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Exercise and spirometry testing are associated with coughing, exhaled respiratory droplets and aerosol generation. The risk of SARS-CoV2 transmission associated with these procedures are unknown. We developed a SARS-CoV2-specific consensus guidance document involving key stakeholders for restoring pulmonary diagnostic services, incorporating a patient and community-level risk stratified approach.
To compare sensitivity of specimens for COVID-19 diagnosis, we tested 151 nasopharyngeal/mid-turbinate swab pairs from 117 COVID-19 inpatients using RT-PCR. Sensitivity was 94% for nasopharyngeal and 75% for mid-turbinate swabs (p=0.0001). In 88 nasopharyngeal/mid-turbinate pairs with matched saliva, sensitivity was 86% for nasopharyngeal swabs and 88% for combined mid-turbinate swabs/saliva.
We estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6–59 months in Bangladesh.
Cross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios.
The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh.
Caregivers of child 6–59 months and BRAC staff members including community health workers were the participants for this study.
The home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis.
The market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.
Characterizing the whole genetic architecture of drought tolerance (DT) is a persistent challenge for the breeders. Here we developed a half-sib population comprising of 404 lines of two recombinant inbred line (RIL) populations with M8206 as the joint parent (M8206 × TongShan and ZhengYang × M8206) and tested for its DT under sand culture. The population was sequenced using restriction-site-associated DNA sequencing filtered with minor allele frequency ≥0.01; 55,936 single nucleotide polymorphisms (SNPs) were obtained and assembled into 6137 SNPLDBs (SNP linkage disequilibrium blocks). The restricted two-stage multi-locus genome-wide association analysis characterized with error and false-positive control identified 40 QTLs with 93 alleles on an average of 34.75% of the phenotypic variance (PV) collectively for relative root length (RRL) and relative shoot length (RSL) that served as potential DT indicators. Among these, eight loci corresponded to previously reported QTLs, whereas 32 loci were therefore novel. The identified QTLs with their corresponding alleles for RRL and RSL were organized into QTL-allele matrices, depicting the comprehensive DT genetic architecture of the three parents/half-sib population. From the matrices, we predicted the possible best/optimal genotype with weighted average value (WAV) 1.553 over two indicators, while for the top 10 single crosses among RILs with 95th percentile WAV was 1.218–1.257, transgressive over the parents (0.693–0.794) yet much less than 1.553. From the detected QTL-allele system, 65 potential candidate genes collectively for both indicators explaining on an average of 24.41% PV were annotated and χ2-tested as a DT candidate gene system involving nine biological processes.
Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.
High levels of stress are expected when crises affect people’s lives. Therefore, this web-based, cross-sectional study was conducted among university students from Pakistan to investigate the psychological impairment and coping strategies during COVID-19 pandemic. Google forms were used to disseminate the online questionnaire to assess anxiety (Generalized Anxiety disorder-7), depression (Patient Health Questionnaire-9) and the coping strategies (Brief-COPE). A total of 1134 responses (age 21.7±3.5 years) were included. The frequency of students having moderate-severe anxiety and depression (score ≥ 10) were ≍ 34% and 45%, respectively. The respondents’ aged ≥ 31 years had significantly lower depression score than those ≤ 20 years (p = 0.047). Males had significantly less anxiety (6.62 ± 5.70 vs 7.84 ± 5.60, p = 0.001) and depression (8.73 ± 6.84 vs 9.71 ± 7.06, p = 0.031) scores. Those having family member, friend or acquaintances infected with disease had significantly higher anxiety score (8.89 ± 5.74 vs 7.09 ± 5.56, p < 0.001). Regarding coping strategies, majority of respondents were found to have adopted religious/spiritual coping (6.45 ± 1.68) followed by acceptance (5.58 ± 1.65), self-distraction (4.97 ± 1.61) and active coping (4.81 ± 1.57). In conclusion, COVID-19 cause significant impairment on mental health of the students. The most frequent coping strategy adopted by students were religious/spiritual and acceptance coping. During epidemics mental health of students should not be neglected.
The paper presents a 1 × 2 B-shaped antenna array for dual-band operation at 4 and 8 GHz. The antenna design consists of a rectangular patch with two annular-strip lines fabricated on the top layer and finite ground plane on the bottom layer. The array is formed by designing an optimum T-shaped microstrip line for impedance matching. The dimensions of the antenna array are 78 × 36 × 1.6 mm3. Full-wave simulations have been conducted and the measured results are in good consent with the simulated results. The measured impedance bandwidth (reference −10 dB) has been observed at 3.84–4.16 and 7.78–8.38 GHz. Measured peak gain and radiation efficiency at 4 and 8 GHz are 8.3, 9.4 dB and 82.5 and 81.2%, respectively.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
A compartmental model is proposed to predict the coronavirus 2019 (Covid-19) spread. It considers: detected and undetected infected populations, social sequestration, release from sequestration, plus reinfection. This model, consisting of seven coupled equations, has eight coefficients which are evaluated by fitting data for eight US states that make up 43% of the US population. The evolution of Covid-19 is fairly similar among the states: variations in contact and undetected recovery rates remain below 5%; however, variations are larger in recovery rate, death rate, reinfection rate, sequestration adherence and release rate from sequestration. Projections based on the current situation indicate that Covid-19 will become endemic. If lockdowns had been kept in place, the number of deaths would most likely have been significantly lower in states that opened up. Additionally, we predict that decreasing contact rate by 10%, or increasing testing by approximately 15%, or doubling lockdown compliance (from the current ~15% to ~30%) will eradicate infections in Texas within a year. Extending our fits for all of the US states, we predict about 11 million total infections (including undetected), and 8 million cumulative confirmed cases by 1 November 2020.
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.
Background: The inappropriate and irrational use of antibiotics both in humans and animals causes bacterial resistance. Bacterial resistance is common in low- and middle-income countries, including Bangladesh. Bangladesh has very limited information on antibiotic use and associated resistance. We sought to better understand antibiotic use in low-resource settings for the development of effective strategies to address inappropriate antibiotic use. Methods: We conducted a cross-sectional study among hospitalized children <5 years of age in a tertiary-care hospital in Barishal, Bangladesh, to collect data on antibiotic use. We collected data from 400 children during February–April 2019. Results: Among these 400 children, >50% were aged <1 year, and >60% of these children were boys. The average hospital stay was 3 days (range, 1–14). Most of the children had history of diarrhea and 18% had pneumonia. Most children (82%) were prescribed antibiotics. A combined form of antibiotics was prescribed for 17% of these children. In total, 14 different antibiotics were used. The most commonly used antibiotic was ceftriaxone (57%) followed by azithromycin (14%). The parental route was mostly preferred (75%) for antibiotic administration. Conclusions: Antibiotic prescription was common in children aged <5 years visiting a tertiary-care hospital. Most of the prescribed antibiotics were broad spectrum, which can promote bacterial resistance. Further studies are needed to identify the factors associated with overuse of antibiotics and bacterial resistance in low-resource settings.
Background: Despite gradual economic growth in Bangladesh, healthcare facilities are still resource limited and do not measure up to the standard to practice for infection prevention and control (IPC) in reducing the risk of hospital-acquired infections. We assessed the existing resources and facilities in tertiary-care public hospitals to guide a context-specific low-resource IPC intervention for routine use in Hospital wards. Methods: We conducted the study in 3 tertiary-care hospitals from November 2017 to January 2018. The study team collected data on existing facilities and resources associated with IPC strategy from hospital records, semi-structured interviews with different level healthcare staff (n = 176) and spot checks (n = 30). Results: The mean bed occupancy rates for study hospitals were 165%, 200%, and 150%, respectively, on admission days. Among study wards, medicine ward (230%) had the highest bed occupancy rate. Different types of patients were placed together in the wards, and there were no isolation areas for highly infectious patients. Moreover, 22%–58% posts of physicians, 15%–20% of nurses and 38%–42% of support staff were vacant against the authorized posts in these hospitals. There were no usable handwashing facilities for support staff, patients, and family caregivers; however, all the allocated handwashing facilities for physicians and nurses were functional. On average, 50% fewer surgical gloves were provided than were actually required. Although supplies of masks were available in the surgery theater, no supplies in general wards were recorded. Disposable nasal cannula for oxygen and nebulizer masks was unavailable; hence, providers had to reuse this equipment for multiple patients. Most of the autoclave machines (20 of 30) were nonfunctional; therefore, one-third of the surgical instruments could not be sterilized by autoclaving. None of the hospital wards followed the 3 steps of surface cleaning, and no segregation of hazardous wastes was observed. All kind of wastes were dumped in the selected open area within the hospital premises. Healthcare workers (n = 110) directly involved in patient care reported that hand hygiene is usually not possible between patient visits. High turnover of patients and shortage of healthcare staff were reported as major barriers to IPC practices, specifically hand hygiene and environmental cleaning. There was no active committee nor specific training program on IPC for healthcare staff. Conclusions: Existing resources and facilities of these hospitals did not support a standard IPC strategy. Coordination from policy level to implementation with proper allocation of resources is required to ensure a practical IPC strategy.
Colonization pressure at the unit level is known to be a risk factor for Clostridioides difficile infections in hospitals. Because C. difficile colonization is not routinely detected in clinical practice, only patients identified as having C. difficile infection (CDI) are included in these pressure calculations. We used data from the University of Iowa Hospitals and Clinics (UIHC) to determine whether highly local CDI pressure, due to patients in nearby rooms, is more strongly correlated with CDI than unit-level CDI pressure. Methods: We designed a base logistic regression model using variables known to be risk factors for CDI: age, antibiotic/gastric acid suppressor use, low albumin, prior hospitalization, comorbidities. To the base model, we add 2 measures, mean colonization pressure (MCP) and sum colonization pressure (SCP) of CDI at the unit level to obtain new models. To the base model, we also added CDI colonization pressure by considering CDI cases at different distance thresholds from the focal patient. Distances between patient rooms were extracted from hospital floor plans. Results: Adding unit-level CDI colonization pressures to the base model improved performance. However, adding CDI colonization pressures due to roommates and due to patients at different distances improved the model much more (Table 1). The top (resp. bottom) row shows in-sample (resp. out-of-sample) C-statistics for the base model, the base model with unit-level MCP, the base model with roommate MCP, and the base model with MCP from patients are different distances added as separate features. C-statistics for the base model and the base model with unit CDI pressure (SCP and MCP) are compared in Fig. 1 with C-statistics from the base model with CDI pressure from patients at distances D = 0, 1, 2, 3, 4, 5, 10, 15, 20 hops (1 hop = 5–6 meters). Conclusions: Our results support the hypothesis that unit CDI colonization pressure is a risk factor for CDI. However, by incorporating spatially granular notions of distances between patients in our analysis, we were able to demonstrate that the true source of CDI pressure at the UIHC is almost exclusively attributable to roommates and patients in adjacent rooms.
Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.
Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: Award
Skilled delivery care has been targeted in the Sustainable Development Goals to reduce preventable maternal and newborn deaths, which mostly occur because of birthing complications. Birthing complications are more frequent in women with unintended than intended pregnancies, and around 43% of total pregnancies in low- and middle-income countries are unintended. This study quantified the impact of unintended pregnancy on skilled birth attendance and delivery in health care facilities in Bangladesh. Data from 4493 women participating in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Multilevel logistic regression models were used to assess the association of unintended pregnancy with skilled birth attendance and delivery in a health care facility through skilled providers while adjusting for individual-, household- and community-level factors identified using a directed acyclic graph. Around 26% of women reported that their last pregnancy (occurring within the previous 3 years) that ended with a live birth was unintended at conception. Only 42% reported having a skilled birth attendant present at their last birth and 38% gave birth in a health care facility. Significant differences were found across pregnancy intention. Lower odds of skilled birth attendance (OR, 0.70, 95% CI, 0.52–0.93) and delivery in a health care facility through skilled providers (OR, 0.65, 95% CI, 0.48–0.89) were found among women who had an unwanted pregnancy relative to women who had a wanted pregnancy. However, a mistimed pregnancy was not found to be associated with skilled birth attendance or delivery in health care facility through skilled providers. Increased availability of health care facilities at the community level is required in Bangladesh to ensure skilled delivery care for women with an unwanted pregnancy. Policies are also required to integrate women with an unwanted pregnancy into mainstream health care services through earlier detection and increased awareness in order to reduce the adverse maternal and fetal outcomes associated with lack of quality birthing care.
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.
Pattern-forming instability in various fields is an interesting research topic because of its complex physical nature and numerous applications. In this paper, we experimentally study capillary surface waves and patterns formed on a liquid film, cast on a plane substrate without physical walls, but pinned to the substrate edges, and subjected to multi-axis horizontal (lateral) oscillations (55–333 Hz). The effect of single-axis ultrasonic horizontal vibrations (20–170 kHz) was also investigated. We show that using substrates with different geometrical shapes and various travelling paths created by multi-axis vibrations with a phase angle difference between the axes produce a plethora of standing and travelling wave patterns on the liquid film surface. We report perfect standing square and spiral-like patterns for low-frequency multi-axis horizontal vibrations, which are commonly observed for vertical vibrations, while the mechanisms of momentum transfer to the liquid film from the vibrating substrate are different in vertical and horizontal vibrations. Other patterns forming on the liquid film surface in our experiments include lines/stripes, circles, swirls, pentagons, triangles, etc. It is also reported that low-frequency excitations create harmonic travelling waves and standing patterns, while the frequency of response waves generated by the application of ultrasonic horizontal vibrations is several orders of magnitude less than the excitation frequency. No subharmonic cross-waves are observed in this study, which strengthens the idea that plane substrates (without walls) are a good approximation for the theoretical case of a horizontally vibrated liquid film with infinite lateral length.