Castillomcdermott7452

Objective It is important to train clinicians to maintain and optimise maternal and neonatal outcomes after vaginal twin delivery. Simulation-based training provides opportunities for training in a realistic way without harming patients. The aim of this study is to evaluate the effect of simulation-based training concerning twin vaginal delivery on knowledge and comfort of obstetrician-gynaecologists. Study design Obstetrician-gynaecologists participated in a twin vaginal delivery simulation between March 2018 and May 2019. Simulation-based training consisted of standardized patient interviews, didactic sessions and three different simulation-based scenarios internal podalic version and breech extraction, assisted vaginal delivery and vaginal breech delivery with problems of aftercoming head. Pre- and posttraining, participants were asked to fill out questionnaires exploring knowledge concerning vertex-vertex twin deliveries and vertex-nonvertex twin deliveries, level of comfort performing various obstetric md to 73.5% after training (p = 0.07). Conclusions Simulation-based training results in beneficial effects on knowledge and comfort concerning vaginal twin deliveries for obstetrician-gynaecologists. This training suggested a potential impact on provider practice with a more favourable attitude towards twin vaginal birth.Objective To examine the associations of maternal age at the start of pregnancy across the full range with second and third trimester uterine and umbilical artery flow indices, and placental weight. Study design In a population-based prospective cohort study among 8271 pregnant women, we measured second and third trimester uterine artery resistance and umbilical artery pulsatility indices and the presence of third trimester uterine artery notching using Doppler ultrasound. Results Compared to women aged 25-29.9 years, higher maternal age was associated with a higher third trimester uterine artery resistance index (difference for women 30-34.9 years was 0.10 SD (95% Confidence Interval (CI) 0.02 to 0.17), and for women aged ≥40 years 0.33 SD (95% CI 0.08 to 0.57), overall linear trend 0.02 SD (95% CI 0.01 to 0.03) per year). Compared to women aged 25-29.9 years, women younger than 20 years had an increased risk of third trimester uterine artery notching (Odds Ratio (OR) 1.97 (95% CI 1.30-3.00)). A linear trend was present with a decrease in risk of third trimester uterine artery notching per year increase in maternal age (OR 0.96 (95% CI 0.94 to 0.98)). Maternal age was not consistently associated with umbilical artery pulsatility indices or placental weight. Conclusions Young maternal age is associated with higher risk of third trimester uterine artery notching, whereas advanced maternal age is associated with a higher third trimester uterine artery resistance index, which may predispose to an increased risk of pregnancy complications.Sleep disruption severely impairs learning ability, affecting academic performance in students. This systematic review and meta-analysis aimed at assessing the prevalence of sleep disruption in medical students and its relationship with academic performance. AXL1717 cost PubMed, Web of Sciences, EBSCO and SciELO databases searches allowed to retrieve 41 papers with data about the prevalence of sleep deprivation, 20 of which also contained data on its association with academic performance. Poor sleep quality was reported by 5646 out of 14,170 students in 29 studies (39.8%, 95% confidence interval = 39.0-40.6%), insufficient sleep duration by 3762/12,906 students in 28 studies (29.1%, 23.3-29.9%) and excessive diurnal sleepiness by 1324/3688 students in 13 studies (35.9%, 34.3-37.4). Academic grades correlated significantly with sleep quality scores (r, 95% CI = 0.15, 0.05-0.26, random-effects model; p = 0.002, n = 10,420 subjects, k = 15 studies) and diurnal sleepiness (r = -0.12, -0.19/-0.06 under the fixed effects model, p less then 0.001, n = 1539, k = 6), but not with sleep duration (r = 0.03, -0.12/0.17 under the random-effects model, p = 0.132, n = 2469, k = 9). These findings advocate for an urgent intervention aiming at improving sleep quality among medical students as a way of increasing academic achievements and, ultimately, the quality of health care.The effect of acetate (HAc) and propionate (HPr) on denitrifying phosphorus removal (DPR) was evaluated in a novel two-sludge A2/O - MBBR (anaerobic/anoxic/oxic - moving bed biofilm reactor) system. Results showed that it was the carbon source transformation and utilization especially the composition of poly-β-hydroxyalkanoates (PHA) (mainly poly-β-hydroxybutyrate (PHB) and poly-bhydroxyvalerate (PHV)) decided DPR performance, where the co-exist of HAc and HPr promoted the optimal nitrogen (85.77%) and phosphorus (91.37%) removals. It facilitated the balance of PHB and PHV and removing 1 mg NO3- (PO43-) consumed 3.04-4.25 (6.84-9.82) mgPHA, where approximately 40-45% carbon source was saved. Mass balance revealed the main metabolic pathways of carbon (MAn,C (consumed amount in anaerobic stage) and MA-O,C (consumed amount in anoxic and oxic stages) 66.38-76.19%), nitrogen (MDPR,N (consumed amount in DPR) 57.01-65.75%), and phosphorus (MWS,P (discharged amount in waste sludge) 81.05-85.82%). Furthermore, the relative abundance and microbial distribution were assessed to elucidate DPR mechanism (e.g. Accumulibacter, Acinetobacter, Dechloromonas, Competibacter, and Defluviicoccus) in the A2/O reactor and nitrification performance (e.g. Nitrosomonas, Nitrosomonadaceae and Nitrospira) in the MBBR. Carbon source was demonstrated as the key point to stimulate the biodiversity and bioactivity related to DPR potential, and the operational strategy of carbon source addition was proposed based on the utilizing rules of HAc and HPr.Cadmium (Cd) and lead (Pb) are two typical heavy metals of the Jialing River, and their threat to the river has been considered by the government in recent years. In this study, the diffusive gradient in thin films (DGT) technique and sequential extraction were employed together to analyse the remobilization and fraction of Cd and Pb in the sediments. The total concentration of Cd and Pb in four sampling sites both followed the order S3>S4>S2>S1. The sequential extraction results indicated that large amounts of Cd and Pb (over 50% of the total concentration) were bound to the exchangeable and reducible fraction. The DGT results showed that both Cd and Pb presented a significant increasing trend at the bottom of the DGT probe (-10 cm to -12 cm) and that the two metals had a significant positive correlation (r = 0.831, p less then 0.01). The apparent diffusive flux result indicated that Cd and Pb had a potential risk of release from surface sediments. A significant correlation was observed between the DGT-labile fraction and sequential extraction at the surface sediments. A further correlation analysis found that the concentration of labile Cd/Pb measured by DGT (CDGT-Cd and CDGT-Pb) had a strong negative correlation with CDGT-Fe, and this process was mainly mitigated by the iron oxides in the sediments. In addition, the correspondence of a "dark area" of AgI gel with corresponding "hotspots" of Chelex gel also proved that the release of Cd and Pb may regulate the dissolved sulfide in the sediments.Deltamethrin is used widely in Eriocheir sinensis aquaculture to remove wild fish and parasites. The residual deltamethrin greatly affects the growth and quality of E. sinensis. In this study, the LC50 of deltamethrin against E. sinensis at 24, 48 and 96 h was determined to be 6.5, 5.0 and 2.8 μg/L, respectively. link2 The enzyme activity and gene transcription of SOD, CAT, and PO in the hepatopancreas of E. sinensis after deltamethrin stimulation showed an increasing tendency, and these enzymes reached their maximum activities at 6-10 d. The MDA content accumulated with increased time of deltamethrin stress. After 15 d of deltamethrin stress, the hepatopancreas of E. sinensis was found to be damaged based on HE staining. These results showed that deltamethrin is highly toxic to E. sinensis. But the half-life of deltamethrin is long and mainly relies on biodegradation. To resolve the pollution of residual deltamethrin, a strain of deltamethrin-degrading bacteria, P-2, was isolated from the sediment of an E. sinensis culture pond. Through morphological observation, physiological and biochemical identification and 16S rDNA sequence analysis, we found that this strain belonged to Paracoccus sp. When the pH was 7, the substrate concentration was low, the inoculation amount was high, and the deltamethrin degradation effect of Paracoccus sp. P-2 was good. The deltamethrin residue in the hepatopancreas and muscle of E. sinensis decreased significantly when Paracoccus sp. P-2 was added at 6.0 × 108 CFU/L. The degradation efficiency of Paracoccus sp. P-2 in the hepatopancreas and muscle was more than 70%. These results showed that Paracoccus sp. P-2, the first deltamethrin-degrading bacterium in aquaculture, could be used to remove residual deltamethrin and improve the food safety of E. link3 sinensis.Microcystin-leucine arginine (MC-LR) is a potent liver toxin produced by freshwater cyanobacteria, also known as blue-green algae. While harmful algal blooms are increasing in frequency and severity worldwide, there is still no established method for the diagnosis and assessment of MC-LR induced liver damage. The guidelines for MC-LR safe exposure limits have been previously established based on healthy animal studies, however we have previously demonstrated that pre-existing non-alcoholic fatty liver disease (NAFLD) increases susceptiblity to the hepatotoxic effects of MC-LR. In this study, we sought to investigate the suitability of clinically used biomarkers of liver injury, specifically alanine aminotransferase (ALT) and alkaline phosphatase (ALP), as potential diagnostic tools for liver damage induced by chronic low dose administration of MC-LR in the setting of pre-existing NAFLD. In our Leprdb/J mouse model of NAFLD, we found that while MC-LR induced significant histopathologic damage in the setting of NAFLD, gene expression of ALT and ALP failed to increase with MC-LR exposure. Serum ALT and ALP also failed to increase with MC-LR exposure, except for a moderate increase in ALP with the highest dose of MC-LR used (100 μg/kg). In HepG2 human liver epithelial cells, we observed that increasing MC-LR exposure levels do not lead to an increase in ALT or ALP gene expression, intracellular enzyme activity, or extracellular activity, despite a significant increase in MC-LR induced cytotoxicity. These findings demonstrate that ALT and ALP may be unsuitable as diagnostic biomarkers for MC-LR induced liver damage.Background and objective Affect provides contextual information about the emotional state of a person as he/she communicates in both verbal and/or non-verbal forms. While human's are great at determining the emotional state of people while they communicate in person, it is challenging and still largely an unsolved problem to computationally determine the emotional state of a person. Methods Emotional states of a person manifest in the physiological biosignals such as electrocardiogram (ECG) and electrodermal activity (EDA) because these signals are impacted by the peripheral nervous system of the body, and the peripheral nervous system is strongly coupled with the mental state of the person. In this paper, we present a method to accurately recognize six emotions using ECG and EDA signals and applying autoregressive hidden Markov models (AR-HMMs) and heart rate variability analysis on these signals. The six emotions include happiness, sadness, surprise, fear, anger, and disgust. Results We evaluated our method on a comprehensive new dataset collected from 30 participants.