Maternal risk factors and perinatal outcome in meconium stained amniotic fluid: a cross sectional study

Background: Meconium staining of amniotic fluid has long been regarded as a sign of fetal distress and fetal asphyxia. Although exact cause is unknown, meconium is thought to be passed from fetal gastro-intestinal tract as a response to hypoxia, mesenteric vasoconstriction induced gut hyper peristalsis, vagal stimulation and normal physiologic function of a mature fetus. Overall frequency has ranged from 5 to 24.6%. Present study is undertaken to detect incidence, mode of delivery, fetal heart rate variability and neonatal outcome in neonates born through MSAF. The objective of the study was to maternal risk factors, mode of delivery and perinatal outcome in labors complicated with meconium stained amniotic fluid.Methods: This is a cross sectional study done at Government Medical College, Thrissur on term, singleton pregnancies complicated with meconium stained amniotic fluid satisfying the inclusion criteria. Patients detailed history, gestational age, per abdominal examination, per speculum and per vaginal examination, admission tests including intrapartum cardiotocography (CTG) was recorded in a predesigned proforma.Results: The age of the patients varied between above 19 and 30 years. Majority of the study population were 69.3% Primi gravidas. Out of 130 cases, 56.2% were grade 2 meconium stained liquor, 30.7% were grade 3 meconium stained and 13.1% were grade 1 meconium stained. Association between neonatal complications in relation to grades of meconium was found to be statistically significant (p = 0.001). NICU admission was 24.7% in grade 2 meconium group. Hypoxic Ischemic encephalopathy was high in grade 3 meconium group, 45%. Majority of babies born through grade 1 meconium were asymptomatic and 10% of babies in grade 3 meconium groups were asymptomatic. Meconium aspiration syndrome, Respiratory distress were more in babies born through deliveries complicated with grade 3 meconium.Conclusions: The study indicated meconium stained amniotic fluid during labour increases the prevalence of abnormal intrapartum CTG, Caesarean section, lower Apgar score, increased duration of NICU and hospital stay, poor perinatal outcome and non-significant difference in incidence of lower birth weight in babies

Bound states in a quasi-two-dimensional Fermi gas

We consider the problem of N identical fermions of mass M and one distinguishable particle of mass m interacting via short-range interactions in a confined quasi-two-dimensional (quasi-2D) geometry. For N=2 and mass ratios M/m<13.6, we find non-Efimov trimers that smoothly evolve from 2D to 3D. In the limit of strong 2D confinement, we show that the energy of the N+1 system can be approximated by an effective two-channel model. We use this approximation to solve the 3+1 problem and we find that a bound tetramer can exist for mass ratios M/m as low as 5 for strong confinement, thus providing the first example of a universal, non-Efimov tetramer involving three identical fermions.Comment: 5 pages, 4 figure

Coconut based integrated farming: A climate-smart model for food security and economic prosperity

A coconut-based integrated farming system (IFS) model suited for lowlands was developed at the Integrated Farming System Research Station (IFSRS), Karamana, Kerala State, India, under Kerala Agricultural University. The area of the model was decided as 0.2 ha, matching the average per capita land availability of a marginal farmer in the State. Apart from the major crop coconut, intercrops, such as vegetables, fruit crops, spices, fodder and tuber crops were included in the model. The allied enterprises integrated were livestock, azolla, and agroforestry. Tree components of the model comprised of teak, jack, breadfruit, garcinia and mango. Research data for five years revealed that the model generated food products above the requirement of a four-member family, and the surplus production could contribute to farmer’s income. The productivity under the IFS model was enhanced ten-folds compared to that under the sole crop of coconut for the same area. Plant nutrients were generated within the farm through organic recycling, which contributed to the substantial saving of chemical fertilizers. The system was found climate-smart because of reduced use of chemical fertilizers and net negative emission of greenhouse gases mostly achieved through agroforestry. This IFS model could also ensure considerable employment generation. The model could be adopted by farmers of lowland tracts of Kerala having similar agro-climatic features for better economic returns and environmental benefits

Improving question formulation for use in evidence appraisal in a tertiary care setting: a randomised controlled trial [ISRCTN66375463]

BACKGROUND: The specificity of clinical questions is gauged by explicit descriptions of four dimensions: subjects, interventions, comparators and outcomes of interest. This study determined whether adding simple instructions and examples on clinical question formulation would increase the specificity of the submitted question compared to using a standard form without instructions and examples. METHODS: A randomised controlled trial was conducted in an evidence-search and appraisal service. New participants were invited to reformulate clinical queries. The Control Group was given no instructions. The Intervention Group was given a brief explanation of proper formulation, written instructions, and diagrammatic examples. The primary outcome was the change in the proportion of reformulated questions that described each the dimensions of specificity. RESULTS: Fifty-two subjects agreed to participate in the trial of which 13 were lost to follow-up. The remaining 17 Intervention Group and 22 Control Group participants were analysed. Baseline characteristics were comparable. Overall, 20% of initially submitted questions from both groups were properly specified (defined as an explicit statement describing all dimensions of specificity). On follow-up, 7/14 questions previously rated as mis-specified in the Intervention Group had all dimensions described at follow-up (p = 0.008) while the Control Group did not show any changes from baseline. Participants in the Intervention Group were also more likely to explicitly describe patients (p = 0.028), comparisons (p = 0.014), and outcomes (p = 0.008). CONCLUSIONS: This trial demonstrated the positive impact of specific instructions on the proportion of properly-specified clinical queries. The evaluation of the long-term impact of such changes is an area of continued research

Clinical Validity and Utility of Circulating Tumor DNA (ctDNA) Testing in Advanced Non-small Cell Lung Cancer (aNSCLC): A Systematic Literature Review and Meta-analysis

PurposeCirculating tumor DNA (ctDNA) testing has become a promising tool to guide first-line (1L) targeted treatment for advanced non-small cell lung cancer (aNSCLC). This study aims to estimate the clinical validity (CV) and clinical utility (CU) of ctDNA-based next-generation sequencing (NGS) for oncogenic driver mutations to inform 1L treatment decisions in aNSCLC through a systematic literature review and meta-analysis.MethodsA systematic literature search was conducted in PubMed/MEDLINE and Embase to identify randomized control trials or observational studies reporting CV/CU on ctDNA testing in patients with aNSCLC. Meta-analyses were performed using bivariate random-effects models to estimate pooled sensitivity and specificity. Progression-free/overall survival (PFS/OS) was summarized for CU studies.ResultsA total of 20 studies were identified: 17 CV only, 2 CU only, and 1 both, and 13 studies were included for the meta-analysis on multi-gene detection. The overall sensitivity and specificity for ctDNA detection of any mutation were 0.69 (95% CI 0.63-0.74) and 0.99 (95% CI 0.97-1.00), respectively. However, sensitivity varied greatly by driver gene, ranging from 0.29 (95% CI 0.13-0.53) for ROS1 to 0.77 (95% CI 0.63-0.86) for KRAS. Two studies that compared PFS with ctDNA versus tissue-based testing followed by 1L targeted therapy found no significant differences. One study reported OS curves on ctDNA-matched and tissue-matched therapies but no hazard ratios were provided.ConclusionsctDNA testing demonstrated an overall acceptable diagnostic accuracy in patients with aNSCLC, however, sensitivity varied greatly by driver mutation. Further research is needed, especially for uncommon driver mutations, to better understand the CU of ctDNA testing in guiding targeted treatments for aNSCLC

Qualitative Exploration of Cross-Sector Perspectives on the Contributions of Local Health Departments in Land-Use and Transportation Policy

INTRODUCTION: Transportation and land-use policies can affect the physical activity of populations. Local health departments (LHDs) are encouraged to participate in built-environment policy processes, which are outside their traditional expertise. Cross-sector collaborations are needed, yet stakeholders\u27 perceptions of LHD involvement are not well understood. The objective of this study was to describe the perceived value of LHD participation in transportation and land-use decision making and potential contributions to these processes among stakeholders. METHODS: We analyzed qualitative data from 49 semistructured interviews in 2015. Participants were professionals in 13 US states and 4 disciplines: land-use planning (n = 13), transportation/public works (n = 11), public health (n = 19), and other (municipal administration and bike and pedestrian advocacy [n = 6]). Two analysts conducted directed content analysis. RESULTS: All respondents reported that LHDs offer valuable contributions to transportation and land-use policy processes. They identified 7 contributions (interrater agreement 91%): 1) physical activity and health perspective (n = 44), 2) data analysis and assessment (n = 41), 3) partnerships in the community and across sectors (n = 35), 4) public education (n = 27), 5) knowledge of the public health evidence base and best practices (n = 23), 6) resource support (eg, grant writing, technical assistance) (n = 20), and 7) health equity (n = 8). CONCLUSION: LHDs can leverage their strengths to foster cross-sector collaborations that promote physical activity opportunities in communities. Our results will inform development of sustainable capacity-building models for LHD involvement in built-environment decision making

Developing Core Capabilities for Local Health Departments to Engage in Land Use and Transportation Decision Making for Active Transportation

OBJECTIVE: To develop a core set of capabilities and tasks for local health departments (LHDs) to engage in land use and transportation policy processes that promote active transportation. DESIGN: We conducted a 3-phase modified Delphi study from 2015 to 2017. SETTING: We recruited a multidisciplinary national expert panel for key informant interviews by telephone and completion of a 2-step online validation process. PARTICIPANTS: The panel consisted of 58 individuals with expertise in local transportation and policy processes, as well as experience in cross-sector collaboration with public health. Participants represented the disciplines of land use planning, transportation/public works, public health, municipal administration, and active transportation advocacy at the state and local levels. MAIN OUTCOME MEASURES: Key informant interviews elicited initial capabilities and tasks. An online survey solicited rankings of impact and feasibility for capabilities and ratings of importance for associated tasks. Feasibility rankings were used to categorize capabilities according to required resources. Results were presented via second online survey for final input. RESULTS: Ten capabilities were categorized according to required resources. Fewest resources were as follows: (1) collaborate with public officials; (2) serve on land use or transportation board; and (3) review plans, policies, and projects. Moderate resources were as follows: (4) outreach to the community; (5) educate policy makers; (6) participate in plan and policy development; and (7) participate in project development and design review. Most resources were as follows: (8) participate in data and assessment activities; (9) fund dedicated staffing; and (10) provide funding support. CONCLUSIONS: These actionable capabilities can guide planning efforts for LHDs of all resource levels

Early growth response gene-2 (Egr-2) regulates the development of B and T cells

The study was supported by Arthritis Research UK. Copyright @ 2011 Li et al.BACKGROUND: Understanding of how transcription factors are involved in lymphocyte development still remains a challenge. It has been shown that Egr-2 deficiency results in impaired NKT cell development and defective positive selection of T cells. Here we investigated the development of T, B and NKT cells in Egr-2 transgenic mice and the roles in the regulation of distinct stages of B and T cell development. METHODS AND FINDINGS: The expression of Egr1, 2 and 3 were analysed at different stages of T and B cell development by RT-PCT and results showed that the expression was strictly regulated at different stages. Forced expression of Egr-2 in CD2+ lymphocytes resulted in a severe reduction of CD4+CD8+ (DP) cells in thymus and pro-B cells in bone marrow, which was associated with reduced expression of Notch1 in ISP thymocytes and Pax5 in pro-B cells, suggesting that retraction of Egr-2 at the ISP and pro-B cell stages is important for the activation of lineage differentiation programs. In contrast to reduction of DP and pro-B cells, Egr-2 enhanced the maturation of DP cells into single positive (SP) T and NKT cells in thymus, and immature B cells into mature B cells in bone marrow. CONCLUSIONS: Our results demonstrate that Egr-2 expressed in restricted stages of lymphocyte development plays a dynamic, but similar role for the development of T, NKT and B cells.This article is provided by the Brunel Open Access publishing fund

Acid value optimization of calcined eggshells catalyzed biodiesel produced from rubber seed oil – A response surface methodology (RSM) approach

Optimization of acid value in biodiesel production from high viscous rubber seed oil (RSO) using solid waste eggshells has been studied. A gradual reduction in acid value from 67.6 (mg KOH/ g oil) to 0.26 (mg KOH/ g oil) was observed in the synthesized biodiesel at the optimum process conditions of 12:1 methanol: oil molar ratio, 4 (wt %) catalyst concentration and 3hours of reaction time. Process parameter optimization was performed using a well organized optimization tool namely response surface methodology (RSM). It is also observed that molar ratio (mol/mol) and reaction time (h) are the more significant process parameters on the final product. Coefficient of determination R2 value of 0.9335 observed from RSM analysis, signifies a minimum error between experimental and predicted responses

Acid value optimization of calcined eggshells catalyzed biodiesel produced from rubber seed oil – A response surface methodology (RSM) approach

411-417Optimization of acid value in biodiesel production from high viscous rubber seed oil (RSO) using solid waste eggshells has been studied. A gradual reduction in acid value from 67.6 (mg KOH/ g oil) to 0.26 (mg KOH/ g oil) was observed in the synthesized biodiesel at the optimum process conditions of 12:1 methanol: oil molar ratio, 4 (wt %) catalyst concentration and 3hours of reaction time. Process parameter optimization was performed using a well organized optimization tool namely response surface methodology (RSM). It is also observed that molar ratio (mol/mol) and reaction time (h) are the more significant process parameters on the final product. Coefficient of determination R2 value of 0.9335 observed from RSM analysis, signifies a minimum error between experimental and predicted responses