Does the effect of adolescent health behaviours on adult cardiometabolic health differ by socioeconomic background? Protocol for a population-based cohort study.

INTRODUCTION: Adolescence is a sensitive period for cardiometabolic health. Yet, it remains unknown if adolescent health behaviours, such as alcohol use, smoking, diet and physical activity, have differential effects across socioeconomic strata. Adopting a life-course perspective and a causal inference framework, we aim to assess whether the effects of adolescent health behaviours on adult cardiometabolic health differ by levels of neighbourhood deprivation, parental education and occupational class. Gaining a better understanding of these social disparities in susceptibility to health behaviours can inform policy initiatives that aim to improve population health and reduce socioeconomic inequalities in cardiometabolic health. METHODS AND ANALYSIS: We will conduct a secondary analysis of the Young Finns Study, which is a longitudinal population-based cohort study. We will use measures of health behaviours-smoking, alcohol use, fruit and vegetable consumption, and physical activity-as exposure and parental education, occupational class and neighbourhood deprivation as effect modifiers during adolescence (ages 12-18 years). Eight biomarkers of cardiometabolic health (outcomes)-waist circumference, body mass index, blood pressure, low-density lipoprotein cholesterol, apolipoprotein B, plasma glucose and insulin resistance-will be measured when participants were aged 33-40. A descriptive analysis will investigate the clustering of health behaviours. Informed by this, we will conduct a causal analysis to estimate effects of single or clustered adolescent health behaviours on cardiometabolic health conditional on socioeconomic background. This analysis will be based on a causal model implemented via a directed acyclic graph and inverse probability-weighted marginal structural models to estimate effect modification. ETHICS AND DISSEMINATION: The Young Finns study was conducted according to the guidelines of the Declaration of Helsinki, and the protocol was approved by ethics committees of University of Helsinki, Kuopio, Oulu, Tampere and Turku. We will disseminate findings at international conferences and a manuscript in an open-access peer-reviewed journal.

Perioperative Management of Parturient Women With Severe Pulmonary Arterial Hypertension Secondary to Atrial Septal Defect.

At our institution, we occasionally see pregnant patients in the later stages of pregnancy who present with severe pulmonary arterial hypertension caused by congenital heart disease. The physiological changes in pregnancy may worsen the cardiovascular status leading to heart failure which is associated with a high incidence of morbidity and mortality. A scheduled caesarean section in such patients ensures delivery in a controlled environment, avoiding prolonged labour, which is detrimental. Perioperative complications that may worsen pulmonary arterial hypertension should be prevented. The perioperative management, in particular, the anaesthesia technique used and the clinical outcome of this population, is discussed through five interesting cases. Despite a multidisciplinary team and intensive care management, two patients with existing cor pulmonale, one of whom received general and the other central neural blockade anaesthesia, succumbed to their illness immediately after lower segment caesarean section. The management of severe pulmonary arterial hypertension in pregnant patients remains a multidisciplinary challenge among participating physicians. Thorough perioperative preparation encompassing monitoring, medical therapy, timing and mode of delivery, and risk consultation is vital in avoiding circumstances that could exacerbate pulmonary arterial hypertension, with physicians readily equipped to promptly detect and manage any untoward event.

Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland.

Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic. Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression. Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019]. Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized.

Performance of Point-of-Care Ultrasonography in Confirming Feeding Tube Placement in Mechanically Ventilated Patients.

BACKGROUND: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). METHOD: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. RESULTS: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients' CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). CONCLUSION: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients.

Factors Associated With COVID-19 Non-Vaccination in Switzerland: A Nationwide Study.

Objectives: We compared socio-demographic characteristics, health-related variables, vaccination-related beliefs and attitudes, vaccination acceptance, and personality traits of individuals who vaccinated against COVID-19 and who did not vaccinate by December 2021. Methods: This cross-sectional study used data of 10,642 adult participants from the Corona Immunitas eCohort, an age-stratified random sample of the population of several cantons in Switzerland. We used multivariable logistic regression models to explore associations of vaccination status with socio-demographic, health, and behavioral factors. Results: Non-vaccinated individuals represented 12.4% of the sample. Compared to vaccinated individuals, non-vaccinated individuals were more likely to be younger, healthier, employed, have lower income, not worried about their health, have previously tested positive for SARS-CoV-2 infection, express lower vaccination acceptance, and/or report higher conscientiousness. Among non-vaccinated individuals, 19.9% and 21.3% had low confidence in the safety and effectiveness of SARS-CoV-2 vaccine, respectively. However, 29.1% and 26.7% of individuals with concerns about vaccine effectiveness and side effects at baseline, respectively vaccinated during the study period. Conclusion: In addition to known socio-demographic and health-related factors, non-vaccination was associated with concerns regarding vaccine safety and effectiveness.

Growth-control of hexagonal CdS-decorated ZnO nanorod arrays with low-temperature preheating treatment for improved properties and efficient photoelectrochemical applications.

The limitations of oxide semiconductor-based solar cells in achieving high energy conversion efficiencies have prompted incessant research efforts towards the creation of efficient heterostructures. Despite its toxicity, no other semiconducting material can fully replace CdS as a versatile visible light-absorbing sensitizer. Herein, we explore the aptness of preheating treatment in the successive ionic layer adsorption and reaction (SILAR) deposition technique and improve the understanding of the principle and the effects of a controlled growth environment on thus-formed CdS thin films. Single hexagonal phases of nanostructured cadmium sulfide (CdS)-sensitized zinc oxide nanorods arrays (ZnO NRs) have been developed without the support of any complexing agent. The influences of film thickness, cationic solution pH and post-thermal treatment temperature on the characteristics of binary photoelectrodes have been investigated experimentally. Interestingly, the preheating-assisted deposition of CdS, which is rarely applied for the SILAR technique, resulted in improved photoelectrochemical performance similar to the post-annealing effect. The X-ray diffraction pattern revealed that optimized ZnO/CdS thin films were polycrystalline with high crystallinity. Examination of the morphology of the fabricated films via field emission scanning electron microscopy showed that film thickness and medium pH altered the growth mechanism of nanoparticles, thereby changing their particle sizes, which had a significant influence on the film's optical behavior. The effectiveness of CdS as a photosensitizer and the band edge alignment for ZnO/CdS heterostructures were evaluated using ultra-violet visible spectroscopy. Facile electron transfer in the binary system as evidenced in electrochemical impedance spectroscopy Nyquist plots, therefore, promotes higher photoelectrochemical efficiencies from 0.40% to 4.30% under visible light illumination as compared with the pristine ZnO NRs photoanode.

Intraoperative phenylephrine infusion to reduce perioperative shivering in lower segment caesarean section: A randomised controlled study.

BACKGROUND: Shivering is described as an involuntary, repetitive activity of the skeletal muscles that can have deleterious effects on anaesthetized patients. This study aimed to evaluate the effectiveness of phenylephrine infusion in preventing perioperative shivering in patients undergoing lower segment cesarean section under spinal anesthesia and to observe the change in the patient's core temperature between the study and control groups. METHODS: A total of 118 patients scheduled for elective lower segment cesarean section under spinal anesthesia were recruited for this prospective, double-blind, randomized controlled study. The patients were randomized into 2 groups with 59 patients per group. The phenylephrine Group received phenylephrine infusion at a rate of 0.5 mcg/kg/minutes, while the Control Group received normal saline at an equivalent rate. Systolic and diastolic blood pressure, heart rate, core temperature, and the presence and intensity of shivering were recorded before induction and every 15 minutes intraoperatively and postoperatively. RESULTS: The incidence of intraoperative shivering was significantly lower in the Phenylephrine Group compared to control group (29.1% vs 47.5% respectively; P = .044). Postoperatively, the Phenylephrine Group also had a lower incidence of shivering (34.5% vs 42.4%), but the difference was not statistically significant (P value = 0.391). There were no significant differences in the intensity of shivering between the 2 groups perioperatively, as well as in the systolic and diastolic blood pressure and core temperature. The phenylephrine Group showed a significantly lower heart rate at 15, 30, and 45 minutes after spinal block (P value = .005, .000, and .008, respectively), and at 0 and 30 minutes (P value = .004 and .020 respectively) in the recovery room. There were no significant differences in perioperative adverse events such as hypotension, hypertension, and bradycardia. CONCLUSION: Phenylephrine infusion reduces the incidence of perioperative shivering in lower segment cesarean sections under spinal anesthesia.

Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial.

BACKGROUND: The serratus plane block is an effective technique for providing analgesia to patients undergoing breast surgery. METHODS: This prospective, double-blind, randomized study enrolled 60 female patients scheduled for unilateral mastectomy and axillary clearance. The patients received either a superficial serratus plane block or deep serratus plane block. Dermatomal spread was recorded 30 minutes after block administration. Postoperatively, pain visual analog scale (VAS) scores were documented at recovery (time 0), at 30 minutes; and in the ward hourly for 4 hours, and 4-hourly until 24 hours postoperatively. The time to first analgesic rescue and cumulative morphine consumption using patient-controlled analgesia morphine (PCAM) were recorded. RESULTS: The results showed lower VAS scores at rest (at 1, 2, 3, and 4 hours postoperatively), and during movement (at 1, 2, 3, 4, 8, and 24 hours postoperatively) in the superficial serratus plane block group, P < .005. Similarly, cumulative morphine usage was lower in the superficial serratus plane group, P < .005. The time to the first rescue analgesic was also significantly longer in the superficial group, P < .001. More patients in the superficial serratus plane group achieved greater dermatomal spread at T2 and T7 than those in the deep group. CONCLUSIONS: Superficial serratus plane block provides better analgesic efficacy than deep serratus plane block in mastectomy and axillary clearance.

Microporous activated carbon developed from KOH activated biomass waste: surface mechanistic study of methylene blue dye adsorption.

In this work, sugarcane bagasse waste (SBW) was used as a lignocellulosic precursor to develop a high-surface-area activated carbon (AC) by thermal treatment of the SBW impregnated with KOH. This SBW activated carbon (SBWAC) was characterized by crystallinity, porosity, surface morphology and functional groups availability. The SBWAC exhibited Type I isotherm which corresponds to microporosity with high specific surface area of 709.3 m2/g and 6.6 nm of mean pore diameter. Further application of SBWAC as an adsorbent for methylene blue (MB) dye removal demonstrated that the adsorption process closely followed the pseudo-second order kinetic and Freundlich isotherm models. Conversely, a thermodynamic study revealed the endothermic nature and spontaneity of MB dye adsorption on SBWAC with high acquired adsorption capacity (136.5 mg/g). The MB dye adsorption onto SBWAC possibly involved electrostatic interaction, H-bonding and π-π interaction. This work demonstrates SBW as a potential lignocellulosic precursor to produce high-surface-area AC that can potentially remove more cationic dyes from the aqueous environment.

Enhanced capacitive performance of cathodically reduced titania nanotubes pulsed deposited with Mn2O3 as supercapacitor electrode.

A facile and simple pulse electrodeposition method was employed to deposit Mn2O3 nanoparticles on cathodically reduced titania nanotubes (R-TNTs) at different deposition time in the range of 3-15 min to investigate the influence of mass loading of Mn2O3 on the electrochemical performance of Mn2O3/R-TNTs nanocomposite for supercapacitor application. Mn2O3 nanoparticles were deposited on circumference of R-TNTs as well as in the nanotubes as revealed by FESEM images for all the deposited time. XPS result confirmed the presence of MnO2 (Mn4+) and MnO (Mn2+) on the Mn2O3/R-TNTs composite which provide pseudocapacitive behaviour for the electrode. Mass loading of Mn2O3 increased linearly with deposition time as confirmed by EDX analysis. The sample deposited for 12 min exhibits the highest areal capacitance of 51 mF cm-2 (which is 22 times enhancement over R-TNTs) at a current density of 0.1 mA cm-2 and specific capacitance of 325 F g-1 at 6 A g-1. The sample also show a high-rate capability by retaining 80% of its capacitance even at higher current density of 30 A g-1. Interestingly, it retained 98% of the capacitance over 5000 charge discharge cycles at 10 A g-1 after initial drop to 95% at 200th cycles suggesting an excellent long-term chemical stability. A considerably low equivalent series resistance (ESR) and charge transfer resistance (R ct) of 9.6 Ω and 0.4 Ω respectively was deduced from electrochemical impedance spectroscopy (EIS) analysis indicating good conductivity and improved charge transfer efficiency of Mn2O3/R-TNTs nanocomposite.

Enhanced decolourization of methyl orange by immobilized TiO2/chitosan-montmorillonite.

Many attempts have been made to improve the photocatalytic performance of immobilized photocatalysts for large-scale applications by modification of the photocatalyst properties. In this work, immobilized bilayer photocatalyst composed of titanium dioxide (TiO2) and chitosan-montmorillonite (CS-MT) were prepared in a layer-by-layer arrangement supported on glass substrate. This arrangement allows a simultaneous occurrence of adsorption and photocatalysis processes of pollutants, whereby each layer could be independently modified and controlled to acquire the desired degree of occurring processes. It was found that the addition of MT clay within the CS composite sub-layer improved the mechanical strength of CS, reduced its swelling and shifted its absorption threshold to higher wavelengths. In addition, the band gap energy of the photocatalyst was also reduced to 2.93 eV. The immobilized TiO2/CS-MT exhibited methyl orange (MO) decolourization rate of 0.071 min-1 under light irradiation, which is better than the single TiO2 due to the synergistic processes of adsorption by CS-MT and photocatalysis by TiO2 layer. The MO dye took 6 h to achieve complete mineralization and produced sulfate and nitrate ions as the by-products. Furthermore, the immobilized TiO2/CS-MT could be reused for at least ten cycles of application without significant loss of its activity.

Comparison of various culture media effectiveness in the isolation of bacteria from Pekan peat swamp forest soil

Aims: Previously described as non-favorable-microbial habitat, peat swamp forest has its own features, which are extremely acidic, poor in nutrient, water-logged and anoxic environment where rate of decomposition of plant litters is quiet slow. Interestingly, current research has proven that there is diversity of microbial communities in this ecosystem. The main objective of this study is to isolate bacteria from Pekan peat swamp forest soil that play a role in the decomposition of plant litters through cultivation on different agar-based medium. The success of isolation of bacteria from this neglected habitat could open the opportunity in unleashing the specific role of bacteria in peat swamp plant litter degradation as well as potential biotechnological application of these bacteria in lignocellulose-related industry. Methodology and results: To mimic the peat condition that is low in nutrient and comprised of plant debris, M1 and peat agar supplemented with cellulose, glucose, lignin and xylan were used. Specifically, for the isolation of actinomycetes, dry and wet heat pre-treatments were applied to the soil samples. Then, the samples were cultivated on three different agars which were oatmeal agar as well as M1 and peat agar supplemented with glucose. Enrichment method was applied in the isolation of cellulase-producing bacteria. It was found that higher number of bacteria and actinomycetes were successfully isolated from peat agar, followed by oatmeal agar and M1. In fact, more actinomycetes were isolated from soil that was treated with wet heat pre-treatment compared to dry heat pre-treatment and on peat agar compared to M1 and oatmeal agar. This finding is promising, indicating that the application of peat water in the agar-based medium is useful to mimic the actual environment of peat swamp and increase the possibility to isolate indigenous bacteria. Primary screening of isolates from samples enriched with carboxymethyl cellulose (CMC) showed positive result of decolourisation zone on Azo-CM-Cellulose agar indicating the ability of isolates to degrade cellulose compound. Conclusions, significance and impacts of study: The study indicates the effectiveness of different culture media in successful isolation of bacteria including actinomycetes. Using the enrichment method, bacteria that are able to degrade cellulose compound was successfully isolated even though it is well known that plant litter degradation in the peat swamp environment happens at very slow rates.