Determinants of Undernutrition among Children under Age 5 in the Puntland State of Somalia

The purpose of this study was to investigate the determinants of nutritional status among children under age 5 (0-59 months) in Puntland. Undernutrition is a global challenge, it does not only adversely affect short‐ and long‐term health and economic well‐being of children but it is also a leading contributor to death and disability globally. Undernutrition short-term effects include mortality and morbidity where long-term effects are that the children do not reach their full developmental potential and would have poor cognitive performance, which in turn has consequences on the country’s economic productivity. Nutritional status of the Somali children in Puntland is relatively poor due to many reasons such as low economic conditions of Somali households, lack of food security and severe drought that has affected the country in recent years and among other factors. This study used data from the Puntland Health and Demographic Survey 2020 which was conducted by the Department of Statistics at Puntland Ministry of Planning, Economic Development, and International Cooperation with technical support from UNFPA Somalia. The analysis used stunting, wasting, and underweight as dependent variables, while the independent variables were children, maternal, and household characteristics. Bivariate and multivariate Logistic regression models were performed to analyze the determinants of nutritional status among the children. The study showed a significant association between children’s nutritional status and most of the explanatory variables under study. Place of residence, gender of household head, wealth index, source of drinking water, source of energy for cooking, toilet facility, mother’s age, marital status, education, breastfeeding, ANC visits, BMI, work status, child’s sex, child’s age, birth order and size at birth have significant associations with children’s nutrition status. The study found that most variables in child, maternal, and household characteristics were significantly associated with stunting and wasting among children under age five.  Based on these findings, the research recommends that a multi-sectoral approach is needed to address undernutrition in Puntland state. Combined nutrition programmes from different sectors in line with National Development Plans (NDP) need to be designed to address the underlying causes of acute and chronic malnutrition

Effect of location in a cylinder wake on dynamics of a flexible energy harvesting plate

© 2019 Penerbit Akademia Baru. Flexible plate in the wake of a bluff body may be exploited to harvest energy, for example by attaching piezoelectric sheets on both surfaces of the plate. A computational investigation on flow-induced vibration of a flexible plate in the wake of a cylinder is undertaken to understand the effects of plate location on their vibrations and hence, energy harvesting potential. Based on cylinder diameter D (0.1m), flow at a sub-critical Reynolds number of 10000 was considered in the present study. The fluid-structure interaction was implemented via a closely-coupled partitioned scheme that employs a Scale-Adaptive Simulation (SAS) of the Shear Stress Transport (SST) method to model flow turbulence. A flexible plate was placed at several locations (streamwise: x/D = 0.5, 1.0, 1.5, 2.0; crossflow: y/D = 0, 0.25, 0.5) downstream of the cylinder and their flow-induced response were compiled and analysed. Benchmarking of present model showed good agreement with previous experimental investigations. Results suggest that maximum deflection may be found if flexible plate is placed in the region between cylinder surface and x/D < 1.0. Oscillation of flexible plate placed at y/D = 0.25 shows similar amplitude, if not slightly higher, than if plate is placed at wake centerline. Present findings suggest that energy output may be optimised by positioning flexible energy harvesting plates at favourable locations in the wake region

BIST hardware synthesis for RTL data paths based on test compatibility classes

New BIST methodology for RTL data paths is presented. The proposed BIST methodology takes advantage of the structural information of RTL data path and reduces the test application time by grouping same-type modules into test compatibility classes (TCCs). During testing, compatible modules share a small number of test pattern generators at the same test time leading to significant reductions in BIST area overhead, performance degradation and test application time. Module output responses from each TCC are checked by comparators leading to substantial reduction in fault-escape probability. Only a single signature analysis register is required to compress the responses of each TCC which leads to high reductions in volume of output data and overall test application time (the sum of test application time and shifting time required to shift out test responses). This paper shows how the proposed TCC grouping methodology is a general case of the traditional BIST embedding methodology for RTL data paths with both uniform and variable bit width. A new BIST hardware synthesis algorithm employs efficient tabu search-based testable design space exploration which combines the accuracy of incremental test scheduling algorithms and the exploration speed of test scheduling algorithms based on fixed test resource allocation. To illustrate TCC grouping methodology efficiency, various benchmark and complex hypothetical data paths have been evaluated and significant improvements over BIST embedding methodology are achieved

POCS-based reconstruction of multiplexed sensitivity encoded MRI (POCSMUSE): A general algorithm for reducing motion-related artifacts.

PURPOSE: A projection onto convex sets reconstruction of multiplexed sensitivity encoded MRI (POCSMUSE) is developed to reduce motion-related artifacts, including respiration artifacts in abdominal imaging and aliasing artifacts in interleaved diffusion-weighted imaging. THEORY: Images with reduced artifacts are reconstructed with an iterative projection onto convex sets (POCS) procedure that uses the coil sensitivity profile as a constraint. This method can be applied to data obtained with different pulse sequences and k-space trajectories. In addition, various constraints can be incorporated to stabilize the reconstruction of ill-conditioned matrices. METHODS: The POCSMUSE technique was applied to abdominal fast spin-echo imaging data, and its effectiveness in respiratory-triggered scans was evaluated. The POCSMUSE method was also applied to reduce aliasing artifacts due to shot-to-shot phase variations in interleaved diffusion-weighted imaging data corresponding to different k-space trajectories and matrix condition numbers. RESULTS: Experimental results show that the POCSMUSE technique can effectively reduce motion-related artifacts in data obtained with different pulse sequences, k-space trajectories and contrasts. CONCLUSION: POCSMUSE is a general post-processing algorithm for reduction of motion-related artifacts. It is compatible with different pulse sequences, and can also be used to further reduce residual artifacts in data produced by existing motion artifact reduction methods

Peer review audit of trauma deaths in a developing country

OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable.RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country

Molecular origins of transcriptional heterogeneity in diazotrophic Klebsiella oxytoca.

Phenotypic heterogeneity in clonal bacterial batch cultures has been shown for a range of bacterial systems; however, the molecular origins of such heterogeneity and its magnitude are not well understood. Under conditions of extreme low-nitrogen stress in the model diazotroph Klebsiella oxytoca, we found remarkably high heterogeneity of nifHDK gene expression, which codes for the structural genes of nitrogenase, one key enzyme of the global nitrogen cycle. This heterogeneity limited the bulk observed nitrogen-fixing capacity of the population. Using dual-probe, single-cell RNA fluorescent in situ hybridization, we correlated nifHDK expression with that of nifLA and glnK-amtB, which code for the main upstream regulatory components. Through stochastic transcription models and mutual information analysis, we revealed likely molecular origins for heterogeneity in nitrogenase expression. In the wild type and regulatory variants, we found that nifHDK transcription was inherently bursty, but we established that noise propagation through signaling was also significant. The regulatory gene glnK had the highest discernible effect on nifHDK variance, while noise from factors outside the regulatory pathway were negligible. Understanding the basis of inherent heterogeneity of nitrogenase expression and its origins can inform biotechnology strategies seeking to enhance biological nitrogen fixation. Finally, we speculate on potential benefits of diazotrophic heterogeneity in natural soil environments

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Abstract Background 4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD). Methods Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap. Results All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions. Conclusions FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner

Itraconazole associated quadriparesis and edema: a case report

<p>Abstract</p> <p>Introduction</p> <p>Itraconazole is an anti-fungal agent widely used to treat various forms of mycosis. It is particularly useful in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. Side effects are uncommon and usually mild. Mild neuropathy is noted to occur very rarely. We present an unusual and, to the best of our knowledge, as yet unreported case of severe neuropathy and peripheral edema due to itraconazole in the absence of a concomitant risk factor.</p> <p>Case presentation</p> <p>A 72-year-old Caucasian man was started on itraconazole following diagnosis of severe asthma with fungal sensitization. One month later he presented with severe bilateral ankle edema with an elevated serum itraconazole level. The itraconazole dose was reduced but his ankle edema persisted and he developed weakness of all four limbs. Itraconazole was completely stopped leading to improvement in his leg edema but he became bed bound due to weakness. He gradually improved with supportive care and neurorehabilitation. On review at six months, our patient was able to mobilize with the aid of two elbow crutches and power had returned to 5/5 in distal extremities and 4+/5 in proximal extremities. The diagnosis was established based on the classical presentation of drug-induced neuropathy and negative investigatory findings for any alternative diagnoses.</p> <p>Conclusion</p> <p>We report the case of a patient presenting with an unusual complication of severe neuropathy and peripheral edema due to itraconazole. Clinicians should be alert to this association when encountered with neuropathy and/or edema in an itraconazole therapy recipient.</p