Effect of Non-Markovian Collisions on Measured Integrated Line Shapes of CO.

Using cavity ring-down spectroscopy to probe R-branch transitions of CO in N_{2}, we show that the spectral core of the line shapes associated with the first few rotational quantum numbers, J, can be accurately modeled using a sophisticated line profile, provided that a pressure-dependent line area is introduced. This correction vanishes as J increases and is always negligible in CO-He mixtures. The results are supported by molecular dynamics simulations attributing the effect to non-Markovian behavior of collisions at short times. This work has large implications because corrections must be considered for accurate determinations of integrated line intensities, and for spectroscopic databases and radiative transfer codes used for climate predictions and remote sensing.

Characteristics of oocytes that failed to fertilize after intracytoplasmic sperm injection.

Background: We assessed the morphologies of meiotic spindles in oocytes that failed to fertilize following intracytoplasmic sperm injection (ICSI) and identified factors contributing to failed fertilization. Methods: A total of 225 unfertilized oocytes were collected after ICSI. Oocytes were fixed and stained for tubulin and chromosomes. Meiotic spindle morphologies, chromosome alignment, and sperm nuclear decondensation were assessed to identify contributing factors to fertilization failure. We identified relationships between several factors and both abnormal spindle morphologies and sperm nuclear decondensation in oocytes that failed to fertilize. Results: Three causes for unfertilized oocytes after ICSI were identified: (I) the absence of a sperm nucleus in the ooplasm; (II) failed oocyte activation; and (III) defects in pronucleus formation or migration. The rate of disarranged polar spindles in oocytes collected from women older than 35 years (73.3%; 33/45 oocytes) was significantly higher than that of those collected from women 35 years and younger (50.4%; 68/135 oocytes; odds ratio [OR]: 2.71, 95% confidence interval [CI]: 1.29-5.69, p = 0.009). The proportion of unfertilized oocytes with abnormal spindles and chromosome misalignment was significantly higher in oocytes collected from women older than 35 years than those from women 35 years and younger (62.2% vs. 41.5%, p = 0.016). The proportion of partially decondensed chromatin in the abnormal sperm morphology group was significantly higher than in the normal sperm morphology group (66.7% versus 52.9%, OR: 1.78, 95% CI: 1.01-3.11, p = 0.044). Conclusions: The main contributor to the failure of oocytes to fertilize after ICSI is failed oocyte activation. The ICSI technique used, the maternal age, and sperm morphology are also contributing factors in fertilization failure after ICSI.

Introduction of the Simple One-Step stool Xpert Ultra method to detect TB in children and adults.

SETTING: In 2020, the National TB Programme (NTP) of Vietnam conducted an implementation pilot of the Simple One-Step (SOS) stool processing method using Xpert® MTB/RIF Ultra (Ultra) among children and people living with HIV (PLHIV) with signs and symptoms of TB.DESIGN and OBJECTIVES: Using data from this pilot and collecting information on healthcare workers´ (HCWs) perceptions, we assessed the feasibility, acceptability and potential impact of routine stool testing for TB.RESULTS: HCWs perceived collection of stools from children as least stressful of all sample types, stool processing as acceptable and the SOS stool method as easy to perform. After a 3-month induction period, the proportion of initial non-determinate Ultra stool tests was less than 5%. Combined Ultra testing of a respiratory sample and stool resulted in an increase in the proportion of bacteriologically confirmed TB among PLHIV and children by respectively 4.1% (95% CI 1.6-6.6) and 3.9% (95% CI 1.6-6.2). Among children, Mycobacterium tuberculosis was more often detected in stool (26.1%) than in respiratory samples (23.4%) (P = 0.06), including one child with rifampicin resistance.CONCLUSION: Stool testing can be feasibly implemented both in adult PLHIV and in children in routine settings, providing a non-invasive alternative sample type for the diagnosis of TB for patients who cannot produce sputum.

Transforming medical education to strengthen the health professional training in Viet Nam: A case study.

The competency-based undergraduate curriculum reform at the University of Medicine and Pharmacy at Ho Chi Minh City, Faculty of Medicine (UMP-FM) is detailed and reviewed in reference to the instructional and institutional reforms, and enabling actions recommended by the Lancet 2010 Commission for Health Professional Education. Key objectives are to: revise the overall 6-year curriculum to be more integrated and competency-based; reinforce students' knowledge application, problem-solving, clinical competence, self-directed learning and soft skills; develop a comprehensive and performance-based student assessment programme; and establish a comprehensive quality monitoring programme to facilitate changes and improvements. New features include early introduction to the practice of medicine, family- and community-based medicine, professionalism, interprofessional education, electives experiences, and a scholarly project. Institutional reform introduces a faculty development programme, joint planning mechanism, a "culture of critical inquiry", and a transparent faculty reward system. Lessons learnt from the curriculum reform at UMP-FM could be helpful to medical schools from low- and middle-income countries considering transitioning from a traditional to a competency-based curriculum. Funding: This work receives no external funding.

Application of machine learning in screening for congenital heart diseases using fetal echocardiography.

There is a growing body of literature supporting the utilization of machine learning (ML) to improve diagnosis and prognosis tools of cardiovascular disease. The current study was to investigate the impact that the ML framework may have on the sensitivity of predicting the presence or absence of congenital heart disease (CHD) using fetal echocardiography. A comprehensive fetal echocardiogram including 2D cardiac chamber quantification, valvar assessments, assessment of great vessel morphology, and Doppler-derived blood flow interrogation was recorded. The postnatal echocardiogram was used to ascertain the diagnosis of CHD. A random forest (RF) algorithm with a nested tenfold cross-validation was used to train models for assessing the presence of CHD. The study population was derived from a database of 3910 singleton fetuses with maternal age of 28.8 ± 5.2 years and gestational age at the time of fetal echocardiography of 22.0 weeks (IQR 21-24). The proportion of CHD was 14.1% for the studied cohort confirmed by post-natal echocardiograms. Our proposed RF-based framework provided a sensitivity of 0.85, a specificity of 0.88, a positive predictive value of 0.55 and a negative predictive value of 0.97 to detect the CHD with the mean of mean ROC curves of 0.94 and the mean of mean PR curves of 0.84. Additionally, six first features, including cardiac axis, peak velocity of blood flow across the pulmonic valve, cardiothoracic ratio, pulmonary valvar annulus diameter, right ventricular end-diastolic diameter, and aortic valvar annulus diameter, are essential features that play crucial roles in adding more predictive values to the model in detecting patients with CHD. ML using RF can provide increased sensitivity in prenatal CHD screening with very good performance. The incorporation of ML algorithms into fetal echocardiography may further standardize the assessment for CHD.

Value of lipocalin 2 as a potential biomarker for bacterial meningitis.

OBJECTIVES: Central nervous system (CNS) infections are common causes of morbidity and mortality worldwide. We aimed to discover protein biomarkers that could rapidly and accurately identify the likely cause of the infections, essential for clinical management and improving outcome. METHODS: We applied liquid chromatography tandem mass spectrometry on 45 cerebrospinal fluid (CSF) samples from a cohort of adults with and without CNS infections to discover potential diagnostic biomarkers. We then validated the diagnostic performance of a selected biomarker candidate in an independent cohort of 364 consecutively treated adults with CNS infections admitted to a referral hospital in Vietnam. RESULTS: In the discovery cohort, we identified lipocalin 2 (LCN2) as a potential biomarker of bacterial meningitis (BM) other than tuberculous meningitis. The analysis of the validation cohort showed that LCN2 could discriminate BM from other CNS infections (including tuberculous meningitis, cryptococcal meningitis and virus/antibody-mediated encephalitis), with sensitivity of 0.88 (95% confident interval (CI), 0.77-0.94), specificity of 0.91 (95% CI, 0.88-0.94) and diagnostic odds ratio of 73.8 (95% CI, 31.8-171.4). LCN2 outperformed other CSF markers (leukocytes, glucose, protein and lactate) commonly used in routine care worldwide. The combination of LCN2, CSF leukocytes, glucose, protein and lactate resulted in the highest diagnostic performance for BM (area under the receiver operating characteristics curve, 0.96; 95% CI, 0.93-0.99). Data are available via ProteomeXchange with identifier PXD020510. CONCLUSIONS: LCN2 is a sensitive and specific biomarker for discriminating BM from a broad spectrum of other CNS infections. A prospective study is needed to assess the diagnostic utility of LCN2 in the diagnosis and management of CNS infections.

National tuberculosis patients cost survey: research findings lead to change in policy and practice, Viet Nam.

In 2016, the Viet Nam National Tuberculosis Programme (NTP) conducted the first national TB patients cost survey to identify the main cost drivers to help guide cost mitigation policies and reduce financial barriers to the treatment of TB patients. The survey findings were widely disseminated and the NTP defined a roadmap. The major components of the roadmap included 1) advocating for patients to be covered by social health insurance; 2) creating a charity fund for TB patients; 3) strengthening the collaboration between the Ministry of Health and Ministry of Labour and Social Affairs; and 4) advocating for donor support. The first national TB patients cost survey has shown that a high proportion of TB patients incurred costs that were classed as 'catastrophic'. The survey findings led to policy changes and new practices in Viet Nam.

En 2016, le Programme National de lutte contre la Tuberculose (PNT) du Viet Nam a mené la première enquête nationale sur les coûts des patients avec la tuberculose (TB) afin d'identifier les principaux inducteurs de coûts permettant d'orienter les politiques de réduction des coûts et de réduire les obstacles financiers des patients tuberculeux. Les résultats de l'enquête ont été largement diffusés et le PNT a défini une feuille de route. Les principales composantes de la feuille de route étaient les suivantes : 1) plaider pour que les patients soient couverts par une assurance maladie sociale ; 2) créer un fonds de charité pour les patients avec la TB; 3) renforcer la collaboration avec le ministère du Travail et des Affaires sociales ; et 4) plaider pour le soutien des donateurs. La première enquête nationale sur les coûts des patients tuberculeux a montré qu'une forte proportion des patients tuberculeux ont encouru des coûts catastrophiques. Les résultats de la recherche ont conduit à des changements de politiques et à de nouvelles pratiques au Viet Nam.

En el 2016, el Programa Nacional de Tuberculosis (PNT) de Viet Nam realizó la primera encuesta nacional sobre los costos que conlleva la tuberculosis (TB) para los pacientes a fin de definir los factores que los determinan, con el propósito de orientar las políticas de mitigación de costos y reducir los obstáculos económicos de los pacientes con TB. Se dio amplia difusión a los resultados de la encuesta y el PNT definió una hoja de ruta. Los principales componentes de la hoja de ruta incluían las siguientes medidas: 1) preconizar la cobertura de los pacientes por parte del seguro social de enfermedad; 2) crear una institución de beneficencia destinada a recaudar fondos para los pacientes con TB; 3) fortalecer la colaboración entre el Ministerio del Trabajo y el Ministerio de Asuntos Sociales; y 4) fomentar el respaldo de los donantes. La primera encuesta nacional sobre los costos sufragados por los pacientes con TB puso en evidencia que estos hacen frente a gastos catastróficos relacionados con la enfermedad. Los resultados de la investigación dieron lugar a modificaciones normativas y nuevas prácticas en Viet Nam.

Process measure of FAST tuberculosis infection control demonstrates delay in likely effective treatment.

SETTING: The tuberculous infection control strategy, FAST (Find cases Actively, Separate safely and Treat effectively), recommends prompt initiation of likely effective anti-tuberculosis treatment informed by Xpert® MTB/RIF results.OBJECTIVE: To describe FAST implementation at Quang Nam Provincial TB and Lung Disease Hospital (QNH), Tam Ky, Viet Nam, using time to initiation of effective TB treatment as a process measure. DESIGN: Hospital logs were used to calculate the time to likely effective treatment in patients with pulmonary TB (PTB) hospitalised during the study period. RESULTS: Between 1 January and 31 December 2016, of 858 patients treated for PTB, 493 (57.5%) received likely effective treatment. The median time to likely effective treatment was 3 days (interquartile range 2.0-6.0), with 213 (43.2%) patients receiving likely effective treatment within 2 days. Of 81 patients receiving likely effective treatment for drug-susceptible TB with a positive Xpert result as their initial in-patient diagnostic test, 64 (79.0%) received likely effective treatment within 2 days compared with 10 (5.7%) who were initially smear-negative then found to be Xpert-positive (P < 0.0001). CONCLUSIONS: A 'time to' process measure of the FAST tuberculous infection control strategy indicates delays in the initiation of likely effective anti-tuberculosis treatment in a resource-limited hospital. Expanding access to Xpert may speed time to likely effective treatment.

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000-2015.

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process-though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.

Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Hanoi, Vietnam.

BACKGROUND: Diabetes mellitus (DM) is recognized as an important comorbidity for the development of tuberculosis (TB). With the increase of DM burden globally, concerns have been raised about the emerging co-epidemics of DM and TB, especially in low- and middle-income countries. METHODS: A facility-based, cross-sectional study was carried out in all 30 district TB units in Hanoi, Vietnam. All eligible, diagnosed TB patients aged 15 years old or older were asked to provide consent and were screened for diabetes using fasting blood glucose (FBG). Pre-tested semi-structured questionnaires were used for collecting demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was done in accordance to parameters set by the American Diabetes Association (2016). RESULTS: Of 870 eligible TB patients, 831 (95.5%) participated in the study. Of those, 241 (29%; 95%CI: 25.9-32.1%) were prediabetic and 114 (13.7%; 95%CI: 11.4-16.1%) were found to have DM. The risk of DM was higher in patients belonging to the age group 40-64 years (OR 6.09; 95%CI 2.81-13.2); or the age group 65 years or older (OR 2.65; 95%CI 1.65-4.25) or who have a family history of DM (OR 2.71; 95%CI 1.33-5.50). CONCLUSIONS: This study demonstrated high prevalence of DM and prediabetes among TB patients in Hanoi, Vietnam. National Tuberculosis Programme needs to establish a systematic screening process for DM among TB patients.

Measuring catastrophic costs due to tuberculosis in Viet Nam.

INTRODUCTION: Progress towards ending tuberculosis (TB) in Viet Nam includes monitoring the costs borne by patients through periodic facility-based surveys. OBJECTIVE: To document the magnitude of costs incurred by TB-affected households and establish a baseline for the top End TB indicator in Viet Nam. METHODS: A national survey with retrospective data collection and projection among 735 participants in 20 stratified clusters was conducted in 2016. Each patient was interviewed on costs, time loss, coping measures and asset ownership. Total costs were expressed as a proportion of annual household income. RESULTS: In Viet Nam, 63% of households affected by TB or multidrug-resistant TB (MDR-TB) experienced costs that were >20% of their annual household income. The mean patient costs were respectively US$1054 and US$4302 per episode of TB and MDR-TB. The most significant drivers of mean costs were income loss reported and purchase of special foods, nutritional supplements, travel and accommodation. CONCLUSION: The proportion of households experiencing catastrophic total costs due to TB in Viet Nam is high, which poses a barrier to TB diagnosis and treatment. Based on study results, programme and partners need to identify key areas for policy action and work towards a national policy guide on intervention to reduce TB patient costs.

Economic burden of multidrug-resistant tuberculosis: a multicenter study across Vietnamese regions.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) has become a major worldwide health problem. Various studies have been conducted on the cost of MDR-TB treatment; however, this has remained largely unexplored in Viet Nam. OBJECTIVE: To estimate the total cost of MDR-TB treatment at several health care facilities in Viet Nam. DESIGN: A prospective, prevalence-based study was conducted at three selected centers from March to June 2016 in 204 patients, 102 of whom were treated for 9 months and 102 for 20 months. Direct medical costs were calculated using electronic hospital databases, while a questionnaire was used to interview participants for evaluating direct non-medical and indirect costs. Total costs were estimated from a societal perspective in 2017 USD. RESULTS: Patients were mostly males aged 25-44 years. The average length of hospitalization in the 9-month treatment group was 168 ± 127 days; in the 20-month group, it was 671 ± 119 days. The average treatment cost for MDR-TB was respectively US$1480.34 ± 211.61 and US$2695.58 ± 294.98 for the 9- and 20-month treatment groups. Direct medical costs generally accounted for the highest proportion of the total costs, while the cost of pharmaceuticals and materials comprised the highest direct cost. CONCLUSION: There was a significant difference in total costs among the three hospitals in the 9- and 20-month treatment groups.

Hydrolysis Activity of Virgin Coconut Oil Using Lipase from Different Sources.

Two types of lipase, Candida rugosa lipase (CRL) and porcine pancreas lipase (PPL), were used to hydrolyze virgin coconut oil (VCO). The hydrolysis process was carried out under four parameters, VCO to buffer ratio, lipase concentration, pH, and temperature, which have a significant effect on hydrolysis of lipase. CRL obtained the best hydrolysis condition at 1 : 5 of VCO to buffer ratio, 1.5% of CRL concentration, pH 7, and temperature of 40°C. Meanwhile, PPL gave different results at 1 : 4 of VCO to buffer ratio, 2% of lipase concentration, pH 7.5, and 40°C. The highest hydrolysis degree of CRL and PPL was obtained after 16 hours and 26 hours, reaching 79.64% and 27.94%, respectively. Besides, the hydrolysis process was controlled at different time course (every half an hour) at the first 4 hours of reaction to compare the initial hydrolysis degree of these two lipase types. FFAs from hydrolyzed products were isolated and determined the percentage of each fatty acid which contributes to the FFAs mixture. As a result, medium chain fatty acids (MCFAs) made up the main contribution in composition of FFAs and lauric acid (C12) was the largest segment (47.23% for CRL and 44.23% for PPL).

Youth Disclosure of Sexual Orientation to Siblings and Extended Family.

OBJECTIVE: To explore the processes and experiences associated with disclosing sexual orientation to siblings and extended family. BACKGROUND: Few studies prioritize the experience of disclosing to siblings and extended family, despite its frequency and potential impact on the family unit. Extended family members often act as sources of support for youth; it is therefore worthwhile to consider whether this remains true during and after disclosure of sexual orientation. METHOD: Interview and questionnaire data were gathered from 22 lesbian, gay, bisexual, and queer (LGBQ) youth, 14 to 21 years of age, from a large Midwestern city. Constructivist grounded theory informed the qualitative methodology and data analysis. We build on concepts of horizontal and vertical family relationships by also introducing the concept of diagonal relationships. RESULTS: Participants described their relationships with aunts as possessing characteristics of horizontal and vertical relationships, allowing them to act as moderators and mediators of the parent-child relationship. CONCLUSION: The concepts of vertical, horizontal, and diagonal relationships take into consideration how the structure (e.g., hierarchy, egalitarianism, boundaries) and nature (e.g., closeness, reciprocity, mentorship) of various relationships shape the coming-out process for LGBQ youth, without dismissing the importance of either immediate or extended family members. IMPLICATIONS: The emerging conceptualization can guide services and interventions as well as illuminate further research on the family systems of LGBQ youth.

Prevalence of latent tuberculous infection among adults in the general population of Ca Mau, Viet Nam.

SETTING: The study was conducted in a randomly selected sample of persons aged 15 years living in Ca Mau Province, southern Viet Nam. OBJECTIVE: To estimate the prevalence of latent tuberculous infection (LTBI) in the general adult population of this province of Viet Nam. The secondary objective was to examine age and sex differences in prevalence. DESIGN: A cross-sectional survey was conducted in a cluster-random sample of the population. Clusters were subcommunes. The presence of LTBI was assessed using the QuantiFERON®-TB Gold In-Tube test system. RESULTS: QuantiFERON tests were performed among 1319 persons aged 15 years (77.7% of those selected). The overall prevalence of positive tests was 36.8% (95%CI 33.4-40.3). The prevalence of a positive test was lower in females than in males (31.0% vs. 44.7%, OR 0.57, 95%CI 0.45-0.72, P < 0.0001). The prevalence of positive tests increased with increasing age quintile (P < 0.0001). CONCLUSION: More than one third of the general adult population in a province in southern Viet Nam have evidence of LTBI. Although LTBI prevalence is higher in males, the sex difference is not as great as that for TB notification rates.

Challenges and Strategies of Sexual Minority Youth Research in Southwest Virginia.

A research team that works on scholarship related to sexual minority issues has been conducting research and recruiting participants since the fall of 2012. In the years since the team was formed, there has been a variety of challenges with recruitment, approval for research through the Institutional Review Board, gaining access to the lesbian, gay, bisexual, and queer (LGBQ) community, and general mistrust of researchers. Using concepts from feminist-informed qualitative research methodology-including reflexivity, positionality, and engaging in research with individuals from marginalized communities-we present reflections on some of the methodological challenges the research team has encountered while trying to conduct LGBQ research in southwest Virginia. This article encompasses the viewpoints of multiple members of the research team, including those who are faculty, graduate students, and undergraduate students with identities across the sexual orientation spectrum.

Latent tuberculous infection in household contacts of multidrug-resistant and newly diagnosed tuberculosis.

BACKGROUND: Differences in the prevalence of latent tuberculous infection (LTBI) and tuberculosis (TB) disease among contacts of patients with multidrug-resistant TB (MDR-TB) and drug-susceptible TB are not well understood. OBJECTIVE: To compare the prevalence of tuberculin skin test (TST) positivity in household contacts of patients with MDR-TB and in contacts of patients never previously treated for TB ('new TB'). DESIGN: Consecutive patients with MDR-TB and their household contacts at nine urban district clinics in Viet Nam were screened for TB and LTBI, and followed up for 6 months. LTBI was defined as a TST result of at least 10 mm. RESULTS: A total of 167 patients with TB and their 337 household contacts were recruited. A total of 167/180 (25.8%) contacts of new TB patients and 60/147 (40.8%) contacts of MDR-TB patients were TST-positive (odds ratio [OR] 2.0, 95%CI 1.3-3.2). Contacts of MDR-TB patients were more likely to have baseline chest radiograph findings consistent with TB (OR 2.6, 95%CI 1.4-5.0). CONCLUSION: Contacts of MDR-TB patients have a high risk of developing TB. Measures to reduce Mycobacterium tuberculosis transmission and accelerate the detection of disease among high-risk contacts should be prioritised to curb the MDR-TB epidemic.

Non-Typhoidal Salmonella Colonization in Chickens and Humans in the Mekong Delta of Vietnam.

Salmonellosis is a public health concern in both the developed and developing countries. Although the majority of human non-typhoidal Salmonella enterica (NTS) cases are the result of foodborne infections or person-to-person transmission, NTS infections may also be acquired by environmental and occupational exposure to animals. While a considerable number of studies have investigated the presence of NTS in farm animals and meat/carcasses, very few studies have investigated the risk of NTS colonization in humans as a result of direct animal exposure. We investigated asymptomatic NTS colonization in 204 backyard chicken farms, 204 farmers and 306 matched individuals not exposed to chicken farming, in southern Vietnam. Pooled chicken faeces, collected using boot or handheld swabs on backyard chicken farms, and rectal swabs from human participants were tested. NTS colonization prevalence was 45.6%, 4.4% and 2.6% for chicken farms, farmers and unexposed individuals, respectively. Our study observed a higher prevalence of NTS colonization among chicken farmers (4.4%) compared with age-, sex- and location- matched rural and urban individuals not exposed to chickens (2.9% and 2.0%). A total of 164 chicken NTS strains and 17 human NTS strains were isolated, and 28 serovars were identified. Salmonella Weltevreden was the predominant serovar in both chickens and humans. NTS isolates showed resistance (20-40%) against tetracycline, chloramphenicol, sulfamethoxazole-trimethoprim and ampicillin. Our study reflects the epidemiology of NTS colonization in chickens and humans in the Mekong delta of Vietnam and emphasizes the need of larger, preferably longitudinal studies to study the transmission dynamics of NTS between and within animal and human host populations.