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In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery.The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39 + 0- and 40 + 6-weeks' gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤ 7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated.A total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p 0.001), PPH (p 0.008), NICU admission (p 0.001), low Apgar score at one-minute (p 0.001) and OASI (p = 0.009). The morbidity associated with OVD was significantly higher compared to spontaneous vaginal delivery, including NICU admission (p 0.001), PPH (p = 0.022), birth injury (p 0.001), shoulder dystocia (p = 0.002) and Apgar score of7 at one-minute (p 0.001). The positive likelihood ratios for composite outcomes (where the OVD was excluded) increases with increasing risk score from 1.005 at risk score of 5% to 2.507 for risk score of50%.In women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.

To understand disease, scientists are producing comprehensive omics datasets. However, the majority of these are Eurocentric. Recently, the inclusion of patients from Asia and the Middle East in genomic analyses uncovered unique loci linked to COVID-19 severity. This demonstrates that focusing on diversity and underrepresented populations can benefit all.

To assess if the effect of intracavernosal injection of prostaglandin E1 (PGE1) on duration and rigidity of erection is dose dependent in patients with different types of vasculogenic erectile dysfunction (ED)?A hundred patients with ED were assigned into 4 groups (n = 25/each); group (A) patients with arteriogenic ED, group (B) patients with veno-occlusive ED, group (C) patients with mixed (arteriogenic and veno-occlusive) ED, and group (D) patients who have only psychogenic ED (control). After intracavernosal injection of PGE1, patients were assessed using penile Doppler ultrasonography and erection hardness score together with calculation of erection duration. The starting dose of PGE1 was 5 μg which was increased to 10 µg and 20 µg as a maximal dose when needed.The mean PSV of patients in groups A, B, C, and D were 24.38 ± 3.3, 37.74 ± 8.28, 22.24 ± 3.85, and 47.76 ± 6.27, respectively. In group D, 88% have achieved the best response at dose of 5 µg while 5.3%, 21.7%, and 0% have achieved the best response at dose of 5 µg in groups A, B, and C, respectively (P.05 for each). The rest of patients have required either 10 or 20µg to achieve the best response. Patients in group C have required the highest dose of PGE1 to achieve the best response (P.05).Intracavernosal injection of PGE1 in escalating doses have improved the rigidity and duration of erection in patients with different types of vasculogenic ED. Patients with mixed arteriogenic and veno-occlusive ED have required the highest dose of PGE1 to achieve the best response.

Funding Information: The work of the contributing biobanks was supported by numerous grants from governmental and charitable bodies. Biobank-specific acknowledgments and more detailed acknowledgments are included in Data S2. Initiative management, S.B.C. J.C. N.J.C. M.J.D. E.E.K. A.R.M. B.M.N. Y.O. A.V.P. D.A.v.H. R.G.W. C.J.W. W.Z. and S.Z.; individual biobank analysis, A.B. Y.B. B.M.B. C.D.B. S.C. T.-T.C. K.C. S.M.D. M.D. G.H.d.B. Y.D. N.J.D. M.-J.F. Y.-C.A.F. S.F. V.L.F. L.G.F. E.R.G. T.R.G. D.H.G. C.R.G. G.G.-A. S.E.G. L.A.G. C.H. J.B.H. W.E.H. H.H. K.H. N.I. A.I. R.J. M. Kurki, J.K. N.K. E.E.K. J.T.K. M. Kanai, T.L. K.L. M.H.L. S.L. K.L. Y.-F.L. V.L.F. R.J.F.L. E.A.L.-M. A.R.-M. S.M.-G. R.M. R.E.M. H.C.M. A.R.M. Y.M. H.M. S.E.M. I.Y.M. B.M. S.M. K.N. S.N. M.A.N.-A. K.N. Y.O. P.P. A.L.-P. A.P. B.P. S.P. M.H.P. D.J.R. N.R. M.D.R. A.R. C.S. S.S. S.S.S. J.A.S. P.S. I.S. T.T. R.T. K.T. J.U. D.A.v.H. B.V. M.V. Y.V. J.M.V. R.G.W. Y.W. S.J.W. B.N.W. K.-H.H.W. M.Z. X.Z. and S.Z.; individual biobank management, N.A. A.A.T. K.M.A.-D. P.A. K.C.B. M. Boehnke, M. Boezen, C.D.B. A.C. Z.C. C.-Y.C. J.C. N.J.C. S.M.D. S.F. Y.-C.A.F. S.F. E.F. T.G. C.R.G. C.J.G. Y.G. H.H. K.A.H. K.H. S.I.I. N.M.J. N.K. E.E.K. J.T.K. C.L. M.H.L. M.T.M.L. L.L. K.L. Y.-F.L. R.J.F.L. J.L. S.M. Y.M. K.M. I.Y.M. Y.O. C.M.O. A.V.P. B.P. D.J.P. D.J.R. M.D.R. S.S. J.W.S. H.S. K.S. T.T. U.T. R.C.T. D.A.v.H. M.V. R.G.W. D.C.W. C.W. J.W. M.Z. X.Z. and S.Z.; study design and interpretation of results, A.B. M. Boehnke, M. Boezen, B.M.B. T.-T.C. C.-Y.C. M.J.D. G.D.S. N.J.D. S.F. M.-J.F. H.K.F. E.R.G. A.G. T.G. J.B.H. J.H. K.H. R.J. M.K. E.E.K. T.K. C.M.L. V.L.F. E.A.L.-M. A.R.M. S.N. B.M.N. C.M.O. J.J.P. B.P. N.R. H.R. J.A.S. I.S. K.T. D.A.v.H. R.G.W. Y.W. D.C.W. S.J.W. C.J.W. B.N.W. J.W. K.-H.H.W. M.Z. H.Z. J.Z. W.Z. X.Z. and S.Z.; drafted and edited the paper, A.B. M. Boehnke, M. Boezen, M.J.D. G.H.d.B. N.J.D. T.R.G. J.B.H. N.I. N.M.J. M.K. V.L.F. S.M. A.R.M. H.M. S.N. B.M.N. C.M.O. B.P. H.R. C.S. J.A.S. J.W.S. K.T. Y.W. D.C.W. C.J.W. K.-H.H.W. H.Z. J.Z. W.Z. and S.Z.; primary meta-analysis and quality control, M.J.D. H.K.F. M. Kanai, J.K. J.T.K. M. Kurki, M.M. B.M.N. C.J.W. K.-H.H.W. and W.Z.; drug discovery: S.N. T.K. K.-H.H.W. W.Z. and Y.O.; fine mapping, M. Kanai, W.Z. M.J.D. and H.K.F.; polygenic risk score, Y.W. S.N. E.A.L.-M. S.K. K.T. K.L. M. Kanai, W.Z. K.W. M.-J.F. L.B. P.A. P.D. V.L.F. R.M. Y.M. B.B. S.S. J.U. E.R.G. N.J.C. I.S. Y.O. A.R.M. and J.B.H.; proteome-wide Mendelian randomization, H.Z. H.R. A.B. G.H. G.D.S. B.M.B. W.Z. B.M.N. T.R.G. and J.Z.; transcriptome-wide association study, A.B. J.B.H. W.Z. J.Z. M. Kanai, B.P. E.R.G. and N.J.C.; asthma, K.T. W.Z. Y.W. M. Kanai, S.N. Y.O. B.M.N. M.J.D. and A.R.M.; heart failure, K.-H.H.W. N.J.D. B.N.W. I.S. S.E.G. J.B.H. N.J.C. M.P. R.J.F.L. M.J.D. B.M.N. W.Z. W.E.H. and C.J.W.; idiopathic pulmonary fibrosis, J.J.P. W.Z. M.J.D. J.T.K. N.J.C. and J.B.H.; primary open-angle glaucoma, V.L.F. A.B. W.Z. Y.W. K.L. M. Kanai, E.A.L.-M. P.S. R.T. X.Z. S.N. S.S. Y.O. N.I. S.M. H.S. I.S. C.W. A.R.M. E.R.G. N.M.J. N.J.C. and J.B.H.; stroke, I.S. K.-H.H.W. W.H. B.N.W. W.Z. J.E.H. A.P. B.B. A.H.S. M.E.G. R.G.W. K.H. C.K. S.Z. M.J.D. B.M.N. and C.J.W.; venous thromboembolism, B.N.W. I.S. K.-H.H.W. B.B. V.L.F. K.T. M.D. B.N. W.Z. J.A.S. and C.J.W. All authors reviewed the manuscript. M.J.D. is a founder of Maze Therapeutics. B.M.N. is a member of the scientific advisory board at Deep Genomics and a consultant for Camp4 Therapeutics, Takeda Pharmaceutical, and Biogen. The spouse of C.J.W. works at Regeneron Pharmaceuticals. C.-Y.C. is employed by Biogen. C.R.G. owns stock in 23andMe, Inc. T.R.G. has received research funding from various pharmaceutical companies to support the application of Mendelian randomization to drug target prioritization. E.E.K. has received speaker fees from Regeneron, Illumina, and 23andMe and is a member of the advisory board for Galateo Bio. R.E.M. has received speaker fees from Illumina and is a scientific advisor to the Epigenetic Clock Development Foundation. G.D.S. has received research funding from various pharmaceutical companies to support the application of Mendelian randomization to drug target prioritization. K.S. and U.T. are employed by deCODE Genetics/Amgen, Inc. J.Z. has received research funding from various pharmaceutical companies to support the application of Mendelian randomization to drug target prioritization. S.M. is a co-founder of and holds stock in Seonix Bio. Publisher Copyright: © 2022 Biobanks facilitate genome-wide association studies (GWASs), which have mapped genomic loci across a range of human diseases and traits. However, most biobanks are primarily composed of individuals of European ancestry. We introduce the Global Biobank Meta-analysis Initiative (GBMI)—a collaborative network of 23 biobanks from 4 continents representing more than 2.2 million consented individuals with genetic data linked to electronic health records. GBMI meta-analyzes summary statistics from GWASs generated using harmonized genotypes and phenotypes from member biobanks for 14 exemplar diseases and endpoints. This strategy validates that GWASs conducted in diverse biobanks can be integrated despite heterogeneity in case definitions, recruitment strategies, and baseline characteristics. This collaborative effort improves GWAS power for diseases, benefits understudied diseases, and improves risk prediction while also enabling the nomination of disease genes and drug candidates by incorporating gene and protein expression data and providing insight into the underlying biology of human diseases and traits.

Basement membranes consist of various proteins, the major ones being laminin and collagen type IV. Primary defects in these two proteins have been extensively associated with kidney pathologies. This study aimed to establish baseline information on the immunohistochemical distribution of laminin and collagen type IV, and to corelate these with the ultrastructure of basal laminae in the uriniferous tubules of the dromedary camel. Tissue samples were taken from the kidneys of eight adult female camels, and processed for immunohistochemical and ultrastructural investigations. Strong intensity of collagen type IV was observed within the basement membranes of Bowman's capsule. The thickness of the basal lamina of the parietal layer of Bowman's capsule varied extensively depending on the region of the renal corpuscle; the thicker areas were always associated with cuboidal epithelial cells. The glomerular basement membrane revealed strong immunostaining of laminin, whereas the mesangial matrix was strongly immunoreactive to collagen type IV. Abundant amount of laminin was found in the basement membranes of proximal convoluted tubules, thin limbs of the loop of Henle, and collecting ducts. Dense immunostainings of laminin and collagen type IV were observed in the medullary regions of uriniferous tubule, in which numerous projections extended from the basal laminae into the subjacent connective tissue. Overall, the present study revealed marked variations in the distribution of the basement membrane markers laminin and collagen type IV in the uriniferous tubules of camel kidney. The results have also shown difference in the thickness of basal laminae. This variation in thickness, however, was unlikely to be influenced by the amount of laminin and collagen type IV.

Aerospace structures are prone to impact which affected their residual strength. The aim of this paper to investigate the impact and after-impact behaviour of multi-walled carbon nanotube (MWCNTs) as nanofiller enhanced flax/carbon fibre composites (FLXC) and flax/glass fibre composites (FLXG) hybrid composites. Wet lay-up method was used to fabricate the hybrid composites. The hybrid composites were impacted with impact energies ranging from 5J to 20J, with different types of surface susceptible to the impactor to compare their response under loading. Compression after impact (CAI) testing were done to evaluate the after-impact properties of the hybrid composites. Obtained results found that FLXG composites impacted at glass surface (G-FLX) showed better impact properties compared to C-FLX composites. In another end, it was found that the compressive strength of FLXG composites is higher compared to FLXC composites due to severe damage occurred on FLXC composites surface compared to FLXG composites. Therefore, from the results, it can be concluded that FLXG hybrid composites shows good behaviour to be applied as the interior and functional surfaces inside an aircraft.

Experimental set-up, development, characterization, and calibration of an in-vacuum PIXE system at the tandem accelerator facility of the Atomic Energy Commission of Syria (AECS) is described. The PIXE system calibration involved experimental characterization of the X-ray detector parameters and careful determination of the H-values that control dependence of the detector solid angle with the X-ray energies and correct imperfect values of the detector efficiency. Setting up of an electron flood gun to compensate charge built up and utilization of a beam profile monitor to perform indirect measurement of the beam charge, provide a direct PIXE measurement of thick insulating samples in-vacuum. The PIXE system has been subsequently examined to verify its ability to perform direct PIXE measurements on geological materials. A combination of minimum sample preparation procedures and specific experimental conditions applied enables simple and accurate elemental analysis. Elemental concentrations of several elements heavier than sodium in different reference geological samples, at about 5–10% absolute accuracy for most elements, have been determined. Comprehensive discussion of the obtained elemental concentration values, for most elements of visible X-ray peaks in the PIXE spectra, has been considered.

Background Chronic stress increases the risk of excess intake of calorie-dense foods. Low-income minority caregivers in the United States are cumulatively exposed to stressors and unhealthy foods, but evidence of this association is limited in this population group. The objective of the current study was to assess the association between chronic stress and unhealthy dietary behaviors among low-income African-American caregivers in Detroit, Michigan. Methods Data came from Detroit Dental Health Project, a longitudinal study of pairs of African-American caregivers and children during 2002–2007. A sample of 912 female caregivers were included and their baseline (2002–2003) survey responses were analyzed to identify those with chronic stress and patterns of dietary behaviors. The likelihood of having unhealthy dietary behaviors was compared between chronically stressed caregivers and others, and the mediator role of depressive symptoms or current smoking was tested. Results Approximately 10% of caregivers experienced chronic stress as they all reported discrimination, residential movement, and lack of social support. Twenty-five percent of the caregivers were found to have an unhealthy dietary pattern characterized by excess intake of high fatty foods and soda. Chronically stressed caregivers were more likely to exhibit unhealthy dietary behaviors (prevalence ratio: 1.39; 95% CI: 1.05, 1.84), and this relation was significantly mediated by depressive symptoms, not current smoking. Conclusions These findings suggest that chronic stress played a role in negatively influencing dietary behaviors. As this association might be mediated by depressive symptoms, an intervention to reduce depressive symptoms can be considered as an effective strategy to promote healthy dietary behaviors among chronically stressed minority caregivers.

Although hepatocellular carcinoma (HCC)-related mortality has increased over the past decades, treatment options are still very limited, underlining the need for developing new therapeutic strategies. The molecular chaperone heat shock protein 90 (Hsp90) plays a key role in post-translational maturation of many oncogenic client proteins that are important for survival and proliferation of cancer cells. Thus, inhibitors of Hsp90 are promising targets for many cancer types. In this study, 15 diarylpyrazole compounds were screened against MCF7 and HepG2 cell lines. Compound 8, which contained a thiophene group, demonstrated the highest antiproliferative activity against HepG2 cells having an IC50 of 0.083 μM. Four additional diarylpyrazoles, each containing a thiophene group, were prepared and screened for antiproliferative activity. None of these four compounds exhibited superior activity to compound 8 on HepG2 cells. Therefore, compound 8 was selected for further in vitro assays. Cell cycle arrest was observed at the G2 phase in compound 8-treated cells. Compound 8 also caused a 7.7-fold increase in caspase-3. These results confirm the apoptotic effect of compound 8 on HepG2 cells. Moreover, compound 8 inhibited Hsp90 (IC50 = 2.67 ± 0.18 µM) in an in vitro assay and caused a 70.8% reduction in Hsp90 levels in a HepG2 cell-based assay. Additionally, compound 8 caused significant reduction in the levels of Hsp90 client proteins (Akt, c-Met, c-Raf, and EGFR) and a 1.57-fold increase in Hsp70. Molecular docking studies were also performed to predict the binding mode of compound 8 and followed by molecular dynamics simulations to give further insights into the binding mode of 8.

Background The caries lesion, the most commonly observed sign of dental caries disease, is the cumulative result of an imbalance in the dynamic demineralization and remineralization process that causes a net mineral loss over time. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions. Methods In 2008, the American Dental Association (ADA) convened a group of experts to develop an easy-to-implement caries classification system. The ADA Council on Scientific Affairs subsequently compiled information from these discussions to create the ADA Caries Classification System (CCS) presented in this article. Conclusions The ADA CCS offers clinicians the capability to capture the spectrum of caries disease presentations ranging from clinically unaffected (sound) tooth structure to noncavitated initial lesions to extensively cavitated advanced lesions. The ADA CCS supports a broad range of clinical management options necessary to treat both noncavitated and cavitated caries lesions. Practical Implications The ADA CCS is available for implementation in clinical practice to evaluate its usability, reliability, and validity. Feedback from clinical practitioners and researchers will allow system improvement. Use of the ADA CCS will offer standardized data that can be used to improve the scientific rationale for the treatment of all stages of caries disease.

The susceptibility of 4th instar larvae of Sitotroga cerealella to modified atmospheres (MAs) containing 25, 40 and 60% CO2 in air at 27 °C with different exposure periods was determined. Also, changes in the activity level of several enzymes were analyzed. Reduction in percentage adult emergence from the treated larvae tended to increase with CO2 concentration and with exposure period. The reduction in emergence of adult from the 4th instar larvae reached 100% after 264 h for 25% CO2, after 240 h for 40% CO2 and after 168 h for 60% CO2. The larvae showed the highest rates of escape for 25% CO2. This could be due to the fact that at higher CO2 contents the narcotic effect overrode the repellent effect. Trehalase, acid phosphatase, acetylcholinesterase, phenoloxidase and lactate dehydrogenase (LDH) enzyme concentrations were found to be higher in the treated larvae. Larvae exposed to MAs exhibited decreasing activity of amylase, alkaline phosphatase and adenosine triphosphatase (ATP'ase) enzymes. Additionally, MAs led to an increase in the total protein, triglyceride and lactate content.

The occurrence of panic symptoms in various anxiety disorders has been associated with more severely impaired and difficult-to-treat cases, but this has not been investigated in dental phobia. We examined the clinical implications of panic symptoms related to sub-clinical and clinically significant dental phobia. The sample consisted of 61 patients at a university dental clinic who endorsed symptoms of dental phobia, 25 of whom met criteria for a formal diagnosis of dental phobia. Participants with dental phobia endorsed more panic symptoms than did those with sub-clinical dental phobia. In the total sample, greater endorsement of panic symptoms was associated with higher dental anxiety, more avoidance of dental procedures, and poorer oral health-related quality of life. Among those with dental phobia, certain panic symptoms exhibited associations with specific anxiety-eliciting dental procedures. Panic symptoms may serve as indicators of clinically significant dental phobia and the need for augmented treatment.

Pearl millet ( Pennisetum glaucum (L.) R. Br., [syn. Cenchrus americanus (L.) Morrone]) is grown in the semi-arid tropics under climatically highly variable environmental conditions. To study the patterns of genotype-by-environment (G × E) interaction and stability of grain yield and nutrient concentrations in Sudan, 225 pearl millet accessions were evaluated for yield performance at three locations over two years (2010–2011). A sub-set of 30 entries was additionally analyzed for grain Fe and Zn concentrations across four location–year combinations. Wide ranges of environmental means were observed for grain yield (73.3–210.8 g m −2 ), Fe (37.4–45.4 mg kg −1 ) and Zn (35.5–38.8 mg kg −1 ). Genotypic, environmental and G × E interaction effects were highly significant ( P

Cubic and hexagonal AlN films have been prepared by vacuum arc discharge technique at different deposition temperatures 100, 200 and 300 °C. The depositions were carried out from pure aluminum targets under nitrogen gas on p-type Si substrates, with Al forming the gate in a metal–insulator–semiconductor configuration. Preferential orientations (111) and (002) of the cubic and hexagonal phases have been affirmed by X-ray diffraction analysis. The Fourier transform infrared spectra revealed the manifestation of the two phases as well. The effect of deposition temperature on the crystalline quality and texture of the films has been also investigated and the grain size of which, has been evaluated as a function of temperature. The best crystalline quality i.e., largest grain size was found to be at 200 °C. The composition and stoichiometry of the films have been determined by the time-of-flight elastic recoil detection analysis (TOF-ERDA) and Rutherford backscattering techniques. The Al/N ratio was found to be around 1, while the O content was less than 1.8%. Scanning electron microscopy and TOF-ERDA measurements demonstrated films thickness of 260 nm. Current density versus electric field and capacitance–voltage (C–V) measurements were also investigated to reveal the field emission and conduction mechanism of the Al/AlN/p-Si devices. Schottky, Pool–Frenkel and Fowler–Nordheim conduction have been found to contribute to the electron transport, and the best emission properties were manifested at 200 °C with a highest current density 525 μA/cm2 at a field 71 V/μm. From C–V curves, the density of traps has been estimated to be 18 × 109 cm− 2 eV− 1 indicating a good quality of the deposited films.

Higher education is critical success of young adults. Higher education can provide a gateway for social mobility and play a critical role in countering social stratification in Malaysia, particularly for the Bumiputera students in Malaysia society. However, change hurts. The transition from school to university is a change that every school students have to face in their quest for higher education. The current scenario giving some signals that there is a challenging life transition in the development of young adults, and many students are inadequately prepared for the psychological, emotional, and academic realities of higher education. These new university students are confronted with the adaptational challenges of living apart from family and friends, adjusting to the academic regimen, assuming responsibility for the tasks of daily living, and developing a new array of social relationships with peers and faculty. Futhermore, not many research have been conducted on this issue except that focused had been made to the secondary and/or high school students only. Therefore, this paper takes the challenge of filling these gaps by analysing some crucial conceptual undertanding what factors exactly influence the student's life at the higher institution.

In this work, we present a new method to analyze thick insulating samples by PIXE technique. The method is based on the use of both an electron flood gun to compensate the charge build-up at the insulating surface and a beam profile monitor (BPM) to provide a precise indirect measurement of the beam current and accumulated charge. A filament extracted from an ordinary flashlight lamp was used as an electron flood gun. While, a commercial BPM has been adapted in order to carry out charge measurements. The results have revealed the convenience of using BPM for measuring the charge in PIXE measurements. The use of the electron flood gun has given very satisfactory results in term of preventing charge build-up and reducing its contribution to the bremsstrahlung background in the PIXE spectra. The applicability and efficiency of the overall system for elemental analysis were successfully verified using IAEA-Soil-7 reference material where both accuracy and precision were found to be better than 10% in most cases.

Background and Aims Thiopurine S-methyltransferase (TPMT) is responsible for inactivation of thiopurine drugs which are commonly used in leukemia, organ transplantation and autoimmune diseases. The gene encoding TPMT is polymorphic, and both phenotyping and genotyping studies have shown ethnic variations in gene sequence and enzyme activity worldwide. The aim of this study is to identify the most common genetic polymorphisms of TPMT in healthy Jordanian volunteers and patients with rheumatoid arthritis (RA). Methods A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used to identify the frequency of TPMT ( *2, *3A, *3B, and *3C ) polymorphisms in 250 healthy Jordanian volunteers and 110 RA patients. Results Only four healthy subjects (1.6%) and one RA patient (0.9%) with variant alleles were identified in this study. Two healthy subjects had the TPMT*3A allele and the other two had the TPMT*3B allele, whereas the one RA patient had the TPMT*3A allele. No homozygous polymorphisms were detected and all genotypes detected were heterozygous ( *1/*3A ) ( *1/*3B ). None of the subjects had TPMT*2 or TPMT*3C variant alleles. Conclusions Mutant alleles identified in this study have a low frequency. TPMT ( *3A and *3B ) were the only detected heterozygous alleles. No homozygous variant allele was detected. Further studies are necessary to identify other variant alleles that might uniquely occur in Jordanians.

Background The authors conducted a systematic review on this research question: "In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost-effectiveness of dental care?" Methods The authors searched 12 electronic databases for articles published through February 2012 and hand searched relevant articles. They assessed the risk of bias of included studies and extracted data. Results The authors screened 7,701 citations, resulting in 18 observational studies that met the inclusion criteria. They judged 13 of the studies to be at high risk of bias, five at moderate risk and one at low risk. The authors found no data regarding cost effectiveness, irreversible diagnostic procedures or diseases other than caries. Conclusions The authors concluded that the quality of the evidence was poor. They found that in select groups in which participants received irreversible dental treatment from teams that included midlevel providers, caries increment, caries severity or both decreased across time; however, there was no difference in caries increment, caries severity or both compared with those in populations in which dentists provided all irreversible treatment. In select groups in which participants had received irreversible dental treatment from teams that included midlevel providers, there was a decrease in untreated caries across time and a decrease in untreated caries compared with that in populations in which dentists provided all treatment. Clinical Implications Generalizability of results to populations other than those studied is limited owing to the age of some of the studies, as well as to clinical and methodological heterogeneity; consequently, the conclusions should be viewed with caution.

Higher order system of boundary value problems arise in several areas of applications. In this paper, we employ the Chebyshev wavelet finite difference method to solve such system of higher order boundary value problems. Numerical experiments are conducted to show the feasibility of the proposed method.

Three titanium oxynitride films have been prepared by vacuum arc discharge technique at different chamber temperatures (50 °C, 150 °C and 300 °C). X-ray photoelectron spectroscopy was used to reveal the elemental and chemical compositions by analyzing high resolution spectra of Ti 2p3/2, N 1s and O 1s. Higher temperatures were found to promote the nitride components and to produce nitrogen-rich films. Homogeneity and thickness of the films have been estimated by means of Rutherford Back Scattering technique, which showed that the film thickness increased with the increasing of temperature. A significant improvement in the crystalline quality and texture when increasing the temperature was found by X-ray diffraction technique. Electrical resistivity of the films was measured at room temperature and was found to decrease from 46.6 μΩ cm down to 26.3 μΩ cm for the samples prepared at 50 °C and 300 °C, respectively.

Given international variation in obstetric practices and outcomes, comparison of labour outcomes in different ethnic groups could provide important information regarding the underlying reasons for rising caesarean delivery rates. Increasing numbers of women from Eastern European countries are now delivering in Irish maternity hospitals. We compared labour outcomes between Irish and Eastern European (EE) women in a large tertiary referral center.This was a prospective consecutive cohort study encompassing a single calendar year. The cohort comprised 5550 Irish and 867 EE women delivered in a single institution in 2009. Women who had multiple pregnancies, breech presentation, and elective or pre-labour caesarean sections (CS) were excluded. Data obtained from birth registers included maternal age, nationality, parity, gestation, onset of labour, mode of delivery and birth weight.The overall intrapartum CS rate was 11.4% and was significantly higher in Irish compared to EE women (11.8% vs. 8.8%; p=0.008). The proportion of primiparas was lower in Irish compared to EE women (44.8% vs. 63.6%; p0.0001). The intrapartum CS rate was almost doubled in Irish compared to EE primiparas (20.7% vs. 11.0%; p0.0001). Analysis of primiparas according to labour onset revealed a higher intrapartum CS rate in Irish primiparas in both spontaneous (13.5% vs. 7.2%; p0.0001) and induced labour (29.5% vs. 19.3%; p=0.005). Irish women were older with 19.7% of primiparas aged more than 35, compared to 1.6% of EE women (p0.0001). The primigravid CS rate in Irish women was significantly higher in women aged 35 years or older compared women aged less than 35 (30.6% vs. 18.3%; p0.0001) consistent in both spontaneous and induced labour. The primiparous induction rate was 45.4% in Irish women compared to 32% in EE women, and more Irish women were induced before 41 weeks gestation.The results highlight that primigravid intrapartum CS rates were significantly lower in EE compared to Irish women. This could potentially be explained by the younger age and lower induction rates in EE primiparas. Further studies are required to determine the factors for this significant difference in labour outcomes for these two Caucasian groups.

Background The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association (ADA) recommendation to seal non-cavitated carious lesions (NCCLs) in children and young adults. Methods The authors mailed a questionnaire to a randomly selected sample of 2,400 general dentists (GDs) and pediatric dentists (PDs) in the United States. The sample was chosen by the ADA's Survey Center. The questionnaire included two photographs of NCCLs (permanent first molar and premolar) in a 12-year-old child. Respondents were provided with radiographic findings and asked to choose from several management options. Results In the absence of radiographic evidence of caries, 37.4 percent and 42.3 percent of GDs and PDs, respectively, indicated that they would seal the NCCL in the molar. For the premolar, a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL. With radiographic evidence of caries in dentin, less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs, and more than 90 percent indicated that they would remove the caries and place restorations. Less than 40 percent of dentists indicated that they sealed NCCLs in their practice. Conclusions The U.S. dentists surveyed have not adopted evidence-based clinical recommendations regarding the sealing of NCCLs. Practice Implications New educational and dissemination programs should be developed regarding these evidence-based caries management approaches.

Proton induced X-ray emission (PIXE) has been used to measure trace elements in sediments of Orontes River. Measurements were carried out using a 2 MeV proton beam produced from of the 3 MV tandem accelerator. Sediment samples were collected from 11 sites covering the important potential pollution sources at the river. The accuracy of the experimental procedure was verified using a certified sediment reference material (IAEA-SL1) and was found to be less than 10%. The results have shown that Pb and As were within the natural levels. In contrast, high concentrations of other elements like Cr, Cu, Ni and Zn have been found at different sites and explained by local human and industrial activities.

BACKGROUND: Some low-income minority children in the U.S. remain at normal weight throughout their childhood despite high risk of obesity. PURPOSE: This study examined whether resilient caregiving accounted for children's healthy weight maintenance and dietary compliance over a 4-year period among poverty-stricken African-American families. METHODS: A representative sample of 317 African-American caregiver-children (aged 3-5 years) pairs from low-income areas of Detroit MI was examined in 2002-2003 with a follow-up assessment in 2007. Capacity for resilience among caregivers was defined using five individual and environmental protective factors. A BMI score for the children was computed from recorded height and weight, and converted into one of three categories (normal weight, overweight, obese) using age- and gender-specific national references. Dietary information was collected using the Block Food Frequency Questionnaire (FFQ) and Block Kids FFQ. Data were analyzed in 2010 to test whether children's weight transition and dietary compliance varied according to their caregivers' capacity for resilience. RESULTS: In all, 95 caregivers (29%) were identified as having capacity for resilience. They were younger, had higher levels of educational attainment, and had lower levels of daily soda consumption. The children of these caregivers had a lower likelihood of remaining overweight or obese than being of normal weight (relative risk ratio=0.5, 95% CI=0.2, 0.9) and had persistently lower soda consumption over 4 years compared with other children. CONCLUSIONS: This finding demonstrates that some caregivers positively influence children's health weight management and dietary compliance despite material deprivation. Interventions to initiate and promote resilient caregiving could benefit the health and health-related behaviors of low-income African-American children.

Objective To evaluate the cardiac activity and hepatoprotection of Crataegus sinaica ( C. sinaica ). Methods All the isolated compounds were isolated by open-column liquid chromatography (CC) using sephadex LH-20 as stationary phase. Elution of the column was performed with EtOH or MeOH. The phytochemical investigation of the young stem of C. sinaica for the first time together with the leaves and flowers lead to the isolation and identification of quercetin, hyperoside, vitexin-2″-O-rhamnoside, epicatechin, procyanidin B2 and procyanidins C1. Results Rats treated with the low and high dose of C. sinaica leaves with flowers extract showed 15% and 17% reduction in the heart rate, and reduction in the ST-segment by 107% and 57%; respectively. The T-amplitude was decreased by 59% of the high dose extract. On the other hand, the young stems and leaves with flowers extracts of C. sinaica on primary culture of rat hepatocytes monolayer indicated a hepatoprotection for the total extract, ethyl acetate, butanol, and chloroform fractions at 100 μg/mL, 75 μg/mL, 50 μg/mL, and 25μg/mL; respectively. Conclusions The results of these chemical and biological studies suggest the use of C. sinaica growing in Egypt as a preventive drug against cardiovascular and hepatic diseases. The chemical studies suggest the use of woody young stems as a newly investigated bioactive organ. The extraction of unsaturated fatty acids from the seeds of the plant would serve as a good health and nutritive product.

Understanding CHF is of an upmost importance in many industries, especially in the design and operation of boilers, nuclear power plants, cryogenic systems, etc. Due to safety issues related to the nuclear power plants, and the adaptation of CHF as the limiting criterion of power generation, it is important to understand the mechanisms of CHF relevant to nuclear systems operation. Moreover, CHF is expected to occur during transients than steady-state conditions. Therefore, knowledge of transient CHF is of great importance for the safety evaluation of nuclear reactors under transient condition. In this paper, the existing CHF experimental and modeling studies are discussed in order to understand the phenomena leading to CHF. Also, the effect of transient conditions on CHF for nuclear fuels has been evaluated.

The metabolism of folate is essential in DNA synthesis, and polymorphisms of genes involved in such metabolism have been implicated in many types of cancer. Among these, the methylene tetrahydrofolate reductase gene (MTHFR) encodes an enzyme that converts folate to a methyl donor used for DNA methylation. We studied the association between the different genotypes of the two most common MTHFR polymorphisms, C677T and A1298C, and the risk of follicular lymphoma (FL). For this purpose, 55 previously diagnosed FL patients and 170 normal control subjects were examined using polymerase chain reaction followed by restriction fragment length polymorphism. The frequency of the A1298C CC homozygous mutant genotype was significantly higher in patients with FL than in control subjects (OR = 3.51, 95% CI = 1.39-8.86, P = 0.008). No such association was found for the heterozygous A1298C AC genotype (OR = 1.08, 95% CI = 0.55-2.12, P = 0.83). On the other hand, no significant association was found for either the C677T CT heterozygous genotype (OR = 0.79, 95% CI = 0.42-1.51, P = 0.49) or the C677T TT homozygous mutant genotype (OR = 0.55, 95% CI = 0.12-2.65, P = 0.46). The present findings add to the very few reports suggesting a link between the A1298C CC homozygous MTHFR genotype and a higher risk of developing FL, and the first such in a Jordanian population.

A simple transportable hemispherical solar still was designed and fabricated, and its performance was experimentally evaluated under outdoors of Dhahran climatic conditions. It was found that over the hours of experimental testing through daytime, the daily distilled water output from the still ranged from 2.8 to 5.7 l/m2 day. The daily average efficiency of the still reached as high as 33% with a corresponding conversion ratio near 50%. It was also found that the average efficiency of the still decreased by 8% when the saline water depth increased by 50%.

This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed the following clinical questions. Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews.

Background In this review, the authors examine evidence regarding the effectiveness of fluoride supplements in preventing caries and their association with dental fluorosis. Methods Using tested search filters, the authors searched MEDLINE, the Cochrane Central Register of Controlled Trials, OVID Evidence-based Reviews and EMBASE. The authors agreed on the inclusion of 20 reports from 12 trials that met defined criteria. They also included five studies published since 1997 regarding the association between dental fluorosis and supplements. Results Eleven of the reports evaluated dosage schedules similar to that recommended by the American Dental Association. One potentially highly biased study of primary teeth of children during the first three years of life reported a 47.2 percent reduction in dental caries experience. Investigators in one trial involving 3- to 6-year-old children found a 43.0 percent difference, and another trial of children in this age group did not find a significant benefit. Researchers in several studies involving older children detected a significant reduction in caries increments in permanent teeth with the use of fluoride supplements. Fifteen of the studies had withdrawal rates of 30 percent or higher. All of the five included studies that evaluated the association between use of fluoride supplements and dental fluorosis found that use of the supplements increased the risk of mild-to-moderate fluorosis. Conclusions There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth. There is evidence that such supplements prevent caries in permanent teeth. Mild-to-moderate dental fluorosis is a significant side effect. Clinical Implications The current recommendations for use of fluoride supplements during the first six years of life should be re-examined.

Background The authors conducted a study to test the hypothesis that high consumption of soft drinks, relative to milk and 100 percent fruit juice, is a risk factor for dental caries in low-income African-American children in Detroit. Methods Trained dentists and interviewers examined a representative sample of 369 children, aged 3 to 5 years, in 2002–2003 and again two years later. The authors used the 2000 Block Kids Food Frequency Questionnaire (NutritionQuest, Berkeley, Calif.) to collect dietary information. They assessed caries by using the International Caries Detection and Assessment System. Results Soft drinks, 100 percent fruit juice and milk represented the sugared beverages consumed by the cohort. A cluster analysis of the relative proportion of each drink at baseline and follow-up revealed four consumption patterns. Using zero-inflated negative binomial models, the authors found that children who changed from being low consumers of soft drinks at baseline to high consumers after two years had a 1.75 times higher mean number of new decayed, missing and filled tooth surfaces compared with low consumers of soft drinks at both time points. Conclusion Children who consumed more soft drinks, relative to milk and 100 percent fruit juice, as they grew older were at a greater risk of developing dental caries. Clinical Implications Health promotion programs and health care providers should emphasize to patients and caregivers the caries risk associated with consumption of soft drinks.

Background This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Types of Studies Reviewed Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. Results The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. Clinical Implications These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

Background The objective of this study was to investigate factors associated with regular dental visits in an adult population. Methods A representative sample of non-institutionalized dentate adults (aged 18 through 69 years) from the Detroit tricounty area (Wayne, Macomb and Oakland counties) was randomly selected using list-assisted random digit dialing. The authors collected the data through a self-administered questionnaire that asked for information about regular dental visits, private dental insurance, perceived oral health status and dental treatment experience. The authors used Corah's Dental Anxiety Scale to measure respondents' dental anxiety level. They also conducted a descriptive analysis and a logistic regression analysis. Results A final sample of 630 adults who resided in 368 households participated in this study. Seventy-two percent of respondents had dental insurance (excluding Medicaid). About 63 percent reported that they visited a dentist regularly. About 12 percent of adults had high dental anxiety (a score of 13 or higher on the Corah scale). A logistic regression model found that dental anxiety, dental insurance status and perceived oral health status were significantly associated with regular dental visits after accounting for sociodemographic factors such as sex, age and income. Among those who had dental insurance, dentally anxious adults were significantly less likely to visit dentists regularly. However, this association was not significant among respondents without dental insurance. Conclusion Dental insurance, perceived oral health status and dental anxiety were associated with regular dental visits. Dental anxiety was an influencing factor in regular dental visit behavior, especially among adults who had private dental insurance. Clinical Implications Practitioners need to be educated about the causes of dental anxiety and receive training in how to treat the problem.

Background and Overview The National Institute of Dental and Craniofacial Research, or NIDCR, in 2001 sponsored the establishment of Centers for Research to Reduce Oral Health Disparities. The centers are based at Boston University; New York University; the University of Michigan; the University of Washington; and the University of California, San Francisco. Reflecting the importance of research to reduce disparities, the centers, along with related grants, represent one of the largest financial commitments ever made by the NIDCR. The centers are sponsored in part by the National Center on Minority Health and Health Disparities, or NCMHHD. Each of the five centers has forged partnerships that include ties with dental societies, state and local health agencies, community and migrant health centers, American Indian tribal nations and institutions that serve other diverse patient populations. Conclusions and Clinical Implications This network is attempting to address the needs of communities with poor oral health. A major part of the effort of these new centers is to build community networks and establish long-term relationships. Center investigators also recognize that solutions to these vexing problems must be built on an understanding of the social, economic, racial, educational, political and behavioral factors that affect most health care issues.

Background Although systematic reviews are the backbone of evidence-based dentistry, they have appeared infrequently in the clinical dental literature and their importance may not be recognized by dentists. The authors describe the steps taken in systematic reviews and perform a literature survey to identify published systematic reviews of topics relevant to clinical dentistry. Methods The authors searched MEDLINE and the Cochrane databases of systematic reviews and abstracts of reviews of effectiveness, as well as identified reviews that were known to the authors but not found in the searches. Systematic reviews included in this survey stated the intention to identify all relevant articles within predefined limitations, applied defined exclusion and inclusion criteria, and presented complete raw or synthesized data from included studies. Results This literature survey identified 131 systematic reviews, 96 of which had direct clinical relevance. During the past 14 years, clinically relevant systematic reviews have been published with increasing frequency. These reviews vary in the types of studies included and the assessment of those studies. The results of the reviews also varied in their definitiveness, with 17 percent finding the evidence to be insufficient to answer the key question. An additional 50 percent of the 96 reviews hedged in answering the key question, by noting that the supporting evidence was weak in quality or limited in quantity. Conclusion The number of systematic reviews that address clinical topics in dentistry is small but growing. However, the authors of more than one-half of these reviews believed that the evidence available to answer the key question was not strong. Clinical Implications As systematic reviews continue to grow, dentistry will become better informed about the adequacy and congruence of the scientific evidence underpinning clinical practice.

Background The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. Methods The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra-and interexaminer reliability was excellent (κ ≥ 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects. Results Only 8.4 percent of the children had visited a dental office before the age of 2 years, and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents' high education status, optimal fluoride concentration in schools' water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores. Conclusion Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience. Practice Implications This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.