Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

<p>Abstract</p> <p>Objectives/background</p> <p>Given the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA) births, low birth weight, stillbirths, perinatal and neonatal mortality. This review evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST).</p> <p>Data sources/review methods</p> <p>A systematic review of randomized controlled trials was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction and Child Health Epidemiology Reference (CHERG) adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) technique were used for data abstraction and overall quality of evidence. Meta-analyses were performed to calculate summary estimates of utility to the LiST model for the specified outcome of incidence of SGA births. We also evaluated the potential impact of multiple micronutrients on neonatal mortality according to the proportion of deliveries occurring in facilities (using a threshold of 60% to indicate functionality of health systems for skilled births).</p> <p>Results</p> <p>We included 17 studies for detailed data abstraction. There was no significant benefit of multiple micronutrients as compared to iron folate on maternal anemia in third trimester [Relative risk (RR) = 1.03; 95% confidence interval (CI): 0.87 – 1.22 (random model)]. Our analysis, however, showed a significant reduction in SGA by 9% [RR = 0.91; 95% CI: 0.86 – 0.96 (fixed model)]. In the fixed model, the SGA outcome remained significant only in women with mean body mass index (BMI) ≥ 22 kg/m². There was an increased risk of neonatal mortality in studies with majority of births at home [RR = 1.47, 95% CI: 1.13-1.92]; such an effect was not evident where ≥ 60% of births occurred in facility settings [RR = 0.94, 95% CI: 0.81-1.09]. Overall there was no increase in the risk of neonatal mortality [RR = 1.05, 95% CI: 0.92 – 1.19 (fixed model)].</p> <p>Conclusion</p> <p>This review provides evidence of a significant benefit of MMN supplementation during pregnancy on reducing SGA births as compared to iron-folate, with no significant increase in the risk of neonatal mortality in populations where skilled birth care is available and majority of births take place in facilities. Given comparability of impacts on maternal anemia, the decision to replace iron-folate with multiple micronutrients during pregnancy may be taken in the context of available services in health systems and birth outcomes monitored.</p

Incast mitigation in a data center storage cluster through a dynamic fair-share buffer policy

Incast is a phenomenon when multiple devices interact with only one device at a given time. Multiple storage senders overflow either the switch buffer or the single-receiver memory. This pattern causes all concurrent-senders to stop and wait for buffer/memory availability, and leads to a packet loss and retransmission—resulting in a huge latency. We present a software-defined technique tackling the many-to-one communication pattern—Incast—in a data center storage cluster. Our proposed method decouples the default TCP windowing mechanism from all storage servers, and delegates it to the software-defined storage controller. The proposed method removes the TCP saw-tooth behavior, provides a global flow awareness, and implements the dynamic fair-share buffer policy for end-to-end I/O path. It considers all I/O stages (applications, device drivers, NICs, switches/routers, file systems, I/O schedulers, main memory, and physical disks) while achieving the maximum I/O throughput. The policy, which is part of the proposed method, allocates fair-share bandwidth utilization for all storage servers. Priority queues are incorporated to handle the most important data flows. In addition, the proposed method provides better manageability and maintainability compared with traditional storage networks, where data plane and control plane reside in the same device

Impact of vitamin A supplementation on infant and childhood mortality

<p>Abstract</p> <p>Introduction</p> <p>Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines.</p> <p>Methods</p> <p>A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A and mortality. Data were abstracted into standardized forms and quality of studies was assessed according to standardized guidelines. Pooled estimates were generated for preventive effect of vitamin A supplementation on all-cause and disease specific mortality of diarrhea, measles, pneumonia, meningitis and sepsis. We did a subgroup analysis for vitamin A supplementation in neonates, infants 1-6 months and children aged 6-59 months. In this paper we have focused on estimation of efficacy of vitamin A supplementation in children 6-59 months of age. Results for neonatal vitamin A supplementation have been presented, however no recommendations are made as more evidence on it would be available soon.</p> <p>Results</p> <p>There were 21 studies evaluating preventive effect of vitamin A supplementation in community settings which reported all-cause mortality. Twelve of these also reported cause specific mortality for diarrhea and pneumonia and six reported measles specific mortality. Combined results from six studies showed that neonatal vitamin A supplementation reduced all-cause mortality by 12 % [Relative risk (RR) 0.88; 95 % confidence interval (CI) 0.79-0.98]. There was no effect of vitamin A supplementation in reducing all-cause mortality in infants 1-6 months of age [RR 1.05; 95 % CI 0.88-1.26]. Pooled results for preventive vitamin A supplementation showed that it reduced all-cause mortality by 25% [RR 0.75; 95 % CI 0.64-0.88] in children 6-59 months of age. Vitamin A supplementation also reduced diarrhea specific mortality by 30% [RR 0.70; 95 % CI 0.58-0.86] in children 6-59 months. This effect has been recommended for inclusion in the Lives Saved Tool. Vitamin A supplementation had no effect on measles [RR 0.71, 95% CI: 0.43-1.16], meningitis [RR 0.73, 95% CI: 0.22-2.48] and pneumonia [RR 0.94, 95% CI: 0.67-1.30] specific mortality.</p> <p>Conclusion</p> <p>Preventive vitamin A supplementation reduces all-cause and diarrhea specific mortality in children 6-59 months of age in community settings in developing countries.</p

Mortality Predictors in Covid-19 Positive Patients with Fractures: A Systematic Review

Objective: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data. Methods: Keywords such as “fracture” and “COVID or COVID-19” were searched through three major databases includes PubMed, EMBASE, and Google Scholar. Selection criteria were all published reports providing the mortality related information of COVID-19 positive fracture patients. Published papers containing mortality data of COVID-19 positive fracture patients were considered for qualitative review. For meta-analysis, the presenting individual’s data were considered to study the different parameters association with mortality. Results: The rate of mean mortality in COVID-19 positive fracture patients was 34%, and 91.7% of patients had hip fractures. Older age and hip fractures had a significant association with higher mortality rates in COVID-19 positive fracture patients.Conclusion: The mortality rates are considerably higher in COVID-19 positive patients with fractures compared to COVID-19 positive patients without fractures and to the COVID-19 negative fracture patients. Early surgical intervention should be preferred in hip fractures among COVID-19 positive patients for general stabilization and improved respiratory function. Older age and hip fractures are the main predictors of mortality in these patients

Resistive switching characteristics in manganese oxide and tantalum oxide devices

The monodisperse manganese oxide nanoparticles with an average diameter of 30 nm were chemically synthesized. The nanoparticles assembled as a close-packed monolayer on Pt bottom electrode by dip-coating and annealing process. The Ta/Ta2O5/MnO/Pt device was fabricated. The bipolar resistive switching behaviors could be caused by the formation and rupture of conductive filaments in the switching layers. The stable self compliance property was demonstrated which can be attributed to the high resistance Ta/Ta2O5 interface, the Schottky barrier of Ta/Ta2O5, and the discontinuity of conduction band at Ta2O5 and MnO interface. The retention characteristics of Ta/Ta2O5/MnO/Pt device were investigated. The conduction mechanisms of Ohmic conduction, space charge limited conduction, Schottky conduction and Poole-Frenkel emission had been investigated for resistance switching mechanism. (C) 2016 Elsevier B.V. All rights reserved

Root Cultures, a Boon for the Production of Valuable Compounds: A Comparative Review

Medicinal plants are an inevitable source of pharmaceutical drugs and most of the world population depends on these plants for health benefits. The increasing global demand for bioactive compounds from medicinal plants has posed a great threat to their existence due to overexploitation. Adventitious root and hairy root culture systems are an alternative approach to the conventional method for mass production of valuable compounds from medicinal plants owing to their rapid growth, biosynthetic and genetic stability. The main purpose of this review is to investigate the recent scientific research published worldwide on the application of adventitious and hairy root cultures to produce valuable compounds from medicinal plants. Furthermore, a comparison of adventitious root vs. hairy root cultures to produce valuable compounds has also been discussed. Various aspects such as medium composition, carbon source, pH, amount of macronutrients, optimization strategy, scale-up cultures, and use of biotic abiotic and nano-elicitors at various concentrations are the topic of discussion in this review. Several studies on adventitious and hairy root cultures of Polygonum multiflorum&cedil; Withania somnifera&cedil; Echinacea purpurea and Ajuga bracteosa have been discussed in detail which highlights the importance of elicitation strategies and bioreactor system, presenting commercial applications

Resistive switching characteristics of manganese oxide thin film and nanoparticle assembly hybrid devices

Improved resistive switching characteristics are demonstrated in a hybrid device with Pt/Ti/MnO (thin film)/MnO (nanoparticle)/Pt structure. The hybrid devices of MnO thin film and nanoparticle assembly were fabricated. MnO nanoparticles with an average diameter of similar to 30nm were chemically synthesized and assembled as a monolayer on a Pt bottom electrode. A MnO thin film of similar to 40nm thickness was deposited on the nanoparticle assembly to form the hybrid structure. Resistive switching could be induced by the formation and rupture of conducting filaments in the hybrid oxide layers. The hybrid device exhibited very stable unipolar switching with good endurance and retention characteristics. It showed a larger and stable memory window with a uniform distribution of SET and RESET voltages. Moreover, the conduction mechanisms of ohmic conduction, space-charge-limited conduction, Schottky emission, and Poole-Frenkel emission have been investigated as possible conduction mechanisms for the switching of the devices. Using MnO nanoparticles in the thin film and nanoparticle heterostructures enabled the appropriate control of resistive random access memory (RRAM) devices and markedly improved their memory characteristics. (C) 2018 The Japan Society of Applied Physics