Retention and the Intersection of Structural Inequities in a Breastfeeding Intervention Study.

Introduction: Women below the poverty threshold have lower representation and retention in breastfeeding studies. Methods: A secondary analysis of a longitudinal randomized controlled self-management for breast and nipple pain during breastfeeding study. Participants completed online surveys at discharge, weeks 1, 2, 3, 6, 9, 12, 18, and 24, with face-to-face interviews at 6 and 24 weeks. Text messages were sent to participants when modules and surveys were due. Retention was assessed in R with descriptive statistics, Mann-Whitney, Pearson's chi-square, and Cox Proportional Hazard Regression. Results: Two hundred and forty-four women (89 ≤$50,000 and 155 >$50,000) were recruited. Retention rates at 1 (93%), 2 (87%), 6 (82%), 9 (77%) and 24 (72%) weeks. For women of low income compared to those of high income there was a hazard ratio (HR) of 2.5 (p=0.0001) for retention. For non-Hispanic Black and Hispanic women compared to the combined non-Hispanic White and Other group, HRs for retention were 3.3 and 2.6 respectively (p=0.0001). Adjustment for age in the final hazard regression model of income, age, race and ethnicity decreased the HR for women of low income to 1.6 and HRs for non-Hispanic Black and Hispanic women to 2.1 and 1.9, respectively (p=.0001). However, none of the individual factors in the model achieved statistical significance. Discussion: Retention in breastfeeding studies impacts breastfeeding duration, a key lifelong preventative health behavior. Despite accessible study design, retention of women desiring to breastfeed was adversely affected by the intersection of income, race and ethnicity, and age.

Pain/Stress, Mitochondrial Dysfunction and Neurodevelopment in Preterm Infants.

Introduction Preterm infants experience tremendous early life pain/stress during their neonatal intensive care unit (NICU) hospitalization, which impacts their neurodevelopmental outcomes. Mitochondrial function/dysfunction may interface between perinatal stress events and neurodevelopment. Nevertheless, the specific proteins or pathways linking mitochondrial functions to pain-induced neurodevelopmental outcomes in infants are remain unidentified. Our study aims to investigate the associations among pain/stress, proteins associated with mitochondrial function/dysfunction, and neurobehavioral responses in preterm infants. Methods We conducted a prospective cohort study, enrolling 33 preterm infants between September 2017 and July 2022 at two affiliated NICUs located in Hartford and Farmington, CT. NICU Network Neurobehavioral Scale (NNNS) datasets were evaluated to explore potential association with neurobehavioral outcomes. The daily pain/stress experienced by infant's during their NICU stay was documented. At 36-38 weeks post-menstrual age (PMA), neurobehavioral outcomes were evaluated using the NNNS and buccal swabs were collected for further analysis. Mass spectrometry-based proteomics was conducted on epithelial cells obtained from buccal swabs to evaluate protein expression level. Lasso statistical methods were conducted to study the association between protein abundance and infants' NNNS summary scores. Multiple linear regression and Gene Ontology (GO) enrichment analyses were performed to examine how clinical characteristics and neurodevelopmental outcomes may be associated with protein levels and underlying molecular pathways. Results During NICU hospitalization, preterm premature rupture of membrane (PPROM) were negatively associated with neurobehavioral outcomes. The protein functions including leptin receptor binding activity, glutathione disulfide oxidoreductase activity and response to oxidative stress, lipid metabolism, phosphate and proton transmembrane transporter activity were negatively associated with neurobehavioral outcomes, in the contrast, cytoskeletal regulation, epithelial barrier and protection function were found to be associated with the optimal neurodevelopmental outcomes. In addition, mitochondrial function associated proteins including SPRR2A, PAIP1, S100A3, MT-CO2, PiC, GLRX, PHB2, and BNIPL-2 demonstrated positive association with favorable neurodevelopmental outcomes, while proteins of ABLIM1, UNC45A, Keratins, MUC1, and CYB5B showed positive association with adverse neurodevelopmental outcomes. Conclusion Mitochondrial function-related proteins were observed to be associated with early life pain/stress and neurodevelopmental outcomes in infants. Large-scale studies with longitudinal datasets are warranted. Buccal proteins could be used to predict potential neurobehavioral outcomes.

Nanoscale Insight into the Effect of Calcium on Early-Age Polymerization of CNASH Gels.

Sodium-containing calcium-alumino-silicate-hydrate (CNASH) gels, the primary binder phase of alkali-activated materials (AAMs), significantly impact the performance of the AAM. Although the effect of the calcium content on the AAM has been extensively studied in the past, few studies focus on the effect of calcium on the structure and performance of gels at a molecular scale. As an important element in gels, the effect of calcium in gels on its atomic-scale properties remains unclear. This study establishes a molecular model of the CNASH gel via reactive molecular dynamics (MD) simulation and verifies the feasibility of the gel model. By employing the reactive MD, the effect of calcium on the physicochemical properties of gels in the AAM is investigated. The simulation highlights that the condensation process of the system containing Ca is accelerated dramatically. This phenomenon is explained from the perspective of thermodynamics and kinetics. The increased calcium content enhances the thermodynamic stability and reduces the energy barrier of the reaction. Then, the phenomenon is further analyzed through the nanosegregation in the structure. It is proved that this behavior is driven by the weaker affinity of calcium for aluminosilicate chains than the particles in the aqueous environment. The difference in affinity leads to nanosegregation in the structure, making Si(OH)4 and Al(OH)3 monomers and oligomers closer for better polymerization.

Impact of rumination on sleep quality among patients with non­alcoholic fatty liver disease: a moderated mediation model of anxiety symptoms and resilience.

BACKGROUND: Poor sleep raises the risk of non-alcoholic fatty liver disease (NAFLD) and hastens disease progression. It is critical to figure out what factors impact the sleep quality of NAFLD patients. The present study aimed to investigate the role of anxiety symptoms in accounting for the impact of rumination on sleep quality and the moderating role of resilience on the associations of rumination with anxiety symptoms and sleep quality. METHODS: In the cross-sectional study, 285 NAFLD patients completed the Chinese version of the Pittsburgh Sleep Quality Index, the Ruminative Responses Scale, the Generalized Anxiety Disorder 7-item scale, and the 14-item Resilience Scale to measure sleep quality, rumination (including brooding and reflection), anxiety symptoms, and resilience, respectively. The PROCESS macro for SPSS v4.0 procedure was applied to perform moderated mediation analysis. RESULTS: The roles of anxiety symptoms in accounting for the positive associations of brooding, reflection and rumination with poor sleep quality were revealed. It was found that there was a significant moderating role of resilience on the positive associations of brooding, reflection and rumination with anxiety symptoms, which were gradually reduced as resilience increased. The direct associations between brooding, reflection and rumination and poor sleep quality were not significantly moderated by resilience. Thus, a moderated mediation model involving anxiety symptoms and resilience for explaining the impact of rumination on poor sleep quality was supported among patients with NAFLD. CONCLUSIONS: Rumination (including brooding and reflection) could be positively related to poor sleep quality, and anxiety symptoms had a significant role in accounting for the relationship among patients with NAFLD. Resilience showed a moderating role that could attenuate the positive association between rumination and anxiety symptoms. Interventions aimed at alleviating rumination, reducing anxiety symptoms, and enhancing resilience could improve the sleep quality of NAFLD patients.

Health disparities in preterm births.

Introduction: Black African American (B/AA) women have a 2-fold to 3-fold elevated risk compared with non-Hispanic White (W) women for preterm birth. Further, preterm birth is the leading cause of mortality among B/AA infants, and among survivors, preterm infant adverse health outcomes occur disproportionately in B/AA infants. Racial inequities in maternal and infant health continue to pose a public health crisis despite the discovery >100 years ago. The purpose of this study was to expand on reported preterm infant outcome disparities. A life-course approach, accumulation of lifelong stress, including discrimination, may explain social factors causing preterm birth rate and outcome inequities in B/AA mothers. Methods: Anthropometric measures and clinical treatment information for 197 consented participants were milled from electronic health records across 4 years. The Neonatal Infant Stressor Scale was used to tally acute and chronic painful/stressful procedures. Neurobehavioral differences were investigated using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. Results: B/AA mothers gave birth to preterm infants earlier than W mothers. NICU hospitalization stays were extended more than 2 weeks for the significantly smaller B/AA preterm infants in comparison to the age-matched W preterm infants. A higher number of chronic lifesaving procedures with demonstrated altered stress response patterns were recorded for B/AA preterm infants. Discussion: This cross-sectional analysis of preterm birth rates and preterm infant developmental and neurodevelopmental outcomes are presented in the context of NICU stress and pain, with attendant implications for infant mortality and future health disparities. Preterm birth rate and outcome inequities further support the need to develop interventions and policies that will reduce the impact of discrimination and improve social determinants of health for Black, Indigenous, and other People of Color.

Prevalence, influencing factors and adverse consequences of workplace violence against nurses in China: A cross-sectional study.

AIMS: The primary objective of this study was to determine the prevalence of workplace violence among nurses in China and its association with demographic characteristics, quality of work life and coping styles. The secondary objective was to explore how nurses deal with workplace violence and the emotional/psychological impact of workplace violence on nurses. BACKGROUND: Workplace violence is a common occupational hazard that causes physical and psychological harm to nurses. METHODS: A cross-sectional study was conducted with 2769 nurses from China. A demographic information questionnaire, hospital workplace violence questionnaire, Chinese version of the work-related quality of life scale and coping style scale were used in this study. The Chi-squared test, Mann-Whitney U test and binary logistic regression analysis were used to investigate the effects of demographic characteristics, quality of work life and coping styles on nurses' workplace violence. RESULTS: A total of 49.12% of the nurses (n = 1360) had experienced at least one type of workplace violence in the past 6 months. Night shifts, work department, chronic diseases (odds ratio [OR] = 1.53, p < .001), sleep disorders (OR = 1.54, p < .001), frequent overtime (OR = 1.78, p < .001), adverse nursing events (OR = 2.01, p < .001) and passive coping (OR = 1.47, p < .001) were risk factors for workplace violence. Working conditions (OR = 0.61, p < .001), general well-being (OR = 0.65, p < .001) and positive coping (OR = 0.76, p < .001) were identified as protective factors for workplace violence. Nurses exposed to workplace violence experience various negative emotional and psychological consequences. CONCLUSIONS: Workplace violence is common among nurses in China. Good working conditions, general well-being and positive coping may help prevent workplace violence injuries. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts should be made to improve and optimize existing workplace violence prevention measures, create and maintain a good working environment for health care workers and develop various coping styles or strategies to manage stress to reduce workplace violence. The cross-sectional study has been approved by the Ethics Committee of the First Affiliated Hospital of China Medical University, with the registration number 2019-221-2. Written informed consent was obtained prior to the survey.

Investigation on Hydration and Mechanical Properties of Mortar Containing Limestone Powder and Fly Ash Based on the Coupled Chemical-Thermal-Mechanical Method.

The composited cementitious materials usually have superior performance; for example, using limestone powder (LP) and fly ash (FA) as the admixtures of cement in concrete/mortar is a popular way of improving the properties of concrete/mortar structures. In this work, we performed experimental tests to study the hydration process and pore distribution in mortar containing different ratios of LP and FA. Based on the results of mercury intrusion porosimetry (MIP), a numerical mortar model with random pore is built. The model can reflect the synergistic hydration interaction and filling effect caused by the admixtures of LP and FA. After analyzing the hydration process, the coupled chemical-thermal-mechanical method was used to simulate the characteristics of mortar containing LP and FA. The coupling model can simulate the "hump-type" hydration acceleration stage of the mortar at early age, which is specifically caused by the LP, proved in the experimental test. Additionally, the special, "hump-type" stage is important to enhance the early strength of the mortar. At different levels of admixture content, the random pore model and coupled method can predict the evolution process of the mechanical properties well, at early age and for long-term strength. Both experimental and numerical results suggest that the mortar containing admixtures of the proper ratio of LP to FA have good mechanical properties, which can be applied to engineering structures.

Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis.

RATIONALE: Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. OBJECTIVES: We investigated whether the detection of intracellular bacteria by a modified Ziehl-Neelsen stain and early secretory antigen target (ESAT)-6 in cerebrospinal fluid leukocytes improves tuberculous meningitis diagnosis. METHODS: Cerebrospinal fluid specimens from patients with suspected tuberculous meningitis were stained by conventional Ziehl-Neelsen stain, a modified Ziehl-Neelsen stain involving cytospin slides with Triton processing, and an ESAT-6 immunocytochemical stain. Acid-fast bacteria and ESAT-6-expressing leukocytes were detected by microscopy. All tests were performed prospectively in a central laboratory by experienced technicians masked to the patients' final diagnosis. MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty patients with suspected tuberculous meningitis were enrolled. Thirty-seven had Mycobacterium tuberculosis cultured from cerebrospinal fluid; 40 had a microbiologically confirmed alternative diagnosis; the rest had probable or possible tuberculous meningitis according to published criteria. Against a clinical diagnostic gold standard the sensitivity of conventional Ziehl-Neelsen stain was 3.3% (95% confidence interval, 1.6-6.7%), compared with 82.9% (95% confidence interval, 77.4-87.3%) for modified Ziehl-Neelsen stain and 75.1% (95% confidence interval, 68.8-80.6%) for ESAT-6 immunostain. Intracellular bacteria were seen in 87.8% of the slides positive by the modified Ziehl-Neelsen stain. The specificity of modified Ziehl-Neelsen and ESAT-6 stain was 85.0% (95% confidence interval, 69.4-93.8%) and 90.0% (95% confidence interval, 75.4-96.7%), respectively. CONCLUSIONS: Enhanced bacterial detection by simple modification of the Ziehl-Neelsen stain and an ESAT-6 intracellular stain improve the laboratory diagnosis of tuberculous meningitis.