To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
There is limited information as to whether people who experience severe acute malnutrition (SAM) as young children are at increased risk of overweight, high body fat, and associated chronic diseases in later life. We followed up, when aged 7-12 years, 100 Zambian children who were hospitalised for SAM before age 2 years and 85 neighbourhood controls who had never experienced SAM. We conducted detailed anthropometry, body composition assessment by bioelectrical impedance (BIA) and deuterium dilution (D2O), and measured blood lipids, haemoglobin (Hb) and haemoglobin A1c (HbA1c). Groups were compared by linear regression following multiple imputation for missing variables. Children with prior SAM were slightly smaller than controls but differences, controlling for age, sex, socioeconomic status, and HIV exposure or infection, were significant only for hip circumference, suprailiac skinfold, and fat-free mass index by D2O. Blood lipids and HbA1c did not differ between groups but Hb was lower by 7.8 (95% CI 0.8, 14.7) g/L and systolic blood pressure was 3.4 (95% CI 0.4, 6.4) mmHg higher among the prior SAM group. Both anaemia and high HbA1c were common among both groups, indicating a population at risk for the double burden of over- and under-nutrition and associated infectious and chronic diseases. The prior SAM children may have been at slightly greater risk than the controls; this was of little clinical significance at this young age but the children should be followed when older and chronic diseases manifest.
The study assessed the community preparedness to manage the COVID-19 and access to healthcare services during the lockdown of 2020 in a rural health block of northern India.
A cross-sectional study was conducted during June-July, 2020 in 25 villages and five wards of a rural administrative block of Haryana. A pre-tested, semi-structured investigator administered checklist was used to assess the community preparedness and practices for COVID-19 prevention/control and healthcare access through direct observations and interviewing community health workers and beneficiaries.
Active surveillance for influenza-like illness was carried out in 86.7% of the study units, though the frequency was once a month. There was poor adherence (adherence: 0-3%) to COVID-19 infection prevention & control (IPC) measures such as physical distancing and use of face masks. Rural beneficiaries reported difficulty accessing essential healthcare services than their urban counterparts.
A qualitative study to understand the facilitators and barriers for the non-adherence to IPCs measures by the study population and formulating behaviour change communication strategies for improving the IPCs is needed. Repeat, cross-sectional surveys at regular intervals may be planned to gauge the change and effect of the interventions on the community preparedness and practices.
This research aimed at investigating the general public perception of social media (SM), impact of COVID-19 (SARS-CoV-2) pandemic, and related misconceptions among the Pakistani population.
Cross-sectional study conducted during the peak of COVID-19 in Pakistan between May and June, 2020 comprised of 2307 Pakistani male and female participants. Subjects under 18 years of age and nationality other than Pakistani were excluded. An online questionnaire was administered via the Internet using various kinds of social media.
The study was comprised of 2307 male and female participants; 2074 (89.90%) used SM for seeking COVID-19 information, 450 (20%) used both Facebook (FB) and WhatsApp (WA), and 267 (11.6%) used FB, WA, Twitter, and Instagram. Respondents’ perceptions showed that: 529 (23%) believed in SM information and 1564 (67.8%) stated that COVID-19 affected their social and mental wellbeing. Respondents’ knowledge revealed that: 1509 (65.40%) had poor knowledge (≤ 50% score), and 798 (34.6%) had good knowledge (> 50% score) (P < 0.001) about COVID-19. Binary logistic regression analysis showed that higher-earning positively correlated, while private jobs were negatively associated, with good knowledge.
FB and WA were the 2 common social media used by study participants (a third had good knowledge). COVID-19 affected the social, mental, and psychological well-being of individuals. Good knowledge was greater in individuals with higher earning and less with private job involvements.
We investigate a class of generalised stochastic complex matrices constructed from the class of all doubly stochastic matrices and a special class of circulant matrices. We determine the exact values of the structured singular values of all matrices in the class in terms of the constant row (column) sum.
Live-cell fluorescence microscopy is an indispensable tool in biomedical and biophysical research, allowing the study of dynamic processes in living systems. Recent developments have given rise to high-end imaging systems capable of live-cell imaging on the nanometer scale. These instrumentation developments have, in turn, increased the demand for enhanced fluorophores to label target proteins within living cells. abberior offers solutions on both fronts. abberior LIVE dyes have higher cell permeability and improved specificity compared to conventional labels, making long-term live-cell imaging at extremely low probe concentrations possible. These low nanomolar working concentrations minimize cell toxic effects. abberior stimulation emission depletion (STED) microscopes offer super-resolution down to ~30 nm with minimal light exposure to the sample. This unique combination takes live-cell imaging to the next level and will make super-resolution imaging of dynamic subcellular processes a routine, easy-to-use visualization method, paving the way for fundamental biological discoveries. At the extreme, minimal emission fluxes (MINFLUX) microscopy offers molecular resolutions of a few nanometers in unprecedented temporal regimes.
Listener-based ratings have become a prominent means of defining second language (L2) users’ global speaking ability. In most cases, local listeners are recruited to evaluate speech samples in person. However, in many teaching and research contexts, recruiting local listeners may not be possible or advisable. The goal of this study was to hone a reliable method of recruiting listeners to evaluate L2 speech samples online through Amazon Mechanical Turk (AMT) using a blocked rating design. Three groups of listeners were recruited: local laboratory raters and two AMT groups, one inclusive of the dialects to which L2 speakers had been exposed and another inclusive of a variety of dialects. Reliability was assessed using intraclass correlation coefficients, Rasch models, and mixed-effects models. Results indicate that online ratings can be highly reliable as long as appropriate quality control measures are adopted. The method and results can guide future work with online samples.
This study aims to assess the stress levels, stress busters (stress relievers), and coping mechanisms among Saudi dental practitioners (SDPs) during the coronavirus disease (COVID-19) pandemic outbreak.
A self-administered questionnaire was sent to SDPs via Google Forms. Cohen’s stress score scale was used for stress evaluation, and the mean scores were compared based on age, gender, qualification, and occupation. In addition, comparisons of the utilization of stress coping mechanisms and stress busters based on gender, age, and occupation were evaluated. Descriptive statistics were carried out using SPSS Version 21.0 (IBM Corp, Armonk, NY).
A total of 206 SDPs (69% males and 31% females) participated in the study. Male SDPs showed a higher score than females (P > 0.05). SDPs around age 50 years and above obtained high stress scores (25 ± 7.4) as compared with other age groups (P < 0.05). The occupational level showed higher stress scores (22.6 ± 4.6 than the other occupation groups (P < 0.05). The majority of the SDPs used watching TV/mobile/computer (80%) as a stress buster, followed by binge eating (64%), exercise (44%), smoking (32%), do-it-yourself (DIY; 23%), and meditation (17%).
SDPs are experiencing stress levels during the COVID-19 pandemic. Male SDPs above age 50 years and private practitioners showed higher levels of stress scores. An overall commonly used stress buster was smoking in males and meditation in females.
We present an asymptotic theory for analytical characterization of the high-Reynolds-number incompressible flow of a Newtonian fluid past a shear-free circular cylinder. The viscosity-induced modifications to this flow are localized and except in the neighbourhood of the rear stagnation point, behave like a linear perturbation of the inviscid flow. Our theory gives a highly accurate description of these modifications by including the contribution from the most significant viscous term in a correctional perturbation expansion about an inviscid base state. We derive the boundary layer equation for the flow and deduce a similarity transformation that leads to a set of infinite, shear-free-condition-incompatible, self-similar solutions. By suitably combining members from this set, we construct an all-boundary-condition-compatible solution to the boundary layer equation. We derive the governing equation for vorticity transport through the narrow wake region and determine its closed-form solution. The near and far-field forms of our wake solution are desirably consistent with the boundary layer solution and the well-known, self-similar planar wake solution, respectively. We analyse the flow in the rear stagnation region by formulating an elliptic partial integro-differential equation for the distortion streamfunction that specifically accounts for the fully nonlinear and inviscid dynamics of the viscous correctional terms. The drag force and its atypical logarithmic dependence on Reynolds number, deduced from our matched asymptotic analysis, are in remarkable agreement with the high-resolution simulation results. The logarithmic dependence gives rise to a critical Reynolds number below which the viscous correction term, counterintuitively, reduces the net dissipation in the flow field.
In-patients subject to Section 37/41 of the Mental Health Act 1983 (MHA) require permission from the Ministry of Justice (MoJ) for leave, transfer and discharge. This study aimed to quantify the time spent waiting for the MoJ to respond to requests, using data on restricted patients recalled to a non-forensic unit over 8 years.
Eleven admissions were identified. The mean total time waiting for response was 95 days per admission, with an estimated cost of £40 922 per admission.
Current procedures may contribute to considerable increases in length of stay. This goes against the principles of the MHA, as non-secure services rarely provide the range of interventions which justify prolonged admission. We suggest several ways to resolve this issue, including broadening the guidance for the use of voluntary admissions and civil sections, and allowing clinicians to make decisions on leave and transfer where there is little risk.
Drought tolerance is a highly complex trait and one of the important components of yield stability in wheat. An experiment was therefore conducted to study the drought tolerance status of 14 high-yielding wheat varieties based on morphological characteristics under a randomized complete block design following factorial arrangement with three replications. Variety × Treatment × Year interactions of wheat genotypes were studied for various morphological traits under normal and drought stress conditions for 2 years in plants grown in pots. Significant differences were observed among the 14 varieties of wheat. Sutlej-86 was found to be highly affected by drought, with maximum reductions in plant height, spike length and number of spikelets/spike. The variety with the maximum tolerance to drought was Bahawalpur-97; this variety also had the lowest reductions in the number of fertile tillers/plant, the number of spikelets/spike, spike weight, the number of grains/spike, 1000-grain weight, grain yield/spike, total biomass and stress susceptibility and tolerance indices. Stronger correlations among the studied attributes under drought stress over normal conditions further highlighted drought stress adversities. The studied traits are thus recognized as drought tolerance indicators for varietal selection, and varieties showing less reduction under drought could be used as a standard check in breeding programmes to identify lineages with drought tolerance and could be recommended for drought-stressed areas.
The intrauterine environment and early-life nutrition are regulated by maternal biomarkers in the blood and breast milk. We aimed to explore epigenetic modifications that may contribute to differential chemerin expression in maternal plasma, colostrum, and breast milk and find its association with fetal cord blood and infant weight at 6 weeks postpartum. Thirty-three gestational diabetes mellitus (GDM) mothers and 33 normoglycemic mothers (NGT) were recruited. Two maternal blood samples (28th week of gestation and 6 weeks postpartum), cord blood, colostrum, and mature milk were collected. Methylation-specific polymerase chain reaction and enzyme-linked immunosorbent assay were conducted. The weight of the babies was measured at birth and 6 weeks postpartum. Serum chemerin levels at the 28th gestational week and 6 weeks postpartum were significantly lower for the NGT group as compared to the GDM group; (P < 0.05). Higher colostrum chemerin concentrations were observed in the GDM group and remained elevated in mature milk as compared to NGT (P < 0.05). Colostrum and breast milk chemerin levels showed an independent association with infant weight at 6 weeks postpartum (r = 0.270; P = 0.034) (r = 0.464; P < 0.001). Forty percent GDM mothers expressed unmethylated chemerin reflecting increased chemerin concentration in the maternal blood. This pattern was also observed in newborn cord blood where 52% of samples showed unmethylated chemerin in contrast to none in babies born to normoglycemic mothers. The results of this study highlight the critical importance of altered chemerin regulation in gestational diabetic mothers and its effect during early life period and suggest a possible role in contributing to childhood obesity.
ABSTRACT IMPACT: By restoring the gut microbiota in patients with acute myeloid leukemia exposed to antibiotics, we will reduce infections during and after curative-intent chemotherapy. OBJECTIVES/GOALS: Infection is a leading cause of death in acute myeloid leukemia (AML). Antibiotics disrupt the gut microbiota, promoting secondary infections. Through a double-blind randomized placebo-controlled phase 2 trial, we will determine whether microbiota restoration using fecal microbiota transplantation (FMT) prevents infections in AML patients. METHODS/STUDY POPULATION: 72 intensively treated AML patients at our institution are randomized in a 2:1 ratio to FMT (arm A) or placebo (arm B). After completing each course of antibacterial antibiotics, patients receive one study treatment. Up to 3 study treatments are administered over 3 months. FMT is delivered as a third-party oral product containing microbiota (˜5x10^11 bacteria) in 4-6 capsules. Stool samples are collected before and after each study treatment. The primary endpoint is 4-month overall infection rate. 16S rRNA gene sequencing of stool samples is used to determine specific taxa that are under- or over-represented in samples preceding infections and compare the two arms for key microbiome features including diversity and composition. Bloodstream infection within 7 days after FMT counts towards stopping rule. RESULTS/ANTICIPATED RESULTS: Five patients have been enrolled: 4 have received 1 dose and 1 received 2 doses. The only adverse event (possibly related to study treatment) has been grade 1 abdominal pain in 1 patient. Notably, no bloodstream infection has occurred. All planned samples have been collected and are sequenced in batches. We expect arm A patients to experience fewer infections and fewer intestinal blooms of pathobionts, and both arms to experience intestinal blooms before specific infections. An interim efficacy analysis will be performed at half total enrollment. DISCUSSION/SIGNIFICANCE OF FINDINGS: Current supportive care during intensive chemotherapy is fundamentally anti-microbial and results in dysbiosis, with detrimental consequences. We will establish the evidence for FMT as a restorative strategy in AML patients. This is the first randomized placebo-controlled trial of repeated FMT, with potential implications to other cancers.
Understanding risk factors for death from Covid-19 is key to providing good quality clinical care. We assessed the presenting characteristics of the ‘first wave’ of patients with Covid-19 at Royal Oldham Hospital, UK and undertook logistic regression modelling to investigate factors associated with death. Of 470 patients admitted, 169 (36%) died. The median age was 71 years (interquartile range 57–82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n = 218, 46.4%), diabetes (n = 143, 30.4%) and chronic neurological disease (n = 123, 26.1%). The most frequent complications were acute kidney injury (AKI) (n = 157, 33.4%) and myocardial injury (n = 21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation. Independent risk factors for death were increasing age (odds ratio (OR) per 10 year increase above 40 years 1.87, 95% confidence interval (CI) 1.57–2.27), hypertension (OR 1.72, 95% CI 1.10–2.70), cancer (OR 2.20, 95% CI 1.27–3.81), platelets <150 × 103/μl (OR 1.93, 95% CI 1.13–3.30), C-reactive protein ≥100 μg/ml (OR 1.68, 95% CI 1.05–2.68), >50% chest radiograph infiltrates (OR 2.09, 95% CI 1.16–3.77) and AKI (OR 2.60, 95% CI 1.64–4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2, lymphopoenia or other comorbidities. These findings will inform clinical and shared decision making, including use of respiratory support and therapeutic agents.
Depression is a global public health problem with highest rates in women in low income countries including Pakistan. Paediatricians may be a resource to help with maternal depression. Little is known in low income countries about the prevalence of depression and its social correlates in mothers of children attending paediatric clinics.
Using cross-sectional design consecutive women attending the paediatric clinic were screened using the Edinburgh Postnatal Depression Scale (n=185). Women scoring 12 or more (n=70) and a random sample of low scorers (n=16) were interviewed using the Clinical Interview Schedule Revised (CIS-R) to confirm the diagnosis of depression, the Oslo scale was used to measure social stress and EQ-5D for health related quality of life.
The prevalence of maternal depression was 51%. The mean age of the sample was 26 years. Depressed mothers were more likely to be living in a joint family household, they were less educated and they and their husbands were less likely to be employed. The depressed mothers had more financial difficulties and they were more likely to sleep hungry during the last month due to financial problems. The depressed mothers had less social support and poorer quality of life compared to non depressed mothers.
Maternal depression in this health care setting is high and it is associated with social stress and poor social support. Paediatric appointments may be an opportunity for care and care delivery for maternal depression.
The aim of study is to determine the maternal perception of inadequate breast feed and compare possible augmentation of breast milk with lactogouges (metclopromide) and structured counseling of mothers, using the new technology of isotope labeling in a community in Rawalpindi, Pakistan.A random sample of 200 lactating mothers having complaints of reduced breast milk production is being recruited from well baby clinic of participating hospitals. All should be practicing exclusive breastfeeding with infants from 2-3 months of age. Their perceptions regarding their breast milk production is assessed. They are randomized into four groups. Group one will be given oral metclopromide, groups 2 will be given structured counseling by trained health workers and group 3 will receive placebo whereas group 4 will receive CBT. Breast-milk production will be measured at completion of 4 weeks of intervention by using the dose-to-the-mother deuterium oxide method also validated in Pakistan by the investigators to a limited sample. Differences in the groups of mothers will be estimated using appropriate statistical techniques, while controlling for possible confounders. Outcome of the study would be able to demonstrate that lactogouges, or simple counselling may have an effect on increasing the breast milk quantity of mothers and also effect of interventions on their perceptions. The results of the study could have a major impact on the breastfeeding teachings and practices in our society which in turn has a potential to improve and have a significant impact on one of the main Millennium Development Goals i.e. child mortality and morbidity.
Risk for emotional and behavioural problems are known to be high among children of depressed mothers, but little is known about the impact of antenatal and postnatal depression on the physical health of the infant. Our one-year prospective follow-up study of 320 mothers and their infants in rural Rawalpindi, Pakistan, shows that infants of antenatally depressed mothers have poorer growth than controls. The relative risk for being underweight (weight-for-age z-score < -2SD) is 4.0 (95%CI 2.1-7.7) at 6 months and 2.6 (95% CI 1.7-4.1) at 12 months, while the risks for stunting (length-for-age z-score < –2SD) is 4.4 (95%CI 1.7-11.4) at 6 months and 2.5 (95% CI 1.6-4.0) at 12 months. Relative risk for ≥5 diarrhoeal episodes per year is 2.4 (95% CI 1.7-3.3). Chronic depression carries a greater risk for poor outcome than episodic depression. The associations remain significant after adjustment for confounders by multivariate analyses. It is concluded that preventive and treatment strategies for maternal depression could benefit not only the mother's well-being but also the infant's physical health and development.
Previous studies have found maternal depression to be a major risk factor for poor growth in infants in Pakistan and south Asia. The mediating mechanisms between maternal depression and infant malnutrition are an important area for research.Studies have shown that maternal depression maybe associated with shorter duration of feeding however the evidence is equivocal. The quantity of breast milk could be another factor which has only been tested with relatively inaccurate methods of clinical scoring and test weighing till date. We aim to study the relationship of maternal depression with duration of breastfeeding and infant feeding practices. Moreover, we would also estimate the breast milk production and intake by the infant in depressed versus normal mothers, using the new technology of isotope dilution, in a rural community in Rawalpindi, Pakistan.
A random sample of 100 depressed and 100 non-depressed women will be recruited for the proposed prospective cohort study. The depressive disorder will be diagnosed antenatlly and 6 months postnatally using validated instruments. The duration of exclusive breastfeeding will be assessed prospectively and infant feeding practices will be assessed at 6 months with appropriate tools. Breast-milk intake will be measured in 30 mothers from each group, using the dose-to-the-mother deuterium oxide method also validated in Pakistan by the investigators. Differences in the two groups of mothers will be estimated using appropriate statistical techniques, while controlling for possible confounders.