Vitamin D and cardio-metabolic biomarkers: small-scale comparative study between Libyan migrants and resident women in Serbia

Libyan women are at high risk of vitamin D deficiency, mostly due to their lifestyle and low exposure to sun. In the last decades, Libyan residents have been forced to seek refuge in countries such as Serbia, a country with high incidence of cardio-metabolic diseases. Serbian residents tend to be deficient in vitamin D, mostly due to the lack of vitamin D fortification policy. The aim of this study was to evaluate vitamin D status in Libyan adult women migrating to Serbia, with the assessment of cardio-metabolic and nutritional biomarkers, including erythrocytes fatty acid composition, magnesium concentration, and dietary intake. The same markers were measured in Serbian women, and comparisons between the groups were made. Despite low vitamin D dietary intake in both study groups, we observed lower plasma vitamin D status in Libyan women. This was accompanied by a significantly lower concentration of magnesium in Libyan women. Libyan women had significantly higher omega-3 index and lower n-6/n-3 ratio in erythrocytes' phospholipids. We observed significant negative correlation between vitamin D and n-6 polyunsaturated fatty acids (PUFA) concentrations in both study groups. Despite lower vitamin D status in the Libyan group, erythrocyte fatty acid composition, along with blood lipids' concentrations, indicated a lower cardiovascular risk. Based on our results, the discrepancy in the vitamin D status could not be ascribed to the participants' dietary intake of the micronutrient, rather is potentially associated with ethnic-specific cardio-metabolic profile, which should be confirmed in larger cohorts

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Funkcionalizacija čestica aluminijum-oksida za kompozite na bazi nezasićenih poliestarskih smola dobijenih iz reciklovanog poli(etilentereftalata)

Cilj ove doktorske disertacije je ispitivanje fizičkih i hemijskih svojstava kompozita na bazi nezasićene smole poliestera (NZPE) sintetisanoj od proizvoda katalitičke depolimerizacije poli (etilen tereftalata) (PET) u višku od 1,2-propilena glikol (PG) sa ojačanjem od nano/mikro čestica alumine. Korišćena su dva tipa alumine: komercijalna (cAl2O3) i sintetizovana dopirana sa Fe (Fe-Al2O3). Da bi dodatno poboljšali gore navedena svojstva NZPE smole, čestice alumine su modifikovane sledećim silanima: Viniltris (2- metoksietoksi)silan (VTMOEO), 3-metakriloksipropil-trimetoksisilan (MEMO) i 3- (aminopropil) trimetoksizilan (APTMS) kao metil estri masnih kiselina lanenog ulja (biodizel - BD). Ispitan je uticaj veličine čestica i udela netretiranih/modifikovanih čestica alumine na mehanička, dinamičko-mehanička i termička svojstva dobijenih kompozita. Sintetisana NZPE smola kvalitativno je okarakterisana korišćenjem NMR i FTIR tehnika, dok su čestice alumine ispitivane uz pomoć XRD, FTIR, SEM i analizom slike kako bi se dobile njihove morfološke karakteristike. Najbolja zatezna čvrstoća postignuta je udelom 1 mas% VTMOEO modifikovanog Fe-Al2O3 u poređenju sa čistom NZPE smolom, dok je mikro Vickers tvrdoća značajno poboljšana u svim analiziranim uzorcima. Rezultati DMA pokazali su značajan uticaj ugradnje čestica alumine u NZPE matricu. Primećeno je da Fe-Al2O3 glinica poseduje veću toplotnu stabilnost u poređenju sa c-Al2O3. Trodimenzionalno orijentisana makroporozna (3DOM) γ-alimina sintetisana je koristeći PMMA kao agens za dobijanje poroznosti konačnog proizvoda. XRD merenja su potvrdila kristalnu fazu γ-alumine, dok su mikro i makro pore potvrđene SEM analizom. Sintetisani adsorbenti su korišćenii za uklanjanje Pb2+, Ni2+ i Cd2+ jona, gde se pokazalo da pH vrednost predstavlja esencijalni parametar za efikasno uklanjanje navedenih polutanata iz vode. Kvalitet adsorpcije je potvrđen modelovanjem izotermi, gde se najadekvatnijim modelom za uklanjanje Pb2+ pokazala Frojndlihova, a za uklanjanje Ni2+ i Cd2+ Dablin-Raduškevičova izoterma. Vrednosti entalpije od 9.59 kJ/mol za Pb2+, 2.45 kJ/mol za Ni2+ i 6.20 kJ/mol for Cd2+ ukazuju na dominantnu fizičku adsorpciju. Kinetički podaci adsorpcije na svim ispitivanim adsorbentima su u dobroj korelaciji sa kinetičkim modelima pseudo drugog reda i Veber-Morrisom, što sugeriše da je adsorpcija difuziono kontrolisana. Izračunate energije aktivacije, Ea, od 4.60 kJ/mol for Ni2+, 0.58 kJ/mol for Cd2+ and 5.71 kJ/mol for Pb2+ dodatno su potvrdile da je adsorpcija navedenih jona na aluminu fizičke prirode. Predstavljeni tehnološki postupci upotrebe otpadnog PET i keramičkog materijala pokazali su mogućnost dobijanja korisnih proizvoda sa dobrim mehaničkim i relativno zadovoljavajućim termičkim karakteristikama. Predstavljena inovativna tehnologija uključuje preradu čvrstog komunalnog otpada, što predstavlja nacionalni interes davanja prednosti ovoj vrsti tehnologije za razvoj/implementaciju zelene i cirkularne ekonomije, kao što je to slučaj u svim razvijenim zemljamaThe aim of this doctoral dissertation is investigation of physical and chemical properties of composites based on unsaturated polyester resin (UPR) resin, produced from the product of the catalytic depolymerization of poly(ethylene terephthalate) (PET) in the excess of 1,2- propylene glycol (PG), with the reinforcement of nano-/micro-scaled alumina particles. There were two types of alumina fillers: commercial (c-Al2O3) and synthesized one doped with Fe (Fe-Al2O3). To additionally improve properties of UPR resin, alumina particles were modified by following silanes: Vinyltris(2-methoxyethoxy)-silane (VTMOEO), 3- methacryloxypropyl-trimethoxysilane (MEMO) and 3-(aminopropyl)trimethoxysilane (APTMS) as well as methyl ester of linseed oil fatty acids (biodiesel - BD). The influence of the pristine and modified alumina particles size and loading on the mechanical, dynamicmechanical and thermal properties of the obtained composites was studied. Synthesized UPR resin is qualitatively characterized by NMR and FTIR analysis, while alumina particles were examined by XRD, FTIR, SEM and Image analysis to obtain their morphological characteristics. The best tensile strength was achieved by incorporating the 1 wt% of VTMOEO modified Fe-Al2O3 compared to pure UPR resin, while the micro Vickers hardness was significantly improved in all analyzed samples. The results of DMA showed significant influence of the embedding the alumina particles into UPR matrix. It was remarked that Fe-Al2O3 possessed higher thermal stability in comparison to c-Al2O3. Three-dimensionally ordered macroporous (3DOM) γ-alumina was synthesized using PMMA as porogen agent. XRD measurements confirmed the γ-alumina crystal phase, while SEM confirmed macro and micro porosity. Synthesized adsorbent was used for Pb2+, Ni2+ , and Cd2+ removal, and the results showed that pH is an important parameter which control effectiveness of pollutant removal. The quality of the isotherm modelling of adsorption data was proved by the correlation coefficients and error functions, and the best adsorption model was found to be Freundlich isotherm for Pb2+ removal and Dubinin-Radushkevich isotherm for Ni2+ and Cd2+ removal. The ΔH 0 value of 9.59 kJ/mol for Pb2+, 2.45 kJ/mol for Ni2+ and 6.20 kJ/mol for Cd2+ adsorption onto γ-alumina indicated the dominance of physical adsorption. The kinetic data of the adsorption on all the investigated adsorbents were well fitted with the pseudo-second-order kinetic and Weber-Morris models, suggesting that the rate-limiting step was diffusion rather than chemical sorption. Calculated activation energies, Ea, of 4.60 kJ/mol for Ni2+, 0.58 kJ/mol for Cd2+ and 5.71 kJ/mol for Pb2+ indicate that the adsorption of all three ions onto γ-alumina is a mainly physical adsorption process. The presented technological procedures of waste PET and ceramic material utilization, have shown that they can be used to obtain useful products with good mechanical and relatively satisfactory thermal characteristics. Presented innovative technology involves the processing of municipal solid waste, which represents a national interest in favoring this type of technology for the development/implementation of the green and circular economy, as is the case in all developed countries

Crisis Foster Care in an Age of HIV and AIDS: Experiences of the Queen Mothers of Manya Klo, Ghana

Older women in communities ravaged by HIV and AIDS in sub-Saharan Africa have been hailed as constituting the most effective response to the growing number of orphans, which has overwhelmed the customary mechanisms of support. Over 80 percent of orphans in Ghana are fostered by women, because an orphan’s kinship networks - and particularly the female members of the networks - are expected to assume responsibility for her/him. Unfortunately, in the Manya Klo Traditional Area of Ghana, AIDS, poverty and other factors have weakened kinship support and cooperation, resulting in patchy external responses to physically frail and economically disempowered traditional female leaders (queen mothers) acting as caregivers. Most of the existing research about orphan care has focused exclusively on the woman-child dyad, thereby obscuring other forms of care. In particular, the “grandmother-led household” has become a self-fulfilling truism that has blinded researchers to other relationships of care. Moreover, the analyses of the situation of orphans are based on frameworks that ignore orphans' perspectives and the social context in which fostering is negotiated. In this study, I employ mixed methods to analyze an orphan care project run by the Manya Krobo Queen Mothers Association (MKQMA) and address three issues: (1) What is the socio-economic and cultural context in which queen mothers foster orphans? In particular, how do queen mothers’ positions as traditional leaders, HIV and AIDS, poverty, and external assistance programs (state and NGO) all shape the organization of orphan care? (2) What are the challenges for depending on the Queen Mothers Association to support orphans? (3) How are orphans’ needs identified and described (from the perspectives of the caregiver, the orphans and those who assist them). In particular, can community-derived measures of childcare rather than the current measures typically used in international development and children’s projects provide better indices of the needs of children after losing a parent?Ph