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The doped/alloyed HfO2 and ZrO2 thin films revolutionized not only the field of ferroelectric physics but also various ranges of device applications. Especially when the two oxides are combined in an 1:1 ratio, the ferroelectric polarization of the material became the most distinctive. Many researchers have investigated various different process conditions such as controlling Hf0.5Zr0.5O2 (HZO) film thickness and modifying different metal electrodes. Here, we explored the effect of additional Ar plasma treatment to the HZO film. The additional Ar plasma was exposed to the plasma-enhanced atomic layer deposition (PEALD) HZO for this study. Then, the sample was compared with a conventional PEALD and thermal ALD HZO films. By understanding the polarization–electric field (P–E), current–electric field (I–E), and electrical breakdown characteristics of the different samples, it was found that the Ar plasma treatment can control the degree of ferroelectric and antiferroelectric phases of HZO film.
This paper presents a low-profile multi-slotted patch antenna for long term evolution (LTE) and fifth-generation (5G) communication applications. The studied antenna comprised of a stepped patch and a ground plane. To attain the required operating band, three slots have been inserted within the patch. The insertion of the slots enhances the capacitive effect and helps the prototype antenna to achieve an operating band ranging from 3.15 to 5.55 GHz (S11 ≤−10 dB), covering the N77/N78/N79 for sub-6 GHz 5G wireless communications and LTE bands of 22/42/43/46. The wideband antenna presented in this paper offers omnidirectional stable radiation patterns, good gains, and efficiency with a compact size which make this design an ideal contender for wireless fidelity (WiFi), wireless local area network (WLAN), LTE, and sub-6 GHz 5G communication applications.
The proportionality test is not expressly referred to in the parlance of Bangladesh’s constitutional jurisprudence. Rather, a somewhat equivalent word, ‘reasonableness’, is used in Bangladesh. A review of cases demonstrates that when a restriction to rights imposed by law would implicate socio-economic matters, the Supreme Court of Bangladesh (SC) has shown greater readiness to defer to the legislative wisdom. So long as the statutory restriction in these areas could be arguably reasonable, the SC would not ordinarily hold it unconstitutional. However, when a restriction is imposed on civil and political rights, the SC is more willing to test the choice of the restraint. In this type of cases, if a less restraining alternative could achieve the same governmental purpose, the SC is more prepared to declare the contested provision as unconstitutional.
Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were ‘only one form’ and ‘multiple forms’ of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother’s education, father’s occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.
A previously healthy 48-year-old female presented to the emergency department with a 2-week history of low back pain, progressive lower extremities weakness, and right leg numbness. There were no bowel or bladder dysfunction symptoms. Spine magnetic resonance imaging (MRI) showed an intradural cystic lesion dorsal to the spinal cord at the level of L1 measuring 1.6 × 2.1 × 4.1 cm, which was T1 hypointense and T2 hyperintense, with a small soft tissue component and no gadolinium enhancement (Figure 1). A small lipomatous component was also noted. There were no associated vertebral anomalies. The patient underwent a T12-L2 laminectomy and cyst resection, which was subtotal due to the cyst adherence to the conus medullaris. Histopathology showed characteristic features of a neurenteric cyst, with respiratory-type epithelium in the cyst wall (Figure 2). Eight months later, follow-up MRI showed no evidence of recurrence. The patient reported improved sensation in the lower extremities; however, there was some residual weakness predominantly in the proximal hip flexors bilaterally.
The incidence of extensively drug-resistant tuberculosis (XDR-TB) has been rising consistently in Pakistan, and the country is likely to experience another surge of cases in the midst of the COVID-19 crisis. It is imperative to consider how the rising proportion of XDR-TB is best tackled during the pandemic; this includes finding a solution to the problem of non-adherence at the level of community-based healthcare, the utility and practicality of simultaneous testing for COVID-19 and TB, and reconciliation of the World Health Organization’s recommendation of home-based treatment with the need for frequent monitoring of anti-tubercular therapy in XDR-TB. Operational research is needed expeditiously to bypass these limitations.
Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < –2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city.
In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models.
Setting and participants:
The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months.
Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09–5·79), 1·52 (range 0·06–6·35), 3·43 (range 0·15–65·60) and 3·70 (range 0·09–126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room.
A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist.
To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites.
Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake.
Seven sites in Asia, Africa and Latin America.
1669 children followed from birth to 24 months of age.
Median estimated %energy from breast milk ranged from 4 to 70 % at 9–12 months, and declined to 0–39 % at 21–24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12–24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups.
MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.
Children in armed conflict are frequently deprived of basic needs, psychologically supportive environments, educational and vocational opportunities, and other resources that promote positive psychosocial development and mental health. This article describes the mental health challenges faced by conflict-affected children and youth, the interventions designed to prevent or ameliorate the psychosocial impact of conflict-related experiences, and a case example of the challenges and opportunities related to addressing the mental health needs of Rohingya children and youth.
In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines.
In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on ‘PubMed’ and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures.
Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral–fecal or fecal–droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable.
IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.
The spectral and energy characteristics of the tunable thin planar dielectric resonator with the movable metal mirror are researched. It is found that the high-Q HE-polarized whispering gallery modes (WGMs) are effectively excited in such a resonator by the dielectric waveguide. A mode set of the tunable thin planar dielectric resonator depends on the presence of an air gap in its design. Changing the height of the air gap affects the energy characteristics of the tunable thin planar dielectric resonators (DR). Shifting the resonant fields of WGMs from the dielectric disk to the air gap is the reason for this effect. It is shown that at certain heights of the air gap, increasing the unloaded Q-factor of the tunable thin planar DR and improving the excitation efficiency of WGMs in it is achieved.
Introduction: Calgary's introduction of rentable electronic scooters (e-scooters) in July of 2019 was met with wild popularity, representing the third most popular launch after Tel-Aviv and Paris. The present study aims to characterize the injury burden seen in all Calgary Emergency Departments (EDs) and Urgent Care Centres (UCCs) attributable to e-scooters since their 2019 introduction. Methods: We retrospectively reviewed all electronic medical records of patients presenting to Calgary EDs or UCCs with the term “scooter” in the triage note, where exclusion criteria are considered for non e-scooter injuries (e.g: non-motorized scooters). Trends in scooter injuries will be compared between April - October 2018 (control arm preceding e-scooter introduction) and April - October 2019. Injury incidence, types, patient demographics, and relative risk compared to bicycle-related injuries will be determined. Descriptive statistics will be calculated. Moreover, 33 ED visits were brought in by EMS and provide information about injury types and locations of injuries involving EMS transport. Results: Preliminary data reveals 540 scooter-related visits (3.10% admitted/transferred) between July 8th and September 30th 2019 (mean age of 28, 56.30% male). Conversely, the number of bicycle-related visits and motor vehicle related injuries were 1482 and 586 (9.90% and 9.70% admitted/transferred) respectively over the same time period suggesting a greater burden but likely a lower per-ride incidence of injury requiring ED or UCC care. Moreover, between July 8th to October 1st 2019, 33 e-scooter presentations involved EMS (21.21% admitted to hospital), where 12.12% involved upper extremity injury, 21.21% were lower extremity injuries, and 6.06% were head injuries (mean age of 34, 48.48% male). Conversely, estimated EMS transfers to EDs or UCCs for bicycle injuries and motor vehicle injuries were 197 and 463 respectively over the same time period. ICU admissions or fatality were not recorded. Conclusion: Representing the most comprehensive study of e-scooter injury patterns in Canada to date, we here demonstrate a significant injury burden attributable to e-scooters following their introduction in Calgary in 2019. Bicycle-related and motor vehicle injuries were both more prevalent in this time period, and required more EMS visits. Further characterization of injury types, injuries and comparison with injury patterns prior to e-scooter introduction is yet to be determined.
Our goals were to evaluate if the presence of severe delusions negatively affects insight, regardless of diagnosis, and whether or not patients gain insight into their delusions when using a third person perspective.
92 delusional patients with psychotic and psychotic mood disorders were asked to speak about their delusions and were evaluated by means of the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (SAPS and SANS). They were then asked to state whether they thought what they said was believable for them and for the interviewer. After two weeks 79 patients were evaluated with the same scales and listened to a tape where their delusion was re-enacted. They were then asked to state if what they heard was believable for them and for the interviewer.
12 patients thought their delusions was unbelievable for the interviewer at first interview, and 17 patients did the same after the second interview; 4 patients stated what they heard from the tape after the second interview was unbelievable both for them and interviewer. Patients with better insight (patients who stated their delusion was not believable) had a lower SAPS score, a lower item delusion score and a significant improvement of item delusion score at second interview
Several patients gain partial insight when using a third person perspective. The severity of delusions negatively affects insight, regardless of the patient's diagnosis.
To estimate the prevalence of depressive symptoms in patients affected by subclinical hypothyroidism by means of Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS); to assess which depressive symptoms are prevalent in our population, with references to the factorialization of HAM-D by Cleary and Guy (1977); to verify whether levothyroxine replacement therapy alone can induce total remission of depressive symptoms.
The study enrolled 63 patients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology service of San Paolo Hospital in Milan. All patients underwent an evaluation by means of HAM-D and MADRS scales and serum TSH, free T4, free T3, TPO-Ab and Tg-Ab levels were measured.
We estimated a prevalence of depressive symptoms in our population of 63.5%. Concerning the qualitative assessment of psychiatric disturbances in the population we considered, our results showed that the most frequent symptoms were part of four factors, according to the Cleary and Guy factorialization of HAM-D: these factors are representative of anxiety and somatisation (factor I), cognitive impairment disturbances (factor III), psychomotor retardation (factor V) and sleep disorders (factor VI). Levothyroxine replacement therapy alone wasn’t effective in inducing total remission of depressive symptoms.
This study suggests the importance of a psychiatric evaluation in patients affected by subclinical hypothyroidism.
Many adolescents with serious mental illnesses experience transfer of care from child to adult mental health services, yet few services have specific arrangements for such transition. The TRACK study aims to identify organisational factors that facilitate or impede effective transition from child & adolescent mental health services (CAMHS) to adult services; determine predictors and outcomes of such transition; and explore user, carer and service provider views on the process.
This multi-site mixed-methods study will: a) map transition policies in CAMHS in London and West Midlands; b) evaluate the process of transition by a case note survey of patients who cross the transition boundary in one year; c) conduct a diagnostic analysis across organisational boundaries; and d) explore views of service users, carers and mental health professionals on the process of transition.
Findings from Stage 1 reveal that in London, nine mental health trusts have 13 transition protocols in operation and two draft protocols. In West Midlands there are three CAMHS services with one operational and two draft protocols. The protocols are similar in the principles that underpin transition policies, but differ in definitions of service boundaries and in transition planning. There are also significant differences in information continuity during transition.
Preliminary findings from the TRACK study reveal similarities in principles but differences in transition process across services in the UK. The implications of these findings will be discussed.
People with severe mental illness neglect their physical health needs. They smoke a lot, they drink a lot and they don’t do exercise. They eat unhealthy food and put on weight. Unfortunately, the antipsychotic medication don’t help and some of the drugs are associated with side effects which make these problems worse.
Medical notes of patients who has been on risperidone long term injectable depot for a year, from the first of January till the 30th 2008 were reviewed and information were input on the form.
65 notes were reviewed. 70% males. 70% between 18-50 years. The following was done baseline:
50% had physical examination.
25% had pulse, blood pressure and ECG.
Body weight 10%.
Urea and electrolytes (U&E)15%.
40% had their liver function tests(LFT).
50% had comorbidity with other physical illness.
The following were done on six monthly maintenance measures:
Only 5% had maintenance ECG.
Only 50% of patients had physical examination. Only quarter of patients had their BP, pulse and ECG done as a baseline. There was no regular physical follow up and investigation and the investigation which were done sporadically. Physical co-morbidity was 50% of the sample while physical examination and investigations were done in less than half of the sample.
Proper physical assessment and regular follow up should be adopted.
Promotion of healthy living and eating, exercise and monitoring weight should be advised.
The purpose of the study was to determine the serum concentration of trace elements, antioxidants and immunoglobulins in generalized anxiety disorder (GAD) patients and compare those values of healthy volunteers matched by age, sex and socioeconomic conditions. 50 GAD patients and 51 healthy volunteers were recruited. Socio-economic data revealed that most of the patients are middle aged and literate. Patients were recruited from Bangabandhu Sheikh Mujib Medical University by random sampling diagnosed by trained psychiatrist. 4 ml of venous blood was aspirated from the subjects and controls. Serum trace elements (Zn, Cu, Mn, Fe, Ca, Mg) were determined by flame atomic absorption spectroscopy. Serum retinol and α- tocopherol were determined using RP-HPLC method, whereas serum vitamin-C was estimated by UV spectrophotometry. Immunoglobulins were determined by turbidimetric method using immunoglobulin kit. Data were analyzed by independent ttest using SPSS. The concentration of Zn decreased significantly (p< 0.05), whereas concentration of Cu, Mn and Fe increased significantly (p< 0.05) in GAD patients. Serum α-tocopherol decreased significantly (p< 0.05) and ascorbic acid increased significantly (p< 0.05) and serum retinol decreased non-significantly (p> 0.05). There was significant(p< 0.05) increase in serum IgM level, but the increase in serum IgA and IgG level were non-significant (p>0.05). From the study it is found that serum concentrations of Cu, Fe, Mn, ascorbic acid and IgM were increased significantly and those of Zn and α- tocopherol decreased significantly in compare to control. Moreover this study may provide prognostic tool for the diagnosis and treatment of this disease.