IntroductionRacial discrimination has been consistently linked to various health outcomes and health disparities, including studies associating racial discrimination with patterns of racial ...disparities in adverse pregnancy outcomes. To expand our knowledge, this systematic review and meta-analysis assesses all available evidence on the association between self-reported racial discrimination and adverse pregnancy outcomes.MethodsEight electronic databases were searched without language or time restrictions, through January 2022. Data were extracted using a pre-piloted extraction tool. Quality assessment was conducted using the Newcastle–Ottawa Scale (NOS), and across all included studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects meta-analyses were performed on preterm birth and small for gestational age. Heterogenicity was assessed using Cochran’s χ2 test and I2 statistic.ResultsOf 13 597 retrieved records, 24 articles were included. Studies included cohort, case–control and cross-sectional designs and were predominantly conducted in the USA (n=20). Across all outcomes, significant positive associations (between experiencing racial discrimination and an adverse pregnancy event) and non-significant associations (trending towards positive) were reported, with no studies reporting significant negative associations. The overall pooled odds ratio (OR) for preterm birth was 1.40 (95% CI 1.17 to 1.68; 13 studies) and for small for gestational age it was 1.23 (95% CI 0.76 to 1.99; 3 studies). When excluding low-quality studies, the preterm birth OR attenuated to 1.31 (95% CI 1.08 to 1.59; 10 studies). Similar results were obtained across sensitivity and subgroup analyses, indicating a significant positive association.ConclusionThese results suggest that racial discrimination has adverse impacts on pregnancy outcomes. This is supported by the broader literature on racial discrimination as a risk factor for adverse health outcomes. To further explore this association and underlying mechanisms, including mediating and moderating factors, higher quality evidence from large ethnographically diverse cohorts is needed.
Advice to drink plenty of fluid is common in respiratory infections. We assessed whether low fluid intake (dehydration) altered outcomes in adults with pneumonia.
We systematically reviewed trials ...increasing fluid intake and well-adjusted, well-powered observational studies assessing associations between markers of low-intake dehydration (fluid intake, serum osmolality, urea or blood urea nitrogen, urinary output, signs of dehydration) and mortality in adult pneumonia patients (with any type of pneumonia, including community acquired, health-care acquired, aspiration, COVID-19 and mixed types). Medline, Embase, CENTRAL, references of reviews and included studies were searched to 30/10/2020. Studies were assessed for inclusion, risk of bias and data extracted independently in duplicate. We employed random-effects meta-analysis, sensitivity analyses, subgrouping and GRADE assessment. Prospero registration: CRD42020182599.
We identified one trial, 20 well-adjusted cohort studies and one case–control study. None suggested that more fluid (hydration) was associated with harm. Ten of 13 well-powered observational studies found statistically significant positive associations in adjusted analyses between dehydration and medium-term mortality. The other three studies found no significant effect. Meta-analysis suggested doubled odds of medium-term mortality in dehydrated (compared to hydrated) pneumonia patients (GRADE moderate-quality evidence, OR 2.3, 95% CI 1.8 to 2.8, 8619 deaths in 128,319 participants). Heterogeneity was explained by a dose effect (greater dehydration increased risk of mortality further), and the effect was consistent across types of pneumonia (including community-acquired, hospital-acquired, aspiration, nursing and health-care associated, and mixed pneumonia), age and setting (community or hospital). The single trial found that educating pneumonia patients to drink ≥1.5 L fluid/d alongside lifestyle advice increased fluid intake and reduced subsequent healthcare use.
No studies in COVID-19 pneumonia met the inclusion criteria, but 70% of those hospitalised with COVID-19 have pneumonia. Smaller COVID-19 studies suggested that hydration is as important in COVID-19 pneumonia mortality as in other pneumonias.
We found consistent moderate-quality evidence mainly from observational studies that improving hydration reduces the risk of medium-term mortality in all types of pneumonia. It is remarkable that while many studies included dehydration as a potential confounder, and major pneumonia risk scores include measures of hydration, optimal fluid volume and the effect of supporting hydration have not been assessed in randomised controlled trials of people with pneumonia. Such trials, are needed as potential benefits may be large, rapid and implemented at low cost. Supporting hydration and reversing dehydration has the potential to have rapid positive impacts on pneumonia outcomes, and perhaps also COVID-19 pneumonia outcomes, in older adults.
To compare rates of necrotising enterocolitis (NEC), late-onset sepsis, and mortality in 5-year epochs before and after implementation of routine daily multistrain probiotics administration in ...high-risk neonates.
Single-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017.
Level 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK.
Preterm neonates at high risk of NEC: admitted to NICU within 3 days of birth at <32 weeks' gestation or at 32-36 weeks' gestation and of birth weight <1500 g.
Prior to 1 January 2013 probiotics were not used. Thereafter, dual-species
and
combination probiotics were routinely administered daily to high-risk neonates; from April 2016 triple-species probiotics (
and
subspecies
) were used.
Incidence of NEC (modified Bell's stage 2a or greater), late-onset sepsis, and mortality.
Rates of NEC fell from 7.5% (35/469 neonates) in the pre-implementation epoch to 3.1% (16/513 neonates) in the routine probiotics epoch (adjusted sub-hazard ratio=0.44, 95% CI 0.23 to 0.85, p=0.014). The more than halving of NEC rates after probiotics introduction was independent of any measured covariates, including breast milk feeding rates. Cases of late-onset sepsis fell from 106/469 (22.6%) to 59/513 (11.5%) (p<0.0001), and there was no episode of sepsis due to
or
. All-cause mortality also fell in the routine probiotics epoch, from 67/469 (14.3%) to 47/513 (9.2%), although this was not statistically significant after multivariable adjustment (adjusted sub-hazard ratio=0.74, 95% CI 0.49 to 1.12, p=0.155).
Administration of multispecies
and
probiotics has been associated with a significantly decreased risk of NEC and late-onset sepsis in our neonatal unit, and no safety issues. Our data are consistent with routine use of
and
combination probiotics having a beneficial effect on NEC prevention in very preterm neonates.
No quantitative research has assessed the trends in English medical student intercalation. In addition, the impacts of the increase in tuition fees, introduced in 2012, and demographic factors on ...intercalation rates are unknown.
Freedom of information requests were sent to all UK universities. Regression analysis compared intercalation rates before (2006–2012) and after (2012–2020) the tuition fee increase. Student’s t-tests compared demographics of medical students who intercalated. Questionnaires were sent to all UK universities to explore reasons for intercalating.
In total, 101,085 students from seven universities responded. The intercalation rate increased from 4.70% to 10.53% (mean percentage difference (MPD) 5.84; 95% confidence interval (CI) 2.94–8.73). Intercalating students were more likely to be <25 years of age (MPD 33.36%; 95%CI 28.34–38.39), without a previous degree (MPD 8.56%; 95% CI 7.00–10.11) and without a disability (MPD 3.15%; 95% CI 0.88–5.42). In total, 389 completed questionnaires were received from 10 universities. Medical students believed an intercalated degree made them a better doctor.
The proportion of students who intercalated was greater following the increase in tuition fees. This might be explained by the value medical that students placed on the skills and opportunities that accompany an intercalated degree.
Objective
Hydroxychloroquine (HCQ) has been used during the coronavirus disease 2019 (COVID-19) pandemic because of its reported anti-viral activity. This study examined the association of chronic ...HCQ use with the incidence and complications of COVID-19.
Methods
This retrospective cohort study included adults with rheumatoid arthritis and/or systemic lupus erythematosus who visited rheumatology clinics in three tertiary hospitals in Riyadh, Saudi Arabia between January 2019 and December 2020. Patients were categorized into two groups based on HCQ use. Data were obtained from the electronic health record and by interviews with patients. The primary study objective was the incidence of COVID-19 and its complications from March 2020 to February 2021.
Results
Almost 11% of the study cohort was positive for COVID-19, and the incidence of COVID-19 was similar between HCQ users (11.11%) and nonusers (10.86%). Disease complication rates were similar in the study arms, and they mainly included fever, dry cough, fatigue, and breathing difficulty.
Conclusions
This study revealed no significant association between chronic HCQ use and the incidence of COVID-19, and disease complications were similar in the study arms.
The Zaer granitic massif is one of the most important Variscan granitoids in the Central Zone of the Western Moroccan Meseta. It is characterized by a deformation which is manifested by a network of ...fractures of different scales. Thanks to the technology currently available, many geological studies rely heavily on the mapping of geological lineaments, especially in structural geology. This has become more reliable with access to earth observation data using optical and radar sensors as well as the various remote sensing techniques. Therefore, the objective of this work is to determine the potential of Landsat 8, ASTER, Sentinel 2 and radar Sentinel 1 datasets using the automatic method to extract lineaments. Furthermore, this work focuses on quantitative lineament analysis to determine lineament trends and subsequently compare them with global and regional tectonic movement trends. The lineaments obtained through different satellite images were validated by including the shaded relief maps, the slope map, the correlation with the pre-existing faults in the geological maps as well as the field investigation. Comparison of these results indicates that Sentinel 1 imagery provides a better correlation between automated extraction lineaments and major fault zones. Thus, Sentinel 1 data is more effective in mapping geological lineaments. The final lineament map obtained from the VH and VV polarizations shows two major fault systems, mainly oriented NE-SW and NW-SE to NNW-SSE.
Sensor Networks are emerging as a new tool for important applications in diverse fields like military surveillance, habitat monitoring, monitoring and gathering events in hazardous environments, ...surveillance of buildings, whether monitoring etc, In the research area of wireless sensor networks the Flat and hierarchical routing protocols is a major issue. In this paper we intend to discuss some of the major Flat routing protocols (AODV, DSDV, GSR, FSR, OLSR, SPIN) and hierarchical routing protocols (LEACH-C, LEACH-F, PEGASIS, ZHLS) for wireless sensor networks. First we will discuss the routing protocols in short and later we will compare and simulate the behavior on lifetime and energy using NS2 simulator.
Etude des machines a traire pour avoir le maximum de connaissances necessaires a la comprehension de leur fonctionnement, description technique des mecanismes des differents composants de la machine ...a traire, description des installations de ces machines et analyse des divers problemes que pose leur utilisation dans les exploitations laitieres du Maroc
PDF
