Impact of Community-Based Maternal Health Workers on Coverage of Essential Maternal Health Interventions among Internally Displaced Communities in Eastern Burma: The MOM Project

Mullany and colleagues report outcomes from a project involving delivery of community-based maternal health services in eastern Burma, and report substantial increases in coverage of care

Prevalence of small-for-gestational age and its mortality risk varies by choice of birth-weight-for-gestation reference population

Background We use data from rural Nepal and South India to compare the prevalence of small-for-gestational-age (SGA) and neonatal mortality risk associated with SGA using different birth-weight-for-gestation reference populations. Methods We identified 46 reference populations in low-, middle-, and high-income countries, of which 26 met the inclusion criteria of being commonly cited and having numeric 10th percentile cut points published. Those reference populations were then applied to populations from two community-based studies to determine SGA prevalence and its relative risk of neonatal mortality. Results The prevalence of SGA ranged from 10.5% to 72.5% in Nepal, and 12.0% to 78.4% in India, depending on the reference population. Females had higher rates of SGA than males using reference populations that were not sex specific. SGA prevalence was lowest when using reference populations from low-income countries. Infants who were both preterm and SGA had much higher mortality risk than those who were term and appropriate-for-gestational-age. Risk ratios for those who are both preterm and SGA ranged from 7.34–17.98 in Nepal and 5.29–11.98 in India, depending on the reference population. Conclusions These results demonstrate the value of a common birth-weight-for-gestation reference population that will facilitate comparisons of SGA prevalence and mortality risk across research studies

Spelling errors and keywords in born-digital data: a case study using the Teenage Health Freak Corpus

The abundance of language data that is now available in digital form, and the rise of distinct language varieties that are used for digital communication, means that issues of non-standard spellings and spelling errors are, in future, likely to become more prominent for compilers of corpora. This paper examines the effect of spelling variation on keywords in a born-digital corpus in order to explore the extent and impact of this variation for future corpus studies. The corpus used in this study consists of e-mails about health concerns that were sent to a health website by adolescents. Keywords are generated using the original version of the corpus and a version with spelling errors corrected, and the British National Corpus (BNC) acts as the reference corpus. The ranks of the keywords are shown to be very similar and, therefore, suggest that, depending on the research goals, keywords could be generated reliably without any need for spelling correction

Aortic valve replacement in patients aged 50 to 70 years: Improved outcome with mechanical versus biologic prostheses

ObjectiveImproved durability of bioprostheses has led some surgeons to recommend biologic rather than mechanical prostheses for patients younger than 65 years. We compared late results of contemporary bioprostheses and bileaflet mechanical prostheses in patients who underwent aortic valve replacement between 50 and 70 years old.MethodsIn this retrospective study, patients received either St Jude bileaflet valves or Carpentier–Edwards bioprostheses. Operations were performed between January 1991 and December 2000, and groups were matched one-to-one according to age, sex, need for coronary artery bypass grafting, and valve size.ResultsFour hundred forty patients were matched, and follow-up was 92% complete, with median durations of 9.1 years for patients who received mechanical valves and 6.2 years for patients who received bioprostheses. The 5- and 10-year unadjusted survivals were 87% and 68% for mechanical valves and 72% and 50% for bioprostheses, respectively (P < .01). Freedoms from reoperation at 10 years were 98% for mechanical valves and 91% for bioprostheses (P = .06). Rates of late stroke or other embolic events and of endocarditis were similar between groups. Hemorrhagic complications necessitating hospitalization occurred in 15% of patients with mechanical valves and 7% of patients with bioprostheses (P = .01). Notably, 19% of patients with bioprostheses were receiving warfarin sodium at last follow-up. After adjustment for unmatched variables, including diabetes, renal failure, lung disease, New York Heart Association functional class, ejection fraction, and stroke, the use of a mechanical valve was protective against late mortality (hazard ratio 0.46, P < .01).ConclusionIn this study, patients aged 50 to 70 years who underwent aortic valve replacement with mechanical valves had a survival advantage relative to matched patients who received bioprostheses. These findings question recommendations of bioprostheses for younger patients and suggest that a randomized trial may be warranted

EMG amplitude in maximal and submaximal exercise is dependent on signal capture rate

This study analysed the effect of different electromyographic (EMG) capture rates during maximal voluntary contraction, submaximal and maximal dynamic cycling activity on EMG amplitude and signal characteristics. Ten healthy subjects participated in this study. Peak power output (PPO) and maximal isometric force output (MVC) were measured, followed by a progressive cycle ride on a cycle ergometer. Electromyographic (EMG) data were simultaneously captured during the MVC and cycling activities at frequencies of 32, 64, 128, 256, 512, 1024 and 1984 Hz. Significant differences in amplitude were found (p &lt; 0.01) between MVC, submaximal (SUB) and maximal cycling activities (PWATT) for all capture rates. Asymptote values for IEMG amplitude occurred at EMG capture rates of 1604 &plusmn; 235.6 Hz during MVC, 503.1 &plusmn; 236.2 Hz during PWATT and 326.2 &plusmn; 105.4 Hz during SUB cycling activity and were significantly different (p &lt; 0.01). No significant differences were found for force/EMG ratios between PWATT and MVC at 1984 Hz capture rates (3.8 &plusmn; 1.7 N/V vs 2.5 &plusmn; 0.9 N/V) while significant differences occurred at 32 Hz capture rate (6.2 &plusmn; 3.8 vs 16.0 &plusmn; 8.0; p &lt; 0.01). Low correlations were found between EMG activity captured at 1984 Hz during PWATT and lean thigh volume (r = 0.36) and MVC (r = 0.32). Asymptote values found on this study suggest that data captured below 326 Hz for SUB, 503 Hz for PWATT and 1604 Hz for MVC are not reliable. Therefore apparatus capturing EMG data at low frequencies from these values cannot be used for quantitative data analyses

Poor Thermal Care Practices among Home Births in Nepal: Further Analysis of Nepal Demographic and Health Survey 2011

Introduction - Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving ‘optimum thermal care’ among home born newborns of Nepal. Methods - Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. Results - A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care. Conclusion - The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal

Clostridium difficile clade 3 (RT023) have a modified cell surface and contain a large transposable island with novel cargo.

The major global pathogen Clostridium difficile (recently renamed Clostridioides difficile) has large genetic diversity including multiple mobile genetic elements. In this study, whole genome sequencing of 86 strains from the poorly characterised clade 3, predominantly PCR ribotype (RT)023, of C. difficile revealed distinctive surface architecture characteristics and a large mobile genetic island. These strains have a unique sortase substrate phenotype compared with well-characterised strains of C. difficile, and loss of the phage protection protein CwpV. A large genetic insertion (023_CTnT) comprised of three smaller elements (023_CTn1-3) is present in 80/86 strains analysed in this study, with genes common among other bacterial strains in the gut microbiome. Novel cargo regions of 023_CTnT include genes encoding a sortase, putative sortase substrates, lantibiotic ABC transporters and a putative siderophore biosynthetic cluster. We demonstrate the excision of 023_CTnT and sub-elements 023_CTn2 and 023_CTn3 from the genome of RT023 reference strain CD305 and the transfer of 023_CTn3 to a non-toxigenic C. difficile strain, which may have implications for the use of non-toxigenic C. difficile strains as live attenuated vaccines. Finally, we show that the genes within the island are expressed in a regulated manner in C. difficile RT023 strains conferring a distinct "niche adaptation"