balance parameters following stroke. The feasibility of the study protocol will be established and results will inform the design of a future multi-centre randomised controlled trial. Trial registration Trial register ISRCTN, Trial identifier ISRCTN10874601 Date of registration 12/03/2018.Background Hypertension (HTN) affects nearly 1 billion people globally and is a major cause of morbidity and mortality. In low- and middle-income countries (LMICs), HTN represents an unmet health care gap that can be addressed by strengthening national health care systems. The National Heart, Lung, and Blood Institute recently funded the T4 Translation Research Capacity Building Initiative in Low Income Countries (TREIN) program to build capacity in dissemination and implementation (D&I) research in HTN in LMICs. The Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) recently developed a massive open online course (MOOC) to train in D&I. Herein, we report on the use of the TDR WHO MOOC in D&I for the TREIN program in Rwanda, assessing feasibility of the MOOC and D&I competencies after MOOC training. Methods Participants in one-group MOOC training completed pre- and post-training questionnaires to assess dissemination and implementation (D&I) competencical diseases, there is potential for scalability to a wider audience of health care researchers, workers, administrators, and policymakers in LMIC interested in D&I research in non-communicable diseases.Background The role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change. Methods The data were previously collected from 100 children enrolled in the Framingham Children's Study at 3-6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on 2015-2020 Dietary Guidelines for Americans and diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses. Results st that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.Background Vitamin D deficiency is highly prevalent in women, and living in a tropical country with a year-round abundance of sunlight as the primary source of vitamin D does not seem to guarantee adequate serum 25(OH)D. While living in the tropics, Minangkabau women are known to dress specifically according to their culture. This study was aimed to elucidate the association of sunlight exposed body surface area with serum 25(OH)D in pregnant Minangkabau women of Indonesia. Methods We performed a cross-sectional study on 88 Minangkabau women in late pregnancy. Lifestyle data were collected using a questionnaire, and dietary intake of vitamin D was calculated from 24-h food recall. The skin pigmentation type was determined by the Fitzpatrick scale, and the body surface area exposed to sunlight was estimated. Serum 25(OH)D was quantified by ELISA method. Serum 25(OH)D differences according to the duration of sunlight exposure, skin pigmentation type, and sunscreen use were statistically analyzed by ANOVA. The correlation of sunlight exposed body surface area and serum 25(OH)D was analyzed by Spearman's correlation. Results Nearly half of the subjects (n = 40; 45.5%) were deficient in vitamin D ( less then 20 ng/ml) with serum 25(OH)D level 23.0 ± 10.0 ng/ml (mean ± SD) and the estimated daily intake of vitamin D was 5.6 ± 3.9 μg/1000 kcal/day (mean ± SD). The median percentage of body area exposed to sunlight was 15.8%. There were no differences in serum 25(OH)D levels according to sunlight exposure time, skin pigmentation type, and sunscreen use. The percentage of body area exposed to sunlight was positively correlated with serum 25(OH)D level (Spearman's ρ = 0.403; p less then 0.001). Conclusions Vitamin D deficiency is prevalent in pregnant Minangkabau women. Since increasing body surface area exposed to sunlight may not be culturally acceptable, vitamin D supplementation needs to be considered in this population.Background Malnutrition is the main risk factor for most common communicable diseases. The aim of this study is to determine the relationship between country-level prevalence of early childhood caries (ECC), malnutrition and anemia in infants and preschool children. Methods Matched country-level ECC, malnutrition and anemia prevalence were generated from databases covering the period 2000 to 2017. Multivariate general linear models were developed to assess the relationship between outcome variables (prevalence of stunting, wasting, overweight, and anemia) and the explanatory variable (ECC prevalence) adjusted for gross national income per capita. Adjusted regression coefficients (B) and partial eta squared were computed. Results The mean (standard deviation (SD)) ECC prevalence was 23.8 (14.8)% for 0-2 year-olds and 57.3 (22.4)% for 3-5-year-olds. The mean (SD) prevalence of wasting was 6.3 (4.8)%, overweight 7.2 (4.9)%, stunting 24.3 (13.5)%, and anemia 37.8 (18.1)%. For 0-2-year-olds, the strongest and only significant association was between the prevalence of ECC and overweight (η2 = 0.21) 1 % higher ECC prevalence was associated with 0.12% higher prevalence of overweight (B = 0.12, P = 0.03). In 3-5-year-olds, the strongest and only significant association was between the prevalence of ECC and anemia (η2 = 0.08) 1 % higher prevalence of ECC was associated with 0.14% lower prevalence of anemia (B = - 0.14, P = 0.048). Conclusion Country-level prevalence of ECC was associated with malnutrition in 0-2-year-olds and with anemia in 3-5-year-olds. The pathway for the direct relationship between ECC and overweight may be diet related. The pathway for the inverse relationship between ECC and anemia is less clear and needs further investigations.Background Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. https://www.selleckchem.com/products/calcipotriene.html In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies. Methods We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test registered 6.11.2019.Background The use of quality injectable oxytocin effectively prevents and treats postpartum hemorrhage, the leading cause of maternal death worldwide. In low- and middle-income countries (LMICs), characteristics of oxytocin-specifically its heat sensitivity-challenge efforts to ensure its quality throughout the health supply chain. In 2019, WHO, UNFPA and UNICEF released a joint-statement to clarify and recommend that oxytocin should be kept in the cold chain (between 2 and 8 °C) during transportation and storage; however, confusion among stakeholders in LMICs persists. Objectives and methods To further support recommendations in the WHO/UNFPA/UNICEF joint-statement, this paper reviews results of oxytocin quality testing in LMICs, evaluates product stability considerations for its management and considers quality risks for oxytocin injection throughout the health supply chain. This paper concludes with a set of recommended actions to address the challenges in maintaining quality for a heat sensitive pharmacenagement.Background Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO2) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults. link2 Methods Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO2 = 12%) or normoxia (FiO2 = 21%). Near-infrared spectroscopy monitored SmO2, oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Suency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.Artificial intelligence or AI has been heralded as the most transformative technology in healthcare, including critical care medicine. Globally, healthcare specialists and health ministries are being pressured to create and implement a roadmap to incorporate applications of AI into care delivery. To date, the majority of Japan's approach to AI has been anchored in industry, and the challenges that have occurred therein offer important lessons for nations developing new AI strategies. Notably, the demand for an AI-literate workforce has outpaced training programs and knowledge. This is particularly observable within medicine, where clinicians may be unfamiliar with the technology. National policy and private sector involvement have shown promise in developing both workforce and AI applications in healthcare. In combination with Japan's unique national healthcare system and aggregable healthcare and socioeconomic data, Japan has a rich opportunity to lead in the field of medical AI.Background Nivolumab and pembrolizumab-two monoclonal antibodies that block human programmed cell death-1 (PD-1)-have been successfully used to treat patients with multiple advanced malignancies. The histologic patterns of hepatic toxicity induced by anti-PD-1 treatment have not been well studied and the aim of this study was to explore them. Methods Eight patients with advanced malignancies who were treated with either nivolumab or pembrolizumab were identified from five institutions. These patients had no history of underlying liver disease and a viral hepatitis panel was negative in all patients. Results Seven of eight patients exhibited mild to moderate gastrointestinal symptoms such as abdominal pain, fatigue, nausea, vomiting, and jaundice after anti-PD-1 treatment. Significant elevations in liver-chemistry tests were detected in all patients. Six cases (6/8) demonstrated an acute lobular hepatitis pattern of histologic injury. link3 The remaining two cases showed different histologic patterns of injury steatohepatitis with mild cholestasis (1/8) and pure acute cholestatic injury (1/8).