Spatial variations and determinants of optimal antenatal care service utilisation in Ethiopia: spatial and survey regression analysis.

OBJECTIVES: Optimal antenatal care (ANC) services are the main strategy to reduce maternal and newborn mortality. Understanding the geographic variation of ANC service utilisation is essential for regional- and local-level interventions. However, data on spatial variation of optimal ANC service utilisation are limited. Hence, this study aimed to investigate the spatial variations and determinants of optimal ANC service utilisation in Ethiopia. STUDY DESIGN: This was a spatial and survey regression analysis. METHODS: The secondary analysis of the Ethiopian Demographic and Health Survey 2019 was performed to investigate the spatial variation and determinants of optimal ANC service utilisation among women who were pregnant in the 5 years preceding the survey. Spatial dependency, clustering and prediction were conducted using Global Moran's I statistics, Getis-Ord Gi∗ and Kriging interpolation, respectively, using ArcGIS version 10.8. A survey binary logistic regression model was fitted to identify determinants of optimal ANC service utilisation. RESULTS: Of 3979 pregnant women, 1656 (41.62%) had optimal ANC visits in Ethiopia. Optimal ANC utilisation was shown more prevalent in Northern, Eastern, Central and Northwestern regions of Ethiopia. The results also identified low levels of optimum ANC utilisation in Northeastern, Southeastern, Southern and Western regions of Ethiopia. Wealth index, timing of initial ANC visit and region were significantly associated with optimal ANC service utilisation in Ethiopia. CONCLUSIONS: Optimal ANC service utilisation showed significant spatial dependency in Ethiopia, with spatial clustering in the Northern and Northwestern regions of the country. In addition, the results from this study suggest that financial support should be considered for women living in households in the poorest wealth index and ANC initiation should begin within the first trimester. It is recommended that targeted policies and strategies are introduced to regions with low levels of optimal ANC service utilisation.

Malignant transformation of adult-onset pilocytic astrocytoma to diffuse leptomeningeal glioneuronal tumor within the thoracic spine: a case report and review of the literature.

We describe a 31-year-old male who presented with progressive myelopathy from a thoracic pilocytic astrocytoma (PA). Following multiple recurrences and resections, 10 years after his index surgery, pathology revealed diffuse leptomeningeal glioneuronal tumor (DLGNT) with high-grade features. We discuss his clinical course, management, histopathological findings, and present a comprehensive review of spinal PA undergoing malignant transformation in adults and adult-onset spinal DLGNT. To our knowledge, we present the first reported case of adult-onset spinal PA malignant transformation to DLGNT. Our case adds to the paucity of clinical data characterizing such transformations and highlights the importance of developing novel management paradigms.

Evaluation of the Padua Prediction Score ability to predict venous thromboembolism in Israeli non-surgical hospitalized patients using electronic medical records.

Venous thromboembolism (VTE) is considered a leading safety concern during hospitalization. The Padua Predication Score (PPS) is a risk model conceived to predict VTE among non-surgical hospitalized patients. The study aim was to evaluate the PPS ability to predict VTE in Israeli non-surgical hospitalized patients using data from electronic medical records. A single center, large-scale, historic cohort study of hospitalized non-surgical patients was conducted. Outcomes included clinically diagnosed symptomatic VTE events, bleeding events, and mortality during hospitalization and up to 90 days thereafter, and readmission up to 90 days after discharge. 5117 patient records were analyzed after screening and validation. 1120 (22%) patients were defined per PPS as high-risk, of which 277 (24.7%) were prophylactically treated. The low-risk group included 3997 (78%) patients. Prevalence of symptomatic VTE was low. Overall, 14 (0.27%) VTE events were diagnosed: 3 cases in the high-risk group (0.27%) and 11 (0.28%) in the low-risk group, with no significant difference, p = 0.768. Prophylactic treatment among the high-risk patients did not significantly improve VTE incidence: 1/277 (0.36%) treated vs. 2/843 (0.24%), p = 0.343. There was no significant difference between the study groups regarding the rates of bleeding, unexplained mortality or readmission. PPS was not found to be an efficient tool for identification of non-surgical hospitalized patients with high risk for clinically significant VTE.

Hepatitis E virus: Whole genome sequencing as a new tool for understanding HEV epidemiology and phenotypes.

Hepatitis E Virus (HEV) is emerging as a public health concern across Europe and tools for complete genome data to aid epidemiological and virulence analysis are needed. The high sequence heterogeneity observed amongst HEV genotypes has restricted most analyses to subgenomic regions using PCR-based methods, which can be unreliable due to poor primer homology. We designed a panel of custom-designed RNA probes complementary to all published HEV full genome NCBI sequences. A target enrichment protocol was performed according to the NimbleGen® standard protocol for Illumina® library preparation. Optimisation of this protocol was performed using 40 HEV RNA-positive serum samples and the World Health Organization International Reference Panel for Hepatitis E Virus RNA Genotypes for Nucleic Acid Amplification Technique (NAT)-Based Assays and related reference materials. Deep sequencing using this target enrichment protocol resulted in whole genome consensus sequences from samples with a viral load range of 1.25 × 104-1.17 × 107 IU/mL. Phylogenetic analysis of these sequences recapitulated and extended the partial genome results obtained from genotyping by Sanger sequencing (genotype 1, ten samples and genotype 3, 30 samples). The protocol is highly adaptable to automation and could be used to sequence full genomes of large sample numbers. A more comprehensive understanding of hepatitis E virus transmission, epidemiology and viral phenotype prediction supported by an efficient method of sequencing the whole viral genome will facilitate public health initiatives to reduce the prevalence and mitigate the harm of HEV infection in Europe.

Pediatric Life-Threatening Coronavirus Disease 2019 With Myocarditis.

We report the case of a pediatric life-threatening coronavirus disease 2019 who presented as myocarditis with heart failure. Clinicians should be aware of this severe presentation of the disease in children, possibly linked to an exaggerated inflammatory host immune response to severe acute respiratory syndrome coronavirus 2.

Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology: an international survey of spine surgeons.

OBJECT The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 "control" cases with normal global spinal alignment and 10 "test" cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.

Optimized microbolometers with higher sensitivity for visible and infrared imaging.

Optimal absorption method for improving the sensitivity of bolometric detection is explored. We show that, in addition to its role in conventional conducting-film detection, the application of plasmon resonance absorption offers highly promising characteristics for efficient far-field thermal detection and imaging. These characteristics include good frequency sensitivity, intrinsic spatial (angle) selectivity without focusing lenses, wide tunability over both infrared and visible light domains, high responsivity and miniaturization capabilities. In this context, we examine the well-known surface plasmon resonance (SPR) regime, but also report on a new type of plasmon resonance excitation, the cavity plasmon resonance (CPR), which offers more flexibility over wide ranges of wavelengths, bandwidths, and device dimensions. Both CPR and SPR occur in metallic films, which are characterized by high thermal diffusivity essential for fast bolometric response.

Immobilized lactoferrin is a stimulus for eosinophil activation.

Eosinophils are strongly implicated in the pathogenesis of asthma, particularly in damage to the airway epithelial lining. We examined the potential for lactoferrin, a multifunctional glycoprotein present in the airway surface liquid, to activate eosinophils. Incubating eosinophils in tissue culture wells pretreated with 1-100 microg/ml human lactoferrin stimulated concentration-dependent superoxide production by eosinophils. The same concentrations of immobilized transferrin were without effect. The potency of immobilized lactoferrin was approximately one-third that of immobilized secretory IgA in the same experiments. In contrast, immobilized lactoferrin did not stimulate neutrophil superoxide production. Eosinophils bound lactoferrin as determined by flow cytometry and by binding of (125)I-labeled lactoferrin. Transferrin did not block binding of (125)I-labeled lactoferrin. Soluble lactoferrin, however, did not activate the eosinophils and did not block superoxide production stimulated by immobilized lactoferrin. Immobilized lactoferrin also stimulated release of eosinophil-derived neurotoxin and low levels of leukotriene C4 production; the latter was significantly enhanced in the presence of 100 pg/ml GM-CSF. GM-CSF also enhanced superoxide production and eosinophil-derived neurotoxin release stimulated by the lower concentrations of immobilized lactoferrin. Pretreatment of the lactoferrin with peptide N-glycosidase F or addition of heparin or chondroitin sulfate to the incubation contents had no or only a minimal effect on the activity of immobilized lactoferrin. These results demonstrate that lactoferrin adherent to the surface epithelium may contribute to the activation of eosinophils that infiltrate the airway lumen in eosinophil-associated disorders such as asthma.

Grating-assisted couplers with broadband characteristics.

Grating-assisted couplers can operate effectively over wavelength intervals that are considerably wider than expected. A scheme for achieving this purpose is presented.

Rigorous analysis of power transfer in grating-assisted couplers.

The fields guided by planar gratings embedded in dielectric layers are amenable to exact analytical solutions if the grating profile is rectangular. Such a solution reveals that power transfer in grating-assisted couplers is optimized if the couplers are designed to operate at a point that does not necessarily satisfy phase-matching conditions.

Wave diffraction by many superposed volume gratings.

A multiple-scattering technique that was recently developed to evaluate wave diffraction by two superposed gratings is extended to situations in which there is an arbitrary number of gratings. In this approach the diffraction process can be represented in terms of a flow graph that serves as a template to construct algorithms for calculating the intensity of any diffracted order. We show that such calculations do not require a large computer memory if they are implemented by judiciously tracking the relevant diffracted order throughout the flow paths. Using two types of typical grating structures as examples, we also investigate the effect of the relative grating phase on the diffraction efficiency. We thus find that the multiple-scattering analysis can readily identify those grating structures that are sensitive to the relative phase relationship.

Analysis of cross talk in volume holographic interconnections.

We utilize a novel multiple-scattering formalism to study cross-talk effects in volume holographic interconnections. Specifically, we explore the composition of that cross talk and evaluate its maximum expected values as functions of various design parameters such as dynamic range, minimum separation between interconnections, and hologram size. Examples are given for canonic interconnections that involve two superposed gratings, but the analysis and results are relevant to a broader class of high-capacity interconnects.

Excitation of surface plasmons by finite width beams.

The field properties of surface plasmons produced by realistically bounded beams incident in various attenuated total reflection (ATR) geometries are examined. Analytical results are first derived for the general case dealing with a beam field incident in a multilayered configuration. We show that, at the phase matching condition, the reflected field can be severely distorted in comparison with the incident beam shape. We also find that the power intensity inside the metal medium can be much smaller than that expected under the assumption of plane wave incidence. However, when the beamwidth is larger than the proportion range of the excited plasmon, the power intensity profiles and find that they exhibit distinguishing characteristics. In particular, for an incident Gaussian beam, the location of maximum power density on the metal surface shifts with respect to the center of the incident beam by a distance of the order of the plasmon propagation length. For a rectangular beam incident at the phase matching condition, on the other hand, the propagation range of the coupled surface plasmon can be found directly from the profile of the reflected field. We also show the overall process of beam wave coupling in the ATR geometry can be simulated by a spatial operating system having the response of either a differentiator (for the reflected field) or an integrator (for the transmitted field).

Incidence angles for optimized ATR excitation of surface plasmons.

By quantitatively examining dispersion curves of surface plasmons along Ag, Al, Ni, and Fe films, we find that the incidence angle theta(o) that produces a reflection minimum in a variety of ATR geometries is actually different from the angle theta(p) that corresponds to the phase-matching condition. The difference between theta(p) and theta(o) is most significant in the Otto and Kretschmann geometries using metal films with large damping loss, such as Ni or Fe. In addition, we determine the angle theta(m) at which maximum power density is coupled into the metal surface and show that in general the value of theta(m) is also different from both theta(o) and theta(p), the difference being again largest in the Otto or Kretschmann geometries. The differences between theta(o), theta(p), and theta(m) are much smaller, but still detectable, in long-range surface plasmon and extended-range surface plasmon geometries. In all cases, the preferred incidence angle depends on whether one needs to optimize either the plasmon field composition or the power density in the metal.

Range extension of surface plasmons by dielectric layers.

The propagation range of surface plasmons in thin-metal-film geometries can be considerably increased if a suitable dielectric layer is placed in parallel to the film. The results show that this range extension depends strongly on the separation between the metal film and the dielectric layer.

Angular shift of a Gaussian beam reflected near the Brewster angle.

A general, accurate, and explicit expression has been derived for the angular shift of a Gaussian beam that is partially reflected by a dielectric interface. This result holds for arbitrary incidence angles, including the vicinity of the Brewster angle, and asymptotically approaches the results obtained by others for incidence away from that angle. A series of reflected beam profiles is shown to clarify the angular-shift phenomenon and to illustrate the beam-distortion effect that occurs at, or near, Brewster incidence.

Simplified approach to surface-wave scattering by blazed dielectric gratings.

The scattering properties of dielectric gratings having asymmetric triangular profiles are determined by a simple approach that views the grating structure as a double set of parallel planes. The energy of an incident surface wave is then scattered in preferential directions that are consistent with the grating periodicity and with a Bragg condition. As a result, the triangular shape can be chosen so that scattering occurs mostly into the region above the grating or into that below it, thus making it possible to maximize the efficiency of beam couplers or other devices. This desirable blazing property can be achieved by satisfying simple design criteria that are obtained from the scattering approach presented here. The range of grating parameters for strong blazing is derived, and gratings with trapezoidal profiles are also discussed.