bluuebunny/crossref_metadata_2025 huggingface dataset:
Real‐time thermal performance investigation of a thermal energy storage integrated direct absorption solar collector under tropical climate
Authors: Gupta Varun Kumar , Kumar Sanjay , Kukreja Rajeev , Chander Nikhil , Ravi Ravi Kant
Published: February 2024

In the last two decades, metallic particles of nano sizes (~10−9 m) have been tested profoundly in volumetric absorption solar collectors (VASC) due to their excellent optical properties and broadband absorption in the entire solar spectrum. However, very limited studies are available for understanding the performance of integrated energy storage VASC systems using nanofluids. For the experimental work presented here, a hybrid nanofluid of gold nanoparticles in Azadirachta indica leaves extract has been synthesized by chemical route. The prepared hybrid nanofluid has shown good absorption in 400 to 700 nm wavelength range and hence achieved high photo‐thermal conversion efficiency for tested VASC system. Furthermore, commercially available paraffin wax is used as a phase change material (PCM) in thermal energy storage (TES) and further integrated with VASC to analyze the thermal performance of the system even after sunshine hours. The real‐time experiments were conducted using different working fluids, and at three mass flow rates, that is, 0.008 kg/s, 0.016 kg/s, and 0.033 kg/s, respectively, during mild winter days in the tropical climate of India. The study revealed a photo‐thermal efficiency enhancement of about 17.1% when hybrid heat transfer fluid was used in the VASC system with TES as compared to base fluid water but without TES. During the heating period, the maximum thermal gain of the hybrid nanofluid was observed to be about 15°C higher than the ambient temperature at mass flow rate of 0.033 kg/s. Thermal efficiency enhancement of about 23.8%, 24%, and 24.1% was observed with hybrid nanofluid compared to base fluid water at a mass flow rate of 0.008 kg/s, 0.016 kg/s, and 0.033 kg/s, respectively, when PCM was kept inside the tank. Furthermore, a maximum zero loss efficiency of 83.8% was estimated at an optimal mass flow rate of 0.033 kg/s for the TES‐integrated VASC system.
Neuro‐educational leadership: Pioneering educational leadership through neuroscience research
Authors: Zhang Yifei , He Qinghua
Published: February 2024

Educators have been increasingly focused on the concept of educational leadership in the context of global educational reform. With the emergence of neuroscience, there is potential to further explore the theory and practice of educational leadership from a neuroscience perspective. This article provides an overview of the neuroscience research related to educational leadership, including leadership traits, styles, decision‐making, and contingency perspectives. Additionally, the article examines the application of neuroscience in the assessment and enhancement of educational leadership with the goal of providing useful insights.
Genome‐wide association studies for rice seed germination under drought stress using 3VmrMLM
Authors: Yang Bin , Chen Shaona , Zheng Zhao , Zeng Jiali , Liu Jiping , Zhao Hua , Zheng Yixiong
Published: February 2024

Improving seed germination under drought stress has the potential to increase crop yield in dry direct‐seeded rice. In this study, a genome‐wide association study (GWAS) was conducted to determine the genetic basis of seed germination under drought stress in a panel of 165 rice accessions using a multi‐locus compressed variance‐component mixed model, 3VmrMLM. A total of 33 quantitative trait nucleotides (QTNs) were identified in association with drought tolerance during seed germination. Around these QTNs, eight were found to be co‐localized with known drought‐related genes. Furthermore, a causal candidate gene, OsGA2ox5, which encodes a gibberellin (GA) 2‐oxidase, was identified for QTN‐Chr07_242906 by integrating linkage disequilibrium (LD) analysis and gene expression analysis. Knockout mutation of OsGA2ox5 resulted in delayed seed germination and retarded seedling growth under drought stress. RNA‐seq analysis revealed that OsGA2ox5 regulates drought tolerance during seed germination mainly by modulating carbohydrate metabolism. Additionally, a non‐synonymous coding variant in OsGA2ox5, SNP‐Chr07_218893, was found to be strongly associated with drought tolerance level during seed germination. These findings provide valuable information for further exploration of novel drought‐related genes and genetic improvement of rice drought tolerance in the future.
Two‐stage credit risk prediction framework based on three‐way decisions with automatic threshold learning
Authors: Li Yusheng , Sha Mengyi
Published: February 2024

Credit risk prediction is a binary classification problem. Using two‐way decisions to classify defaulters may lead to decision errors due to insufficient information. To solve this issue, in addition to identifying borrowers as defaulters and nondefaulters, this paper introduced the delay‐decision mechanism in three‐way decisions, so that records acquiring more information do not make decisions immediately. A two‐stage credit risk prediction framework based on three‐way decisions was proposed to reduce decision risk. In this framework, the decision cost values of three‐way decisions were simplified by analyzing the credit risk prediction, and the expression of threshold calculation was also modified. An optimization objective was built according to the trade‐off between information gain and decision cost, and the particle swarm optimization algorithm was applied to learn the decision thresholds. After adding more supplementary information, the samples in the delayed‐decision region were made further decisions. A dataset from a commercial bank in China was employed to conduct experiments, and the results demonstrated that our proposed method outperformed various base classifiers.
Determination of the presence and antimicrobial resistance of Arcobacter species in broiler carcasses at different stages of slaughter line
Authors: Akkemik Yasin , Güner Ahmet
Published: February 2024

In this study, to investigate Arcobacter spp. contamination post‐scalding and de‐feathering, post‐evisceration, post‐chilling, and packaged products, which are the most essential contamination stages of broiler slaughter, a total of 108 samples were taken from three different broiler slaughterhouses at different times. Isolates obtained by cultural methods in 104 of 108 samples were analyzed by mPCR method to identify pathogen Arcobacter spp. Arcobacter butzleri, Arcobacter cryaerophilus, and mixed contamination of both Arcobacter species were detected in 51 samples. Of the 51 isolates, 27 (52.9%) were A. butzleri, 16 (31.4%) were A. cryaerophilus, and 8 (15.7%) were mixed contamination of A. butzleri and A. cryaerophilus, while Arcobacter skirrowii was not detected. A. butzleri and A. cryaerophilus contamination was 59.2% post‐scalding and de‐feathering, 43.4% post‐evisceration, 44.4% and 48.1% post‐chilling and in packaged products, respectively. All A. butzleri strains were found to be 100% resistant to cefoperazone and penicillin and sensitive to tetracycline. A. cryaerophilus strains were 100% resistant to cefoperazone, penicillin, and cloxacillin and susceptible to tetracycline and erythromycin. In the study, it was determined that Arcobacter spp. caused a very intense contamination (85.18%–100%) and also contamination rates of identified pathogen strains (A. butzleri and A. cryaerophilus) were very high (59.2% and 43.4%) in broiler slaughtering stages. Considering that each step in broiler slaughter could contaminate the next stage, developing a safe slaughter and minimizing the risk toward the final product, it was concluded that critical control points could not be well managed in broiler slaughterhouses, and broiler meat may pose a significant risk to public health.
Predicting progression to Alzheimer's disease dementia using cognitive measures
Authors: Macdougall Amy , Whitfield Tim , Needham Kelly , Schott Jonathan M. , Frost Chris , Walker Zuzana
Published: February 2024

Objectives

It is important to determine if cognitive measures identified as being prognostic in dementia research cohorts also have utility in memory clinics. We aimed to identify measures with the greatest power to predict future Alzheimer's disease (AD) dementia in a clinical setting where expensive biomarkers are not widely available.

Methods

This study utilized routine Memory Clinic data collected over 18 years. From 2214 patients assessed in the clinic, we selected 328 patients with an initial diagnosis of subjective cognitive decline or mild cognitive impairment. We compared two types of statistical model for the prediction of AD dementia. The first model included baseline cognitive test scores only, while the second model also included change scores between baseline and the first follow‐up.

Results

Baseline scores on tests of global cognitive function (Mini‐mental state examination and Cambridge Cognitive Examination‐Revised), verbal episodic memory and psychomotor speed were the best predictors of conversion to AD dementia. The inclusion of cognitive change scores over 1 year of follow‐up improved predictive accuracy versus baseline scores alone.

Conclusions

We found that the best cognitive predictors of AD dementia in a clinical setting were similar to those previously identified using research cohorts. Taking change in cognitive function into account enabled the onset of AD dementia to be predicted with greater accuracy.
Multiplex dynamic networks in the newborn brain disclose latent links with neurobehavioral phenotypes
Authors: Al‐Sa'd Mohammad , Vanhatalo Sampsa , Tokariev Anton
Published: February 2024

The higher brain functions arise from coordinated neural activity between distinct brain regions, but the spatial, temporal, and spectral complexity of these functional connectivity networks (FCNs) has challenged the identification of correlates with neurobehavioral phenotypes. Characterizing behavioral correlates of early life FCNs is important to understand the activity dependent emergence of neurodevelopmental performance and for improving health outcomes. Here, we develop an analysis pipeline for identifying multiplex dynamic FCNs that combine spectral and spatiotemporal characteristics of the newborn cortical activity. This data‐driven approach automatically uncovers latent networks that show robust neurobehavioral correlations and consistent effects by in utero drug exposure. Altogether, the proposed pipeline provides a robust end‐to‐end solution for an objective assessment and quantitation of neurobehaviorally meaningful network constellations in the highly dynamic cortical functions.
Oppositionally‐intertwined ecologies: A single‐system, multi‐theory mapping of marginalized students’ experiences
Authors: Johnson Kayla M. , Levitan Joseph
Published: February 2024

This chapter offers a “single‐system, multi‐theory” approach to understanding and improving the “oppositionally‐intertwined” ecologies of marginalized students as they navigate to and through higher education. Drawing from research conducted with Indigenous students in Peru, we use Ecological Systems Theory (EST) as a schematic for visualizing students’ experiences and two theoretical perspectives to illuminate the forces they encounter. We demonstrate how this approach can help educators identify leverage points that can result in both immediate and systemic change to improve educational opportunities and outcomes.

Practical Takeaways

Marginalized students live in a complex system of multiple, often intertwined forces that both oppress and support them.

Ecological systems theory provides a schematic for visualizing forces, tensions, and interconnections, within students’ systems.

Using multiple theories to analyze students’ experiences can help educators form more comprehensive understandings of students’ ecological systems and how to affect change within it.
How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? A scoping review
Authors: Tancred Tara , Falkenbach Michelle , Raven Joanna , Caffrey Margaret
Published: February 2024

Inadequate numbers, maldistribution, attrition, and inadequate skill‐mix are widespread health and care workforce (HCWF) challenges. Intersectoral—inclusive of different government sectors, non‐state actors, and the private sector—collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty‐six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision‐making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data‐informed recruitment; and learn from COVID‐19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF.
Arabic websites assessment of irritable bowel syndrome: How trustworthy are they? A cross‐sectional study
Authors: Abugharbieh Hamzeh M. I. , Alshareef Raneen Bilal , Ghazaleh Robin Abu , Jobran Afnan W. M. , Ashhab Hazem Al
Published: February 2024

Background and Aims

Irritable bowel syndrome (IBS) is a chronic GI disorder that affects people all over the world. Patients frequently look for information about their ailments online. Despite being widely and easily accessible, online information's quality and readability are under doubt. In this investigation, we assessed the effectiveness and usability of IBS Arabic websites found on significant search engines.

Methods

IBS‐related search terms in Arabic were entered into two search engines (Google and YouTube), and the first 30 websites per word from Google, and the first 20 websites per word from YouTube were assessed for eligibility. Eligible Google websites were assessed for quality and readability, while YouTube websites were assessed for quality. Quality was assessed using the DISCERN score and the JAMA Benchmark. Readability was assessed using the automatic Arabic readability index (AARI). Associations between quality, readability, types of websites (medical/nonmedical), and video length were analyzed.

Results

For Google: A total of 48 websites were evaluated, mean DISCERN score was 40.4 (SD = 10.28) indicating fair quality. The mean JAMA score was 1.6 (SD = 0.69), with the readability being worse the higher the quality. Medical websites had higher quality scores than nonmedical ones. For YouTube: A total of 34 YouTube videos were evaluated, mean DISCERN score was 34.7 (SD = 7.35), indicating poor quality. The mean JAMA score was 1.4 (SD = 0.72). Medical websites had higher quality scores than nonmedical ones. There was no association between the quality of the videos and their length.

Conclusion

The majority of websites were of low to fair quality and required a high degree of readability. As a result, we advise (1) healthcare practitioners to offer helpful websites to their patients, and (2) the development of IBS‐related websites under the guidance of experts, with the involvement of patients.
Clinical and historical features of cesarean scar pregnancies in a tertiary hospital with a high rate of cesarean section: A case–control survey
Authors: Sharami Seyedeh Hajar , Arzpeyma Sima Fallah , Montazeri Sina , Ghadim‐limudahi Zahra Haghparast , Eslami‐Kenarsari Habib , Attari Seyedeh Maryam , Kamakoli Harir Tanhaye
Published: February 2024

Background and Aims

Cesarean scar pregnancy (CSP) is a rare medical condition accounting for 1:2000 of all pregnancies with prior history of cesarean deliveries (CS). As the rate of CS is increasing worldwide, it is important to know the nature of CSP and its complications.

Methods

In this retrospective case–control study, we evaluated 264 pregnant women; 86 cases with ultra‐sonographic findings of CSP and 178 controls: normal pregnancies with gestational age less than 12 weeks. The variables consisted of demographic characteristics, the features and causes of the prior CS, the time distance to the current pregnancy, sonographic features, and the final management. All data analyzed using SPSS version 21.

Results

There was a significant difference between the two study groups regarding to parity, abortions and D&Cs (p < 0.001). In the case group, 19.8% of patients had positive results for STDs versus 16.3% in the control group (p > 0.990). The mean average of intervals between the last CS and current pregnancies were 48.22 ± 37.03 in the case group versus 61.25 ± 36.25 months in the control group (p < 0.001). Regression Logistic analysis showed advanced maternal age (p < 0.001), positive history of abortions and D&C (p < 0.001), elective type of prior c/s (p < 0.001) and the short time interval between prior CS and current pregnancy (p < 0.001) could significantly predict the patients at higher risk of presenting CSP in the case group.

Conclusions

Based on our findings, advanced maternal age, positive history of abortion, the elective type of the former CS, and short time intervals between previous CS and current pregnancy are the main risk factors of CSP.
Unleashing the power of retatrutide: A possible triumph over obesity and overweight: A correspondence
Authors: Naeem Muhammad , Imran Laiba , Banatwala Umm E Salma Shabbar
Published: February 2024

Background and Aims

Overweight and obesity have become global health challenges with increasing prevalence. Several drugs have received Food and Drug Administration approval for nonsyndromic obesity treatment, but most have limitations, including gastrointestinal side effects and limited weight loss efficacy.

Body

Retatrutide, a novel incretin mimetic agent, has shown promise in clinical trials for significant weight reduction. It has demonstrated dosage‐dependent pharmacokinetics with favorable safety profiles. The primary focus of this paper is to explore retatrutide and critically assess its clinical trials to justify its use and feasibility while highlighting its shortcomings. This paper also delves into the subject of obesity and its health manifestations.

Conclusion

It is expected that the use of retatrutide, a triple agonist, will result in significant weight loss among individuals who are obese or overweight.
The linkage between IL‐6 rs1800797 variant and breast cancer susceptibility in Bangladeshi women: A case‐control study
Authors: Khanom Mohima , Hossen Md. Shafiul , Barek Md. Abdul , Ahamed Md. Shuvo , Alam Md. Sohanur , Bhowmik Khokon Kanti , Jafrin Sarah , Aziz Md. Abdul , Islam Mohammad Safiqul
Published: February 2024

Background and Aims

Breast cancer is one of the deadliest diseases affecting women in Bangladesh, and its prevalence is increasing year by year. Although several IL‐6 single nucleotide polymorphisms have been implicated in BC susceptibility and prognosis in various studies, no research has been done to investigate the relationship between breast cancer and IL‐6 in Bangladeshi women. This investigation aimed to explore the linkage between the rs1800797 variant of IL‐6 and the susceptibility to breast carcinoma among women in Bangladesh.

Methods

The IL‐6 rs1800797 variant was genotyped in 218 subjects (110 cases and 108 controls) using the tetra‐primer ARMS‐PCR method. The statistical analysis was applied utilizing the SPSS software version 24.0. UALCAN database was used for IL‐6 mRNA analysis, and genotype‐based gene expression was retrieved from GTEx Portal.

Results

This study found a significant link between IL‐6 rs1800797 variants and increased chance of breast cancer across different genetic inheritance models, including additive model 1 (AG vs. GG: OR = 2.16, p = 0.035); dominant model (AG + AA vs. GG: OR = 2.26, p < 0.05); overdominant model (AG vs. GG + AA: OR = 2.08, p < 0.05); and allelic model (A vs. G: OR = 2.15, p < 0.05). However, an insignificant association of breast cancer was found in both additive model 2 (AA vs. GG: OR = 2.91, p > 0.05) and the recessive model (AA vs. GG + AG: OR = 2.52, p > 0.05). Under the analysis of the probability of false positive reports, no significant values were found in different models when the OR was 1.5, and the prior probability was 0.25.

Conclusions

A significant relationship was found between the IL‐6 rs1800797 genetic variant and the risk of breast cancer. However, the findings of the study should be further investigated with a larger sample size to validate the correlation.
Influence of tea leaf morphology on water interception for droplet impact
Authors: Pan Qingmin , Jin kuang , Hu Yongguang
Published: February 2024

It is common for plant canopy to intercept water during rainfall or sprinkler irrigation. How tea leaves intercept water droplets are unknown. The objective of this study is to investigate the influence of different shapes of tea leaves on the water droplet retention and distribution. First, the shapes of different tea varieties (Zhongcha 108, Maolu, Longjing 43, Huangjinya, and Anji Baicha) were statistically classified, and a high‐speed camera (with a frame rate of 10 000 fps) was used to record and analyse the interception of single droplet. The results showed that the morphology of tea leaves is flat, V‐shaped and hemispherical. The percentage of flat shaped leaves is the highest in each variety (45.38%–63.20%), the proportion of V‐shaped leaves is 30.40%–42.97%, and the proportion of hemispherical leaves is the least. When the impact velocity is 1.35 ± 0.05 m/s, it takes only 20–26 ms for droplet to start hitting each morphology of leaves and be retained as a static liquid. Droplets were kept as a film of water on the flat leaf, and similar situation happened to the hemispherical leaf, but they slid downward due to gravity. When impact position is near the midrib or leaf surface angle is smaller, retained droplets tends to converge to the bottom of the V‐shape with a symmetrical distribution. This study aids to better understand and model water interception within tea canopies for future practice of irrigation and chemical spraying.
Bank resolution in South Africa: Recent developments
Authors: Nyaude Ashley Batsirai , Van Heerden Corlia
Published: February 2024

In this contribution, the authors explore recent developments in South Africa's approach to bank resolution, assessing compliance of its new regime with the Financial Stability Board's Key Attributes of Effective Resolution Regimes for Financial Institutions (KAs). Emphasizing the imperative for orderly resolutions to avert financial crises, the authors scrutinize the post‐2008 Global Financial Crisis regulatory landscape. Until June 2023, South Africa's approach to bank failure was limited to curatorship and liquidation under the Banks Act 94 of 1990. Addressing gaps identified by international bodies such as the Financial Stability Board, International Monetary Fund, and the World Bank, and taking lessons from the failure of African Bank in 2014, South Africa has transitioned to a Twin Peaks regulatory model and also introduced a comprehensive resolution framework effective June 1, 2023, captured in the Financial Sector Regulation Act 9 of 2017. This framework currently applies to banks only. The South African Reserve Bank now holds an explicit financial stability mandate and is designated as the resolution authority. The article discusses the design features for an effective resolution regime as recommended in the KAs to benchmark the new South African resolution regime, noting overall compliance. However, it acknowledges the need for further development in certain respects to enhance alignment.
Transient ischemic attack and pregnancy, delivery and neonatal outcomes—An evaluation of a population database
Authors: Amikam Uri , Badeghiesh Ahmad , Baghlaf Haitham , Brown Richard , Dahan Michael H.
Published: February 2024

Objective

Transient ischemic attack (TIA) is rare in women of reproductive age. We aimed to compare perinatal outcomes between women who suffered from a TIA to those who did not.

Methods

A retrospective population‐based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP‐NIS). All women who delivered or had a maternal death in the US (2004–2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD‐9 diagnosis of a TIA to those without.

Results

Overall, 9 096 788 women met the inclusion criteria. Of these, 203 women (2.2/100000) had a TIA (either before or during pregnancy). Women with TIA, compared to those without, were more likely to be older than 35 years of age, white, in the highest income quartile, be insured by private insurance and suffer from obesity and chronic hypertension. Patients in the TIA group, compared to those without, had a higher rate of pregnancy‐induced hypertension (aOR 2.5, 95% CI: 1.55–4.05, P < 0.001), pre‐eclampsia (aOR 3.77, 95% CI: 2.15–6.62, P < 0.001), eclampsia (aOR 28.05, 95% CI: 6.91–113.95, P < 0.001), preterm delivery (aOR 1.78, 95% CI: 1.03–3.07, P = 0.039), and maternal complications such as deep vein thrombosis (aOR 33.3, 95% CI: 8.07–137.42, P < 0.001). Regarding neonatal outcomes, patients with a TIA, compared to those without, had a higher rate of congenital anomalies (aOR 7.04, 95% CI: 2.86–17.32, P < 0.001).

Conclusion

Women with a TIA diagnosis before or during pregnancy had a higher rate of maternal complications, including hypertensive disorders of pregnancy and venous thromboembolism, as well as an increased risk of congenital anomalies.
Outpatient cervical ripening with balloon catheters: A Bayesian network meta‐analysis of randomized controlled trials
Authors: Zhao Ge , Song Guang , Liu Jing
Published: February 2024

Background

One in four labors are induced. The process of cervical ripening can be lengthy and pre‐labor hospitalization is required. Outpatient cervical ripening can be an attractive alternative.

Objectives

To evaluate the efficacy and safety of outpatient cervical ripening with a balloon catheter compared with inpatient balloon catheter or prostaglandin E2 (PGE2).

Search Strategy

The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to October 15, 2022.

Selection Criteria

Randomized controlled trials comparing the outpatient balloon catheter with inpatient balloon catheter or inpatient PGE2 for term cervical ripening.

Data Collection and Analysis

Bayesian network meta‐analysis was performed. The primary outcome was the cesarean delivery rate. The secondary outcomes included instrumental delivery, the time from intervention‐to‐birth, oxytocin augmentation, total hospital duration, and maternal/neonatal adverse events.

Main Results

Twenty‐nine randomized controlled trials with a total of 6004 participants were identified. No difference in the cesarean delivery rate was revealed among the three interventions. Compared with inpatient balloon catheter, outpatient balloon catheter had shorter total hospital duration (mean difference −8.58, 95% confidence interval −17.02 to −1.10). No differences were revealed in the time from intervention‐to‐birth, instrumental delivery, postpartum hemorrhage, 5‐min Apgar score less than 7, umbilical cord arterial pH less than 7.1, and neonatal intensive care unit admission among the three interventions.

Conclusions

Outpatient balloon catheter in low‐risk term pregnancies is an available option that could be considered for cervical ripening. The safety and effectiveness are comparable to inpatient cervical ripening methods.
Risk factors for early postpartum hemorrhage: A retrospective, population‐based, cohort analysis
Authors: Abecassis Avishag , Wainstock Tamar , Sheiner Eyal , Miodownik Shayna , Pariente Gali
Published: February 2024

Objective

To identify risk factors for developing early postpartum hemorrhage (PPH) and to examine whether risk factors vary according to severity and mode of delivery.

Methods

A population‐based cohort study was conducted in which all deliveries at a tertiary medical center were included. Risk factors for developing early PPH were compared based on the severity of bleeding as well as the mode of delivery. Multiple logistic regression models were used to control for confounders.

Results

Among 322 497 deliveries included in the analysis, early PPH complicated 1811 (0.56%) of all deliveries. Among all cases of early PPH, 505 deliveries (28%) were complicated with severe PPH. Using a logistic regression model, in vitro fertilization (IVF) pregnancy, previous cesarean delivery (CD), pre‐eclampsia, placental abruption, and uterine rupture were independently associated only with severe early PPH, while non‐progressive second stage of labor, induction of labor, and large for gestational age were independently associated with both severe and mild early PPH. When applying an additional logistic regression model, whereas IVF pregnancy, pre‐eclampsia, and large for gestational age were independently associated with early PPH among vaginal deliveries only, placenta previa was independently associated with early PPH among CD only.

Conclusions

Independent risk factors for developing severe PPH solely include IVF pregnancy, previous CD, pre‐eclampsia, placental abruption, and uterine rupture. IVF pregnancy, pre‐eclampsia, and large for gestational age are independent risk factors for early PPH following vaginal delivery, while placenta previa is independently associated with early PPH after CD only. Due to the recognition of the importance of both the provider and institutional planning and preparation for PPH, the study's results should be viewed within the scope of its retrospective cohort design.
Design and development of artificial intelligence‐based application programming interface for early detection and diagnosis of colorectal cancer from wireless capsule endoscopy images
Authors: Selvaraj Jothiraj , Jayanthy A. K.
Published: February 2024

The colorectal cancer (CRC) is gaining attention in the context of gastrointestinal tract diseases as it ranks third among the most prevalent type of cancer. The early diagnosis of the CRC can be done by periodic examination of the colon and rectum for innocuous tissue abnormality called polyp as it has the potential to evolve as malignant in future. The CRC diagnosis using wireless capsule endoscopy requires the dedicated commitment of the medical expert demanding significant time, focus and effort. The accuracy of manual analysis in identifying polyps is extensively reliant on the cognitive condition of the physician, thus emphasizing the requirement for automatic polyp identification. The artificial intelligence integrated computer‐aided diagnosis system could assist the clinician in better diagnosis, thereby reducing the miss‐rates of polyps. In our proposed study, we developed an application program interface to aid the clinician in automatic segmentation of the polyp and evaluation of its dimension by manual placement of four landmarks on the predicted polyp. The segmentation is performed by the proposed light weight Padded U‐Net for the effective polyp segmentation in the colorectal images. We trained and validated the Padded U‐Net with augmented images of Kvasir dataset and calculated the performance parameters. In order to facilitate image augmentation, a graphical user interface called Augment Tree was developed, which incorporates 92 augmentation techniques. The accuracy, recall, precision, IoU, F1‐score, loss achieved during validation of Padded U‐Net were 95.6%, 0.946%, 0.985%, 0.933%, 0.965% and 0.080% respectively. We demonstrated that accuracy was improved and loss was reduced when the model was trained with augmented images rather than only the limited original dataset images. On comparison of our Padded U‐net architecture with recently developed architectures, our model attained optimal performance in all the metrics except accuracy in which it attained marginal performance to the highest value.
In Vitro Digestion of Cow's Milk Proteins by Duodenal Juice from Infants with Various Gastrointestinal Disorders
Authors: Jakobsson Iréne , Lindberg Tor , Benediktsson Birgitta
Published: February 2024

The hydrolysis of bovine α‐lactalbumin, β‐lactoglobulin, and casein by duodenal juice from 20 infants (18 with normal exocrine pancreatic function, 2 with pancreatic insufficiency), aged 3–19 months was studied in vitro with the aid of electroimmunoassay and sodium dodecyl sulfate–poly‐acrylamide gel electrophoresis. The results from the two methods were almost identical. Duodenal juice from infants with cow's milk protein intolerance (7), celiac disease (5), and unclassified gastrointestinal disorder (6) had the same capacity to hydrolyze the milk proteins. No hydrolysis occurred in the two patients with pancreatic insufficiency. The hydrolyzing capacity was not correlated with age in the actual age group. The hydrolysis of the milk proteins occurred at a considerably slower rate when the proteins were crude, as in cow's milk, adapted, or unadapted formula, than when they were in a purified form. About 1 mg of purified α‐lactalbumin or β‐lactoglobulin, and about 30 mg of purified casein could be hydrolyzed per milliliter duodenal juice per minute. Corresponding figures for the hydrolysis of the various proteins in cow's milk were 0.03, 0.12, and 16.1 mg/ml duodenal juice/min. Preincubation (60 min) with gastric aspirate after adjusting pH to 4–5 did not change the results. In conclusion, the duodenal juice from infants with normal exocrine pancreatic function has a great ability to hydrolyze casein. Corresponding hydrolytic capacity for α‐lactalbumin or β‐lactoglobulin is considerably lower.
The Lipolytic Triad Human Lingual, Breast Milk, and Pancreatic Lipases
Authors: Jensen Robert G. , Clark Richard M. , deJong Felice A. , Hamosh Margit , Liao Teresa H. , Mehta Nitin R.
Published: February 2024

The characteristics of human lingual, breast milk, and pancreatic lipases as related to the digestion of dietary fats in infants are discussed. The activity and specificity of these enzymes and structure of the dietary fats largely determine the rates of lipolysis, the types of digestion products formed, and the rates of absorption. Also possibly influenced are micelle formation, intestinal health, breast milk jaundice, and the absorption of other nutrients. In premature infants, the action of lingual and breast milk lipase are particularly important in the absorption of dietary fatty acids.
Protein Synthesis by Gastric Mucosal Ribosomes During Development in Rats
Authors: Majumdar A. P. N.
Published: February 2024

Oxyntic gland mucosal ribosomes from 7− to 30‐day‐old rats were asayed for their ability to synthesize endogenous messenger RNA (mRNA) and poly(U)‐directed protein in a cell‐free system. Normal rat liver cell sap (105,000 g supernatant) was used as a source for transfer RNA (tRNA) and activating enzymes. Total mucosal DNA and ribosome content [as assessed by ribosomal RNA (rRNA)] were also determined. Although both DNA and rRNA content increased throughout the 4 post‐natal weeks, the rRNA/DNA ratio rose sharply during the 2nd and 4th week after birth. The ability of mucosal polyribosomes to synthesize endogenous mRNA‐directed protein in a cell‐free system remained elevated up to the age of 18 days, then decreased markedly within the next 3 days, and thereafter, declined more slowly. In 21− and 30‐day‐old rats, the rate of endogenous mRNA‐directed protein synthesis by mucosal ribosomes was 50–60% below that of the 7‐day‐old suckling rats. The protein/ polyphenylalanine ratio, which represents a ratio of polysomes to monosomes, was found to be about 57% lower for ribosomes from 30‐day‐old rats as compared to 7‐day‐old suckling animals. The ability of run‐off ribosomes (devoid of endogenous mRNA) to translate poly(U) was also found to be 33% lower for 30‐day‐old rats as compared to the 7‐day‐old suckling animals.
Total Parenteral Nutrition in Sick Preterm Infants
Authors: Malloy Michael H. , Rassin David K. , Richardson C. Joan
Published: February 2024

The effects of supplementing total parenteral nutrition (TPN) solutions with cysteine were assessed at two different levels of nitrogen intake by determining nitrogen retention, sulfate excretion, and sulfur‐containing amino acid concentrations. Ten infants received 72 mg/ kg/day of cysteine‐HCl in a TPN solution for a period of 6 days. Five of these infants received 251 ± 48 (±SD) mg/kg/day of nitrogen, and five received 403 ± 45 mg/ kg/day of nitrogen. Two other groups of five infants each received unsupplemented TPN at nitrogen intakes of 235 ± 48 and 412 ± 54 mg/kg/day, respectively. Fluid and nonprotein caloric intakes were similar for all four groups. Cysteine supplementation increased plasma and urine free cyst(e)ine concentrations and enhanced total sulfur retention, but did not enhance nitrogen retention. [Cyst(e)ine refers to the mixture in any proportion of the sulfhydryl (cysteine) and the disulfide (cystine) forms of this compound.] Nitrogen retention, sulfate excretion, cyst(e)ine excretion, and plasma taurine concentrations increased as the result of the increase in nitrogen intake.
Acute Gallbladder Dilatation in a Neonate
Authors: Bowen A'Delbert
Published: February 2024

A neonate with giant‐cell hepatitis developed gallbladder dilatation that was identified on ultrasonography and treated by tube cholecystostomy. Previous reports of hydrops and cholecystitis in neonates are reviewed. Ultrasound identifies gallstones and dilated bile ducts, establishes a large gallbladder as the cause of a palpable mass, and is the ideal way to follow the course of gallbladder dilatation.
Systemic Histiocytosis
Authors: Moroz S. P. , Schroeder M. , Trevenen C. L. , Cross H.
Published: February 2024

A male child first presented with chronic perianal skin disease at 33 months of age and later developed gingival disease and loose teeth associated with alveolar bone erosion. Biopsy of gingival and perianal lesions showed histiocytic proliferation. Following therapy with vinblastine, prednisone, methotrexate, and cyclophosphamide, the lesions healed but disease recurred in the mastoid and was successfully treated with vinblastine alone. Although the perianal area is an unusual site of skin involvement in systemic histiocytosis, this disorder should be considered in any child with chronic unexplained perianal disease, and biopsy of these lesions should be obtained.
Quantitative Analysis of Small Intestinal Mucosa in Cow's Milk‐Sensitive Enteropathy
Authors: Maluenda C. , Phillips A. D. , Briddon A. , Walker‐Smith J. A.
Published: February 2024

The appearance of the small intestinal mucosa in cow's milk protein intolerance (CMPI) was studied using quantitative morphometry. The parameters under study were the numbers of eosinophil cells in the lamina propria and epithelium, villous height, crypt zone depth, villous height/crypt zone depth ratio, and total mucosal thickness. Tracings of whole sections were analysed using a suitably programmed minicomputer linked to a digitising table. Small bowel biopsy specimens from children with untreated CMPI, from children before and after clinical relapse on cow's milk challenges, and from children with resolved CMPI were compared to each other, to those from control infants, and to those from children with coeliac disease. No change of diagnostic significance could be found in the number of lamina propria eosinophil cells, but levels of intraepithelial eosinophils were significantly increased following cow's milk challenge. Quantification of mucosal dimensions confirmed the presence of a cow's milk‐sensitive enteropathy and established the finding of a thin mucosa in CMPI regardless of clinical disease activity. Mucosal thickness was not different from control values following resolution of the disease. In coeliac disease mucosal thickness was significantly greater than in CMPI (apart from young children with untreated coeliac disease whose mucosa was not thicker than that of children with untreated CMPI) but not different from control values. It is suggested that in CMPI there is a limitation in the capacity of crypt cells to compensate for the loss of villous epithelium.
Mast Cells and Eosinophils in the Jejunal Mucosa of Patients with Intestinal Cow's Milk Allergy and Celiac Disease of Childhood
Authors: Kosnai I. , Kuitunen P. , Savilahti E. , Sipponen P.
Published: February 2024

We counted the number of granulated mast cells with high iron diamine staining, and the number of eosinophils with hematoxyline‐eosin staining, in the lamina propria of the jejunum in 12 untreated patients with intestinal cow's milk allergy (CMA), 47 with celiac disease (CD), and 14 controls. A decreased number of mast cells and an increased number of eosinophils were found in 58% of patients with CMA, and in 60% of those with CD. The number of mast cells showed a significant positive correlation with the villous height, and the number of eosinophils a negative correlation with both the villous height, and the number of mast cells. Appropriate dietary treatment resulted in a rise in the number of granulated mast cells and a decrease in the number of eosinophils in both patient groups.
Oral Rehydration of Neonates and Young Infants with Dehydrating Diarrhea
Authors: Bhargava S. K. , Sachdev H. P. S. , Gupta B. Das , Daral T. S. , Singh H. P. , Mohan Man
Published: February 2024

Oral rehydration among infants aged 0–3 months has not been adequately investigated. A controlled, randomized study was thus conducted in 65 young infants hospitalized with acute noncholera dehydrating diarrhea. The study was designed to compare the efficacy and safety of the standard WHO oral glucose‐electrolyte solution containing 90 mmol of sodium per liter (Group A: 22 infants) with that of an oral glucose‐electrolyte solution containing 60 mmol of sodium per liter (Group B: 22 infants) and with standard intravenous therapy (Group C: 21 infants). Among the 44 infants in Groups A and B, none required intravenous therapy. Dehydration, acidosis, and initial hyponatremia or hypokalemia were corrected with equal efficacy in all the three groups. In the critical first 8 h, the mean sodium absorption was significantly higher (p < 0.01) in Group A. This resulted in hypernatremia (50%), periorbital edema (50%), mild pedal edema (27%), excessive irritability, and convulsions (4.5%). The mean serum sodium levels at 8, 24, and even 48 h were significantly higher (p < 0.05) than those in Groups B and C. It is concluded that glucose‐electrolyte oral solution containing 60 mmol of sodium per liter is as safe and effective as intravenous rehydration for the treatment of noncholera neonatal and early infantile diarrhea, while the standard WHO solution carries a significant risk of hypernatremia under similar conditions.
Bile Acid Malabsorption in Cystic Fibrosis With and Without Pancreatic Insufficiency
Authors: Colombo Carla , Roda Aldo , Roda Enrico , Sereni Lucia Piceni , Brega Antonio , Fugazza Rita , Giunta Annamaria
Published: February 2024

Serum conjugated cholic acid (CCA) and conjugated chenodeoxycholic acid (CCDCA) fasting levels were measured in 30 children with cystic fibrosis (CF) without liver involvement, and mean levels were not significantly different from control values. In seven children (four with partially corrected pancreatic insufficiency and three without pancreatic insufficiency) serum levels of both primary bile acids (BAs) were also measured after the ingestion of a standard liquid meal; the values were then compared with those for total and fractional fecal BA excretion. The CCA mean peak increase was significantly reduced in patients with pancreatic insufficiency (p < 0.01), as well as in those without pancreatic insufficiency (p < 0.05), as compared to controls. The CCDCA mean peak increase was reduced only in patients with pancreatic insufficiency (p < 0.01). Fecal results confirmed serum data, showing a significantly increased excretion of cholic and deoxycholic acids in patients without pancreatic insufficiency as compared to controls (p < 0.02), despite a similar total BA excretion. In patients with pancreatic insufficiency, total fecal BA levels were markedly increased compared to control values (p < 0.001); the fecal percentage of chenodeoxycholic and lithocholic acids was greater than that recorded in patients without pancreatic insufficiency (p < 0.05), in agreement with the different behaviour of serum CCDCA postprandial curves for the two groups of patients. The results are consistent with selective malabsorption of cholic acid in CF, independent of the presence of pancreatic insufficiency; they confirm the usefulness of serum BA postprandial determinations in measuring BA malabsorption.
Zinc Nutriture in Type I Diabetes Mellitus
Authors: Canfield Wesley K. , Hambidge K. Michael , Johnson LuAnn K.
Published: February 2024

Zinc concentrations in plasma, hair, and urine from children and young adults with insulin‐requiring or Type I diabetes mellitus were significantly correlated with height, weight, and age, as well as with indices of metabolic control, i.e., fasting serum glucose, percent glyco‐sylated hemoglobin (HbA,), and 24‐h urine glucose and insulin excretion. Urinary zinc excretion was greater in subjects than in controls (p < 0.0001) and significantly correlated with urine glucose (p < 0.004, r = 0.35) and volume (p < 0.0007, r = 0.40). Urinary zinc and volume were not correlated in controls. Hyperzincuria in the subjects was not secondary to hyperinsulinuria, although zinc and insulin excretion were significantly correlated in controls (p <0.03, r = 0.63). Zinc in insulin preparations could not explain the excessive zinc excretion. Mean fasting plasma zinc was significantly higher than in controls, and positively correlated with height for age, while, being inversely correlated with age, duration of diabetes, HbA1, urine volume, and glucose excretion. Both the mean and range of hair zinc concentration in the subjects were not different from controls. Male subjects with diabetes had a significantly lower hair concentration when, compared with female subjects with diabetes (p < 0.0009). Zinc homeostasis appears to be altered as a consequence of glucose intolerance in diabetes. Continued urinary zinc losses over time may result in a zinc deficiency state not demonstrable by altered zinc concentrations in plasma and hair.