Employment preferences of obstetricians and gynecologists to work in the district hospitals: evidence from a discrete choice experiment in Nepal.

BACKGROUND: A mismatch between the requirement and annual production of obstetricians and gynecologists (OBs-GYNs) was observed in Nepal. On top of that, recruitment and retention of OBs-GYNs is a pressing problem, especially in district hospitals of Nepal. In this connection, evidence on the job priorities and preferences of OBs-GYNs, which is currently lacking in Nepal, would help in policymakers in devising recruitment and retention strategies in these hospitals. This study, therefore, aims at exploring the most relevant job attributes that OBs-GYNs would prefer to work in the district hospitals of Nepal using a discrete choice experiment (DCE) technique. METHODS: Job attributes relevant to design the questionnaire were identified using keyinformant interviews and focusgroup discussions with policymakers and top managers. Then, 48 choice sets were developed using a fractional factorial design. Using these unlabeled choice sets, a DCE was conducted among 189 OBs-GYNs. The multinomial logistic regression model was used to estimate the marginal utilities and other model parameters. The willingness to pay/accept estimates was also measured for each job attribute. RESULTS: OBs-GYNs preferred the presence of a full team at the workplace (OB-GYN, pediatrician, and anesthesiologist), provision of primary and secondary education for children, and opportunity of private practice. On the other hand, a few job attributes such as a higher duration of service in district hospitalsand the provisions of a car allowance were preferred less by the respondents. Results from the marginal utility by the OBs-GYNs would be open to trade among the attributes. CONCLUSIONS: The job attributes identified as incentives in this study should be included in a package to attract OBs-GYNs to serve in district hospitals of Nepal rather than offering a standard incentive package to all health workers. Similarly, this study confirmed the importance of the combination of non-monetary and monetary interventions in attracting and retaining health workers in district hospitals of Nepal.

MAL2 promotes proliferation, migration, and invasion through regulating epithelial-mesenchymal transition in breast cancer cell lines.

BACKGROUND: Breast cancer is one of the most common malignant tumors in women. However, the underlying molecular mechanisms of breast cancer are still far to clear. With the development of sequencing technology, we discovered that MAL2 is overexpressed in tumor tissues. But the major function of MAL2 in breast cancer has not to be well confirmed. MATERIALS AND METHODS: We downloaded and analyzed the MAL2 expression in The Cancer Genome Atlas (TCGA) database. Real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to detect the expression of MAL2 in 35 breast cancer patients. Then, we performed proliferation, colony formation, migration, invasion and western blot assays to investigate the role of MAL2 in breast cancer cell lines (MDA-MB-231 and BT-549). RESULTS: In our research, we found that MAL2 is remarkably overexpressed in breast cancer tissues compared to adjacent non-cancer tissues by RT-qPCR (T: N = 5.28 ±â€¯4.34:1.82 ±â€¯1.11, P < 0.001) and high expression of MAL2 has worse overall survival in TCGA cohort (P = 0.0032). Knocked down MAL2 could decrease the ability of proliferation, migration, and invasion of breast cancer cell lines. Our Western Blot assay results investigated that MAL2 could regulate EMT. CONCLUSION: In this study, we demonstrated the function of MAL2 in breast cancer cell lines and it might act as an oncogene in breast cancer.

Mayer-Rokitansky-Kuster-Hauser Syndrome: A rare case report from Nepal.

Introduction: Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) is a rare congenital disorder with an incidence of 1 in 5000 females. It is characterized by uterovaginal aplasia with normal secondary sexual characteristics and genetic karyotype 46XX. The exact etiology of MRKH syndrome is not known. Case presentation: We report a case of type 2 MRKHS with agenesis of left kidney. Discussion: The diagnosis of MRKH mainly depends on imaging study. Transabdominal ultrasonography is the first line investigation but abdomino-pelvic MRI gives more precise and clear information than the prior. So, we suggested our patient to do MRI even though she had done ultrasonography earlier. The differential diagnosis includes congenital vaginal agenesis, low transverse vaginal septum, androgen insensitivity, and imperforate hymen. Conclusion: This case presents that MRKH syndrome can occur with normal endocrine function and secondary sexual characteristics. Surgical correction by creating a neovagina is a good treatment method in young females for sexual intercourse.

A Semi-Empirical Deflection-Based Method for Crack Width Prediction in Accelerated Construction of Steel Fibrous High-Performance Composite Small Box Girder.

Accelerated construction in the form of steel⁻concrete composite beams is among the most efficient methods to construct highway bridges. One of the main problems with this type of composite structures, which has not yet been fully clarified in the case of continuous beam, is the crack zone initiation that gradually expands through the beam width. In the current study, a semi-empirical model was proposed to predict the size of cracks in terms of small box girder deflection and intensity of load applied on the structure. To this end, a set of steel⁻concrete composite small box girders were constructed by the use of steel fibrous concrete and experimentally tested under different caseloads. The results were then used to create a dataset of the box girder response in terms of beam deflection and crack width. The obtained dataset was then utilized to develop a simplified formula providing the maximum width of cracks. The results showed that the cracks initiated in the hogging moment region when the load exceeded 80 kN. Additionally, it was observed that the maximum cracked zone occurred in the center of the beam due to the maximum negative moment. Moreover, the crack width of the box girder at different loading cases was compared with the test results obtained from the literature. A good agreement has been found between the proposed model and experiment results.

Experimental Investigation of a Slip in High-Performance Steel-Concrete Small Box Girder with Different Combinations of Group Studs.

Due to the significant advantages of steel-concrete composite beams, they are widely used for accelerated bridge construction (ABC). However, there is still a lack of experimental research on the proper design of ABC, especially in the slip with a different group of shear connectors. As a component of steel-concrete composite structure, shear studs play a vital role in the performance of composite structures. This paper investigates the influence of group studs in simply supported and continuous box girders. To this end, three sets of simply supported steel-concrete composite small box girders and two continuous steel-concrete composite small box girders were made with different groups of shear studs, and the slip generated along the beams was recorded under different caseloads. The results were then compared with the proposed simplified equations. The results show that the slip value of the test beam is inversely proportional to the degree of shear connection. The slip of Simply Supported Prefabricated Beam-3 (SPB3) is 1.247 times more than Simply Supported Prefabricated Beam-1 (SPB1), and 2.023 times more than Simply Supported Prifabricated Beam-2 (SPB2). Also, the slip value of Experimental Continuous Beam-1 (ECB1) is 1.952 times more than Experimental Continuous Beam-2 (ECB2). The higher the degree of shear connection, the smaller the maximum slip value.

Analysis clinical features of COVID-19 infection in secondary epidemic area and report potential biomarkers in evaluation

ObjectiveBased on the clinical characteristics of infected patients with novel coronavirus in secondary epidemic areas, we aimed to identify potential biomarkers for the evaluation of novel coronavirus-infected patients, guide the diagnosis and treatment of this disease in secondary epidemic areas and provide a reference for the clinical prevention and control of this epidemic situation. MethodsThe clinical data of 33 patients with respiratory symptoms caused by the novel coronavirus in Wenzhou city from January 15 to February 12, 2020, were thoroughly reviewed. At the onset of the disease, we found that the primary symptoms were fever, cough, fatigue, chest tightness, chest pain and specific blood test results. According to the patients histories, the patients were divided into two groups: those who spent time in the main epidemic area and those who did not spend time in the main epidemic area. The differences in the clinical manifestations between these two groups were analyzed. ResultsThe main clinical symptoms of patients infected with novel coronavirus in the secondary epidemic area were respiratory tract ailments and systemic symptoms. After grouping patients based on the presence or absence of residency in or travel history to the main epidemic area, there was no significant difference between the baseline data of these two groups, and there were no significant differences in symptoms and signs between the two groups (P>0.05). Some patients had abnormally increased serum amyloid protein A (SAA). There were statistically significant differences in the leukocyte count/C-reactive protein, monocyte ratio/C-reactive protein, neutrophil count/C-reactive protein, monocyte count/C-reactive protein and hemoglobin/C-reactive protein values between the two groups (P < 0.05). ConclusionRespiratory tract ailments and systemic symptoms were the primary symptoms of novel coronavirus infection in the secondary epidemic area; these symptoms are not typical. The abnormal increase in serum amyloid protein (SAA) may be used as an auxiliary index for diagnosis and treatment. CRP changes before other blood parameters and thus may be an effective evaluation index for patients with COVID-19 infection.

Comparison of severe and non-severe COVID-19 pneumonia: review and meta-analysis

ObjectiveTo compare the difference between severe and non-severe COVID-19 pneumonia and figure out the potential symptoms lead to severity. MethodsArticles from PubMed, Embase, Cochrane database, and google up-to 24 February 2020 were systematically reviewed. Eighteen Literatures were identified with cases of COVID-19 pneumonia. The extracted data includes clinical symptoms, age, gender, sample size and region et al were systematic reviewed and meta analyzed. Results14 eligible studies including 1,424 patients were analyzed. Symptoms like fever (89.2%), cough (67.2%), fatigue (43.6%) were common, dizziness, hemoptysis, abdominal pain and conjunctival congestion/conjunctivitis were rare. Polypnea/dyspnea in severe patients were significantly higher than non-severe (42.7% vs.16.3%, P<0.0001). Fever and diarrhea were higher in severe patients(p=0.0374and0.0267). Further meta-analysis showed incidence of fever(OR1.70,95%CI 1.01-2.87), polypnea/dyspnea(OR3.53, 95%CI 1.95-6.38) and diarrhea(OR1.80,95%CI 1.06-3.03) was higher in severe patients, which meant the severe risk of patients with fever, polypnea/dyspnea, diarrhea were 1.70, 3.53, 1.80 times higher than those with no corresponding symptoms. ConclusionsFever, cough and fatigue are common symptoms in COVID-19 pneumonia. Compared with non-severe patients, the symptoms as fever, polypnea/dyspnea and diarrhea are potential symptoms lead to severity.