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AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.
We investigate kinetic entropy-based measures of the non-Maxwellianity of distribution functions in plasmas, i.e. entropy-based measures of the departure of a local distribution function from an associated Maxwellian distribution function with the same density, bulk flow and temperature as the local distribution. First, we consider a form previously employed by Kaufmann & Paterson (J. Geophys. Res., vol. 114, 2009, A00D04), assessing its properties and deriving equivalent forms. To provide a quantitative understanding of it, we derive analytical expressions for three common non-Maxwellian plasma distribution functions. We show that there are undesirable features of this non-Maxwellianity measure including that it can diverge in various physical limits and elucidate the reason for the divergence. We then introduce a new kinetic entropy-based non-Maxwellianity measure based on the velocity-space kinetic entropy density, which has a meaningful physical interpretation and does not diverge. We use collisionless particle-in-cell simulations of two-dimensional anti-parallel magnetic reconnection to assess the kinetic entropy-based non-Maxwellianity measures. We show that regions of non-zero non-Maxwellianity are linked to kinetic processes occurring during magnetic reconnection. We also show the simulated non-Maxwellianity agrees reasonably well with predictions for distributions resembling those calculated analytically. These results can be important for applications, as non-Maxwellianity can be used to identify regions of kinetic-scale physics or increased dissipation in plasmas.
Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth.4
Background: Simulations based on models of healthcare worker (HCW) mobility and contact patterns with patients provide a key tool for understanding spread of healthcare-acquired infections (HAIs). However, simulations suffer from lack of accurate model parameters. This research uses Microsoft Kinect cameras placed in a patient room in the medical intensive care unit (MICU) at the University of Iowa Hospitals and Clinics (UIHC) to obtain reliable distributions of HCW visit length and time spent by HCWs near a patient. These data can inform modeling efforts for understanding HAI spread. Methods: Three Kinect cameras (left, right, and door cameras) were placed in a patient room to track the human body (ie, left/right hands and head) at 30 frames per second. The results reported here are based on 7 randomly selected days from a total of 308 observation days. Each tracked body may have multiple raw segments over the 2 camera regions, which we “stitch” up by matching features (eg, direction, velocity, etc), to obtain complete trajectories. Due to camera noise, in a substantial fraction of the frames bodies display unnatural characteristics including frequent and rapid directional and velocity change. We use unsupervised learning techniques to identify such “ghost” frames and we remove from our analysis bodies that have 20% or more “ghost” frames. Results: The heat map of hand positions (Fig. 1) shows that high-frequency locations are clustered around the bed and more to the patient’s right in accordance with the general medical practice of performing patient exams from their right. HCW visit frequency per hour (mean, 6.952; SD, 2.855) has 2 peaks, 1 during morning shift and 1 during the afternoon shift, with a distinct decrease after midnight. Figure 2 shows visit length (in minutes) distribution (mean, 1.570; SD, 2.679) being dominated by “check in visits” of <30 seconds. HCWs do not spend much time at touching distance from patients during short-length visits, and the fraction of time spent near the patient’s bed seems to increase with visit length up to a point. Conclusions: Using fine-grained data, this research extracts distributions of these critical parameters of HCW–patient interactions: (1) HCW visit length, (2) HCW visit frequency as a function of time of day, and (3) time spent by HCW within touching distance of patient as a function of visit length. To the best of our knowledge, we provide the first reliable estimates of these parameters.
Background: Hospital-acquired infections are commonly spread through the movement of healthcare professionals (HCPs). Computational simulations provide a powerful tool for understanding how HCP behavior contributes to these infections, but how well they reflect the real world rests on a number of critical parameters. Our goal is to provide accurate, fine-grained estimates of real HCP movement and interaction parameters suitable for simulating the potential spread of pathogens over different types of inpatient facilities. Methods: We obtained a commercial data set with 44 million deidentified elements compiled from >27,000 HCPs from >30 job types. The data were collected over 27 months from >20 facilities of varying size using a proprietary electronic sensor system. Each observation recorded an HCP visiting 1 of 12,000 rooms (38% being patient rooms) and consisted of the entry and exit time stamps, hand hygiene behavior, and for many rooms, their (x, y) geometric coordinates within the facility. From these data, we can reconstruct the behavior (including location and hand-hygiene adherence) of each instrumented HCP across multiple shifts. Results: Distributions describing various aspects of HCP behavior (eg, arrival rates and dwell times) were derived using HCP job function, department or unit assignment, type of shift (day vs night), time of day, facility size, and staffing of facility. In a similar fashion, we constructed HCP cross-table transition probabilities using job type, room type, department type, unit type, and facility type. These distributions were used to generate reasonable HCP movement and behavior patterns in a simulation environment. Distributions of dwell time were, for the most part, heavy tailed, but they varied by type of job and facility: dwell times over all facilities, job types, and room types averaged ∼339 seconds (SD, 495 seconds), with a mean of maximums by job type of ∼37,168 seconds. However, these distributions differ within job type but across facilities (ie, nurses in 1 facility averaged 397 seconds, but 277 seconds in another) and within facility but across job type. For example, physicians averaged 292 seconds, whereas nurses averaged 397 seconds and physical therapists averaged 861 seconds. Conclusions: Our results provide a unique resource for disease modelers who wish to build meaningful simulations of the transmission of hospital-acquired infections. The scale and diversity of the data gave us the unique capability to provide, with confidence, distinct parameter sets for different types and sizes of healthcare facilities across a wide range of situations.
Background: Mobility patterns of healthcare workers (HCWs) (ie, the spatiotemporal distribution of patient rooms they visit) have a significant impact on the spread of healthcare acquired infections (HAIs). Objective: In this project, we used fine-grained data from a sensor deployment at the medical intensive care unit (MICU) in the University of Iowa Hospitals and Clinics (UIHC) to study the mobility patterns of HCWs and their impact on HAI spread. Methods: We analyzed 10 days of data from a 20-bed MICU sensor deployment. For parameters t1 and t2, each pair of rooms i and j is assigned a weight W(i, j) representing the number of times an HCW spends at least t1 seconds in room i followed by at least t1 seconds in room j, within t2 seconds of each other. W(i, j) is a measure of HCW traffic going from room i to room j; we study the correlation between W(i, j) and the distance between rooms i and j. Additionally, we perform 2 disease-spread simulations: (1) a base simulation, obtained by replaying observed HCW mobility traces and (2) a perturbed simulation, which is the same as the base simulation, except that we replace each HCW who visits a room by a random available HCW. Thus, the perturbed simulation removes correlations in the observed HCW mobility traces. Results: We computed W(i, j) for all room pairs i, j for parameters t1 = 30 seconds and t2 = 1,800 and 3,600 seconds. For nurses, there was a strong negative correlation of between pairwise room distance and the weights W(i, j) (−0.768 for t2 = 1,800; −0.711 for t2 = 3,600), The more distant 2 rooms were, the less they shared nurse traffic. This was not true for physicians (correlation = −0.027 for t2 = 1,800; −0.014 for t2 = 3,600). Figure 1 shows a weight versus distance scatter plot for nurses for t1 = 30 and t2 = 1,800. This spatial correlation has positive implications for disease spread; the base simulation, which preserves these spatial correlations, has between 12% and 55% fewer mean infected patients (>100 replicates) for different simulation parameters compared to the perturbed simulation. Conclusions: Our results, based on fine-grained data, show a “naturally emerging” cohorting behavior of nurses, where nurses are more likely to visit rooms close to each other within a 30–60 minute time window, than rooms further away. Through simulations, this behavior provides substantial protection against disease spread.
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.
The March 1988 genocide in Halabja, in which 4000–7000 Kurdish women, children and men were killed by the then Iraqi regime, was the most brutal gas attack on a civil population in modern history. This study challenges currently held understandings of PTSD and how traumatic transformations are expressed in other parts of the world; thereby contributing to the new field of traumatology. The study is quantitative analysis of the prevalence of PTSD, measured using (IES), in two Kurdish towns; Halabja and Suleimaniyah, encompassing 110 participants. The study's primary aim was to compare the prevalence of PTSD in Halabja with that in Suleimaniyah which was not attacked, the expectation being that PTSD would be more prevalent in Halabja than in Suleimaniyah. secondly, that women and those with shorter education would report a higher prevalence of PTSD symptoms, and thirdly that participants with higher levels of social support would report a lower prevalence of PTSD symptoms. The results showed that the prevalence of PTSD symptoms in total, of reliving and of hyperarousal in the trauma exposed town was significantly higher than in Suleimaniyah, thus supporting the primary hypothesis. The results further showed a significant connection between sex and PTSD symptoms and a clear linear relation between education and prevalence of PTSD symptoms, thus supporting the second hypothesis. However, the results showed no support for the third hypothesis. The study thus indicates that researchers and practitioners working with PTSD need a broader cultural understanding to carry out studies in best possible manner.
The pathophysiology of tardive dyskinesia (TD) is not completely
To assess the relationship of TD with 5-HT2A receptor gene, serotonin transporter gene (5 HTT), and catechol-o-methyltransferase (COMT) gene polymorphisms.
Our study comprised 111 unrelated subjects who strictly met DSM-IV criteria for schizophrenia and 32 TD, and 79 healthy unrelated controls; all the subjects were of Turkish origin. The analyses of 5-HT2A receptor gene, 5 HTT gene, and COMT gene polymorphisms were performed using polymerase chain reaction (PCR) technique.
The polymorphisms of these genes were not significantly different between the schizophrenic patients, TD and control subjects.
Our findings indicated that 5-HT2A receptor gene, 5 HTT gene, and COMT gene polymorphisms were similar in schizophrenia with non-TD, schizophrenia with TD, and healthy controls. These polymorphisms, though, do not help to evaluate the susceptibility to TD.
Over the last decades, acupuncture has been seen as an acceptable primary detoxification treatment for opiate dependence, and currently used to relieve the severity of opiate withdrawal symptoms among MMT patient.
To investigate the effectiveness of electroacupuncture treatment in reducing opiate withdrawal symptoms among MMT patient.
This was a pilot study with randomized, single-blinded, and parallel. Recruitment of 22 subjects, 11 in methadone treatment + acupuncture and 11 in methadone treatment without acupuncture. The severity of withdrawal reaction was assessed by Objective Opiate Withdrawal Scale (OOWS) and Subjective Opiate Withdrawal Scale (SOWS) at baseline, third, fifth, seventh, tenth and fourteenth day of treatment.
One way Analysis of Variance (ANOVA) comparing the mean scores of the OOWS between treatment and control group has shown at tenth day of treatment p value is 0.026 and at fourteenth day p value is 0.022. One way ANOVA comparing the mean scores of the SOWS between treatment and control groups has shown at tenth day of treatment, p value is 0.015 and at fourteenth day, p value is 0.009.
The study has shown the promising results, where electroacupuncture treatment had an effectiveness in relieving opiate withdrawal symptoms among MMT patient.
High prevalence of poor sleep quality has been reported among Methadone Maintenance Therapy (MMT) patients. in order to reduce side effects and prevent relapse, new treatment approaches should be considered and recently, electroacupuncture (EA) has believed to have a therapeutic effect in the treatment of drug addiction.
To investigate the effects of EA on sleep quality in patients receiving MMT.
A prospective, open-labelled, parallel, randomized-controlled trial was conducted among MMT patients in Kajang, Selangor, Malaysia. A total of 22 drug misusers who met DSM-IV were randomly assigned into two groups. The treatment group was given methadone plus EA stimulation at 1.1+80Hz while the control group received methadone plus Sham EA without increasing the intensity of the stimulation. Both groups received the EA treatment 30 minutes per session for 14 days. Sleep quality was assessed by validated Pittsburgh Sleep Quality Index.
In terms of pre and post treatment comparison, we found that there were significant difference of mean sleep latency (p= 0.011), use of medication (p= 0.043) and global PSQI (p= 0.009) for the treatment group. However, only sleep efficiency (p= 0.014) showed a significant difference between pre and post treatment for the control group. in terms of group comparison, we found that there was significant difference of mean sleep latency (p= 0.004), sleep efficiency (0.004) and global PSQI (0.008) for post treatment. No significant difference was found for pre treatment.
Electroacupuncture may have adjunct effect on sleep improvement and have potential to reduce Benzodiazepine use among MMT patients.
In schizophrenia negative symptoms often persist and determine an unfavourable course. Reviews including studies with small sample sizes indicate improvement of negative symptoms in schizophrenia patients by repetitive transcranial magnetic stimulation (rTMS), but provide heterogenous results. To prove the clinical efficacy of rTMS on negative symptoms trials with larger samples of patients are needed.
In a multicentre randomized, sham-controlled, rater- and patient-blind clinical trial including 197 patients we investigated the efficacy and tolerability of a 3 week 10 Hertz (Hz) rTMS add-on to antipsychotic therapy (in total 15000 stimuli, stimulation intensity 110 % of the individual motor threshold) over the left dorso-lateral prefrontal cortex (LDLPFC) immediately after treatment and during a 12 weeks follow-up.
According to our primary outcome parameter we observed a significant decline in negative symptoms (negative sum score of the PANSS) in the verum and sham group (N = 124), but could not find a significant superior reduction in the verum group at day 21. At day 28 significant more patients in the verum compared to the sham group showed a clinical meaningful reduction of PANSS negative subscore (= 20 %) (N = 89; 57.5 % vs. 32.7 %, p = 0.033), however this effect did not persist at further follow-up.
High-frequency (10 Hz) rTMS of LDLPFC over 3 weeks provided only a small benefit in the reduction of negative symptoms, however HF-rTMS was well tolerated. We discuss our results in comparison to current meta-analyses and previous studies.
The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates.
Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient.
A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04).
The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.
The present study aimed to identify the factors that affect immediate (within 24 h after farrowing onset) postnatal piglet mortality in litters with hyperprolific sows, and investigate their associations with behaviour of postpartum sows in two different farrowing housing systems. A total of 30 sows were housed in: (1) CRATE (n=15): the farrowing crate closed (0.80×2.20 m) within a pen (2.50×1.70 m), and (2) OPEN (n=15): the farrowing crate open (0.80×2.20×1.80 m) within a pen (2.50×2.40 m) with a provision of 20 ls of hay in a rack. A total of 518 live born piglets, produced from the 30 sows, were used for data analyses during the first 24 h after the onset of parturition (T24). Behavioural observations of the sows were assessed via video analyses during T24. Total and crushed piglet mortality rates were higher in OPEN compared with CRATE (P<0.01, for both). During T24, the OPEN sows tended to show higher frequency of postural changes (P=0.07) and duration of standing (P=0.10), and showed higher frequencies of bar-biting (P<0.05) and piglet trapping (P<0.01), when compared with the CRATE sows. During T24, the mortality rates caused by crushing were correlated with the piglet trapping event (r=0.93, P<0.0001), postural changes (r=0.37, P<0.01), duration of standing (r=0.32, P<0.01) and frequency of bar-biting behaviour (r=0.51, P<0.01) of the sows (n=30). In conclusion, immediate postnatal piglet mortality, mainly due to crushing, may be associated with potential increases in frequency of postural changes, duration of standing and incidence of piglet trapping in postpartum sows in the open crate system with large litters.
Zygogramma bicolorata Pallister is a potential biocontrol agent of Parthenium hysterophorus L. (Asteraceae). This study was carried out to understand the effect of abiotic (temperature and moisture) and biotic factors (age and reproductive status) on the induction and termination of diapause in Z. bicolorata. We also evaluated the effect of diapause on longevity and fecundity of Z. bicolorata. In Z. bicolorata the induction of diapause occurred between the months of July and December. No diapause was observed in May and June, which coincided with the commencement of the monsoon rains. The percentage of diapause induction in Z. bicolorata was found to increase from one generation to another as well as with the age of adults. Diapause significantly increased the fecundity of females as compared to the fecundity in pre-diapause conditions. Soil moisture (80% RH) played an important role in providing the conditions for initiation and termination of diapause. Similarly, 18.4 and 12.5% of diapause adults resumed their activity in 6 and 5 days when exposed to temperatures of 40° and 45° C for 2 h every day, respectively. Exposure of adults to low temperatures, i.e. 5° and 10° C induced 94.3 and 92.5% diapause, respectively, with no adult mortality. Thus, our findings reveal suitable conditions for preventing and inducing diapause in Z. bicolorata, which is of great importance in the suppression of P. hysterophorus. We discuss the implications of these findings in the control of P. hysterophorus.
Introduction: Over the last few decades, health care facility design has been studied to look at its effect on many patient-centred outcomes. However, limited data exists on the impact that specific physical features of a clinical space may have on learning and the educational experience. The aim of this study is to develop a set of characteristics which clinicians, clinical teachers and residents believe should be present in a clinical space to maximize trainees learning, using an emergency department (ED) as a context. Methods: A qualitative methodology used semi- structured interviews with a purposive sample of twelve attending physicians and residents who work in EDs of varying age and design at several sites of a quaternary university hospital. We explored their perceptions of the physical features in the clinical and learning environment that supported or impeded teaching and learning. The interviews were transcribed and thematically analyzed. Results: Preliminary results show that many physical characteristics of the clinical space are perceived to have an impact on trainees learning experience. A design with separation between clinician-learner dyads and the patients, with a visual access; shared clinical space among different health care professionals within a reasonable distance; availability of enough clinical space for specific emergency presentations; features such as adequate size, appropriate light, and control of sound were all perceived to enhance and augment clinical learning. Not surprisingly, non-design factors such as the presence of a functioning team and the availability of adequate equipment and technology was considered as important as the characteristics of physical space to optimize learning. Conclusion: This study demonstrates the importance and the impact of physical space design on trainees learning in a dynamic clinical environment. It provides teachers and policy-makers with a basis for developing criteria of the physical characteristics of a healthcare facility to maximize learning.
To examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh.
We used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999–2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <−2), underweight (weight-for-age Z-score <−2) and wasting (weight-for-height/length Z-score <−2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms.
Whole of Bangladesh.
Children under 5 years of age.
Our results demonstrate that in 1999–2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels.
We identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.
Compensatory gain describes an accelerated growth seen in animals following a period of nutrient restriction. Methionine (Met) is the second limiting amino acid in typical swine diets and is essential for muscle growth. This study was conducted to determine (1) if a Met-deficient diet can cause growth retardation in growing pigs, (2) if returning to a normal feeding can yield compensatory gain in the pigs previously fed the Met-deficient diet, and (3) if this Met-deficiency followed by the normal feeding program affects carcass characteristics. Twenty individually-penned crossbred young barrows were randomly allotted to two dietary treatments (n = 10). One Met-deficient (D1) and one Met-adequate (D2) diets were formulated based on corn and soybean meal and fed to respective pigs for 31 days. After that, all pigs were fed the same commercial grower-finisher diet until market weight (around 125 kg), then slaughtered, and carcass characteristics measured. The D1 and D2 pigs began with similar body weights (23.5 vs. 23.6 kg; P = 0.935), but after 31-days on the dietary treatments, D1 pigs were lighter than D2 pigs (51.6 vs. 55.0 kg; P = 0.102). After feeding the normal diet for 55 days, D1 and D2 pigs had similar body weights (122.7 vs. 122.6 kg; P = 0.989). In terms of carcass characteristics, however, D1 pigs had thicker back-fat (at 10th rib; 2.95 vs. 2.51 cm; P = 0.015), heavier belly weight (11.0 vs. 9.6 kg; P = 0.005), lighter ham weights (untrimmed: 20.8 vs. 21.6 kg; P = 0.043; trimmed: 19.6 vs. 20.6 kg; P = 0.016), lighter picnic shoulder weight (8.72 vs. 9.80 kg; P = 0.041), lighter total lean cut weight (51.8 vs. 53.8 kg; P = 0.055), and lower lean cut percentage (56.4 vs. 59.0%; P = 0.012). These results indicate that the Met-deficient diet produced growth-retarded pigs, which showed compensatory gain after the normal feeding. At slaughter, the pigs previously fed the Met-deficient diet had more fat and less lean tissue than their non-deficient counterparts.