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Previous animal studies found beneficial effects of choline and betaine on maternal glucose metabolism during pregnancy, but few human studies explored the association between choline or betaine intake and incident gestational diabetes mellitus (GDM). We aimed to explore the correlation of dietary choline or betaine intake with GDM risk among Chinese pregnant women. A total of 168 pregnant women with GDM cases and 375 healthy controls were enrolled at the Seventh People’s Hospital in Shanghai during their GDM screening at 24–28 gestational weeks. A validated semi-quantitative FFQ was used to estimate choline and betaine consumption through face-to-face interviews. An unconditional logistic regression model was adopted to examine OR and 95 % CI. Compared with the controls, those women with GDM incidence were likely to have higher pre-pregnancy BMI, be older, have more parities and have higher plasma TAG and lower plasma HDL-cholesterol. No significant correlation was observed between the consumption of choline or betaine and incident GDM (adjusted OR (95 % CI), 0·77 (0·41, 1·43) for choline; 0·80 (0·42, 1·52) for betaine). However, there was a significant interaction between betaine intake and parity on the risk of GDM (Pfor interaction = 0·01). Among those women with no parity history, there was a significantly inverse correlation between betaine intake and GDM risk (adjusted OR (95 % CI), 0·25 (0·06, 0·81)). These findings indicated that higher dietary betaine intake during pregnancy might be considered a protective factor for GDM among Chinese women with no parity history.
This study aimed to assess hemoglobin concentration and its association with oral contraceptive (OC) use, food insecurity (FI) and dietary iron availability (DIA) in adult women of reproductive age (20–44 years). This is a population-based cross-sectional study that analysed 505 women living in favelas and urban communities in a capital city in northeastern Brazil. Hemoglobin concentration was determined using capillary blood samples. FI and DIA were assessed using the Brazilian Food Insecurity Scale and the 24-h food recall, respectively. Association analysis was carried out using logistic regression. A directed acyclic graph (DAG) was designed to illustrate the causal paths between hemoglobin concentration and DIA. A significance level of 5 % was adopted. Low hemoglobin concentrations (11·2 g/dl: (1·79)) and a high prevalence of anaemia (64·0 %) were observed; 28·7 % used OC (28·7 %) and 76·4 % were in FI. An average energetic intake of 1495 kcal/d (482·0) and 0·46 mg/d (0·27) of DIA were also observed. In the DAG-guided multivariable analysis, it was observed that hemoglobin concentrations ≥ 12 mg/dl were directly associated with higher DIA (OR: 1·67; 95 % CI (1. 08, 2·59)) and OC use (OR: 1·67; 95 % CI (1·10, 2·55)) and inversely associated with mild FI (OR: 0·60; 95 % CI (0·37, 0·96)) or severe FI (OR: 0·37; 95 % CI: (0·18, 0·76)). Women taking OC and with a higher DIA were less likely to have low hemoglobin concentrations, while those in the context of FI were in the opposite situation.
This article explores Bernard Stiegler’s concept of Epiphylogenesis as an alternative framework for understanding modern nations while aspiring to resolve major gaps in the classic theories of Benedict Anderson and Anthony Smith. Epiphylogenesis offers a fresh perspective and broader scope for the study of nations, with a view to critically enlarging the dynamic interaction between modern mass media and cultural traditions, particularly as conceptualized by Anderson and Smith. Stiegler classifies modern nations as chapters in the broader narrative of technical evolution. In epiphylogenesis, cultural traditions and technical artefacts function as a working partnership; modern nations are seen as the outcome of this co-constitutive process, wherein mass media technical systems (that is, print capitalism) exteriorize cultural traditions (ethnié), dressing them up in distinctive, open, pervasive, and standardized forms. This discussion concludes by exploring the relevance of epiphylogenesis for assessing the impact of networked communications on contemporary national identities.
The anti-apartheid movement and Save Darfur campaign were important moments of African American activism towards Africa. Howard University played a central role by divesting from both South Africa and Sudan. This article examines each divestment within Howard University’s history of engagement with Africa. While each divestment was linked by a concern to support oppressed African peoples, the roles of race and racism operated differently in each action. Such an analytic provides space to reconsider the role of US higher education in African-facing human rights activism during the age of Black Lives Matter.
This article contends that investigating relationalities between business continuity management (BCM), staff behaviours, and bureaucratic resilience advances understandings of the survival of international organisations (IOs). Drawing on in-depth interviews, a global staff survey, and a discourse analysis of United Nations (UN) reports and applying a post-colonial feminist theoretical approach foregrounding care ethics to the study of IOs, the article examines how the UN Secretary-General’s Alternative Working Arrangements directive to close physical offices and open ‘virtual offices’ was implemented in the first 18 months of the Covid-19 pandemic. It is contended that BCM is necessary for IO survival, since if the IO bureaucracy is unable to be productive and maintain its spheres of influence during a crisis, it risks losing power and authority. Between March 2020 and August 2021, staff facilitated IO survival organically, from the bottom up, in four ways: demonstrating good performance and productivity; being adaptable and resilient; maintaining personal spheres of influence; and building communities of care within the UN. However, the UN’s neoliberal, technocratic approach to business continuity and bureaucratic resilience-building neglected staff care needs. Consequently, IO survival is predicated on staff performing as exploited gendered and racialised ‘neoliberal subjects’, revealing a chronic structural crisis rooted in the UN bureaucracy’s hierarchical composition and unequal employment regime.
Election violence is increasingly taking place online. However, we still do not know much about how such attacks affect the representation of politically marginalized groups such as women. This article develops and applies strategies for analyzing (gendered) exposure to and impacts of online attacks against political candidates. It focuses on the 2019 parliamentary election campaign in Tunisia and combines manual analysis of Tunisian candidates’ public Facebook pages with candidate interviews. We find no gendered patterns in exposure to online election violence in the Facebook data and a low general exposure to attacks. The interview data nevertheless suggests gendered perceptions and impacts of attacks, as well as a perception among the candidates that online election violence is widespread and problematic. These discrepancies highlight that we need a combination of methods and materials to capture the multifaceted nature of online election violence, and in particular those that directly link candidate exposure to impact.
Predicting the transient flow fields that develop when a shock wave passes through an area expansion is a fundamental problem in compressible fluid mechanics and significant in many engineering applications. Experiments, large eddy simulations and geometrical shock dynamics are used to study the mechanism by which a normal shock wave that expands across an area expansion evolves into a uniform normal shock far downstream of it. This study analyses shock waves with moderate Mach numbers of 1.1–1.8 that expand at area ratios of up to 5. As the shock wave propagates into the expanded region, it experiences rapid deceleration, forming a non-uniform shock front. Impinging on the walls of the larger cross-section region, the shock wave reflects and generates a complex and highly transient shock pattern near the expansion region. We have found that as the shock front propagates further downstream, a laterally moving shock wave that intersects the shock front at a triple point reverberates laterally between the walls. This process effectively evens out the flow behind the incident shock front, thus reducing the variation of properties behind it. The extended duration of this process leads to significant pressure fluctuation behind the shock front. The results show that the evolution of the shock front can be scaled using the expanded region height and the velocity of the shock wave far downstream of the expansion. The results enabled the formulation of a simple empirical relation, allowing us to predict the shock velocity far downstream of gradual and abrupt area expansions.
The past 5 years have seen numerous court judgments and changes to rules and procedures that relate to the work of expert psychiatric witnesses in the British Isles. This article outlines these changes, pointing out their implications for the expert witness, and highlights pertinent judgments in over 100 court and tribunal cases.
To examine the relationship between race and ethnicity and central line-associated bloodstream infections (CLABSI) while accounting for inherent differences in CLABSI risk related to central venous catheter (CVC) type.
Design:
Retrospective cohort analysis.
Setting:
Acute care facilities within an academic healthcare system.
Patients:
Adult inpatients from January 2012 through December 2017 with CVC present for ≥2 contiguous days.
Methods:
We describe variability in demographics, comorbidities, CVC type/configuration, and CLABSI rate by patient’s race and ethnicity. We estimated the unadjusted risk of CLABSI for each demographic and clinical characteristic and then modelled the effect of race on time to CLABSI, adjusting for total parenteral nutrition use and CVC type. We also performed exploratory analysis replacing race and ethnicity with social vulnerability index (SVI) metrics.
Results:
32,925 patients with 57,642 CVC episodes met inclusion criteria, most of which (51,348, 89%) were among non-Hispanic White or non-Hispanic Black patients. CVC types differed between race/ethnicity groups. However, after adjusting for CVC type, configuration, and indication in an adjusted cox regression, the risk of CLABSI among non-Hispanic Black patients did not significantly differ from non-Hispanic White patients (adjusted hazard ratio [aHR] 1.19; 95% confidence interval [CI]: 0.94, 1.51). The odds of having a CLABSI among the most vulnerable SVI subset compared to the less vulnerable was no different (odds ratio [OR] 0.95; 95% CI: 0.75–1.2).
Conclusions:
We did not find a difference in CLABSI risk between non-Hispanic White and non-Hispanic Black patients when adjusting for CLABSI risk inherent in type and configuration of CVC.
In West Africa, vast areas are being deforested; the remnant forest patches provide a wealth of ecosystem services and biodiversity conservation potential, yet they are threatened by human activity. Forest patches <100 ha have not been widely catalogued before; we mapped forest loss of small forest patches outside of protected areas in the Guinean savannah and humid Guineo-Congolian bioclimatic regions of Togo, Benin, Nigeria and Cameroon between 2000 and 2022. Focusing on the dynamics of small patches, without considering the splitting process of larger patches, we quantified changes in their number and area and the rate and trend of forest loss. Small forest patches are widespread, yet their area and number have decreased, while the forest loss rate is increasing. Primary forest patches lost almost half of their area annually – twice as much as secondary forests, and this loss was especially pronounced across small patches (0.5 – 10 ha), suggesting deforestation preferentially occurs in the smallest patches of primary forest. If forest loss continues at the current rate, 14% of the total forest area mapped in this study will have disappeared by 2032, jeopardizing their potential to provide ecosystem services and emphasizing the need for measures to counter their deforestation.
This study aims to assess the surgical outcome of borderline hypoplastic left ventricle before and after the induction of the left ventricle rehabilitation strategy.
Methods:
A retrospective review investigated patients with borderline hypoplastic left ventricle who underwent surgical intervention between 2012 and 2022. The patient cohort was stratified into two groups based on the initiation of left ventricle rehabilitation: an early-era group (E group, 2012–2017) and a late-era group (L group, 2018–2022). Left ventricle rehabilitation was defined as palliation combined with other procedures aimed at promoting left ventricular growth such as restriction of atrial septal defect, relief of inflow/outflow obstructive lesions, and resection of endocardial fibroelastosis.
Results:
A total of 58 patients were included. Primary diagnosis included 12 hypoplastic left heart syndromes, 11 critical aortic valve stenosis, and others. A total of 9 patients underwent left ventricle rehabilitation, 8 of whom underwent restriction of atrial septal defect. As for clinical outcomes, 9 of 23 patients achieved biventricular repair in the E group, whereas in the L group, 27 of 35 patients achieved biventricular repair (39% vs. 77%, p = 0.004). Mortality did not differ statistically between the two groups (log-rank test p = 0.182). As for the changes after left ventricle rehabilitation, left ventricular growth was observed in 8 of 9 patients. The left ventricular end-diastolic volume index (from 11.4 to 30.1 ml/m2, p = 0.017) and left ventricular apex-to-right ventricular apex ratio (from 86 to 106 %, p = 0.014) significantly increased after left ventricle rehabilitation.
Conclusions:
The introduction of the left ventricle rehabilitation strategy resulted in an increased proportion of patients achieving biventricular repair without a concomitant increase in mortality. Left ventricle rehabilitation was associated with enhanced left ventricular growth and the formation of a well-defined left ventricle apex. Our study underscores the significance of left ventricle rehabilitation strategies facilitating successful biventricular repair. The data suggest establishing restrictive atrial communication may be a key factor in promoting left ventricular growth.
To compare rates of Clostridioides difficile infection (CDI) recurrence following initial occurrence treated with tapered enteral vancomycin compared to standard vancomycin.
Design:
Retrospective cohort study.
Setting:
Community health system.
Patients:
Adults ≥18 years of age hospitalized with positive C. difficile polymerase chain reaction or toxin enzyme immunoassay who were prescribed either standard 10–14 days of enteral vancomycin four times daily or a 12-week tapered vancomycin regimen.
Methods:
Retrospective propensity score pair matched cohort study. Groups were matched based on age < or ≥ 65 years and receipt of non-C. difficile antibiotics during hospitalization or within 6 months post-discharge. Recurrence rates were analyzed via logistic regression conditioned on matched pairs and reported as conditional odds ratios. The primary outcome was recurrence rates compared between standard vancomycin versus tapered vancomycin for treatment of initial CDI.
Results:
The CDI recurrence rate at 6 months was 5.3% (4/75) in the taper cohort versus 28% (21/75) in the standard vancomycin cohort. The median time to CDI recurrence was 115 days versus 20 days in the taper and standard vancomycin cohorts, respectively. When adjusted for matching, patients in the taper arm were less likely to experience CDI recurrence at 6 months when compared to standard vancomycin (cOR = 0.19, 95% CI 0.07–0.56, p < 0.002).
Conclusions:
Larger prospective trials are needed to elucidate the clinical utility of tapered oral vancomycin as a treatment option to achieve sustained clinical cure in first occurrences of CDI.
Using tools from computable analysis, we develop a notion of effectiveness for general dynamical systems as those group actions on arbitrary spaces that contain a computable representative in their topological conjugacy class. Most natural systems one can think of are effective in this sense, including some group rotations, affine actions on the torus and finitely presented algebraic actions. We show that for finitely generated and recursively presented groups, every effective dynamical system is the topological factor of a computable action on an effectively closed subset of the Cantor space. We then apply this result to extend the simulation results available in the literature beyond zero-dimensional spaces. In particular, we show that for a large class of groups, many of these natural actions are topological factors of subshifts of finite type.