrics were adjusted to different doses of ultraviolet (UV) irradiation, which act as a crosslinking factor to the silicone rubber, rather than as a photocatalytic agent for enhancing the antimicrobial activity of the ZnO NPs. The synthesized ZnO NPs were characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM); meanwhile, its impurity was examined using energy dispersive X-ray (EDS) analysis. The thermal stability and surface morphology of the coated fabrics were characterized by thermogravimetric analysis (TGA) and scanning electron microscopy (SEM). The results showed that the mechanical strength (MPa) of the coated fabrics was enhanced by ∼11% after UV irradiation for 120 min, accompanied by decrease in its swelling and solubility by ∼10 and 20%, respectively, as a result of UV crosslinking effect upon RTVSR. Meanwhile, the antimicrobial activity of the coated fabrics was enhanced by ∼50%, as a result of the photocatalytic effect of UV irradiation (120 min), at the constant percentage of 3% (ZnO NPs) in the coating formulations.
Tensile strength of reinforced laminates after oblique ballistic impact: An experimental study
Authors: Randjbaran Elias , Abdul Majid Dayang Laila , Sultan MTH , Mazlan Norkhairunnisa , Zahari Rizal
Published: September 2022

The present study endeavoured to examine the tensile strength of the laminates, which were made of carbon/Kevlar hybrid reinforced fibre with carbon nanotubes (CNTs) post oblique impacts. Although a number of experimental investigations on tensile properties of CNTs have been already performed, the coupling effects of CNTs and oblique impacts on tensile strength have yet to be reported. Due to the superior elastic modulus, the advanced nano-fillers were chosen as reinforcement of the carbon/Kevlar hybrid fibre. The inter-ply woven fabric possess high strength and excellent toughness due to the carbon and Kevlar fibre respectively and therefore well suited for ballistic impact applications. In spite of the fact that the effects of direct impact is most detrimental and widely reported, the effect of nano-fillers on the tensile integrity of oblique impacted specimens are of primary interest as most impact events are random in nature. CNTs with 0.1–1.5% loading ratios are dispersed into the epoxy resin and intra-ply Carbon Kevlar hybrid fabrics composite plates are fabricated via hand layup process. A loading of minimum 0.1% to maximum 1.5% CNTs were dispersed into liquid epoxy resin. The reinforced epoxy resin was applied to carbon/Kevlar fabric composite by layup process. Inclusion of CNT revealed depreciating mechanical properties in terms of tensile toughness; however, the inclusion demonstrated a potential reinforcement in a high modulus/strength in composite laminate’s specimens. Findings indicated that 0.7% of CNT had maximum tensile toughness values; whereas, the highest values of Young modulus were followed by tensile strength at 1.5% CNT. Moreover, compared with other factors, the impact load had a great influence on its specimens’ strength, and the effects of angled targets on the impact load of the specimens as well as CNTs' value were mostly obvious. Consequently, this investigation may be considered as a practical basis for designing and optimising of CNT contents and possible angle degrees and analysing tensile behaviour after the impact events.
The influence of structure uniformity on resonant frequency of ultra-high frequency radio frequency identification tag thread With normal mode helix dipole antenna
Authors: Zhang Yong , Meng Fenye , Hu Jiyong , Yan Xiong , Yang Xudong
Published: September 2022

The stable performance of ultra-high frequency radio frequency identification (UHF RFID) tag thread with normal mode helical dipole antenna (NMHDA) was required for industrialized application. The ununiform helical pitches and helical radiuses caused by the unstable tension in the preparation process and material properties of carrying yarn probably deteriorate the performance of UHF RFID tag thread with NMHDA, while previous work focused on the properties of UHF RFID tag thread with uniform structure by finite element simulation. This work conducted numerical experiments with the actual statistical distribution of helical pitch and helical radius, i.e. normal distribution, and discussed the influence of the distributed parameters on resonant frequency. And then, the relationship between structure uniformity and resonant frequency was explored. Furthermore, the relationship was put into practice of the design of UHF RFID tag thread with stable properties. The results show that the fluctuation of resonant frequency first decreases and then increases with the increase of the mean helical pitch ( S me), and the resonant frequency decreases with the increase of the standard deviation of helical pitch ( S st) and that of helical radius ( r st). When the reactance of helical coil linearly changes with helical radius, the mean helical radius ( r me) has a negligible effect on the fluctuation of resonant frequency. The importance of the factors for the resonant frequency conforms to the following order: r me> S st> S me> r st. Additionally, the stable reading range of prototype (14.13 ± 0.06 m) demonstrated the practice of these results in the design of UHF RFID tag thread with NMHDA.
Dimensional stability, density, void and mechanical properties of flax fabrics reinforced bio-phenolic/epoxy composites
Authors: Ismail Ahmad Safwan , Jawaid Mohammad , Hamid Norul Hisham , Yahaya Ridwan , Sain Mohini , Sarmin Siti Noorbaini
Published: September 2022

Due to the growing trend to promote alternative materials, the use of cellulosic fibers as filler/reinforcement in polymer composites has increased in popularity. The objective of this research is to determine the effect of flax fabric loading on the physical and mechanical properties of bio-phenolic/epoxy composites. The composites were fabricated using hand lay-up method in a mould and cured using a hot press. Bio-phenolic/epoxy blend was fabricated as control. The sample was tested for physical, tensile, flexural, impact and morphological properties. The result showed that, increasing the flax fabric loading has increased the water absorption and density of composites. The highest water absorption density was shown by the composite with 50 wt% flax fabric loading which is 3.73% and 1.23 g/cm3. In addition, there is no significant difference in void content for all composites. Moreover, the incorporation of flax fabric as reinforcement has improved the mechanical properties of composites. According to the morphological analysis results of the experiments, there was a good bonding interaction between the flax fabric and bio-phenolic/epoxy. The highest tensile strength, tensile modulus and impact strength was shown by composite with 50 wt% flax fabric which was 105.04 MPa, 9.10 GPa and 11.94 kJ/m2 respectively while composite with 40 wt% showed the highest flexural strength and modulus which was 150.45 MPa and 8.4 GPa respectively. It was concluded that, bio-phenolic/epoxy blend reinforced with 50 wt% flax fabric showed the best overall mechanical properties and it will be used in the future study to fabricate carbon/kevlar/flax reinforced bio-phenolic/epoxy for ballistic helmet application.
Potential Functions of the tRNA-Derived Fragment tRF-Gly-GCC Associated With Oxidative Stress in Radiation-Induced Lung Injury
Authors: Deng Lin , Wang Housheng , Fan Ting , Chen Liuyin , Shi Zhiling , Mi JingLin , Huang WeiMei , Wang Rensheng , Hu Kai
Published: September 2022

Objective

Transfer RNA-derived small RNAs (tsRNAs) are a novel type of non-coding RNA with various regulatory functions. They are associated with oxidative stress in various diseases, but their potential functions in radiation-induced lung injury (RILI) remain uncertain.

Methods

To explore the role of tsRNAs in RILI, we used X-rays to irradiate human bronchial epithelial cells and examined the expression profile of altered tsRNAs by RNA sequencing and bioinformatics analysis. Sequencing results were verified by qRT-PCR. tsRNA functions were explored using several methods, including CCK-8, reactive oxygen species (ROS) assays, cell transfection, and western blotting.

Results

Eighty-six differentially expressed tRNA-derived fragments (tRFs) were identified: 64 were upregulated, and 22 were downregulated. Among them, the regulation of tRF-Gly-GCC, associated with oxidative stress, may be mediated by the inhibition of cell proliferation, promotion of ROS production, and apoptosis in the occurrence and development of RILI. A Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis suggested that the underlying molecular mechanism may involve the PI3K/AKT and the FOXO1 signaling pathways.

Conclusion

Our findings provide new insights into the molecular mechanisms underpinning RILI, advancing the clinical prevention and treatment of this disease.
From human-centric digital health to digital One Health: Crucial new directions for mutual flourishing
Authors: Lupton Deborah
Published: September 2022

This brief communication puts forward an argument for expanding the concept of ‘digital health’ to that of ‘digital One Health’ by going beyond a human-centric approach to incorporating nonhuman agents, including other living things, places and space. One Health approaches recognise the interconnected and ecological dimensions of human health and wellbeing, but rarely focus on the role of digital technologies. A set of key questions can take the idea of digital One Health forward: (i) How can we learn more about and establish deeper connections with other animals and the natural environment through digital media, devices and data?; (ii) How can we attune humans to these more-than-human worlds using digital technologies, cultivating attentiveness and responsiveness?; (iii) How can we better develop and implement digital technologies that support the health and wellbeing of the planet and all its living creatures (including humans) so that all can flourish?; and (iv) How can digital technologies affect ecological systems, for better or for worse? Developing digital One Health expands both the digital health field and the One Health perspective, leading them into crucial new directions for mutual flourishing.
Vietnamese EFL Students’ Use and Misconceptions of Cohesive Devices in Writing
Authors: Bui Hung Phu
Published: September 2022

As part of a larger project, this study explores Vietnamese college students’ use and concepts of cohesive devices in writing. Cohesion is a crucial element that ties components of a text together. Although the use of cohesive devices in L2 writing has been investigated by a large body of research, there is no such study exploring the effects of L2 learners’ misconceptions of this word class. One hundred sixty-eight academic reports of totally 67,400 words written by Vietnamese final-year English-majored undergraduate students were collected for data analysis. An email invitation was sent, and 23 students accepted to participate in semi-structured interviews which were audio-recorded for analysis. The findings showed that the students employed references, conjunctions, and lexical items the most frequently in writing. Interestingly, the students’ cohesion use and errors had similar patterns. The transcript analysis showed that the students’ misconceptions of some language items and writing requirements affected their choice of cohesive devices. The current study gives implications for teaching and learning of this word class in L2 contexts.
Changes in Social, Economic, and Health Risk Factors Across the Lifespan during the COVID-19 Pandemic: A Latent Transition Analysis
Authors: Jackson Alexandra , Weaver Raven H. , Weybright Elizabeth , Lanigan Jane , Parker Louise , Iniguez Anaderi , Decker Autumn
Published: September 2022

The COVID-19 pandemic led to unique, pervasive, and changing global impacts. It is imperative to characterize groups of individuals based on modifiable factors, and to describe how groups have been impacted by the continuing pandemic in the United States to promote health and well-being and to inform preventive interventions. We used latent transition analysis to identify subgroups of modifiable psychosocial, economic, and health risk factors; to explore subgroup shifts across time; and to assess the prevalence of non-modifiable factors associated with subgroup membership. We recruited 450 participants 18 years and older living in the United States to complete a longitudinal survey exploring health during the pandemic. Participants completed three waves of data collection from April to November 2020. We used latent transition analysis to identify statuses, shifts in prevalence over three waves, and the relationships of non-modifiable covariates with each status. Five statuses were identified: high risk together, low risk together, high risk alone, low risk alone, and financial risk together. Statuses were relatively stable over time; the majority (60%–66%) of participants were in statuses categorized by multiple indicators of high modifiable risk, and the largest transitions were to lower risk subgroups. Increasing age, being male, and living in an urban area were the only non-modifiable covariates associated with status membership. It is imperative to continue to scale up targeted interventions aimed at promoting resilience, well-being, financial well-being, delays in healthcare use, food insecurity, and depression among individuals in higher-risk subgroups to promote health and well-being.
Seismic safety of informally constructed reinforced concrete houses in Puerto Rico
Authors: Murray Polly B , Feliciano Dirsa , Goldwyn Briar H , Liel Abbie B , Arroyo Orlando , Javernick-Will Amy
Published: September 2022

More than 1.6 billion people worldwide live in informally constructed houses, many of which are reinforced with concrete. Patterns of past earthquake damage suggest that these homes have significant seismic vulnerabilities, endangering their occupants. The characteristics of these houses vary widely with local building practices. In addition, these vulnerabilities are potentially exacerbated by incremental construction practices and building practices that address wind/flood risk in multi-hazard environments. Yet, despite the ubiquity of this type of construction, there have not been efforts to systematically assess the seismic risks to support risk-reducing design and construction strategies. In this study, we developed a method to assess the seismic collapse capacity of informally constructed housing that accounts for local building practices and materials, quantifying the effect of building characteristics on collapse risk. We exercise the method to assess seismic performance of housing in the US. Caribbean Island of Puerto Rico, which has high seismic hazard and experiences frequent hurricanes. This analysis showed that heavy construction, often due to the addition of a second story, and the presence of an open ground story leads to a high collapse risk. Severely corroded steel bars could also worsen performance. Although houses with infill performed better than those with an open ground story, confined masonry construction techniques produced a major reduction in collapse risk when compared to infilled or open-frame construction. Infill construction with partial height walls performed very poorly. Well-built reinforced concrete column jackets and the addition of infill in open first-story bays can reduce the greater risks of open-ground-story houses. These findings, which are quantified in the results portion of this article, are intended to support the development of design and construction recommendations for safer housing.
Efficient removal of crystal violet from solution by montmorillonite modified with docosyl-trimethylammonium chloride and sodium dodecyl sulfate: modelling, kinetics and equilibrium studies
Authors: Sarabadan Malihe , Bashiri Hadis , Mousavi Seyed Mahdi
Published: September 2022

Two novel modified montmorillonite (Mnt) components were prepared using Mnt nanoparticles and two surfactants: docosyl-trimethylammonium chloride (BTAC) and sodium dodecyl sulfate (SDS). These modified Mnts were used to remove a carcinogenic and harmful dye, crystal violet (CV), from solution. Optimization and modelling studies of the adsorption of these two modified Mnts were performed using response surface methodology. Four influential variables (concentration of adsorbent, temperature, pH and CV concentration) were studied to obtain the optimum conditions for CV removal. The optimal values of these variables for the two modified Mnts yielded 100% dye-removal efficiency. The optimum conditions for CV adsorption on Mnt-BTAC and Mnt-BTAC-SDS, respectively, are temperatures of 25.00 and 33.29°C, pH values of 9 and 10.1, CV concentrations of 50.00 and 10.44 mg L–1 and adsorbent concentrations of 1.00 and 0.98 g L–1. In equilibrium studies of the two modified Mnts, the Temkin isotherm was selected as an appropriate model, and in kinetic studies of these Mnts, the fractal-like integrated kinetics Langmuir model was found to be the best model. The Mnt-BTAC-SDS component is an affordable adsorbent with high adsorption capacity for CV.
Dabigatran in the treatment and secondary prophylaxis of venous thromboembolism in children with thrombophilia
Authors: Brandão Leonardo R. , Tartakovsky Igor , Albisetti Manuela , Halton Jacqueline , Bomgaars Lisa , Chalmers Elizabeth , Luciani Matteo , Saracco Paola , Felgenhauer Judy , Lvova Olga , Simetzberger Monika , Sun Zhichao , Mitchell Lesley G.
Published: September 2022

In the phase 2b/3 DIVERSITY trial, 3 months treatment with dabigatran was noninferior to standard of care (SOC) for acute venous thromboembolism (VTE) in children. In a single-arm, phase 3, secondary VTE prevention study, up to 12 months dabigatran use was associated with favorable safety. Dabigatran is approved by the European Medicines Agency and US Food and Drug Administration for pediatric indications. We assessed primary composite efficacy (complete thrombus resolution and freedom from VTE recurrence/VTE-related death) in subgroups with thrombophilia vs those with negative/unknown thrombophilia status in the DIVERSITY trial and safety in both studies. Thrombophilia types were similar between the DIVERSITY trial (total population) and secondary prevention studies: factor V Leiden, 42% vs 33%; prothrombin mutation (G20210A), 19% vs 17%; antithrombin deficiency, 15% vs 20%; protein C/S deficiency, 23% vs 25%; and antiphospholipid antibodies, 18% vs 20% of patients, respectively. In DIVERSITY, 36% and 22% of thrombophilia subgroup patients treated with dabigatran and SOC, respectively, met the primary end point (Mantel-Haenszel–weighted rate difference, −0.135; 95% confidence interval, −0.36 to 0.08; noninferiority P = .0014); comparable to the total DIVERSITY trial population (46% vs 42%) showing dabigatran noninferiority to SOC. Within this subgroup, numerically fewer patients experienced VTE recurrence or progression of index thrombus in the dabigatran treatment group vs SOC. In the secondary prevention study, VTE recurrence at 12 months occurred in 2.8% of patients with thrombophilia vs 0% with negative/unknown thrombophilia. Safety profiles were consistent with those reported previously. Although they should be interpreted with caution, these exploratory findings suggest dabigatran could be an appropriate long-term anticoagulant for children with thrombophilia. These trials were registered at www.clinicaltrials.gov as #NCT01895777 and #NCT02197416.
Production and nonclinical evaluation of an autologous iPSC–derived platelet product for the iPLAT1 clinical trial
Authors: Sugimoto Naoshi , Nakamura Sou , Shimizu Shin , Shigemasa Akiko , Kanda Junya , Matsuyama Nobuki , Tanaka Mitsunobu , Hayashi Tomoya , Fuchizaki Akihiro , Nogawa Masayuki , Watanabe Naohide , Okamoto Shinichiro , Handa Makoto , Sawaguchi Akira , Momose Dai , Koh Ki-Ryang , Tani Yoshihiko , Takaori-Kondo Akifumi , Eto Koji
Published: September 2022

Donor-derived platelets are used to treat or prevent hemorrhage in patients with thrombocytopenia. However, ∼5% or more of these patients are complicated with alloimmune platelet transfusion refractoriness (allo-PTR) due to alloantibodies against HLA-I or human platelet antigens (HPA). In these cases, platelets from compatible donors are necessary, but it is difficult to find such donors for patients with rare HLA-I or HPA. To produce platelet products for patients with aplastic anemia with allo-PTR due to rare HPA-1 mismatch in Japan, we developed an ex vivo good manufacturing process (GMP)–based production system for an induced pluripotent stem cell–derived platelet product (iPSC-PLTs). Immortalized megakaryocyte progenitor cell lines (imMKCLs) were established from patient iPSCs, and a competent imMKCL clone was selected for the master cell bank (MCB) and confirmed for safety, including negativity of pathogens. From this MCB, iPSC-PLTs were produced using turbulent flow bioreactors and new drugs. In extensive nonclinical studies, iPSC-PLTs were confirmed for quality, safety, and efficacy, including hemostasis in a rabbit model. This report presents a complete system for the GMP-based production of iPSC-PLTs and the required nonclinical studies and thus supports the iPLAT1 study, the first-in-human clinical trial of iPSC-PLTs in a patient with allo-PTR and no compatible donor using the autologous product. It also serves as a comprehensive reference for the development of widely applicable allogeneic iPSC-PLTs and other cell products that use iPSC-derived progenitor cells as MCB.
Analysis of controlling genes for tiller growth of Psathyrostachys juncea based on transcriptome sequencing technology
Authors: Li Zhen , Yun Lan , Ren Xiaomin , Shi Fengling , Mi Fugui
Published: September 2022

Background

Tillering is a complicated process in plant and is a significant trait that affects biomass and seed yield of bunch grass Psathyrostachys juncea, a typical perennial forage species. To clarify the regulatory mechanisms of tillering in P. juncea and to explore related candidate genes could be helpful to improve the seed and forage yield of perennial gramineous forages. We selected the tiller node tissues of P. juncea for transcriptome sequencing to determine the differentially expressed genes (DEG) between dense and sparse tillering genotypes. The metabolic pathway was studied, candidate genes were screened, and reference genes stability were evaluated.

Results

The results showed that approximately 5466 DEGs were identified between the two genotypes with dense and sparse tillers of P. juncea, which significantly differed in tiller number. Tillering regulation pathways analysis suggested that DEGs closely related to the biosynthesis of three plant hormones, namely auxin (IAA), cytokinin (CTK), and strigolactones (SLs), while “biosynthesis of lignin” and “nitrogen metabolism” have remarkable differences between the dense and sparse tillering genotypes. Meanwhile, the reference gene Actin1, having the best stability, was screened from twelve genes with highest expression level and was used in verification of ten tillering related candidate genes.

Conclusions

The tillering mechanism of perennial grass P. juncea was expounded by transcriptome analysis of tiller node tissues. We demonstrated that dense-tillering genotypes may be distinguished by their low expression patterns of genes involved in SL, IAA, and high expression patterns of genes involved in CTK biosynthesis at the tillering stage, and nitrogen metabolism and lignin biosynthesis can also affect the number of tillers. Furthermore, the expression level of ten tillering related candidate genes were verified using Actin1 as reference gene. These candidate genes provide valuable breeding resources for marker assisted selection and yield traits improvement of P. juncea.
Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case–control study
Authors: Bovonsunthonchai Sunee , Vachalathiti Roongtiwa , Hiengkaew Vimonwan , Bryant Mon S. , Richards Jim , Senanarong Vorapun
Published: September 2022

Background

Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups.

Methods

Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables.

Results

There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking.

Conclusions

Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.
Development of a risk prediction nomogram for sarcopenia in hemodialysis patients
Authors: Cai Genlian , Ying Jinping , Pan Mengyan , lang Xiabing , Yu Weiping , Zhang Qinqin
Published: September 2022

Background

Sarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early.

Methods

A total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method.

Results

The study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783.

Conclusions

This study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.
Gestational weight gain as a risk factor for dystocia during first delivery: a multicenter retrospective cohort study in Japan
Authors: Kyozuka Hyo , Hiraiwa Tsuyoshi , Murata Tsuyoshi , Sugeno Misa , Jin Toki , Ito Fumihito , Suzuki Daisuke , Nomura Yasuhisa , Fukuda Toma , Yasuda Shun , Fujimori Keiya
Published: September 2022

Background

Dystocia is a common obstetric complication among nulliparous women, which requires medical intervention and carries the risk of negative maternal and neonatal outcomes. Our aim was to examine the association between body mass index (BMI) and the occurrence of dystocia. We also identified cutoffs of gestational weight gain, based on pre-pregnancy BMI, associated with the risk of dystocia.

Methods

This was a multicenter, retrospective, cohort study conducted in two tertiary Maternal–Fetal medicine units in Fukushima, Japan. The study population included nullipara women who delivered at either of the two units between January 1, 2013, and December 31, 2020. Women (n = 2597) were categorized into six groups (G) based on their pre-pregnancy BMI: G1 (< 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), G5 (25.0 to < 30.0 kg/m2), and G6 (≥ 30.0 kg/m2). Using G3 as a reference, multiple logistic regression analyses were performed to estimate the risk of dystocia for each BMI category. Receiver operating characteristic curve analyses were performed to determine the cutoff value of gestational weight gain for the risk of dystocia.

Results

The highest BMI category (G6) was an independent risk factor for dystocia (adjusted odds ratio, 3.0; 95% confidence interval, 1.5–5.8). The receiver operating characteristic curve analysis revealed no association between gestational weight gain and the occurrence of dystocia in G5 and G6 (P = 0.446 and P = 0.291, respectively). For G1 to G4, AUC and predictive cutoffs of gestational weight gain for dystocia were as follows: G1, AUC 0.64 and cutoff 11.5 kg (P < 0.05); G2, AUC 0.63 and cutoff 12.3 kg (P < 0.05); G3, AUC 0.67 and cutoff 14.3 kg (P < 0.01); and G4, AUC 0.63 and cutoff 11.5 kg (P < 0.05).

Conclusion

A pre-pregnancy BMI > 30.0 kg/m2 was an independent risk factor for dystocia. For women with a pre-pregnancy BMI < 25.0 kg/m2, the risk of dystocia increases as a function of gestational weight gain. These findings could inform personalized preconception care for women to optimize maternal and neonatal health.
Regional variation in long-term care spending in Japan
Authors: Jin Xueying , Iwagami Masao , Sakata Nobuo , Mori Takahiro , Uda Kazuaki , Tamiya Nanako
Published: September 2022

Background

Health inequalities are widening in Japan, and thus, it is important to understand whether (and to what extent) there is a regional variation in long-term care (LTC) spending across municipalities. This study assesses regional variation in LTC spending and identifies the drivers of such variation.

Methods

We conducted a cross-sectional study using publicly available municipality-level data across Japan in 2019, in which the unit of analysis was municipality. The outcome of interest was per-capita LTC spending, which was estimated by dividing total LTC spending in a municipality by the number of older adults (people aged ≥ 65). To further identify drivers of regional variation in LTC spending, we conducted linear regression of per-capita spending against a series of demand, supply, and structural factors. Shapley decomposition approach was used to highlight the contribution of each independent variable to the goodness of fit of the regression model.

Results

In Fiscal 2019, per-capita LTC spending varied from 133.1 to 549.9 thousand yen (max/min ratio 4.1) across the 1460 municipalities analyzed, showing considerable regional variation. The included covariates explained 84.0% of the total variance in LTC spending, and demand-determined variance was remarkably high, which contributed more than 85.7% of the overall R2. Specifically, the highest contributing factor was the proportion of severe care-need level and care level certification rate.

Conclusions

Our results demonstrate that, even after adjusting for different municipalities’ age and sex distribution, there is a large variation in LTC spending. Furthermore, our findings highlight that, to reduce the spending gap between municipalities, the issues underlying large variations in LTC spending across municipalities must be identified and addressed.
“I don’t know whose mouth has been on this”: youth nicotine and cannabis vaping practices in the context of the COVID-19 pandemic
Authors: Islam Sabrina , Thompson Kirsten , Abadi Melissa , Wharton Kristina , Lipperman-Kreda Sharon
Published: September 2022

Early COVID-19 safety protocols urged physical and social distancing, resulting in minimal contact with others. As social contexts are central to vaping among youth, we used semi-structured interviews to describe how youth who vape are making sense of their use practices and adaptations. The qualitative analyses revealed changes in vaping frequency and access, social isolation shaping substance- and product-specific use, and motivations and outcomes of dual use of nicotine and cannabis which were closely linked to the pandemic. The findings indicate variation of youth vaping experiences within the early stages of the pandemic that should be attended to in future studies.
Assessing community health workers’ time allocation for a cervical cancer screening and treatment intervention in Malawi: a time and motion study
Authors: Chinkhumba Jobiba , Low Dorothy , Ziphondo Evelyn , Msowoya Lizzie , Rao Darcy , Smith Jennifer S. , Schouten Erik , Mwapasa Victor , Gadama Luis , Barnabas Ruanne , Chinula Lameck , Tang Jennifer H.
Published: September 2022

Background

Community health workers (CHWs) are essential field-based personnel and increasingly used to deliver priority interventions to achieve universal health coverage. Existing literature allude to the potential for detrimental effects of multi-tasking CHWs. This study objective was to assess the impact of integrating cervical cancer screening and prevention therapy (CCSPT) with family planning (FP) on time utilization among CHWs.

Methods

A time and motion study was conducted in 7 health facilities in Malawi. Data was collected at baseline between October-July 2019, and 12 months after CCSPT implementation between July and August 2021. CHWs trained to deliver CCSPT were continuously observed in real time while their activities were timed by independent observers. We used paired sample t-test to assess pre-post differences in average hours CHWs spent on the following key activities, before and after CCSPT implementation: clinical and preventive care; administration; FP; and non-work-related tasks. Regression models were used to ascertain impact of CCSPT on average durations CHWs spent on key activities.

Results

Thirty-seven (n = 37) CHWs were observed. Their mean age and years of experience were 42 and 17, respectively. Overall, CHWs were observed for 323 hours (inter quartile range: 2.8–5.5). Compared with the period before CCSPT, the proportion of hours CHWs spent on clinical and preventive care, administration and non-work-related activities were reduced by 13.7, 8.7 and 34.6%, respectively. CHWs spent 75% more time on FP services after CCSPT integration relative to the period before CCSPT. The provision of CCSPT resulted in less time that CHWs devoted towards clinical and preventive care but this reduction was not significant. Following CCPST, CHWs spent significantly few hours on non-work-related activities.

Conclusion

Introduction of CCSPT was not very detrimental to pre-existing community services. CHWs managed their time ensuring additional efforts required for CCSPT were not at the expense of essential activities. The programming and policy implications are that multi-tasking CHWs with CCSPT will not have substantial opportunity costs.
Epigenetic and transcriptomic alterations in offspring born to women with type 1 diabetes (the EPICOM study)
Authors: Knorr Sine , Skakkebæk Anne , Just Jesper , Johannsen Emma B. , Trolle Christian , Vang Søren , Lohse Zuzana , Bytoft Birgitte , Damm Peter , Højlund Kurt , Jensen Dorte M. , Gravholt Claus H.
Published: September 2022

Background

Offspring born to women with pregestational type 1 diabetes (T1DM) are exposed to an intrauterine hyperglycemic milieu and has an increased risk of metabolic disease later in life. In this present study, we hypothesize that in utero exposure to T1DM alters offspring DNA methylation and gene expression, thereby altering their risk of future disease.

Methods

Follow-up study using data from the Epigenetic, Genetic and Environmental Effects on Growth, Metabolism and Cognitive Functions in Offspring of Women with Type 1 Diabetes (EPICOM) collected between 2012 and 2013.

Setting

Exploratory sub-study using data from the nationwide EPICOM study.

Participants

Adolescent offspring born to women with T1DM (n=20) and controls (n=20) matched on age, sex, and postal code.

Main outcome measures

This study investigates DNA methylation using the 450K-Illumina Infinium assay and RNA expression (RNA sequencing) of leucocytes from peripheral blood samples.

Results

We identified 9 hypomethylated and 5 hypermethylated positions (p < 0.005, |ΔM-value| > 1) and 38 up- and 1 downregulated genes (p < 0.005, log2FC ≥ 0.3) in adolescent offspring born to women with T1DM compared to controls. None of these findings remained significant after correction for multiple testing. However, we identified differences in gene co-expression networks, which could be of biological significance, using weighted gene correlation network analysis. Interestingly, one of these modules was significantly associated with offspring born to women with T1DM.

Functional enrichment analysis, using the identified changes in methylation and gene expression as input, revealed enrichment in disease ontologies related to diabetes, carbohydrate and glucose metabolism, pathways including MAPK1/MAPK3 and MAPK family signaling, and genes related to T1DM, obesity, atherosclerosis, and vascular pathologies. Lastly, by integrating the DNA methylation and RNA expression data, we identified six genes where relevant methylation changes corresponded with RNA expression (CIITA, TPM1, PXN, ST8SIA1, LIPA, DAXX).

Conclusions

These findings suggest the possibility for intrauterine exposure to maternal T1DM to impact later in life methylation and gene expression in the offspring, a profile that may be linked to the increased risk of vascular and metabolic disease later in life.
High prevalence and significant ethnic differences in actionable HbA1C after gestational diabetes mellitus in women living in Norway
Authors: Sharma Archana , Nermoen Ingrid , Qvigstad Elisabeth , Tran Anh T. , Sommer Christine , Sattar Naveed , Gill Jason M. R. , Gulseth Hanne L. , Sollid Stina T. , Birkeland Kåre I.
Published: September 2022

Background

The type 2 diabetes risk after gestational diabetes mellitus (GDM) is twice as high in South Asian compared to European women. Current guidelines differ regarding which test to use as a screening-tool post-GDM. We aimed to identify ethnic differences in the prevalence rates and early predictors for actionable HbA1c (defined as prediabetes and diabetes) short time after GDM.

Methods

This cross-sectional study, enrolling South Asian and Nordic women 1–3 years after a diagnosis of GDM, was undertaken at three hospitals in Norway. We performed a clinical and laboratory evaluation including an oral glucose tolerance test (OGTT). Medical records were used to retrieve data during pregnancy. Prediabetes was classified with HbA1c alone or combined with OGTT glucose measurements according to the WHO, WHO-IEC, and ADA criteria (fasting plasma glucose (FPG) 6.1–6.9 mmol/L, FPG 6.1–6.9 mmol/L and/or HbA1c 42-47 mmol/mol (6.0-6.4%), and FPG 5.6–6.9 mmol/L and/or HbA1c 39-47 mmol/mol (5.7-6.4%)). Ethnic differences in prevalence and predictors of glucose deterioration were assed by χ2 (Pearson) tests and logistic regression models.

Results

We included 163 South Asian and 108 Nordic women. Actionable HbA1c levels were highly prevalent and more so among South Asian than Nordic women (WHO-IEC-HbA1c: 25.8% vs. 6.5% (p ≤ 0.001), ADA-HbA1c: 58.3% vs. 22.2% (p ≤ 0.001)). Although adding OGTT-data gave higher combined prevalence rates of prediabetes and diabetes (WHO: 65.6% vs. 47.2% (p ≤ 0.05), WHO-IEC: 70.6% vs. 47.2% (p ≤ 0.001), ADA: 87.8% vs. 65.7% (p ≤ 0.001)), the excess risk in the South Asian women was best captured by the HbA1c. Important predictors for glucose deterioration after GDM were: South Asian ethnicity, GDM before the index pregnancy, use of glucose-lowering drugs in pregnancy, higher age, and higher in-pregnancy fasting glucose levels.

Conclusions

In women with GDM 1–3 year previously, we found high prevalence and significant ethnic differences in actionable ADA-HbA1c levels, with South Asian ethnicity, GDM before the index pregnancy, and the use of glucose-lowering drugs in pregnancy as the most important risk factors. This study reinforces the importance of annual screening—preferably with HbA1c measurements—to facilitate early intervention after GDM.
Initiation of the SGLT2 inhibitor canagliflozin to prevent kidney and heart failure outcomes guided by HbA1c, albuminuria, and predicted risk of kidney failure
Authors: Tye Sok Cin , Jongs Niels , Coca Steven G. , Sundström Johan , Arnott Clare , Neal Bruce , Perkovic Vlado , Mahaffey Kenneth W. , Vart Priya , Heerspink Hiddo. J. L.
Published: September 2022

Background

Sodium glucose co-transporter-2 (SGLT2) inhibitors reduce the risk of kidney and heart failure events independent of glycemic effects. We assessed whether initiation of the SGLT2 inhibitor canagliflozin guided by multivariable predicted risk based on clinical characteristics and novel biomarkers is more efficient to prevent clinical outcomes compared to a strategy guided by HbA1c or urinary-albumin-creatinine ratio (UACR) alone.

Methods

We performed a post-hoc analysis of the CANVAS trial including 3713 patients with available biomarker measurements. We compared the number of composite kidney (defined as a sustained 40% decline in eGFR, chronic dialysis, kidney transplantation, or kidney death) and composite heart failure outcomes (defined as heart failure hospitalization or cardiovascular (CV) death) prevented per 1000 patients treated for 5 years when canagliflozin was initiated in patients according to HbA1c ≥ 7.5%, UACR, or multivariable risk models consisting of: (1) clinical characteristics, or (2) clinical characteristics and novel biomarkers. Differences in the rates of events prevented between strategies were tested by Chi2-statistic.

Results

After a median follow-up of 6.1 years, 144 kidney events were recorded. The final clinical model included age, previous history of CV disease, systolic blood pressure, UACR, hemoglobin, body weight, albumin, estimated glomerular filtration rate, and randomized treatment assignment. The combined biomarkers model included all clinical characteristics, tumor necrosis factor receptor-1, kidney injury molecule-1, matrix metallopeptidase-7 and interleukin-6. Treating all patients with HbA1c ≥ 7.5% (n = 2809) would prevent 33.0 (95% CI 18.8 to 43.3 ) kidney events at a rate of 9.6 (95% CI 5.5 to 12.6) events prevented per 1000 patients treated for 5 years. The corresponding rates were 5.8 (95% CI 3.4 to 7.9), 16.6 (95% CI 9.5 to 22.0) (P < 0.001 versus HbA1c or UACR approach), and 17.5 (95% CI 10.0 to 23.0) (P < 0.001 versus HbA1c or UACR approach; P = 0.54 versus clinical model). Findings were similar for the heart failure outcome.

Conclusion

Initiation of canagliflozin based on an estimated risk-based approach prevented more kidney and heart failure outcomes compared to a strategy based on HbA1c or UACR alone. There was no apparent gain from adding novel biomarkers to the clinical risk model. These findings support the use of risk-based assessment using clinical markers to guide initiation of SGLT2 inhibitors in patients with type 2 diabetes.
Plasma mannose as a novel marker of myocardial infarction across different glycaemic states: a case control study
Authors: Fortin Elena , Ferrannini Giulia , Campi Beatrice , Mellbin Linda , Norhammar Anna , Näsman Per , Saba Alessandro , Ferrannini Ele , Rydén Lars
Published: September 2022

Background

Plasma mannose, an emerging novel biomarker of insulin resistance, is associated with both diabetes mellitus and coronary atherosclerosis, but the relationship between mannose concentrations and myocardial infarction (MI) across different glycaemic states remains to be elucidated. The aim of this study was to investigate the independent association between mannose and a first MI in a group of subjects characterized according to their glycaemic state.

Methods

Fasting plasma mannose concentrations were analysed in 777 patients 6–10 weeks after a first myocardial infarction and in 770 matched controls by means of high-performance liquid chromatography coupled to tandem mass spectrometry. Participants without known diabetes mellitus were categorized by an oral glucose tolerance test (OGTT) as having normal glucose tolerance (NGT, n = 1045), impaired glucose tolerance (IGT, n = 246) or newly detected type 2 diabetes (T2DM, n = 112). The association between mannose and MI was investigated across these glycaemic states by logistic regression.

Results

Mannose levels increased across the glycaemic states (p < 0.0001) and were significantly associated with a first MI in the whole study population (odds ratio, OR: 2.2; 95% CI 1.4 to − 3.5). Considering the different subgroups separately, the association persisted only in subjects with NGT (adjusted OR: 2.0; 95% CI 1.2–3.6), but not in subgroups with glucose perturbations (adjusted OR: 1.8, 95% CI 0.8–3.7).

Conclusions

Mannose concentrations increased across worsening levels of glucose perturbations but were independently associated with a first MI only in NGT individuals. Thus, mannose might be a novel, independent risk marker for MI, possibly targeted for the early management of previously unidentified patients at high cardiovascular risk.