bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Health Care Seeking Behavior of Peri-Urban Women With Disability in Busiro South, Wakiso District, Uganda: a Community Based Study
Authors: Natukunda Bonny , Musoke David , Kiconco Arthur , Mugambe Samuel , Atuhairwe Christine , Taremwa Ivan Mugisha , Nanyingi Miisa
Published: August 2020

Background: In Uganda women with disabilities attend antenatal care (ANC) while pregnant, however, majority of these deliver from the hands of Traditional Birth Attendants (TBAs) due to due to fear of being mistreated by skilled birth attendants. We explored the determinants of the maternal health seeking behavior of women with disability in Busiro health sub district (HSD), Wakiso district, Uganda.Methods: A community based cross-sectional study involving quantitative and qualitative methods of data collection was conducted among 182 participants. Quantitative data were collected from disabled women, and qualitative data from six key informants (midwives and in-charges) at selected health facilities in Busiro HSD, Wakiso district. Logistic regression was used to determine the factors influencing the decision to seek maternal health care services (ANC and delivery at health facilities) among women with disability. Qualitative data were analyzed by content analysis.Results: The findings revealed that 82.3% of women with disability attended ANC during pregnancy, and of these, 80.8% delivered their babies at health facilities. Attendance of ANC by the women with disability was influenced by parity (having 1-3 children) (AOR 7.7; 95% CI: 0.249-239.040), mode of delivery-normal delivery verses caesarian section (AOR 2.6, 95%CI: 0.296-22921), place visited during pregnancy TBA visa vie public health facilities (AOR 4.5, 95%CI: 0.922-22.576), and distance to the health facility being less than 5 Kilometres (AOR 2.3 95% CI: 0.695-7.661). Conclusion: There is need to intensify awareness of the use of skilled health workers during pregnancy and child birth to women with disability in the communities so as to improve uptake of maternal health care services.
Establishment of a Pediatric COVID-19 Biorepository: Unique Considerations and Opportunities for Studying the Impact of the COVID-19 Pandemic on Children
Authors: Lima Rosiane , Gootkind Elizabeth , Flor Denis De La , Yockey Laura , Bordt Evan , D'Avino Paolo , Ning Shen , Heath Katerina , Harding Katherine , Zois Jaclyn , Park Grace , Hardcastle Margot , Grinke Kathleen A. , Grimmel Sheila , Forde Pamela J. , Davidson Susan P. , Hall Kathryn E. , Neilan Anne , Matute Juan D. , Lerou Paul H. , Fasano Alessio , Shui Jessica E. , Edlow Andrea G. , Yonker Lael M.
Published: August 2020

Background: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples in a standardized manner to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods: A broad study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. Results: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens.Conclusions: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility, and, immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
Significant improvement of sperm motility parameters through surface modification with Nano Diamond particles
Authors: Lesani Ali , Kazemnejad Somaieh , Mousavi Hengameh , Sarbandi Iman Ramazani , Zand Mahdi Moghimi
Published: August 2020

The employment of Nanotechnology as a valuable tool could be beneficial to patients and also offer new alternatives for Assisted Reproductive Technology (ART). Surface modification by nanoparticles leads to the alteration of surface characteristics (e.g. roughness, elasticity, and surface charge). These alterations affect sperm behavior especially its motility since sperms exhibit wall following behavior and surface accumulation. Moreover, surface modification is an attempt towards mimicking the complex in vivo environment of the female tract (highly folded and ciliated) with continually changing surface topology and also its functions. In this paper, we present the results of investigating the interactions between sperm cells and surface modified substrates using Nano diamond particles. A combinational and low-cost method was used for modification. The results show that the sperm motility parameters are significantly improved from 5 to 85%. Also, the results indicate that in optimized surface modification condition, the sperms swim faster and straighter and the surface facilitates the swimming due to the inherent characteristics of ND particles.
Taken together, the replacement of normal with modified surfaces in fertility-aid microfluidic devices can enhance their efficiency and further improve their outcomes.
Bronchoscopist's Perception of the Quality of the Single-use Fiberoptic Bronchoscope (Ambu Ascope4 ™) in Conventional Bronchoscopies. A Multicenter Study in 21 Spanish Pulmonology Services.
Authors: Aldeyturriaga Javier Flandes , Giraldo Luis , Alfayate Javier , Fernández-Navamuel Iker , Agustí Carlos , Lucena Carmen M. , Rosell Antoni , Andreo Felipe , Centeno Carmen , Montero Carmen , Garcia Iria Vidal , Alfonso Lucia García , Bango Antonio , Ariza Miguel , Dominguez Rocio Gallego , Caamaño Marta Orta , Bello Salvador , Mincholé Elisa , Torrego Alfons , Pajares Virginia , González Hector , Pérez Aurelio Luis Wangüemert , Pérez-Izquierdo Julio , Disdier Carlos , Sanchez Blanca de Vega , Cordovilla Rosa , Cascón Juan , Cruz Antonio , García-López J. Javier , Puente Luis , Benedetti Paola , García-Gallo Cristina L. , Nuevo Gema Díaz , Aguado Silvia , Partida Concepcion , Díaz-Agero Prudencio , Crespo Estefania Luque , Masa Maria Pavón , Paez Francisco , Cases Enrique , Martinez Raquel , Briones Andres , Fernandez Cleofe , Serrano Concepcion Martin , Uribe-Hernandez Ana Maria , Robles Jose
Published: August 2020

Background:The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. Methods: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis.Results:The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 minutes. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores> 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score.Conclusions:The aScope4 ™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.
Prevalence of depression, anxiety, delirium, and post-traumatic stress disorder among COVID-19 patients: protocol for a living systematic review
Authors: Shi Jiyuan , Li Yuanyuan , Zhao Liang , Yan Meili , Niu MingMing , Chen Yamin , Song Ziwei , Ya Gao , Tian Jinhui
Published: August 2020

Background Previous studies on the impact of COVID-19 on the mental health of the patients has been limited by the lack of relevant data. With the rapid and sustained growth of the publications on COVID-19 research, we will perform a living systematic review (LSR) to provide comprehensive and continuously updated data to explore the prevalence of depression, anxiety, delirium, and post-traumatic stress disorder (PTSD) among COVID-19 patients.Methods We will perform a comprehensive search of the following databases: Cochrane Library, PubMed, Web of Science, Embase, and Chinese Biomedicine Literature to identify relevant studies. We will utilize different tools to examine the bias risks (quality) regarding studies of varying design types, such as the revised Cochrane risk-of-bias tool (RoB 2) for randomized controlled trials (RCT), the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, etc. The literature searches would be updated every month. We will perform meta-analysis if any new eligible studies or data are obtained and resubmit an updated systematic review if any change in outcomes and heterogeneity is determined after the addition of the new studies. There will be no restrictions on language or year of publication.Discussion This LSR would provide an in-depth and up-to-date summary of the psychological impact of COVID-19 diagnosis and treatment on the patients. Systematic review registration PROSPERO CRD42020196610
Factors Shaping Uptake of Antenatal Care in Surabaya, Indonesia: a Qualitative Study
Authors: Jones Lisa , Damayanti Nyoman Anita , Wiseman Nicola , Harris Neil
Published: August 2020

Background: Antenatal Care (ANC) is a central plank in reducing maternal mortality in low and middle income countries. ANC provides pivotal education to all individuals involved and can be utilised as a preventative tool in avoiding complications during childbirth. Within Indonesia, the maternal mortality ratio (MMR) remains unacceptably high in comparison to high income country counterparts, with an ANC coverage of 77% for a minimum of 4 visits. Few studies within Indonesia have explored the experiences of pregnant women accessing ANC and the impact this has on uptake of ANC services.Methods:  Five focus group discussions (FGDs) with pregnant women were conducted at community health facilities within the city and urban areas of Surabaya, Indonesia, along with five semi-structured interviews with midwives employed at these health facilities. Results: Findings suggest individual circumstances, social and cultural dynamics and community and health care conditions shaping the uptake of ANC services. Fears of negative diagnosis prior to initial ANC appointment, personal beliefs and myths surrounding pregnancy, influence of husbands, family and friends and long waiting times with overcrowding leading to limited seating were shaping timely access and achieving 4 ANC visits. In addition, feeling comfortable with the quality of the service and receiving a friendly service from the practitioners was a theme across all FGDs. Finally, it was acknowledged feeling afraid of being referred to a hospital if deemed a high-risk pregnancy shaped return ANC visits. Conclusions:  Efforts to decrease maternal and infant mortality rates in Surabaya have largely centred on increasing ANC coverage. The findings of this study highlight several factors shaping the uptake of ANC services by mothers. However, with ANC coverage (minimum 4 visits) now at 77% of the population, findings suggest that future research should be directed towards the standard of quality of ANC services being delivered.
Post-Partum Hemorrhage is Still Killing Mothers in Bangladesh: An Observation from the 2016 Bangladesh Maternal Mortality Survey (BMMS)
Authors: Rahman Aminur , Austin Anne , Begum Tahmina , Anwar Iqbal
Published: August 2020

The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC). Both of these interventions mandate the administration of oxytocin. In Bangladesh there are nonfunctioning institutionalized guidelines from the Director General of Health Services on the storage of oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to evaluate the potency of current stores of oxytocin used in both in public and private facilities, develop and enforce protocols to ensure the potency of oxytocin, and promote universal access to quality AMSTL and CEmOC services.
Orthodontic Treatment as a Protective Factor for Dental Caries Experience and Severity: A Population-Based Study
Authors: Alsulaiman Ahmed A.
Published: August 2020

Background: As the current evidence remains contradictory and inconclusive, there is an urgent need to determine the ability of orthodontic treatment to reduce the risk of dental caries development later in life. Thus, the objective of this study is to assess the effects of orthodontic treatment on the experience, prevalence, and severity of dental caries later in life in a representative sample of U.S. adults.Methods: Using a population-based study design, data from 9,486 participants in the third National Health and Nutrition Survey (NHANES), including self-reported information on previous history of orthodontic treatment and its timing, were obtained. Caries experience and prevalence was assessed using the decayed (DT) and filled (FT) teeth indices (i.e., DT>0, FT>0, and their aggregate DFT>0). Severe dental caries experience and prevalence was defined as DT>2, FT>11, and DFT>12. Unadjusted and adjusted logistic regression models that accounted for the complex sampling design were used to assess the association between orthodontic treatment and dental caries experience, prevalence, and severity. Statistical significance was set at a p-value of less than 0.05.Results: Previous history of orthodontic treatment was reported in 19.62% of the adults. Around 94% of participants had at least one decayed or filled tooth (DFT>0), and 21.09% met the aggregate DFT criterion for severe caries (DFT>12). After controlling for confounding variables, a reported history of orthodontic treatment was found to significantly decrease the odds of DT>0, DT>2, FT>11, and DFT>12 (odds ratios [OR] = 0.41, 0.36, 0.74, and 0.60 respectively).Conclusion: A history of orthodontic treatment was a protective factor for untreated dental caries, in assessments of the severity and prevalence of dental caries experience.
Comparison of Oral Hygiene Status and Relative Abundance of Periodontal Pathogens Between Individuals With and Without Intellectual Disabilities: a Cross-Sectional Study
Authors: Oda Yuki , Furutani Chiaki , Kawano Reo , Murakami Jumpei , Mizota Yuika , Okada Yoshiyuki , Nikawa Hiroki
Published: August 2020

Background: Studies have reported a high prevalence of periodontal disease in individuals with intellectual disability (ID). The aim of this study was to compare the relative abundance of periodontal pathogens (red, orange, yellow, purple, and green complexes) between individuals with ID and healthy controls.Methods: Of the 31 subjects enrolled in this study, 16 with severe ID were selected from the outpatient clinic of the Special Care Dentistry of Hiroshima University Hospital, and 14 healthy subjects were selected from the outpatient clinic of another department at the same hospital. Dental plaque was sampled after oral examination. Decayed, missing, and filled permanent teeth (DMFT) counts were obtained and periodontal measurements were taken using the papillary-marginal-attached (PMA) index, plaque index (PI), gingival index (GI), and probing depth (PD). Gene sequencing (16S rRNA) was performed for each sample using next-generation high-throughput sequencing methods. The relative abundance of the periodontal pathogens and the clinical parameters were compared. An unpaired t-test was used to compare the oral health status in both groups and analysis of covariance was performed to compare the relative abundance of each pathogen.Results: No statistically significant difference in DMFT was observed between the two groups. However, significant differences in the median PMA index, PI, and GI were noted between the groups (P < 0.0001). In addition, the mean PD in the ID group was significantly higher than that in the control group (P < 0.0001). The relative abundances of Tannerella spp. and Treponema spp. were significantly higher in the ID group when compared to the control group at the genus level (P = 0.0383 and 0.0432, respectively); alternatively, the relative abundance of Porphyromonas spp. was significantly lower in the ID group (P < 0.0001).Conclusions: The PMA index, PI, GI, and PD were significantly lower in the ID group than in the control group. On the other hand, no significant difference in DMFT was observed between the two groups. Furthermore, our findings indicate that Tannerella forsythia might be more closely associated with periodontal disease than Porphyromonas gingivalis in individuals with ID.
Rhamnolipid Coating Reduces Microbial Biofilm Formation on Titanium Implants: an in-vitro Study
Authors: Tambone Erica , Bonomi Emiliana , Ghensi Paolo , Maniglio Devid , Ceresa Chiara , Agostinacchio Francesca , Caciagli Patrizio , Nollo Giandomenico , Piccoli Federico , Caola Iole , Fracchia Letizia , Tessarolo Francesco
Published: August 2020

Background: Peri-implant mucositis and peri-implantitis are biofilm-related diseases causing major concern in oral implantology, requiring complex anti-infective procedures or implant removal. Microbial biosurfactants emerged as new of anti-biofilm agents for coating implantable devices preserving biocompatibility. This study aimed to assess the efficacy of rhamnolipid biosurfactant R89 (R89BS) to reduce Staphylococcus aureus and Staphylococcus epidermidis biofilm formation on titanium. Methods: R89BS was physically adsorbed on titanium discs (TDs) and the ability of coated TDs to inhibit biofilm formation was evaluated by quantifying biofilm biomass and cell metabolic activity, at different time-points, with respect to uncoated controls. A qualitative analysis of sessile cells was also performed by scanning electron microscopy. Results: R89BS-coated discs showed no cytotoxic effects on normal lung fibroblasts (MRC5). TDs coated with 4 mg/mL R89BS inhibited the biofilm biomass of S. aureus by 98%, 49% and 10% and of S. epidermidis by 53%, 29%, and 10% at 24, 48 and 72 h respectively. A significant reduction of the biofilm metabolic activity was also documented. The same coating applied on three commercial implant surfaces resulted in a biomass inhibition higher than 90% for S. aureus, and up to 75% for S. epidermidis at 24 h. Conclusions: R89BS-coating was effective in reducing Staphylococcus biofilm formation at the titanium implant surface. The anti-biofilm action can be obtained on several different commercially available implant surfaces, independently of their surface morphology.
Broncho-alveolar inflammation in COVID-19 patients: a correlation with clinical outcome
Authors: pandolfi laura , Tommaso Fossali , Vanessa Frangipane , Sara Bozzini , Monica Morosini , Maura D’Amato , Sara Lettieri , Mario Urtis , Alessandro Di Toro , Laura Saracino , Elena Percivalle , Stefano Tomaselli , Lorenzo Cavagna , Emanuela Cova , Francesco Mojoli , Paola Bergomi , Davide Ottolina , Daniele Lilleri , Guido Corsico Angelo , Eloisa Arbustini , Riccardo Colombo , Federica Meloni
Published: August 2020

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly reached pandemic proportions. We conducted a prospective study to assess deep lung inflammatory status in patients with moderate to severe COVID-19.
Methods
Diagnostic bronchoalveolar lavage (BAL) was performed in 33 adult patients with SARS-CoV-2 infection by real-time PCR on nasopharyngeal swab admitted to the Intensive care unit (ICU) (n = 28) and to the Intermediate Medicine Ward (IMW) (n = 5). We analyze the differential cell count, ultrastructure of cells and Interleukin(IL)6, 8 and 10 levels.
Results
ICU patients showed a marked increase in neutrophils (72%, 60–81), lower lymphocyte (8%, 4–12) and macrophages fractions (17%, 11–27) compared to IMW patients (3%, 2–17, 15%, 6–26 and 74%, 58–90, respectively) (p < 0.01). Ultrastructural study from ICU patients showed viral-like particles in cytopathic mononuclear cells however extensive cytopathic damage in all cell lineages. Immunostaining with anti-viral capsid and spike antibodies specifically immunoreacted with BAL cells, mostly cytopathic ones. IL6 and IL8 were significantly higher in ICU patients than in IMW (IL6 p < 0.01, IL8 p < 0.0001), and also in patients who did not survive (IL6 p < 0.05, IL8 p = 0.05 vs. survivors). IL10 did not show a significant variation between groups. Dividing patients by treatment received, lower BAL concentrations of IL6 were found in patients treated with steroids as compared to those treated with tocilizumab (p < 0.1) or antivirals (p < 0.05).
Conclusions
Alveolitis, associated with COVID-19, is mainly sustained by innate effectors which showed features of extensive activation. The burden of pro-inflammatory cytokines IL6 and IL8 in the broncho-alveolar environment is associated with clinical outcome.
Multinomial Propensity Score for Ternary Exposure for Genetic Study
Authors: Fann Cathy S. J. , Dinh Thai Son , Chang Yu-Hsien , Sie Jia Jyun , Lian Ie-Bin
Published: August 2020

Background: Propensity score (PS) is a popular method for reducing multiple confounding effects in observational studies. It is applicable mainly for situations wherein the exposure/treatment of interest is dichotomous and the PS can be estimated through logistic regression. However, multinomial exposures with 3 or more levels are not rare, e.g., when considering genetic variants, such as single nucleotide polymorphisms (SNPs), which have 3 levels (aa/aA/AA), as an exposure. Conventional PS is inapplicable for this situation unless the 3 levels are collapsed into 2 classes first. Methods: A simulation study was conducted to compare the performance of the proposed multinomial propensity score (MPS) method under various contrast codings and approaches, including regression adjustment and matching.Results: MPS methods had more reasonable type I error rate than the non-MPS methods, of which the latter could be as high as 30~50%. Compared with MPS-direct adjusted methods, MPS-matched cohort methods have better power but larger type I error rate. Performance of contrast codings depend on the selection of MPS models. Conclusions: In general, two combinations had relatively better performance in our simulation of ternary exposure: MPS-matched cohort method with Helmert contrast and MPS-direct adjusted regression with treatment contrasts. Compared with the latter, the former had better power but larger type I error rate as a trade-off.
A Global Perspective on the Management of Bacterial Infections in Pregnancy: A Systematic Review of International Guidelines
Authors: Koucky Michal , Kamel Rasha , Vistejnova Lucie , Kalis Vladimir , Ismail Khaled M.K.
Published: August 2020

Introduction: Maternal sepsis is a leading cause of maternal and neonatal mortality. Despite the availability of management protocols, there is disparity in case fatality rates for pregnancy-related sepsis compared to other maternity-related complications. The main aim of this systematic review was to assess concordance between international evidence-based guidelines for the prevention and management of childbirth-related bacterial infections. Material and methods: The PRISMA statement was followed during the conduct and reporting of this review. PubMed and G-I-N were searched electronically from 2009 to November 2019 for clinical guidelines covering the topic of childbirth-related infections and specific searches for relevant guidelines on the websites of the top 5 international professional bodies most commonly identified by our searches. We did not apply any language restrictions. Guidelines were included if they provided any information about the prevention or management of childbirth-related bacterial infections irrespective of whether the guideline stated a recommendation or not. Two independent reviewers undertook study selection, decisions about inclusion of selected guidelines and data extraction. Extracted information was synthesized under the following topics: Asymptomatic bacteriuria; group B streptococcal infection (GBS); preterm premature rupture of membranes (P-PROM); Intrauterine infection; Interventions and procedures; maternal sepsis; miscellaneous. Concordance was defined as absence of contradictory information between the different guidelines with regards to a specific topic, subtopic or recommendation. Quality of included guidelines was assessed against the AGREE II guideline reporting domains.Results: A total of 43 guidelines were selected of which 11 were excluded leaving 32 guidelines that fulfilled our inclusion criteria. None of the guidelines fulfilled all the quality assessment domains and 11 (34%) of the guidelines satisfied 1 - 2 of domains only. Two guidelines covered the topic of asymptomatic bacteriuria, nine for GBS, five for P-PROM and three covered each of intra-amniotic infections maternal sepsis, obstetric procedures and interventions topics. The remaining guidelines covered miscellaneous topics.Conclusions: There was concordance between guidelines with regards to several aspects in the prophylaxis and treatment of bacteriological infections in pregnancy. Nevertheless, there were several areas of discordance, some of which reached the extent of contradictory information as in the case of antenatal screening for GBS.
The Knowledge of Danger Signs of Obstetric Complications Among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program
Authors: Ahmad Danish , Mohanty Itismita , Hazra Avishek , Niyonsenga Theo
Published: August 2020

Background: Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IHLMF) program on the knowledge of maternal danger signs in marginalised women from one of India’s most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages.Methods: Secondary data from the IHLMF program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program’s effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level.Results: SHG member women receiving health literacy were 27 per cent more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics.Conclusions: The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.
Which Texture Property of Semi-Solid Food Affects the Effort of Pharyngeal Swallow in the Elderly?
Authors: Park Jin-Woo , Lee Seul , Yoo Byoungseung , Nam Kiyeon
Published: August 2020

Background: Increasing viscosity can reduce the risk of aspiration into the airway, but conversely, very thick solid food may require greater strength and effort. We assumed that semi-solid foods with similar viscosities will behave differently in the oropharynx and there might exist the possibility that properties other than viscosity may have clinical relevance. This study aimed to find out the texture of semi-solid foods that affects the effort of pharyngeal swallow in the elderly. Methods: Nine kinds of semi-solid foods not requiring mastication were selected for texture profile analysis (TPA), and included whipped cream, mayonnaise, soft tofu, mango pudding, boiled mashed pumpkin, boiled mashed potatoes, boiled mashed sweet potatoes, red bean paste, and peanut butter. Hardness, adhesiveness and cohesiveness of each food were measured three times by using the rheometer. A blinded sensory test using a 9-point hedonic scale was also conducted in eighteen elderly people to investigate how much effort was required to swallow food, and how much of the food remained in the pharynx after swallowing. The correlation between texture and sensory outcome was statistically analyzed.Results: Foods that belonged to the same viscosity category showed different texture values, and the participants also rated different scores respectively. Only adhesiveness among three properties was significantly correlated with the sensory test. (r= 0.882, p=0.002 for difficult to swallow, r=0.879, p=0.002 for sense of residue).Conclusions: Adhesiveness was the most important property of the semi-solid foods, requiring most efforts in pharyngeal swallow in the elderly. If we select and provide food having low adhesiveness value in the same viscosity category, there might be the possibility to make it easier to swallow in older adults.
Hypertension Before Pregnancy and Infant Outcomes: Secondary Analysis of North Carolina Pregnancy Risks Assessment Monitoring System (PRAMS) Data
Authors: Avorgbedor Forgive , Silva Susan , Blumenthal James A , Yeo Seonae , Merwin Elizabeth , Holditch-Davis Diane
Published: August 2020

Background: Chronic hypertension complicates birth outcomes. This secondary analysis of data from the North Carolina 2009-2011 Pregnancy Risks Assessment Monitoring System (PRAMS) examined factors associated with infant outcomes (preterm birth and small for gestational age) among women with hypertension before pregnancy to determine if the maternal age and race/ethnicity moderated the effect of preexisting hypertension on preterm birth and small for gestational age infants.Methods: We performed logistic regression to determine whether hypertension before pregnancy (HTN, n=292; non-HTN controls, n=2625), maternal age and race/ethnicity (Black vs Non-Black) and their interactions with hypertension before pregnancy predicted preterm birth and small for gestational age infants compared to normotensive women. Results: Results indicated that women with hypertension before pregnancy had significantly higher rates of preterm birth (29.8% vs. 21.3%) and small for gestational infants (23.0% vs. 17.9%) compared to non-HTN controls without adjusting for covariates. HTN had an effect on preterm birth that was independent of other maternal risk factors (aOR= 1.31) after adjusting for covariates . Being Black was associated with a greater likelihood of preterm birth (aOR=1.55). Conclusion: Hypertension before pregnancy is more likely to be associated Black race and with adverse birth outcomes. Black women are especially likely to experience poor birth outcomes. Continuous education to encourage all women and especially women of color and women with chronic illness to access preconception care is needed
Incidence and Time-Varying Predictors of HIV and Sexually Transmitted Infections Among Male Sex Workers in Mexico City
Authors: Ganley Karla , Wilson-Barthes Marta , Zullo Andrew R. , Sosa-Rubí Sandra G. , Conde-Glez Carlos J. , García-Cisneros Santa , Lurie Mark N. , Marshall Brandon D.L. , Operario Don , Mayer Kenneth H. , Galarraga Omar
Published: August 2020

Introduction: Male sex workers (MSWs) are at high-risk for HIV/STI acquisition. We quantified HIV/STI incidence rates and identified their time-varying predictors among MSWs in Mexico City. Methods: MSWs recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results and Discussion: Among 227 MSWs, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV (5.28; 95%CIs 2.52, 11.07), chlamydia (4.63; 95% 2.41, 8.90), gonorrhea (3.92; 95% 1.96, 7.84), syphilis (12.44; 95% 8.11, 19.08), hepatitis B (2.09; 95% 0.79, 5.58), hepatitis C (0.96; 95% 0.24, 3.85), any STI except HIV (17.61; 95% 12.51, 22.72), and any STI including HIV (19.93; 95%CI 14.78, 26.89). In the multivariable-adjusted model, incident STIs (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio (OR) = 0.03, 95% 0.00, 0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions: HIV/STI incidence is high among MSWs in Mexico City. Consistent condom use is an important protective factor for HIV/STIs, and should be an important component of interventions to prevent incident infections.
Understanding the Crisis in Harm Reduction Funding in Central and Eastern Europe
Authors: Miovský Michal , Miklíková Silvia , Mravčík Viktor , Grund Jean-Paul , Černíková Tereza
Published: August 2020

BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformationhad significant consequences for drug policies in the region. A large number of the emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable,and closelyassociated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input.The main objectiveof the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution buildingwhich represents a major threatto the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions.RESULTS: The insufficient investments in finalising the process of the institution building of HR services has resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. CONCLUSION:The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s,which remains present until today, togetherwith all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.
Rapid emergence of clonal interference during malaria parasite cultivation
Authors: Jett Catherine , Dia Aliou , cheeseman ian H.
Published: August 2020

Laboratory cultivation of the malaria parasite Plasmodium falciparum has underpinned nearly all advances in malariology in the past 30 years. When freshly isolated clinical isolates are adapted to in vitro culture mutations rapidly fix increasing the parasite growth rate and stability. While the dynamics of culture adaptation are increasingly well characterized, we know little about the extent of genomic variation that arises and spreads during long term culture. To address this we cloned the 3D7 reference strain and maintained a culture for ~84 asexual cycles (167 days). Growth rate of the culture population increased 1.14-fold over this timeframe. We used single cell genome sequencing of parasites at cycles 21 and 84 to measure the accumulation of diversity in vitro . This parasite population showed strong signals of adaptation across this time frame. By cycle 84 two dominant clades had arisen and were segregating with the dynamics of clonal interference. This highlights the continual process of adaptation in malaria parasites, even in parasites which have been extensively adapted to long term culture.
Accuracy of Intraoperative Estimation of Femoral Stem Anteversion in Cementless Total Hip Arthroplasty by Using a Digital Protractor and a Spirit Level
Authors: Pongkunakorn Anuwat , Phetpangnga Nawakun , Kananai Narawit
Published: August 2020

Introduction: The femoral component anteversion during surgery is traditionally assessed by a visual assessment of the surgeon and has proven to be imprecise. We sought to determine the accuracy of a digital protractor and a spirit level to measure the stem anteversion during cementless THA.Methods: A prospective study was conducted among 107 patients (114 hips) who underwent primary cementless THA via posterolateral approach. A pipe with a spirit level was attached to the tibial tubercle and intermalleolar midpoint. While the leg was held perpendicularly to the floor, stem anteversion was estimated by 3 methods: method A by visual assessment; method B by a digital protractor alone; and method C by a digital protractor combined with a spirit level. The angles were compared with the true anteversion measured by postoperative CT scan.Results: The average anteversion by method C (22.8° ± 6.9°, range -2° to 40°) was significantly lower than method A (24.6° ± 5.2°, range 0° to 30°) (p=0.033), but not different from the true anteversion (22.1° ± 8.2°, range -5.4° to 43.1°) (p=0.445). There were no significant differences between method B (23.2° ± 8.2°, range -4° to 45°) and method A, C or the true anteversion. The mean deviation of the intraoperative estimation from the true anteversion was 0.8° ± 3.7° (range -7.1° to 8.0°) by method C; 1.2° ± 5.1° (range -8.8° to 14.3°) by method B; and 2.5° ± 7.4° (range -19.0° to 16.0°) by method A. Estimation error within 5° was found in 107 hips (93.9%) with method C; 86 hips (75.4%) with method B; and 59 hips (51.8%) with method A.Conclusion: Accurate estimation of stem anteversion during cementless THA can be determined intraoperatively by the use of a digital protractor and a spirit level. Trial registration: Thai Clinical Trials Registry (TCTR 20180326003). Registered on 20 March 2018. Retrospectively registered. http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3375
Tidal surface states as ﬁngerprints of non-Hermitian nodal knot metals
Authors: Lee Ching Hua , Li Guangjie , Liu Yuhan , Tai Tommy , Thomale Ronny , Zhang Xiao
Published: August 2020

The paradigm of metals has undergone a revision and diversification from the viewpoint of topology. Non-Hermitian nodal knot metals (NKMs) constitute a class of matter without Hermitian analog, where the intricate structure of complex-valued energy bands gives rise to knotted lines of exceptional points and new topological surface state phenomena. We introduce a formalism that connects the algebraic, geometric, and topological aspects of these surface states with their underlying parent knots, and complement our results by an optimized constructive ansatz that provides tight-binding models for non-Hermitian NKMs of arbitrary knot complexity and minimal hybridization range. In particular, we identify the surface state boundaries as ``tidal' intersections of the complex band structure in a marine landscape analogy. We further find these tidal surface states to be intimately connected to the band vorticity and the layer structure of their dual Seifert surface, and as such provide a fingerprint for non-Hermitian NKMs.
Cell type-specific predictive models for prioritizing genes and gene sets associated with autism spectrum disorder
Authors: Guan Jinting , Wang Yang , Lin Yiping , Yin Qingyang , Zhuang Yibo , Ji Guoli
Published: August 2020

Background Autism spectrum disorder (ASD) is characterized by substantial phenotypic and genetic heterogeneity. Although bulk transcriptomic analyses revealed convergence of disease pathology on common pathways, the brain cell type-specific molecular pathology of ASD is still needed to study. Different gene functions may be dysregulated and causal genes may be distinct among different brain cells in ASD. Gene expression profiling-based machine learning studies can be conducted for the diagnosis of ASD, prioritizing high-confidence gene candidates and promoting the design of effective interventions.Methods To characterize the cell type heterogeneity of ASD and to take advantage of the potential of gene expression signature as diagnostic biomarkers for ASD, we construct multiple kinds of classification models for ASD based on the recently available human brain nucleus gene expression data of ASD and controls. Firstly, we construct cell type-specific predictive models based on individual genes to screen cell type-specific genes associated with ASD. Then from the view of gene set, we construct cell type-specific gene set-based predictive models to screen cell type-specific gene sets associated with ASD. These two kinds of predictive models can be applied to predict the diagnosis of a given nucleus with known cell type. Lastly, we further construct a multi-label predictive model for predicting the cell type and diagnosis of a given nucleus at the same time.Results It is found that the functions of genes with predictive power for ASD are not consistent and the top important genes are distinct among different cells, demonstrating the cell type heterogeneity of ASD. Our findings suggest that layer 2/3 and layer 4 excitatory neurons, layer 5/6 cortico-cortical projection neurons, parvalbumin interneurons, and protoplasmic astrocytes are preferentially affected in ASD. Gene BCYRN1 and CCK are prioritized in excitatory neurons, and HSPA1A is of note in protoplasmic astrocytes.Limitations Our study utilized methods of machine learning to identify biomarkers of ASD, while it is more convincing if subsequent experiments could be conducted to validate the results.Conclusions The results show that it may be feasible to use single cell/nucleus gene expression for ASD detection and the constructed predictive models can promote the diagnosis of ASD. Our analytical pipeline prioritizes ASD-associated cell type-specific genes and gene sets, which may be used as potential biomarkers of ASD.
Enhancement of Monascus Azaphilone Pigments Production by Activating the cAMP Signalling Pathway in Monascus Purpureus HJ11
Authors: Liu Jiawei , Du Yun , Ma Hongmin , Pei Xiaolin , Li Mu
Published: August 2020

Background: Monascus azaphilone pigments (MonAzPs), which were produced by Monascus species, have been used as important food colorant and food supplements for more than one billion people during their daily life. Moreover, MonAzPs recently have received more attention because of their diverse physiological activities. However, the high microbial production of MonAzPs is still not always guaranteed. Herein, the aim of this study was to develop an efficient biotechnological process for MonAzPs production.Results: In this study, exogenous cyclic adenosine monophosphate (cAMP) treatment not only induced MonAzPs production, but also stimulated the expression of a cAMP phosphodiesterase gene, named as mrPDE, in M. purpureus HJ11. Subsequently, MrPDE was identified as a cAMP phosphodiesterase by in vitro enzymatic reaction with purified enzyme. Further, a gene knockout mutant of mrPDE was constructed to verify the activation of cAMP signalling pathway. Deletion of mrPDE in M. purpureus HJ11 improved cAMP concentration by 378 % and enhanced PKA kinase activity 1.5-fold, indicating that activation of cAMP signalling pathway was achieved. The ΔmrPDE strain produced MonAzPs at 8563 U/g, with a 2.3-fold increase compared with the WT strain. Moreover, the NAPDH/NADP+ ratio of the ΔmrPDE strain was obviously higher than that of the wild type strain, which led to a higher proportion of yellow MonAzPs. With fed-batch fermentation of the ΔmrPDE strain, the production and yield of MonAzPs achieved 332.1 U/mL and 8739 U/g.Conclusions: A engineered M. purpureus strain for high MonAzPs production was successfully developed by activating the cAMP signalling pathway. This study not only describes a novel strategy for development of MonAzPs-producing strain, but also provides a roadmap for engineering efforts towards the production of secondary metabolism in other filamentous fungi.