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Demographic, social and health system factors associated with maternal mortality in Pakistan: A nested case-control study
Background Pakistan has experienced a significant reduction in maternal mortality with a decline of 33 percent between 2006 and 2019. However, the country still grapples with a high number (186 per 100,000 live births) of maternal deaths each year. This study aims to identify socio-demographic and health system related factors associated with maternal mortality. Methods Using the nested case-control design, we conducted an in-depth analysis of Pakistan Maternal Mortality Survey (PMMS) 2019. We identified 147 maternal deaths occurring within three years prior to the PMMS 2019 as “cases” and 724 women who gave birth and were alive during the same period as “controls”. Socio-demographic characteristics of cases and controls were compared, and multivariate regression was employed to investigate the predictors of maternal mortality in Pakistan. Results Cases and controls were similar on access to antenatal care (ANC) and ANC provider but differed on age, education, number of pregnancies, type of delivery, tetanus toxoid vaccination during last pregnancy, and contraceptive usage. A higher proportion of cases had deliveries by skilled birth attendants (83% compared to 63% among controls) while home deliveries were more common among controls (32% compared to 25% among cases). Odds of maternal death were lowest among women aged 20–29 years (odds ratio–OR: 0.5; 95% CI 0.23–1.07) and those with secondary or higher education (OR: 0.35; 95% CI 0.17–0.74). Surprisingly, deliveries attended by skilled birth attendants were associated with higher odds of maternal death (OR: 4.07; 95% CI 2.19–7.57) compared to those who were not. Conclusion This study identifies secondary or higher maternal education, having had tetanus injection during the last pregnancy, ever-used contraception or being in the age group of 20–29 years were factors associated with lower risk of maternal mortality. Conversely, skilled birth attendance increases the risk of maternal death in Pakistan. Further investigation is needed into the determinants of high maternal mortality.
Identification of important genes related to ferroptosis in early missed abortion based on WGCNA
Effects of maximum dose on local control after stereotactic body radiotherapy for oligometastatic tumors of colorectal cancer
This study aimed to identify radiotherapy dosimetric parameters related to local failure (LF)-free survival (LFFS) in patients with lung and liver oligometastases from colorectal cancer treated with stereotactic body radiotherapy (SBRT). We analyzed 75 oligometastatic lesions in 55 patients treated with SBRT between January 2014 and December 2021. There was no constraint or intentional increase in maximum dose. LF was defined as the progression of the treated lesion until the last follow-up or death. The dose distributions were recalculated using Monte Carlo-based algorithms. The significance of the planning target volume (PTV) biologically effective dose (BED) 10s (D2, D95, D98, Dmean) in LFFS was evaluated using Cox regression, considering sex, age, primary cancer, tumor site, oligometastatic status, multiplicity, and either tumor size or one of the volume parameters. LF occurred in 23.4% of the lesions. Lesions showing LF received significantly lower PTV D2 (146 ± 21 vs. 164 ± 23, p = 0.006). Multivariate analysis revealed that PTV D2 (< 159 Gy10 vs. ≥ 159 Gy10) was the sole dosimetric parameter associated with LFFS. Tumors equal to or larger than the median size/volume yet receiving < 159 Gy10 of PTV D2 showed the lowest LFFS following stratification by median PTV D2 combined with tumor size or volume parameters. The maximum dose (PTV D2) was significantly associated with LFFS after SBRT for lung and liver oligometastases from colorectal cancer. Increasing the maximum dose may be beneficial for managing larger tumors.
Multiomic characterization, immunological and prognostic potential of SMAD3 in pan-cancer and validation in LIHC
The influence of workload on muscle fatigue, tissue properties, and postural stability in older and younger workers
Demographic aging and extended working lives have prompted interest in the physiological changes that occur with age, particularly in the lumbar spine. Age-related declines in muscle quality and intervertebral disc alterations may reduce muscular endurance, strength, and postural stability, potentially increasing the risk of musculoskeletal injuries in older workers. As experienced workers play an important role in addressing labor shortages, understanding the impact of age-related physiological changes on the biomechanical properties of the lumbar spine is key to ensure safe and sustainable employment for aging individuals. This study aimed to compare the impact of daily work-related physical efforts on lumbar muscular endurance and fatigue, spine tissue properties, and postural stability between older and younger workers. A total of 40 participants, 20 in Group 1 (young workers: ≤50 years; mean age: 28.89 ± 7.23) and 20 in Group 2 (older workers: >50 years; mean age: 59.40 ± 5.29) were recruited. Measurements taken at the beginning and end of the workday included lumbar muscle endurance, maximal voluntary contraction, disc height and postural stability. Age groups were compared using repeated measures ANOVA across the two measurement times. No significant interaction between age and time of day was observed, indicating that, for similar workload, both age groups experienced similar changes. Despite age-related effects on maximal force production and postural stability, incorporating weight as a covariate revealed that these differences were partially explained by the weight discrepancy between older and younger workers. The study suggests that age may not be the primary determinant of the impact of a workday on older workers.
Latent profiles and determinants of postoperative sleep quality in elective surgery patients
How the nursing work environment moderates the relationship between clinical judgment and person-centered care among intensive care unit nurses
Background Person-centered care focuses on individualized care that respects patients’ values, preferences, and autonomy. To enhance the quality of critical care nursing, institutions need to identify the factors influencing ICU nurses’ ability to provide person-centered care. This study explored the relationship between clinical judgment ability and person-centered care among intensive care unit (ICU) nurses, emphasizing how the ICU nursing work environment moderates this relation. Methods A cross-sectional survey was conducted between September 4 and September 18, 2023, with 192 ICU nurses recruited from four general hospitals with a convenience sample (valid response rate = 97.4%). Participants completed online self-report structured questionnaires. The collected data were analyzed using hierarchical multiple regression and PROCESS macro Model 1, with a 95% bias-corrected bootstrap confidence interval to verify moderating effects. Results Clinical judgment ability (β = .24, p < .001) and ICU nursing work environment (β = .50 p < .001) were found to be significant predictors of person-centered care. These two predictors explained the 47.0% of person-centered care in the final hierarchical regression model. Additionally, Clinical judgment (B = 0.28, p < .001, Boot. 95%CI = 0.13~0.42) and the ICU nursing work environment (B = 0.41, p < .001, Boot. 95%CI = 0.30~0.52) positively affected person-centered care, and the interaction term of clinical judgment and ICU nursing work environment (B = 0.16, p = .026, Boot. 95%CI = 0.02~0.30) also positively affected person-centered care. The moderating effect was particularly significant when the ICU nursing work environment score was 2.90 points (below 14.6%, above 85.4%) or higher on a scale of 1–5 and As the ICU nursing work environment score increased, the positive moderating effect also increased. Conclusions The ICU nurses’ clinical judgment ability positively affected person-centered care, and the nursing work environment moderated the relationship between clinical judgment ability and person-centered care. Therefore, strategies for enhancing person-centered care among ICU nurses should focus on developing educational programs to improve clinical judgment ability and implementing comprehensive efforts to effectively improve and manage the nursing work environment.
Risk-based bridge life cycle cost and environmental impact assessment considering climate change effects
Factors associated with contracting border malaria: A systematic and meta-analysis
Vector resistance, human population movement, and cross-border malaria continue to pose a threat to the attainment of malaria elimination goals. Border malaria is prominent in border regions characterised by poor access to health services, remoteness, and vector abundance. Human socio-economic behaviour, vectoral behaviour, access and use of protective methods, age, sex, and occupation have been identified in non-border regions as key predictors for malaria. We conducted a systematic and meta-analysis review to characterise and establish pooled effect sizes of the factors associated with the occurrence of border malaria. An exhaustive search was done in EBSCOHost (Medline Full Text), Health Source, Google Scholar, Regional Office for Africa Library, African Index Medicus, and PubMed databases. A total of 847 articles were identified from the search and after screening for quality and eligibility, twelve (12) articles were included in the review. Pooled odds ratios, inverse variance statistic (I2), Luis Furuya-Kanamori (LFK) index, and forest plot were computed. Findings from this study suggest night outdoor activities (POR 2.87 95% CI, 1.17 7,01), engaging in forestry activities (POR 2.76 95% CI, 2.08 3.67), working in mines (POR 197 95% CI, 175 22171), access to poor housing structure (POR 3.42 95% CI, 2.14 5.46), and cross-border movement (POR 50.86 95% CI, 12.88 200.85) none use of insecticide-treated nets (POR 5.09 95% CI, 2.44 10.63) were all significantly associated with contracting malaria within border regions. The use of insecticide-treated nets (ITN) (POR 0.61 95% CI, 0.50 0.76) and indoor residual spraying (IRS) (POR 0.61 95% CI, 0.47 0.79) were protective. Risk factors for border malaria are comparable to non-border malaria. Effective border malaria control requires an integrated and targeted approach that addresses socio-economic, environmental, and behavioural drivers. Established vector control interventions remain protective and should be sustained to mitigate the border malaria burden effectively. Novel strategies should be developed to address the unique challenge of cross-border human population movement underpinned by robust regional, bilateral, and multi-sectoral collaborative initiatives.
Theoretical study of Ti and Cr as candidate assisted metals for mechanical exfoliation of monolayer transition metal dichalcogenides
Factors influencing fans’ spectating experience and configuration effects in CBA league
The low satisfaction of fans’ spectator experience, the weak willingness to continue to watch games have become the realistic barriers limiting the sustained and favorable development of Chinese Basketball Association league (CBA League). Using Structural Equation Modeling (SEM) and Fuzzy-set Qualitative Comparative Analysis (fsQCA), this study clarifies the complex causal relationship behind the phenomenon of fans’ spectator experience, explore the linkage mechanism between different influencing factors of spectator experience. Also constructs a variety of grouping paths to enhance the fans’ spectator experience in the CBA League. The results shows that Sense, Feel, Think, Act, Relate and Spectator Service all positively affect the satisfaction of the live Spectator experience in the CBA League. Among six influencing factors, none of them is the necessary condition for high satisfaction of Fans’ Spectator Experience. In this way, the characteristics of multi-factors and different paths of the live Spectator experience were verified. Influential factors were coupled to form six grouping paths for high satisfaction of the fans’ spectator experience, which were categorized into two types of configurations by combining the grouping characteristics: 1) Led by spectator service, feel and act experience co-driven, 2) Spectator service and think experience co-driven. The findings provide theoretical guidance for enhancing fan experience and meeting the practical needs of cultivating loyal CBA fan groups while expanding the league’s influence.
Demonstration of active neutron interrogation of special nuclear materials using a high-intensity short-pulse-laser-driven neutron source
AbstractDetecting shielded special nuclear material, such as nuclear explosives, is a difficult challenge pursued by non-proliferation, anti-terrorism, and nuclear security programs worldwide. Interrogation with intense fast-neutron pulses is a promising method to characterize concealed nuclear material rapidly but is limited by suitable source availability and proven instrumentation. In this study we have pioneered a demonstration of such an interrogation method using a high-intensity, short-pulse, laser-driven neutron source that offers potential benefits compared to conventional neutron sources. The measurement results reported here represent the first experimental demonstration of this interrogation approach on enriched uranium items and demonstrate the feasibility of a precise measurement using realistic nuclear materials, representative of field scenarios, even with just a single laser-driven neutron pulse. Bright pulsed sources can overcome the nuisance background of items with strong internal neutron sources, improving analytical power, while single-shot assay is attractive in high-throughput situations where time is at a premium. The science and technology of this type of neutron production is developing rapidly, and we anticipate that practical mobile interrogation systems will become available based on the detection concepts demonstrated here to meet the growing measurement needs.
Perceived racial discrimination, resilience, and oral health behaviours of adolescents with immigrant backgrounds
Introduction Unmet oral health needs remain a significant issue among immigrant adolescents, often exacerbated by experiences of racial discrimination. This study aimed to examine the associations between perceived discrimination and oral health behaviours in adolescents with immigrant backgrounds and explore the potential moderating role of resilience on this association. Methods Ethical approval for this cross-sectional study was obtained from the University of Alberta Research Ethics Board. Participants were 12 to 18-year-old adolescents from immigrant backgrounds. Participants were recruited through nine community organizations using a snowball sampling technique. After obtaining active parental consent and assent from the adolescent, the participants completed a questionnaire covering demographics, oral health behaviours, and perceived racial discrimination and resilience. Perceived racial discrimination and resilience were measured using validated scales. Descriptive statistics summarized variables. Logistic regression assessed associations, controlling for confounding factors. Resilience’s moderating impact was analyzed via the interaction model of regression analysis. Results In this cross-sectional study of 316 participants, average age of 15.3 (SD = 1.9) years, and a median age of 15 years (Inter Quartile Range-12-18), 76% reported discrimination experiences. Adjusted analysis showed that an increase of one unit in the total discrimination distress score was associated with 51% less likelihood of categorizing self-rated oral health as good (OR = 0.49, 95% CI: 0.29–0.81). The odds of brushing teeth more than twice a day, as opposed to once a day, decreased by 58% with one unit increase in the total discrimination distress score (OR = 0.42, 95% CI: 0.25–0.71). The odds of visiting the dentist for an urgent procedure instead of a regular check-up were 2.3 times higher with a unit increase in the total discrimination distress score (OR = 2.3: 95% CI:1.3–4.0) Resilience did not moderate the observed association. Conclusion Perceived racial discrimination was associated with the pattern for dental attendance, tooth brushing frequency, and self-rated oral health. Resilience did not moderate the observed association.
Production of Oncorhynchus mykiss biosensor based on polyvinyl alcohol/chitosan nanocomposite using phycocyanin during refrigerated storage
PtpA protein from Mycobacterium avium subsp. paratuberculosis as a potential marker of rheumatoid arthritis in humans
Studies have noted the connection between Mycobacterium avium subspecies paratuberculosis (MAP) and autoimmunity. MAP is an intracellular pathogen that infects and multiplies in macrophages. To overcome the hostile environment elicited by the macrophage, MAP secretes a battery of virulence factors to neutralize the toxic effects of the macrophage. One of the virulence factors is the Protein Tyrosine Phosphatase A (PtpA), a protein secreted by MAP that interferes in the phago-lysosome fusion, rendering the pathogen unnoticed in the cytoplasm of the macrophage. This study aimed to assess the presence of PtpA antibodies in the sera of Mexican individuals with rheumatoid arthritis (RA) and investigate its possible use as a biomarker for disease activity. We compared RA patients (n = 100) to control subjects (CS) (n = 100) by assessing specific immune responses to PtpA (the antigen) by an indirect ELISA method. Results showed a significant difference in PtpA levels between RA and CS, with RA patients having a median OD of 0.4645 compared to 0.1372 in CS. Antibodies against PtpA were present in 95% of RA patients and 16% of CS (AUC = 0.9163, p = 0.0001). Male control subjects showed higher PtpA reactivity than female CS. The Disease Activity Score (DAS-28) analysis showed that individuals with moderate to high disease activity had lower levels of PtpA reactivity. The results suggest a potential connection between RA and MAP infection.
The optimal neoadjuvant treatment strategy for HR+/HER2 + breast cancer: a network meta-analysis
AbstractThe efficacy of neoadjuvant therapy varies significantly with hormone receptor (HR) status for patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer (BC). Despite extensive research on HER2 + BC, the optimal neoadjuvant strategy for HR+/HER2 + BC remains inconclusive. This study aimed to identify the optimal neoadjuvant regimen for HR+/HER2 + BC treatment. We conducted a systematic search for trials comparing neoadjuvant regimens for HR+/HER2 + BC and a network meta-analysis. Odds ratios for pathological complete response (pCR) and hazard ratios for event-free survival (EFS) were calculated. Treatment regimens were ranked using the surface under the cumulative ranking curve. 20 trials with 2809 patients were included. In pCR analysis, three neoadjuvant regimens sequentially ranked at the top, namely those comprising T-DM1, pertuzumab with trastuzumab, and tyrosine kinase inhibitor with trastuzumab, demonstrating significantly higher pCR rates than monotherapies. In EFS analysis, pertuzumab with trastuzumab ranked the first while T-DM1 containing regimen ranked the last. Anthracycline-free regimens showed a marginally higher pCR rate than anthracycline-containing regimens, while carboplatin-containing regimens demonstrated a numerically higher pCR rate than carboplatin-free regimens. Significant heterogeneity was observed in endocrine therapy analysis, which may be caused by different strategies for incorporating endocrine therapy. In conclusion, trastuzumab plus pertuzumab stands out as the optimal neoadjuvant HER2-targeting regimen for HR+/HER2 + BC Furthermore, anthracycline-free carboplatin-containing chemotherapy emerges as a promising combination treatment. Further investigation is required to clarify the role of endocrine therapy in HR+/HER2 + BC to guide its clinical application.
Clonal phylogenies inferred from bulk, single cell, and spatial transcriptomic analysis of epithelial cancers
Epithelial cancers are typically heterogeneous with primary prostate cancer being a typical example of histological and genomic variation. Prior studies of primary prostate cancer tumour genetics revealed extensive inter and intra-patient genomic tumour heterogeneity. Recent advances in machine learning have enabled the inference of ground-truth genomic single-nucleotide and copy number variant status from transcript data. While these inferred SNV and CNV states can be used to resolve clonal phylogenies, however, it is still unknown how faithfully transcript-based tumour phylogenies reconstruct ground truth DNA-based tumour phylogenies. We sought to study the accuracy of inferred-transcript to recapitulate DNA-based tumour phylogenies. We first performed in-silico comparisons of inferred and directly resolved SNV and CNV status, from single cancer cells, from three different cell lines. We found that inferred SNV phylogenies accurately recapitulate DNA phylogenies (entanglement = 0.097). We observed similar results in iCNV and CNV based phylogenies (entanglement = 0.11). Analysis of published prostate cancer DNA phylogenies and inferred CNV, SNV and transcript based phylogenies demonstrated phylogenetic concordance. Finally, a comparison of pseudo-bulked spatial transcriptomic data to adjacent sections with WGS data also demonstrated recapitulation of ground truth (entanglement = 0.35). These results suggest that transcript-based inferred phylogenies recapitulate conventional genomic phylogenies. Further work will need to be done to increase accuracy, genomic, and spatial resolution.
Biosynthesis and health promoting traits of green synthesized cobalt oxide nanoparticles
Research on hydrodynamic performance of S-type turbine based on linear wave
The hydrodynamic performance of a Savonius type turbine (S-type turbine) in wave field is studied. The method of combining numerical simulation with physical experiment is adopted.Based on linear wave theory and turbulence model, Star CCM+numerical simulation software is used for digital modeling, and overlapping grid technology is used for grid modeling. Dynamic Fluid Body Interaction (DFBI) model is called to control the movement of S-type turbine, and second-order time discretization is adopted to establish a two-dimensional wave field model and conduct numerical simulation. At the same time, the physical test system of S-type turbine was developed for physical experiment verification, and the rotating performance of S-type turbine under different wave heights and pe-riods was measured, and the results of numerical simulation and physical experiment were com-prehensively evaluated. The results show that in wave field, the inverted S-shape arrangement of horizontal axis is better than the positive S-shape arrangement of horizontal axis and the vertical axis arrangement, and the captured energy is more than 3 times. At the same time, the fluctuating rotation speed of S-type turbine in wave field needs to be close to the wave frequency to capture more wave energy, which has guiding significance for practical engineering.