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Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14–17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10–21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2–5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5–0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.
The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described.
Methods:
Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3–5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter.
Results:
Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar.
Conclusions:
In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.
Sierra Leone is a country highly prone to disasters, still recovering from the catastrophic 2014 Ebola epidemic. In 2018, the country launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the direct supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) to be delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center. This on-going training package represents the first Disaster Medicine training course for prehospital health professionals in Sierra Leone.
We present the data and initial results from the first pilot survey of the Evolutionary Map of the Universe (EMU), observed at 944 MHz with the Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The survey covers $270 \,\mathrm{deg}^2$ of an area covered by the Dark Energy Survey, reaching a depth of 25–30 $\mu\mathrm{Jy\ beam}^{-1}$ rms at a spatial resolution of $\sim$11–18 arcsec, resulting in a catalogue of $\sim$220 000 sources, of which $\sim$180 000 are single-component sources. Here we present the catalogue of single-component sources, together with (where available) optical and infrared cross-identifications, classifications, and redshifts. This survey explores a new region of parameter space compared to previous surveys. Specifically, the EMU Pilot Survey has a high density of sources, and also a high sensitivity to low surface brightness emission. These properties result in the detection of types of sources that were rarely seen in or absent from previous surveys. We present some of these new results here.
Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes.
Methods:
Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay.
Results:
One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004).
Conclusions:
Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.
Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.
Objective:
The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.
Design and measurements:
We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.
Results:
The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.
Conclusions:
Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.
Rabies is endemic in Bangladesh. To identify risk factors, a case-control study was conducted based on hospital-reported rabid animal bite (RAB) cases in domestic ruminants, 2009 − 2018. RAB cases (n = 449) and three controls per case were selected. Dogs (87.8%) and jackals (12.2%) were most often identified as biting animals. In the final multivariable model, the risk of being a RAB case was significantly higher in cattle aged >0.5–2 years (odds ratio (OR) 2.89; 95% confidence interval (CI): 1.56–5.37), >2–5 years (OR 3.63; 95% CI: 1.97–6.67) and >5 years (OR 6.42; 95% CI: 3.39–12.17) compared to those aged <0.5 years. Crossbred cattle were at higher risk of being a RAB case (OR 5.48; 95% CI: 3.56–8.42) than indigenous. Similarly, female cattle were more likely to be a RAB case (OR 1.26; 95% CI: 1.15–2.29) than males. Cattle in rural areas (OR 39.48; 95% CI: 6.14–254.00) were at a much higher risk of being RAB cases than those in urban areas. Female, crossbred and older cattle, especially in rural areas should either be managed indoors during the dog breeding season (September and October) or vaccinated. A national rabies elimination program should prioritise rural dogs for mass vaccination. Jackals should also be immunised using oral bait vaccines. Prevention of rabies in rural dogs and jackals would also reduce rabies incidence in humans.
Immune mechanisms have been implicated in the pathogenesis of schizophrenia. This has lead to clinical trials of re-purposing drugs with off-target anti-inflammatory actions. They include the antibiotic minocycline and simvastatin (HMP-Co reductase inhibitor), which decrease microglial activation, and ondansetron a 5-HT3-receptor antagonist that has limited effects on cytokine production. This presentation will address their efficacy and mechanism of action.
Aims
1) Update on trials with minocycline including our own positive finding on negative symptoms (PMID: 16959472)
2) Present new results with ondansetron and simvastatin summarised below.
Methods
Ondansetron (8mg) and simvastatin (40mg) vs placebos in 2x2 design (PMID: 23782463). Patients aged 18-65, stable treatment, DSM IV schizophrenia-related diagnosis. PANSS and cognition at 0,3,6 months.
Results
The four cells of the 2x2 design contained 302 patients. The interaction between ondansetron and simvastatin was significant at p=.006 reflecting the lower scores in the 3 active treatment groups than in the P+P group. Ondansetron improved verbal (p=.007) and visual list learning (p=.02) with no other treatment effects on cognition.
Conclusions
Minocycline appears to benefit negative symptoms in early psychosis with a minor effect on cognition. Simvastatin had limited effects in our patients with established schizophrenia but its anti-inflammatory effects could be worth investigating in early psychosis. Ondansetron has a significant effect on new learning, which might be expected from its 5-HT3 antagonist properties. This may underlie a benefit on negative symptoms reported by others and us.
We use experimental methods to investigate subsidy incidence, the transfer of subsidy payments from intended recipients to other economic agents, in privately negotiated spot markets. Our results show that market outcomes in treatments with a subsidy given to either buyers or sellers are significantly different from both a no-subsidy treatment and the competitive prediction of a 50% subsidy incidence. The disparity in incidence across treatments relative to predicted levels suggests that incidence equivalence does not hold in this market setting. Moreover, we find no statistical difference in market outcomes when benefits are framed as a “subsidy” versus a schedule shift.
Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.
To estimate the prevalence of underweight and overweight among Bangladeshi adults and to determine if the double burden of underweight and overweight differs by gender and other socio-economic characteristics of individuals.
Design
We used data from the Bangladesh Demographic and Health Survey 2011. Multinominal logistic regression was used to examine associations between the different nutritional statuses of individuals and related determinants. Interaction effect was checked between gender and various socio-economic factors.
Setting
Nationwide, covering the whole of Bangladesh.
Subjects
Individuals aged >18 years (women, n 16 052; men, n 5090).
Results
Underweight was observed among 28·3 % of men and 24·4 % of women, whereas overweight was observed among 8·4 % of men and 16·9 % of women. The odds of being overweight were significantly lower among urban men (OR=0·46; 95 % CI 0·37, 0·57) compared with urban women, whereas the odds of being underweight were significantly higher among urban men (OR=1·33; 95 % CI 1·07, 1·64) compared with urban women. The odds of being overweight were lower among higher educated men (OR=0·48; 95 % CI 0·39, 0·58) and men of rich households (OR=0·45; 95 % CI 0·37, 0·54) compared with higher educated women and women of rich households, respectively.
Conclusions
There are important gender differences in the prevalence of underweight and overweight among the adult population in Bangladesh. Women with higher education, in rich and urban households have higher chances of being overweight and lower chances of being underweight compared with their male counterparts.
Factors associated with purchase likelihoods and amounts spent on fresh and preserved vegetables in Malaysia are investigated. A sample selection system is applied to data from a national survey in Malaysia. Statistical test supports separate analyses for urban and rural households. Income and sociodemographic characteristics such as ethnicity, location of residence, household size, and education are closely associated with household expenditure patterns of fresh and preserved vegetables. Urban-rural differences are also uncovered in these effects. Several observations are noted vis-à-vis the expenditure patterns for fresh and preserved vegetables in Malaysia.
A sample selection system is used to examine factors associated with likelihoods of purchase and amounts spent on fresh, frozen, and processed meats in Malaysia based on data from the 2009/10 Malaysian Household Expenditure Survey. Statistical tests support use of the sample selection system estimator over more conventional estimation procedures. Results indicate that household size, location of residence, ethnicity, age, education, and income are closely associated with patterns of household expenditures for fresh, frozen, and processed meats. Several observations are noted regarding determinants of purchase likelihoods and expenditure patterns for meat in Malaysia.
Nanostructured anatase TiO2 is a promising material for gas sensing and photocatalysis. In order to modify its catalytic properties, the lanthanide (Ln) ions Eu3+, Gd3+, Nd3+ and Yb3+ were precipitated on the surface of TiO2 nanoparticles (NPs) by hydrothermal treatment. Results from Raman spectroscopy and X-ray diffraction (XRD) measurements show that the anatase structure of the TiO2 nanoparticles was preserved after hydrothermal treatment. SEM and TEM show a heterogeneous distribution in size and a nanocrystallite morphology of the TiO2 NPs (∼ 14 nm in size) and EDX confirmed the presence of the Ln-ion surface doping after hydrothermal treatment. An increase in photoluminescence (PL) was observed for the Ln-surface-doped TiO2 NPs when measurements were made in forming gas (5% H2 + 95% Ar) at 520 °C. In contrast, the PL measurements made at room temperature did not show any noticeable difference in forming gas or in ambient air. Our temperature-dependent PL results obtained in different gas environments are consistent with modification of oxygen-vacancies and hole-defects due to a combination of hydrothermal treatment and surface Ln-doping.
Necrotic enteritis (NE) caused by Clostridium spp. is an economically significant bacterial disease of poultry worldwide. Traditionally the disease has been prevented through feed supplementation with antibiotics sub-therapeutically as antimicrobial growth promoters (AGPs). However this practice has led to the emergence of resistant pathogenic microbes and drug residues, potentially threatening animal and public health. Therefore the marketing and incorporation of AGPs into poultry feed has been banned in Europe which has exacerbated the incidence of NE, bringing about huge economic losses to poultry farmers. Poultry researchers, exporters and consumers have emphasised AGP-free poultry rearing and have been searching for non-antibiotic and cost effective alternatives to control NE. Strategies suggested include vaccination, coccidiosis control, probiotics, competitive exclusion products, prebiotics, egg yolk immunoglobulins, bacteriophages (or phage gene products), organic acids, feed enzymes, plants and plants extracts/essential oils and nutritional changes.
There are many predisposing as well as virulence factors for NE induction and pathogenesis and more are expected to be discovered in the future. The ambiguous pathogenesis trend of the disease is still hindering the development of a potent active vaccine against NE. The choice of a single and fully effective approach is difficult. However, probiotics and specific egg yolk immunoglobulins (IgYs) alone or in combination could serve as promising strategies for controlling NE in broilers in the absence of AGPs.
The study aimed to determine the geographical diversity in seasonality of major diarrhoeal pathogens among 21 138 patients enrolled between 2010 and 2012 in two urban and two rural sites in Bangladesh under the surveillance system of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Distinct patterns in seasonality were found for rotavirus diarrhoea which peaked in winter across the sites (December and January) and dipped during the rainy season (May) in urban Dhaka, August in Mirpur and July in Matlab, equated by time-series analysis using quasi-Poisson regression model. Significant seasonality for shigellosis was observed in Dhaka and rural Mirzapur. Cholera had robust seasonality in Dhaka and Matlab in the hot and rainy seasons. For enterotoxogenic Escherichia coli (ETEC) diarrhoea, clearly defined seasonality was observed in Dhaka (summer). Understanding the seasonality of such pathogens can improve case management with appropriate therapy, allowing policy-makers to identify periods of high disease burden.
Termite species and functional groups differ among regions globally (the functional-diversity anomaly). Here we investigate whether similar differences in biomass and abundance of termites occur among continents. Biomass and abundance data were collected with standardized sampling in Cameroon, Malaysia and Peru. Data from Peru were original to this study, while data from Cameroon and Malaysia were compiled from other sources. Species density data were sampled using a standardized belt transect (100 × 2 m) while the biomass and abundance measurements were sampled using a standardized protocol based on 2 × 2-m quadrats. Biomass and abundance data confirmed patterns found for species density and thus the existence of the functional diversity anomaly: highest estimates for biomass and abundance were found in Cameroon (14.5 ± 7.90 g m−2 and 1234 ± 437 ind m−2) followed by Malaysia (0.719 ± 0.193 g m−2 and 327 ± 72 ind m−2) and then Peru (0.345 ± 0.103 g m−2 and 130 ± 39 ind m−2). The biomass and abundance for each functional group were significantly different across sites for most termite functional groups. Biogeographical distribution of lineages was the primary cause for the functional diversity anomaly with true soil-feeding termites dominating in Cameroon and the absence of fungus-growing termites from Peru. These findings are important as the biomass and abundance of functional groups may be linked to ecosystem processes. Although this study allowed for comparisons between data from different regions further comparable data are needed to enhance the understanding of the role of termites in ecosystem processes on a global scale.
Rapid Thermal Oxidation (RTO) of AlGaN barrier has been employed to reduce the gate leakage current in AlGaN/GaN High Electron Mobility Transistors. Current Voltage (I – V) and Capacitance Voltage (C – V) characteristics of Schottky Barrier diodes and Metal Oxide Semiconductor diodes are compared. At room temperature, reduction in gate leakage current over an order of magnitude in reverse bias and four orders of magnitude in forward bias is achieved upon oxidation. While the gate current reduces upon RTO, gate capacitance does not change indicating gate control over the channel is not compromised. I – V and C – V characterization have been carried out at different temperatures to get more insight into the device operation.