Prevention Of Defects Research Articles

12-Year Trends of Orofacial Clefts in the United States: Highlighting Racial/Ethnic Differences in Prevalence of Cleft Lip and Cleft Palate.

Discrepancies in prevalence among infants with orofacial clefts are public health research priorities. Our objective was to calculate updated estimated prevalence of orofacial clefts in the United States, with sub-analyses by racial/ethnic group. The National Birth Defect Prevention Network database was used to evaluate trends in cases with orofacial cleft in the United States from 2006 to 2018. Cases with cleft lip with and without cleft palate (CL ± P) and cleft palate (CP) alone were sub-stratified by racial/ethnic category. Estimated prevalence was calculated using the total live births reported in each maternal racial/ethnic group. The odds ratio (OR) was calculated to measure the strength of association between racial/ethnic group and risk of orofacial clefts. Estimated prevalence rates show that maternally-reported Native American/Alaskan Native individuals were 43.8% (p < 0.0001) and 36.0% (p < 0.0001) more likely to have CL ± P and CP alone, respectively, compared to maternally-reported non-Hispanic White individuals. Estimated prevalence of CL ± P in maternally-reported non-Hispanic Black individuals (OR = 0.64) and maternally-reported Asians/Pacific Islander individuals were significantly lower than in maternally-reported non-Hispanic White individuals (OR = 0.63, p < 0.0001). Estimated prevalence of CP alone was significantly lower in maternally-reported non-Hispanic Black individuals (OR = 0.64, p < 0.0001), maternally-reported Asians/Pacific Islander individuals (OR = 0.69, p < 0.0001), and maternally-reported Hispanic individuals (OR = 0.81, p < 0.0001). Across the total population, there was no significant change in estimated orofacial cleft prevalence. However, there were significant disproportions in estimated orofacial cleft prevalence across racial/ethnic groups, which may guide further discussion among craniofacial health care providers and centers and their patients regarding differences in cleft risk factors.

Enhancing Software Quality through Early-Phase of Software Verification and Validation Techniques

Purpose: The core objectives of this conducted research were threefold: first, to assess whether early-phase verification and validation (V&amp;V)techniques, encompassing software design review, code review, and inspection, significantly contribute to defect prevention throughout the software development process; second, to evaluate the impact of these techniques on the efficiency of software development in terms of time, cost, and resource allocation; and third, to conduct a comprehensive comparative analysis between early-phase verification and validation (V&amp;V)techniques and traditional post-development testing regarding their effectiveness in defect prevention and software quality improvement.&#x0D; Methodology: Employing an experimental approach, this study conducted case studies within Tanzanian software development organizations. Data were meticulously gathered through surveys and interviews involving software professionals. Both quantitative and qualitative data were systematically analyzed to ensure data reliability and ethical considerations.&#x0D; Findings: The research findings indicate that early-phase verification and validation (V&amp;V) techniques shine as powerful tools for defect prevention, leading to a substantial reduction in defect counts and elevating software quality metrics, such as reliability and user satisfaction. Notably, these techniques demonstrated a favorable impact on software development efficiency by shortening development cycles and curtailing costs. When compared to traditional post-development testing, early-phase verification and validation (V&amp;V) techniques consistently outperformed in the realm of defect prevention and software quality enhancement.&#x0D; Unique Contribution to Theory, Practice and Policy: The study's outcomes underscore the transformative potential of early-phase verification &amp;validation techniques, urging the software development industry to pivot from defect detection to defect prevention. The insights garnered here offer practical guidance for organizations aiming to streamline their software development processes, economize costs, and deliver top-notch software products that closely align with user expectations. While conducted in a Tanzanian context, these findings reverberate across the global software development landscape, underscoring the universal relevance of early-phase verification and validation (V&amp;V) techniques as pivotal enablers of software quality assurance and operational efficiency.

Folic acid supplements and perinatal mortality in China.

Periconceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects. From the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks' gestation and early neonatal deaths within 7 days of delivery. Among the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks' gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China. Periconceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.

Prevention of surface defects in calendered poly(vinyl chloride) sheets using a succinate‐capped poly(caprolactone) additive

AbstractSurface defects known as “gas checks” often mar the surfaces of poly(vinyl chloride) (PVC) calendered films. These defects are typically prevented through changes in the calender operating parameters, a costly exercise which also limits the sheet thickness and the production rate. Adding a low concentration of poly(caprolactone) (PCL)‐based star‐shaped compound can eliminate gas check defects in PVC calendering. The effects of a triheptylsuccinate‐terminated PCL with a PCL triol core and number average molecular weight of 540 g/mol (i.e., PCL540‐[(succ)‐C7]3) has been investigated on the material, thermal, and processing properties of PVC blends containing diisononyl phthalate (DINP) as a primary plasticizer and PCL540‐[(succ)‐C7]3 in low quantities (i.e., 0, 5, or 10 parts per hundred rubber (phr)) as a secondary plasticizer and processing aid. The most significant differences between PVC blends containing PCL540‐[(succ)‐C7]3 and those without are in the rheological properties of the PVC blends at higher temperatures and lower angular frequencies. Under these conditions, PVC blends containing 10 phr of PCL540‐[(succ)‐C7]3 have a complex viscosity nearly three times higher than those containing only DINP. PVC/PCL540‐[(succ)‐C7]3 blends had comparable tensile properties to those containing only DINP, with no significant change in maximum elongation and a small but significant increase of 28% in maximum stress. The addition of PCL540‐[(succ)‐C7]3 made it possible to produce calendered films without gas checks that were twice as thick as those produced in its absence. In addition to reduced wastage of marred films, the increased calender operating range for PVC films containing PCL540‐[(succ)‐C7]3 has the potential to significantly reduce energy costs for the calendering of thick PVC films.

Structural forming of soil composites using as a pavement subgrade strengthening

The article substantiates the possibility of obtaining composite materials with improved functional properties to strengthen the subgrade, containing technogenic soil stabilized by an additive based on a gelling polymer. The introduction of technogenic soils into composites will not only reduce the consumption of expensive materials, but also solve a complex of acute environmental problems. Composite materials can be used in the construction of structural layers of road pavements, foundations of buildings and structures, sites for various purposes, for the prevention and elimination of defects in the foundations of engineering structures during their construction, reconstruction and repair, including in permafrost areas. Stabilized technogenic soils are more durable, frost-resistant and waterproof, which makes them applicable for creating impervious curtains in hydraulic structures and sealing storage facilities for hazardous substances. The cryogenic effect on a composite material allows one to vary its properties within a wide range and modify its macroporous structure. Studying the process of structure formation of the resulting organic-inorganic materials, consisting of macromolecules of high-molecular substances and inorganic inclusions that have undergone cryogenic treatment, will make it possible to specifically regulate their performance characteristics. The best values of strength characteristics were obtained for samples with a stabilizing additive concentration of 100 g/l. The resulting composite materials are hydrophobic, frost-resistant, characterized by a compressive strength of 2.3–6.5 MPa and a thermal conductivity of 0.19–0.20 W/(m·K). Data from differential scanning calorimetry and thermogravimetry and IR spectroscopy revealed that the binding of mineral particles by a stabilizing additive occurs due to the formation of organomineral complexes with the participation of clay minerals and the restructuring of hydration shells. SEM data indicate that crystallinity zones formed due to hydrogen bonds of hydroxyl groups of neighboring polymer chains can participate in the formation of the composite structure. An increase in the number of cryogenic treatment cycles promotes additional structuring and strengthening of the polymer phase due to the formation of additional nodes of the supramolecular network, ordering of crystallinity zones and the appearance of compacted areas in the structure. Computed X-ray tomography revealed an increase in the density of the composite upon drying, which helps to increase its strength characteristics. The structure of the sample is characterized by heterogeneity of the pore space, which is characterized by the presence of both fine-porous and large-porous regions, which determines its thermophysical properties.

The detection efficacy of noninvasive prenatal genetic testing (NIPT) for sex chromosome abnormalities and copy number variation and its differentiation in pregnant women of different ages

ObjectiveTo analyze the efficacy of noninvasive prenatal genetic testing (NIPT) in detecting fetal sex chromosome abnormalities and copy number variation (CNV), compare the efficacy between NIPT and serological screening alone, and further analyze the fetal sex chromosome abnormalities and CNV differentiation in pregnant women of different ages, so as to provide a reference for the prevention and control of fetal birth defects. MethodsClinical data from 22,692 pregnant women admitted to our hospital from January 2013 to December 2022 were retrospectively analyzed. All participants underwent serological screening and NIPT screening to compare fetal chromosomal abnormalities between the two screening modalities. 145 women whose fetus were diagnosed as sex chromosome abnormalities and 36 women whose fetus were diagnosed as CNV abnormalities based on NIPT screening were selected for prenatal diagnosis by amniocentesis or karyotyping. Taking prenatal diagnosis as the standard, the four-grid table method was used to detect the positive predictive value of NIPT screening for fetal sex chromosomal abnormalities and CNV. According to the age, pregnant women were divided into 18–30 years old (n = 9844), 31–35 years old (n = 7612), >35 years old (n = 5236), and then the detection rates of sexual fetal chromosomal abnormalities, CNV and total chromosomal abnormalities were compared in pregnant women. ResultsAmong the 22,692 pregnant women in this study, the high-risk proportion of serologic screening with 4.38% was higher than that of NIPT screening with 1.93% (P < 0.05). Among the 145 women with fetal sex chromosome abnormalities screened by NIPT, 122 cases of fetal sex chromosome abnormalities were diagnosed prenatally, including 45, X/47, XXX/47, XYY/47, XXY. The positive predictive values of NIPT screening were 25.00%, 58.82%, 85.71%, and 85.71%, respectively, with an overall predictive value of 44.26%. The positive predictive value of fetal sex chromosome abnormalities in NIPT screening was higher than that of serological screening (P < 0.05). Among the 36 pregnant women with fetal CNV, NIPT screening showed that CNVs≤10 Mb and CNVs>10 Mb were 33.33% and 66.67%, respectively. There were 12 cases of prenatal diagnosis of fetal CNV, among which the NIPT-screened positive predictive values of fetal copy number deletion, duplicate, deletion and duplicate were 50.00%, 57.14% and 100.00%, respectively, with an overall predictive value of 58.33%. The positive predictive value of CNV in NIPT screening was higher than that of serological screening without statistically significant difference (P > 0.05). The results of NIPT screening showed that the detection rate of fetal sex chromosome abnormalities and total abnormalities of pregnant women over 35 years of age was significantly higher than that of pregnant women aged 18–30 and 31–35 years (P < 0.05). ConclusionNIPT screening could greatly improve the detection efficacy of fetal sex chromosome abnormalities, CNV and other chromosome abnormalities, and decline the false positive rate. However, the positive predictive value of NIPT screening was relatively low, and further prenatal testing and genetic counseling are still required. In addition, NIPT screening for fetal sex chromosome abnormalities, and the detection rate of total abnormalities in pregnant women older than 35 years old were increased significantly, and pregnancy at an advanced age may be one of the risk factors for fetal chromosomal abnormalities.

Knowledge and Practices on Periconceptional use of Folic Acid for the Prevention of Neural Tube Defects Among Women in Childbearing Age in Boralesgamuwa Medical Officer of Health Area, Sri Lanka

Introduction: Neural Tube Defects (NTD) remain a major public health burden globally. It is widely acknowledged that folic acid plays a vital role to reduce the risk of developing NTDs. The study aimed to determine knowledge, and practice regarding periconceptional use of folic acid for the prevention of NTD among women in childbearing age at Boralesgamuwa Medical Officer of Health (MOH) area, Sri Lanka.Methods: A descriptive cross-sectional study was carried out among randomly selected 422 women in childbearing age in the said MOH area. Data were collected through a pre-tested interviewer administered questionnaire. The overall knowledge level was classified as adequate (&gt;75%), moderately adequate (50-75%) and inadequate (&lt;50%).Results: Out of 422 participants, the majority was Sinhalese (95.7%), married (66.8%) and unemployed (62.1%). Mean age was 32.02 ±8.625 years. Nearly 56 % had heard about NTDs and 95.5% had heard about folic acid. A majority (279, 66.1%) had ‘inadequate’ level of knowledge, 120 (28.4%) had ‘moderately adequate’ knowledge and only 5.5% (n=23) had ‘adequate’ knowledge. Approximately 60% had taken folic acid and out of them only 42.4% had started folic acid before pregnancy. Age (p&lt;0.001), marital status (p&lt;0.001), parity (p&lt;0.001), educational qualification of participants (p&lt;0.001), monthly household income (p=0.004) and where health services sought from (p &lt;0.001) were associated with the level of knowledge.Conclusions: Majority of participants had inadequate knowledge regarding periconceptional use of folic acid for the prevention of NTDs. However, out of those who have used FA, majority had started to take it before pregnancy. The study findings warrant more educational programmes on the topic bridging the gap of knowledge among women in childbearing age in the study setting.

Factors associated with infant sex and preterm birth status for selected birth defects from the National Birth Defects Prevention Study, 1997-2011.

Birth defects and preterm birth co-occur, with some overlapping risk factors. Many birth defects and preterm births tend to have a male preponderance. We explored potential risk factors impacting sex and preterm (<37 weeks of gestation) birth differences among infants with selected birth defects delivered from 1997 to 2011 using data from the National Birth Defects Prevention Study (NBDPS). The NBDPS was a large multisite, population-based case-control study. Using random forests, we identified important predictors of male preterm, female preterm, and male term, each compared with female term births for each birth defect. Using logistic regression, we estimated odds ratios for associations between important predictors and sex-preterm birth status by birth defect. We examined 11,379 infants with nine specific birth defects. The top 10 most important predictors of sex-preterm birth status from the random forests varied greatly across the birth defects and sex-preterm comparisons within a given defect group, with several being novel factors. However, one consistency was that short interpregnancy interval was associated with sex-preterm birth status for many of the studied birth defects. Although obesity has been identified as a risk factor for preterm birth and birth defects in other research, it was not associated with sex-preterm birth status for any of the examined defects. We confirmed expected associations for sex-preterm birth status differences and found new potential risk factors for further exploration among the studied birth defects.

Defect Engineering of Metal Halide Perovskite Nanocrystals via Spontaneous Diffusion of Ag Nanocrystals.

Perovskite nanocrystals (NCs) have emerged as a promising building block for the fabrication of optic-/optoelectronic-/electronic devices owing to their superior characteristics, such as high absorption coefficient, rapid ion mobilities, and tunable energy levels. However, their low structural stability and poor surface passivation have restricted their application to next-generation devices. Herein, a drug delivery system (DDS)-inspired post-treatment strategy is reported for improving their structural stability by doping of Ag into CsPbBr3 (CPB) perovskite NCs; delivery to damaged sites can promote their structural recovery slowly and uniformly, averting the permanent loss of their intrinsic characteristics. Ag NCs are designed through surface-chemistry tuning and structural engineering to enable their circulation in CPB NC dispersions, followed by their delivery to the CPB NC surface, defect-site recovery, and defect prevention. The perovskite-structure healing process through the DDS-type process (with Ag NCs as the drug) is analyzed by a combination of theoretical calculations (with density functional theory) and experimental analyses. The proposed DDS-inspired healing strategy significantly enhances the optical properties and stability of perovskite NCs, enabling the fabrication of white light-emitting diodes.

Analysis, simulation and experimental research on the mechanisms of lantern-shaped strand defects in the conductor construction of transmission line

This paper focuses on theoretical, numerical simulation, and experimental research on the lantern-shaped strand defect that arises in tension stringing constructions of large-section conductors. Starting from considerations for factors such as the construction environment and the characteristics of the conductor passing through blocks, this paper presents the causes of conductor torque generation and analyzes the distribution of axial forces on the outmost layer strands and the outmost adjacent layer strands of the conductor when subjected to bending and twisting. Taking into account the contact forces between strands in different layers, this paper thoroughly examines the mechanical causes that lead to the occurrence of the lantern-shaped strand defect in conductors. It concludes that the axial compression and the external contact force acting on the outermost adjacent layer strands are crucial in the formation of the lantern-shaped strand defect. To numerically simulate the lantern-shaped defect, a finite element model is developed to replicate the passage of a 1250 mm2 large-section conductor through the block system. Furthermore, considering actual working conditions, a test equipment is designed and constructed to replicate the lantern-shaped defect. The shape and size of the lantern-shaped defect obtained from the tests exhibited a substantial agreement with the simulation results, suggesting concordance between theoretical analysis and real situation. This research methodology can be used to analyze defects in conductors with varying sections, serving as a theoretical foundation for the prevention and control of construction defects in conductors.

Antifungal medication use during pregnancy and the risk of selected major birth defects in the National Birth Defects Prevention Study, 1997-2011.

Recent studies suggest increased birth defect risk associated with maternal use of specific oral antifungals. We estimated associations between first-trimester antifungal use and selected non-cardiac birth defects using National Birth Defects Prevention Study (NBDPS) data. Participants with a pregnancy affected by a study-eligible birth defect ("cases") were ascertained from 10 birth defect surveillance programs; participants who delivered livebirths without a major birth defect ("controls") were randomly selected from birth records or hospital discharge lists. First-trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects with ≥5 exposed cases using logistic regression. We estimated crude ORs and exact 95% CIs for birth defects with 3-4 exposed cases. Additionally, we conducted a probabilistic bias analysis of exposure misclassification. Our analysis included 19 624 cases and 11 427 controls; 257 (1.3%) cases and 123 (1.1%) controls reported first-trimester antifungal use. Of those who reported antifungals, 62.6% of cases and 64.2% of controls reported topical antifungals; 10.1% of cases and 4.9% of controls reported oral antifungals. We observed the strongest associations for encephalocele and Dandy-Walker malformation and modestly elevated estimates for several other defects. Bias-adjusted estimates were similar to the main analysis. First-trimester antifungal use was positively associated with several birth defects in our analysis, although CIs were imprecise. Further study is warranted to investigate associations between antifungal use and birth defects, including potential bias due to confounding by indication.

Bias analyses to investigate the impact of differential participation: Application to a birth defects case-control study.

Certain associations observed in the National Birth Defects Prevention Study (NBDPS) contrasted with other research or were from areas with mixed findings, including no decrease in odds of spina bifida with periconceptional folic acid supplementation, moderately increased cleft palate odds with ondansetron use and reduced hypospadias odds with maternal smoking. To investigate the plausibility and extent of differential participation to produce effect estimates observed in NBDPS. We searched the literature for factors related to these exposures and participation and conducted deterministic quantitative bias analyses. We estimated case-control participation and expected exposure prevalence based on internal and external reports, respectively. For the folic acid-spina bifida and ondansetron-cleft palate analyses, we hypothesized the true odds ratio (OR) based on prior studies and quantified the degree of exposure over- (or under-) representation to produce the crude OR (cOR) in NBDPS. For the smoking-hypospadias analysis, we estimated the extent of selection bias needed to nullify the association as well as the maximum potential harmful OR. Under our assumptions (participation, exposure prevalence, true OR), there was overrepresentation of folic acid use and underrepresentation of ondansetron use and smoking among participants. Folic acid-exposed spina bifida cases would need to have been ≥1.2× more likely to participate than exposed controls to yield the observed null cOR. Ondansetron-exposed cleft palate cases would need to have been 1.6× more likely to participate than exposed controls if the true OR is null. Smoking-exposed hypospadias cases would need to have been ≥1.2 times less likely to participate than exposed controls for the association to falsely appear protective (upper bound of selection bias adjusted smoking-hypospadias OR = 2.02). Differential participation could partly explain certain associations observed in NBDPS, but questions remain about why. Potential impacts of other systematic errors (e.g. exposure misclassification) could be informed by additional research.

Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: Findings from the National Birth Defects Prevention Study.

Previous studies report an association between prenatal maternal urinary tract infections (UTI) and specific congenital heart defects (CHDs); however, the role of fever and antibiotic use on this association is poorly understood. Using data from the National Birth Defects Prevention Study, we examined whether the relationship between maternal UTIs during the periconceptional period and occurrence of CHDs is modified by the presence of fever due to UTI and corresponding antibiotic use among 11,704 CHD case infants and 11,636 live-born control infants. Information on UTIs, fever associated with UTI and antibiotic use (sulfonamides, nitrofurantoin, cephalosporins, penicillin, macrolides, and quinolones) during pregnancy were obtained using a computer-assisted telephone interview. Using unconditional multivariable logistic regression, we calculated adjusted odds ratios (ORs) to determine the association between maternal UTIs and subtypes of CHDs. Analyses were stratified by the presence of fever and medication use associated with UTI. The prevalence of UTIs during the periconceptional period was 7.6% in control mothers, and 8.7% in case mothers. In the absence of fever, UTI was associated with secundum atrial septal defects (ASD) (OR 1.3; 95% confidence interval [CI] 1.1-1.5) and in the absence of antibiotics, UTI was associated with conotruncal defects as a group and for four specific CHDs. When fever and UTI occurred concomitantly, no significantly elevated odds ratios were noticed for any subtypes of CHD. Among women with UTIs who used antibiotics, an elevated but statistically non-significant estimate was observed for secundum ASD (OR 1.4; 95% CI 1.0-2.0). Findings in the present study suggest that fever due to UTI and corresponding maternal antibiotic use do not substantially modify the association between maternal UTIs and specific CHDs in offspring. Further studies with larger sample sizes are warranted to guide clinical management of UTIs during the periconceptional period.

Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: a systematic review

Folic acid (pteroylmonoglutamic acid) supplements are highly effective for prevention of neural tube defects (NTD) prompting implementation of mandatory or voluntary folic acid fortification for prevention of NTDs. We used plasma folate levels in population studies by country and year to compare effects of folic acid fortification types (mandatory or voluntary folic acid fortification policies) on plasma folate levels, NTD prevalence and stroke mortality rates. We conducted systematic reviews of (i) implementation of folic acid fortification in 193 countries that were member states of the World Health Organization by country and year, and (ii) estimated population mean plasma folate levels by year and type of folic acid fortification. We identified relevant English language reports published between Jan 1, 1990 and July 31, 2023 using Google Scholar, Medline, Embase and Global Health. Eligibility criteria were observational or interventional studies with >1000 participants. Studies of pregnant women or children <15 years were excluded. Using an ecological study design, we examined the associations of folic acid fortification types with NTD prevalence (n=108 studies) and stroke mortality rates (n=3 countries). Among 193 countries examined up to 31 July 2023, 69 implemented mandatory folic acid fortification, 47 had voluntary fortification, but 77 had no fortification (accounting for 32%, 53% and 15% of worldwide population, respectively). Mean plasma folate levels were 36, 21 and 17nmol/L in populations with mandatory, voluntary and no fortification, respectively (and proportions with mean folate levels >25nmol/L were 100%, 15% and 7%, respectively). Among 75 countries with NTD prevalence, mean (95% CI) prevalence per 10,000 population were 4.19 (4.11-4.28), 7.61 (7.47-7.75) and 9.66 (9.52-9.81) with mandatory, voluntary and no folic acid fortification, respectively. However, age-standardised trends in stroke mortality rates were unaltered by the introduction of folic acid fortification. There is substantial heterogeneity in folic acid fortification policies worldwide where folic acid fortification are associated with 50-100% higher population mean plasma folate levels and 25-50% lower NTD prevalence compared with no fortification. Many thousand NTD pregnancies could be prevented yearly if all countries implemented mandatory folic acid fortification. Further trials of folic acid for stroke prevention are required in countries without effective folic acid fortification policies. Medical Research Council (UK) and British Heart Foundation.

Discussion on the status quo and solutions to the prevention and control of birth defects among primary obstetricians and gynecologists in the era of molecular genetic testing

Birth defects are an important factor for the quality of newborn population. With the development of molecular genetic technology, an increasing number of genetic disorders leading to birth defects can now be detected. The lack of the knowledge for the basics and clinical applications of molecular genetic techniques have emerged as a shortcoming for primary care physicians who have formed the first tier prevention for birth defects. Currently, government has paid more attention to the above problems and formulated more training programs for primary obstetricians and gynecologists, e.g., "Prenatal Screening and Prenatal Diagnosis Post Training Program", "National Birth Defects Training Program", "National Primary Obstetrician Training Program". To some extent, such programs have met the urgent need for birth defect prevention in primary hospitals. But at the same time, some problems have also emerged. For instance, the knowledge for birth defects among primary obstetricians and gynecologists is poor, and there is lack of young personnel. This article has aimed to discuss the strategies to systematically improve the ability for preventing birth defects among primary care physicians by analyzing the obstacles and challenges for primary obstetricians and gynecologists in the era of molecular genetic testing.

Preconception dietary glycemic index and risk for large-for-gestational age births

ObjectivesDiets with a high glycemic index (GI) leading to elevated postprandial glucose levels and hyperinsulinemia during pregnancy have been inconsistently linked to an increased risk for large-for-gestational-age (LGA) births. The effects of prepregnancy dietary GI on LGA risk are, to our knowledge, unknown. We examined the association of prepregnancy dietary GI with LGA births and joint associations of GI and maternal overweight/obesity and infant sex with LGA births among 10 188 infants born without congenital anomalies from 1997 to 2011, using data from the National Birth Defects Prevention Study (NBDPS). The aim of this study was to investigate this association among infants without major congenital anomalies (controls) who participated in the NBDPS and to evaluate how prepregnancy BMI and infant sex may modify this association on the additive scale. MethodsDietary intake was ascertained using a 58-item food frequency questionnaire. We dichotomized dietary GI into high and low categories using spline regression models. Infants with a birth weight at or above the 90th percentile for gestational age and sex, according to a U.S. population reference, were considered LGA. We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs). ResultsOf the infants, 859 (9%) had a high dietary GI (cut-point: 59), and 1244 infants (12%) were born LGA. Unadjusted analysis suggested an inverse association between high dietary GI and LGA (OR, 0.79; 95% CI, 0.62–0.99). No association was observed in multivariable models when comparing high dietary GI intake between LGA births and all other births (OR, 0.94; 95% CI, 0.74–1.20) or when excluding small-for-gestational-age (SGA) births (OR, 0.94; 95% CI, 0.73–1.19). No joint associations with maternal overweight/obesity or infant sex were observed. ConclusionHigh prepregnancy maternal GI was not associated with LGA births independently of or jointly with other factors.

Newborn screening for congenital hypothyroidism, congenital adrenal hyperplasia and glucose-6-phosphate dehydrogenase deficiency in Bihar: A pressing priority in today's time.

Newborn screening (NBS) aims towards early detection of congenital disorders or prevention of intellectual and physical defects and life-threatening illness. Three disorders namely congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH) and glucose-6-phosphate dehydrogenase deficiency (G-6-PDD) were selected for a preliminary study for NBS. The study aimed to establish NBS in the Indian scenario that could lay a framework for future such initiatives. A screening programme was conducted at a tertiary care hospital for 1 year. All the neonates born at All India Institute of Medical Sciences (AIIMS), Patna, were screened for their blood levels of glucose-6-phosphate dehydrogenase (G-6-PD), 17-hydroxyprogesterone (17-OHP) and thyroid-stimulating hormone (TSH). Heel-prick blood samples were collected within 48-72 h of birth, and the level of these parameters was accessed by enzyme immunoassay (EIA). A total of 492 neonates were born from January 2020 to December 2020, of which 369 newborns were screened for CAH, CH and G-6-PDD. Of 369 neonates, one case (male) had an increased level of TSH, six cases (all males) had an increased level of 17-OHP and no case was found with G-6-PDD. Preliminary data on the prevalence of various genetic disorders revealed that CAH is the most prevalent disorder followed by CH in the population of Bihar. More efforts need to be undertaken to create awareness and to make screening a successful programme in India. A cost-effective nationwide screening programme is highly recommended for the detection of such cases at the earliest to avoid their future complication.

Ultraphonophoresis of an enzyme gel with direct proteolytic activity in patients with hypertrophic skin scars

BACKGROUND: Correction and prevention of severe cicatricial deformities is a labor-intensive task for doctors of aesthetic and rehabilitation medicine. Often, as a result of skin scarring, the psychological status of the patient changes due to the presence of persistent subjective sensations or the location of defects in open, functionally active areas of the skin. The steady annual growth in trauma, the number of surgical interventions and invasive procedures actualizes the question of finding an optimal, effective and widely available method for preventing severe skin scarring or correcting fibrous deformities.&#x0D; AIM: scientific and practical substantiation of the use of enzyme gel ultraphonophoresis with direct proteolytic activity in patients with hypertrophic skin scars.&#x0D; MATERIALS AND METHODS: A prospective interventional cohort comparative study of the efficacy and safety of enzyme gel ultraphonophoresis with direct proteolytic activity in patients with hypertrophic skin scars was performed. The study included 42 patients with a diagnosis of "Hypertrophic scars" (ICD-10, L91) of postoperative or post-traumatic genesis, divided into observation and comparison groups with emerging (n=20) and mature (n=22) scars. In the course of the study, clinical, instrumental and medical and sociological research methods were used.&#x0D; RESULTS: A pronounced positive dynamic of indicators of clinical and instrumental parameters of scar tissue was established, improvement of quality-of-life indicators was the most significant in patients of the observation group with developing scars. The expediency of using the enzyme gel ultraphonophoresis technique with direct proteolytic activity in patients with hypertrophic skin scars is confirmed by a combination of parameters: positive dynamics of the clinical status, functional properties of scar tissue and quality of life indicators, a high safety profile and patient satisfaction with treatment. The effectiveness of correction in patients with developing and mature hypertrophic scars was 83–87%.&#x0D; CONCLUSION: The therapeutic and preventive technology of enzyme gel ultraphonophoresis with direct proteolytic activity is an effective and promising method for the correction and prevention of postoperative and post-traumatic cicatricial skin defects.

Review of Classification and Prevention of Subgrade Defects

Subgrade defects classification is one of the important means for highway management and maintenance departments to prevent and reduce disaster, and it is also the basis for using engineering analogy methods to prevent subgrade defects. For this reason, firstly, subgrade defects are divided into slope defects and subgrade subsidence defects according to the definition. and the existing subgrade defects classification methods are divided into single-factor index classification method and multi-factor index classification method, and through comparison, it is concluded that the multi-factor index classification method is better. Finally, the prevention and control measures of the existing subgrade defects are summarized from three aspects: optimization design, foundation reinforcement and improvement of drainage facilities. This will provide reference and ideas for the classification and prevention of subgrade defects.

Relationship between Agile Maturity and Digital Transformation Success

Digital transformation has become increasingly important for information technology software companies, as it can have a significant impact on the organization's bottom line. However, many companies struggle to achieve success in their digital transformation journey. One of the key challenges that organizations face is the lack of agility. Organizations need to develop their agile maturity levels in order to achieve their desired results. This paper investigates the relationship between agile maturity levels and digital transformation success in information technology software companies. The study also examines the key agile practices that contribute to digital transformation success. A descriptive study was conducted on different software companies. 100 employees working on agile projects were given a survey, and the responses were examined using the SPSS software. In addition to the quantitative data, the study also conducted qualitative interviews with 10 professionals who have implemented agile transformation in their organizations. The findings of the study suggest that there is a significant positive relationship between agile maturity levels and digital transformation success. The correlation analysis revealed a strong relationship between the three agile maturity dimensions (self-organized team, agile project management, and test-driven development) and digital transformation success. It also showed a moderate relationship between the six agile maturity dimensions (performance management, defect prevention, customer availability, requirement management, collaborative development, and regular delivery) and digital transformation success. The paper also found that the key challenge that organizations face in their digital transformation journey is the lack of clarity around the goals of the transformation. The results of the paper have practical implications for agile practitioners and organizations in identifying the order of key areas of agile maturity and activities that should be introduced to achieve a successful digital transformation journey.