Clean Home-Delivery in Rural Southern Tanzania: Barriers, Influencers, and Facilitators

The study explored the childbirth-related hygiene and newborn care practices in home-deliveries in Southern\ud Tanzania and barriers to and facilitators of behaviour change. Eleven home-birth narratives and six focus group discussions were conducted with recently-delivering women; two focus group discussions were conducted with birth attendants. The use of clean cloth for delivery was reported as common in the birth narratives; however, respondents did not link its use to newborn’s health. Handwashing and wearing of gloves by birth attendants varied and were not discussed in terms of being important for newborn’s health, with few women giving reasons for this behaviour. The lack of handwashing and wearing of gloves was most commonly linked to the lack of water, gloves, and awareness. A common practice was the insertion\ud of any family member’s hands into the vagina of delivering woman to check labour progress before calling the birth attendant. The use of a new razor blade to cut the cord was near-universal; however, the cord was usually tied with a used thread due to the lack of knowledge and the low availability of clean thread. Applying something to the cord was near-universal and was considered essential for newborn’s health. Three hygiene practices were identified as needing improvement: family members inserting a hand into\ud the vagina of delivering woman before calling the birth attendant, the use of unclean thread, and putting\ud substances on the cord. Little is known about families conducting internal checks of women in labour, and more research is needed before this behaviour is targeted in interventions. The use of clean thread as cord-tie appears acceptable and can be addressed, using the same channels and methods that were used for successfully encouraging the use of new razor blade

Community next steps for making globally unique identifiers work for biocollections data

Biodiversity data is being digitized and made available online at a rapidly increasing rate but current practices typically do not preserve linkages between these data, which impedes interoperation, provenance tracking, and assembly of larger datasets. For data associated with biocollections, the biodiversity community has long recognized that an essential part of establishing and preserving linkages is to apply globally unique identifiers at the point when data are generated in the field and to persist these identifiers downstream, but this is seldom implemented in practice. There has neither been coalescence towards one single identifier solution (as in some other domains), nor even a set of recommended best practices and standards to support multiple identifier schemes sharing consistent responses. In order to further progress towards a broader community consensus, a group of biocollections and informatics experts assembled in Stockholm in October 2014 to discuss community next steps to overcome current roadblocks. The workshop participants divided into four groups focusing on: identifier practice in current field biocollections; identifier application for legacy biocollections; identifiers as applied to biodiversity data records as they are published and made available in semantically marked-up publications; and cross-cutting identifier solutions that bridge across these domains. The main outcome was consensus on key issues, including recognition of differences between legacy and new biocollections processes, the need for identifier metadata profiles that can report information on identifier persistence missions, and the unambiguous indication of the type of object associated with the identifier. Current identifier characteristics are also summarized, and an overview of available schemes and practices is provided

Nonlinear hydrodynamical evolution of rotating relativistic stars: Numerical methods and code tests

We present numerical hydrodynamical evolutions of rapidly rotating relativistic stars, using an axisymmetric, nonlinear relativistic hydrodynamics code. We use four different high-resolution shock-capturing (HRSC) finite-difference schemes (based on approximate Riemann solvers) and compare their accuracy in preserving uniformly rotating stationary initial configurations in long-term evolutions. Among these four schemes, we find that the third-order PPM scheme is superior in maintaining the initial rotation law in long-term evolutions, especially near the surface of the star. It is further shown that HRSC schemes are suitable for the evolution of perturbed neutron stars and for the accurate identification (via Fourier transforms) of normal modes of oscillation. This is demonstrated for radial and quadrupolar pulsations in the nonrotating limit, where we find good agreement with frequencies obtained with a linear perturbation code. The code can be used for studying small-amplitude or nonlinear pulsations of differentially rotating neutron stars, while our present results serve as testbed computations for three-dimensional general-relativistic evolution codes.Comment: 13 pages, 10 figures, submitted to MNRA

Study of the volume and spin collapse in orthoferrite LuFeO_3 using LDA+U

Rare earth (R) orthoferrites RFeO_3 exhibit large volume transitions associated with a spin collapse. We present here ab initio calculations on LuFeO_3. We show that taking into account the strong correlation among the Fe-3d electrons is necessary. Indeed, with the LDA+U method in the Projector Augmented Wave (PAW), we are able to describe the isostructural phase transition at 50 GPa, as well as a volume discontinuity of 6.0% at the transition and the considerable reduction of the magnetic moment on the Fe ions. We further investigate the effect of the variation of U and J and find a linear dependence of the transition pressure on these parameters. We give an interpretation for the non-intuitive effect of J. This emphasizes the need for a correct determination of these parameters especially when the LDA+U is applied to systems (e.g in geophysical investigations) where the transition pressure is a priori unknown

The impact of direct oral anticoagulants on viscoelastic testing – A systematic review

Background: In case of bleeding patients and in acute care, the assessment of residual direct oral anticoagulant (DOAC) activity is essential for evaluating the potential impact on hemostasis, especially when a timely decision on urgent surgery or intervention is required. Viscoelastic tests are crucial in a modern goal-directed coagulation management to assess patients' coagulation status. However, the role of viscoelastic test to detect and quantify residual DOAC plasma levels is controversially discussed. The aim of this review was to systematically summarize the evidence of viscoelastic tests for the assessment of residual DOAC activity. Method: PubMed, Embase, Scopus, and the Cochrane Library were searched for original articles investigating the effect of rivaroxaban, apixaban, edoxaban, or dabigatran plasma levels on different viscoelastic tests of the adult population from database inception to December 31, 2021. Results: We included 53 studies from which 31 assessed rivaroxaban, 22 apixaban, six edoxaban, and 29 dabigatran. The performance of viscoelastic tests varied across DOACs and assays. DOAC specific assays are more sensitive than unspecific assays. The plasma concentration of rivaroxaban and dabigatran correlates strongly with the ROTEM EXTEM, ClotPro RVV-test or ECA-test clotting time (CT) and TEG 6s anti-factor Xa (AFXa) or direct thrombin inhibitor (DTI) channel reaction time (R). Results of clotting time (CT) and reaction time (R) within the normal range do not reliable exclude relevant residual DOAC plasma levels limiting the clinical utility of viscoelastic assays in this context. Conclusion: Viscoelastic test assays can provide fast and essential point-of-care information regarding DOAC activity, especially DOAC specific assays. The identification and quantification of residual DOAC plasma concentration with DOAC unspecific viscoelastic assays are not sensitive enough, compared to recommended anti-Xa activity laboratory measurements. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=320629], identifier [CRD42022320629]. Keywords: ClotPro; DOAC; FII inhibitor; FXa inhibitor; ROTEM; TEG; point-of-car

Extreme rainfall variability in Australia: Patterns, drivers and predictability

Leading patterns of observed monthly extreme rainfall variability in Australia are examined using an Empirical Orthogonal Teleconnection (EOT) method. Extreme rainfall variability is more closely related to mean rainfall variability during austral summer than in winter. The leading EOT patterns of extreme rainfall explain less variance in Australia-wide extreme rainfall than is the case for mean rainfall EOTs. We illustrate that, as with mean rainfall, the El Niño-Southern Oscillation (ENSO) has the strongest association with warm-season extreme rainfall variability, while in the cool-season the primary drivers are atmospheric blocking and the subtropical ridge. The Indian Ocean Dipole and Southern Annular Mode also have significant relationships with patterns of variability during austral winter and spring. Leading patterns of summer extreme rainfall variability have predictability several months ahead from Pacific sea surface temperatures (SSTs) and as much as a year in advance from Indian Ocean SSTs. Predictability from the Pacific is greater for wetter than average summer months than for months that are drier than average, whereas for the Indian Ocean the relationship has greater linearity. Several cool-season EOTs are associated with mid-latitude synoptic-scale patterns along the south and east coasts. These patterns have common atmospheric signatures denoting moist onshore flow and strong cyclonic anomalies often to the north of a blocking anti-cyclone. Tropical cyclone activity is observed to have significant relationships with some warm season EOTs. This analysis shows that extreme rainfall variability in Australia can be related to remote drivers and local synoptic-scale patterns throughout the year

The effect of skin fatty acids on Staphylococcus aureus

Staphylococcus aureus is a commensal of the human nose and skin. Human skin fatty acids, in particular cis-6-hexadecenoic acid (C-6-H), have high antistaphylococcal activity and can inhibit virulence determinant production. Here, we show that sub-MIC levels of C-6-H result in induction of increased resistance. The mechanism(s) of C-6-H activity was investigated by combined transcriptome and proteome analyses. Proteome analysis demonstrated a pleiotropic effect of C-6-H on virulence determinant production. In response to C-6-H, transcriptomics revealed altered expression of over 500 genes, involved in many aspects of virulence and cellular physiology. The expression of toxins (hla, hlb,hlgBC) was reduced, whereas that of host defence evasion components (cap, sspAB, katA) was increased. In particular, members of the SaeRS regulon had highly reduced expression, and the use of specific mutants revealed that the effect on toxin production is likely mediated via SaeRS

Traumatic brain injury leads to alterations in contusional cortical miRNAs involved in dementia

There is compelling evidence that head injury is a significant environmental risk factor for Alzheimer's disease (AD) and that a history of traumatic brain injury (TBI) accelerates the onset of AD. Amyloid-β plaques and tau aggregates have been observed in the post-mortem brains of TBI patients; however, the mechanisms leading to AD neuropathology in TBI are still unknown. In this study, we hypothesized that focal TBI induces changes in miRNA expression in and around affected areas, resulting in the altered expression of genes involved in neurodegeneration and AD pathology. For this purpose, we performed a miRNA array in extracts from rats subjected to experimental TBI, using the controlled cortical impact (CCI) model. In and around the contusion, we observed alterations of miRNAs associated with dementia/AD, compared to the contralateral side. Specifically, the expression of miR-9 was significantly upregulated, while miR-29b, miR-34a, miR-106b, miR-181a and miR-107 were downregulated. Via qPCR, we confirmed these results in an additional group of injured rats when compared to naïve animals. Interestingly, the changes in those miRNAs were concomitant with alterations in the gene expression of mRNAs involved in amyloid generation and tau pathology, such as β-APP cleaving enzyme (BACE1) and Glycogen synthase-3-β (GSK3β). In addition increased levels of neuroinflammatory markers (TNF-α), glial activation, neuronal loss, and tau phosphorylation were observed in pericontusional areas. Therefore, our results suggest that the secondary injury cascade in TBI affects miRNAs regulating the expression of genes involved in AD dementia

Wingless-related integration site (WNT) signaling is activated during the inflammatory response upon cardiac surgery: A translational study

ObjectiveCardiac surgery and the use of cardiopulmonary bypass initiate a systemic inflammatory response. Wingless-related integration site (WNT) signaling is part of the innate immunity and has been attributed a major role in the regulation of inflammation. In preclinical research, WNT-5a may sustain an inflammatory response and cause endothelial dysfunction. Our aim was to investigate WNT signaling after cardiac surgery and its association with postoperative inflammation (Clinicaltrials.gov, NCT04058496).MethodsIn this prospective, single-center, observational study, 64 consecutive patients for coronary artery bypass grafting (CABG) ± valve surgery were assigned into three groups: off-pump CABG (n = 28), on-pump CABG (n = 16) and combined valve-CABG surgery (n = 20). Blood samples were acquired before surgery, at intensive care unit (ICU) admission and 4, 8, and 48 h thereafter. Plasma concentrations of WNT-5a and its antagonists Secreted frizzled-related protein 1 (sFRP-1), Secreted frizzled-related protein 5 (sFRP-5), and WNT inhibitory factor 1 (WIF-1) were determined by enzyme-linked immunosorbent assay. In addition, plasma concentrations of six inflammatory cytokines were measured by multiplex immunoassay. Parameters were analyzed for evolution of plasma concentration over time, interactions, intergroup differences, and association with clinical outcome parameters.ResultsAt baseline, WNT-5a, sFRP-1, and WIF-1 were present in a minimal concentration, while sFRP-5 was elevated. A higher baseline value of WNT-5a, sFRP-5, and WIF-1 resulted in higher subsequent values of the respective parameter. At ICU admission, WNT-5a and sFRP-5 reached their maximum and minimum value, respectively. WIF-1 decreased over time and was lowest 8 h after surgery. sFRP-1 changed minimally over time. While WNT-5a returned to the baseline within 48 h, sFRP-5 and WIF-1 did not reach their baseline value at 48 h. Of the investigated WNT system components, only WIF-1 partially reflected the severity of surgery. WNT-5a and WIF-1 had an impact on postoperative fluid balance and noradrenaline requirement.ConclusionWNT-5a, sFRP-5, and WIF-1 are part of the systemic inflammatory response after cardiac surgery. WNT-5a peaks immediately after cardiac surgery and returns to baseline within 48 h, presumably modulated by its antagonist sFRP-5. Based on this translational study, WNT-5a antagonism may be further investigated to assess potentially beneficial effects in patients with a dysregulated inflammation after cardiac surgery

Improved Task Performance, Low Workload, and User-Centered Design in Medical Diagnostic Equipment Enhance Decision Confidence of Anesthesia Providers: A Meta-Analysis and a Multicenter Online Survey

Decision confidence-the subjective belief to have made the right decision-is central in planning actions in a complex environment such as the medical field. It is unclear by which factors it is influenced. We analyzed a pooled data set of eight studies and performed a multicenter online survey assessing anesthesiologists' opinions on decision confidence. By applying mixed models and using multiple imputation to determine the effect of missing values from the dataset on the results, we investigated how task performance, perceived workload, the utilization of user-centered medical diagnostic devices, job, work experience, and gender affected decision confidence. The odds of being confident increased with better task performance (OR: 1.27, 95% CI: 0.94 to 1.7; p = 0.12; after multiple imputation OR: 3.19, 95% CI: 2.29 to 4.45; p < 0.001) and when user-centered medical devices were used (OR: 5.01, 95% CI: 3.67 to 6.85; p < 0.001; after multiple imputation OR: 3.58, 95% CI: 2.65 to 4.85; p < 0.001). The odds of being confident decreased with higher perceived workload (OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001; after multiple imputation, OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001). Other factors, such as gender, job, or professional experience, did not affect decision confidence. Most anesthesiologists who participated in the online survey agreed that task performance (25 of 30; 83%), perceived workload (24 of 30; 80%), work experience (28 of 30; 93%), and job (21 of 30; 70%) influence decision confidence. Improved task performance, lower perceived workload, and user-centered design in medical equipment enhanced the decision confidence of anesthesia providers. Keywords: diagnostic; diagnostic confidence; gender; online survey; over-confidence; self-assessment; under-confidence; user-centered design; workloa