Three machining parameters with four levels considered in this research are feed, revolutions per minute (RPM), and depth of cut (ap). The influences of those three factors on material removal rate (MRR), surface roughness (Ra), and cutting force (Fc) were of specific interest in this research. The results showed that turning control variables has a substantial influence on the process responses. Furthermore, the paper demonstrates an adaptive neuro fuzzy inference system (ANFIS) model to predict the process response at various parametric combinations. It was observed that the ANFIS model used for prediction was accurate in predicting the process response at varying parametric combinations. The proposed model presents correlation coefficients of 0.99, 0.98, and 0.964 for MRR, Ra, and Fc, respectively.This research presents the parametric effect of machining control variables while turning EN31 alloy steel with a Chemical Vapor deposited (CVD) Ti + Al The developed linear regression equation also showed a reliable agreement with the confirmation experiment during the turning operation [2 tool. Furthermore, the depth of cut, speed, and feed have impacts on forces, RA, and wear of the insert [2 of amino acid salt solution [Metal cutting plays a crucial role in the field of manufacturing. It was found that turning factors such as feed, depth of cut, and speed influence material removal rate (MRR) and surface roughness (RA) . Howeverperation . The surperation . Carbidee insert . Using me insert . The spee insert . Grey ree insert . Cryogene insert . The inte insert . The ANOe insert . When mae insert . The fuze insert . The weae insert . The obje insert . The hybe insert . The proe insert . The hybe insert . The ANFe insert . The ANFe insert . The ANFe insert . ANFIS ce insert . The come insert . ANFIS we insert . The adse insert . The FFAe insert . The ANFe insert . The inte insert . The ANFsolution . The shesolution . The optsolution . The crysolution .p) having four levels, were adopted for experimentation. The selection of the input parameters and their levels was done considering the literature survey and trial experiments. The diameter of the work material considered was 150 mm with a length of 1500 mm. The rpm values were selected based on the pilot experiment. More than 20 pilot experiments were conducted to choose the levels of each parameter. The experimentation was performed on Panther Geared Centre Lathe . Cutting variables which include revolutions per minute (RPM), feed, and depth of cut  + Alp is the depth of the cut, f is the feed, and N is the RPM. Ra was measured with a roughness tester,  the measurement was done at three different points in the finished sample with three repetitions, and the average of the same was utilized for further analysis; and Fc were measured using the dynamometer . The MRR was evaluated with an analytical equation—MRR = πdDfN, where d remains the diameter of the work piece, aThe results achieved in this research work are presented in this section. The analysis of the MRR is presented in The ANOVA for the MRR is depicted in It was observed that both rpm and feed have major contributions (69% and 24% respectively) to the MRR. The contribution of error is negligibly small and hence ignored. The other parameters (feed and depth of cut) are less significant. Percentage contributions of the process parameters on MRR as a pie chart are shown in The consequence of process variables on surface roughness is represented in The depth of cut does not show much significance up to a certain level. However, a greater depth of cut rises the Ra values. A higher value of depth shows a further reduction of material from the work surface, causing better surface finish as removal of material from the work surface takes place slowly. The significance of turning parameters on cutting force is represented in The ANOVA test for cutting force is presented in ANFIS is a well-known hybrid model which was discovered by Jang in 1993 . Indeed,Layer I: The most relevant layer of all the layers which converts the input set to fuzzy set takes place. The membership function plays a prime role to undergo a conversion of the input set to a fuzzy set. There are a set of adaptive nodes in a fuzzy layer whose functions are described as:P, Q, and R are input variable nodes. x, y, z, B, C, and D are labels connected with variable input nodes having µ(P), µ(Q) and µ(R) as membership functions. Due to the versatility, Gaussian shape is selected in this case out of all membership function.Layer II: The output layer is a fixed function of input signal and the node function and is represented as:A2 represents the output of layer II, and Gx corresponds to the fuzzy strength rule.Layer III: It has a defined function node network like layer II and layer strength III depicted as:A3 represents the output of layer III, and Gl is the normalized strength rule for layer III.Layer IV: The nature of this is layer is inconsistent and varies spontaneously. Due to the nature of the layer node being adaptable, and the strength function is defined as:Here, Glx is the normalized weight of xth rule. fx is a fuzzy rule for x = 1,2. Therefore the fuzzy rule setup is evaluated as:Ux, Vx, and Wx are the defined parameters.Layer V: Total outcome is calculated in this layer. It has a fixed node, and the total output of the total system is evaluated by:The training of input values was done by applying the backpropagation method and was tested based upon the trained values.The Gaussian membership function was selected and applied due to its versatility and reliability. The root mean square error (RMSE), correlation coefficient (R), and mean absolute percentage error (MAPE) of the predicted values were evaluated by using the following relations :(9)MAPE=VE is the experimental value, VP is the predicted value, EVM is the mean of the experimental value, PVM is the mean of the predicted value, and noT is the number of experiments.Here The experimental results and predicted values of MRR, Ra, and Fc are represented in The comparative plot of predicted values based upon the ANFIS model and experimental values is shown in Furthermore, The parametric analysis was performed considering three process factors, namely, RPM, feed, and depth of cut, and three process performance variables—MRR, Ra, and Fc. It was observed that the cutting parameters influence the process characteristics. The RPM is the most promising factor for all the performance parameters, namely, MRR, Ra, and Fc. The correlation coefficient suggested that the prediction model is reliable and can be utilized for predicting the output responses, such as MRR, Ra, and Fc .The ANFIS-based prediction was undertaken in this research to predict the process response values at different parametric combinations. The research concludes that the proposed ANFIS model used for prediction is accurate at predicting the process responses at varying variable combinations. The developed model is useful for predicting the values of performance criteria at different parametric combinations in a turning operation. Machining of EN31 alloy steel, which is high carbon alloy steel, has been a critical area of study in the of metal cutting domain in the past several years. Moreover, it is related to a wide range of applications, such as round bars, necessarily, the connectors between pipes in oil and gas systems, water supply systems, and plugs to resist pressure in pressure valves, which are made available at lengths of 100 mm to 6000 mm with a diameter range from 5 mm to 500 mm. Despite the wide range of applications, the machining of EN31 alloy steel has always been a challenge due to its physical properties, especially the hardness.The research presents an experimental investigation and ANFIS-based modelling during the turning operation of EN31 alloy steel. The major findings of the research work are as follows.The proposed model presents R values of 0.99, 0.98, and 0.964 for MRR, Ra, and Fc, respectively.The RPM is the major contributing parameter for all performance responses, such as MRR, Ra, and Fc.The proposed ANFIS model is suitable for predicting the performance responses at all values of parametric combinations.Machining of EN 31 alloy steel, which is a high carbon alloy steel, has been an essential area of research in the field of metal cutting in the past several years owning to its wide range of applications, such as: round bars essentially as the connectors between pipes in oil and gas systems, water supply systems, and plugs to resist pressure in pressure valves. Moreover, this material is available at lengths from 100 mm to 6000 mm with a diameter range from 5 to 500 mm. Despite the wide range of applications, the machining of EN 31 alloy steel has always been a challenge due to its physical properties, especially the hardness. Therefore, machining parameter optimization becomes a critical area of research and this research has contributed to the body of knowledge in this area. The findings of this research may be useful for the manufacturers and future researchers in this area.


Insert conditions significantly influence the product quality and manufacturing efficiency of lathe machining. This study used the power spectral density distribution of the vibration signals of a lathe machining accelerometer to design an insert condition classification system applicable to different machining conditions. For four common lathe machining insert conditions , herein, the insert condition classification system was established with two stages—insert condition modeling and machining model fusion. In the insert condition modeling stage, the magnitude features of the segmented frequencies were captured according to the power spectral density distributions of the accelerometer vibration signals. Principal component analysis and backpropagation neural networks were used to develop insert condition models for different machining conditions. In the machining model fusion stage, a backpropagation neural network was employed to establish the weight function between the machining conditions and insert condition models. Subsequently, the insert conditions were classified based on the calculated weight values of all the insert condition models. Cutting tests were performed on a computer numerical control (CNC) lathe and utilized to validate the feasibility of the designed insert condition classification system. The results of the cutting tests showed that the designed system could perform insert condition classification under different machining conditions, with a classification rate exceeding 80%. Using a triaxial accelerometer, the designed insert condition classification system could perform identification and classification online for four common insert conditions under different machining conditions, ensuring that CNC lathes could further improve manufacturing quality and efficiency in practice. In machining processes, machine tools operators frequently determine the operating conditions of the cutting tools based on their professional experience. However, this approach cannot increase manufacturing efficiency and is expected to result in unreliable machining quality and long machining times. Therefore, in recent years, developing reliable tool condition monitoring systems has become an important issue in product manufacturing. Tool condition monitoring systems can identify the operating conditions of cutting tools and perform classification correctly so that defective cutting tools can be changed at the appropriate time, enhancing the machining quality and manufacturing efficiency. In this study, an insert condition classification system applicable to lathe machining processes was developed to classify four common insert conditions: built-up edge, flank wear, normal, and fracture. The main implementation procedure of tool condition monitoring comprises the selection and mounting of a sensor, signal acquisition and processing, feature capture, and condition classification ,2, and iA tool condition monitoring system mainly captures sensing signal features and performs tool condition classification. In the sensing signal capture stage, the system performs signal processing of the acquired original sensing signals and subsequently captures the appropriate sensing features from the processed signals. Signal processing and feature capturing are typically performed using time-domain analysis, frequency-domain analysis, time-frequency analysis, and statistical property methods. In the tool condition classification stage, common classification technologies are utilized, such as fuzzy logic ,18, artiKaya et al. used an SVM to develop a tool condition monitoring system that could acquire cutting force, cutting torque, vibration, and acoustic emission signals. This system uses the sensor fusion method to capture time-domain statistical features from the sensing signals and subsequently employs a genetic algorithm to determine the main features of the cutting tool conditions . Wang etPresently, tool condition monitoring systems universally employ cutting force, vibration, and acoustic emission signals. However, dynamometers used for accurate measurement of cutting force and cutting torque tend to be expensive and large; they occupy part of the manufacturing machine’s working space and influence the movements of the cutting tools. If a force sensor is mounted on the tool holder of a tool condition monitoring system, the structural rigidity is expected to be insufficient, and cutting path interference can occur. Kulandaivelu et al. found that acoustic emission signals were related to the flank wear advance along the side edge of an insert; therefore, an acoustic emission sensor should be installed on the side face of a tool holder . HoweverDesigning an insert condition classification system that can be used to identify and classify four common lathe machining insert conditions—built-up edge, flank wear, normal, and fracture.Using the magnitude features of the PSD distribution of the signals obtained from a lathe machining accelerometer to identify and classify the insert conditions under different machining conditions.Performing cutting tests with different machining conditions on a CNC lathe to evaluate the feasibility and performance of the insert condition classification system developed in this study from different machining aspects.In this study, the power spectral density (PSD) was utilized to analyze the accelerometer vibration signals. It was found that different insert conditions had various feature magnitudes at certain frequencies and that different machining conditions could influence the distribution of the feature magnitudes. To achieve the applicability of the insert condition feature capture and classification method designed in this study to different machining conditions, an L9 orthogonal array was used for the lathe machining plan to obtain the experimental data for the insert condition modeling. Because an L9 orthogonal array has nine machining conditions, correspondingly, nine insert condition models were built in this study. In the insert condition modeling stage, the PSD distribution magnitude featured numerous accelerometer signals. In this study, PCA was employed to reduce the feature dimensions, following which the principal features were utilized for backpropagation neural network (BPNN) modeling. Because nine insert condition models were built based on the experimental plan of the L9 orthogonal array, a machining model fusion mechanism needed to be designed so that these models could be used for classification under different machining conditions. In this study, a BPNN was employed to design the weight functions between the machining conditions and the insert condition models, which were applicable to the machining model fusion mechanism. Lathe machining was performed to validate the feasibility and efficiency of the proposed approach and design. Based on the lathe machining results, under the machining conditions of the experimental plan and in the range of the cutting force, the correct classification rate of the insert condition classification system designed in this study was higher than 80%. Moreover, this rate was significantly better than that of the Autoencoder+Softmax learning system. The purpose of this study includes the following:The rest of this paper is organized as follows. As shown in As machining and insert conditions significantly influence the variance in accelerometer signals, this study set three levels of machining conditions –(15). The execution process and results of the insert condition classification system designed in this study are described below and listed in The frequency segments were executed according to the PSD distributions to obtain the magnitude features.The principal components were calculated using PCA according to the obtained magnitude features.The insert condition classification, The weight values, The weighted sum values of the built-up edge, flank wear, normal, and fracture insert conditions were calculated using Equations (8)–(11).The normalized values of the insert conditions were calculated using Equations (12)–(15).According to the normalized values of the insert conditions listed in In this study, the machining conditions listed in There were six signals for the built-up edge insert condition, among which the classification results of five signals were correct, and that of one signal was incorrect. The classification rate was 83.33%.There were six signals for the flank wear insert condition, and the classification result was completely correct. The classification rate was 100%.There were six signals for the normal insert condition, among which the classification results of four signals were correct, and those of two signals were incorrect. The classification rate was 66.67%.There were six signals for the fracture insert condition, among which the classification results of five signals were correct, and that of one signal was incorrect. The classification rate was 83.33%.The classification rate resulting from the experiment under the machining conditions of a cutting speed of 318 m/min, depth of cut of 1.8 mm, and cutting feed of 0.19 mm/rev was 92.86%.The classification rate resulting from the experiment under the machining conditions of a cutting speed of 305 m/min, depth of cut of 1.4 mm, and cutting feed of 0.23 mm/rev was 87.5%.The classification rate resulting from the experiment under the machining conditions of a cutting speed of 285 m/min, depth of cut of 1.6 mm, and cutting feed of 0.18 mm/rev was 81.25%.The experimental results obtained using a cutting speed of 290 m/min, depth of cut of 1.9 mm, and cutting feed of 0.23 mm/rev showed that the correct classification rate of the insert condition classification system designed in this study was 83.33%. Subsequently, the approaches for the cutting tests under the different machining conditions were the same. The results were as follows:Therefore, the correct classification rate of the insert condition classification system developed in this study for the machining conditions within the range of the machining experiment plan was at least 80%. To evaluate the insert condition classification rate of the classification system developed in this study for the machining conditions outside the range of the machining experiment plan, a cutting speed of 323 m/min, depth of cut of 2.3 mm, and cutting feed of 0.14 mm/rev were used for the cutting tests. A total of 15 signals were obtained: four signals each for the built-up edge, flank wear, and normal insert conditions, respectively, and three signals for the fracture insert condition. The 15 test signals derived from the experiment were classified by the insert condition classification system developed in this study, and the results are listed in 2), 2), 2, To observe the effect of the cutting force on the classification rate, in this study, cutting tests were performed, wherein the machining conditions for the cutting force experiment were in the range listed in as 0.978 .(16)F=kIn this study, machining with a cutting speed of 306 m/min, depth of cut of 1.1 mm, and cutting feed of 0.22 mm/rev was performed for the cutting tests. The calculated cutting force was 271.4 N. A total of 14 signals were obtained by this experiment: four signals for the built-up edge insert condition, three signals for the flank wear insert condition, three signals for the normal insert condition, and four signals for the fracture insert condition. These obtained 14 test signals were classified using the classification system developed in this study, and the results are listed in Summarizing, considering the above-mentioned experimental results, an experimental comparison table was established, which is provided in This study compared two systems for insert condition classification. System 1 was the insert condition classification system developed in this study, and System 2 was the Autoencoder+Softmax learning system ,35. The The experimental results listed in Lathe machining product quality and production efficiency are significantly influenced by insert conditions. This study developed an insert condition classification system by referring to the PSD distribution of accelerometer signals. The system developed in this study used PCA and ANNs, and four common insert conditions—built-up edge, flank wear, normal, and fracture— could be classified under different machining conditions. In this study, the PSD distribution of the signals of a lathe machining accelerometer was observed, and it was found that different insert and machining conditions influenced the distributions of the magnitude features of the PSD. To enable the insert condition classification system developed in this study to classify the insert conditions under different machining conditions, an L9 orthogonal array was used to plan the lathe machining experiments. In the insert condition modeling stage, the PSD magnitude feature distributions could determine the frequency range with significantly different magnitude features among the insert conditions. Subsequently, PCA was employed to reduce the feature dimensions, and a BPNN was utilized to build insert condition models. Because the L9 orthogonal array lathe machining experiment plan had nine machining conditions, nine insert condition models were built in this study corresponding to these conditions. For the nine insert condition models, a BPNN was employed to establish the machining model fusion mechanism; thus, the insert condition classification system developed in this study could classify the insert conditions of the different machining conditions. The machining model fusion mechanism established the weight function between the machining conditions and the insert condition models. Therefore, the fusion mechanism had three inputs: cutting speed, depth of cut, and cutting feed, as well as nine outputs, which were the weight values of the nine insert condition models. In the machining model fusion stage, the classification system used the BPNN machining model fusion mechanism to calculate the weight values of the nine insert condition models based on the machining conditions when acquiring the accelerometer signals. The insert condition classification system designed in this study could classify the built-up edge, flank wear, normal, and fracture insert conditions according to the classification results of the insert condition models and the weight values of the machining model fusion mechanism. The cutting tests performed on a CNC lathe could evaluate the feasibility and the performance of the insert condition classification system developed in this study. The experimental results showed that the correct classification rate of the insert condition was influenced by the machining conditions and the cutting force. The classification rate of the classification system tested for the planned machining conditions exceeded 80%. In addition, the classification system had a higher classification rate when there was a larger cutting force. In comparison to the Autoencoder+Softmax learning system, the classification system designed in this study had a higher classification rate. The experimental results showed that the insert condition classification system developed in this study could be used for lathe machining under different machining conditions and that the correct classification rate of the insert conditions was higher than 80%. The contributions of this study include the following points.Development of an insert condition classification system that integrates the insert condition modeling method and machining model fusion mechanism to ensure that the system can be used to identify and classify four common insert conditions online—built-up edge, flank wear, normal, and fracture.Development of an insert condition modeling method that considers the resultant PSD distributions of the accelerometer signals, and use of PCA with the frequency segment selection developed in this study to ensure that the data dimension can be significantly reduced in subsequent applications.Development of a machining model fusion mechanism that considers both the insert condition models and different machining conditions to ensure that the insert condition classification system developed in this study can be applied to different machining conditions in practice.This study used an L9 orthogonal array to plan the lathe machining experiments. The correct classification rate of the developed classification system was higher than 80%. However, to further improve the correct classification rate, more insert condition models are required through the use of the orthogonal array with larger dimensions.


Echinococcus granulosus tapeworm infect different intermediate hosts including sheep, cattle, and camels. The intermediate host’s immune response to the hydatid cyst is still conflict and complex. The current study was designed to evaluate the immune response in sera of hydatid naturally infected sheep, cattle, and camels in the form of features of inflammatory cell infiltrations, levels of Th1 and Th2 cytokines, besides the humoral specific immunoglobulin G (IgG) responses.Cystic echinococcosis (CE) is a widespread parasitic disease caused by E. granulosus infection was measured using an indirect enzyme-linked immunosorbent assay.Thirty-nine sheep, 74 cattle, and 79 camels’ sera were collected and considered as CE naturally infected and ten samples from each species were graded as non-infected. Lung specimens were collected for histopathological examination. The quantitative concentrations of tumor necrosis factor-α, interleukin (IL)-6, IL-4, and IL-10 were determined. Different antigens were prepared from hydatid cyst; hydatid cyst fluid of lung origin hydatid cyst fluid of liver origin, hydatid cyst protoscoleces of lung origin (HCP-g), hydatid cyst protoscoleces of liver origin, hydatid cyst germinal layer of lung origin, and hydatid cyst germinal layer of liver origin; and characterized by gel electrophoresis and Western blotting analysis. The total specific IgG level against The results indicated that the cellular immune response in the infected tissues was characterized by inflammatory cell penetration. The pro-inflammatory Th1 cytokine profile was predominant in infected animals in comparison with non-infected ones. However, the humoral immune response was seen as a high level of IgG in infected animals. The presented data approved that the HCP-g antigen could be considered as a delegate antigen for all other prepared antigens with an immunoreactive band at molecular weights 32 kDa.This study provides a fundamental insight into the events that manipulate cellular and humoral immune profiles in an intermediate host; sheep, cattle, and camel that naturally infected with CE. Hence, it was concluded that CE is a constant disease and confirm the reactivity Th1 in combating hydatid cyst. Besides, it could lead to the activation of the humoral immune response in the form of a high level of IgG. Echinococcus granulosus. Hydatidosis is a silent cyclozoonotic disease of humans and herbivore animals causing high morbidity and mortality rate [E. granulosus has a complex life cycle which alternates between definitive carnivore hosts such as dogs and other canids [Cystic echinococcosis (CE) or hydatidosis is a worldwide parasitic disease caused by the cestode ity rate . The larr canids  and inter canids . Furtherr canids . Activatr canids . The hydr canids  and gradr canids . The hydr canids . The hosr canids . The defr canids . Recent r canids .E. granulosus [E. granulosus displays different immunological relationships with its hosts, therefore, great efforts have been invested to understand the immunobiology of the parasite in the intermediate host [et al. [th week and this suggests that the shift in Th1-type cytokine profile toward Th2-type explains that CE is a constant disease and confirm the reactivity Th1 in combating E. granulosus infection.The establishment of hydatid cysts within the intermediate host occurs in long-term growth, so different immune mechanisms are induced during host-parasite interplay . The earanulosus . E. granate host . T-helpeate host . The earate host . In addiate host . Moreoveate host . Furtherate host . Moreoveate host . Rostami [et al.  found thE. granulosus infections in farm animals.In Egypt, CE exists in various intermediate hosts, including cattle, buffaloes, sheep, and camels . UnfortuThe current study was designed to evaluate the immune response in sera of hydatid naturally infected sheep, cattle, and camels in the form of features of inflammatory cell infiltrations, evaluate levels of Th1 and Th2 cytokines, besides the humoral specific IgG responses. Furthermore, the characterization of hydatid cyst different prepared antigens; protoscoleces, hydatid cyst fluid, and germinal layer of camel origin was done as an example.This study was approved by the Medical Research Ethics Committee of National Research Centre, Egypt (Number: 16230). The experiments were conducted according to the guidelines established by the International Animal Ethics Committee and according to the local laws and regulations.Tissue samples with their corresponding blood were collected from 397 sheep, 401 cattle, and 341 camels presented for slaughter at El-Warak, El-Basatin, and El-Moneibs laughterhouses from April 2017 to June 2018. All samples of each species were classified into two groups infected and non-infected according to postmortem examination. Thirty-nine sheep, 74 cattle, and 79 camels were considered as naturally infected with CE and ten animals from each species were graded as non-infected based on the absence of visible CE infection and clinical signs. Sera were aliquoted and stored at −20°C until use. Liver and lung specimens were collected and rapidly fixed for histopathological examination. Hydatid cysts of camel origin were collected in phosphate-buffered saline (PBS) PH, 7.4 for the preparation of antigens.Lung tissue specimens from infected animals were fixed rapidly in 10% neutral buffered formalin for about 24 h. Fixed specimens were trimmed, washed, dehydrated in ascending grades of ethyl alcohol, cleared in xylene, and embedded in paraffin wax. Then, thin sections of 4-5 µm thickness were performed and stained with hematoxylin and eosin for general microscopic examination .Sandwich enzyme-linked immunosorbent assay (ELISA) was utilized to measure serum cytokine levels. TNF-α, IL-6, IL-4, and IL-10 concentrations were determined with commercially available kits  following the manufacturer’s instructions. The color change was measured by a spectrophotometer at a wavelength of 450 nm.g for 20 min in a cooling centrifuge. The supernatants were collected, dialyzed, and stored as HCF-g and HCF-v antigens at −20°C. Protoscoleces were obtained from the sediment of collected cyst fluid. They were washed 3 times with PBS, pH 7.2, and resuspended in PBS. The protoscoleces were exposed to three cycles of freezing, thawing, and sonication (1 min and 0.5 amplitude), then they were microscopically checked until no intact protoscoleces were detected. Then, the antigens were centrifuged at 10,000× g for 30 min and supernatants were collected and stored as HCP-g and HCP-v antigens at −20°C. Germinal layers of hydatid cysts were separated, washed several times and homogenized in PBS, pH 7.2. The homogenate was sonicated for three cycles (1 min and 0.5 amplitude) and centrifuged at 10,000× g for 30 min in a cooling centrifuge. The supernatants were aspirated and stored as HCG-g and HCG-v antigens at −20°C. The total protein content of different hydatid cyst antigens was measured according to Lowry et al. [Collected hydatid cysts from infected lungs and livers of the slaughtered camels were used for preparing different hydatid cyst antigens; hydatid cyst fluid of lung origin (HCF-g), hydatid cyst fluid of liver origin (HCF-v), hydatid cyst protoscoleces of lung origin (HCP-g), hydatid cyst protoscoleces of liver origin (HCP-v), hydatid cyst germinal layer of lung origin (HCG-g), and hydatid cyst germinal layer of liver origin (HCG-v) . Hydatidy et al. .All the hydatid cyst prepared antigens were individually fractionated in four 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) using pre-stained molecular weights (MW) protein marker 16-270 kDa . After SDS-PAGE, one gel was stained with Coomassie Brilliant Blue R-250 dye and analyzed using a gel documentation system . The othThe prevalence of hydatid cyst infection, sensitivity, and specificity of HCP-g antigen was calculated in contrast to the parasitological investigation of the examined camel sera .E. granulosus infection was performed using indirect ELISA (I-ELISA). Checkerboard titrations were used for the determination of the optimal concentration of antigens, tested sera dilutions, and conjugate dilution. The assay was performed according to the method previously described [et al. [Evaluation of IgG antibody levels against escribed . Briefly [et al. . Sera obThe data were analyzed using a one-way analysis of variance. Results were expressed as mean ± standard deviation and values of p<0.05 and p<0.01 were considered statistically significant and highly significant respectively. The curves were represented by MEDCALC easy-to-use statistical software.As shown in Lungs of camels had marked hydatid cysts that were consisted of the outer laminated layer and fibrous layer penetrated with inflammatory cells. The surrounding pulmonary alveoli were collapsed and some were emphysematous. Scoleces were found in alveoli  with monThe serum level of Th-1 pro-inflammatory cytokines, TNF-α and IL-6 and Th-2 anti-inflammatory cytokines, IL-4 and IL-10, in all the animals, was determined by sandwich ELISA, and the results obtained are presented in Overall polypeptide bands exhibited by the different prepared antigens; HCP-g, HCF-g, HCG-g, HCP-v, HCF-v, and HCG-v were 7, 3, 5, 16, 2, and 5 bands in number at MW 270, 103, 68.7, 47.7, 37.5, 32.8, and16 kDa; 65.8, 46.0, and 16.2 kDa; 98.9, 70.7, 54.0, 45.6, and 32.1 kDa; 270, 250.9, 223,175, 151.3, 112.1, 97.6, 70.9, 55.7, 48.1, 45.5, 41, 38.5, 36.4, 32, and 23 kDa; 70.9, and 20 kDa; and 105.1, 73.2, 55.8, 46.5, and 31.8 kDa, respectively . The resThe reactive band profiles presented by binding of specific IgG in positive naturally infected sera against hydatid cyst antigens; HCP-g, HCF-g, HCG-g, HCP-v, and HCG-v were identified at MW 270, 190, 94.7, 70.3, 62.5, 56, 50.6, 48, 45, 42, 38.1, and 20.1 kDa; 103.2, 71.5, 59.1, 54.7, 41, 29.1, and 21.8 kDa; 99, 82.6, 50.8, 36.7, 32, 31.2, 19.5, and 16 kDa; 270, 155.2, 129.6, 122.6, 102.5, 83.7, 79.7, 65.8, 55.8, 45, 42, 40.7, 37.5, 32, and 17.9 kDa; and 100.4, 83.5, 50.5, 32, and 16 kDa, respectively. However, HCF-v did not show any reaction with naturally infected sera . The shaThe reactive profile of immunogenic bands presented when such hydatid cyst antigens of camel origin verified against pooled positive naturally infected cattle and sheep sera revealed the immunoreactive band at MW 32 kDa with HCP-g antigen, while HCP-v antigen showed the bands at MW 50, 31, and 30 kDa and 53, 33, and 32 kDa when using positive naturally infected cattle and sheep sera, respectively  and b.HCP-g antigen was evaluated in the detection of hydatid cyst infection in collected camel sera using indirect ELISA. The used antigen achieved 75% sensitivity and a limited specificity 33%. The apparent prevalence of hydatidosis in tested serum samples was 69%.The total IgG level was determined to detect the humoral antibody responses to echinococcal infection. The IgG level was high in all infected animals in comparison with the non-infected ones .E. granulosus could be considered as a basic cause of high rates of liver and lung condemnation in slaughtered farm animals [ animals . Urgent In the current study, the lungs of camels had marked hydatid cysts which consisted of the outer laminated layer and fibrous layer penetrated with inflammatory cells. The surrounding pulmonary alveoli were collapsed, and some were emphysematous. Scoleces were found in alveoli with mononuclear inflammatory cells and few multinucleated giant cells aggregation. The cellular reaction associated with hydatid cysts was indicative of delayed hypersensitivity reactions . The obset al. [The echinococcal infection can stimulate or suppress immune responses, which persist and flourish for a long time in their mammalian hosts . Th1 andet al.  which reet al. ; howeveret al. . This coet al. . As wellet al.  as it iset al. .Modulation of the host immune response may also be relevant for selection toward commensalism, since it may prevent deleterious effects to the host resulting from the exacerbated immune response . In geneet al. [In the present study, a comprehensive investigation to immunoreactive protein expression patterns of different prepared hydatid cyst antigens of camel origin; HCP-g, HCF-g, HCG-g, HCP-v, HCF-v, and HCG-v are electro-blotted against their homologous serum  and heterologous sera of positive naturally infected-hydatid cyst cattle and sheep sera. The resultant data revealed that HCP-g antigen could be considered a representative antigen for all other prepared antigens, where, such antigen shared them in one or more immune reactive polypeptide bands detected at MW 50, 45, 42, and 32 kDa among HCP-g, HCG-g, and HCG-v; HCP-g and HCP-v; HCP-g and HCP-v; and HCG-v, HCP-v, and HCG-g, respectively, using their homologous serum. Moreover, Burgu et al. .et al. [The results revealed a limited specificity (33%), which could be attributed to the failure of HCP-g antigen in the detection of true negative animal cases in non-infected hydatid cyst camels’ sera. In addition, HCP-g antigen recorded a good sensitivity (75%) and apparent prevalence (69%) which may be attributed to the common shared immunoreactive bands which exhibited at MW 32 kDa by HCP-g antigen and may be responsible for detecting high number of true positive cases in parasitological infected hydatid cyst camels’ sera. Similar results were obtained by El-Shanawany et al.  who founet al.  where ouet al. [The current results indicated an elevation in the total IgG levels in infected camels comparing with non-infected ones. Furthermore, Rostami-Rad et al. , the totet al. .E. granulosus infection. In addition, echinococcal infection could lead to activation of the humoral immune response in the form of a high level of IgG.CE naturally infected farm animals developed cellular and humoral immune responses. The results showed a pattern of increase in Th-1 type cytokines and decrease in Th-2 type cytokines. This could explain that CE is a constant disease and confirm the reactivity Th1 in combating FAMA designed the study, performed the immunological analysis, and contributed to laboratory work analysis, statistics, data interpretation, manuscript preparation, and corresponded the authorship. SHMH contributed to antigens preparation, gel electrophoresis and Western blotting analysis with their interpretation. SSO performed the histopathological examination. DA shared in the preparation of antigens. EEE shared in gel electrophoresis and Western blotting analysis. All authors assisted in manuscript preparation and have read and approved the final manuscript.


Preterm infants born 30 to 33 weeks’ gestation often require early support with intravenous fluids because of respiratory distress, hypoglycemia or feed intolerance. When full feeds are anticipated to be reached within the first week, risks associated with intravenous delivery mode and type must be carefully considered. Recommendations are for parenteral nutrition to be infused via central venous lines (because of the high osmolarity), however, given the risks associated with central lines, clinicians may opt for 10% glucose via peripheral venous catheter when the need is short-term. We therefore compare a low osmolarity peripheral intravenous parenteral nutrition (P-PN) solution with peripheral intravenous 10% glucose on growth rate in preterm infants born 30 to 33 weeks’ gestation.+ 0 to 33+ 6 weeks’ gestation, were randomised within 24 h of age, to receive either P-PN  or a control of peripheral intravenous 10% glucose. Both groups received enteral feeds according to hospital protocol. The primary outcome was rate of weight gain from birth to 21 days of age.In this parallel group, single centre, superiority, non-blinded, randomised controlled trial, 92  infants born 30n = 42, 18.7, SD 6.6 g/d vs control, n = 50, 14.8, SD 6.0 g/d; adjusted mean difference 3.9 g/d, 95% CI 1.3 to 6.6; P = 0.004), with the effect maintained to discharge home. Days to regain birthweight were significantly reduced and length gain significantly increased in P-PN infants. One infant in the P-PN group had a stage 3 extravasation which rapidly resolved. Blood urea nitrogen and triglyceride levels were significantly higher in the P-PN group in the first week of life, but there were no instances of abnormally high levels. There were no significant differences in any other clinical or biochemical outcomes.The rate of weight gain was significantly increased in P-PN infants compared with control (P-PN, P-PN improves the rate of weight gain to discharge home in preterm infants born 30 to 33 weeks gestation compared with peripheral intravenous 10% glucose.ACTRN12616000925448. Registered 12 July 2016.Australian New Zealand Clinical Trials Registry  Infants born 30 to 33 weeks’ gestation constitute approximately 2–3% of the infant population and a large proportion of neonatal admissions. This population of preterm infants often requires transient respiratory support, are at risk of hypoglycemia and feed intolerance such that intravenous fluids are often provided during the early stages of their care. This early neonatal period corresponds to a critical window during which under-nutrition may have long lasting effects on growth and development. Lower intelligence quotient and more attention and behavioral problems at school age are evident not only in very preterm infants  but alsoAlthough recommendations for early parenteral amino acids and lipid support for very preterm infants (< 32 weeks’ gestation) are clear , 8, the Consequently, these infants receive less protein and lipid nutrition in the first week of life in comparison to both in-utero accretion and their more immature ex-utero counterparts. Clinicians therefore are balancing the risks associated with the use of central venous lines to deliver parenteral nutrition with the risks associated with short term poorer nutrition as full enteral feeds are established. We therefore aimed to determine the efficacy and safety of providing peripherally administered, low osmolarity, intravenous parenteral nutrition to preterm infants born 30 to 33 weeks’ gestation.The study was a single centre , parallel group, superiority, randomised controlled trial conducted between September 2016 and June 2018. The trial protocol was approved by the Human Research Ethics Committee (HREC/15/WCHN/134) of the Women’s and Children’s Hospital and the study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000925448). The study adheres to CONSORT guidelines for reporting of randomised controlled trials [+ 0 to 33+ 6 weeks’ gestation at the Women’s and Children’s Hospital who required intravenous fluids and were less than 24 h of age and whose parents were able to provide informed written consent, were eligible to participate. Multiple births were eligible and were randomised individually. Infants receiving fluids administered centrally or presenting with major congenital or chromosomal abnormalities were ineligible. Infants were required to be enrolled and randomised before 24 h of age.Infants born 30+ 0 to 31+ 6 and 32+ 0 to 33+ 6 weeks’ using permuted blocks of random sizes. Unfortunately, during development, the sequence of randomisations within each stratum was unintentionally re-sorted according to a randomly generated uninformative study identifier; this was not discovered until the study was complete. This essentially nullified the effects of blocking and meant the final randomisation procedure most closely approximated simple randomisation.Infants were randomised to one of two groups: the peripheral parenteral nutrition (P-PN) group or control  with a 1:1 allocation according to a computer-generated randomisation schedule developed by an independent statistician. Originally the schedule was to be stratified by sex and gestational age 30Parents of eligible infants were approached by a clinician  and followed-up for consent by a research nurse who was not involved in clinical care. Upon consent, infants were randomised by a research nurse or clinician using REDCap (Research Electronic Data Capture) - a secure web-based software platform hosted at the South Australian Health and Medical Research Institution , 18. DatThe intervention P-PN solution was prepared by Baxter Healthcare and contained amino acids (as Primene®) 30 g/L, glucose 80 g/L (8%) and heparin 500 IU/L. The P-PN solution was provided in 400 mL bags and had an estimated osmolality of 678 mOsm/L. The intervention was given to a maximum of 100 mL/kg/d, so the infant received a maximum intravenous protein intake of 3 g/kg/d. If additional parenteral fluid was required to maintain the targeted total fluid volume or for physiological homeostasis, 10% glucose was given as a separate line via the same peripheral intravenous site. The lipid solution was a 17% lipid emulsion with added vitamins for administration  with the estimated osmolality of 340 mOsm/L. The lipid emulsion (with vitamins) was administered using a separate line via the same peripheral intravenous site at 2 g/kg/d and was included in the total amount of intravenous daily fluids. For the period prior to randomisation and commencement of the intervention solutions, infants received intravenous 10% glucose via peripheral venous catheter.The control group received peripheral intravenous 10% glucose (osmolarity 556 mOsm/L) administered as per the Women’s and Children’s Hospital neonatal fluid management guidelines. Electrolytes were added, if clinically indicated, using a commercially available premixed solution .The fluid management approach was the same for both groups and followed the Hospital guidelines with total fluid volume commenced at 60 mL/kg/d, increasing by 10–15 mL/kg/d to 150–170 ml/kg/d. Enteral feeds  are commenced when clinically stable. EBM is typically fortified when the enteral intake is > 80 mL/kg/d. The IV infusions ceased in both the intervention and control groups when an enteral intake of 120 mL/kg/d was reached and maintained for 3 days. Lipid emulsion was administered at 2 g/kg/d and ceased at an enteral intake of 100 mL/kg/d. Fluid balance records were audited daily for compliance with the trial protocol. Peripheral venous cannulae were routinely changed every 72 h.The primary outcome was weight gain (g/d) from birth to 21 days ±2 days. Body weight was measured by clinical staff at approximately the same time daily using electronically balanced scales. Secondary efficacy outcomes included: weight (g/d), length and head circumference gain (mm/d) from birth to discharge home; weight, length and head circumference at 21 days of age ± 2 days and on discharge home. Length was measured weekly and on day of discharge home by clinical staff using a recumbent length board measured to the nearest 0.1 cm. Head circumference was measured around the largest occipitofrontal circumference, using a non-stretching tape, weekly and on day of discharge home by clinical staff. Secondary safety outcomes included extravasation stage 3 or 4 , the numProtein, lipid and energy intake over the first 21 days were assessed. Parenteral and enteral intake data were collected prospectively from fluid balance charts. The macronutrient composition of the intravenous solutions and formula were based on manufacturer information, and human milk on published values , 18.P < 0.05). Consultation with the neonatal medical team agreed that this was a clinically important difference on which clinical practice would change.Assuming a standard deviation in weight gain of 5 g per day in this population , 45 infa+ 0 to 31+ 6 and 32+ 0 to 33+ 6 weeks) and generalised estimating equations used to account for clustering due to multiple births. Secondary efficacy and safety outcomes were compared between groups using linear, logistic, and negative binomial regression models as appropriate, again using generalised estimating equations to account for clustering due to multiple births. Secondary biochemical measures obtained from the blood samples and weight z-scores were compared between groups over time using linear mixed models, with fixed effects terms for group, time and the interaction between group and time included in each model. For the primary outcome only, a per-protocol analysis including only those infants whose clinical care adhered to the study protocol  was also undertaken. We calculated z-scores for weight using Australian standards [All analyses were carried out on an intention to treat basis according to a pre-specified statistical analysis plan. Weight gain from birth to 21 days was compared between groups using linear regression, with adjustment made for sex and gestational age at birth . Infants randomised to P-PN had significantly higher parenteral protein, lipid and energy intake in week 1 . The number of days requiring intravenous therapy were similar between groups  (Table P = 0.0008) when analysed per protocol, i.e. excluding the 4 infants who required a central line and received ‘standard preterm PN’ [Infants randomised to P-PN had a significantly greater rate of weight gain from birth to day 21 compared with infants randomised to control  (Table P = 0.001). Length gain to discharge home was also significantly greater in P-PN infants compared with control , however there were no differences in rate of head circumference gain (Table P = 0.008)  Table . Weight 1) Table . By disc1) Table . On discThere were no significant differences between groups in the proportion of infants treated for hypoglycemia or developing feeding intolerance, or in days taken to reach full enteral feeds Table . There wP < 0.0001) with BUN levels significantly increased to day 7 and triglyceride levels to day 14 in the P-PN group compared with control  and SMOFlipid® resulted in a significantly greater rate of weight gain from birth to 21 days of age when compared with peripheral intravenous 10% glucose.The increased rate of weight gain was maintained to discharge home. The time to regain birthweight in P-PN infants was significantly less than control infants with P-PN infants weighing significantly more at 21 days of age and on discharge home. Length gain from birth to 21 days and birth to discharge home were also significantly greater with the intervention, however, there was no effect on head circumference. We found no evidence of adverse effects relating to the P-PN intervention.To the best of our knowledge this is the first randomised controlled trial of parenteral nutrition in this population. Previous observational reports show wide variation in clinical practice between countries and centres reflecting the lack of evidence in the nutritional management of this population , 28–30. P = 0.03), need for intravenous fluids  with no difference in feeding tolerance. However, their population was considerably more mature (32–36 weeks’ gestation) with the trial specifically designed for infants small for gestational age. Their approach may not translate to the less mature infant and such a study would need to be repeated in this population.Our study is unique in that parenteral nutrition was administered via peripheral venous catheter, thus avoiding the use of a central line, and reducing need for intensive care, while maximising nutritional intake. Zecca et al.  studied n = 1440) RCT suggested that delaying the introduction of parenteral nutrition for 7 days is advantageous in critically ill children [n = 209) of participants in their study were neonates and all were term born, it is therefore unknown if this benefit would apply to infants with the degree of prematurity included in our study and who had mild transitional problems. Observational studies in the moderately preterm infant have shown an association between minimising postnatal weight losses and improved growth rate [During the conduct of this study results from a large  thus minimising the risk of phlebitis and extravasation injuries associated with hyperosmolar solutions. The osmolarity of the available standardised formulations exceeded this range . We achiWe found no adverse events associated with the intervention. Although there was one grade 3 extravasation in the intervention group this rapidly resolved on removal of the cannula without any further intervention. The parenteral nutrition and lipid intervention were well tolerated. While the BUN levels were higher in the first week of life in the P-PN infants than in the control there were no instances of abnormally high levels, nor was there any evidence of metabolic acidosis. Hypertriglycidaemia occurred in only one infant in each group, with the infant in the control group not having received intravenous lipids; and instances of both hypo- and hyperglycemia were similar between groups.Our study was limited by not being able to blind the intervention. The study team considered many options for blinding such as having the intervention and control fluids masked within amber opaque syringes and infusion tubing. However, safety considerations were thought to be prohibitive for this strategy. Data analysts were blinded to group allocation and unblinding did not occur until all analyses according to the a priori statistical analysis plan were complete. The randomisation schedule error resulted in simple rather than blocked randomisation. While this led to a small imbalance in numbers between groups , sex and gestational age strata were balanced between groups. A further limitation was that secondary outcomes were analysed without adjustment for multiple comparisons. Although treatment effects on secondary growth and biochemistry outcomes were clinically plausible and often highly statistically significant, the lack of multiplicity adjustment means these findings should be interpreted with additional caution.Providing peripherally administered parenteral nutrition of 8% glucose, 30 g/L amino acids and SMOFlipid® improves short-term weight and length gain in infants born 30–33 weeks’ gestation.Additional file 1: Supplementary Table 1. Baseline characteristics. Supplementary Table 2. Parenteral and enteral intake over 21 day study period. Supplementary Table 3. Clinical outcomes. Supplementary Table 4. Peripheral intravenous cannula. Supplementary Table 5. Mean biochemical measures by day of life and overall. Supplementary Table 6. Biochemical measures outside normal clinical parameters.


There were 902 live births. Compliance with the intervention was similar across groups . There were no significant differences between DHA and placebo groups for birth weight , length , or head circumference . The mean gestational age at delivery was similar between groups  as were APGAR scores at 1 and 5 min. Supplementing mothers through pregnancy with 400 mg/day DHA did not impact the offspring‘s birthweight, length, or head circumference.Long-chain omega-3 fatty acid status during pregnancy may influence newborn anthropometry and duration of gestation. Evidence from high-quality trials from low- and middle-income countries (LMICs) is limited. We conducted a double-blind, randomized, placebo-controlled trial among 957 pregnant women  in India to test the effectiveness of 400 mg/day algal docosahexaenoic acid (DHA) compared to placebo provided from enrollment through delivery. Among 3379 women who were screened, 1171 were found eligible; 957 were enrolled and were randomized. The intervention was two microencapsulated algal DHA (200 × 2 = 400 mg/day) or two microencapsulated soy and corn oil placebo tablets to be consumed daily from enrollment (≤20 weeks) through delivery. The primary outcome was newborn anthropometry . Secondary outcomes were gestational age and 1 and 5 min Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score. The groups (DHA;  Birth weight is a key predictor of the health trajectory of a child . In 2015LBW can be the result of preterm birth (PTB) and/or intrauterine growth restriction (IUGR). The underlying causes of both PTB and IUGR are multi-factorial, including infectious diseases, hypertensive disorders, trauma and illness, maternal characteristics, and social determinants. However, the etiologies lead to a common pathway of insufficient uterine–placental perfusion and fetal nutrition . Among tp = 0.019) when compared to women whose intake was above median, that is, 9.33 g/day (interquartile range: 5.10–15.69) [p = 0.041) and greater birth weight , length , and head circumference (HC)  [Growing evidence suggests that supplementation during pregnancy with omega-3 fatty acids, especially DHA, may improve birth outcomes. In a prospective cohort study from southern India, women who did not eat fish during the third trimester had a significantly higher risk of LBW  . A revie= 0.012) . Among M= 0.012) . In the As results have been inconsistent, and little research on this question comes from LMIC contexts where the underlying nutritional status and etiology of LBW may differ, we assessed the impact of maternal DHA supplementation on newborn anthropometry, APGAR score, duration of gestation, and low birth weight among Indian women.n-3 fatty acid (DHA) supplementation during pregnancy on newborn birth weight and gestational age in India) was established as a randomized, double-blinded, placebo-controlled trial to assess the effect of 400 mg/day algal prenatal DHA consumption by healthy Indian women from ≤20 weeks of singleton gestation till delivery on their offspring’s size  at birth. The detailed trial protocol has been published elsewhere [DHANI (effect of lsewhere . DHANI in-3 LC-PUFA-rich Indian foods), anthropometric measurements, a non-fasting blood draw, and vital signs were obtained at enrollment. The women were then given the supplements in the form of coded bottles (each bottle had a 2 week supply) matching the allotted code for the participant. Further supplements were either collected by the women from the study site or were delivered to the women’s homes every fortnight by fieldworkers.The study population was healthy pregnant women, aged 18–35 years with singleton pregnancy under ≤20 weeks of gestation, with no obstetric high-risk conditions, medical complications, or chronic diseases, attending the Department of Obstetrics and Gynecology at the Prabhakar Kore Hospital (PKH) in Belgavi, a largely rural district in Karnataka State, southwest India for antenatal care. Designated project staff approached women, and the consulting obstetrician on site, considering obstetric history and complications, affirmed final eligibility. Consenting eligible women were randomized by project staff to receive either 400 mg/day DHA or a placebo after providing written informed consent using a form in their preferred local language  and observed by a witness. Information on sociodemographic characteristics, obstetric and medical history, dietary intake , pregnancy outcome, APGAR  score, newborn anthropometry , and maternal and cord blood samples.The randomization list for 1200 women was generated using a permuted block design . The assignment code list was placed in a sealed envelope at the beginning of the study and in a secure location at PHFI by a staff member not involved in the trial. Study participants and research staff (including those at the study site) remained blinded to the treatment allocation throughout the duration of fieldwork. After obtaining due approval from the Data Safety Monitoring Board (DSMB) of the study, full analyses were carried out. Unblinding of the treatment group was done only after the generation of the primary tables.Schizochytrium sp. . The sealed capsules had a shelf life of 2 years from the date of manufacture when stored at room temperature (25 °C) and 90 days once the bottle was opened. The women were instructed to store capsules in a cool, dry place and to take two capsules daily, preferably at the same time each day. Supplements were provided for more than two weeks in cases where the woman shared plans to travel. Enrolled women received supplements from the date of randomization through 6 months postpartum; for the present analysis, only supplement intake through delivery was considered.The details of the intervention have been published already , but briThe primary outcome for the DHANI trial was newborn anthropometry . Secondary outcomes included gestational age, APGAR scores at 1 and 5 min, still births, LBW, and preterm. All research staff at the study site were apprised of the data collection methods before the start of the trial and were provided regular refresher training every 6 months. Abstracted data included gestational age, pregnancy outcome , and APGAR score at 1 min and 5 min. Gestational age at delivery was calculated in weeks by noting the number of days from the last menstrual period (LMP) until delivery. Preterm delivery was defined as delivery after 20 weeks and before 37 completed weeks. Anthropometric data were collected by a trained research assistant within 24 h of delivery. Birth weight was measured to the nearest 10 g by using a portable single-pan digital pediatric weighing scale. Low birth weight was defined as recorded birth weight less than 2500 g. Birth length and head circumference were measured by trained research staff to the nearest 1 mm using a portable anthropometer with a fixed headpiece and a non-stretchable measuring tape, respectively, according to standard procedures. Fetal losses during pregnancy—including miscarriages/abortions and still-births and the APGAR scores were obtained from the hospital records by study personnel on-site, or details were brought by field workers . Stillbirths were defined as fetuses delivered at 20 weeks of gestation or later with no signs of life and recorded as occurring before or during the onset of labor; neonatal deaths were defined as deaths among live-born infants occurring within 28 days after delivery.Subjects were asked to maintain a daily record of their supplement consumption using a form provided by study staff. Weekly calls were made by the research staff to encourage compliance and inquire about general well-being. The used bottles were collected (for pill count) by the field-workers during the fortnightly home visits. The compliance was calculated as the total number of capsules actually consumed, expressed as a percentage of the total number expected to be consumed, which was assessed based on a compliance form filled by the participant and verified by the research staff at all home visits. A sub-sample of venous blood samples collected from the mother at recruitment and delivery was analyzed for DHA levels.Using data from published literature from another developing country setting , we estiBaseline maternal and offspring characteristics were summarized as means and standard deviations or medians and inter-quartile ranges as appropriate, and categorical variables were summarized using proportions.t-test to compare the differences in mean birth weight, birth length, head circumference, and APGAR score at 1 min and 5 min at delivery between the DHA and placebo groups. We also calculated the z score for birth weight, length, and head circumference using standards established by the  Project [z score between DHA and placebo group using two-sample t-tests. The differences in proportion for preterm birth and LBW between the DHA and placebo groups were compared using the two-proportion z-test. The analysis was done using the intent to treat (ITT) principle.We used a two-sample  Project  and comp2; 18.5–23.0 kg/m2; 23.0–27.5 kg/m2; and 27.5 kg/m2) as per Asian cut-offs [p-value for heterogeneity was calculated by including the interaction term between the characteristic of interest and treatment group in the linear regression model. The significance of within-subgroup treatment effects was adjusted for multiplicity for multiple subgroup analyses using the Bonferroni criterion, i.e., by dividing the overall significance level by the total number of subgroup analyses performed. For sensitivity analysis, we compared the baseline characteristics between the final study sample and those who were lost to follow-up. p values <0.05 were considered to be statistically significant. All statistical analysis was done using STATA 16.0 version  and R 3.6.2 software .We conducted several pre-specified subgroup analyses to estimate the treatment effects within different categories of maternal age , body mass index (BMI) at enrollment (<18.5 kg/mn = 478) or placebo (n = 479)  .Overall, the mean (SD) age of the mothers was 23.5 (3.6) years, and gestational age ) at enrolment was 15.0  weeks. A total of 79% of the women had completed at least secondary school and 23% of the women were employed. About 12% of the women reported monthly household income more than Rs 20,000 (285 USD taking 1 USD = 70 INR). Baseline characteristics of the enrolled women were similar between DHA and placebo groups . The detThe two groups did not differ in estimated intake of energy or any macronutrient at baseline . The meap = <0.001; placebo 0.24 , p = 0.0002).n = 478) and placebo (n = 479) groups, respectively. Compliance was high in both groups (DHA: 88.5% and placebo: 87.1%). There were 230 (52.3%) and 235 (53.4%) male children in the DHA and placebo groups, respectively, and percentages were calculated based on 440 (DHA) and 440 (placebo) analyzed neonates.There were 450 (94.1%) and 452 (94.3%) live births in the DHA (p = 0.54), birth length , or head circumference . The APGAR scores at 1 min and 5 min were similar between the groups. We did not find any significant difference between DHA and placebo groups in z scores for birth weight, length, and head circumference.p = 0.54). The prevalence of preterm birth and low birth weight did not differ significantly between the groups. Unfortunately, the causes of preterm birth and the number of intra uterine growth retardation (IUGR) cases were not collected.Gestational age at delivery was similar between DHA and placebo groups . Similarly, there was no evidence of differences by compliance, the gender of the child, or preterm status.In this study, maternal supplementation with 400 mg/day DHA in the second half of pregnancy did not affect the weight, length, or head circumference of the offspring at birth. While this was in contrast to findings from some high-income settings , it concAlthough mechanistic pathways linking maternal polyunsaturated fatty acid (PUFA), especially DHA status with gestational length, are poorly delineated, prenatal DHA supplementation has been shown to enhance the gestation duration in some studies . This loA recent 2018 Cochrane review  looking Key strengths of this study are the strong study design combined with high retention rates and compliance (verified by the rise in erythrocyte DHA levels).Another parameter which is often of interest is the timing of initiation of supplementation during pregnancy. The other salient trials ,19 initiThe complexity of multiple other factors apart from DHA in affecting birth size needs to be recognized. Factors like the maternal diet at multiple time points during pregnancy, family support, stress levels , and theIn summary, no beneficial effects of prenatal supplementation of Indian women with DHA from mid-pregnancy through delivery on newborn anthropometry were observed.


Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure–outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth  1.28, 2.32), NICU or stepdown stay , and extended hospitalization . Associations between housing insecurity and infant fair or poor health  and poor temperament  were not statistically significant. PAF estimates ranged from 0.9–2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families. The United States (U.S.) is in the midst of a housing affordability crisis. Because income growth has not kept pace with rising housing costs, fewer and fewer families are able to afford housing . Owing tHousing insecurity among pregnant women takes a toll on maternal mental health and the health of a fetus. Depression, anxiety, and stress increase a woman’s likelihood of delivering preterm or giving birth to a low birth weight infant ,11,12. IDespite this growing body of evidence, there are important gaps in our knowledge about how housing insecurity in the U.S. may influence the health of infants at birth into childhood. Past studies have not examined the association between housing insecurity on costly birth outcomes such as stays in neonatal intensive care units (NICUs) and extended hospital stays after delivery. Moreover, studies to date have not examined associations between prenatal housing insecurity and children’s health beyond birth. Uncovering the relationship between prenatal housing insecurity on birth-related healthcare utilization and later infant health and development outcomes will add to our understanding of the costs associated with the housing affordability crisis, both human and economic.To fill these gaps, we conduct analyses testing a hypothesized link between severe housing insecurity  during pregnancy and adverse health outcomes measured at birth and during infancy in a cohort of low income, urban mothers and infants. Specific outcomes include low birth weight or preterm birth, NICU or stepdown facility stays, and extended hospital stays after delivery, as well as parent-reported health and temperament at age one. Our findings allow stakeholders to gauge population health implications of reducing severe housing insecurity among low-income, pregnant women in U.S. cities. Because evictions and adverse birth outcomes are both concentrated in communities of color, these results have important implications for health equity and social justice.We utilized data from the Fragile Families and Child Wellbeing Cohort Study (FFCWS). The study is a birth cohort of nearly 5000 children born to “fragile families”  in 20 U.S. cities with populations greater than 200,000 between 1998 and 2000 and followed for 15+ years. The study methods are described in detail in previous publications . Within Our study population was comprised of infants for whom maternal medical records were available, who had available information on length of hospital stay and method of delivery, and for whom infant outcomes  were available at the age one study visit. We excluded infants from multiple gestation pregnancies and those with congenital chromosomal and central nervous system abnormalities because of systematically different birth and infant outcomes in these groups. The Johns Hopkins Bloomberg School of Public Health Institutional Review Board reviewed protocols for this secondary data analysis and determined the project to be non-Human Subjects Research.Severe housing insecurity during pregnancy was the main exposure of interest. The binary indicator was abstracted retrospectively from the mother’s medical records and indicates whether there was any mention of “homelessness or threatened eviction” during pregnancy. Because clinicians may have limited knowledge of patients’ housing situation outside of crisis situations, this definition likely fails to capture less severe forms of housing insecurity.We measured three adverse birth outcomes abstracted from medical records. The first outcome was a composite outcome of low birth weight <2500 g) and/or preterm birth (<37 weeks gestation) . The sec00 g and/At age one, we measured two infant health outcomes. The first was a measure of infant health, as reported by the infant’s primary caregiver, defined by FFCWS as the biologic parent or adult who lives with the index child at least half of the time, defaulting to the mother if the infant lives with both biologic parents. The caregiver was asked to rate their infant’s general health on a scale as excellent, very good, good, fair, or poor, which we dichotomized to fair or poor health versus excellent, very good, or good. We also constructed a measure of temperament based on three items from the emotionality subscale of the Emotionality, Activity, and Sociability (EAS) Temperament Survey for Children: Parental Ratings . Items iWe included several variables as controls in our analytic models out of concern that they may confound the relationship between severe housing insecurity during pregnancy and birth and infant health outcomes. These variables were largely maternal factors: age group , race/ethnicity, poverty level , educational attainment , marital status, pre-pregnancy mental health status, substance use during pregnancy , and a composite indicator of preexisting conditions . We also included an indicator for infant sex.We first compared the distributions of maternal and infant factors as well as birth and infant outcomes by severe housing insecurity during pregnancy, testing for differences with chi square statistics.For each birth and infant outcome, we constructed a separate regression model, with housing insecurity as the main exposure. We used Poisson regression with robust variance to approximate log binomial regression models and estimate crude and adjusted risk ratios and 95% confidence intervals for each outcome. We used generalized estimating equations (GEE) to estimate population-averaged associations, accounting for clustering by the infant’s city of birth. For all models of outcomes other than low birth weight and/or preterm birth, we included an indicator for low birth weight and/or prematurity to gauge the degree to which severe housing insecurity acts on outcomes directly vs. indirectly operating indirectly through low birth weight or preterm birth  using the formula derived by Miettinen  and recop-value <0.05 was used to indicate statistical significance. Data were analyzed from 2019–2020.We conducted all analyses using Stata version 15.1 , and a Out of the 4898 mother–infant dyads enrolled in FFCWS, 3428 were included in analyses of birth outcomes, while 3035 were included in analyses of infant outcomes. p < 0.05).Among the 3428 mother–infant dyads included in the birth outcome analyses, 1.6% had a record of severe housing insecurity during pregnancy . MothersThe crude risk of each outcome was high in the comparison group and considerably higher among infants born to severely housing insecure mothers. Fourteen percent of infants born to mothers with no reported housing insecurity were born preterm or with low birth weight, 16% stayed in NICUs or stepdown facilities, and 17% had extended hospital stays after delivery. Among infants born to severely housing insecure mothers, these proportions were much higher, at 38, 40, and 42%, respectively. Whereas 3% of infants in the comparison group had fair or poor health at age 1 and 21% had a poor temperament, 10 and 44% of infants in the housing insecure group experienced these adverse outcomes, respectively. Crude risk estimates are depicted in In adjusted models, women experiencing severe housing insecurity during pregnancy had 1.73 times the risk of low birth weight and/or preterm birth compared to women who did not experience severe housing insecurity ; PAF = 1.6% of NICU or stepdown facility stays ; 1.6% of extended hospital stays after delivery ; PAF = 2.7% of fair or poor infant health ; PAF = 0.9% of low infant temperament scores  in the study population C. NinetyWe tested whether severe housing insecurity  during pregnancy is linked to adverse child health outcomes measured at birth and age one. In this sample of disproportionately unmarried, low-income mother–child dyads from 20 U.S. cities, there was a 73% higher risk of low birth weight or preterm birth among infants born to mothers who experienced (compared to those who did not) severe housing insecurity during pregnancy. We also found statistically significant increases in the risk of NICU or stepdown stays and extended hospital stays after delivery  among these dyads. At one year of age, infants of women who experienced severe housing insecurity while pregnant were 2.6 times more likely than others to have fair or poor health and 1.5 times more likely than others to have a poor temperament score, although these differences were not statistically significant. Compared to estimates from primary models, estimates from models including birth outcomes (low birth weight or preterm birth) were, in general, attenuated toward the null. This result is consistent with our hypothesis that some proportion of the associations we see between severe housing insecurity and healthcare and infant outcomes was related to the infant’s preterm or with low birth weight status.Population attributable fraction estimates suggest that the United States could avoid approximately 1.8% of low birth weight or preterm birth, 1.6% of NICU or stepdown facility stays, 1.6% of extended hospital stays after delivery, 2.7% of fair or poor infant health, and 0.9% of poor infant temperament by eliminating severe housing insecurity among low income, pregnant women in its large cities. While these percentages may seem modest, they represent significant reductions in outcomes that are both common and costly in the U.S., particularly among infants born to disadvantaged women. Nearly 700,000 infants are born to low socioeconomic status, urban mothers each year in the U.S., around fourteen percent of them have low birth weight and/or are preterm . Per ourIt should be noted that the women experiencing severe housing insecurity in our sample were likely exposed to multiple social determinants of health concurrently. For example, evidence suggests that people experiencing housing insecurity also struggle to access healthcare  and adeqWe believe our estimates to be conservative due to two main data limitations. First, two covariates included in multivariable models could be mediators rather than confounders of the associations due to the time at which they were measured. Maternal poverty and substance use were first measured at birth and during pregnancy, respectively, and thus could represent downstream effects of housing insecurity rather than causes. By including these potential mediators in statistical models, risk ratios estimating associations between severe housing insecurity and outcomes may be biased toward the null, resulting in conservative estimates. Second, measurement error in the exposure could also result in conservative estimates. Clinician notes in the mother’s medical record regarding homelessness or threatened eviction were likely to capture only the most extreme cases of housing insecurity—street homelessness, for example. We expect that a considerable number of women currently considered housing secure in our analysis in fact experienced some degree of housing insecurity during pregnancy. We hypothesize that this misclassification would lead to an excess risk of negative birth and infant outcomes in the comparison group, attenuating estimates. This issue may be compounded in our calculation of population attributable fraction, given that PAFs are a function not only of effect size, but also the prevalence of the exposure, which, again, is likely underestimated in our study population. Housing insecurity has grown dramatically since these data were collected as a consequence of the housing affordability crisis . CurrentEven our conservative estimates suggest that severe housing insecurity during pregnancy contributes to adverse birth and infant outcomes. Because evictions and adverse birth outcomes disproportionately affect Black and Latinx mothers and infants, these results also suggest an opportunity to narrow disparities in birth outcomes. Given the current housing affordability crisis in the U.S., these results warrant attention from clinicians and policymakers. Clinically, our results suggest that prenatal screening and referrals to prevent maternal evictions and homelessness could improve birth and infant outcomes. Thinking more upstream, the results underscore a need for policies to lessen the burden of housing insecurity among pregnant women. Across the country, city and state governments are considering initiatives to increase the stock of affordable housing  and prevent evictions . Our results suggest that pregnant women and their infants stand to benefit greatly from these policy interventions.


Chen-Ning Yang  is the most distinguished Chinese theoretical physicist. In 1954, together with Robert Mills, he formulated the Yang–Mills Gauge Theory, which led to the development of the Standard Model, the leading framework for understanding particle physics. In 1956, Yang and Tsung-Dao Lee  proposed the possibility of parity non-conservation in weak interaction, which won them the Nobel Prize in Physics in 1957. Besides these two major achievements, Yang made many other seminal contributions to particle physics, statistical physics and condensed matter physics.NSR’s Executive Editor-in-Chief Mu-ming Poo , a neurobiologist, and Alexander Wu Chao , an accelerator physicist at Stanford University, talked with Professor Yang on a variety of topics, ranging from his retrospective view on Yang–Mills theory, on his contemporary physicists, on tastes in scientific research, and on the current and future developments of Chinese science. The following is an excerpt from this conversation that took place on 21 March 2019 at Tsinghua University, Beijing. Chao: Let’s start with Yang–Mills theory. Among the many important contributions you made, people consider Yang–Mills theory to be the most important. Do you agree? Why do you think it is so important?Yang: In the field of basic theoretical physics, it is generally believed that Yang–Mills gauge theory is one important element at its foundation. When it was first published in the 1950s, most people did not expect it to survive. However, by the 1970s, after the first round of experimental evidences, and after some important additional insights were introduced, namely the idea of symmetry breaking, it gradually evolved into the Standard Model, which has become the most important development in fundamental physics in the second half of the 20th century.. I believe this short phrase captures the spirit of why gauge theory is so important. It also captures the direction of developments in theoretical physics in the future.How about the future? In a 1980 article I wrote about Einstein, I coined the phrase, ‘Symmetry dictates interaction’. It means that the structure of all forces in the universe are intimately related to the concept of symmetry. In Chinese it becomes Among the questions we have not yet answered, the most important are how to integrate gravity into the system, and how to unify the system. I believe, and most physicists believe, that the way to accomplish these is to introduce more symmetry. Searching for these additional symmetries has been the concentrated effort in the past 40 years. But so far it has not succeeded.Chao: This new symmetry surely is not a simple symmetry like left–right symmetry?Yang: Yes. Certainly it will be more subtle, more intricate.), which is one simple but important manifestation of symmetry in Chinese literature.The concept of symmetry exists, for example, already in early Chinese culture, through couplets  was beautifully made, resulting in what is now called the Standard Model. And this model has been successfully tested experimentally in hundreds of experiments. It should be regarded as the triumphant grand contribution of the experimental and theoretical high energy physics community in the last 60 or 70 years. It had won several Nobel Prizes for about a dozen theoretical and experimental physicists.Poo: You have been credited with bringing math and physics together in the 1970s. Please tell us the story.Yang: In 1975 Tai Tsun Wu  and I published a paper about the physicist’s electromagnetic field theory and its relationship with the mathematician’s fiber bundle theory. To clarify the deep precise relation between these two theories we constructed a dictionary. It happens that in 1976 Isadore Singer visited Stony Brook and I gave him a copy of our reprint. He took it to Oxford to show it to Michael Atiyah and other mathematicians; they were deeply interested and began to work on gauge fields and related topics, leading to a period of close collaboration between mathematicians and physicists. I believe this is an important event in the long history of both disciplines. In 1988 Singer, in an article about Weyl, recounted this story. Reprinted below is the Wu–Yang dictionary in Singer’s article.), one of the founding mathematicians of fiber bundle theory:For me, the recognition that gauge theory equations are SPECIAL CASES of equations in a subtle field of mathematics called fiber bundles was at once exhilarating and humbling. In a 1979 article celebrating the 100th anniversary of the birth of Einstein, I had recounted a conversation with Shiing-Shen Chern  We had much to talk about: friends, relatives, China. When our conversation turned to fiber bundles, I told him that I had finally learned from Jim Simons the beauty of fiber-bundle theory and the profound Chern–Weil theorem. I said I found it amazing that gauge fields are exactly connections on fiber bundles, which the mathematicians developed without reference to the physical world. I added ‘this is both thrilling and puzzling, since you mathematicians dreamed up these concepts out of nowhere.’ He immediately protested, ‘No, no. These concepts were not dreamed up. They were natural and real.’Poo: Freeman Dyson once called you a conservative revolutionary. Do you agree?Yang: Before he coined that phrase, I had never thought I was conservative. After his speech in 1999 with that title I thought about it and felt that he was quite right: I value tradition and tend to strike out in new directions only when necessary.Poo: This is related to taste in doing research. You have often said that in doing science it is important to have one’s own taste.Yang: Yes, and I would add: it is important not only for issues with large impact. Even for a graduate student it is important to develop one’s own taste: what ideas, what types of questions, what types of approach to concentrate on, etc. Taste formation is influenced by many factors: native talent, family environment, early teachers, one’s own temperament and luck.Poo: How did you develop your taste in physics?Yang: I was gifted in math, but was discouraged to go into math by my father who thought math was not what China needed. I was extraordinarily lucky in college, in wartime Kunming, to have two professors, Ta-You Wu  and Jwu-Shi Wang , who channeled me into fields of physics that later developed into major areas of research. Working in these two nascent fields greatly influenced my taste and style in research.Yang: You (Poo) have said that Chinese scientists are particularly hard-working, dedicated and persistent. That is the reason why the complete artificial synthesis of bovine insulin and the development of the anti-malaria drug artemisinin were all striking early achievements in China when the country was still very backward industrially.I agree, and would like to add some additional points.China has her special traditional Confucian culture, which values hard work and patience, puts family and country before the individual and greatly values education.Poo: I agree, of course. But is the Confucian tradition too conservative?Yang: I agree that compared to American tradition Chinese tradition is conservative. But is that bad? My answer: bad in some respects. But I would fault the American tradition more. It is too ‘progressive’.Chao: Is the rapid economic growth in China connected to the culture issue?Yang: I believe very closely connected.Chao: So from the point of view of economic growth, is it that being conservative and conforming to authority are good things? Everybody should work toward the same goal?Poo: Fine. But being too conservative may slow scientific development.Yang: Yes. To decide for a nation whether to be conservative or progressive in scientific development is a highly complex problem.): not going to extremes.I believe in two basic principles. One, national interest always over group interest. Two, adopt the middle philosophy , who was 54 years younger than I. These were all right decisions.Other than that, I have no important regrets in my research in physics. I made many correct and important personal decisions in my long career: I visited China in 1971, and later in around 2003 decided to return completely to China. In 2004 I married Fan Weng (Chao: Finally, we have a simple question. We would like to know if you have any advice to the young people? Many young people work very hard, but they do not know how they can do better.Yang: I think Chinese young students often ignore the importance of their own interests, which maybe a result of China’s special cultural and educational system. They are taught to conform to the needs of society, but not to explore and fulfill their own interests. So I suggest that Chinese young students pay more attention to the development of their own interests. Meanwhile, if you ask me to give suggestions to American students, I would recommend that they pay less attention to some of their so-called interests and consider more the major developmental trends of society and science.Of course, there is also a suggestion for Chinese parents and teachers: please encourage and foster the interests of the young.