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To compare the impact on child diet and growth of a multisectoral community intervention v. nutrition education and livestock management training alone.
Longitudinal community-based randomized trial involving three groups of villages assigned to receive: (i) Full Package community development activities, delivered via women’s groups; (ii) livestock training and nutrition education alone (Partial Package); or (iii) no intervention (Control). Household surveys, child growth monitoring, child and household diet quality measures (diet diversity (DD), animal-source food (ASF) consumption) were collected at five visits over 36 months. Mixed-effect linear regression and Poisson models used survey round, treatment group and group-by-round interaction to predict outcomes of interest, adjusted for household- and child-specific characteristics.
Households (n 974) with children aged 1–60 months (n 1333).
Children in Full Package households had better endline anthropometry (weight-for-age, weight-for-height, mid-upper-arm-circumference Z-scores), DD, and more consumption of ASF, after adjusting for household- and child-specific characteristics. By endline, compared with Partial Package or Control groups, Full Package households demonstrated preferential child feeding practices and had significantly more improvement in household wealth and hygiene habits.
In this longitudinal study, a comprehensive multisectoral intervention was more successful in improving key growth indicators as well as diet quality in young children. Provision of training in livestock management and nutrition education alone had limited effect on these outcomes. Although more time-consuming and costly to administer, incorporating nutrition training with community social capital development was associated with better child growth and nutrition outcomes than isolated training programmes alone.
This study addresses the question of why so many of the world's legislators are lawyers or law graduates. Drawing from previous studies on lawyer-legislators and electoral systems, it develops the argument that ‘first-pass-the-post’ single-member district electoral systems presume a principal-agent logic of representation and are therefore conducive to political parties selecting representatives with either occupational experience or educational training in the field of law. By contrast, proportional representation (PR) elections presume a microcosm model of representation incentivizing parties to select candidates representing diverse demographic and occupational backgrounds. This conjecture is tested by examining legislator backgrounds in three large parliaments with mixed electoral systems: Germany, Japan, and South Korea. As expected, single-member plurality elections are linked to a greater share of lawyers and law graduates in parliaments compared to those elected via PR even after controlling for several alternative explanations.
The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.
The Colombian Final Accord is an innovative agreement, particularly with respect to the amount of overall content devoted to transitional justice, victims, and the emphasis on subsequent implementation (Herbolzheimer, 2016; Nylander, Sandberg, and Tvedt, 2018). Some of the most contentious issues in the negotiations that produced the accord were related to truth and reconciliation processes, prosecution and sentencing for war crimes, prisoners release, and amnesty, and the armed actors and negotiators showed great interest in learning from other peace processes. The overall end result of these efforts was the reaching of what is almost certainly the most victim-centered comprehensive peace agreement ever negotiated.1
In this article, I give a crystalline characterization of abelian varieties amongst the class of smooth projective varieties with trivial tangent bundles in characteristic
. Using my characterization, I show that a smooth, projective, ordinary variety with trivial tangent bundle is an abelian variety if and only if its second crystalline cohomology is torsion-free. I also show that a conjecture of KeZheng Li about smooth projective varieties with trivial tangent bundles in characteristic
is true for smooth projective surfaces. I give a new proof of a result by Li and prove a refinement of it. Based on my characterization of abelian varieties, I propose modifications of Li’s conjecture, which I expect to be true.
We study the impact of a severe drought on children's educational outcomes in rural Maharashtra, a state in central India. Using pooled cross section data on children's test scores, we employ a difference-in-differences methodology to estimate the impact. We find that the drought caused a decline of 4.14 per cent in math scores and 2.67 per cent in reading scores of affected children. We also study heterogeneity in the impact by gender, age, parents' schooling, and household wealth, finding evidence in support of an income effect whereby households with limited means to smooth consumption disinvest in their children in response to the drought.
Populations of Critically Endangered White-rumped Gyps bengalensis and Slender-billed G. tenuirostris Vultures in Nepal declined rapidly during the 2000s, almost certainly because of the effects of the use in livestock of the non-steroidal anti-inflammatory drug diclofenac, which is nephrotoxic to Gyps vultures. In 2006, veterinary use of diclofenac was banned in Nepal and this was followed by the gradual implementation, over most of the geographical range of the two vulture species in Nepal, of a Vulture Safe Zone (VSZ) programme to advocate vulture conservation, raise awareness about diclofenac, provide vultures with NSAID-free food and encourage the veterinary use in livestock of a vulture-safe alternative NSAID (meloxicam). We report the results of long-term monitoring of vulture populations in Nepal before and after this programme was implemented, by means of road transects. Piecewise regression analysis of the count data indicated that a rapid decline of the White-rumped Vulture population from 2002 up to about 2013 gave way to a partial recovery between about 2013 and 2018. More limited data for the Slender-billed Vulture indicated that a rapid decline also gave way to partial recovery from about 2012 onwards. The rates at which populations were increasing in the 2010s exceeded the upper end of the range of increase rates expected in a closed population under optimal conditions. The possibility that immigration from India is contributing to the changes cannot be excluded. We present evidence from open and undercover pharmacy surveys that the VSZ programme had apparently become effective in reducing the availability of diclofenac in a large part of the range of these species in Nepal by about 2011. Hence, community-based advocacy and awareness-raising actions, and possibly also provisioning of safe food, may have made an important contribution to vulture conservation by augmenting the effects of changes in the regulation of toxic veterinary drugs.
The success of dicamba-tolerant soybean [Glycine max (L.) Merr.] has revived concerns about plant growth regulator (PGR) herbicide exposure to conventional soybean. In laboratory studies, soybean root nodulation is inhibited by excess auxin, which is the mechanism of action of PGR herbicides. Soybean exposed to PGRs in a field environment may have a similar response, and if nodulation is compromised, nitrogen (N) fixation may be reduced, with subsequent seed yield or protein content decreases. Many soybean–N studies report minimal impact to soybean yield. However, if soybeans show foliar PGR injury symptoms, could N application compensate for a potential nodulation inhibition response? This study examined the response of non–PGR tolerant soybean to N after exposure to low doses of 2,4-D and dicamba applied once (at soybean growth stages V1, V3, and early reproduction [R1 or R2]) or twice (V1 + V3 or V3 + R). N was either foliar or soil applied at early (∼5 d after PGR application) or late (10 d after PGR application) timings. Nodulation and plant growth were evaluated at R3, and grain yield and seed protein and oil content were quantified at maturity. Plant biomass and nodulation were reduced by 10% with some PGR treatments, and early foliar N application after PGR injury resulted in reduction up to 25%. N applications to non–PGR treated soybean did not increase yield. Soybean treated with PGR at V1 or V3, with or without N, had yields similar to control treatments. However, yield reductions of up to 20% were observed when PGRs were applied at V5 or R stages or when double PGR applications were followed by early foliar N application. Seed protein and oil content were not affected by PGR or N treatment.
Indian railway systems are fourth largest in the world, and cause on average 15 deaths daily due to various intentional and unintentional reasons. This study presents a 5-year retrospective data analysis of polytrauma patients with train-related injuries.
To highlight key lessons learned from data analysis to inform better safety measures and laws.
Trauma registry data between 2012 and 2016 were analyzed for patients with train-related injuries. Data from 726 patients were analyzed for demographics, event, injuries, management, and final outcome. ISS was used to quantify the extent of injury.
Mean patient age was 33 years with an 86% to 14% male to female ratio. 62% of patients were in the 20- to 40-year age group. Average time of arrival at health facility post-injury was 3.3 hours. Half of the patients were trespassers. Mean ISS was 11.65. Chest injuries were present in 24.6% of patients, with half requiring interventions like ICD insertion or surgery. 20% of patients underwent amputations of extremities. 40% of patients needed admission to the ICU. 3.5% died in the Emergency Department (ED). Mean hospital stay was 17 days with an in-hospital mortality of 17.4%.
This analysis is the largest to date showing comprehensive injury patterns and outcomes of train-related injuries from a developing country. Patients injured on the platform and off the platform had the same severity of injuries. This analysis shows the need for safety measures and strict law enforcement both at the station and at the track.
Protein-based materials are a powerful instrument for a new generation of biological materials, with many chemical and mechanical capabilities. Through the manipulation of DNA, researchers can design proteins at the molecular level, engineering a vast array of structural building blocks. However, our capability to rationally design and predict the properties of such materials is limited by the vastness of possible sequence space. Directed evolution has emerged as a powerful tool to improve biological systems through mutation and selection, presenting another avenue to produce novel protein materials. In this prospective review, we discuss the application of directed evolution for protein materials, reviewing current examples and developments that could facilitate the evolution of protein for material applications.
(1) To characterise changes in dead space fraction during the first 120 post-operative hours in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome, including hybrid procedure; (2) to document whether dead space fraction varied by shunt type (Blalock–Taussig shunt and Sano) and hybrid procedure; and (3) to determine the association between dead space fraction and outcomes.
Retrospective chart review in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome in a cardiac intensive care unit over a consecutive 30-month period. A linear mixed model was used to determine the differences in dead space over time. Multivariable linear regression and a multivariable linear mixed model were used to assess the association between dead space and outcomes at different time points and over time, respectively.
Thirty-four neonates received either a Blalock–Taussig shunt (20.5%), Sano shunt (59%), or hybrid procedure (20.5%). Hospital mortality was 8.8%. Dead space fractions in patients undergoing the hybrid procedure were significantly lower on day 1 (p = 0.01) and day 2 (p = 0.02) and increased over time. A dead space fraction >0.6 on post-operative days 3–5 was significantly associated with decreased duration of mechanical ventilation in all surgical groups (p < 0.001).
Dead space fraction >0.6 on post-operative days 3–5 was associated with lower duration of mechanical ventilation in all surgical groups. A more comprehensive, prospective assessment of dead space in this delicate patient population would likely be beneficial in improving outcomes.
To evaluate the feasibility and potential effectiveness of a lifestyle intervention (diet and physical activity) among women with history of gestational diabetes mellitus (GDM), delivered by trained facilitators.
Fifty-six normoglycaemic or prediabetic women with prior GDM were recruited at mean of 17 months postpartum. Socio-demographic, medical and anthropometric data were collected. Six sessions on lifestyle modification were delivered in groups (total four groups, with 12–15 women in each group). Pre and post intervention (6 months) weight, body mass index (BMI), waist circumference, 75 g oral glucose tolerance test, blood pressure (BP) and lipid parameters were compared.
The intervention was feasible, with 80% of women attending four or more sessions. Post-intervention analyses showed a significant mean reduction of 1.8 kg in weight, 0.6 kg/m2 in BMI and 2 cm in waist circumference. There was also a significant drop of 0.3 mmol/L in fasting plasma glucose, 0.9 mmol/L in 2 h post glucose load value of plasma glucose, 3.6 mmHg in systolic BP, and 0.15 mmol/L in triglyceride levels. Changes in total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and diastolic BP were non-significant.
This study showed feasibility of the lifestyle intervention delivered in group sessions to women with prior gestational diabetes.
Advances in material science and semiconductor technology have enabled a variety of inventions to be implemented in electronic systems and devices used in the medical, telecommunications, and consumer electronics sectors. In this paper, a wireless charging system is described as a wearable body heater that uses a chair as a transmitter (Tx). This system incorporates the widely accepted Qi wireless charging standard. Alignment conditions of a linear three-element coil arrangement and a 3 × 3 coil matrix array are investigated using voltage induced in a coil as a performance indicator. The efficiency obtained is demonstrated to be up to 80% for a voltage of over 6.5 Volts and a power transfer of over 5 Watts. Our results and proposed approach can be useful for many applications. This is because the wireless charging system described herein can help design seating areas for the elderly and disabled, commercial systems, consumer electronics, medical devices, electronic textiles (e-textiles), and other electronic systems and devices.
Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.