Algal treatment of membrane rejects: a unique approach towards zero liquid discharge.

A major concern in membrane-based water purification system is generation of huge concentrate stream and wastage of water. A typical Reverse osmosis (RO) or Nanofiltration (NF) system generates 20-25% reject containing high amount of dissolved salts and other contaminants. Contrary to popular belief, this reject water cannot be used without removing the contaminants or cannot be discharged anywhere. Main goal of this project is to find a cheapest and green way for treatment of RO/NF reject. Algal evaporation technique was explored in laboratory scale, to find its suitability for treatment of chloride-rich membrane reject in actual scenario and based on the results obtained, a pilot plant of 48KL was established on Hooghly Met Coke division (HMC), Tata Steel. Particular species of microalgae was selected, to take up minerals from reject water. There are several types of bacteria and symbiotic algae associated with selected micro algae survive in high TDS. A unique slope roof system, connected with algae growth tank, helps in efficient evaporation of water ensuring a Zero discharge. A markedly improved performance was achieved when algal evaporation followed solar evaporation. A total evaporation of 11 L/m2/day was observed, which was almost five times faster than Solar evaporation.

Algae based evaporation technology was explored to find its suitability for treatment of high chloride-based membrane reject. Specific Species of microalgae, which can take up minerals from reject water was selected.Based on algal evaporation, a pilot plant of 48 KL was established on Hooghly Met Coke division (HMC), Tata Steel India site.Rate of evaporation 11 L/m²/day was observed, which was almost five times faster than solar evaporation.

Application of coke breeze for removal of colour from coke plant wastewater.

Treatment of coking waste water has always been a challenge because of its complex and toxic nature. Numbers of technologies like biological treatment, advanced oxidation processes, activated carbon treatment etc. are available for removal of color and organic contaminants from wastewater. However, challenges and problems associated with application of biological, advanced oxidation methods for removal of color, chemical oxygen demand (COD), cyanides led to thrust for the development of new promising technologies. In this study, the application of coke breeze for the treatment of wastewater through adsorption has been demonstrated. A pseudo second order reaction kinetics has been observed through batch process adsorption study. Furthermore, adsorption data has found to be best fitted with the Freundlich adsorption isotherm model. Color removal efficiency of 80-90% along with COD removal efficiency of 40-50% was observed within 30 min by 120 g/L dosage of the adsorbent. The removal of phenolic and other organic compounds from coking wastewater has been measured through UV-Vis spectroscopy. The morphological changes of the adsorbent coke breeze have been captured through scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) analysis. However, because of the significant abundance in the steel plant, cost effectiveness and applicability of the post-treated coke breeze in sintered plant as fuel, turn it into a suitable adsorbent despite of having much lower specific surface area compared to commercial activated carbon (AC). Therefore, application of the coke breeze turns it into a very promising material and the technique is sustainable towards the coke quenching effluent treatment.

Projected Impact of Concurrently Available Long-Acting Injectable and Daily-Oral Human Immunodeficiency Virus Preexposure Prophylaxis: A Mathematical Model.

BACKGROUND: Long-acting injectable (LAI) human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP. METHODS: The reference model represents the current HIV epidemiology and DO-PrEP coverage (15% among those with behavioral indications for PrEP) among men who have sex with men in the southeastern United States. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP. RESULTS: Compared with the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% simulation interval, -7.3% to 14.5%) of infections would be averted over 10 years. The impact of LAI-PrEP is slightly greater than that of the DO-PrEP-only regimen, based on assumptions of higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% simulation interval, 6.7%-26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved. CONCLUSIONS: If LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence is greater for LAI-PrEP.

Comparative characterization of cyanide-containing steel industrial wastewater.

In the steel industry, cyanide in the wastewater is a major environmental concern. There are several chemical, physical, and biological treatment processes available for the removal of cyanide from industrial wastewater. But the efficacy of every treatment process depends on the complex elemental matrix of wastewater and the interference associated with them. Thus, water characterization plays a vital part in finding a suitable cyanide treatment process for any wastewater. Characterization data can give a clear overview of the complexity of cyanide in the wastewater, which ultimately helps in selecting the right remediation process. The present work includes comparative characterization of coke plant and blast furnace wastewater collected from an integrated steel plant. Three months of data for physico-chemical properties of the two different sources were analysed and compared. Pearson's correlation analysis of physico-chemical properties with free cyanide was also studied. The different forms of cyanide in coke plant and blast furnace water were also characterised, along with interference associated with them. It was observed that the water matrix of coke plant and blast furnace effluents are totally different. It was also evident that free cyanide concentration is much more affected in coke plant wastewater than in blast furnace water.

A couple-focused, integrated unplanned pregnancy and HIV prevention program in urban and rural Zambia.

BACKGROUND: Zambia's total fertility rate (5 births per woman) and adult HIV prevalence (11.5%) are among the highest in the world, with heterosexual couples being the most affected group. Jointly counseling and testing couples for HIV has reduced up to 58% of new HIV infections in Zambian clinics. Married women using contraceptives in Zambia have a high (20%) unmet need for family planning and low (8.6%) uptake of cost-effective long-acting reversible contraceptives. We present an integrated counseling, testing, and family-planning program to prevent HIV and unplanned pregnancy in Zambia. OBJECTIVE: The objective of this study was to integrate effective HIV prevention and family-planning services for Zambian couples. STUDY DESIGN: A 3 year program (2013-2016) progressively integrated the promotion and provision of couples' voluntary HIV counseling and testing and long-acting reversible contraceptives. The program was based in 55 urban and 215 rural government clinics across 33 districts. In the first year, a couples' family-planning counseling training program was developed and combined with existing couples HIV counseling training materials. To avoid congestion during routine clinic hours, joint counseling services were initially provided on weekends, while nurses were trained in intrauterine device and hormonal implant insertion and removal during weekday family-planning services. Demand was created through mutual referral between weekend and weekday programs and by clinic staff, community health workers, and satisfied family-planning clients. When the bulk of integrated service training was completed, the program transitioned services to routine weekday clinic hours, ensuring access to same-day services. Performance indicators included number of staff trained, clients served, integrated service referrals, HIV infections averted, and unplanned pregnancies averted. RESULTS: A stepwise approach trained high-performing service providers to be trainers and used high-volume clinics for practicum training of the next generation. In total, 1201 (391 urban, 810 rural) counselors were trained and served 120,535 urban and 87,676 rural couples. In urban clinics, 236 nurses inserted 65,619 long-acting reversible contraceptives, while in rural clinics, 243 nurses inserted 35,703 implants and intrauterine devices. The program prevented an estimated 12,869 urban and 8279 rural adult HIV infections, and 98,626 unintended urban pregnancies. In the final year, the proportion of clients receiving joint counseling services on weekdays rose from 11% to 89%, with many referred from within clinics including HIV testing and treatment services (32%), outpatient department (31%), family planning (16%), and infant vaccination (15%). The largest group of clients requesting long-acting reversible contraceptives (45%) did so after joint fertility goal-based counseling, confirming the high impact of this couple-focused demand creation approach. Remaining family-planning clients responded to referrals from clinic nurses (34%), satisfied implant/intrauterine device users (13%), or community health workers (8%). CONCLUSION: Integrated HIV and unplanned pregnancy prevention can be implemented in low-resource public sector facilities. Combination services offered to couples mutually leverage HIV prevention and unplanned pregnancy prevention. The addition of long-acting reversible contraceptives is an important complement to the method mix available in government clinics. Demand creation in the clinic and in the community must be coordinated with a growing supply of well-trained providers.

Phytoremediation of cyanide containing steel industrial wastewater by Eichhornia crassipes.

Water pollution has become one of the serious problems of today's civilization. Free cyanide and complex cyanide, including HCN and CN- is the most reactive and toxic substance of all industrial pollutants. R&D, Tata Steel preliminary investigation reports have established that cyanide in the blast furnace (BF) blows down water above permissible limit. Presently, chemical treatment has been applied to attenuate the cyanide level 0.2 ppm (permissible limit of free cyanide as per environmental norms). From the economic point of view, phytoremediation could be an attractive technology in dealing with this dangerous pollutant. Cyanide BF blow down water could possibly be removed by the water hyacinth because of its high biomass production, and tolerance to cyanide (CN). This investigation is related to the study of the potential of water hyacinth on the cyanide ion pollutant removal from BF water using cost-effective biological technology-Phytoremediation. The experimental results have shown that about 95% removal of cyanide from blast furnace water could be achieved by water hyacinth in 3 days in 6 L and also in 100 L water. Water hyacinth is also effective for reducing biochemical oxygen demand (BOD) and chemical oxygen demand (COD). This aquatic plant is also capable of reducing ammonia, TDS, and hardness of water.

Modification of UASB reactor by using CFD simulations for enhanced treatment of municipal sewage.

Up-flow anaerobic sludge blanket (UASB) has been in use since last few decades for the treatment of organic wastewaters. However, the performance of UASB reactor is quite low for treatment of low strength wastewaters (LSWs) due to less biogas production leading to poor mixing. In the present research work, a modification was done in the design of UASB to improve mixing of reactor liquid which is important to enhance the reactor performance. The modified UASB (MUASB) reactor was designed by providing a slanted baffle along the height of the reactor having an angle of 5.7° with the vertical wall. A two-dimensional computational fluid dynamics (CFD) simulation of three phase gas-liquid-solid flow in MUASB reactor was performed and compared with conventional UASB reactor. The CFD study indicated better mixing in terms of vorticity magnitude in MUASB reactor as compared to conventional UASB, which was reflected in the reactor performance. The performance of MUASB was compared with conventional UASB reactor for the onsite treatment of domestic sewage as LSW. Around 16% higher total chemical oxygen demand removal efficiency was observed in MUASB reactor as compared to conventional UASB during this study. Therefore, this MUASB model demonstrates a qualitative relationship between mixing and performance during the treatment of LSW. From the study, it seems that MUASB holds promise for field applications.

Bioremediation of steel plant wastewater and enhanced electricity generation in microbial desalination cell.

Microbial desalination cell (MDC) is a propitious technology towards water desalination by utilizing wastewater as an energy source. In this study, a multi-chambered MDC was used to bioremediate steel plant wastewater using the same wastewater as a fuel for anodic bacteria. A pure culture of Pseudomonas putida MTCC 1194 was isolated and inoculated to remove toxic phenol. Three different inoculum conditions, namely P. putida (INC-A), a mixture of P. putida and activated sludge (INC-B), and activated sludge alone (INC-C) were employed in an anodic chamber to mainly compare the electricity generation and phenol degradation in MDCs. The study revealed the maximum phenol removal of 82 ± 2.4%, total dissolved solids (TDS) removal of 68 ± 1.5%, and power generation of 10.2 mW/m2 using INC-B. The synergistic interactions between microorganisms, can enhance the toxic phenol degradation and also electricity generation in MDC for onsite wastewater application.

Phytoremediation of industrial mines wastewater using water hyacinth.

The wastewater at Sukinda chromite mines (SCM) area of Orissa (India) showed high levels of toxic hexavalent chromium (Cr VI). Wastewater from chromium-contaminated mines exhibit potential threats for biotic community in the vicinity. The aim of the present investigation is to develop a suitable phytoremediation technology for the effective removal of toxic hexavalent chromium from mines wastewater. A water hyacinth species Eichhornia crassipes was chosen to remediate the problem of Cr (VI) pollution from wastewater. It has been observed that this plant was able to remove 99.5% Cr (VI) of the processed water of SCM in 15 days. This aquatic plant not only removed hexavalent Cr, but is also capable of reducing total dissolved solids (TDS), biological oxygen demand (BOD), chemical oxygen demand (COD), and other elements of water also. Large-scale experiment was also performed using 100 L of water from SCM and the same removal efficiency was achieved.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

BACKGROUND: Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. METHODS: The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. RESULTS: In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. CONCLUSIONS: The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

Switching to Dolutegravir/Lamivudine Two-Drug Regimen: Durability and Virologic Outcomes by Age, Sex, and Race in Routine US Clinical Care.

Purpose: Two-drug regimens (2DR) may address drug-drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load <50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race. Methods: From the OPERA® cohort, people with HIV with a viral load <50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥50 copies/mL), confirmed virologic failure (2 viral loads ≥200 copies/mL or discontinuation after 1 viral load ≥200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race. Results: The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related reasons (viremia, adverse diagnosis, side effect, lab abnormality). For all outcomes, incidence rates were comparable across strata of age, sex, and race. Conclusion: This descriptive study demonstrates that DTG/3TC 2DR is an effective and well-tolerated treatment option for people with HIV with a viral load <50 copies/mL at switch, regardless of their age, sex, or race.

Inadequate sanitation in healthcare facilities: A comprehensive evaluation of toilets in major hospitals in Dhaka, Bangladesh.

BACKGROUND: Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh. METHODS: From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste. RESULTS: Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people. CONCLUSION: A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators.

Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment.

INTRODUCTION: Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention. OBJECTIVE: This analysis aims to understand potential users' preferences for LA-PrEP, with audience segmentation. DESIGN: Willingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men's Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). Conditional and mixed logit models were run; the final model was a dummy-coded mixed logit that interacted with the opt-out. SETTING: US national online sample. RESULTS: Among 2506 MSM respondents, most (75%) indicated a willingness to use LA-PrEP versus daily oral PrEP versus no PrEP. Respondents were averse to side effects and increasing costs and preferred increasing levels of protection. Respondents preferred a 2-hour time to obtain LA-PrEP vs 1 hour, with a strong aversion to 3 hours. Overall, there was an aversion to opting out of LA-PrEP, with variations: those with only one partner, no/other insurance or who were Black, Indigenous or People of Colour were significantly less likely to prefer LA-PrEP, while those who were Hispanic/Latino, college educated and <40 years significantly preferred LA-PrEP. CONCLUSIONS: A large proportion of MSM expressed a preference for LA-PrEP over daily oral pills. Most respondents chose LA-PrEP regardless of cost, clinic time, side effects or protection level; however, preferences varied by sociodemographics. These varied groups likely require tailored intervention strategies to achieve maximum LA-PrEP uptake and persistence.

Challenges faced by medical officers in providing healthcare services at upazila health complexes and district hospitals in Bangladesh - a qualitative study.

Background: Upazila Health Complexes (UHCs) and District Hospitals (DHs) play a crucial role in the healthcare delivery system of Bangladesh. But very few research has been conducted to find out the prevailing challenges of the medical officers working in these tiers. The objective of the study was to identify the challenges faced by medical officers in providing healthcare services at UHCs and DHs. Methods: In-depth interviews of 51 medical officers from 17 UHCs and nine DHs were done between March and April 2021. All participants were purposively sampled. Data were transcribed verbatim and analysed using thematic analysis. Findings: Inadequate service rooms, unavailability of proper medical equipment, poor housing conditions, lack of public amenities, shortage of health workforce, lack of laboratory services, and excessive workload were the common challenges mentioned by the medical officers in providing healthcare services in UHCs and DHs. Lack of workplace safety, security, and undue pressure from local political leaders and journalists made the work environment fearful. The absence of proper implementation of policy related to higher education, posting, transfer, and promotion was also stated as challenge for the medical officers. Interpretation: Infrastructural improvements along with increased safety and security of the doctors at their workplace and transparent implementation of reformed policies are essential to reduce the workplace challenges of medical officers in UHCs and DHs of Bangladesh. Funding: The study was funded by Hospital Services Management, Directorate General Of Health Services (DGHS), Mohakhali, Dhaka, and Bangabandhu Sheikh Mujib Medical University.

Stakeholder engagement to introduce a standardised register for improved inpatient care of newborns and sick children in Bangladesh.

Background: Despite a global decrease of 59% in under-five mortality rates from 1990 to 2021, child survival remains a pressing issue. This holds true for Bangladesh, as well. In response, the Government of Bangladesh introduced a standardised register for strengthening the inpatient management of newborns and sick children in 2021. Methods: We employed a comprehensive four-phase stakeholder engagement process to implement an inpatient register for newborns and sick children. The first stage included identifying and prioritising potential stakeholders at the national and district levels. We identified eight organisations involved in newborn and child health and selected 24 participants from various other sectors for workshops aimed at raising awareness about the register's introduction. These stakeholders also participated in the register's design, development strategies planning, and implementation phases. These phases were led by the 'National Newborn Health and IMCI programme' with support from various partners. A technical working group reviewed existing registers and helped prepare training materials. Feedback from each workshop was crucial in finalising the register. Results: The Government of Bangladesh has recognised the need for an indoor register for newborns and sick children, which was to be established in collaboration with development partners. This initiative can enhance the quality of care for sick children and increase service provider accountability. Due to its successful implementation, it will continue to be used in the Kushtia and Dinajpur districts, with plans for a nationwide scale-up. The Government has allocated funds in the next health sector programme for orientation and register printing. A strengths, weaknesses, opportunities, and threats (SWOT) analysis of the stakeholder engagement process highlighted strengths such as a context-specific approach and collaborative engagement, as well as challenges such as time resource requirements. Conclusions: Implementing an inpatient register for newborns and sick children through stakeholder engagement can effectively improve child health care services. Aside from challenges such as resource intensiveness and stakeholder commitments, success depended on the organising authority's expertise in relationship building, budget allocation, time management, and workforce dedication. Therefore, strategic planning, staff recruitment, networking, and budgeting are crucial for successful stakeholder engagement and health care initiatives.

Introducing a standardised register for strengthening the inpatient management of newborns and sick children: Implementation research in selected health facilities of Bangladesh.

Background: It is imperative to maintain accurate documentation of clinical interventions aimed at enhancing the quality of care for newborns and sick children. The National Newborn Health and IMCI programme of Bangladesh led the development of a standardised register for managing newborns and sick children under five years of age during inpatient care through stakeholder engagement. We aimed to assess the implementation outcomes of the standardised register in the inpatient department. Methods: We conducted implementation research in two district hospitals and two sub-district hospitals of Kushtia and Dinajpur districts from November 2022 to January 2023 to assess the implementation outcomes of the standardised register. We assessed the following World Health Organization implementation outcome variables: usability, acceptability, adoption (actual use), fidelity (completeness and accuracy), and utility (quality of care) of the register against preset benchmarks. We collected data through structured interviews with health care providers; participant enrolment; and data extraction from inpatient registers and case record forms. Results: The average usability and acceptability scores among health care providers were 73 (standard deviation (SD) = 14) and 82 (SD = 14) out of 100, respectively. The inpatient register recorded 96% (95% confidence interval (CI) = 95-97) of under-five children who were admitted to the inpatient department (adoption - actual use). The proportions of completed data elements in the inpatient register were above the preset benchmark of 70% for all the assessed data elements except 'investigation done' (24%; 95% CI = 23-26) (fidelity - completeness). The percentage agreements between government-appointed nurses posted and study-appointed nurses were above the preset benchmark of 70% for all the reported variables (fidelity - accuracy). The kappa coefficient for the overall level of agreement between these two groups regarding reported variables indicated moderate to substantial agreement. The proportion of newborns with sepsis receiving injectable antibiotics was 62% (95% CI = 47-75) (utility - quality of care). We observed some variability in the completeness and accuracy of the inpatient register by district and facility type. Conclusions: The inpatient register was positively received by health care providers, with evaluations of implementation outcome variables showing encouraging results. Our findings could inform evidence-based decision-making on the implementation and scale-up of the inpatient register in Bangladesh, as well as other low- and middle-income countries.

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities.

BACKGROUND: The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. METHODS: Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities' infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. RESULTS: Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers' PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers' ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. CONCLUSIONS: These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.

Clinico-hematological profile of visceral leishmaniasis among immunocompetent patients.

We studied cases of visceral leishmaniasis (VL) over a 2-year period among immunocompetent patients who presented to a rural medical college in West Bengal, India to determine a clinical and hematological profile among these patients. We studied a total of 36 cases of VL; the male to female ratio of the cases was 1.6:1 and the mean age was 20.1+/-11.1 years. A detailed history, physical examination, hemogram, bone marrow or splenic aspiration and chest x-ray were conducted on all cases. A CT-scan of the thorax and fiberoptic bronchoscopy were performed in selected cases. Fever and splenomegaly were present in all cases. Weakness, abdominal pain, bleeding, and hepatomegaly were seen in 63.9, 27.8, 8.3 and 58.3% of cases, respectively. Pancytopenia, bicytopenia, leukopenia and thrombocytopenia were seen in 58.3, 41.7, 61.1 and 83.3% of cases, respectively. Five patients (13.9%) had cough, 2 (5.6%) had hemoptysis, 6 (16.7%) had an abnormal chest x-ray and 3 (8.3%) had localized reticulo-nodular opacities on a CT-scan of the thorax. Bronchoalveolar lavage showed gram-positive cocci in 2 cases (5.6%). One patient died of acute respiratory distress syndrome. Cytopenia was common among the series of VL patients. Pulmonary complications, usually secondary infection, were less frequent (found in 13.9% cases) but was fatal in one patient.

Emerging Strategies in Stimuli-Responsive Silk Architectures.

The utilization of implantable devices beseeches highly invasive surgeries considering the adversaries in the insertion of large, impliable devices through the body channels, which necessitate the development of implantable devices using biocompatible shape memory polymers. Silk displays prodigious heterogeneity in its genetic structure and physical properties in accordance with the spinning and storage process, where proteins undergo folding and unfolding. The stimuli-responsive nature of silk can be explained with the help of the structural morphology and composition of the material, where the hydrogen bonds in ß-sheet domains and amorphous region act as switch points and net points, respectively. This review provides a primary attempt to enswathe all the literature available to date on the stimuli-responsive nature of silk and silk-based materials as a natural and biodegradable alternative for commercially used synthetic shape memory materials taking their elastomeric nature and reduction in glass transition temperature into account. Further constitutive model using the continuum approach has been utilized to explain the anisotropic elasticity damping effect and plastic deformation based on the α-helix chains, ß-sheets, and ß-spiral structures. The practicability to develop biomedical devices such as patient-specific-injectable scaffolds, drug carriers, and artificial muscles has been encompassed in this article.

Variation in Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among US Men Who Have Sex with Men: A Latent Class Analysis.

Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) is efficacious, with a good safety profile, and was approved by the US Food and Drug Administration in December 2021. Understanding variations in potential user preferences for LA PrEP may inform implementation and subsequently improve uptake and community-level effectiveness. HIV-negative, sexually active men who have sex with men (MSM) aged ≥15 years were recruited online for the 2019 American Men's Internet Survey, before LA PrEP approval. Respondents completed a discrete-choice experiment (DCE) with hypothetical LA PrEP attributes (out-of-pocket cost, perceived side effects, injection frequency, perceived stigma, service location). Latent class analysis segmented respondents into groups based on their preferences for the attributes presented, and relative importance of preference weights and willingness-to-pay were calculated. While the majority had never used daily oral PrEP, 73% of the 2489 respondents were very or somewhat likely to use LA PrEP. Three latent classes were identified from 2241 respondents in the DCE. The "side effects-averse" class was the largest group (64% of respondents) and placed 61% relative importance on side effects. The "ambivalent" class (20% of respondents) placed higher importance on stigma (17% of relative importance) than other classes. The "cost-conscious" class (16% of respondents) placed higher relative importance (62%) on cost compared with other attributes and classes. Perceived side effects were an important hypothetical barrier for LA PrEP uptake among a large proportion of potential MSM users. Minimizing out-of-pocket costs is likely to increase uptake and may be important to equitable access. Tailored communication strategies are recommended for the different groups of potential LA PrEP users.