101 results on '"Semrau K"'
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2. Vulnerable newborn types : analysis of subnational, population‐based birth cohorts for 541 285 live births in 23 countries, 2000-2021
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Erchick, D. J., Hazel, E. A., Katz, J., Lee, A. C. C., Diaz, M., Wu, L. S. F., Yoshida, S., Bahl, R., Grandi, C., Labrique, A. B., Rashid, M., Ahmed, S., Roy, A. D., Haque, R., Shaikh, S., Baqui, A. H., Saha, S. K., Khanam, R., Rahman, S., Shapiro, R., Zash, R., Silveira, M. F., Buffarini, R., Kolsteren, Patrick, Lachat, Carl, Huybregts, Lieven, Roberfroid, D., Zeng, L., Zhu, Z., He, J., Qiu, X., Gebreyesus, S. H., Hadush, Kokeb Tesfamariam, Bekele, D., Chan, G., Baye, E., Workneh, F., Asante, K. P., Kaali, E. B., Adu‐Afarwuah, S., Dewey, K. G., Gyaase, S., Wylie, B. J., Kirkwood, B. R., Manu, A., Thulasiraj, R. D., Tielsch, J., Chowdhury, R., Taneja, S., Babu, G. R., Shriyan, P., Ashorn, P., Maleta, K., Ashorn, U., Mangani, C., Acevedo‐Gallegos, S., Rodriguez‐Sibaja, M. J., Khatry, S. K., LeClerq, S. C., Mullany, L. C., Jehan, F., Ilyas, M., Rogerson, S. J., Unger, H. W., Ghosh, R., Musange, S., Ramokolo, V., Zembe‐Mkabile, W., Lazzerini, M., Rishard, M., Wang, D., Fawzi, W. W., Minja, D. T. R., Schmiegelow, C., Masanja, H., Smith, E., Lusingu, J. P. A., Msemo, O. A., Kabole, F. M., Slim, S. N., Keentupthai, P., Mongkolchati, A., Kajubi, R., Kakuru, A., Waiswa, P., Walker, D., Hamer, D. H., Semrau, K. E. A., Chaponda, E. B., Chico, R. M., Banda, B., Musokotwane, K., Manasyan, A., Pry, J. M., Chasekwa, B., Humphrey, J., Black, R. E., Ali, Hasmot, Christian, Parul, Klemm, Rolf D. W., Massie, Alan B., Mitra, Maithili, Mehra, Sucheta, Schulze, Kerry J., Shamim, Abu Ahmed, Sommer, Alfred, Barkat Ullah, MD., West, Keith P., Begum, Nazma, Chowdhury, Nabidul Haque, Shafiqul Islam, Md., Mitra, Dipak Kumar, Quaiyum, Abdul, Diseko, Modiegi, Makhema, Joseph, Cheng, Yue, Guo, Yixin, Yuan, Shanshan, Roro, Meselech, Shikur, Bilal, Goddard, Frederick, Haneuse, Sebastien, Hunegnaw, Bezawit, Berhane, Yemane, Worku, Alemayehu, Kaali, Seyram, Arnold, Charles D., Jack, Darby, Amenga‐Etego, Seeba, Hurt, Lisa, Shannon, Caitlin, Soremekun, Seyi, Bhandari, Nita, Martines, Jose, Mazumder, Sarmila, Ana, Yamuna, Deepa, R, Hallamaa, Lotta, Pyykkö, Juha, Lumbreras‐Marquez, Mario I., Mendoza‐Carrera, Claudia E., Hussain, Atiya, Karim, Muhammad, Kausar, Farzana, Mehmood, Usma, Nadeem, Naila, Nisar, Muhammad Imran, Sajid, Muhammad, Mueller, Ivo, Ome‐Kaius, Maria, Butrick, Elizabeth, Sayinzoga, Felix, Mariani, Ilaria, Urassa, Willy, Theander, Thor, Deloron, Phillippe, Nielsen, Birgitte Bruun, Muhihi, Alfa, Noor, Ramadhani Abdallah, Bygbjerg, Ib, Moeller, Sofie Lykke, Aftab, Fahad, Ali, Said M., Dhingra, Pratibha, Dhingra, Usha, Dutta, Arup, Sazawal, Sunil, Suleiman, Atifa, Mohammed, Mohammed, Deb, Saikat, Kamya, Moses R., Nakalembe, Miriam, Mulowooz, Jude, Santos, Nicole, Biemba, Godfrey, Herlihy, Julie M., Mbewe, Reuben K., Mweena, Fern, Yeboah‐Antwi, Kojo, Bruce, Jane, Chandramohan, Daniel, Prendergast, Andrew, Lawn, Joy E., Blencowe, Hannah, Ohuma, Eric, Okwaraji, Yemi, Yargawa, Judith, Bradley, Ellen, Katz, Joanne, and the Subnational Vulnerable Newborn Prevalence Collaborative Group and Vulnerable Newborn Measurement Core Group, [missing]
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RISK ,small for gestational age ,PRETERM ,newborn ,MIDDLE-INCOME COUNTRIES ,MORTALITY ,FOR-GESTATIONAL-AGE ,Medicine and Health Sciences ,preterm birth ,INFANTS ,WEIGHT ,TERM ,low birthweight - Abstract
Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low-and middle-income countries (LMICs) spanning 2000–2021. Population: Liveborn infants. Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [
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- 2023
3. The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses
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Vesel, L., Delaney, M.M., Bose, C., Semrau, K., Adair, L., North, K., and Lee, A.C.C.
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Approximately 15% of infants worldwide are born with low birthweight (
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- 2021
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4. What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation
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Sacks, E, Benova, L, Moller, A-B, Hill, K, Vaz, LME, Morgan, A, Hanson, C, Semrau, K, Al Arifeen, S, Moran, AC, Sacks, E, Benova, L, Moller, A-B, Hill, K, Vaz, LME, Morgan, A, Hanson, C, Semrau, K, Al Arifeen, S, and Moran, AC
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BACKGROUND: Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators. METHODS: A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling. RESULTS: We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity. CONCLUSION: Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of i
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- 2020
5. Implementing the WHO Safe Childbirth Checklist: lessons from a global collaboration
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Perry, WRG, primary, Bagheri Nejad, S, additional, Tuomisto, K, additional, Kara, N, additional, Roos, N, additional, Dilip, TR, additional, Hirschhorn, LR, additional, Larizgoitia, I, additional, Semrau, K, additional, Mathai, M, additional, and Dhingra-Kumar, N, additional
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- 2017
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6. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis
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Seale, AC, Blencowe, H, Manu, AA, Nair, H, Bahl, R, Qazi, SA, Zaidi, AK, Berkley, JA, Cousens, SN, Lawn, JE, Agustian, D, Althabe, F, Azziz-Baumgartner, E, Baqui, AH, Bausch, DG, Belizan, JM, Qar Bhutta, Z, Black, RE, Broor, S, Bruce, N, Buekens, P, Campbell, H, Carlo, WA, Chomba, E, Costello, A, Derman, RJ, Dherani, M, El-Arifeen, S, Engmann, C, Esamai, F, Ganatra, H, Garcés, A, Gessner, BD, Gill, C, Goldenberg, RL, Goudar, SS, Hambidge, KM, Hamer, DH, Hansen, NI, Hibberd, PL, Khanal, S, Kirkwood, B, Kosgei, P, Koso-Thomas, M, Liechty, EA, McClure, EM, Mitra, D, Mturi, N, Mullany, LC, Newton, CR, Nosten, F, Parveen, S, Patel, A, Romero, C, Saville, N, Semrau, K, Simões, AF, Soofi, S, Stoll, BJ, Sunder, S, Syed, S, Tielsch, JM, Tinoco, YO, Turner, C, and Vergnano, S
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Background: Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America. Methods: We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012. Findings: We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1-9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4-12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million-8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million-4·2 million) in south Asia, 2·6 million (2·1 million-3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million-1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06-1·18) than girls. We estimated that there were 0·68 million (0·46 million-0·92 million) neonatal deaths associated with pSBI in 2012. Interpretation: The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management. Funding: The Wellcome Trust and the Bill and Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme. © 2014 Seale et al.
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- 2014
7. Review of the impact of demand-side interventions to improve maternal and neonatal outcomes: Is quality of care a problem?
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Hurst, T., primary, Semrau, K., additional, Patna, M., additional, Gawande, A., additional, and Hirschhorn, L., additional
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- 2015
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8. P02-07. High concentrations of interleukin-15 and low concentrations of CCL5 in breast milk are associated with protection against postnatal HIV transmission
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Walter, J, primary, Ghosh, MK, additional, Kuhn, L, additional, Semrau, K, additional, Sinkala, M, additional, Kankasa, C, additional, Thea, DM, additional, and Aldrovandi, GM, additional
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- 2009
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9. HIV care and treatment factors associated with improved survival during TB treatment in Thailand: an observational study
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Jiang Dd, Ningsanond P, Kankasa C, Zachariah R, Organek N, Alibhai A, van Griensven J, Chasombat S, Bailey Rc, Malinga J, Tappero Jw, Hoi Hs, Akksilp S, Ruhunda A, Kittikraisak W, Bukusi Ea, Nateniyom S, Kvalsund M, Bass J, Bradbury R, Sirinak C, Cain Kp, Thanprasertsuk S, Cohen Cr, Mwiya M, Kipp We, Hwang Kp, Bostrom A, Carrico Aw, Burapat C, Jirawattanapisal T, Isichei Co, Scott N, Fischer Pr, DeSilva Mb, Mangombe C, Obure A, McCurley E, Fox K, Wells Cd, Cha Ss, Konde-Lule J, Murray Lk, McConnell Ms, Mankatittham W, Monkongdee P, Kaile T, Tseng Sh, Mock Pa, Kwena Z, Montandon M, Yang Sl, Varma Jk, Pinyopornpanich S, Siangphoe U, Sattayawuthipong W, Reid T, Merry Sp, Rohrer Je, Byers Pa, Nguti R, Birbeck Gl, Malama K, Saunders D, Rasschaert F, Semrau K, Thea Dm, Yuktanont P, Shiboski S, Chomba E, Lertpiriyasuwat C, and Bolton P
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Program evaluation ,Adult ,Male ,Economic growth ,Time Factors ,Adolescent ,Anti-HIV Agents ,Population ,Antitubercular Agents ,Developing country ,HIV Infections ,lcsh:Infectious and parasitic diseases ,Cohort Studies ,Young Adult ,Acquired immunodeficiency syndrome (AIDS) ,Risk Factors ,Medicine ,Humans ,lcsh:RC109-216 ,education ,Tuberculosis, Pulmonary ,Aged ,Proportional Hazards Models ,education.field_of_study ,Poverty ,AIDS-Related Opportunistic Infections ,business.industry ,Middle Aged ,medicine.disease ,Thailand ,Infectious Diseases ,Treatment Outcome ,Female ,Rural area ,business ,Developed country ,Qualitative research ,Research Article - Abstract
Background In Southeast Asia, HIV-infected patients frequently die during TB treatment. Many physicians are reluctant to treat HIV-infected TB patients with anti-retroviral therapy (ART) and have questions about the added value of opportunistic infection prophylaxis to ART, the optimum ART regimen, and the benefit of initiating ART early during TB treatment. Methods We conducted a multi-center observational study of HIV-infected patients newly diagnosed with TB in Thailand. Clinical data was collected from the beginning to the end of TB treatment. We conducted multivariable proportional hazards analysis to identify factors associated with death. Results Of 667 HIV-infected TB patients enrolled, 450 (68%) were smear and/or culture positive. Death during TB treatment occurred in 112 (17%). In proportional hazards analysis, factors strongly associated with reduced risk of death were ART use (Hazard Ratio [HR] 0.16; 95% confidence interval [CI] 0.07–0.36), fluconazole use (HR 0.34; CI 0.18–0.64), and co-trimoxazole use (HR 0.41; CI 0.20–0.83). Among 126 patients that initiated ART after TB diagnosis, the risk of death increased the longer that ART was delayed during TB treatment. Efavirenz- and nevirapine-containing ART regimens were associated with similar rates of adverse events and death. Conclusion Among HIV-infected patients living in Thailand, the single most important determinant of survival during TB treatment was use of ART. Controlled clinical trials are needed to confirm our findings that early ART initiation improves survival and that the choice of non-nucleoside reverse transcriptase inhibitor does not.
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- 2009
10. Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?
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Kuhn, L., primary, Kasonde, P., additional, Sinkala, M., additional, Kankasa, C., additional, Semrau, K., additional, Scott, N., additional, Tsai, W.-Y., additional, Vermund, S. H., additional, Aldrovandi, G. M., additional, and Thea, D. M., additional
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- 2005
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11. Quantitation of Human Immunodeficiency Virus Type 1 in Breast Milk
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Ghosh, M. K., primary, Kuhn, L., additional, West, J., additional, Semrau, K., additional, Decker, D., additional, Thea, D. M., additional, and Aldrovandi, G. M., additional
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- 2003
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12. α-Defensins in the prevention of HIV transmission among breastfed infants
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Kuhn, L., Daria Trabattoni, Kankasa, C., Semrau, K., Kasonde, P., Lissoni, F., Sinkala, M., Ghosh, M., Vwalika, C., Aldrovandi, G. M., Thea, D. M., and Clerici, M.
13. Influence of Power Input on Efficiency of Dust Scrubbers
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Semrau, K. T., primary, Marynowski, C. W., additional, Lunde, K. E., additional, and Lapple, C. E., additional
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- 1958
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14. Correction - "Influence of Power Input on Efficiency of Dust Scrubbers"
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Semrau, K. T., primary, Marynowski, C. W., additional, Lunde, K. E., additional, and Lapple, C. E., additional
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- 1959
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15. SO2 from smelters: By-product markets a powerful lure
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Argenbright, L, primary, Preble, Bennett, additional, Ferguson, F, additional, and Semrau, K, additional
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- 1970
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16. Outcomes of a Coaching-based WHO Safe Childbirth Checklist Program in India.
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Semrau, K. E. A., Hirschhorn, L. R., Delaney, M. Marx, Singh, V. P., Saurastri, R., Sharma, N., Tuller, D. E., Firestone, R., Lipsitz, S., Dhingra-Kumar, N., Kodkany, B. S., Kumar, V., and Gawande, A. A.
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- 2018
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17. Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia
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Cohen Judith A, Semrau Katherine, Thea Donald, Imasiku Mwiya, Chomba Elwyn, Bass Judith, Murray Laura K, Lam Carrie, and Bolton Paul
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PTSD ,assessment validation ,children ,low resource country ,mental health ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Sexual violence against children is a major global health and human rights problem. In order to address this issue there needs to be a better understanding of the issue and the consequences. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia. Methods The PTSD-RI was adapted through the addition of locally relevant items and validated using local responses to three cross-cultural criterion validity questions. Reliability of the symptoms scale was assessed using Cronbach alpha analyses. Discriminant validity was assessed comparing mean scale scores of cases and non-cases. Concurrent validity was assessed comparing mean scale scores to a traumatic experience index. Sensitivity and specificity analyses were run using receiver operating curves. Results Analysis of data from 352 youth attending a clinic specializing in sexual abuse showed that this adapted PTSD-RI demonstrated good reliability, with Cronbach alpha scores greater than .90 on all the evaluated scales. The symptom scales were able to statistically significantly discriminate between locally identified cases and non-cases, and higher symptom scale scores were associated with increased numbers of trauma exposures which is an indication of concurrent validity. Sensitivity and specificity analyses resulted in an adequate area under the curve, indicating that this tool was appropriate for case definition. Conclusions This study has shown that validating mental health assessment tools in a low-resource country is feasible, and that by taking the time to adapt a measure to the local context, a useful and valid Zambian version of the PTSD-RI was developed to detect traumatic stress among youth. This valid tool can now be used to appropriately measure treatment effectiveness, and more effectively and efficiently triage youth to appropriate services.
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- 2011
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18. Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study
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Sinkala Moses, Semrau Katherine, Kankasa Chipepo, Kuhn Louise, Walter Jan, Thea Donald M, and Aldrovandi Grace M
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Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Single-dose nevirapine (SDNVP) for the prevention of mother-to-child HIV transmission (PMTCT) results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood. Methods We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders. Results Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0). Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19%) at both the first (unexposed) and second (exposed) delivery. The results were unchanged, if infant death was included as an outcome. Conclusion These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
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- 2008
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19. Emission of fluorides from industrial processes: a review
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Semrau, K
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- 1957
20. LNG coldplex offers savings in energy, equipment costs
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Semrau, K
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- 1976
21. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017.
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP Jr, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, and Black RE
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Objective: To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017., Design: Descriptive multi-country secondary data analysis., Setting: Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America., Population: Liveborn infants from 15 population-based cohorts., Methods: Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42
+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks., Main Outcome Measures: Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births)., Results: We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality., Conclusions: In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns., (© 2024 John Wiley & Sons Ltd.)- Published
- 2024
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22. Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021.
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Erchick DJ, Hazel EA, Katz J, Lee ACC, Diaz M, Wu LSF, Yoshida S, Bahl R, Grandi C, Labrique AB, Rashid M, Ahmed S, Roy AD, Haque R, Shaikh S, Baqui AH, Saha SK, Khanam R, Rahman S, Shapiro R, Zash R, Silveira MF, Buffarini R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zeng L, Zhu Z, He J, Qiu X, Gebreyesus SH, Tesfamariam K, Bekele D, Chan G, Baye E, Workneh F, Asante KP, Kaali EB, Adu-Afarwuah S, Dewey KG, Gyaase S, Wylie BJ, Kirkwood BR, Manu A, Thulasiraj RD, Tielsch J, Chowdhury R, Taneja S, Babu GR, Shriyan P, Ashorn P, Maleta K, Ashorn U, Mangani C, Acevedo-Gallegos S, Rodriguez-Sibaja MJ, Khatry SK, LeClerq SC, Mullany LC, Jehan F, Ilyas M, Rogerson SJ, Unger HW, Ghosh R, Musange S, Ramokolo V, Zembe-Mkabile W, Lazzerini M, Rishard M, Wang D, Fawzi WW, Minja DTR, Schmiegelow C, Masanja H, Smith E, Lusingu JPA, Msemo OA, Kabole FM, Slim SN, Keentupthai P, Mongkolchati A, Kajubi R, Kakuru A, Waiswa P, Walker D, Hamer DH, Semrau KEA, Chaponda EB, Chico RM, Banda B, Musokotwane K, Manasyan A, Pry JM, Chasekwa B, Humphrey J, and Black RE
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Objective: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021., Design: Descriptive multi-country secondary data analysis., Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021., Population: Liveborn infants., Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study., Results: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%)., Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2023
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23. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017.
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP Jr, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, and Black RE
- Abstract
Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs)., Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000., Setting: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America., Population: Live birth neonates., Methods: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies., Main Outcome Measures: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification., Results: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies., Conclusions: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2023
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24. Safe recovery after cesarean in rural Africa: Technical consensus guidelines for post-discharge care.
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Kateera F, Hedt-Gauthier B, Luo A, Niyigena A, Galvin G, Hakizimana S, Molina RL, Boatin AA, Kasonde P, Musabeyezu J, Ngonzi J, Riviello R, Semrau K, and Sayinzoga F
- Subjects
- Pregnancy, Female, Humans, Cesarean Section, Parturition, Africa South of the Sahara, Patient Discharge, Aftercare
- Abstract
Despite increasing cesarean rates in Africa, there remain extensive gaps in the standard provision of care after cesarean birth. We present recommendations for discharge instructions to be provided to women following cesarean delivery in Rwanda, particularly rural Rwanda, and with consideration of adaptable guidelines for sub-Saharan Africa, to support recovery during the postpartum period. These guidelines were developed by a Technical Advisory Group comprised of clinical, program, policy, and research experts with extensive knowledge of cesarean care in Africa. The final instructions delineate between normal and abnormal recovery symptoms and advise when to seek care. The instructions align with global postpartum care guidelines, with additional emphasis on care practices more common in the region and address barriers that women delivering via cesarean may encounter in Africa. The recommended timeline of postpartum visits and visit activities reflect the World Health Organization protocols and provide additional activities to support women who give birth via cesarean. These guidelines aim to standardize communication with women at the time of discharge after cesarean birth in Africa, with the goal of improved confidence and clinical outcomes among these individuals., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
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- 2023
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25. Crystal structure and initial characterization of a novel archaeal-like Holliday junction-resolving enzyme from Thermus thermophilus phage Tth15-6.
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Ahlqvist J, Linares-Pastén JA, Håkansson M, Jasilionis A, Kwiatkowska-Semrau K, Friðjónsson ÓH, Kaczorowska AK, Dabrowski S, Ævarsson A, Hreggviðsson GÓ, Al-Karadaghi S, Kaczorowski T, and Nordberg Karlsson E
- Subjects
- Archaea genetics, Archaea metabolism, Holliday Junction Resolvases chemistry, Holliday Junction Resolvases genetics, Holliday Junction Resolvases metabolism, Thermus thermophilus, Bacteriophages genetics, Bacteriophages metabolism, DNA, Cruciform
- Abstract
This study describes the production, characterization and structure determination of a novel Holliday junction-resolving enzyme. The enzyme, termed Hjc_15-6, is encoded in the genome of phage Tth15-6, which infects Thermus thermophilus. Hjc_15-6 was heterologously produced in Escherichia coli and high yields of soluble and biologically active recombinant enzyme were obtained in both complex and defined media. Amino-acid sequence and structure comparison suggested that the enzyme belongs to a group of enzymes classified as archaeal Holliday junction-resolving enzymes, which are typically divalent metal ion-binding dimers that are able to cleave X-shaped dsDNA-Holliday junctions (Hjs). The crystal structure of Hjc_15-6 was determined to 2.5 Å resolution using the selenomethionine single-wavelength anomalous dispersion method. To our knowledge, this is the first crystal structure of an Hj-resolving enzyme originating from a bacteriophage that can be classified as an archaeal type of Hj-resolving enzyme. As such, it represents a new fold for Hj-resolving enzymes from phages. Characterization of the structure of Hjc_15-6 suggests that it may form a dimer, or even a homodimer of dimers, and activity studies show endonuclease activity towards Hjs. Furthermore, based on sequence analysis it is proposed that Hjc_15-6 has a three-part catalytic motif corresponding to E-SD-EVK, and this motif may be common among other Hj-resolving enzymes originating from thermophilic bacteriophages., (open access.)
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- 2022
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26. Modification of oxytocin use through a coaching-based intervention based on the WHO Safe Childbirth Checklist in Uttar Pradesh, India: a secondary analysis of a cluster randomised controlled trial.
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Marx Delaney M, Kalita T, Hawrusik B, Neal BJ, Miller K, Ketchum R, Molina RL, Singh S, Kumar V, and Semrau K
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- Adult, Checklist standards, Cluster Analysis, Delivery, Obstetric standards, Female, Guideline Adherence statistics & numerical data, Humans, India, Infant, Newborn, Mentoring standards, Parturition drug effects, Perinatal Mortality, Pregnancy, Quality Improvement, World Health Organization, Checklist methods, Delivery, Obstetric statistics & numerical data, Mentoring methods, Oxytocin therapeutic use, Resuscitation statistics & numerical data
- Abstract
Objective: To understand the prevalence of intrapartum oxytocin use, assess associated perinatal and maternal outcomes, and evaluate the impact of a WHO Safe Childbirth Checklist intervention on oxytocin use at primary-level facilities in Uttar Pradesh, India., Design: Secondary analysis of a cluster-randomised controlled trial., Setting: Thirty Primary and Community public health facilities in Uttar Pradesh, India from 2014 to 2017., Population: Women admitted to a study facility for childbirth at baseline, 2, 6 or 12 months after intervention initiation., Methods: The BetterBirth intervention aimed to increase adherence to the WHO Safe Childbirth Checklist. We used Rao-Scott Chi-square tests to compare (1) timing of oxytocin use between study arms and (2) perinatal mortality and resuscitation of infants whose mothers received intrapartum oxytocin versus who did not., Main Outcome Measures: Intrapartum and postpartum oxytocin administration, perinatal mortality, use of neonatal bag and mask., Results: We observed 5484 deliveries. At baseline, intrapartum oxytocin was administered to 78.2% of women. Two months after intervention initiation, intrapartum oxytocin (I) was administered to 32.1% of women compared with 70.6% in the control (C) (P < 0.01); this difference diminished after the end of the intervention (I = 48.2%, C = 74.7%, P = 0.03). Partograph use remained at <1% at all facilities. Resuscitation was performed on 7.5% of infants whose mother received intrapartum oxytocin versus 2.0% who did not (P < 0.0001)., Conclusions: In this setting, intrapartum oxytocin use was high despite limited maternal/fetal monitoring or caesarean capability, and was associated with increased neonatal resuscitation. The BetterBirth intervention was successful at decreasing intrapartum oxytocin use. Ongoing support is needed to sustain these practices., Tweetable Abstract: Coaching + WHO Safe Childbirth Checklist reduces intrapartum oxytocin use and need for newborn resuscitation., (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
- Published
- 2021
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27. Maternal waiting homes: shortening the distance to safer childbirth.
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Semrau K
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- Female, Humans, Pregnancy, Delivery, Obstetric, Parturition
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- 2021
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28. The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses.
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North K, Marx Delaney M, Bose C, Lee ACC, Vesel L, Adair L, and Semrau K
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- Birth Weight, Child, Humans, Infant, Infant Nutritional Physiological Phenomena, Infant, Newborn, Infant, Very Low Birth Weight, Milk, Human, Systematic Reviews as Topic, Infant Formula, Infant, Premature
- Abstract
Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low-birthweight infants, with particular focus on low- and lower middle-income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500-2500 g in low- and lower middle-income countries., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)
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- 2021
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29. Going to extremes - a metagenomic journey into the dark matter of life.
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Aevarsson A, Kaczorowska AK, Adalsteinsson BT, Ahlqvist J, Al-Karadaghi S, Altenbuchner J, Arsin H, Átlasson ÚÁ, Brandt D, Cichowicz-Cieślak M, Cornish KAS, Courtin J, Dabrowski S, Dahle H, Djeffane S, Dorawa S, Dusaucy J, Enault F, Fedøy AE, Freitag-Pohl S, Fridjonsson OH, Galiez C, Glomsaker E, Guérin M, Gundesø SE, Gudmundsdóttir EE, Gudmundsson H, Håkansson M, Henke C, Helleux A, Henriksen JR, Hjörleifdóttir S, Hreggvidsson GO, Jasilionis A, Jochheim A, Jónsdóttir I, Jónsdóttir LB, Jurczak-Kurek A, Kaczorowski T, Kalinowski J, Kozlowski LP, Krupovic M, Kwiatkowska-Semrau K, Lanes O, Lange J, Lebrat J, Linares-Pastén J, Liu Y, Lorentsen SA, Lutterman T, Mas T, Merré W, Mirdita M, Morzywołek A, Ndela EO, Karlsson EN, Olgudóttir E, Pedersen C, Perler F, Pétursdóttir SK, Plotka M, Pohl E, Prangishvili D, Ray JL, Reynisson B, Róbertsdóttir T, Sandaa RA, Sczyrba A, Skírnisdóttir S, Söding J, Solstad T, Steen IH, Stefánsson SK, Steinegger M, Overå KS, Striberny B, Svensson A, Szadkowska M, Tarrant EJ, Terzian P, Tourigny M, Bergh TVD, Vanhalst J, Vincent J, Vroling B, Walse B, Wang L, Watzlawick H, Welin M, Werbowy O, Wons E, and Zhang R
- Subjects
- Bioprospecting organization & administration, Computational Biology, Databases, Genetic, Europe, Hydrothermal Vents virology, Viral Proteins chemistry, Viral Proteins genetics, Viral Proteins metabolism, Virome genetics, Viruses classification, Viruses genetics, Genome, Viral genetics, Metagenomics
- Abstract
The Virus-X-Viral Metagenomics for Innovation Value-project was a scientific expedition to explore and exploit uncharted territory of genetic diversity in extreme natural environments such as geothermal hot springs and deep-sea ocean ecosystems. Specifically, the project was set to analyse and exploit viral metagenomes with the ultimate goal of developing new gene products with high innovation value for applications in biotechnology, pharmaceutical, medical, and the life science sectors. Viral gene pool analysis is also essential to obtain fundamental insight into ecosystem dynamics and to investigate how viruses influence the evolution of microbes and multicellular organisms. The Virus-X Consortium, established in 2016, included experts from eight European countries. The unique approach based on high throughput bioinformatics technologies combined with structural and functional studies resulted in the development of a biodiscovery pipeline of significant capacity and scale. The activities within the Virus-X consortium cover the entire range from bioprospecting and methods development in bioinformatics to protein production and characterisation, with the final goal of translating our results into new products for the bioeconomy. The significant impact the consortium made in all of these areas was possible due to the successful cooperation between expert teams that worked together to solve a complex scientific problem using state-of-the-art technologies as well as developing novel tools to explore the virosphere, widely considered as the last great frontier of life., (© The Author(s) 2021. Published by Oxford University Press on behalf of FEMS. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2021
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30. What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation.
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Benova L, Moller AB, Hill K, Vaz LME, Morgan A, Hanson C, Semrau K, Al Arifeen S, and Moran AC
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- Humans, Infant, Newborn, Reproducibility of Results, Infant Health standards, Maternal Health standards, Quality Indicators, Health Care
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Background: Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators., Methods: A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling., Results: We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity., Conclusion: Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of indicator validity among the various global and local stakeholders working within maternal and newborn health., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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31. Meiotic crossovers characterized by haplotype-specific chromosome painting in maize.
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do Vale Martins L, Yu F, Zhao H, Dennison T, Lauter N, Wang H, Deng Z, Thompson A, Semrau K, Rouillard JM, Birchler JA, and Jiang J
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- Chromosomes, Plant, In Situ Hybridization, Fluorescence, Oligonucleotides genetics, Reproducibility of Results, Sequence Analysis, DNA, Chromosome Painting methods, Crossing Over, Genetic, Haplotypes genetics, Meiosis, Zea mays genetics
- Abstract
Meiotic crossovers (COs) play a critical role in generating genetic variation and maintaining faithful segregation of homologous chromosomes during meiosis. We develop a haplotype-specific fluorescence in situ hybridization (FISH) technique that allows visualization of COs directly on metaphase chromosomes. Oligonucleotides (oligos) specific to chromosome 10 of maize inbreds B73 and Mo17, respectively, are synthesized and labeled as FISH probes. The parental and recombinant chromosome 10 in B73 x Mo17 F
1 hybrids and F2 progenies can be unambiguously identified by haplotype-specific FISH. Analysis of 58 F2 plants reveals lack of COs in the entire proximal half of chromosome 10. However, we detect COs located in regions very close to the centromere in recombinant inbred lines from an intermated B73 x Mo17 population, suggesting effective accumulation of COs in recombination-suppressed chromosomal regions through intermating and the potential to generate favorable allelic combinations of genes residing in these regions.- Published
- 2019
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32. Coherence in measurement and programming in maternal and newborn health: experience from the BetterBirth trial.
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Panariello N, Jurczak A, Spector J, Kumar V, and Semrau K
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- Adult, Delivery, Obstetric standards, Delivery, Obstetric statistics & numerical data, Female, Humans, Infant, Infant, Newborn, Male, Pregnancy, Child Health Services standards, Child Health Services statistics & numerical data, Delivery, Obstetric mortality, Infant Mortality, Maternal Health Services standards, Maternal Health Services statistics & numerical data, Maternal Mortality
- Published
- 2019
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33. Effectiveness of community outreach HIV prevention programs in Vietnam: a mixed methods evaluation.
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Sabin LL, Semrau K, DeSilva M, Le LTT, Beard JJ, Hamer DH, Tuchman J, Hammett TM, Halim N, Reuben M, Mesic A, and Vian T
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- Adult, Cross-Sectional Studies, Female, HIV Infections epidemiology, Homosexuality, Male psychology, Homosexuality, Male statistics & numerical data, Humans, Male, Program Evaluation, Qualitative Research, Risk Assessment, Risk-Taking, Sex Workers psychology, Sex Workers statistics & numerical data, Sexual Behavior psychology, Substance Abuse, Intravenous epidemiology, Surveys and Questionnaires, Vietnam epidemiology, Community-Institutional Relations, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice, Mass Screening statistics & numerical data, Risk Reduction Behavior
- Abstract
Background: In 2014, Vietnam was the first Southeast Asian country to commit to achieving the World Health Organization's 90-90-90 global HIV targets (90% know their HIV status, 90% on sustained treatment, and 90% virally suppressed) by 2020. This pledge represented further confirmation of Vietnam's efforts to respond to the HIV epidemic, one feature of which has been close collaboration with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Starting in 2004, PEPFAR supported community outreach programs targeting high-risk populations (people who inject drugs, men who have sex with men, and sex workers). To provide early evidence on program impact, in 2007-2008 we conducted a nationwide evaluation of PEPFAR-supported outreach programs in Vietnam. The evaluation focused on assessing program effect on HIV knowledge, high-risk behaviors, and HIV testing among high-risk populations-results relevant to Vietnam's push to meet global HIV goals., Methods: We used a mixed-methods cross-sectional evaluation design. Data collection encompassed a quantitative survey of 2199 individuals, supplemented by 125 in-depth interviews. Participants were members of high-risk populations who reported recent contact with an outreach worker (intervention group) or no recent contact (comparison group). We assessed differences in HIV knowledge, risky behaviors, and HIV testing between groups, and between high-risk populations., Results: Intervention participants knew significantly more about transmission, prevention, and treatment than comparison participants. We found low levels of injection drug-use-related risk behaviors and little evidence of program impact on such behaviors. In contrast, a significantly smaller proportion of intervention than comparison participants reported risky sexual behaviors generally and within each high-risk population. Intervention participants were also more likely to have undergone HIV testing (76.1% vs. 47.0%, p < 0.0001) and to have received pre-test (78.0% vs. 33.7%, p < 0.0001) and post-test counseling (80.9% vs. 60.5%, p < 0.0001). Interviews supported evidence of high impact of outreach among all high-risk populations., Conclusions: Outreach programs appear to have reduced risky sexual behaviors and increased use of HIV testing services among high-risk populations in Vietnam. These programs can play a key role in reducing gaps in the HIV care cascade, achieving the global 90-90-90 goals, and creating an AIDS-free generation.
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- 2019
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34. Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India.
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Makowiecka K, Marchant T, Betemariam W, Chaturvedi A, Jana L, Liman A, Mathewos B, Muhammad FB, Semrau K, Wunnava SS, Sibley LM, Berhanu D, Gautham M, Umar N, Spicer N, and Schellenberg J
- Abstract
Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the 'characterisation framework', based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where., Competing Interests: Competing interests: None declared.
- Published
- 2019
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35. Whole-chromosome paints in maize reveal rearrangements, nuclear domains, and chromosomal relationships.
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Albert PS, Zhang T, Semrau K, Rouillard JM, Kao YH, Wang CR, Danilova TV, Jiang J, and Birchler JA
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- Chromosome Aberrations, Chromosome Painting methods, Genome, Plant genetics, Metaphase genetics, Oligonucleotides genetics, Transcription, Genetic genetics, Cell Nucleus genetics, Chromosomes, Plant genetics, DNA Probes genetics, Gene Rearrangement genetics
- Abstract
Whole-chromosome painting probes were developed for each of the 10 chromosomes of maize by producing amplifiable libraries of unique sequences of oligonucleotides that can generate labeled probes through transcription reactions. These paints allow identification of individual homologous chromosomes for many applications as demonstrated in somatic root tip metaphase cells, in the pachytene stage of meiosis, and in interphase nuclei. Several chromosomal aberrations were examined as proof of concept for study of various rearrangements using probes that cover the entire chromosome and that label diverse varieties. The relationship of the supernumerary B chromosome and the normal chromosomes was examined with the finding that there is no detectable homology between any of the normal A chromosomes and the B chromosome. Combined with other chromosome-labeling techniques, a complete set of whole-chromosome oligonucleotide paints lays the foundation for future studies of the structure, organization, and evolution of genomes., Competing Interests: Conflict of interest statement: K.S. and J.-M.R. are employees of Arbor Biosciences., (Copyright © 2019 the Author(s). Published by PNAS.)
- Published
- 2019
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36. Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India.
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Gass JD Jr, Semrau K, Sana F, Mankar A, Singh VP, Fisher-Bowman J, Neal BJ, Tuller DE, Kumar B, Lipsitz S, Sharma N, Kodkany B, Kumar V, Gawande A, and Hirschhorn LR
- Subjects
- Female, Humans, India, Infant, Newborn, Male, Parturition, Patient Discharge, Postnatal Care, Quality Improvement, Reproducibility of Results, Spouses, Call Centers, Patient Reported Outcome Measures, Postpartum Period, Program Evaluation
- Abstract
Background: Maternal and neonatal outcomes in the immediate post-delivery period are critical indicators of quality of care. Data on childbirth outcomes in low-income settings usually require home visits, which can be constrained by cost and access. We report on the use of a call center to measure post-discharge outcomes within a multi-site improvement study of facility-based childbirth in Uttar Pradesh, India., Methods: Of women delivering at study sites eligible for inclusion, 97.9% (n = 157,689) consented to follow-up. All consenting women delivering at study facilities were eligible to receive a phone call between days eight and 42 post-partum to obtain outcomes for the seven-day period after birth. Women unable to be contacted via phone were visited at home. Outcomes, including maternal and early neonatal mortality and maternal morbidity, were ascertained using a standardized script developed from validated survey questions. Data Quality Assurance (DQA) included accuracy (double coding of calls) and validity (consistency between two calls to the same household). Regression models were used to identify factors associated with inconsistency., Findings: Over 23 months, outcomes were obtained by the call center for 98.0% (154,494/157,689) consenting women and their neonates. 87.9% of call center-obtained outcomes were captured by phone call alone and 12.1% required the assistance of a field worker. An additional 1.7% were obtained only by a field worker, 0.3% were lost-to-follow-up, and only 0.1% retracted consent. The call center captured outcomes with a median of 1 call (IQR 1-2). DQA found 98.0% accuracy; data validation demonstrated 93.7% consistency between the first and second call. In a regression model, significant predictors of inconsistency included cases with adverse outcomes (p<0.001), and different respondents on the first and validation call (p<0.001)., Conclusions: In areas with widespread mobile cell phone access and coverage, a call center is a viable and efficient approach for measurement of post-discharge childbirth outcomes., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
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37. Modification of quaternary structure of Candida albicans GlcN-6-P synthase and its desensitization to inhibition by UDP-GlcNAc by site-directed mutagenesis.
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Kwiatkowska-Semrau K, Wojciechowski M, Gabriel I, Crucho S, and Milewski S
- Subjects
- Binding Sites, Candida albicans genetics, DNA, Fungal genetics, Escherichia coli genetics, Fungal Proteins genetics, Gene Expression Regulation, Fungal, Glutamine-Fructose-6-Phosphate Transaminase (Isomerizing) genetics, Protein Structure, Quaternary, Candida albicans enzymology, Fungal Proteins chemistry, Glutamine-Fructose-6-Phosphate Transaminase (Isomerizing) chemistry, Mutagenesis, Site-Directed
- Abstract
Site-directed mutagenesis of the CaGFA1 gene encoding glucosamine-6-phosphate synthase from Candida albicans was performed. Desensitization of the enzyme to inhibition by UDPGlcNAc was achieved upon T487I and H492F substitutions at the UDP-GlcNAc binding site, exchange of D524, S525 and S527 for Ala at the dimer:dimer interface and construction of the tail-lock array (L434R and L460A) at the C-tail region. The first two sets if mutageneses but not the last one resulted in conversion of the tetrameric enzyme into its dimeric form. Evidence for links and communication between the UDP-GlcNAc binding site and the dimer-dimer contact areas are presented. The CaGfa1-T487IH492F and CaGfa1-KHSH-D524AS525AS527A muteins are the first examples of the successful conversion of eukaryotic GlcN-6-P synthase into its prokaryotic-like version upon rational site-directed mutagenesis., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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38. The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia.
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Henry EG, Thea DM, Hamer DH, DeJong W, Musokotwane K, Chibwe K, Biemba G, and Semrau K
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- Female, Health Care Surveys, Humans, Pregnancy, Zambia, Delivery, Obstetric, Emergency Treatment, Maternal Health, Program Evaluation
- Abstract
In 2012, Saving Mothers, Giving Life (SMGL), a multi-level health systems initiative, launched in Kalomo District, Zambia, to address persistent challenges in reducing maternal mortality. We assessed the impact of the programme from 2012 to 2013 using a quasi-experimental study with both household- and health facility-level data collected before and after implementation in both intervention and comparison areas. A total of 21,680 women and 75 non-hospital health centres were included in the study. Using the difference-in-differences method, multivariate logistic regression, and run charts, rates of facility-based birth (FBB) and delivery with a skilled birth provider were compared between intervention and comparison sites. Facility capacity to provide emergency obstetric and newborn care was also assessed before and during implementation in both study areas. There was a 45% increase in the odds of FBB after the programme was implemented in Kalomo relative to comparison districts, but there was a limited measurable change in supply-side indicators of intrapartum maternity care. Most facility-level changes related to an increase in capacity for newborn care. As SMGL and similar programmes are scaled-up and replicated, our results underscore the need to ensure that the health services supply is in balance with improved demand to achieve maximal reductions in maternal mortality.
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- 2018
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39. Can community health workers identify omphalitis? A validation study from Southern Province, Zambia.
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Herlihy JM, Gille S, Grogan C, Bobay L, Simpamba K, Akonkwa B, Chisenga T, Hamer DH, and Semrau K
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- Algorithms, Anti-Infective Agents, Local administration & dosage, Chlorhexidine administration & dosage, Community Health Workers, Female, Humans, Infant, Infant Mortality, Infant, Newborn, Male, Reproducibility of Results, Sensitivity and Specificity, Skin Diseases, Bacterial epidemiology, Skin Diseases, Bacterial mortality, Skin Diseases, Bacterial prevention & control, Zambia epidemiology, Checklist standards, Community Health Services standards, Maternal-Child Health Services standards, Skin Diseases, Bacterial diagnosis, Umbilical Cord
- Abstract
Objective: Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low-resource settings. We tested an algorithm that task-shifts omphalitis diagnosis to community-level workers in sub-Saharan Africa., Methods: Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis., Results: Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%., Conclusion: Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub-Saharan African setting., (© 2018 John Wiley & Sons Ltd.)
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- 2018
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40. Comparative Oligo-FISH Mapping: An Efficient and Powerful Methodology To Reveal Karyotypic and Chromosomal Evolution.
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Braz GT, He L, Zhao H, Zhang T, Semrau K, Rouillard JM, Torres GA, and Jiang J
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- Animals, Chromosome Painting methods, Chromosomes, Chromosomes, Plant, Diploidy, Karyotype, Karyotyping, Solanum lycopersicum genetics, Polyploidy, Solanum tuberosum genetics, Synteny, Translocation, Genetic, In Situ Hybridization, Fluorescence methods
- Abstract
Developing the karyotype of a eukaryotic species relies on identification of individual chromosomes, which has been a major challenge for most nonmodel plant and animal species. We developed a novel chromosome identification system by selecting and labeling oligonucleotides (oligos) located in specific regions on every chromosome. We selected a set of 54,672 oligos (45 nt) based on single copy DNA sequences in the potato genome. These oligos generated 26 distinct FISH signals that can be used as a "bar code" or "banding pattern" to uniquely label each of the 12 chromosomes from both diploid and polyploid (4× and 6×) potato species. Remarkably, the same bar code can be used to identify the 12 homeologous chromosomes among distantly related Solanum species, including tomato and eggplant. Accurate karyotypes based on individually identified chromosomes were established in six Solanum species that have diverged for >15 MY. These six species have maintained a similar karyotype; however, modifications to the FISH signal bar code led to the discovery of two reciprocal chromosomal translocations in Solanum etuberosum and S. caripense We also validated these translocations by oligo-based chromosome painting. We demonstrate that the oligo-based FISH techniques are powerful new tools for chromosome identification and karyotyping research, especially for nonmodel plant species., (Copyright © 2018 by the Genetics Society of America.)
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- 2018
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41. Implementation and results of an integrated data quality assurance protocol in a randomized controlled trial in Uttar Pradesh, India.
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Gass JD Jr, Misra A, Yadav MNS, Sana F, Singh C, Mankar A, Neal BJ, Fisher-Bowman J, Maisonneuve J, Delaney MM, Kumar K, Singh VP, Sharma N, Gawande A, Semrau K, and Hirschhorn LR
- Subjects
- Delivery, Obstetric adverse effects, Delivery, Obstetric mortality, Female, Humans, India, Infant, Infant Mortality, Infant, Newborn, Maternal Mortality, Pregnancy, Data Accuracy, Health Services Research standards, Maternal Health Services standards, Parturition, Quality Assurance, Health Care standards, Quality Improvement standards, Quality Indicators, Health Care standards, Research Design standards
- Abstract
Background: There are few published standards or methodological guidelines for integrating Data Quality Assurance (DQA) protocols into large-scale health systems research trials, especially in resource-limited settings. The BetterBirth Trial is a matched-pair, cluster-randomized controlled trial (RCT) of the BetterBirth Program, which seeks to improve quality of facility-based deliveries and reduce 7-day maternal and neonatal mortality and maternal morbidity in Uttar Pradesh, India. In the trial, over 6300 deliveries were observed and over 153,000 mother-baby pairs across 120 study sites were followed to assess health outcomes. We designed and implemented a robust and integrated DQA system to sustain high-quality data throughout the trial., Methods: We designed the Data Quality Monitoring and Improvement System (DQMIS) to reinforce six dimensions of data quality: accuracy, reliability, timeliness, completeness, precision, and integrity. The DQMIS was comprised of five functional components: 1) a monitoring and evaluation team to support the system; 2) a DQA protocol, including data collection audits and targets, rapid data feedback, and supportive supervision; 3) training; 4) standard operating procedures for data collection; and 5) an electronic data collection and reporting system. Routine audits by supervisors included double data entry, simultaneous delivery observations, and review of recorded calls to patients. Data feedback reports identified errors automatically, facilitating supportive supervision through a continuous quality improvement model., Results: The five functional components of the DQMIS successfully reinforced data reliability, timeliness, completeness, precision, and integrity. The DQMIS also resulted in 98.33% accuracy across all data collection activities in the trial. All data collection activities demonstrated improvement in accuracy throughout implementation. Data collectors demonstrated a statistically significant (p = 0.0004) increase in accuracy throughout consecutive audits. The DQMIS was successful, despite an increase from 20 to 130 data collectors., Conclusions: In the absence of widely disseminated data quality methods and standards for large RCT interventions in limited-resource settings, we developed an integrated DQA system, combining auditing, rapid data feedback, and supportive supervision, which ensured high-quality data and could serve as a model for future health systems research trials. Future efforts should focus on standardization of DQA processes for health systems research., Trial Registration: ClinicalTrials.gov identifier, NCT02148952 . Registered on 13 February 2014.
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- 2017
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42. Implementing the WHO Safe Childbirth Checklist: lessons learnt on a quality improvement initiative to improve mother and newborn care at Gobabis District Hospital, Namibia.
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Kabongo L, Gass J, Kivondo B, Kara N, Semrau K, and Hirschhorn LR
- Abstract
Background Although there are many evidence-based practices that reduce the risk of maternal and neonatal mortality around the time of birth, there remains a gap between what is known and the care received. This know-do gap is a source of preventable maternal and perinatal deaths and is the focus of improvement efforts in many countries. Following an increase in perinatal and maternal deaths, Gobabis District Hospital initiated a quality improvement (QI) initiative to increase adherence to these WHO Safe Childbirth Checklist (SCC)-targeted essential birth practices (EBPs). Methods We implemented the SCC with support from leadership, coaching and organisational redesign. Implementation was led by a facility champion supported by a QI team and adapted through a series of three 8-week Plan-Do-Study-Act (PDSA) cycles. Results During the 6-month period, we observed an improvement of average EBPs delivered from 68% to 95%. We also found reductions in perinatal mortality rates from 22 deaths/1000 deliveries to 13.8/1000 deliveries largely due to a drop in fresh stillbirths. Conclusion We conclude that replicating the programme is feasible, acceptable and effective in areas where gaps exist, but it requires local leadership, ongoing coaching and adaptation through PDSA cycles., Competing Interests: Competing interests: None declared.
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- 2017
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43. The influence of quality maternity waiting homes on utilization of facilities for delivery in rural Zambia.
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Henry EG, Semrau K, Hamer DH, Vian T, Nambao M, Mataka K, and Scott NA
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- Adult, Female, Humans, Pregnancy, Rural Population, Zambia, Delivery, Obstetric standards, Health Services Accessibility, Maternal Health Services organization & administration, Maternal Health Services statistics & numerical data, Quality of Health Care
- Abstract
Background: Residential accommodation for expectant mothers adjacent to health facilities, known as maternity waiting homes (MWH), is an intervention designed to improve access to skilled deliveries in low-income countries like Zambia where the maternal mortality ratio is estimated at 398 deaths per 100,000 live births. Our study aimed to assess the relationship between MWH quality and the likelihood of facility delivery in Kalomo and Choma Districts in Southern Province, Zambia., Methods: We systematically assessed and inventoried the functional capacity of all existing MWH using a quantitative facility survey and photographs of the structures. We calculated a composite score and used multivariate regression to quantify MWH quality and its association with the likelihood of facility delivery using household survey data collected on delivery location in Kalomo and Choma Districts from 2011-2013., Results: MWH were generally in poor condition and composite scores varied widely, with a median score of 28.0 and ranging from 12 to 66 out of a possible 75 points. Of the 17,200 total deliveries captured from 2011-2013 in 40 study catchment area facilities, a higher proportion occurred in facilities where there was either a MWH or the health facility provided space for pregnant waiting mothers compared to those with no accommodations (60.7% versus 55.9%, p <0.001). After controlling for confounders including implementation of Saving Mothers Giving Life, a large-scale maternal health systems strengthening program, among women whose catchment area facilities had an MWH, those women with MWHs in their catchment area that were rated medium or high quality had a 95% increase in the odds of facility delivery than those whose catchment area MWHs were of poor quality (OR: 1.95, 95% CI 1.76, 2.16)., Conclusions: Improving both the availability and the quality of MWH represents a potentially useful strategy to increasing facility delivery in rural Zambia., Trial Registration: The Zambia Chlorhexidine Application Trial is registered at Clinical Trials.gov (identifier: NCT01241318).
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- 2017
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44. Breast milk and in utero transmission of HIV-1 select for envelope variants with unique molecular signatures.
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Nakamura KJ, Heath L, Sobrera ER, Wilkinson TA, Semrau K, Kankasa C, Tobin NH, Webb NE, Lee B, Thea DM, Kuhn L, Mullins JI, and Aldrovandi GM
- Subjects
- Breast Feeding, Cohort Studies, Female, HIV-1 genetics, Humans, Infant, Infant, Newborn, Male, Maternal-Fetal Exchange, Pregnancy, Sequence Analysis, DNA, env Gene Products, Human Immunodeficiency Virus genetics, Genotype, HIV Infections transmission, HIV Infections virology, HIV-1 classification, HIV-1 isolation & purification, Infectious Disease Transmission, Vertical, Selection, Genetic
- Abstract
Background: Mother-to-child transmission of human immunodeficiency virus-type 1 (HIV-1) poses a serious health threat in developing countries, and adequate interventions are as yet unrealized. HIV-1 infection is frequently initiated by a single founder viral variant, but the factors that influence particular variant selection are poorly understood., Results: Our analysis of 647 full-length HIV-1 subtype C and G viral envelope sequences from 22 mother-infant pairs reveals unique genotypic and phenotypic signatures that depend upon transmission route. Relative to maternal strains, intrauterine HIV transmission selects infant variants that have shorter, less-glycosylated V1 loops that are more resistant to soluble CD4 (sCD4) neutralization. Transmission through breastfeeding selects for variants with fewer potential glycosylation sites in gp41, are more sensitive to the broadly neutralizing antibodies PG9 and PG16, and that bind sCD4 with reduced cooperativity. Furthermore, experiments with Affinofile cells indicate that infant viruses, regardless of transmission route, require increased levels of surface CD4 receptor for productive infection., Conclusions: These data provide the first evidence for transmission route-specific selection of HIV-1 variants, potentially informing therapeutic strategies and vaccine designs that can be tailored to specific modes of vertical HIV transmission.
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- 2017
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45. Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries.
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Baqui AH, Mitra DK, Begum N, Hurt L, Soremekun S, Edmond K, Kirkwood B, Bhandari N, Taneja S, Mazumder S, Nisar MI, Jehan F, Ilyas M, Ali M, Ahmed I, Ariff S, Soofi SB, Sazawal S, Dhingra U, Dutta A, Ali SM, Ame SM, Semrau K, Hamomba FM, Grogan C, Hamer DH, Bahl R, Yoshida S, and Manu A
- Subjects
- Cohort Studies, Databases, Factual, Epidemiologic Studies, Humans, Infant, Infant, Newborn, Randomized Controlled Trials as Topic, Rural Population, Time Factors, Developing Countries, Infant Mortality, Parturition
- Abstract
Objective: To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries., Methods: We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality., Findings: Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality., Conclusion: Neonatal mortality within 24 hours of birth in predominantly rural areas of six low- and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings.
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- 2016
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46. Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?
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Herlihy JM, Hamomba L, Bonawitz R, Goggin CE, Sambambi K, Mwale J, Musonda V, Musokatwane K, Hopkins KL, Semrau K, Hammond EE, Duncan J, Knapp AB, and Thea DM
- Subjects
- Adult, Cohort Studies, Controlled Before-After Studies, Female, Humans, Infant, Infant, Newborn, Male, Pregnancy, Prenatal Care methods, Retrospective Studies, Young Adult, Zambia, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, HIV Infections transmission, Infectious Disease Transmission, Vertical prevention & control, Medication Adherence, Pregnancy Complications, Infectious drug therapy, Prenatal Care organization & administration
- Abstract
Background: Early initiation of combination antiretroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care, disease-stage assessment delays, and loss to follow-up., Intervention: Our intervention had 3 components: integrated HIV and antenatal services in 1 location with 1 provider, laboratory courier to expedite CD4 counts, and community-based follow-up of women-infant pairs to improve prevention of mother-to-child transmission attendance. Preintervention HIV-positive pregnant women were referred to HIV clinics for disease-stage assessment and cART initiation for advanced disease (CD4 count <350 cells/μL or WHO stage >2)., Methods: We used a quasi-experimental design with preintervention/postintervention evaluations at 6 government antenatal clinics (ANCs) in Southern Province, Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Postintervention data were collected from all antiretroviral therapy-naive, HIV-positive pregnant women and their infants presenting to ANC from December 2011 to June 2013., Results: Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. The proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% [relative risk (RR) = 1.81; 95% confidence interval (CI): 1.57 to 2.08; P < 0.01]. The proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR = 2.25; 95% CI: 1.78 to 2.83; P < 0.01). The proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8% (RR = 1.33; 95% CI: 1.18 to 1.51; P < 0.01)., Conclusions: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.
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- 2015
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47. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.
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Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, and Haynes AB
- Subjects
- Adult, Cross-Sectional Studies, Female, Gestational Age, Global Health, Humans, Infant, Infant, Newborn, Postpartum Period, Pregnancy, Cesarean Section statistics & numerical data, Infant Mortality trends, Maternal Mortality trends
- Abstract
Importance: Based on older analyses, the World Health Organization (WHO) recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize maternal and neonatal outcomes., Objectives: To estimate the contemporary relationship between national levels of cesarean delivery and maternal and neonatal mortality., Design, Setting, and Participants: Cross-sectional, ecological study estimating annual cesarean delivery rates from data collected during 2005 to 2012 for all 194 WHO member states. The year of analysis was 2012. Cesarean delivery rates were available for 54 countries for 2012. For the 118 countries for which 2012 data were not available, the 2012 cesarean delivery rate was imputed from other years. For the 22 countries for which no cesarean rate data were available, the rate was imputed from total health expenditure per capita, fertility rate, life expectancy, percent of urban population, and geographic region., Exposures: Cesarean delivery rate., Main Outcomes and Measures: The relationship between population-level cesarean delivery rate and maternal mortality ratios (maternal death from pregnancy related causes during pregnancy or up to 42 days postpartum per 100,000 live births) or neonatal mortality rates (neonatal mortality before age 28 days per 1000 live births)., Results: The estimated number of cesarean deliveries in 2012 was 22.9 million (95% CI, 22.5 million to 23.2 million). At a country-level, cesarean delivery rate estimates up to 19.1 per 100 live births (95% CI, 16.3 to 21.9) and 19.4 per 100 live births (95% CI, 18.6 to 20.3) were inversely correlated with maternal mortality ratio (adjusted slope coefficient, -10.1; 95% CI, -16.8 to -3.4; P = .003) and neonatal mortality rate (adjusted slope coefficient, -0.8; 95% CI, -1.1 to -0.5; P < .001), respectively (adjusted for total health expenditure per capita, population, percent of urban population, fertility rate, and region). Higher cesarean delivery rates were not correlated with maternal or neonatal mortality at a country level. A sensitivity analysis including only 76 countries with the highest-quality cesarean delivery rate information had a similar result: cesarean delivery rates greater than 6.9 to 20.1 per 100 live births were inversely correlated with the maternal mortality ratio (slope coefficient, -21.3; 95% CI, -32.2 to -10.5, P < .001). Cesarean delivery rates of 12.6 to 24.0 per 100 live births were inversely correlated with neonatal mortality (slope coefficient, -1.4; 95% CI, -2.3 to -0.4; P = .004)., Conclusions and Relevance: National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.
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- 2015
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48. Demand-side interventions for maternal care: evidence of more use, not better outcomes.
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Hurst TE, Semrau K, Patna M, Gawande A, and Hirschhorn LR
- Subjects
- Female, Humans, Infant, Infant, Newborn, Pregnancy, Quality Improvement, Infant Mortality, Maternal Health Services supply & distribution, Maternal Mortality, Perinatal Mortality, Prenatal Care statistics & numerical data, Stillbirth epidemiology
- Abstract
Background: Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children., Methods: We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University's Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP)., Results: Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures., Conclusions: We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.
- Published
- 2015
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49. Learning before leaping: integration of an adaptive study design process prior to initiation of BetterBirth, a large-scale randomized controlled trial in Uttar Pradesh, India.
- Author
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Hirschhorn LR, Semrau K, Kodkany B, Churchill R, Kapoor A, Spector J, Ringer S, Firestone R, Kumar V, and Gawande A
- Subjects
- Checklist, Delivery, Obstetric standards, Female, Humans, India, Midwifery education, Parturition, Pregnancy, Quality Improvement, Randomized Controlled Trials as Topic methods, Research Design, Delivery, Obstetric methods
- Abstract
Background: Pragmatic and adaptive trial designs are increasingly used in quality improvement (QI) interventions to provide the strongest evidence for effective implementation and impact prior to broader scale-up. We previously showed that an on-site coaching intervention focused on the World Health Organization Safe Childbirth Checklist (SCC) improved performance of essential birth practices (EBPs) in one facility in Karnataka, India. We report on the process and outcomes of adapting the intervention prior to larger-scale implementation in a randomized controlled trial in Uttar Pradesh (UP), India., Methods: Initially, we trained a local team of physicians and nurses to coach birth attendants in SCC use at two public facilities for 4-6 weeks. Trained observers evaluated adherence to EBPs before and after coaching. Using mixed methods and a systematic adaptation process, we modified and strengthened the intervention. The modified intervention was implemented in three additional facilities. Pre/post-change in EBP prevalence aggregated across facilities was analyzed., Results: In the first two facilities, limited improvement was seen in EBPs with the exception of post-partum oxytocin. Checklists were used <25 % of observations. We identified challenges in physicians coaching nurses, need to engage district and facility leadership to address system gaps, and inadequate strategy for motivating SCC uptake. Revisions included change to peer-to-peer coaching (nurse to nurse, physician to physician); strengthened coach training on behavior and system change; adapted strategy for effective leadership engagement; and an explicit motivation strategy to enhance professional pride and effectiveness. These modifications resulted in improvement in multiple EBPs from baseline including taking maternal blood pressure (0 to 16 %), post-partum oxytocin (36 to 97 %), early breastfeeding initiation (3 to 64 %), as well as checklist use (range 32 to 88 %), all p < 0.01. Further adaptations were implemented to increase the effectiveness prior to full trial launch., Conclusions: The adaptive study design of implementation, evaluation, and feedback drove iterative redesign and successfully developed a SCC-focused coaching intervention that improved EBPs in UP facilities. This work was critical to develop a replicable BetterBirth package tailored to the local context. The multi-center pragmatic trial is underway measuring impact of the BetterBirth program on EBP and maternal-neonatal morbidity and mortality., Clinical Trials Identifier: NCT02148952 .
- Published
- 2015
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50. Combined in vitro transcription and reverse transcription to amplify and label complex synthetic oligonucleotide probe libraries.
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Murgha Y, Beliveau B, Semrau K, Schwartz D, Wu CT, Gulari E, and Rouillard JM
- Subjects
- Base Sequence, Cell Line, DNA Primers chemistry, DNA Primers genetics, DNA, Single-Stranded chemistry, Fluorescent Dyes chemistry, Humans, In Situ Hybridization, Fluorescence methods, Oligonucleotide Array Sequence Analysis methods, Oligonucleotide Probes chemistry, RNA chemistry, Transcription, Genetic, DNA, Single-Stranded genetics, Fluorescent Dyes metabolism, Gene Library, Oligonucleotide Probes genetics, RNA genetics, Reverse Transcription
- Abstract
Oligonucleotide microarrays allow the production of complex custom oligonucleotide libraries for nucleic acid detection-based applications such as fluorescence in situ hybridization (FISH). We have developed a PCR-free method to make single-stranded DNA (ssDNA) fluorescent probes through an intermediate RNA library. A double-stranded oligonucleotide library is amplified by transcription to create an RNA library. Next, dye- or hapten-conjugate primers are used to reverse transcribe the RNA to produce a dye-labeled cDNA library. Finally the RNA is hydrolyzed under alkaline conditions to obtain the single-stranded fluorescent probes library. Starting from unique oligonucleotide library constructs, we present two methods to produce single-stranded probe libraries. The two methods differ in the type of reverse transcription (RT) primer, the incorporation of fluorescent dye, and the purification of fluorescent probes. The first method employs dye-labeled reverse transcription primers to produce multiple differentially single-labeled probe subsets from one microarray library. The fluorescent probes are purified from excess primers by oligonucleotide-bead capture. The second method uses an RNA:DNA chimeric primer and amino-modified nucleotides to produce amino-allyl probes. The excess primers and RNA are hydrolyzed under alkaline conditions, followed by probe purification and labeling with amino-reactive dyes. The fluorescent probes created by the combination of transcription and reverse transcription can be used for FISH and to detect any RNA and DNA targets via hybridization.
- Published
- 2015
- Full Text
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