Prevention Of Defects Research Articles

Antioxidant Intake and the Relationship between Air Pollution and Birth Defects: A comparison of approaches for effect modification

BACKGROUND AND AIM: Previous research suggests that intake of antioxidants during pregnancy may reduce the harmful effects of air pollution exposure. However, examining effect modification in the context of multiple air pollutants and antioxidants can present a number of challenges. Prior to conducting an epidemiologic study to understand the relationship between air pollution, antioxidants and birth defects, we aim to compare methods for identifying effect measure modification within higher-dimensional exposure and dietary data. METHODS: We first perform a simulation, based on a real-word case-control study of birth defects, to generate realistic data on exposure to criteria air pollutants in the first trimester of pregnancy, maternal dietary intake of antioxidants and birth outcomes. We construct multiple realistic scenarios, varying levels of correlation between features, the magnitude of association between air pollutants, antioxidants and congenital heart defects and the amount of effect measure modification by antioxidants. Using these data, we compare two data-driven methods, the Deletion-Substitution-Addition (DSA) algorithm and boosted regression trees, to the traditional use of multiple logistic regression models for evaluating effect measure modification. RESULTS:This talk will describe the performance of each method across the various exposure-outcome scenarios. CONCLUSIONS:Results from this simulation study will subsequently be applied to data from the National Birth Defects Prevention Study to investigate whether evidence exists for antioxidant intake during pregnancy to modify the relationship between early-pregnancy air pollution exposure and congenital heart defects in offspring. KEYWORDS: pregnancy, methods, environment-diet interactions

Modeling complex effects of exposure to particulate matter and extreme heat during pregnancy on congenital heart defects

BACKGROUND AND AIM: Previous research suggests gestational exposure to particulate matter ≤ 2.5 μm (PM2.5) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies the associations between PM2.5 exposure and specific congenital heart defects (CHDs). METHODS: We identified live-birth, stillborn, and induced termination CHD cases (n = 2,824) and non-malformed live-birth controls (n = 4,033) from pregnancies ending between October 1997 and December 2011 in the National Birth Defects Prevention Study (NBDPS). We assigned mothers 6-week averages for 24-hour PM2.5 exposure during the cardiac critical period (gestational weeks 3-8) using the closest monitor within 50 kilometers of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile from daily maximum temperature distribution for region, year, and season) during this period using the closest weather station. Using generalized additive models (GAMs), we explored logit-nonlinear exposure-outcome relationships, observing that linearity assumptions were reasonable. We estimated joint effects of PM2.5 and EHDs on six CHDs using logistic regression models adjusted for critical period regional mean dewpoint and maternal age, education, and race/ethnicity. In final models, we assessed multiplicative and additive effect modification. RESULTS:In adjusted models, conditional on mothers experiencing the highest observed EHD count (17), each 5 μg/m³ increase in average PM2.5 exposure was associated with increased odds of any septal defect (OR: 1.52 [95% CI: 1.04, 2.23]) and perimembranous ventricular septal defects (OR: 1.68 [95% CI: 1.02, 2.83]). Associations conditional on low/median maternal EHDs were null or inverse. Multiplicative and additive effect modification estimates were consistently positive when considering septal defects. CONCLUSIONS:Results suggest cumulative extreme temperature exposure during early pregnancy may modify associations between PM2.5 and some CHDs. Specifically, maternal extreme heat and PM2.5 exposure may jointly increase risk of offspring septal defects. Abstract does not represent EPA/CDC policy. KEYWORDS: particulate matter, temperature extremes, birth outcomes, cardiovascular diseases

A hybrid Decision Support System for automating decision making in the event of defects in the era of Zero Defect Manufacturing

Defects are unavoidable during manufacturing processes, and a tremendous amount of research aimed at improving defect prevention has been conducted by scholars. Zero Defect Manufacturing (ZDM) seeks to eliminate defects in production. In addition, technological advancements now allow the repair of defective products. This creates the need to re-schedule productions more frequently in order to take into account the actions necessary to fix defective parts. This study focuses on detection and repair-based ZDM strategies. It implements a newly developed, hybrid Decision Support System (DSS) that uses data-driven and knowledge-based approaches to detect defects and then automate the necessary decision-making processes. The system uses an ontology based on the MASON ontology in order to describe the production domain and enrich the available data with contextual information. Real time production data and past knowledge are utilized to analyse defects, identify their type and severity, and suggest alternative repair plans. Possible repair plans are evaluated using a dynamic multi-criteria approach that determines the plan most suited to production conditions at the time of defect detection. To test the efficacy of the DSS developed for this study, it was integrated with a dynamic scheduling tool and was also used in an industrial application in the semiconductor domain. The simulations and the real-world implementation both show that the proposed DSS system can efficiently detect defects and automate the post-detection decision-making process. The multi-criteria approach adopted by this study proves that the DSS can make well-adapted decisions, handle the dynamic nature of a production system, and help manufacturers move closer to Zero Defect Manufacturing.

Modification of the effects of nitrogen dioxide and sulfur dioxide on congenital limb defects by meteorological conditions.

Can meteorological conditions modify the associations between NO2 and SO2 exposure and congenital limb defects (CLDs) during the first trimester of pregnancy? Increases in NO2 and SO2 exposure were consistently associated with higher risks of CLDs during the first trimester of pregnancy; both low- and high-temperature exposure and high air humidity act synergistically with the two air pollutants on CLDs. Animal studies have indicated air pollutants are associated with CLDs, but corresponding epidemiological studies are limited with equivocal conclusions. Meteorological conditions are closely connected to the generation, diffusion, distribution and even chemical toxicity of air pollutants. This case-control study included 972 cases of CLDs and 9720 controls in Changsha, China during 2015-2018. Cases from the hospital based monitoring system for birth defects (including polydactyly, syndactyly, limb shortening, and clubfoot) and healthy controls from the electronic medical records system were studied. Complete data on daily average NO2 and SO2 concentrations and meteorological variables were obtained from local monitoring stations to estimate monthly individual exposures during the first trimester of pregnancy, using the nearest monitoring station approach for NO2 and SO2 concentrations, and the city-wide average approach for temperature and relative humidity, respectively. The 25th and 75th percentiles of daily mean temperature, as well as the 50th percentile of daily mean relative humidity during the study period were used to classify high- and low-temperature exposure, and high humidity exposure based on existing evidence and local climate characteristics. Multivariate logistic regression models were used to estimate the independent effects per 10 μg/m3 increase in NO2 and SO2 on CLDs, and the attribute proportions of interaction (API) were used to quantify the additive joint effects of air pollutants with meteorological conditions after including a cross product interaction term in the regression models. NO2 and SO2 exposures during the first trimester of pregnancy were consistently and positively associated with overall CLDs and subtypes, with adjusted odd ratios (aORs) ranging from 1.13 to 1.27 for NO2, and from 1.37 to 2.49 for SO2. The effect estimates were generally observed to be the strongest in the first month and then attenuated in the second and third months of pregnancy. Synergistic effects of both low and high temperature in combination with NO2 (with APIs ranging from 0.07 to 0.38) and SO2 (with APIs ranging from 0.18 to 0.51) appeared in the first trimester of pregnancy. Several significant modifying effects by high humidity were also observed, especially for SO2 (with APIs ranging from 0.13 to 0.38). Neither NO2 nor SO2 showed an interactive effect with season of conception. The methods used to estimate individual exposure levels of air pollutants and meteorological factors may lead to the misclassification bias because of the lack of information on maternal activity patterns and residential mobility during pregnancy. Moreover, we were unable to consider several potentially confounding factors, including socioeconomic status, maternal nutrient levels, alcohol use and smoking during early pregnancy due to unavailable data, although previous studies have suggested limited change to the results after when including these factors in the analysis. The findings are helpful for understanding the combined effects of air pollution and meteorological conditions on birth defects. Environmental policies and practices should be formulated and implemented to decrease air pollutant emissions and improve meteorological conditions to reduce their harmful effects on pregnancy. Additionally, pregnant women should be suggested to reduce outdoor time when the air quality is poor, especially when ambient temperature is higher or lower than what is comfortable, or when it is excessively humid. The study is funded by Major Scientific and Technological Projects for Collaborative Prevention and Control of Birth Defects in Hunan Province (2019SK1012), Major Research and Development Projects in Hunan Province (2018SK2060) and Scientific and Technological Department Projects in Hunan Province (2017SK50802). There are no competing interests. N/A.

Processing defect study and prevention in continuous stepped nanostructures fabricated by nanoskiving

Cracking of slabs and fracturing of continuous stepped nanostructures were investigated by varying the cutting parameters during the nanoskiving process. The slabs containing continuous stepped nanostructures were obtained under various nanoskiving cutting angles (0°–90°, stepped in units of 5°). The slab cracking and the nanostructure morphology were observed using atomic force microscopy. The pitched line height was greater than that of the straight lines in this nanostructure, and the integrity of structures obtained at a 55° cutting angle was superior to that of 0° and 90°. The cracking of slabs during the cutting process was mitigated by changing the cutting depth or knife tool material. Comparing electrical properties of nanostructures under two coating methods (electron -beam evaporation and magnetron sputtering), sputtering has a lower resistivity because of its larger grain size and tightness of distribution. All defects could be explained by analyzing the cutting force used during the cutting and trimming processes, whereby optimization schemes for fracture and crack prevention were obtained.

Maternal exposure to hydroxychloroquine and birth defects

BackgroundHydroxychloroquine is a treatment for rheumatic disease and considered safe during pregnancy. Interest in hydroxychloroquine has increased as it is being examined as a potential treatment and prophylaxis for coronavirus disease 2019. Data on the risks of specific birth defects associated with hydroxychloroquine use are sparse.MethodsUsing data from two case–control studies (National Birth Defects Prevention Study and Slone Epidemiology Center Birth Defects Study), we described women who reported hydroxychloroquine use in pregnancy and the presence of specific major birth defects in their offspring. Cases had at least one major birth defect and controls were live‐born healthy infants. Women self‐reported medication use information in the few months before pregnancy through delivery.ResultsIn total, 0.06% (19/31,468) of case and 0.04% (5/11,614) of control mothers in National Birth Defects Prevention Study, and 0.04% (11/29,838) of case and 0.05% (7/12,868) of control mothers in Birth Defects Study reported hydroxychloroquine use. Hydroxychloroquine users had complicated medical histories and frequent medication use for a variety of conditions. The observed birth defects among women taking hydroxychloroquine were varied and included nine oral cleft cases; the elevated observed:expected ratios for specific oral cleft phenotypes and for oral clefts overall had 95% confidence intervals that included 1.0.ConclusionWhile teratogens typically produce a specific pattern of birth defects, the observed birth defects among the hydroxychloroquine‐exposed women did not present a clear pattern, suggesting no meaningful evidence for the risk of specific birth defects. The number of exposed cases is small; results should be interpreted cautiously.

Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight

Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight. We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and >7 days. We examined the association between opioid use and preterm birth (defined as gestational age <37 weeks) and term low birthweight (defined as <2500 g at gestational age ≥37 weeks). Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for > 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight. Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy.

Prevalence And Treatment Of Wedge-Shaped Teeth Defects

Local (exogenous) and general (endogenous) factors affect the occurrence of wedge-shaped teeth defects.Common factors include somatic pathologies, mainly endocrine diseases. Most of the mineral part of the hard tissues of human and animal teeth consists of apatites, and the similarity of the recently used hydroxypatite with hard tissues of teeth is undeniable. On this basis, the use of hydroxyapatite-containing preparations for the prevention and treatment of wedge-shaped teeth defects can be considered theoretically justified.

Epidemiological overview of multidimensional chromosomal and genome toxicity of cannabis exposure in congenital anomalies and cancer development

Cannabis and cannabinoids are implicated in multiple genotoxic, epigenotoxic and chromosomal-toxic mechanisms and interact with several morphogenic pathways, likely underpinning previous reports of links between cannabis and congenital anomalies and heritable tumours. However the effects of cannabinoid genotoxicity have not been assessed on whole populations and formal consideration of effects as a broadly acting genotoxin remain unexplored. Our study addressed these knowledge gaps in USA datasets. Cancer data from CDC, drug exposure data from National Survey of Drug Use and Health 2003–2017 and congenital anomaly data from National Birth Defects Prevention Network were used. We show that cannabis, THC cannabigerol and cannabichromene exposure fulfill causal criteria towards first Principal Components of both: (A) Down syndrome, Trisomies 18 and 13, Turner syndrome, Deletion 22q11.2, and (B) thyroid, liver, breast and pancreatic cancers and acute myeloid leukaemia, have mostly medium to large effect sizes, are robust to adjustment for ethnicity, other drugs and income in inverse probability-weighted models, show prominent non-linear effects, have 55/56 e-Values > 1.25, and are exacerbated by cannabis liberalization (P = 9.67 × 10–43, 2.66 × 10–15). The results confirm experimental studies showing that cannabinoids are an important cause of community-wide genotoxicity impacting both birth defect and cancer epidemiology at the chromosomal hundred-megabase level.

Maintenance optimization of a production system considering defect prevention and spare parts ordering

An innovative maintenance policy is proposed in this paper. This policy can involve spare parts ordering, production quality, and buffer inventory for an efficient production system. In the system, certain batches are required to be produced, and when each batch is finished, a determination is made whether maintenance is needed. The machine state deteriorates with the number of completed batches, and it can be improved by performing maintenance. Two types of maintenance activity, replacement and imperfect maintenance, can be selectively chosen to minimize cost. The defect rate of each batch is related to the number of completed production batches. An innovative concept, defined as the “virtual number” of completed production batches, is used to establish a link between maintenance and defect rate. Monte Carlo simulation and enumerative search is then used to determine cost-effective spare parts ordering and maintenance policies to minimize the cost for the production cycle. Finally, numerical examples are presented to demonstrate the model and to conduct sensitivity analysis. We find that in situations with a high buffer inventory costs, spare parts should be ordered late. When increasing the buffer inventory cost, more replacements should be performed compared to imperfect maintenance. Also, the buffer inventory cost rate and replacement duration time effect the rate of defective products significantly. These two parameters should be kept small, and controlled, if a very low defect rate is needed.

ОПЫТ УСПЕШНОЙ РЕАБИЛИТАЦИИ ПОСЛЕ САМОПРОИЗВОЛЬНОГО АБОРТА

The state of health of the child begins to form in the prenatal period and is determined by both the health of the parents and the conditions of pregnancy. In accordance with the WHO recommendations, it is possible to reduce reproductive failures by consulting women of reproductive age even before conception — at the pre-pregnancy stage, with measures aimed at reducing miscarriage and premature birth, as well as complications during pregnancy. According to the Russian clinical protocols for the management of patients after spontaneous termination of pregnancy in the early stages, a dose of folic acid 400 mcg is adequate for the prevention of neural tube defects and other fetal malformations, which often lead to early spontaneous pathological abortions. Folate is involved in the synthesis of DNA and prevents its changes by methylation, which is extremely important in rapidly dividing cells, which is characteristic of pregnancy. This is the basis for reducing the risk of miscarriage and premature birth, contributing to the normalization of the process of ovum nidation and placentation, as well as reducing the complications of gestation, the frequency of malformations in children. The purpose of this study is to prove by the example of a clinical case study that the inclusion of the active form of folate in pre-gravidar preparation is an effective way of rehabilitation after spontaneous abortion. Folate deficiency can lead to a state of hyperhomocysteinemia, leading to increased microthrombosis and changes in microcirculation, which leads to implantation defects and fetoplacental disorders. These processes may underlie the pathogenesis of miscarriage in early gestation, as well as the formation of chronic placental insufficiency and fetal growth retardation in the second half of pregnancy. Folate deficiency may be the cause of reproductive failures that are not related to other causes that cause spontaneous termination of pregnancy, as may have occurred in the clinical case we are studying.

Maternal occupation as a nail technician or hairdresser during pregnancy and birth defects, National Birth Defects Prevention Study, 1997–2011

ObjectiveNail technicians and hairdressers may be exposed to chemicals with potential reproductive effects. While studies have examined birth defects in children of hairdressers, those in children of nail technicians have...

A Comprehensive Review of Intestinal Atresias

A Comprehensive Review of Intestinal Atresias

Prevention of Neural Tube Defects in Europe: A Public Health Failure.

Objective: Thirty years ago it was demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). Despite Public Health Initiatives across Europe recommending that women take 0.4 mg folic acid before becoming pregnant and during the first trimester, the prevalence of NTD pregnancies has not materially decreased in the EU since 1998, in contrast to the dramatic fall observed in the USA. This study aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in Europe from 1998 as it had been in the USA.Design and Setting: The number of NTD pregnancies from 1998 to 2017 that would have been prevented if folic acid fortification had been implemented in the 28 countries who were members of the European Union in 2019 was predicted was predicted using data on NTD prevalence from 35 EUROCAT congenital anomaly registries and literature searches for population serum folate levels and folic acid supplementation.Results: From 1998 to 2017 an estimated 95,213 NTD pregnancies occurred amongst 104 million births in the 28 countries in the EU, a prevalence of 0.92 per 1,000 births. The median serum folate level in Europe over this time period was estimated to be 14.1 μg/L. There is a lack of information about women taking folic acid supplements before becoming pregnant and during the first trimester of pregnancy, with one meta-analysis indicating that around 25% of women did so. An estimated 14,600 NTD pregnancies may have been prevented if the European countries had implemented fortification at the level adopted by the USA in 1998 and 25% of women took folic acid supplements. An estimated 19,500 NTD pregnancies would have been prevented if no women took folic acid supplements.Conclusions: This study suggests that failure to implement mandatory folic acid fortification in the 28 European countries has caused, and continues to cause, neural tube defects to occur in almost 1,000 pregnancies every year.

Rodents on a High-Fat Diet Born to Mothers with Gestational Diabetes Exhibited Sex- Specific Lipidomic Changes in Reproductive Organs, Hormonal Imbalances and Insulin Resistance

Background: Maternal gestational diabetes mellitus (GDM) and offspring high-fat diet (HFD) have shown to have sex-specific detrimental effects on the health of offspring. Methods: A maternal GDM mice model was established by feeding maternal C57BL/6 mice HFD and then their offspring were exposed to either HFD or low-fat diet. Testes, ovaries, liver and gonadal adipose tissue were collected from offspring at 20 weeks, and their reproductive lipidomic profiles were characterized using gas chromatography-mass spectrometry. Findings: Male offspring following HFD had a substantially elevated body weight. In reproductive organs and hormones, male offspring from GDM mothers had decreased testes weights and testosterone levels, while female offspring from GDM mothers had increased ovary weights and estrogen levels. AKT pathway were increased in the offspring liver and gonadal adipose tissue of those fed with HFD. The fatty acid profiling showed that testes were prone to the effect of maternal GDM, whereas ovarian metabolite profiles were upregulated in maternal GDM and downregulated in offspring following HFD. Eicosapentaenoic acid were attenuated in both maternal serum and offspring testes under the impact of maternal GDM and in offspring following HFD. Interpretation: Maternal GDM and offspring HFD have different metabolic effects on offspring reproductive organs, and PUFAs may protect against detrimental outcomes in offspring such as obesity. Funding: the National Natural Science Foundation of China, The 111 Project, The National Key Research and Development Program of Reproductive Health & Major Birth Defects Control and Prevention, Chongqing Health Commission, Kuanren Talents Programs, and Chongqing Science & Technology Commission. Declaration of Interest: Andi Wang, Xinyang Yu, Zhu Chen, Yinyin Xia, Chang Chen, Hongbo Qi, Philip N. Baker, Richard Saffery, Ting-Li Han and Hua Zhang declare that they have no conflict of interest. Ethical Approval: All WT C57BL/6 mice in this study were purchased from the Model Animal Research Center of Nanjing University. All animal experiments complied with the ARRIVE guidelines and approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Batch number: 2020-41).

Association between maternal exposure to gaseous pollutants and atrial septal defect in China: A nationwide population-based study

BackgroundThe association between maternal exposure to gaseous air pollutants and congenital heart defects (CHD) remains unclear. The concentration-response relationship and the time windows of susceptibility to gaseous pollutants may vary by pollutant species and CHD subtypes. ObjectiveWe aimed to examine the relationship between maternal exposures to four species of gaseous pollutants (NO2, O3, SO2, and CO) and atrial septal defect (ASD), which is a common subtype of CHD, and to determine the critical time windows of susceptibility for each gaseous pollutant. MethodsAmong 1,253,633 infants born between October 1, 2013 and December 31, 2016 in China, 1937 newborns were diagnosed with isolated ASD, a prevalence of 1.55‰. Maternal exposures to the gaseous pollutants were estimated by matching the geocoded maternal addresses with the gridded ambient concentrations. The adjusted odds ratios (aOR) between exposures and ASD were quantified by using mixed-effects logistic regression models. ResultsWe found significantly positive associations between ASD and maternal exposures to NO2, O3, SO2, and CO during entire pregnancy, first-, second-, and third-trimester. However, no statistically significant association was found between maternal exposure to PM2.5, PM2.5-10 and ASD risk (P > 0.05). In the fully adjusted model with respect to average exposure over entire pregnancy, the adjusted odds ratios (aOR) for each 10 μg/m3 increment of NO2, O3, SO2 were 1.33 (95% CI: 1.22–1.45), 1.13 (95% CI: 1.10–1.16), 1.28 (95% CI: 1.20–1.35), respectively; the aOR for each 100 μg/m3 increment of CO was 1.10 (95% CI: 1.06–1.15). The observed concentration-response relationships varied by exposure periods and pollutants, with the strongest association for NO2 during the 1st-8th embryology weeks, for O3 during the third trimester, for SO2 during the second trimester, and for CO without obvious variation. ConclusionsThe findings suggest an increased risk of ASD in association with maternal exposures to four common gaseous pollutants. From the perspective of birth defects prevention and ASD risk mitigation, it is critical to reduce maternal exposure to gaseous pollutants especially during the most susceptible time windows.

Estimating the Serum Folate Concentration Associated With the Red Blood Cell Folate Threshold for Optimal Neural Tube Defects Prevention: A Population Based Biomarker Survey

ObjectivesTo estimate the serum folate insufficiency threshold (sf-IT) corresponding to the red blood cell (RBC) folate insufficiency threshold for optimal neural tube defect (NTD) prevention. MethodsParticipants were 977 women of reproductive age (WRA; 15–40y; not pregnant or lactating) from a population-based biomarker survey in Southern India. Venous blood samples were collected at enrollment. Plasma, serum, and red blood cells were centrifuged, processed, and stored < -80°C until batch analysis. Total vitamin B12 concentrations were measured via chemiluminescence; RBC and serum folate concentrations were measured using the World Health Organization-recommended microbiological assay. Vitamin B12 deficiency was defined as total vitamin B12 < 148 pmol/L. Folate insufficiency was defined as RBC folate < 748 nmol/L, the recommended calibrator-adjusted equivalent of the threshold for population optimal NTD prevention. A previously developed Bayesian model and the RBC and serum folate distributions in this population were used to estimate the sf-IT corresponding to the RBC folate insufficiency threshold for optimal NTD prevention, overall and by age, body mass index (BMI) category, HbA1c, anemia, and vitamin B12 status. ResultsThe overall estimated median sf-IT was 37.8 nmol/L (95% credible interval [33.8–43.3]). This threshold was lower in overweight WRA (BMI: ≥25.0 kg/m2: 32.0 nmol/L [27.3–40.2] vs. BMI < 25.0 kg/m2: 36.2 nmol/L [32.2–43.3]), and varied by age (< 25y: 61.3 nmol/L [44.3–111.8]; 25 to 35y: 35.7 nmol/L [30.8–43.5]; ≥35y: 30.8 nmol/L [26.9–37.2]). The sf-IT was lower in anemic WRA (32.9 nmol/L [28.5–40.1]) compared to non-anemic WRA (42.0 nmol/L [36.1–51.3]), and lower in WRA with elevated HbA1c (≥5.7% to < 6.5: 32.4 nmol/L [27.3–41.6]; ≥6.5%: 20.9 nmol/L [17.8–25.6]) vs. WRA with HbA1c < 5.7% (43.8 nmol/L, [37.5–53.7]). The median sf-IT was higher in WRA with vitamin B12 deficiency (72.1 nmol/L [52.0–126.0]), compared to women who were not vitamin B12 deficient (28.1 nmol/L [25.6–31.5]). ConclusionsThe estimated sf-IT is dependent on anemia, elevated HbA1c, BMI, age, and vitamin B12 status. Funding SourcesCenters for Disease Control and Prevention; AF was supported by the National Institutes of Health #5 T32 HD087137.

An Empirical Study on Enhancing Product Quality and Customer Satisfaction Using Quality Assurance Approach in an Indian Manufacturing Industry

The aim of this paper is to investigate the utilization of quality assurance approach in improving the product quality and customer satisfaction while implementing total quality management (TQM) initiatives in leading tractors manufacturing industry situated in Mohali, Punjab, India and highlight the improvements that have taken place as a result of these initiatives. ABC Ltd. (name changed) started implementing TQM as a business management approach in 2007 and its implementation helped the organization to excel in quality, cost and delivery to gain flexibility, provide quality products of wide range and gain operational excellence. Initially, the focus of the industry was on traditional approach that is inspection and control but after TQM it got shifted to prevention of defects and quality assurance. Improvement in field quality, supplier quality and manufacturing quality were mainly focused under quality assurance approach in order to improve product quality and customer satisfaction. Implementation of TQM initiatives helped the industry to double the revenue, triple the profit in just three years and as a result the company got Deming Prize in 2012. The customer satisfaction index improved from 76 to 106, sales volume increased from 27000 to 67000 tractors and market share enhanced from 9.1 to 12.6 percent after TQM deployment within a period of five years. The empirical study presented in this paper is a novel study on augmenting the product quality and customer satisfaction may give insight to the TQM practitioners in promoting similar approaches in their organizations for enhancing customer satisfaction and product quality.

Short interpregnancy intervals and risks for birth defects: support for the nutritional depletion hypothesis

Research suggests short interpregnancy intervals increase risks for adverse perinatal outcomes, including some birth defects. A hypothesized cause is nutritional depletion, including folic acid (FA). We evaluated associations between short interpregnancy intervals, alone and in combination with FA intake, and the occurrence of select malformations. Data were from the National Birth Defects Prevention Study (US case-control, 1997-2011). Participants included multiparous women whose prior pregnancy resulted in live birth. Cases included 8 noncardiac and 6 cardiac defect groups (n=3219); controls were nonmalformed live-borns (n=2508). We categorized interpregnancy interval (<6, 6-11, 12-17, and 18-23 mo) and periconceptional FA intake [no FA supplement use and dietary folate equivalents (DFE) <400 µg/d, no FA supplement use and DFE ≥400 µg/d, or any FA supplement use]. We controlled for age, race/ethnicity, income, pregnancy intention, and study center. ORs <0.8 or >1.2 were considered to represent potentially meaningful associations. ORs for <6 compared with 18-23 mo were >1.2 for 4/8 noncardiac and 3/6 cardiac malformations. Among participants with any FA supplement use, ORs comparing <6 with 6-23 mo were <1.2 for most defects. Conversely, most ORs were >1.2 for <6 mo+no FA supplement use and DFE <400 µg/d compared with 6-23 mo+any FA supplement use. Magnitude and precision varied by defect. Short interpregnancy intervals were associated with a trend of higher risks for several defects, notably in the absence of FA supplement use. To our knowledge, our study is the first to provide preliminary empirical support that these etiologies may be related to shorter interpregnancy intervals and possible nutritional deficiencies. Because FA intake is highly correlated with other nutrients, and because our estimates were generally imprecise, more research with larger sample sizes is needed to better understand the role of FA compared with other nutrients in each defect-specific etiology.

LEAN MANUFACTURING PRACTICES AND SUPPLY CHAIN PERFORMANCE OF SUGAR MANUFACTURING FIRMS IN WESTERN KENYA

Introduction: Western Kenya is the largest producer of sugar in Kenya, supporting about 170,000 smallholder farming households and contributing about 80 percent of the total sugar produced in Kenya. This contribution is however threatened given that the sugar firms in that region are producing sub optimally with obsolete technology. Comparing to related sector, other firms in Kenya such as the tea manufacturing firms have implemented energy efficiency practices so as to manage energy wastage and reduce production costs. Were they to employ effective production methods, they could increase their production significantly. While that is the case, scholars have suggested that adoption of lean manufacturing practices is a panacea to quality addition and waste minimization. Perhaps what these firms need are lean practices.&#x0D; Purpose: This study interrogated the extent to which the firms have adopted lean manufacturing practices, just-in-time and total quality control and if they have, its effect on supply chain performance.&#x0D; Methodology: The study targeted and conducted a census on the 11 sugar manufacturing firms in the Western Kenya belt where the procurement managers, line managers, finance managers, production managers, production engineers, quality assurance officers and operations managers of each of the 11 firms (total 87) were targeted. The study employed a descriptive research design to collect quantitative data. Quantitative primary data was collected through questionnaires and analyzed using statistical package for social sciences.&#x0D; Findings: The findings of the study indicated that the just in time productionand total quality control are positively and significantly associated with supply chain performance of the sugar manufacturing firms.&#x0D; Unique Contribution to Practice and Policy: The study recommended adoption of just in time production practices such as availing labor on demand in order to manage labor costs, availing resources on demand in order to manage wastage, production on demand in order to manage inventory costs, ordering raw materials from the suppliers only when there is demand for production from customers, having a simplified production design to ensure timely production and having multiple skilled workers to ensure faster production. In addition, in order for the sugar manufacturing firms to increase supply chain performance, there is need to adopt total quality control practices such as having manageable defect prevention costs related to quality planning, putting in place manageable defect prevention costs related to investment in quality related information systems, having manageable appraisal costs related to test and inspection of purchased materials, having manageable appraisal costs related to quality audits, having controllable internal failure costs related to reworks and having manageable internal failure costs related to scrap.