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While breastfeeding has long been an important, globally recognized aspect of population health, disparities exist across Canada. The Baby-Friendly Initiative (BFI) is a WHO/UNICEF best-practice program that helps ensure families receive evidence-based perinatal care and is associated with improved breastfeeding rates. However, 80%); however, breastfeeding exclusivity rates did not meet targets. All BFI care indicators improved across participating facilities. All skin-to-skin indicators improved, with rates of immediate and sustained skin-to-skin meeting targets of >80% for vaginal births. BFI care indicators of documented assistance and support with breastfeeding within 6 hours of birth, rooming-in and education about community supports also met target levels. Leadership buy-in, parent partner engagement and collaborative activities of workshops, webinars and mentoring with BFI Project leadership were viewed as valuable.This BFI Project demonstrated that hospitals could successfully implement Baby-Friendly practices in various Canadian settings despite challenges introduced by the COVID-19 pandemic. Indicators collected as part of this work demonstrate that delivery of Baby-Friendly care improved in participating facilities. Sustainability and scaling up BFI implementation in both hospitals and community health services across Canada through implementation of a BFI Coach Mentor Program is ongoing to enable continued progress and impact on breastfeeding and maternal-child health.

Background: The aim of this study is to evaluate the knowledge, perceptions, and attitude of the public in Pakistan (using social media) towards COVID-19. Methods: A cross-sectional study was conducted amongst 1120 individuals nationwide. A self-developed, pre-tested questionnaire was used that comprised of sections covering demographic characteristics, medical history, hygiene awareness, COVID-19-related knowledge, and learning attitude. Descriptive statistics were used for frequencies, percentages, averages and standard deviations. Inferential statistics were done using the Student’s t-test and ANOVA. Results: The average age of participants was 31 years (range 18-60 years). In total 56 individuals (5%) had completed primary or secondary school education; 448 (40%) were employed (working from home) and 60% were jobless due to the COVID-19 crisis. Almost all the study subjects (1030 (92%)) were washing their hands multiple times a day. A total of 83% had awareness regarding quarantine time, 82% used face masks whenever they left their homes, 98% were aware of the origin of the disease, and 70% had knowledge regarding the most common symptoms of COVID-19. Conclusion: It can be concluded from the current study that female participants had higher level of education, and more awareness regarding the coronavirus. The majority of the participants followed proper hand washing regimes and washed their faces. Further knowledge and awareness should be promoted.

Background: Cervical spine allow maximum and necessary movements for the functioning of head and sensory organs. Any issue with the flexibility and joint movement can be determined by assessing the cervical range of motion. Cervical range of motion (CROM) assessment is commonly used in clinical practice. The current study aims to find the effects of wearing a hijab on the cervical range of motion compared to the normal cervical range of motions. Methodology: A cross-sectional study was conducted among hijab-wearing female students from Bahria University Medical and Dental College, from November 2019 to January 2020. The study subjects were recruited using a CROM device. Hijab-wearing female students between 18–23 years of age who wear hijab for at least 3 months, with the duration of wearing hijab for at least or at most 6 hours/day were included in the study. Results: A total of 384 students were recruited. Mean Cervical flexion for wearing hijab ≤ 6 hours was 61.06 ± 17.19, and > 6 hours was 55.28 ± 16.09 (p 6 hours was 37.96 ± 10.94 (p=0.008). Mean Lateral flexion for wearing hijab ≤ 6 hours was 42.66 ± 10.32, and > 6 hours was 38.96 ± 11.01 (p=0.002). While mean right rotation for wearing hijab ≤ 6 hours was 59.50 ± 14.27, and 6 hours was 63.47 ± 14.13 (p=0.010). Moreover, the mean Left rotation for wearing hijab ≤ 6 hours was 64.66 ± 17.86, and >6 hours was 70.58 ± 14.34 (p=0.001). Conclusion: The routine wearing of the hijab affects cervical mobility. Moreover, it is concluded that wearing a hijab for > 6 hours greatly affects the range of the head for movement, by decreasing the cervical range of motion.

The presence of various organic pollutants in surface and ground waters has raised serious environmental threats across the world. In the present work, the solvothermal process was applied to prepare a ternary composite of barium defect-modified graphitic carbon nitride (DM g. C3N4) decorated with silver and titanium oxide for the photocatalytic removal of dyes and pesticides in visible light. Methylene blue (MB) and glyphosate were targeted pollutants. Enhanced structural defects in the carbon nitride framework were reported and characterized by using FTIR, SEM, EDS, XRD, and UV/Visible spectroscopy. Various analytical techniques confirmed the proficient coating of titanium oxide and silver on the surface of DM g. C3N4. The photocatalytic efficiency of synthesized materials for the degradation of persistent organic pollutants and various parameters such as the effect of pH, catalytic dosage, the concentration of pollutant, reusability of the catalyst, etc., were estimated by using UV/Visible spectroscopy. Batch experiments were performed to estimate the degradation efficiency and other parameters by using an absorption study. A scavenger analysis confirmed hydroxyl radicals as the main reactive species for the degradation of various pollutants. The results confirm that the ternary composite of barium DM g. C3N4 showed an increased response in the visible region, greater stability, and excellent photocatalytic efficiency toward the degradation of the organic compounds. The results confirm that the maximum degradation of the said organic pollutants occurs in 105 min.

Neurodevelopmental challenges in children born very preterm are common and not improving. This study tested the feasibility of using Evidence-based Practice to Improve Quality (EPIQ), a proven quality improvement technique that incorporates scientific evidence to target improving language abilities in very preterm populations in 10 Canadian neonatal follow-up programs. Feasibility was defined as at least 70% of sites completing four intervention cycles and 75% of cycles meeting targeted aims. Systematic reviews were reviewed and performed, an online quality improvement educational tool was developed, multidisciplinary teams that included parents were created and trained, and sites provided virtual support to implement and audit locally at least four intervention cycles of approximately 6 months in duration. Eight of ten sites implemented at least four intervention cycles. Of the 48 cycles completed, audits showed 41 (85%) met their aim. Though COVID-19 was a barrier, parent involvement, champions, and institutional support facilitated success. EPIQ is a feasible quality improvement methodology to implement family-integrated evidence-informed interventions to support language interventions in neonatal follow-up programs. Further studies are required to identify potential benefits of service outcomes, patients, and families and to evaluate sustainability.

Abstract Background Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. Methods A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. Results Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity’s beliefs and valueswith respect to preterm and LBW babies;health professionals’ acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. Conclusions Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.

الهدف من البحث: بناء مقياس المركزية واللامركزية في صنع قرارات الاتحاد العراقي المركزي لكرة السلة. التعرف على ترتيب عوامل مركزية ولامركزية صنع القرارات في الاتحاد العراقي المركزي لكرة السلة من وجهة نظر العاملين في الاتحادات الرياضية الفرعية. اُستخدم المنهج الوصفي بطريقة المسح لملاءمته ولطبيعة البحث، وتألفت العينة من قسمين، القسم الأول شمل عينة البناء التي بلغ عددها (108) أفراد عاملون في الاتحادات الرياضية الفرعية لكرة السلة في العراق، في حين شمل القسم الثاني عينة التطبيق التي بلغ عددها (40) فرداً عاملاً في الاتحادات الرياضية الفرعية لكرة السلة في العراق. من وسائل جمع البيانات: أداة لقياس المركزية واللامركزية في صنع القرارات: قام الباحثان ببناء مقياس المركزية واللامركزية في صنع القرارات لدى الاتحاد العراقي لكرة السلة بعد أن توافرت الشروط العلمية للمقياس، وقد تضمن المقياس (20) فقرة. عُولجت البيانات إحصائياً باستخدام: الوسط الحسابي والانحراف المعياري وقانون النسبة المئوية والمتوسط الفرضي ومعامل ألفا ومعادلة جتمان، واُستخدمت معادلة سبيرمان براون. أهم الاستنتاجات هي: صلاحية مقياس المركزية واللامركزية في صنع القرارات في قياس طبيعة صنع قرارات الاتحاد العراقي لكرة السلة. أسلوب صنع قرارات الاتحاد العراقي لكرة السلة هو الأسلوب اللامركزي من وجهة نظر العاملين في الاتحادات الرياضية الفرعية. وفي ضوء النتائج قدم الباحثان عدداً من التوصيات من أهمها: تطبيق مقياس المركزية واللامركزية في صنع القرارات بعد تكييفه بطريقة علمية على اتحادات أخرى في أنحاء العراق كافة. ضرورة استمرارية الاتحاد العراقي لكرة السلة في دعم التوجه نحو اللامركزية في صنع القرارات، وذلك بمنح العاملين في الاتحادات الرياضية الفرعية المزيد من الصلاحيات الضرورية للقيام بواجباتهم بمرونة وفاعلية، وطرح القضايا المطلوب اتخاذ قرار بشأنها ومناقشتها مع العاملين الذين يقع على عاتقهم تنفيذ القرار. على القيادات الإدارية في الاتحاد العراقي المركزي لكرة السلة أن تقوم بالإجراء المناسب الذي يضمن المشاركة الأوسع للعاملين في الاتحادات الرياضية الفرعية في عملية صنع القرارات بشكل فعال وذلك من خلال زيادة عقد الاجتماعات وفتح قنوات الاتصال كافة معهم والقيام بزيارات ميدانية إلى المحافظات. وقدم الباحثان المقترحين الآتيين: إجراء دراسة مقارنة في مركزية ولامركزية صنع قرارات الاتحاد العراقي لكرة السلة مع اتحادات أُخر. 2. العمل على إصدار قانون لتفرغ العاملين في الاتحادات الرياضية للقيام بمهامهم في الاتحادات مع الاحتفاظ بحقوقهم الرسمية في المؤسسات التي يعملون بها، وذلك من أجل أن تتاح لهم فرصة الإبداع، وتقديم الخدمات في كلتا الوظيفتين.

Abstract Background Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits. Methods In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge. Results We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P = .02. Secondary outcomes were not significantly different between groups. Conclusions Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings. Trial registration ClinicalTrials.gov Identifier NCT02879799 , retrospectively registered August 26, 2016.

OBJECTIVES: The purpose of this study is to compare the critical view of safety technique with the infundibular technique in laparoscopic cholecystectomy in terms of mean operative time and bile duct injuries (BDI). METHODOLOGY: Between 2018 and 2020, 220 patients had laparoscopic cholecystectomy in the Surgical "A" unit at Hayatabad Medical Complex in Peshawar, Pakistan. The patients were divided into two groups, with the first receiving a critical view of safety and the second receiving an infundibular procedure. Operation time and bile duct injury were compared between the two groups. RESULTS: The operative time was significantly reduced with the critical view of safety (CVS) approach, with a mean time of 35.07 minutes for CVS and 40.58 minutes for infundibular technique, with a significant P-value (0.013). About 17 (7.7%) cases required open cholecystectomy; the conversion rate was higher in the infundibular group, with a significant P-value (

The sorption capacity of cadmium (Cd (II)) on three new generated nanocomposite beads sodium alginate (SA) based; SA-Clay (SA-C) beads, SA-Phosphate (SA-P) beads, and SA- Activated Charcoal (SA-Ch) beads was investigated in a batch scale, then a continuous flow reactor.The highest adsorption capacity (137 mg/g) was obtained for SA-Ch using 1000 mg/L of initial Cd (II). The isotherm results showed that the adsorption equilibrium is compatible with the Langmuir isotherm and the sorption capacity of SA-Nano-adsorbent beads is very high. The models used for representing kinetic data was given that the removal of Cd (II) be well-fitted by second-order reaction kinetics. For the fixed bed column treatment, the maximum breakthrough times were 30, 38, and 48 h respectively for the SA-C, SA-P, and SA-Ch.According to the obtained results, it was concluded that SA-Nano-adsorbent bead is an excellent designed material as a nanocomposite for cadmium elimination from wastewater in a continuous treatment process.

Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.

Background: Online learning or E-learning are approaches to broadcasting teaching by the means of internet technology and software applications. Kingdom of Saudi Arabia is likewise embarking on the rapid growth in online education. The purpose of this study is to investigate the student’s perceptions regarding online teaching and learning during COVID 19. Methods: An online computer-based cross-sectional study was conducted between May and June 2020. A pre-validated questionnaire was used and administrated to health sciences students studying at Dammam Universities through online software QuestionPro. Results: Out of total 281, 68% of the participants were females (n=188) while 31.9% (n=88) were male students with an average age of 23.1(4.5) years. Overall, 176 (62%) of the students expressed their satisfaction with online learning. Conclusion: Findings will help academicians to identify strengths, areas of improvement, and encourage faculty to think deeply to restructure course learning objectives, teaching techniques to engage students and improve learning process.

COVID-19 is an infectious disease that affects the respiratory system and is caused by the novel coronavirus SARS-CoV-2. It was first reported in Wuhan, China, on December 31, 2019, and has affected the entire world. This pandemic has caused serious health, economic and social problems. In this situation, the only solution to combat COVID-19 is to accelerate the development of antiviral drugs and vaccines to mitigate the virus and develop better antiviral methods and excellent diagnostic and prevention techniques. With the development of nanotechnology, nanoparticles are being introduced to control COVID-19. Graphene oxide (GO), an oxidized derivative of graphene, is currently used in the medical field to treat certain diseases such as cancer. It is characterized by very important antiviral properties that allow its use in treating certain infectious diseases. The GO antiviral mechanism is discussed by the virus inactivation and/or the host cell receptor or by the physicochemical destruction of viral species. Moreover, the very high surface/volume ratio of GO allows the fixation of biomolecules by simple absorption. This paper summarizes the different studies performed on GO's antiviral activities and discusses GO-based biosensors for virus detection and approaches for prevention.

Objective: This study aimed to determine the range of weight loss, at 3 days postnatal age, associated with the lowest risk of mortality/short-term morbidity in preterm infants

Adaptations have been proposed for resuscitation of infants born to women with COVID-19, to protect health care providers, maintain infection control, and limit post-natal transmission. Changes especially impact respiratory procedures, personal protective equipment (PPE) use, resuscitation environments, teamwork, and family involvement. Adding viral filters to ventilation devices and modifications to intubation procedures might hinder effective ventilation. PPE could delay resuscitation, hinder task performance, and degrade communication. Changes to resuscitation locations and team composition alter workflow and teamwork. Physical distancing measures and PPE impede family-integrated care. These disruptions need to be considered given the uncertainty of vertical transmission of SARS-CoV-2.

Abstract Background Breastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Additionally, current practitioner-focused care provision in the NICU can result in decreased breastfeeding self-efficacy (BSE), which is predictive of breastfeeding rates in mothers of preterm infants at 6 weeks postpartum. Methods Family Integrated Care (FICare) integrates and supports parents to actively participate in the care of their infant while in the NICU. Nested within the broader FICare trial, we will conduct an explanatory sequential mixed methods study to investigate if FICare improves maternal BSE and rates of breastmilk feeding in moderate and late preterm infants at discharge from the NICU. In phase 1, we will calculate the mean difference between admission and discharge BSE scores for the intervention group. Mothers who score in the top and bottom 20th percentile of change scores will be invited to participate in a semi-structured telephone interview exploring maternal experiences with infant feeding in the NICU. We will conduct inductive thematic analysis to identify and describe the facilitators and barriers of FICare on maternal feeding experiences. Once data saturation is achieved and themes have been established, phase 2 will revisit the quantitative data to determine whether FICare was impactful on BSE and breastmilk feeding rates. Findings from the qualitative and quantitative phases will be integrated to determine how infant feeding experiences on FICare units work to improve or detract from maternal BSE and rates of breastmilk feeding. Discussion FICare may help to improve maternal BSE and rates of breastmilk feeding in moderate and late preterm infants. Improved breastmilk feeding outcomes can have a substantial impact on overall infant health, developmental outcomes, and maternal-infant bonding and will help to improve long-term health outcomes for moderate and late preterm infants. Trial registration (NCT02879799). Registered May 27, 2016 protocol version June 9, 2016 Version 2.

Abstract Background Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [320/7] to 336/7 weeks) and late preterm (340/7 to 366/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs. Methods We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study. Discussion Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare. Trial registration ClinicalTrials.gov, ID: NCT02879799 . Registered on 27 May 2016. Protocol version: 9 June 2016; version 2.

After publication of our article [1], the authors have reported mathematical errors made in the sample size calculation for this cluster randomized controlled trial (cRCT) (Benzies et al. 2017).

Background: Adverse birth outcomes (ABO) such as prematurity and small for gestational age confer a high risk of mortality and morbidity. ABO have been linked to air pollution; however, relationships with mixtures of industrial emissions are poorly understood. The exploration of relationships between ABO and mixtures is complex when hundreds of chemicals are analyzed simultaneously, requiring the use of novel approaches. Objective: We aimed to generate robust hypotheses spatially linking mixtures and the occurrence of ABO using a spatial data mining algorithm and subsequent geographical and statistical analysis. The spatial data mining approach aimed to reduce data dimensionality and efficiently identify spatial associations between multiple chemicals and ABO. Methods: We discovered co-location patterns of mixtures and ABO in Alberta, Canada (2006–2012). An ad-hoc spatial data mining algorithm allowed the extraction of primary co-location patterns of 136 chemicals released into the air by 6279 industrial facilities (National Pollutant Release Inventory), wind-patterns from 182 stations, and 333,247 singleton live births at the maternal postal code at delivery (Alberta Perinatal Health Program), from which we identified cases of preterm birth, small for gestational age, and low birth weight at term. We selected secondary patterns using a lift ratio metric from ABO and non-ABO impacted by the same mixture. The relevance of the secondary patterns was estimated using logistic models (adjusted by socioeconomic status and ABO-related maternal factors) and a geographic-based assignment of maternal exposure to the mixtures as calculated by kernel density. Results: From 136 chemicals and three ABO, spatial data mining identified 1700 primary patterns from which five secondary patterns of three-chemical mixtures, including particulate matter, methyl-ethyl-ketone, xylene, carbon monoxide, 2-butoxyethanol, and n-butyl alcohol, were subsequently analyzed. The significance of the associations (odds ratio > 1) between the five mixtures and ABO provided statistical support for a new set of hypotheses. Conclusion: This study demonstrated that, in complex research settings, spatial data mining followed by pattern selection and geographic and statistical analyses can catalyze future research on associations between air pollutant mixtures and adverse birth outcomes. Keywords: Adverse birth outcomes, Air pollution, Industrial air emissions, Spatial data mining, BTEX group, Particulate matter

In addition to small for gestational age (SGA) and low birth weight at term (LBWT), critically ill cases of SGA/LBWT are significant events from outcomes and economic perspectives that require further understanding of risk factors. We aimed to assess the spatiotemporal distribution of locations where there were consistently higher numbers of critically ill SGA/LBWT (hot spots) in comparison with all SGA/LBWT and all births. We focused on Edmonton (2008-2010) and Calgary (2006-2010), Alberta, and used a geographical information system to apply emerging hot spot analysis, as a new approach for understanding SGA, LBWT, and the critically ill counterparts (ciSGA or ciLBWT). We also compared the resulting aggregated categorical patterns with proportions of land use and socioeconomic status (SES) using Spearman correlation and logistic regression. There was an overall increasing trend in all space-time clusters. Whole period emerging hot spot patterns among births and SGA generally coincided, but SGA with ciSGA and LBWT with ciLBWT did not. Regression coefficients were highest for low SES with SGA and LBWT, but not with ciSGA and ciLBWT. Open areas and industrial land use were most associated with ciLBWT but not with ciSGA, SGA, or LBWT. Differences in the space-time hot spot patterns and the associations with ciSGA and ciLBWT indicate further need to research the interplay of maternal and environmental influences. We demonstrated the novel application of emerging hot spot analysis for small newborns and spatially related them to the surrounding environment.

Background: Melasma Area and Severity Index (MASI), the scoring system in melasma, needs to be refined. Aims and Objectives: To propose a more practical scoring system, named as Melasma Severity Index (MSI), for assessing the disease severity and treatment response in melasma. Materials and Methods: Four dermatologists were trained to calculate MASI and also the proposed MSI scores. For MSI, the formula used was 0.4 (a × p 2 ) l + 0.4 (a × p 2 ) r + 0.2 (a × p 2 ) n where "a" stands for area, "p" for pigmentation, "l" for left face, "r" for right face, and "n" for nose. On a single day, 30 enrolled patients were randomly examined by each trained dermatologist and their MASI and MSI scores were calculated. Next, each rater re-examined every 6 th patient for repeat MASI and MSI scoring to assess intra- and inter-rater reliability of MASI and MSI scores. Validity was assessed by comparing the individual scores of each rater with objective data from mexameter and ImageJ software. Results: Inter-rater reliability, as assessed by intraclass correlation coefficient, was significantly higher for MSI (0.955) as compared to MASI (0.816). Correlation of scores with objective data by Spearman′s correlation revealed higher rho values for MSI than for MASI for all raters. Limitations: Sample population belonged to a single ethnic group. Conclusions: MSI is simpler and more practical scoring system for melasma.

In the last decade, pathogenic bacteria and organic micropollutants have become a major issue in the water purification process. Heterogeneous photocatalysis is a low-cost and an ecofriendly process, which provides a sustainable solution for water treatment and its utilization in rural areas. In this context, we studied the generation and the surface engineering of polyacrylonitrile (PAN)/goethite composite nanofibers for photocatalytic water remediation under visible-light illumination. The photocatalytic activity was evaluated for dye (methylene blue) degradation and bacteria inactivation, as contaminant models, of the composite nanofibers. The PAN/goethite nanofibers were elaborated by an electrospinning technique, and the morphology and the composition, before and after spin coating, were investigated by Scanning Electron Microscopy (SEM) and Energy Dispersive X-Ray (EDX). The results showed partially intercalated structures of the PAN/goethite Composite-nano-fiber (CNF) were identified by SEM and EDX analysis. The composite nanofibers exhibited high photoefficiency upon dye bleaching (only 10% left after 5 h of illumination) and bacterial deactivation Escherichia coli and Clostridium perfringens (4.4- and 3.5-fold, respectively, in less than 5 h). The steadiness and pliancy of the generated nanofibers provide a promising application in the continuous flow system.

Abstract Miller–Dieker syndrome (MDS) is a rare genetic syndrome associated with lissencephaly, developmental delay, and high mortality. We describe a patient who was diagnosed postnatally with both MDS and congenital lobar emphysema. We believe that this is the first reported case of the two conditions presenting in the same patient.

If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT) to achieve gas exchange.The aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO2), VT, and rate of carbon dioxide elimination (VCO2) to assess lung aeration in preterm infants requiring respiratory support immediately after birth.A prospective observational study was performed between March and July 2013. Infants born at

To describe temporal changes in systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively) in term and preterm infants immediately after birth.Prospective observational two-center study. In term infants SBP, DBP, and MBP were assessed non-invasively every minute for the first 15 minutes, and in preterm infants every minute for the first 15 minutes, as well as at 20, 25, 30, 45, and 60 minutes after birth. Regression analyses were performed by gender and respiratory support in all neonates; and by mode of delivery, cord clamping time, and development of ultrasound-detected brain injury in preterm neonates.Term infants (n = 54) had a mean (SD) birth weight of 3298 (442) g and gestational age of 38 (1) weeks, and preterm infants (n = 94) weighed 1340 (672) g and were 30 (3) weeks gestation. Term infants' SBP, DBP and MBP within the first 15 minutes after birth were independent of gender or respiratory support. Linear mixed regression analysis showed that preterm infants, who were female, born vaginally, had delayed cord clamping and did not require positive pressure ventilation nor develop periventricular injury or ventriculomegaly, had significantly higher SBP, DBP, and MBP at some measurement points within the first hour after birth.We present novel reference ranges of BP immediately after birth in a cohort of term and preterm neonates. They may aid in optimization of cardiovascular support during early transition at all gestations.

Although recent advances in neonatal care have improved survival rates, rates of bronchopulmonary dysplasia remain unchanged. Although neonatologists are increasingly applying gentle ventilation strategies in the neonatal intensive care unit, the same emphasis has not been applied immediately after birth. A lung-protective strategy should start with the first breath to help in the establishment of functional residual capacity, facilitate gas exchange, and reduce volutrauma and atelectotrauma. This paper will discuss techniques and equipment during breathing assistance in the delivery room.

Background: Chronic autoimmune urticaria (CAU) is one of the most challenging therapeutic problems faced by a dermatologist. Recently, weekly autologous serum injections have been shown to induce a prolonged remission in this disease. Aim: To evaluate the efficacy of repeated autologous serum injections in patients with CAU. Materials and Methods: Seventy patients of CAU were prospectively analyzed for the efficacy of nine consecutive weekly autologous serum injections with a post-intervention follow-up of 12 weeks. Total urticaria severity score (TSS) was monitored at the baseline, at the end of treatment and lastly at the end of 12 weeks of follow up. Response to treatment was judged by the percentage reduction in baseline TSS at the end of treatment and again at the end of 12 weeks-follow-up. Results: Out of the 70 patients enrolled, 11 dropped out of the injection treatment after one or the first few doses only. Among the rest of 59 patients, only 7 patients (12%) went into a partial or complete remission and remained so over the follow-up period of 12 weeks. Forty patients (68%) did not demonstrate any significant reduction in TSS at the end of the treatment period. Rest of the 12 patients showed either a good or excellent response while on weekly injection treatment, but all of them relapsed over the follow-up period of 12 weeks. Conclusion: Autologous serum therapy does not seem to lead to any prolonged remission in patients of CAU.

Background: The aim of this study is to evaluate the knowledge, perceptions, and attitude of the public in Pakistan (using social media) towards COVID-19. Methods: A cross-sectional study was conducted amongst 1120 individuals nationwide. A self-developed, pre-tested questionnaire was used that comprised of sections covering demographic characteristics, medical history, hygiene awareness, COVID-19-related knowledge, and learning attitude. Descriptive statistics were used for frequencies, percentages, averages and standard deviations. Inferential statistics were done using the Student’s t-test and ANOVA. Results: The average age of participants was 31 years (range 18-60 years). In total 56 individuals (5%) had completed primary or secondary school education; 448 (40%) were employed (working from home) and 60% were jobless due to the COVID-19 crisis. Almost all the study subjects (1030 (92%)) were washing their hands multiple times a day. A total of 83% had awareness regarding quarantine time, 82% used face masks whenever they left their homes, 98% were aware of the origin of the disease, and 70% had knowledge regarding the most common symptoms of COVID-19. Conclusion: It can be concluded from the current study that female participants had higher level of education, and more awareness regarding the coronavirus. The majority of the participants followed proper hand washing regimes and washed their faces. Further knowledge and awareness should be promoted.

Background: The aim of this study is to evaluate the knowledge, perceptions, and attitude of the public in Pakistan (using social media) towards COVID-19. Methods: A cross-sectional study was conducted amongst 1120 individuals nationwide. A self-developed, pre-tested questionnaire was used that comprised of sections covering demographic characteristics, medical history, hygiene awareness, COVID-19-related knowledge, and learning attitude. Descriptive statistics were used for frequencies, percentages, averages and standard deviations. Inferential statistics were done using the Student’s t-test and ANOVA. Results: The average age of participants was 31 years (range 18-60 years). In total 56 individuals (5%) had completed primary or secondary school education; 448 (40%) were employed (working from home) and 60% were jobless due to the COVID-19 crisis. Almost all the study subjects (1030 (92%)) were washing their hands multiple times a day. A total of 83% had awareness regarding quarantine time, 82% used face masks whenever they left their homes, 98% were aware of the origin of the disease, and 70% had knowledge regarding the most common symptoms of COVID-19. Conclusion: It can be concluded from the current study that female participants had higher level of education, and more awareness regarding the coronavirus. The majority of the participants followed proper hand washing regimes and washed their faces. Further knowledge and awareness should be promoted.